Because infants and young children usually have several visits with their medical home before ever seeing a dentist, the primary care clinician is often the first person to recognize and address their oral health needs.
The American Dental Association and the American Academy of Pediatrics recommend that children have their first oral health screening by their first birthday. This first screening is considered an important first step toward a lifetime of good oral health. Some state Medicaid programs provide enhanced payments, when a modifier (EP) is applied to the claim, for clinicians for specific oral health services during well-child visits.
Primary care clinicians can help all children by:
- providing anticipatory guidance regarding bottle feeding, nutrition, thumb sucking, oral care, flossing, and brushing
- assessing local water fluoride levels and prescribing fluoride if necessary
- administering dental varnish
- assisting with access to dental care
Children with special health care needs may face additional oral health challenges related to:
- inability to perform self-care
- medical devices that impact oral health
- medications that have adverse effects on oral health
- oral aversions from previous medical procedures
Screening should include visual inspection of the mouth for:
- tooth decay
- gum disease
- tooth discoloration
- tongue plaques
- canker sores
- cold sores
- chipped teeth
- jaw pain
Online training modules are available for clinicians interested in learning about how to conduct oral health screening, including positioning and assessing for oral and dental conditions. For examples, see: Oral Health Screening Online Module and Open Wide: Oral Health Training for Health Professionals. Screenings may begin by age 1 to assess for proper tooth eruption, daily oral care, and other oral health conditions. For children who receive oral health screening from programs like Early Intervention, the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), or Early Head Start, medical homes may choose to limit screening to questions about feeding problems and continue with anticipatory guidance.
Anticipatory guidance for young children should include:
- bottles and sippy cups should not be propped or left with infants when caregivers are not actively feeding
- thumb sucking should be discouraged after age 4 or 5
- nutrition should include fruits and vegetables and limit fruit juices to 6 ounces per day (see: Oral Health Pocket Guide)
- daily oral care should include cleaning infant’s gums and brushing starting once teeth erupt
- flossing should occur daily
- toothpaste should be fluoridated and brushing should occur twice a day
- varnish should be applied approximately twice a year
- teeth cleanings with dental visits should be done twice a year
- fluoride from the local water supply should be assessed before prescribing fluoride (see: My Water's Fluoride
- sealants should be considered for high-risk children and applied by trained health care professionals
- bottled water use by families should be assessed to determine the need for additional fluoride
- soda and sugary drinks should be avoided
Anticipatory guidance for older children includes discussion of about the specific information on adverse effects of:
- energy drinks
- illegal drugs, including methamphetamines
- oral piercings
- smoking/tobacco use
Prophylactic antibiotics may be prescribed for infective endocarditis, mitral valve prolapsed with regurgitation, or indwelling catheters placed near the right side of the heart[Tong: 2000].
Anticipatory guidance materials for providers are available through: Oral Health Pocket Guide. Fluoride levels for local water sources can be found through the Centers for Disease Control and Prevention at: My Water's Fluoride.
521.00, Dental caries
523.00, Gingival and periodontal diseases
784.99, Other symptoms involving head and neck (halitosis)
V07.8, Other specified prophylactic measure (e.g. sealant application)
V07.31, Prophylactic fluoride administration
V15.89, Other specified personal injury history presenting hazards to health (use as secondary diagnosis for patients lacking preventive dental care)
V20.2, Routine infant or child health check (use with V82.89 Special screening for other specified conditions (secondary))
V65.49, Other specified counseling
V72.2, Dental examination (cannot report with V20.2, report for symptomatic visits)
Description: Provides risk assessment guides, anticipatory guidance information, fluoride supplement chart, and other tools for improving the oral health of children.
Source: Bright Futures, American Academy of Pediatrics. Free for download.
Citations: Oral Health Pocket Guide
Children's Oral Health ( 2.8 MB)
Report identifies impact the problem of poor oral health, how it affects children, and recommendations to improve the situation, from the Schuyler Center for Analysis and Advocacy.
Oral Health Anticipatory Guidance List
A brief list of anticipatory guidance items for children from birth to young adulthood from Bright Futures.
Oral Health Pocket Guide
Anticipatory guidance information, risk assessment guides, fluoride supplement chart, and tools for improving the oral health of children from before birth to young adulthood, from Bright Futures.
Top Problems in Your Mouth Slideshow
Images and descriptions of common oral health problems from WebMD.
Oral Health Screening Online Module
An overview of oral health screening from the Minnesota Department of Health
Open Wide: Oral Health Training for Health Professionals
Detailed information about tooth decay, risk factors, prevention, and anticipatory guidance from the National Maternal and Child Oral Health Resource Center.
Oral Health (Mayo Clinic)
A brief overview of conditions that may be caused or affected by poor oral health from the Mayo Clinic.
Parent's Checklist for Good Dental Practices in Child Care ( 1023 KB)
A one-page checklist with additonal resources for parents with information about foods, brushing, preventing tooth decay, safety issues, and dental emergencies.
Your Oral Health ( 7.6 MB)
An educational presentation developed by members of the Utah Dental Hygienists' Association that contains information about preventive care for infants, children, and teens; cavities; brushing; fluoride and sealants; and oral health during pregnancy. The presentation includes information about risks from smoking, drugs, piercings, energy drinks, and diseases.
2-1-1 Dental Resources Salt Lake County
A list of dental resources compiled by Utah 2-1-1. Dated December 2011.
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|Compiled and edited by:||Alfred Romeo, RN, PhD - 6/2011|
|Content Last Updated:||6/2011|
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An American Academy of Pediatrics Policy Statement. Optimal practices of diet, oral hygiene, and fluoride exposure can significantly and positively impact a child’s predisposition to early childhood caries. Pediatricians and pediatric health care professionals should perform oral health risk assessments on all patients beginning at 6 months of age. A dental home should be established by 1 year of age for children deemed at risk.
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