Oral Health for Pregnant Women, Infants and Toddlers A

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					                                      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
                                                                                                                                                                                             baby’s teeth.
                                                                                                                                            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


 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,
                                                    don’t rinse.
                                                  • 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                   silvia.navarro@co.jefferson.or.us                     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.                     bfcole@co.douglas.or.us                               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
                                                                                                    Ruth Converse
herself and her child.
                                                                                                    541-474-5325 ext. 2229
Baby Smiles Program Elements help pregnant women learn the importance of good                       rconverse@co.josephine.or.us
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.