INFANT ORAL HEALTH CARE

DEPARTMENT OF PEDODONTICS & PREVENTIVE DENTISTRY

PRESENTED BYRISHAB MALHOTRA

DEFINITION

INFANT-Acc. To STONE & CHURCH(1975) child ranging from age 0 to 15 months is an infant HEALTH(Acc. To WHO,1948) A state of complete physical,mental and social well being and not merely the absence of disease or infirmity.

Goals of infant oral heath care

Break cycle of early childhood caries Disrupt acquisition of harmful micro flora Manage risk/benefit of habit Establish dental home for health and harm Impart optimal fluoride protection Use anticipatory guidance to arm parents in the therapeutic alliance

1.

BREAK CYCLE OF EARLY CHILDHOOD CARIESPrimary tooth caries(early childhood caries):problem for many children Early intervention prevent caries

2. DISRUPT ACQUISITION OF HARMFUL MICROFLORA Inoculation of caries initiating bacteria in infant, is by kissing,sharing food ,or other contact,with care taker, primarily mother.

3.MANAGE RISK/BENEFIT OF HABIT Infant oral health permit dentist to enter the habit continuum while it still provide a benefit to child and work with the family to migrate deleterious effect and transition of child out of the habit.

4.ESTABLISH A DENTAL HOME FOR HEALTH OR HARM (AAPD adopted in 2001 ,revised in 2004) Dental home is inclusive of all aspect of oral health that results from the interaction of patient ,parents,nondental professional and dental professionals.

5. IMPART OPTIMAL FLUORIDE PROTECTION Fluoride remain dentistrys best preventive tool and optimal fluoride exposure is tenet of early intervention

6. USE OF ANTICIPATORY GUIDANCE TO ARM PARENTS IN THE THERAPEUTIC ALLIANCE

Parental involvement has become a tenet of child health care because infant oral health is so heavily weighted toward risk assessment & protective factor at home, the parent become a co therapist

CONCEPT OF INFANT ORAL HEALTH

1.

RISK ASSESSMENTIt is defined as identification of factor known or believe to be associated with a condition or disease for purpose of further diagnosis prevention or treatment Caries assessment tool(CAT) DEVELOPED by AAPD in 2002 revised in 2006 can be used by different health professionals to identify the risk

2. ANTICIPATORY GUIDANCE Defined as protective counseling of parents and patient about developmental change that will occur in the interval between health supervision

3. HEALTH SUPERVISION -is defined as the longitudinal partnership between dentist and family individualized to focus on health outcome for family and child

INFANT ORAL HELTH AS A DIAGNOSTIC PROCESS

The best way to envision the infant oral health visit is to compare it with the traditional medical model CHIEF COMPLAINT HISTORY PHYSICAL EXAMINATION DIFFERENTIAL DIGNOSIS TREATMENT PLAN

ELEMENTS OF INFANT ORAL HEALTH VISIT

1.
2.

3. 4.

RISK ASSESSMENT ORAL EXAMINATION & ASSESSMENT OF CLINICAL RISK FACTOR RISK PROFILING ANTICIPATORY GUIDANCE

RISK ASSESSMENT FROM INFANT ORAL HEALTH

Health History
Did birthmother have problems during pregnancy? Was the child premature? Was Childs birth weight low? Were there any complications at birth? Has your infant been ill? Is your child on any medication? Notes ___________________________

Fluoride Adequacy
Do you know the fluoride level of your water? Do you have well water? If yes, has the water been tested? Do you use bottled water? Do you use a water conditioner or filtration system? Does your child take fluoride supplements? If Yes, please list __________________ Do you use a fluoridated toothpaste for your child? Notes __________________________

Diet and Nutrition

Is/was your child breastfed? Does your child sleep with a bottle? Does your child drink from a cup? Is Your child on a special diet? Notes _________________________

RISK ASSESSMENT FROM INFANT ORAL HEALTH

Injury Prevention/Trauma
Is your child walking? Is your home childproofed? Do you use a car seat for your child? Has your child had an oral/facial injury? Notes _______________________

Oral Habits
Does your child use a pacifier? Does your child suck a thumb or finger (s)? Does your child grind teeth day or nitht? Notes_________________________

Oral Hygiene
Do you clean your childs teeth/gums? Do you use a toothbrush to clean your childs teeth? Do you use toothpaste to clean your childs teeth? Notes __________________________

Oral Development
Does your child have any teeth? Childs age (in months) when first tooth erupted ________________. Has your child experienced teething problems? Have you noticed any oral problems in your child? Notes _______________________

ORAL EXAMINATION AND ASSESMENT OF CLINICAL RISK FACTOR

Child examination differs in different ways1.Use of dental chair unnecessary 2.Parent participates as learner and immobilizer 3.Teaching about oral cavity occurs during the examination process 4. Child may cry which is desirable and useful

Knee to knee position

NATEL & NEONETAL TEETH

Natal teeth are those observable in oral cavity at birth & neonatal teeth are those that erupt during 30 days of life(MASSLER &SAVARA 1950)

Unusual Neonatal tooth in maxillary Ist molar region

( Subrata Sarkar 2007)

Treatment of natal/neonatal teeth

Smoothening of incisal margin Extraction-vit.K supplementation

Dibulin appliance

Riga-Fede Dieases

Traumatic ulceration that occur on the tongue in neonates and infant. Associated with Natal & NeoNatal teeth

Treatment options of Rigafede disease

1.
2. 3. 4. 5.

