This document provides guidelines for providing anticipatory guidance to parents at different stages of their child's development. It covers topics such as oral development, nutrition, oral hygiene, fluoride use, habits, and injury prevention. Guidelines are provided for prenatal counseling, and ages 6-12 months, 12-24 months, 2-6 years, 6-12 years, and adolescence. The document emphasizes educating parents on establishing good oral health habits and preventing dental injuries at each stage.

1. Good after noon

2. SUBMITTED BY,
SNEHAPRIYA C S
FINAL YR PART 1
GOV.DENTAL COLLEGE
KOTTAYAM

3. CONTENTS
1. INTRODUCTION
2. PRENATAL COUNSELLING
3. GUIDELINES FOR 6 TO 12 MONTHES OF AGE
4. GUIDELINES FOR 12 TO 24 MONTHES OF AGE
5. GUIDELINES FOR 3 TO 6 YEARS OF AGE
6. GUIDELINES FOR 6 TO 12 YEARS OF AGE
7. GUIDELINES FOR ADOLESCENCE
8. SUMMARY
9. REFERANCE

4. INTRODUCTION
 ANTICIPATORY GUIDANCE is a proactive development
based counselling technique that focus on the needs of a child at
each stage of life
 It is a compliment to Caries Assessment Tool
 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.

5. PRENATAL COUNSELLING
 Parents should be educated regarding
 Oral development of their child
 Appropriate feeding practices
 Dental disease process
 Oral hygiene measures
 Mothers health during pregnancy
 Increased food demand during pregnancy

6. Why are the primary teeth important?
 It act like the foundation stone for
permanent teeth
 Maintain proper space for the permanent
teeth
 Help in normal growth of jaw height and
give shape to the face
 Provide a sense of self worth by
contributing to one’s appearance
 Help in the first step of grinding of food ,

7. Milestones: the eruption of the first
primary tooth
Guidelines for 6 to 12 months of
age

8. Oral development
 Review pattern of eruption
 Review teething fact- local discomfort, irritablity & excess salivation
Fluoride
 Assess fluoride status- no more than rice sized fluoridated toothpaste used
twice daily
 Determine suppliments if needed such as fluoride varnishes
Oral hygiene/health
 Review oral hygiene techniques with parents
 Plan for next visit based on risk assessment
Habits
 Review pacifier use
 Discuss thumb sucking effects on mouth

9.  Nutrition and diet
 Encourage weaning at the appropriate time
 Weaning should occur at 4 -6 momths
 Stage 1 – 4-6 months - food must be sieved, pureed or very finely minced
 Stage 2 – 6-9 months – minced and mashed food includes small soft lumps
 Stage 3 – 9-12 months – baby should eat similar foods to the rest of the family
 Discuss the role of sugar in dental caries initiation
 Injury prevention
 Review what to do if patient has traumatic injury
 Provide emergency number

11. Milestones : completion primary dentition, occlusal
relationships establishment, arch length determined
Guidance for 12 to 24 months of age

12. Oral development
 Discuss importance of space maintaining
 Discuss bruxing
Fluoride
 Reassess fluoride status
 Discuss toxicity and how to manage accidental ingestion
Oral hygiene/health
 Review home oral care procedure and compliance
 Plan for next visit

13. Habits
 Review non nutritive sucking
 Thumb sucking and pacifiers use will lead to
Anterior open bite, maxillary constriction etc..
Nutrition and diet
 Discuss carbohydrate and their role in plaque development
 Discuss the frequency of carbohydrate intake as caries factor
Injury prevention
 Discuss electric cord safety, child proofing the house, and use of car
seats
 Develop plans for oral trauma management for preschool and child
care

14. Milestones : loss of first primary tooth, eruption
of first permanent molar or incisor
Guidance for 2 to 6 years of age

15. Oral development
 Review patterns of eruption, point out permanent incisor
 Describe healthy periodontal tissue
Fluoride
 Reassess fluoride status at periodic visit and determine both
supplement and age appropriate vehicle
 Fluoridated toothpastes not more than a pea size
 Child should brush under the supervision of parents to ensure
expectoration
Oral hygiene/health
 Review home oral care procedures and compliance
 Discuss dental sealants and describe dental radiographs
 Plan for next visit based on risk assessment

16. Habits
 If child is still sucking the thumb, discuss hoe to help him stop the
habit
Nutrition and diet
 Review diet outside the home and its caries potential
 Discourage the use of food as a behavioral tool
Injury prevention
 Encourage the use of helmets, mouth guards, and car seats
 Develop plans for oral trauma management
 Review difference between primary and
permanent teeth with parents during examination

17. Milestones: eruption of first permanent molar
Guidance for 6 to 12 years of age

18. Oral development
 Discuss about the importance first permanent
molar
 Discuss the various preventive measures taken
at this stage to prevent progression of caries
Nutrition and diet
 Review diet outside the home and its caries
potential
Fluorides
 Application topical fluorides if needed
 Regular use of tooth paste is recommended

