Pediatricians' Checklist on Oral Health of Children

Introduction

Good oral health is an essential part of overall health for children and teenagers. Majority of young patients visit the pediatrician more than the dental practitioner. Therefore, pediatricians are regarded to be at a unique position to provide preventive oral advice and to diagnose dental diseases in their patients at the earliest. According to studies, number of children (infants and 1-year-old) seen by pediatricians is approximately 89 percent as compared to only 1.5 percent who had dental visits every year.

Consequently, the ratio of visits to doctors versus visits to dentists is around 250:1. Data has also reported that the prevalence of Early Childhood Caries (ECC) is around 36-85% globally, while in India, it is 44%. In 1975, mothers hospitalized for one week following delivery of the infants were taught and prompted (for approximately 60 minutes) by dental hygienists about oral and dental care of their kids.

Five decades later, in an epidemiological survey, the kids of these motivated mothers were compared to healthy children of the area. The kids of the motivated mothers showed 64% less proximal caries on radiographs compared to other children. Therefore, the most crucial factor influencing preventive dentistry operation is the knowledge and function of pediatricians/physicians regarding their visit and oral health advice.

Nearly, all children have medical visits by their first birthday. As mentioned earlier, medical visits outnumber dental visits almost 250 times, for both babies and toddlers. Given this scenario, the health home provides a satisfactory and apt setting to deliver timely preventive dental health care. The American Academy of Pediatrics guidelines recommend that the primary health care provider should suggest an oral health risk assessment for babies before age 1 and dental referrals by age 1.

These guidelines are important because literature indicates that dental referrals by pediatricians raises the likelihood and timely visits to the dentist, especially in high-risk children with early childhood caries.

By acquiring the skills to conduct oral examinations, apply preventive strategies, counsel parents, and appropriately refer patients to pediatric dentists, pediatricians can help eliminate oral health disparities.

Preventive measures can be divided into different phases:

A. Stage 1- Pregnancy

Prenatal oral health counselling for parents is the first step towards infant oral health. The purpose of this stage is to create awareness among parents concerning oral disease and its prevention, along with giving a suitable atmosphere for child development.

Prenatal counseling

ECC is an early appearing, potentially devastating and virulent type of dental caries lesion. Both poor nutrition and low birth weight are risk factors for the development of this condition. ECC not only affects teeth, but also results in pain, illness, and impairment of oral functioning, which ultimately leads to malnutrition and diminished quality of life.

Under nourished or malnourished infants, and infants with low birth weight are at an increased risk of enamel hypoplasia or incomplete enamel formation. Enamel hypoplasia may lead to irregular tooth surfaces, which could result in areas prone to decay. Therefore, optimizing nourishment during the third trimester of pregnancy and first year of infant’s life, should be the priority of expectant mothers as this is when the tooth is undergoing maturation.

Prospective parents need to understand that prenatal assessment and instructions are essential for the oral health of their child. Prenatal assessment includes evaluation of the oral health conditions of the parent.

Parent's risk of dental caries and gum problems has to be assessed -

Studies suggest an association between –

• Maternal periodontitis and preterm birth,
• Clinical periodontitis at delivery and preeclampsia, and
• Streptococcus mutans levels in mothers and caries experience in their children.

Uncontrolled caries in parent means that the parent has a high amount of Streptococcus Mutans, which can be transferred to the baby later. If the parent is at risk, dentist must provide preventive treatment and educate the parent on efficient plaque control. Nutritional counseling should be provided and the parent must be made aware about the risk of transmissibility of these bacteria to the infant. Regular follow-ups must be done to ensure establishment of

adequate oral hygiene measures, and good dietary habits. Mother's oral hygiene, diet, and use of mouth rinses have a significant impact on child's caries rate later on.

Anticipatory guidance

It is the process of preparing parents for the substantial physical, psychological, and physiological milestones of the child by providing practical and developmentally appropriate information regarding children's health.

Comprehensive anticipatory guidance for the mother includes the following:

• Education concerning development of dental disease and it’s prevention.
• Demonstration of dental hygiene procedures and proper tooth brushing tech
• Counseling to instill preventive attitudes of healthcare and motivation for consistent efforts.
• Providing information to pregnant women about pregnancy g
• ingivitis. This condition is related to hormonal changes during pregnancy that cause an exacerbated response to dental plaque, resulting in inflammation of the gingiva. Gums become swollen, sensitive and tend to bleed. These signs become more evident in the second trimesterand peak during the last month of pregnancy.
• Visiting a dentist for examination and restoration of all active carious lesions whenever possible and decreasing chances of pregnancy gingivitis by proper oral hygiene measures.
• Eating - healthy foods such as fruits, vegetables, grain.
• Limiting - sugar consumption as frequent ingestion of foods high in sugar, such as toffees, cookies, cake, carbonated drinks (e.g., fruit juice, soda), raises the risk of tooth decay.
• Avoiding - foods that easily adhere to the enamel surface as frequent ingestion of dried fruit and candy, increases caries risk.
• Cleaning teeth thoroughly with fluoridated toothpaste and flossing every day to promote good oral health.
• Inhaling tobacco is injurious for your oral health. No smoking cigarettes or chewing tobacco.

Dental treatment of women during pregnancy

Frequently, pediatricians are asked for advice regarding dental problems.

Important information about the type of dental treatment which can be undertaken may be summarized as follows:

First Trimester: It is the most vital period for fetal growth. Only emergency dental treatment should be undertaken in consultation with the patient's doctor.