6.
7.

Smooth off incisal edge of lower incisors. Modify feeding. Treat symptoms Kenalog in Orabase. Composite over the edge. Do Nothing. Extract lower incisors. Excise the Lesion

TEETHING

Eruption of deciduous teeth leads to teething in infant FEATURES: LOCAL SIGN Hyperemia Patches of erythema on cheek Flushing SYSTEMIC SIGN Crying .increase salivation .diarrhea Loss of appetite .cough .vomiting Sleeplessness .fever TREATMENT-Symptomatic treatment

RISK PROFILING

From the historical and clinical data obtained from the parents and child the dentist can create a risk profile using the same six area of anticipatory guidance Useful visual for risk profiling is also the CAT of AAPD

ANTICIPATORY GUIDANCE

1.AAPD gives a form for use in infant oral health.It is a check list of most typical recommendation for infant

PARENT INFORMATION FROM FOR INFANT ORAL HEALTH

Child Next Dental Care Visit _______

Oral Habits
Thumb/finger sucking habit-Discourage buy age _____________ Pacifier use-Discourage by age ____ Use pacifier that conforms to lips and cheeks and supports the lips Bruxing or other habit ____________

Diet and Nutrition

Discontinue breastfeeding/bottle No at-will nursing Modify breastfeeding/bottle Only water in sleep-time bottles Encourage use of a spill-proof cup Weaning plan__________________ Decrease sugar intake Change diet ___________________

Injury Prevention/Trauma
Child has experienced oral injury Childproof your home Use infant/child care seat Other protective device ___________

Fluoride Adequacy
Obtain home fluoride analysis Contact _______________________ Suggest fluoride supplementation___ Increase water intake to supplement feedings Recommended toothpaste ________

PARENT INFORMATION FROM FOR INFANT ORAL HEALTH

Oral Development
Total primary teeth erupted ________ Next tooth to erupt _______________ Child requires further assessment ______________________________

Oral Hygiene
Use a soft toothbrush Do not use toothpaste Use a smear/pea-sized amount toothpaste Special instructions _____________________________

of

TOPIC AREAS FOR ANTICIPATORY GUIDANCE

Oral Development
Dental and oral milestones Eruption of the first milestones Development of occlusion Teething and tooth eruption times Anatomical landmarks

Oral Hygiene
Mouth cleaning Streptococcus mutans testing Tooth cleaning implements Positioning and supervision

Diet and Nutrition

Bottle-related dental caries Weaning Role of carbohydrates Role of and identification of plaque

Fluoride Adequacy
Water evolution and supplementation Breastfeeding Formula feeding External sources of fluoride Safety and toxicity Dentifrice and topical agents.

Injury Prevention
Child abuse and neglect Car safety Child proofing Electric cord safety Emergency instructions.

Habits
Nonnutritive sucking Pacifiers

ROLE OF PEDODONTIST IN INFANT CARE

1.TIMING OF 1ST VISIT Should be within the 1st 6 month of eruption of 1st primary tooth 2.FEEDING PRACTICE From nutritional point of view breast milk has systemic and immunologic advantage over preparatory formula.

BREAST FEEDING VS.BOTTLE FEEDING

BREAST FEEDING VS.BOTTLE FEEDING

Compositon of Breast Milk Iodine Lactose Iron Protien Vitamin A Caesin Vitamin D Fat Tocopherol Sodium Thiamine Potassium Riboflavin Chloride Vtamin B6 Calcium Nicotinic Acid Phosphorus Vitamin B12 Magnesium Folic Acid Copper Vitamin C Zinc Lactoalbumin Lacto Peroxidase Complement C3 & C5

IMPORTANT TIPS ON BOTTLE FEEDING

Provide more attention to child Remove bottle immediately after feeding Substitute the milk or non-sweetened juices with plain boiled water Encourage baby to stay in upright position with a bottle Use bottle with a nipple that has a small hole to enable the infant to work with his muscle activity to get milk from bottle Introduce a cup to drink as soon as possible Bottle feeding be allowed at interval It should not be used as pacifier Give water after feeding with the bottle and clean the mouth soon after feeding

QUANTITY OF FEEDING

(GHOSH 2005)

COMPOSITION OF MILK/100 ml

(GHOSH 2005)

