Addressing Concern

All of these red flags are also potential areas for collaboration and/or mutual promotion of anticipatory guidance with a PNP. PNPs spend a lot of time providing anticipatory guidance to parents regarding infants and toddlers because they are at a critical point in their development. Having pediatric dentists that can also reinforce these areas of anticipatory guidance, would really help promote very positive outcomes for young children and also promote their caregivers to seek continued health care.

green= oral health issues

yellow= anticipatory guidance

Review each area of concern and see some things that could be addressed for each.

Diet

Diet counseling is an integral part of anticipatory guidance during the infant oral health visit.
  • Juice intake should be limited and offered from a cup without a cover as part of a meal or snack. Review with Jessie’s mom the benefits of juice but caution about the overuse of juice in an infant and toddlers diet.
  • Instruct Jessie’s parents that while snacks are part of a healthy diet, chewy/gummy-based foods (raisins, gummy animals) adhere to tooth surfaces and may predispose her to early childhood caries.

Habits

Pediatric dentists carefully watch the way children’s teeth erupt and jaws develop, keeping the sucking habit in mind at all times.

Non-nutritive sucking is a normal part of infancy. Once Jessie reaches 2 years of age, thumb sucking and pacifier use may affect the shape of the mouth and affect tooth alignment.

Sleep

Frequent night time bottle feeding may be associated with increased risk for caries.

Nighttime or naptime bottle-feeding with milk and/or juice and repeated use of a “sippy” cup have been associated with early childhood caries. Children should be weaned to a non-covered cup at 12 months of age. Review the following strategies to wean from a bottle to a cup with Jessie’s parents:

  • Decrease use of bottle one bottle at a time
  • Use an interesting or colorful straw which may entice skeptical bottle-users
  • If you have been exclusively breastfeeding, once a child reaches 9-12 months you may progress directly to a cup and skip the bottle
  • Offer rewards for making it through the day or night
  • Once a decision is made to completely give up the bottle, remove all bottles from the home to avoid “giving in”

Immunizations

Pediatric dentists can reinforce areas of anticipatory guidance at this critical point in young child’s development. This may promote very positive outcomes for infants and also promote their caregivers to seek continued health care.

The PNP would recommend discussing with Jessie’s mother about the benefits of immunizations versus the risks from disease. Immunizations are an efficacious and cost-effective way to improve the overall health of children. Immunizations have nearly eliminated many childhood diseases, such as polio, worldwide.

Allergies

There is nothing in the patient’s history or evaluation that warrants discussion of allergies at this time.

Ambulation

Practitioners should provide age-appropriate injury prevention counseling for orofacial trauma.

The PNP would recommend discussing with Jessie’s mother because once children are ambulatory, safety is a major concern. Instruct Jessie’s parents on the hazards of household hazards including the need to: keep poisons, medications and chemicals locked up; keep hot liquids out of reach; safeguard stairways, windows, and sharp corners.

Oral hygiene

Oral hygiene measures should be addressed and implemented no later than the time of eruption of the first primary tooth.

At this age, Jessie’s oral hygiene should consist of brushing teeth with a soft toothbrush and clean water. A smear of fluoride toothpaste may be added when she is 15 months of age.

Fluoride

Decisions concerning the administration of fluoride are based on the unique needs of each patient and should be discussed at this first office visit.

Optimal exposure to fluoride is important to all dentate infants and children. In Jessie’s case she is receiving no fluoridated toothpaste however has been prescribed systemic fluoride by her PNP and has received topical fluoride varnish at her medical visit. Careful monitoring of fluoride is indicated in the use of fluoride-containing products. Fluorosis has been associated with cumulative fluoride intake during enamel development.

Speech

There is nothing in the patient’s history or evaluation that warrants discussion of speech at this time.