Department of Dentistry | Experts Corner

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Early childhood caries, according to the American Academy of Pediatric Dentists (AAPD), is the most prevalent, chronic childhood disease, 5 times more common than asthma and 4 times more common than childhood obesity. Recently, the American Academy of Pediatrics (AAP) released a new Campaign for Dental Health, addressing the importance of oral health prevention and public concerns about fluoride use. The campaign includes five tools for health care providers, including:

The AAP also offers additional tools, such as an Oral Health Risk Assessment Tool and an illustrated Oral Health Self Management Tool for Parents/Caregivers.

Isabelle Chase, DDS, FRCD(C), associate in the Department of Dentistry at Boston Children’s Hospital and director of the Postdoctoral Pediatric Dentistry program at Harvard Dental School, thinks these new tools will help providers maintain a clear and consistent message about fluoride benefits and safety. It will also help identify children who are at a high risk for early childhood caries, resulting in more timely dental referrals.

“Kids go to the physician about 11 times before the age of two, but they’ve never seen a dentist. If we can get this started by a physician, nurse practitioner or nurse, in the office, we can help reduce the risk of dental caries,” Chase says. In fact, according to the AAPD, as many as 50 percent of children have never seen a dentist.

That’s why the dental team at Boston Children’s Hospital has begun working closely with their primary care clinic partners to do a better job of reaching children and parents early, focusing on risk assessment and prevention. “We’re working with pediatricians and nurses in our primary care clinic, teaching how to assess cavity risk for our patients. Our primary care clinic is now painting fluoride on kids’ teeth. We want our physicians to get those dental referrals out,” Chase says.

Common fluoride fears

Parents often have concerns regarding fluoride use, says Chase, due to misinformation in the media about the safety of fluoride-supplemented public water supplies. Confusion also occurs in response to over-the-counter oral hygiene products that do not contain fluoride and are marketed as safe to swallow, leading parents to believe fluoride should be avoided. She stresses the importance of alleviating parental concerns about water fluoridation, as well as educating parents about age-appropriate use of fluoridated toothpaste.

Fluoridated toothpaste should be limited to:

  • a rice-sized smear for children less than 3 years of age
  • a pea-sized amount for children 3-6

Should fluorosis be a concern?

A common worry regarding fluoride supplementation is the risk of fluorosis. But physicians can confidently reassure parents that fluorosis is a cosmetic condition and has a low likelihood of occurring.

“If you look at the population studies, very few children are affected by fluorosis," Chase says. "In the United States, the rates of fluorosis are less than 1 percent for severe fluorosis, 2 to 3 percent for moderate fluorosis, and less than 5 percent for mild fluorosis. Most of the population is unaffected."

Clinical hallmarks of fluorosis include:

  • mild: snowflake, bright white discoloration
  • moderate: tan or light brown discoloration
  • severe: mottled, brown discoloration

Brief interventions can make a big impact

Chase says a fast risk assessment and brief education can help put parents on the right track, including:

  • An easy non-invasive exam: Lift the upper lip to assess the front teeth. If there’s a coating of plaque on the maxillary incisors, scrape a bit off with a gloved finger to show parents where they can improve with brushing.
  • Stress to parents that anything in the bottle or sippy cup other than water, particularly at bedtime, can put the child at a significantly higher risk of cavities.
  • Remind parents to brush baby teeth with a fluoridated toothpaste: it may seem obvious, but often parents aren’t aware that brushing baby teeth is important.
  • Encourage early dental visits.

Parents often look to primary care providers for expert health care advice, and a healthy mouth is an important factor for overall physical health. Pediatricians can make a lasting impact on a child’s oral health, using the AAP’s Campaign For Dental Health tools as their guide.

To discuss fluoride treatment, fluorosis or other topics related to dental health, contact Boston Children's Hospital's Department of Dentistry.

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- Sandra L. Fenwick, President and CEO

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