To help pediatricians address issues of dental caries (an infectious, transmissible disease process caused by bacteria) and general oral health, the American Academy of Pediatricians released a policy statement on preventive oral health intervention for pediatricians. We talked to Man Wai Ng, DDS, MPH, chief of Dentistry at Children’s, and Wanessa Risko, MD, DSc, a pediatrician in Children’s Hospital Primary Care Center, about these recommendations.
Dr. Ng: Pediatricians and primary care providers are in an ideal
situation to screen children for oral health problems. Although the AAP, the American Academy of Pediatric Dentistry and the American Dental Association all recommend the establishment of dental care by age 1, the reality is that most children who need to see a dentist don’t see one early enough. However, pediatricians see children frequently in the first few years of a child’s life.
Dr. Risko: Early childhood cavities (ECC) affect 40 percent of
children by the time they reach kindergarten. Pediatricians can teach parents how to prevent cavities, stop the progression of tooth decay, identify those children at risk for ECC and facilitate access to a pediatric dentist.
Dr. Ng: In young children, the bacteria are usually transmitted from the primary caregiver, often the mother, through direct
inoculation from saliva transfer. When cariogenic bacteria are exposed to dietary sugars and fermentable carbohydrates, they metabolize these substrates, producing acids. The acids cause a drop in pH of the plaque and saliva in the mouth, resulting in a loss of minerals from the tooth. Over repeated cycles of demineralization, a cavity can form. At its early stage, caries is reversible through the process of remineralization, when there is an uptake of calcium and phosphate from the saliva into the tooth enamel, which is facilitated by the addition of fluoride.
Dr. Ng: Children with untreated tooth decay often experience pain, eating difficulties and sleep disturbance such that their growth and development may be affected. Pain and suffering from untreated diseases can lead to problems in speaking and learning.
Dr. Risko: Infants in poverty, whose mothers have low education levels and those who consume a high-sugar diet are 32 times more likely to have caries by age 3 than infants without these risk
factors. Other major risk factors for cavities are a mother with history of tooth decay, children with chronic illness and children who eat frequently.
Dr. Ng: Pediatricians should begin assessing risk starting at 6 months, with the eruption of the first tooth. Depending on the risk factors, pediatricians can reevaluate the risk at subsequent well-child visits. Risk assessment consists of asking parents a few questions about the family history of tooth decay, the child’s diet, oral hygiene practices and exposure to fluoride.
Dr. Risko: Also, children who are born prematurely or who have a low birth weight have a greater propensity for teeth defects. Pediatricians should consider referring children who have significant medical histories or who are born prematurely to the dentist at an earlier age.
Dr. Risko: We need to counsel families about the importance of tooth brushing/cleaning twice a day, as soon as teeth are evident, discouraging grazing eating patterns with frequent exposure to sugars and limiting juice consumption to no more than four ounces daily. Fluoridated water should be used for cooking and drinking, as most bottled water does not have adequate fluoride.
Dr. Ng: Bottles and sippy cups containing juice or any fermentable carbohydrate allow frequent or prolonged consumption, which increases tooth decay risk. Sleeping with a bottle containing
anything other than water should be discouraged. During nighttime, salivary flow rate is decreased significantly, reducing the buffering of acids.
Dr. Risko: Pediatricians can ask simple questions during well visits to assess risk of cavities, and conduct a quick oral health exam looking for presence of early signs of caries such as white lines of demineralization, plaque and frank decay. Don’t forget to lift the child’s upper lip, since ECC/plaque may be evident near the gums.