Oral Health for Pregnant Women,
Infants and Toddlers:
A Dental Professional’s Plan for Good Oral Health in Pregnancy & Cavity-Free Young Children
AGE ESSENTIALS OF PREVENTION STANDARD OF DENTAL CARE MESSAGES TO DELIVER TO PARENTS
Pregnant Women Dental care is safe and essential Focus on preventing the transmission Good oral health is important for a healthy
during pregnancy. of disease by eliminating maternal pregnancy and your baby’s health.
reservoirs of caries- causing bacteria:
Tooth decay is caused by a bacterial Baby teeth are important. Infections in baby
(S. mutans) infection. Bacteria are 1) Extract hopeless teeth teeth cause infections in permanent teeth when
transmitted from mother to infant. 2) Restore active caries lesions babies grow up.
For prevention messages to work, dental 3) Treat gross gingivitis with debridement Preventing the infections that cause tooth decay
providers must show they care for both the and chlorhexidine rinses. begins with the first tooth. Bring your baby to
mother and her baby. 4) Coach good oral hygiene but keep a dentist for a prevention check-up by the 1st
it simple. birthday even if you see nothing wrong with your
For details on safety, see Guidelines for
Oral Health in Pregnancy (see URL below).
Birth to 1 year of age High risk babies acquire S. mutans before Apply fluoride varnish no less than every As soon as your baby has a tooth, begin tooth
the teeth are present. S. mutans can 6 months as soon as teeth appear. brushing twice a day. Use a tiny amount of
comprise half of all bacteria in the plaque. fluoridated toothpaste. Any toothpaste with
Concurrent application of PVP-iodine fluoride is okay to use.
Caries prevention begins before the (Betadine) is recommended (see
first tooth. instructions below*). Let your baby play with a child-size toothbrush
while you brush their teeth. Try brushing at bath
Fluoridated toothpaste is safe for high- Be playful with the baby to establish non- time. Have fun.
risk children. Begin use with the eruption fearful rapport. Ask parents how they are
of the first tooth regardless of age doing with brushing their baby’s teeth. Non-fluoride toothpaste and baby tooth gels do
(see URL below for new topical fluoride not work to prevent cavities.
recommendations). Help parents practice brushing their
baby’s teeth. Our goal is for your child to have no infections
Both fluorides and oral antiseptics may and no tooth decay. Bring your baby back for
be needed to prevent cavities in highly Teach parents how to “lift the lip” and another prevention visit in 6 months even if you
infected children. look at their baby’s teeth for potential see nothing wrong with your baby’s teeth.
spots of tooth decay.
1 to 2 years of age Up to 50% of high-risk children develop Apply fluoride varnish to all teeth at Our goal is for your child to have no tooth decay.
cavities by age 2 years. preventive visits or at least 2 times per To do that, we want to see your child every 6
year in the knee-to-knee position. months for a preventive visit even if you don’t
Any decalcification (white or yellow-brown see anything wrong with their teeth.
areas or hypocalcification) must be Ask parents how they are doing with
actively treated to avoid actual cavitation. brushing their child’s teeth. Help parents OR …
practice brushing their child’s teeth. Your child has the first signs of the infections
The “watch and do nothing” approach is Show parents how to floss crowded teeth. that cause tooth decay. Bring him/her back as
out of date and not standard of care. OR … soon as possible for dental treatments.
Atraumatic restorative care using only a With a finding of any decalcification or Brush your child’s teeth twice a day. Use a tiny
spoon and glass ionomer cement is the frank decay, apply PVP-iodine and fluoride amount of fluoride toothpaste. Any fluoride
standard of care. Studies show it is not varnish in sequence every 2 months. toothpaste is okay. After brushing, have your
necessary to remove all the “decay”. Continue application until age 36 months child spit out the excess toothpaste or wipe their
and re-evaluate. mouth. Rinsing is not necessary.
Provide atraumatic restorative care. Children like to pretend to brush their teeth but a
Minimize trauma to avoid creating parent is needed to brush their child’s teeth well
fearful children. enough to keep the teeth healthy.
Floss any teeth that are crowded.
2 to 3 years of age Active caries lesions can be arrested. It Apply fluoride varnish to all teeth at Most parents have some struggles brushing
takes both fluoride and an antiseptic in preventive visits or at least 2 times per year their child’s teeth. Children this age want to be
high risk children. independent.
Ask parents how they are doing with
Atraumatic restorative care using only a brushing their child’s teeth. Actively help. Ask the parents:
spoon and glass ionomer cement is the Can I answer any questions about brushing
standard of care. Studies show it is not OR … or help coach you on ways to brush your
necessary to remove all the “decay”. With a finding of any decalcification or child’s teeth?
frank decay, apply PVP-iodine and fluoride
Restorations without intensive fluoride and varnish in sequence every 2 months. Morning is often the hardest time to get it done.
antiseptics fail in most cases. Continue application until age 36 months How’s that going for you?
and re-evaluate. What about bedtime?
Provide atraumatic restorative care.
Minimize trauma to avoid creating fearful
* Instructions for applying Povidone Iodine: Always apply iodine before applying fluoride varnish. It can be purchased in a pharmacy
in either a bottle or as single use applicators. Dip a Q-tip into povidone iodine solution or open a single use applicator. Dry teeth
with gauze. Apply iodine solution to all tooth surfaces as you would with fluoride varnish. Use gauze to gently wipe off excess and
apply fluoride varnish. PVP iodine does not stain and does not sting or taste bad. A child can be given water or eat after. There is no
scientific basis for telling parents not to allow the child to eat.