SARAS MILK
Composition of SARAS Milk (100 ml) Carbohydrates 4.6 gm Protein 3.2 gm fat 3.0 gm Energy K.cal 58 Cholesterol Traces Phosphorus 85 mg Calcium 122 mg Vitamin A 54 iu Vitamin B .05 mg

Pacifier
ADVANTAGE Satisfies suck need Provide comfort Decrease thumb sucking Help in sleeping DISADVANTAGE Interfere with breastfeeding Dental caries Increase candida infection Orthodontic problems Interfere speech developmant

Types of pacifier

Premature pacifier- Gerber,smaller

0-6 Month-Gerber(Nuk),Mam(Oval shape),Playtex(Natural),Avent(Round) 6-18Month-Gerber(Nuk),Mum,Playtex 18Month-2 Yr -Gerber

Difference between physiologically& nonphysiologically designed nipple

physiologic
Improved

nonphysilogic
Improper

labial seal Natural tongue position Physiologic tongue action possible

labial seal Incorrect tongue position Physiologic tongue action impossible

ANTICIPATORY GUIDANCE

Providing an insight into the development of a child will involve the parent with much more focused strategy

Prenatal counseling
Purpose
To educate parents about dental development of the child To educate parents about dental disease and prevention To provide a suitable environment for the child To strengthen and prepare the child and dentition for life

Content
External Component (Parents) Parents education concerning dental disease and oral hygiene Parents motivation for plaque removal program Changes in mothers oral health Intake of sweets

Methods
Education concerning development, prevention, and disease Demonstration of oral hygiene procedures Counseling to instill preventive attitudes and motivation Evaluation of learning, acceptance, and needs

Prenatal counseling
Internal component (Parents and child)
Parents education/development of child Effect of life-style on child Habits (smoking, alcohol consumption) Intake of sweets Exposure to disease (e.g., rubella, syphilis) Effect of drugs on child (e.g., tetracycline's) Nutrition Calcium Vitamins

Fluorides Essential nutrients Childs needs after birth Breastfeeding versus bottle feeding Fluoride supplementation Teething Hygiene Nonnutritive sucking First Visit

ORAL HYGEINE PRACTICES

1.

GUM PAD-

TEETH

Tooth brush Tooth mouse Dentifrices Tooth wipe provide an effective method of plaque removal before the eruption of primary molar Tooth wipe are highly accepted by infant and caregiver especially after night feeding practices
(Anna Galganny-Almeida et al 2007)

ROLE OF PEDIATRICIAN

1 st health care providers & can act to evaluate their oral health status

Points needed to be discussed1.Tooth eruption 2.Preventive oral hygiene 3.Orofacial development 4.Fluoridation 5.Diet

ROLE OF OTHER PERSONNEL

Prenatal classes by gynecologist Neonatologist counsel the parents regarding any congenital defect Importance of breast feeding can be emphasized by medical persons Importance of mothers on oral hygiene

ORAL HEALTH CARE FOR SPECIAL CHILDREN(CLEFT PALATE)

AGE 0-6 Month 3 Months Dental Counselling Detal Advice Treatment Orthodontic Counselling Feeding Aids Surgical Repair of Cleft lip Flouride Supliment, Diet Control, Regular Examination, Motivate Parents Repair of Cleft Palate

6 Month-3 years 12 Months

Habermann feeder Proved very successful in Cleft Babies

Bilateral clefts-nasoalveolar molding device

CONCLUSION
Industrialized countries may claim of a reduction in caries incidence. Developing countries such as India face a uphill task as the caries incidence is still on increase .in attempt to strike at root of problem INFANT ORAL HEALTH CARE is valuable fundamental step.

REFERRENCES

PEDIATRIC DENTISTRY 4th edi. PINKHAM DENTISTRY FOR THE CHILD AND ADOLESCENT 8 th edi.MC.DONALD AVERY TEXT BOOK OF PEDODONTICS BY SHOBHA TANDON ESSENTIAL OF PREVENTIVE &COMMUNITY DENTISTRY ,SOBEN PETER NUTRITION & DIET BY GHOSH NATAL & NEONATAL TEETH ,Review of literature,ROBSON FREDERICO CUNHA et al,pediatric dent.23:158-162,2001 EFFECTIVENESS OF A NOVEL INFANT TOOTH WIPE IN HIGH CRIES RISK BABIES 8-15 MONTH OLD,Anna galgannyAlmeida,pediatric dent.2007;29:337-42

AAPD GUIDELINES 2007 Steptococcus mutans ,early childhood caries & new opportunity,Harold c.slavkin,DDS,JADA Dec.1999 Nutritive and nonnutritive sucking habit: A review- Huguette Turgeon etall.ASDC Dec-1996 Modern Management of the Cleft Lip and Palate Patient.- Allan R. Thom. Dental Update Dec 1990 Treatment alternative for Sublingual traumatic ulceration- Riga-Fede Disease. Rebecca L slayton. Pediatric Dentistry 2000

THANK YOU

questions ?