Oral Health Screening

Oral Health

Oral health screening by the primary care clinician is an important part of comprehensive well- child care. Oral health affects eating habits, sleep, smiling, social interactions, and the overall health of the child.
Smiling Boy with Healthy Teeth and a Confidant Smile.jpg
In addition, poor oral health increases the risks of developing problems with drinking, eating, and speaking for children with special health care needs. [Weckwerth: 2016] Because infants and young children usually have several visits with their medical home before ever seeing a dentist, the primary care clinician is often the first person to recognize and address their oral health needs; >20% of children ages 2-11 have untreated dental caries that could be identified in the medical home. [National: 1999] Caries can cause pain and increase the risk of systemic infections.

Screening and Assessment

The American Academy of Pediatrics recommends that an oral health risk assessment should be performed in the medical home starting at the 6- and 9-month well-child checks. [Bright: 2010] If the child’s family has not yet established a dental home, repeat the assessment at the 12-, 18-, 24-, and 30-month well-child checks and the 3- and 6-year checks. [Centers: 1999] See Oral Health Risk Assessment Tool (AAP) (PDF Document 302 KB) for photos and a brief questionnaire about risk factors, protective factors, and clinical findings.
For children who receive oral health screening from programs like Early Intervention, the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), or Early Head Start, medical homes may choose to limit screening to questions about feeding problems and continue with anticipatory guidance. 

Anticipatory Guidance

Primary care clinicians can help all children by providing anticipatory guidance that includes: [Clinical: 2016]
  • Wipe the infant's gums and tongue with a wet cloth after feeding.
  • Brush twice daily using fluoride toothpaste. Once teeth erupt, all children <3 years old should use a smear of fluoride toothpaste (about the size of a grain of rice) and older children should use a pea-size amount.
  • Floss daily
  • All family members should see a dentist twice a year for preventive care and cleaning.
  • Bottles and sippy cups should not be propped or left with infants when caregivers are not actively feeding the child.
  • Once teeth erupt, avoid nursing or feeding at night because the milk remaining in the mouth can lead to caries. The caregiver can offer water if the older infant or child is thirsty at night.
  • Wean from bottle feeding by age 12 months.
  • Discourage thumb sucking after age 4 or 5 years.
  • Provide healthy snacks (e.g., cheese, fruit, and vegetables).
  • Prevent frequent snacking on sugar- and carbohydrate-containing foods; these increase durations of acidity in the mouth.
  • Minimize juice consumption to 0-6 ounces per day of 100% fruit juice; avoid soda, energy drinks, and other sweetened beverages.
  • Drink and cook with fluoridated tap water, if it is available.
  • Consider daily xylitol use.
  • Consider fluoride mouthwash for children ≥6 years old. [Council: 2013]
For older children, also discuss the adverse effects of:
Bright Futures Oral Health Pocket Guide
For anticipatory guidance information, a risk assessment guide, a fluoride supplement chart, and tools for improving the oral health of children from before birth to young adulthood, see the Oral Health Pocket Guide (Bright Futures) (image, left, links to pdf).

Supplemental Fluoride

The recommended level for community fluoride in water supply is 0.7 mg fluoride per liter (0.7 parts per million). Fluoride occurs naturally in water supplies, so if the level is unknown (such as in well water) it should be tested to determine if supplementation is needed. [American: 2017] Fluoride content of water supplies in the United States can be found at My Water's Fluoride (CDC).
Fluoride Supplement Dosage Schedule
Fluoride Supplement Dosage Schedule
American Dental Association (Oral Health Topics)
Oral fluoride supplements for children ages 6 months to 16 years are recommended for children with suboptimal fluoridated water intake (consider drinking water, cooking water, water at school, etc.). [American: 2017] Supplementation of fluoride and Vitamin D during the first year of life is associated with fewer cavities in the primary teeth. [Kühnisch: 2016] Although recommendations are from 2010, the table, left, still provides current supplementation information.

Fluoride dental varnish should be placed approximately every 6 months, either in the medical or dental home. If in the medical home, administration of the varnish may be performed by trained staff, such as a medical assistant or nurse. A 1-hour, online course, with continuing medical education credits available, can be found at Online Fluoride Varnish Training (SFL). For more information about fluoride, see The Debate Over Fluoridated Water (AAP).

Referral to a Dental Home

The medical home should talk with families about establishing a dental home by 12 months of age (and as early as 6 months of age). [American: 2005] A dental home is a primary care dental provider with a comprehensive and up-to-date approach to pediatric dental care, including preventing dental problems, providing anticipatory guidance about dental issues and nutrition and behaviors that affect dental care, assessing for adequate fluoride and prescribing supplements (see Tools and Resources for dosing) when indicated, administering topical fluoride applications, assessing and treating dental issues, placing sealants for high-risk children, and referring to dental specialists as needed for surgery or orthodontics. [EQIPP: 2017] The primary care clinician can assist parents in identifying a dentist who is covered through their insurance plan. For more information about access to and funding for dental services for CYSHCN, please see Oral Health & Dental Care for CYSHCN

Resources

Information & Support

Resources for Clinicians:

Online Training Modules for Clinicians

Oral Health Screening Online Module (MDH)
Learn about the primary care providers role in providing oral health screening; free of charge from the Minnesota Department of Health.

Open Wide: Oral Health Training for Health Professionals (OHRC)
Four, free modules about tooth decay, risk factors, prevention, and anticipatory guidance; National Maternal and Child Oral Health Resource Center, Georgetown University.

