This document discusses preventive strategies in pediatric dentistry. It outlines how the old infectious disease model was deficient and has been replaced by anticipatory guidance. Anticipatory guidance provides age-specific counseling to parents on oral development, diet, fluoride, habits, hygiene, and injury prevention. It aims to address protective factors to prevent oral health problems. Starting prevention early in infancy allows for developing an individualized plan. To be effective, anticipatory guidance should be coupled with oral health risk assessment and caries risk tools to properly evaluate risk factors and customize prevention.

1. Preventive Strategies in the
Pediatric patient
Dr. Mohamed Magdi Hassan
Department of preventive Sciences
Division of Pediatric Dentistry

2. Pediatric Prevention
• What is Pediatric Dentistry ?
▫ an age-defined specialty that provides both primary and
comprehensive preventive and therapeutic oral health care for
infants and children through adolescence, including those with
special health care needs.
• What is Prevention for the pediatric patient ?
▫ To prevent is to avoid occurrence.
• What to prevent in a Pediatric Patient ?
▫ Transmission of Mutans streptococci.
▫ Development of Caries.
▫ Occurrence of Trauma.
▫ Development of anomalies and malocclusion.
• How to prevent all Theses from Occurring ?
Anticipatory Guidance, Infant oral health Assessment, Caries Risk Assessment

3. Pediatric Prevention
• Infectious Disease Model
Old model
Dental
Caries

4. Pediatric Prevention
• The old concept was to have children have their FIRST dental
visit at age 3 yrs
• Caries was epidemic.
• Anticipatory guidance began in the medical field to educate
parents on their children's growth, development and health.
• Also known as the WELL-CHILD-CARE visits.
• Adopted by Dentistry to help deal with all issues related to dental
health

5. Pediatric Prevention
• Anticipatory Guidance: is pro-active counseling of parents and
patients about developmental changes that will occur in the
intervals between health visits that include information about
daily care taking specific to the upcoming interval.
Caries Assessment
Tool
• Anticipatory guidance is a complement to CAT
• The aim of AG is to address protective factors in effort to prevent
oral health problem.
• AG would include discussion on oral development, diet and
nutrition, fluoride adequacy, oral habits, injury prevention and
oral hygiene.

6. Pediatric Prevention
• AG is age specific, which:
▫ Makes the message concise
▫ Makes the message less static
• Infancy represents a clean slate, but as the child grows the risk of
problem increases.
• Unlike the old infectious disease model, where the Doctor gave
the information and the parent listened. AG provides interaction
between the dentist and the parents.
• Individual plan is developed for each patient.

7. Anticipatory Guidance
Oral Development
Dental and Oral Milestone
Eruption of the first tooth
Development of occlusion
Teething and tooth eruption time
Anatomical landmarks
Diet and Nutrition
Bottle related dental caries
Weaning
Role of Carbohydrates
Role and Identification of Plaques
Fluoride Adequacy
Water evaluation and supplementation
Breastfeeding
External source of fluoride
Safety and toxicity
Dentifrice and topical agents
Habits
Non-nutritive sucking
Pacifiers
Oral Hygiene
Mouth cleaning
Streptococcus mutans testing
Tooth cleaning implements
Positioning and supervision
Injury Prevention
Child abuse and neglect
Car safety
Child proofing
Electric cord safety
Emergency instruction

8. Pediatric Prevention

10. Anticipatory Guidance
Topic
6-12 months
months 12-24
months 24-36
Dental and oral
development
•milestones
• patterns of eruption
• environmental and genetic
influences
• teething
• infant oral cavity
• occlusion
• spacing issues
• speech and teeth
• tooth calcification
•last primary tooth erupted
• exfoliation
• future orthodontic needs
• radiographs
Fluoride
supplementation
•F mechanisms
• sources of F
• choice of F vehicles
• F and vitamins
• toxicity issues/ storage
• formula and F
•F dentifrice use
• F in food sources
• avoiding excessive ingestion
•F use revisited at every interval
• daily access
Non-nutritive
habits
•pacifier use and types/safety
• mouthing/oral Stimulators
•digit habit issues
• effect on occlusion
• revisit habit issues

11. Topic
6-12 months
months 12-24
months 24-36
Injury prevention
• signs of trauma
• child abuse oral signs
• emergency access instructions
• implications for permanent teeth
• car seats
• daycare instructions
• electric cord safety
• re-plantation warning Re:
primary teeth
• child proofing
• helmet safety
• seat belts
• safety network
Diet
• nutrition and dental health
• bottle use and weaning
• Sippy-cup use and content
• breast feeding
• caries process
• role of carbohydrates
(juice) exposures
• retention of food
• review caries process
• revisit Sippy-cup issues
• snacks
• frequency issues
• review caries process
• role of carbohydrates
(juice) exposures
• revisit Sippy-cup issues
Oral hygiene
• oral as part of general hygiene
• acquisition of S. mutans
• positioning baby for oral hygiene
• special techniques
• child participation
• dentifrice use
• Fl dentifrice for high risk
• electric brushes/ toddler
techniques
• use of floss
• continued parental
Participation

14. Pediatric Prevention
Increase in irritability
Loss of appetite
Change in eating habits
Difficulty sleeping
Diarrhea
Fever
Vomiting
Discomfort – pain
Drooling

15. Pediatric Prevention
• Oral Health Risk Assessment:
• Systemic evaluation of presence and intensity of etiological
and contributory caries risk factors (and other diseases) to
provide disease risk estimation.
• Helps in providing preventive measures in a customized
fashion.