REFERENCES: Guidelines for Oral Health Care in Pregnancy. Freely downloadable at http://depts.washington.edu/nacrohd/
resources/pregnancy-reference-card. • Lift the Lip. http://www.dental.washington.edu/conted/store/documents/Lift%20the%20
Lip%20Brochure%202009.pdf. • Topical Fluoride Recommendations for High-Risk Children. Development of Decision Support
Matrix. Recommendations from MCHB Expert Panel. October 22-23, 2007, Altarum Institute, Washington, DC. http://mchoralhealth.
org/PDFs/TopicalFluorideRpt.pdf. Featherstone, J.D., Adair, S.M., Anderson, M.H., Berkowitz, R.J., Bird, W.F., Crall, J.J., Den Besten,
P.K., Donly, K.J., Glassman, P., Milgrom, P., Roth, J.R., Snow, R., & Stewart, R.E. (2003). Caries management by risk assessment:
consensus statement, April 2002. Journal of the California Dental Association, 31(3), 257-269.; Berg JH, Slayton RL (eds). • Early
Childhood Oral Health. Ames, IA: Wiley-Blackwell, 2009.
Baby Smiles Baby Smiles
Protecting Your Child’s Teeth Begins in Pregnancy
A Cooperative Project of Oregon County Health Departments,
Dental Care Organizations, and the University of Washington
RECOMMENDED MESSAGES ABOUT TOOTH BRUSHING RECOMMENDED MESSAGES ABOUT HOW TO SPOT EARLY SIGNS OF TOOTH DECAY
How to Brush a • Baby’s teeth begin to form before birth; the It is easy to spot tooth decay.
Baby’s Teeth bottom 2 front teeth usually come through About once a month look at both sides of your baby’s teeth.
the gums first.
• Start brushing with a small amount of Lay your child across
fluoridated toothpaste as soon as you see your lap so your child’s
teeth come in (around 6 months old). teeth are easier to see.
• Use a simple, gentle, back and forth motion.
• Rinsing is not necessary.
• Brush twice per day if possible.
• Find a position that is comfortable and
safe for you and your baby.
How to Brush • Brush all surfaces of your child’s teeth Gently move your
1 to 3 Year Olds’ Teeth twice a day. Use a child-size toothbrush child’s lips back and
that has a small head and soft bristles. look at the teeth.
• Use fluoridated toothpaste.
• Teach your child to spit out the toothpaste,
• Add tooth brushing as part of your child’s
morning and bedtime routines.
How to Brush • Brush all surfaces of your child’s teeth with Look for discoloration
3 to 5 Years Olds’ Teeth fluoridated toothpaste. Do this twice a day. or white color changes
• Help your child do some of the brushing
on the teeth.
themselves so they learn how to brush.
• Go over their brushing to make sure all
surfaces are clean.
Remember, watching for tooth decay takes just a few minutes
once a month. If you see any white spots or discoloration on the
teeth, contact the dentist right away to have this checked out!
Baby Smiles is a research project to improve the oral health of low-income pregnant Baby Smiles Programs and Counselors are located in 4 Oregon Counties:
women and keep their young children cavity-free. To be eligible for Baby Smiles,
JEFFERSON COUNTY LINCOLN COUNTY
a pregnant woman must be enrolled in Oregon Health Plan (OHP) and receive
nutrition services through the Women, Infants and Children (WIC) program in Silvia Navarro Amanda Claxton
one of four Oregon Counties. Baby Smiles puts into action new standards of 541-475-4456 541-265-0402
care to eliminate the transmission of oral disease from mothers to their children email@example.com AClaxton@co.lincoln.or.us
and prevent dental decay in children. As part of Baby Smiles, dental offices are LINCOLN COUNTY
asked to schedule pregnant women within two weeks of the time they request an DOUGLAS COUNTY
appointment. It is critical to get the women seen by a dentist promptly in order to Beverly Cole Bethany Bickel
stop dental disease. Insurance coverage for dental care for low-income women is 541-440-3577 541-265-0406
often available only during the period of pregnancy and two months after birth. firstname.lastname@example.org BBickel@co.lincoln.or.us
Baby Smiles Counselors work in each participating county health department. The JOSEPHINE COUNTY
counselor’s job is to motivate and assist pregnant women to receive dental care for
herself and her child.
541-474-5325 ext. 2229
Baby Smiles Program Elements help pregnant women learn the importance of good email@example.com
oral health for their health and the health of the baby. Counselors help women
identify local dentists who accept OHP insurance and who have experience treating
pregnant women and young children. Counselors share with women information
about what to expect at a dental visit and how to make the visits successful so the
dentist and staff can provide good care in a timely way.
MODEL CREDITS: National Maternal and Child Health Oral Health Resource Center and families of CA SUGGESTED CITATION: Northwest Center to Reduce Oral Health Disparities. 2010. Oral Health For
Riedy, C Cole, G Garson, J Hardwick, and R. Myer. Pregnant Women, Infants, and Toddlers: A Dental Professional’s Plan for Good Oral Health
in Pregnancy & Cavity-Free Young Children. Seattle, WA: School of Dentistry, University of
These recommendations have been reviewed with dentists throughout Oregon. We believe they Washington. This content is solely the responsibility of the authors and does not necessarily
represent the standard of care in Oregon. represent the official views of the National Institute of Dental & Craniofacial Research or the
National Institute of Health.
PRODUCED: March 31, 2010 with support from the Northwest Center to Reduce Oral Health Disparities
(NIH/NIDCR U54 DE019346), School of Dentistry, University of Washington.