In the past, we have tried to prevent dental caries by maintaining good oral hygiene, using topical and systemic fluorides, and limiting prolonged exposure to sugars in the diet. These are all reasonable and still useful in preventing tooth decay when many teeth have already erupted into the mouth, but the process of tooth decay can start as early as 4-6 months of age. This is the time when the teeth first come into the mouth for many children. Most children don’t have their first visit with the dentist until they are about 2-3 years of age, where they can already be suffering from severe dental caries or when they already have pain. Some children are not referred to a pediatric dentist until age 5, when it becomes a requirement for entry into kindergarten.
Ideally, we want to take steps to inform expecting mothers that their own oral hygiene is so important and can affect the oral health of their children. Many moms will share utensils with their children or clean their child’s pacifiers with their own mouth, increasing the risk of transferring oral bacteria to their babies very early. By lowering the number of cavity-causing bacteria in the mother’s mouth, we are reducing the possibility of those same cavity-causing bacteria from being transferred to her child. The bacteria can also be transferred from any caregiver (i.e. nanny, father) to the child. Therefore, any caregiver should be informed of these possibilities.
A caries risk assessment should be done to determine which families might have children who are at higher risk of developing caries. For example, children who have moms or caregivers with a history of caries are more likely to get caries, as well as children who belong to families of low socioeconomic status. Children with special health care needs, staining or white spots on the teeth, or who sleep with a bottle or breastfeed through the night are also at a higher risk of developing caries.
Why Is This Information Important?
Although we may not be able to get a caregiver’s oral hygiene up to par unless s/he is already visiting the dentist, we can still work together to protect the children from this highly transmissible disease called dental caries. A child’s first visit is always with their Pediatrician. If Pediatricians can relay this information to families and caregivers and do a caries risk assessment when a child is 4-6 months of age, they are setting the stage for a healthy mouth for a lifetime.
Although screening for caries and oral health counseling by the Pediatrician is a good approach to begin caries control, it is not a substitute for establishment of the “dental home.” The idea of a “dental home” is derived from the American Academy of Pediatrics idea of the “medical home.” The American Academy of Pediatric Dentistry encourages parents and other health care providers to establish a “dental home” for their patients by 12 months of age.
Therefore, Pediatricians should refer patients by 12 months of age or earlier if needed to a Pediatric Dentist. A Pediatric Dentist will be able to provide the appropriate routine and acute oral health care and an individualized plan for each child based on their age, caries risk assessment, growth and development, etc. At the same time, Pediatric Dentists may have concerns requiring an evaluation by the Pediatrician. By working together, Pediatricians and Pediatric Dentists can provide the comprehensive care every child needs.