16. What to Address
What to Ask
Medical history: pre-/perinatal history
(hypoplasia), general health (healthy vs.
special needs), medications (some high in
sucrose)
Nutritional deficiencies in pregnancy
Prematurity (~ < 36 weeks gestational period)
Birth weight (~ < 2.5 kg)
Medical problems/special health care needs
(i.e. compromised salivary flow, compromised
oral hygiene due to behavior problems, high caloric
diets, etc.).
History of hospitalization and past/current medications
Oral hygiène: visible plaque on
maxillary anterior teeth is one of the
best predictors of future caries
Age brushing began?
Are the child’s teeth brushed daily, once in
while or not yet?
Who brushes the child’s teeth?
When are the child’s teeth brushed: morning,
before bedtime, morning and before bedtime
and/or after meals?
Any problems with positioning, child’s
cooperation, etc.?

17. What to Address
What to Ask
Infant Feeding: only formulas, Breast milk or water
in infant bottles; milk is not cariogenic, but a
vehicle for cariogenic substances (i.e. chocolate
powder); breast milk alone is not cariogenic,
prolonged on-demand nighttime feeding associated
with increased risk for caries; weaning from the
bottle/sippy-cup at age 1 and from the breast as
long as the mother and the child desires;
breastfeeding in the 1st year of life found to be
protective of future Obesity
Breastfed/Bottle-fed?
Breastfed/Bottle-fed to sleep and/or in the
middle of the night? If yes, duration and
frequency for each
If bottle-fed, content of bottle: formula, milk,
milk and sugary substances, juice/sugary
drinks and/or water?
Dietary Habits: early introduction
of unhealthy foods (i.e. sugary drinks
and snacks) can alter taste preferences
for foods and beverages and predispose
to obesity; high frequency of sugary
drinks and snacks between meals (≥ 3
times) increases caries risk; limit juice
and sugary drinks daily intake to 4-6 oz
and best given in open cups; best to limit
sweet foods/drinks at mealtimes
Does the child regularly eat sweets more than
2 a day?
What does the child like to snack on and how
frequently?
What type of container does the child usually
use for drinks?
Daily amount in oz during meals and/or
throughout the day for the following drinks:
100% juice, juice drinks, regular/diet soda
and sugary drinks (i.e. Kool-Aid)

18. What to Address
What to Ask
Fluoride Adequacy: daily
fluoride exposure through water or
supplementation, and monitored use of
fluoridated toothpaste (no more than a
lateral smear) can be effective primary
preventive procedures
Main water source from which the child is
drinking: city water (unfiltered, Brita/Pur
filter), city water (filtered, reverse osmosis),
well water or bottle water?
Fluoride level in the child’s drinking water?
Does the child take fluoride supplements? If
yes, dosage and frequency
Does the child use fluoridated toothpaste daily,
once in a while or not yet? If yes, amount
placed on toothbrush
Bacteria Transmission:Mutans
streptococci (MS) transmission can be
direct or indirect, vertical (usually from
mother) or horizontal (within or outside of
the family
Does the child’s mother (intimate caregiver)
have any untreated decay?
Does the child and mother (intimate caregiver)
share the same utensils, foods and cups?
Does the mother (intimate caregiver) pre-chew
the child’s food or kiss the child on the mouth?

19. What to Address
What to Ask
Demographic data:
low SES, low maternal educational level, and minority groups are at higher risk for ECC
Teeth characteristics:
white spot lesions considered severe ECC in children younger than 3 years of age; inspect
for enamel hypoplasia, enamel defects, retentive pits/fissures; stained pits/fissures not
common in primary dentition (possible higher risk for future cavitation?)
Iatrogenic factors:
use of braces or orthodontic/oral appliances provide hard, non-desquamating surfaces
and serve as plaque traps
Salivary assays for MS:
IvoclarVivadent CRT system (www.ivoclarviva.com), MSKB
agar plates

20. Pediatric Prevention
• Summery:
The old infectious disease model was deficient
Anticipatory Guidance replaced the old infectious disease model
Anticipatory Guidance is more concise, less static, more
interactive and helps develop an individual preventive plan for
each patient
Starting with an infant represents a clean slate to prevent the
development of many oral diseases and conditions
To be effective, Anticipatory Guidance should be coupled with
Infant Oral Health Risk Assessment and Caries Risk Tool

21. Thank you