The document provides anticipatory guidance for dental care from prenatal counseling through adolescence. It discusses oral development milestones, nutrition and diet, oral hygiene, fluoride use, habits, injury prevention, and other topics. Guidelines are provided for different age groups, outlining what parents and dentists should discuss and assess. The goal is to educate parents and prevent oral health issues by addressing risk factors at each stage of a child's development.

1. REFERENCE
TEXTBOOK OF PEDODONTICS – SHOBHA TANDON
TEXTBOOK OF PEDODONTICS - NIKHIL MARWAH
TEXTBOOK OF PEDIATRIC DENTISTRY-PINKHAM
ORTHODONTICS
ORAL HYGIENE /HEALTH
&
AVULSION

3. CONTENTS
• INTRODUCTION
• PRENATAL COUNSELLING
• GUIDELINES FOR 6 TO 12 MONTHS OF AGE
• GUIDELINES FOR 12 TO 24 MONTHS OF AGE
• GUIDELINES FOR 3 TO 6 YEARS OF AGE
• GUIDELINES FOR 6 TO 12 YEARS OF AGE
• GUIDELINES FOR ADOLESCENCE
• SUMMARY
• REFERENCE

4. INTRODUCTION
Anticipatory guidanceis 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 Anticipatory guidance is to address protective factors
in effort to prevent oral health problem.Anticipatory Guidance would include
discussion on oral development ,diet and nutrition , flouride adequacy, oralhabits,
injury prevention and oral hygiene.
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
WHY ARE THE PRIMARY TEETH IMPORTANT
• It act like the foundation stone for permanent teeth.
• Maintain proper space for the permanent teeth.
• Helps in normal growth of jaw height and give shape to the face.
• Provide a sense of self worth by contributing to one’s appearance.
• Helps in the first step of grinding of food.
Guidelines for 6 to 12 months of age
Milestones: Eruption of the first primary tooth
ORAL DEVELOPMENT
• Review pattern of eruption.

5. • Review teething fact – local discomfort,irritability and excess.
FLOURIDE
• Assess fluoride status – no more than rice sized flouridated tooth paste used
twice daily.
• Deteminesupplements if needed such as flouride varnish.
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.
NUTRITION AND DIET
• Encourage weaning at the appropriate time.
• Weaning should occur at 4-6 months.
• Stage 1 -4-6 months-food must be sieved, pureed or very finely minced
• Stage2 -6-9 months-minced and mashed food includes small soft lumps.
• Stage3 – 9-12months- baby should eat similar foods as 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
Guidance for 12 to 24 months of age
Milestones: Completion of primary dentition. Establishment of occulusal
relationships, arch length determined
ORAL DEVELOPMENT

6. • Discuss importance of space maintaining.
• Discuss bruxing
FLOURIDE
• Reassess flouride status
• Discuss toxicity and how to manage accidental ingestion.
ORAL HYGIENE/HEALTH
• Review home oralcare procedure and compliance.
• Plan for next visit
HABITS
• If child is still sucking the thumb,discuss to help him stop the habit
NUTRITION AND DIET
• Review diet outside the home and it’s caries potential.
• Discuss 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.
Guidance for 2-6 years of age
Milestones :Loss of first primary tooth,eruption of first permanent molar or
incisor
ORAL DEVELOPMENT
• Review patterns of eruption, point out permanent tooth eruption
• Describe healthy periodontal tissue

7. FLOURIDE
• Reassess flouride status at periodic visit and determine both supplement and
age appropriate vehicle
• Flouridated tooth pastes 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
HABITS
• If child is still sucking the thumb,discuss to help him stop the habit
NUTRITION AND DIET
• Review diet outside the home and it’s caries potential.
• Discuss 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.
Guidance for 6 to 12 years of age
Milestones: Eruption of first permanent molar
ORAL DEVELOPMENT
• Discuss about the importance of the first permanent molar
• Discuss the various preventive measures taken at this stage to prevent
progression of caries

8. NUTRITION AND DIET
• Review diet outsidethe home and it’s caries potential.
FLOURIDES
• Application of topical flouridesif needed
• Regular use of tooth paste is recommended
ORAL HYGIENE/HEALTH
• Parent should continue to monitor brushing and flossing frequency
• Application of pit and fissures if needed
HABITS
• Educate about any oral habits if present
• Educate the parents about the transitional changes in the developing dentition
and the importance of primary and permanent dentition
Guidance for Adolescent
• Prevention of periodontal diseases become a special concern
• At this age group the main process utilized are
• Rejection of many parental values
• The beginning of independent struggle
• The testing out types of behavioral experimentation
• Parents are educated that they should treat the child at this age very
diplomatically
• Parents should have a friendly approach
• The child should be given enough emotional support from parents
ORALHYGIENE/HEALTH

9. • 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 lesion halted with an appropriate diet and aggressive flouride
therapy
FLOURIDES
• Systemic flouridesare no longer benefit after the last permanent tooth erupt at
about age of 13 years except for patients who have functional third molars
• Topical flourides are the most effective preventivemeaure of smooth surface
decay
ORTHODONTICS
• Many patients undergo orthodontic treatment at this age
• High risk for both gingivitis , gingival hyperplasia and for dental caries
• Topical flouride 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 or counselled not to rag or punish the adolescent
as it may further worsen the habit
• Discuss the health risk in smoking
• Instruct parents to avoid smoking infront of the children
• Discuss nicotine replacement and medication
• Prevention of dental injuries

10. • 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
and 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
AVULSION
• Do not reimplant 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
• Gently rinse off debris with saline or milk.Hold tooth by crown only
• Avoid touching the root.Donot clean or rub it.it is important to preserve
the periodontal ligament for tooth survival
• Reimplant an avulsed permanent tooth immediately, ensuring correct
orientation. The tooth should be reimplanted within 20 minutes . But the
best outcome is with teeth replaced in 5 minutes
• Instruct patient to bite on gauze or a hand kerchief or to hold the tooth in
place
• Send to a dentist or maxillofacial surgeon immediately for radiographs
,splinting and antibiotic prophylaxis
• If tooth cannot be reimplanted on scene, transport it in a tooth storage
solution ,warm milk, saline or saliva
• A tooth should not be transported dry or in plain water,as this significantly
decreases the chance of ligament survival.
• Never suggest a child to hold the damaged tooth in his or her mouth

11. ACCIDENT PREVENTION
Suggestions for accidental prevention specifically related to oral trauma
• Advice parents about possible injury to developing tooth from trauma if a
primary tooth is injured
• Review and anticipate developmental milestones
• Discuss child proofing the home
• Review safety measures for out door activities and sports
• Stress the importance of adequate supervision at all times,especially on
furnitures ,stairs, at the play ground and at athletic events and practices
• 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
SPORTS AND PROTECTIVE GEAR
Sports participationposses 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
MOUTH GUARDS
Mouth guard use is mandatory for football, ice hockey, field hockey and boxing.
Several states have passed regulations mandating mouth guards for soccer,
basketball and wrestling
SUMMARY
Anticipatory Guidanceis to provide an insight in to the development of a child will
involve the parent with a much more focussedstrategy.At every stage it is essential
that the dentist takes in to consideration the various milestones of dental
development.Thus anticipatory guidance makes the parents more at ease during
childhood dental visit,these pointers are also essential in preventing many of the
possible dental problems in children.
REFERENCE

12. TEXTBOOK OF PEDODONTICS – SHOBHA TANDON
TEXTBOOK OF PEDODONTICS - NIKHIL MARWAH
TEXTBOOK OF PEDIATRIC DENTISTRY-PINKHAM