High caries rates run in families and are usually passed from mother to child from generation to generation. The children of mothers with high caries rates are at higher risk of decay.
Dr. David Stewart DDS from Little People’s Dental explains why early intervention is the key to preventing cavities in children.
When should children first be seen by a dentist and why?
At what age should children be seen by a dentist?
It is recommended that children be seen by a dentist by one year of age or within six months of the eruption of the first tooth whichever comes first.
Often the question is asked, “Why the guideline for infants to be seen by a dentist at one year or within six months of the first tooth?” To truly understand the guideline we have to understand a few concepts. One is that a tooth is at risk for decay as soon as it enters the mouth. A case in point was an 18 month old child that had to have 8 teeth extracted because they were decayed to the gum line. This child had the right bacteria in his mouth, the right diet, and limited flossing and brushing being performed. As a result he had a significant amount of decay at a very young age.
As soon as teeth enter the mouth they are at risk for decay, so the guideline is in place so that a dental provider can help the person providing the child’s day to day care to understand what they can do to prevent decay from occurring in the child’s teeth. To understand the guideline it is important to understand that the guideline was not set up with the expectation that the dentist would be finding decay in a one year old; but instead it was set up with the expectation that a parent would take their child to the dentist so that an assessment of the child’s risks for decay could be made and then a plan could be created with the parent that helps to minimize the child’s chance of getting decay. At these early infant exams, the child’s specific risks are identified and then the parent is taught how to minimize those risks. The goal of the recommendation is to prevent decay from ever occurring.
Is decay really still an issue? With fluoride in the water, sealants, and fluoride toothpastes to help prevent dental decay are children still getting cavities in their teeth?
“Overall dental caries (the process of getting cavities) in the baby teeth of children 2 to 11 declined from the early 1970’s until the mid 1990’s; but from the mid 1990’s until the most recent (1999-2004) National Health and Nutrition Examination survey, this trend has reversed: A small but significant increase in decay in primary teeth was found. This trend reversal was more severe in younger children.” (National Institute of Dental and Craniofacial Research) We were seeing a decrease in dental decay for a time period but recently we are seeing an increase, particularly in children under 5 years of age.
So what can be done to reverse this trend and start decreasing decay in young children?
To curb this increasing trend in childhood caries we need to address the issue on all fronts. The current recommendation from the American Academy of Pediatric Medicine is, “Every child should begin to receive oral health risk assessments by 6 months of age from a pediatrician or a qualified pediatric health care provider to identify known risk factors for early childhood dental caries. Infants identified as having significant risk of dental caries should be entered into an aggressive anticipatory guidance and intervention program provided by a dentist at between 6 to 12 months of age.”
This recommendation is given with the following three points in mind. First, high caries rates run in families and are usually passed from mother to child from generation to generation. The children of mothers with high caries rates are at higher risk of decay. Second, approximately 70% of all dental caries are found in 20% of our nations children. Third, the modification of the bacteria in a mother’s mouth at the time that her child is getting bacteria in its mouth significantly impacts the child’s caries rate. Therefore, an oral health risk assessment before one year of age affords the opportunity to identify high risk patients and to provide timely referral and intervention for the child and allows an invaluable opportunity to decrease the level of cavity causing bacteria in the mother’s mouth who has a significant caries risk before and during bacterial colonization of her infant.
“Tooth decay is a disease that is, by and large, preventable. Because of how it is caused and when it begins, steps to prevent it ideally should begin pre-natally with pregnant women and continue with the mother and young child, beginning when the infant is approximately 6 months of age. The primary thrust of early risk assessment is to screen for parent infant groups who are at risk of early childhood dental caries and would benefit from early aggressive intervention. The ultimate goal of early assessment is the timely delivery of educational information to populations at high risk of caries to avoid the need for later surgical intervention.” (American Academy of Pediatrics Policy Statement on Oral Health Risk Assessment Timing and Establishment of then Dental Home.)
What are some of the risk factors that would put an infant into the significant risk group?
• Children with special health care needs
• Children of mothers with a high caries rate
• Children with demonstrable caries, plaque, demineralization, and/or staining
• Children who sleep with a bottle or breastfeed throughout the night
• Later order offspring
• Children in families of low socioeconomic status
• Children who snack frequently
Children with one or more of these risk factors should be referred to a dentist as early as 6 months of age and no later than 6 months after the first tooth erupts or 12 months of age, whichever comes first.
Because we cannot always predict dental decay from just the risk factors identified; the ideal approach to early childhood caries prevention and management is the early establishment of a dental home.
What is a dental home?
The concept of the “dental home” is derived from the American Academy of Pediatrics concept of the “medical home”. The Academy states that the medical care of infants, children, and adolescents ideally should be accessible, continuous, comprehensive, family centered, coordinated, compassionate, and culturally effective. It should be delivered or directed by well-trained physicians who provide primary care and help to manage and facilitate essentially all aspects of pediatric care. Pediatric dental care needs to be delivered in a similar manner. Children receiving an oral health examination by a dentist who provides care for infants and young children 6 months after the first tooth erupts or by 12 months of age establishes the child’s dental home and provides an opportunity to implement preventive dental health habits that meet each child’s unique needs and keep the child free from dental or oral disease. The dental home should be expected to provide:
• An accurate risk assessment for dental diseases and conditions.
• An individualized preventive dental health program based on the risk assessment.
• Anticipatory guidance about growth and development issue (i.e., teething, finger or pacifier habits, and feeding practices)
• A plan for emergency dental trauma
• Information about proper care of the child’s teeth and gingival tissues
• Information regarding proper nutrition and dietary practices
• Comprehensive dental care in accordance with accepted guidelines and periodicity schedules for pediatric dental health
• Referrals to other dental specialists, such as endodontists, oral surgeons, orthodontists, and periodontists, when care cannot be provided directly within the dental home.
The goal of creating a dental home is create a place where a child can receive comprehensive dental care specific to their individual needs. The ideal is that a dental home be set up in advance of dental caries or a dental emergency. Thus the guideline for seeing children at one year of age or within six months of the eruption of the first tooth allows dental decay to be minimized and comprehensive dental care to begin.
For more information of keeping your child cavity free contact Dr. Stewart at www.littlepeoplesdental.com 1268 W. South Jordan Parkway
South Jordan, Utah 84095