19. Oral hygiene/health
 Parents should continues to monitor brushing and flossing frequency
and adequacany
 Application of pit and fissure sealants if necessary
Habits
 Educate about any oral habits if it is present
 Educate the parents about transitional changes in the developing
dentition and the importance of primary and permanent dentition

20. Guidance for adolescent

21.  Prevention of periodontal disease become a special concern
 At this age group the main process utalized are
a) Rejection of many parentral values
b) The beginning of independent struggle
c) The testing out types of behavioural experimentaion
 Parents are educated that they should treat the child at this stage
very diplomatically
 Parents should have a friendly approach
 The child should be given enough emotional support from parents

22. Oral hygiene/health
 The adolescent patient posses the fine motor skills necessary for adequate
tooth brushing and flossing
 Problems in compliance are likely to be encountered
 Diet
 High frequency of sugar consumption
 Progression of lession halted with an appropriate diet and aggressive topical
fluoride therapy
 Fluorides
 Systemic fluorides are no longer benefit after the last permanent tooth erupt at
about age of 13 yrs, except for patients who have functional third molars
 Topical fluorides are the most effective preventive measure of smooth surface
decay

23.  Orthodontics
 Many Patients undergo orthodontic treatment at this stage
 High risk for both gingivitis and gingival hyperplasia and for dental caries
 Topical fluoride application and thorough removal of the plaque from gingival
areas
Smokeless tobacco
 Peer pressure and advertising exert pressure on adolescent to establish a
habit that may result in addiction.
 Parents should be instructed / counseled not to rag or punish the
adolescent as it may further worson the habit
 Discuss the health risk in smoking
 Instruct parents to avoid smoking infront of the children
 Discuss nicotine replacement and medication

25. PREVENTION OF DENTAL INJURIES
 Dental injuries can lead to discoloration,
malformation and even loss of tooth
 Primary care clinicians are in a unique position to
help families prevent accidental trauma, including
oral trauma, by providing anticipatory guidance at
routine visits
 Most injuries to primary teeth occurs within
toddlers 12 to 30 months of age
 The best approach to take active measures to
prevent injuries

26. AVULSION
Do NOT re-implant a primary tooth, as this may damage the underlying
permanent tooth. Instead, refer to a dentist within 24 hours.
•Avulsion should be managed as follows:
1. Gently rinse off debris with saline or milk. Hold tooth by crown only.
2. Avoid touching the root. Do not clean or rub it. It is important to
preserve the periodontal ligament for tooth survival.
3. Re-implant an avulsed permanent tooth immediately, ensuring
correct orientation. The tooth should be re-implanted within 20
minutes, but the best outcome is with teeth replaced within 5
minutes.
4. Instruct patient to bite on gauze or a handkerchief or to hold the
tooth in place.

27. 5. Send to a dentist or maxillofacial surgeon immediately for
radiographs, splinting, and antibiotic prophylaxis.
6. If the tooth cannot be re-implanted on scene, transport it
(ordered by preference) in: a tooth storage solution, warm milk,
saline, or saliva.
7. A tooth should not be transported dry or in plain water, as this
significantly decreases the chance of ligament survival.
8. Never suggest a child hold the damaged tooth in his or her
mouth

28. Accident Prevention
 Suggestions for accident prevention specifically related to oral
trauma:
1. Advise parents about possible injury to developing permanent teeth
from trauma if a primary tooth is injured.
2. Review and anticipate developmental milestones.
3. Counsel about the risks of walkers and trampolines.
4. Discuss childproofing the home.
5. Review safety measures for outdoor activities and sports.
6. Stress the importance of adequate supervision at all times, especially on
furniture, stairs, at the playground, and at athletic events or practices.
7. During trauma if the tooth is avulsed, parents should be instructed to
keep the avulsed teeth under tongue of child or store the tooth in saline
or milk and contact dentist

29. Sports and Protective Gear
Sports participation poses a significant risk for trauma
The highest risk sports for oral trauma are baseball,
soccer, football, basketball, and hockey.
Skateboarding, rollerblading, and bicycling injuries
are also common.
Helmet and face masks should be properly fitted and
worn during all games and practices for the sports in
which they are recommended.
Statistically, children are more often injured in
practice than during a game, so all protective gear
should be worn during practice as well.

30. Mouth Guards
Mouth guard use is mandatory for football, ice hockey,
lacrosse, field hockey, and boxing.
Several states have passed regulations mandating mouth
guards for soccer, basketball, and wrestling

31. SUMMARY
 Anticipatory guidance is to providing an insight into the
development of a child will involve the parent , with a much more
foccused stratergy
 At every stage it is essential that the dentist takes into
consideration the various milestones of dental development
 Such AG makes the parents more at ease during childhood dental
visit, these pointers are also essential in preventing many of the
possible dental problems in childrens

33. REFERANCE
Textbook Of Pedodontics, Shoba Tandon
Textbook Of Paedodontics , Nikhil Marwah
Textbook Of Pediatric Dentistry , Pinkham
Www.Isojournals.Com