Protecting All Children's Teeth (PACT): A Pediatric Oral Health Training Program (AAP)
A free, comprehensive online training module for primary care providers to learn more about providing pediatric care and guidance. Continuing medical education credits available; American Academy of Pediatrics.

Online Fluoride Varnish Training (SFL)
A 1-hour, free course to train medical home providers on how and when to administer fluoride varnish and other care. This is within the Access the Caries Risk Assessment, Fluoride Varnish, and Counseling module. Continuing medical education credits available; Smiles for Life National Oral Health Curriculum.

For Professionals

Oral Health Anticipatory Guidance List (Bright Futures)
A brief list of anticipatory guidance items for children from birth to young adulthood.

The Debate Over Fluoridated Water (AAP)
Pro-fluoride and anti-fluoride facts and myths; American Academy of Pediatrics.

Children's Oral Health (SCAA) (PDF Document 2.8 MB)
Reports the impacts of poor oral health and gives recommendations to improve the situation; Schuyler Center for Analysis and Advocacy.

Community Water Fluoridation FAQs (CDC)
Information about guidelines, scientific reports, and frequently asked questions about fluoride in wells and bottled water; Centers for Disease Control and Prevention.

For Parents and Patients

Campaign for Dental Health (AAP)
Created to ensure that people of all ages have access to the most effective, affordable and equitable way to protect teeth from decay; American Academy of Pediatrics.

Dental Exam for Children (MayoClinic)
Discusses why dental exams are important for children, how they are performed, what to expect from the assessment.

Top Problems in Your Mouth Slideshow (WebMD)
Images and descriptions of common oral health problems.

The Debate Over Fluoridated Water (AAP)
Pro-fluoride and anti-fluoride facts and myths; American Academy of Pediatrics.

Practice Guidelines

Casamassimo P, Holt K.
Bright Futures: Oral Health—Pocket Guide, 3rd edition.
2016; 3rd. Washington, DC: National Maternal and Child Oral Health Resource Center.

Moyer VA.
Prevention of dental caries in children from birth through age 5 years: US Preventive Services Task Force recommendation statement.
Pediatrics. 2014;133(6):1102-11. PubMed abstract / Full Text

Patient Education

What Is Infective Endocarditis? (AHA) (PDF Document 571 KB)
A fact sheet about this condition and the importance of treatment; American Heart Association.

Tools

My Water's Fluoride (CDC)
A user-friendly, searchable database that allows consumers to learn about the fluoride levels in their drinking water; Centers for Disease Control and Prevention.

Oral Health Pocket Guide (Bright Futures)
Anticipatory guidance information, risk assessment guides, a fluoride supplement chart, and tools for improving the oral health of children from before birth to young adulthood.

Oral Health Risk Assessment Tool (AAP) (PDF Document 302 KB)
A tool to aid in the implementation of oral health risk assessment during health supervision visits. Contains photos and a brief questionnaire about risk factors, protective factors, and clinical findings; American Academy of Pediatrics.

Services

Early Intervention for Children with Disabilities/Delays

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General Dentistry

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Head Start/Early Head Start

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Oral Surgery

See all Oral Surgery services providers (13) in our database.

Orthodontics

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Pediatric Dentistry

See all Pediatric Dentistry services providers (67) in our database.

WIC Clinics

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For other services related to this condition, browse our Services categories or search our database.

Authors

Page Bibliography

American Dental Association.
Fluoride Supplements.
(2017) http://www.ada.org/en/member-center/oral-health-topics/fluoride-supple.... Accessed on June 2018.

Bright Futures.
Bright Futures Medical Screening Reference Table 2 to 5 Day (First Week) Visit.
American Academy of Pediatrics; (2010) https://brightfutures.aap.org/Bright%20Futures%20Documents/MSRTable_In.... Accessed on June 2018.

Centers for Disease Control & Prevention.
The National Health and Nutrition Examination Survey (NHANES).
National Institute of Dental and Craniofacial Research. 1999; https://www.nidcr.nih.gov/DataStatistics/FindDataByTopic/DentalCaries/...

Clinical Affairs Committee.
Guideline on Antibiotic Prophylaxis for Dental Patients at Risk for Infection.
Pediatr Dent. 2016;38(6):328-333. PubMed abstract / Full Text

Council on Clinical Affairs.
Guideline on caries-risk assessment and management for infants, children, and adolescents.
Pediatr Dent. 2013;35(5):E157-64. PubMed abstract / Full Text

Kühnisch J, Thiering E, Heinrich-Weltzien R, Hellwig E, Hickel R, Heinrich J.
Fluoride/vitamin D tablet supplementation in infants-effects on dental health after 10 years.
Clin Oral Investig. 2016. PubMed abstract

National Institute of Dental and Craniofacial Research.
Dental Caries in Children (Age 2 to 11).
National Institutes of Health; (1999) https://www.nidcr.nih.gov/DataStatistics/FindDataByTopic/DentalCaries/.... Accessed on June 2018.

Weckwerth SA, Weckwerth GM, Ferrairo BM, Chicrala GM, Ambrosio AM, Toyoshima GH, Bastos JR, Pinto EC, Velasco SR, Bastos RS.
Parents' perception of dental caries in intellectually disabled children.
Spec Care Dentist. 2016;36(6):300-306. PubMed abstract