Quality Resource Guide
l
Early Childhood Oral Health in the General Dentistry Office 3rd Edition
5
www.metdental.com
in children of which is a risk factors for ECC.
50-52
The
current
literature
suggests
that
the
establishment of an infant’s oral microbiome is
multifactorial in nature.
53
However, we know on
the population level, women with untreated dental
caries are twice as likely to have children who
experience ECC; sociodemographic and cultural
determinants largely drive this by influencing
maternal health behaviors, values, and parenting.
8
Overall, given the relationship between maternal
and child oral health, oral health messaging is of
prime importance during pregnancy. A free web
resource with information on prenatal oral care is
www.prenataloralhealth.org
.
53
Teething
Teething can lead to intermittent, localized
discomfort in the areas of emerging primary teeth,
irritability, and excessive salivation; however
many children have no apparent difficulties.
53
The AAPD recommends using chilled rings to
treat symptoms.
5
Topical analgesics, including
over-the-counter teething gels, are no longer
recommended
given
potential
toxicity
and
development of methemoglobinemia.
54
Upon reviewing these preventive messages,
the bOHP website allows for charting of this
information that in turn develops a bOHP report
card for the family. The report card provides the
opportunity to use motivational interviewing and
ask caregivers about their level of commitment to
change (
Figure 2
).
Early childhood
developmental milestones
& their relationship to clinical
practice
Performing
a
pediatric
dental
examination
should be considered in the context of each
child’s development.
Tables 1
and
2
review
developmental stages and clinical considerations
for infants and toddlers.
20,55
This information can
help the dental team contextualize the visit and
address one of the greatest challenges identified
by providers caring for young children - a lack of
comfort interacting with the child patient.
56
Considering development
when examining & applying
fluoride in young children
General dentists report them and their staff being
most uncomfortable when presented with “crying”
children.
56
This section provides strategies for
performing a clinical examination and applying
fluoride varnish on a spirited or strong-willed
toddler. The three-minute video on the “Spirited
Toddler,” located under the training panel on the
bOHP website, offers helpful guidance.
20,57
1.
Prepare the caregiver
Let the caregiver know that it is typical for young
children to cry during an examination. Try to
use “positive” words in your explanation. You
may consider spelling out the word “cry” to the
caregiver as you indicate that this is a common
behavior.
Children are highly attuned and listen to what
providers and caregivers discuss. Review with the
caregiver proper knee-to-knee positioning and
need for the caregiver to stabilize their child’s legs
and hands in a “hugging” position (
Figure 3
). A
60 second video on knee-to-knee examinations is
available in English and Spanish on the final slide
of the bOHP website’s caregiver presentation.
2.
Prepare yourself and your staff
Have all necessary instruments and materials
arranged and within reach before you begin. Do
not lay the child back until your gloves, mask and
protective eyewear is on.
3.
Distractive interactions
Interact with a child prior to laying them back into
the knee-to-knee position. Consider counting
their fingers with your mirror or toothbrush. If you
have them hold the toothbrush, assure it remains
in the package. Counting a parent’s fingers or
pretending to count a stuffed animal’s teeth to
demonstrate teeth counting can also be helpful.
Using your mask in a playful manner, play “peek-
a-boo” by putting your mask over your mouth
and then over your chin, making the situation
less intimidating for the child. Finally, avoid using
the air water syringe as toddlers’ reactions to
this can be unpredictable. You may wish to use
the disposable multi-color plastic mirrors for the
child to hold and use for pretend play at home.
(Injury prevention anticipatory guidance should
include no running around with plastic mirrors or
toothbrushes at home.)
4.
Knee-to-knee exam vs. sitting up
It is tempting for providers to look in the mouth
while the child is simply sitting in the caregiver’s
lap if the child is not keen on leaning back.
While the general rule of “not ruining happiness
to get to perfection” is a good pediatric mantra,
a sitting-up examination precludes the dentist
from performing a more accurate assessment of
the child’s oral health. It also limits the ability to
demonstrate proper oral hygiene techniques for
the child and does not allow for safe application
of fluoride varnish.
5.
A moving and “spirited” child
Proper child stabilization is key to a successful
knee-to-knee
examination
and
fluoride
application. When the child is moving, stop to
ensure that the caregiver has his or her body
stabilized - the child’s legs should be around
the caregiver’s waist with the caregiver holding
their child’s hands. Assure that you, your dental
assistant (DA) or hygienist (DH) has a gentle but
firm hold of the child’s head. The DA or DH should
position themselves at 5:00 or 7:00 o’clock and
use the child’s thick plastic handle toothbrush to
Knee-to-knee examination.
Figure 3