Oral Health in Children

1. See Also
   1. Oral Health
   2. Teething
   3. Primary Teeth
   4. Fluoride Supplementation
2. Guidelines: Prenatal (Maintain maternal Oral Health)
   1. Lowers infant colonization of mutans streptococci
      1. Kohler (1994) Arch Oral Biol 39:907-11 [PubMed]
   2. Refer mother for Dental Caries or Periodontal Disease
   3. Preventive measures
      1. ToothBrushing and flossing
      2. Fluoride mouth rinse (e.g. ACT)
      3. Xylitol chewing gum qid
3. Guidelines: Birth to 6 months
   1. Do not prop bottles
   2. Use only Breast Milk or formula in bottles (no juice)
   3. Avoid formulas that contain sucrose
4. Guidelines: 6 months and older
   1. See Teething
   2. Dentistry referral
      1. High risk for caries: Start dental visits at 1 year
      2. Low risk for caries: Start dental visits at 3 years (some recommend 1 year start for all children)
      3. Fluoride dental varnish application yearly after Tooth Eruption
   3. Oral Exam at each Well Child Visit
      1. Child lies supine on table
         1. Examine from head of bed (intubation position)
      2. Observe for altered tooth appearance
         1. Yellow-Brown cavities or erosions in teeth
         2. White lines or spots in the enamel
   4. Preventive measures
      1. Introduce early Tooth Brushing
      2. Fluoride Supplementation if inadequate water supply
         1. See Fluoride Supplementation
      3. Tooth Brushing twice daily with fluoride toothpaste
         1. Limit toothpaste amounts for young children
            1. Use no toothpaste or rice grain-size for under age 3 years old
            2. Use pea sized or less amount of toothpaste for ages 3-6 years old
         2. Age under 3 years: Parent brushes childs teeth without toothpaste (or rice-grain size)
         3. Age 3-6 years: Brush with pea-size amount of low fluoride toothpaste
         4. Age over 6 years: Brush with regular fluoride toothpaste
   5. Baby bottle related prevention
      1. Discontinue bottle after 12 months of age
      2. Avoid putting child to bed with bottle
      3. Encourage use of cup by age 1 year
      4. Wipe infant's teeth with moist cloth after feedings
   6. Dietary measures
      1. Schedule meals and snacks
      2. Avoid Simple Sugars outside of scheduled times
      3. Limit juice to <4-6 ounces per day
      4. Avoid carbonated beverages
      5. Only milk or tap water between meals
5. References
   1. (2014) Pediatrics 134(6): 1224-9 [PubMed]
   2. Harris (2022) Am Fam Physician 105(3): 299-300 [PubMed]
   3. Nasir (2015) Am Fam Physician 92(4): 274-8 [PubMed]