Expert’s Corner: Getting an early start on childhood dental health

dental health


According to the American Academy of Pediatric Dentists (AAPD), early childhood caries (tooth decay) is the most prevalent chronic, infectious childhood disease, five times more common than asthma and four times more common than childhood obesity. In response to the prevalence, the American Academy of Pediatrics (AAP) created the Campaign for Dental Health (CDH), which includes a group of oral health advocates and health care professionals working in partnership to ensure that the whole population has access to fluoride via community water fluoridation — the most effective and affordable way to prevent tooth decay.

The campaign, which addresses the importance of dental health prevention and public concerns about fluoride use, offers five tools for health care providers, including:

The AAP also offers additional tools, such as an Oral Health Risk Assessment Tool and an illustrated Oral Health Self Management Tool for parents and caregivers.

Isabelle Chase, DDS, FRCD(C), associate in the Department of Dentistry at Boston Children’s Hospital and director of the Postdoctoral Pediatric Dentistry Program at Harvard School of Dental Medicine, believes these new tools will help providers maintain a clear and consistent message about fluoride benefits and safety. It will also help physicians and other health care providers identify children who are at a high risk for early childhood caries, resulting in more timely dental referrals.

“Children see their physician about 11 times before age 2 for well-child visits, but they’ve never seen a dentist,” Chase says. “If physicians, nurse practitioners or nurses can identify children at high risk for dental cavities and administer fluoride in the office, as well as refer the patient to a dentist to establish a dental home by 12 months of age, we can help reduce the risk of dental caries.”

Children see their physician about 11 times before age 2 for well-child visits, but they’ve never seen a dentistIn fact, according to the AAPD, as many as 50 percent of children have never seen a dentist.

That’s why the dental team at Boston Children’s has been working closely with their primary care clinic partners to do a better job of reaching children and parents early, focusing on risk assessment and prevention and placement of fluoride varnish. “We’ve been working with pediatricians and nurses in our primary care clinic, teaching them how to assess cavity risk for our patients. Our primary care clinic is now applying fluoride varnish and referring children to the dental clinic to establish a dental home,” Chase says.

Common fluoride concerns

Parents often have concerns regarding fluoride use, says Chase, due to misinformation in the media about the safety of fluoride-supplemented public water supplies. Confusion also occurs in response to over-the-counter oral hygiene products that do not contain fluoride and are marketed as safe to swallow, leading parents to believe fluoride should be avoided. She stresses the importance of alleviating parental concerns about water fluoridation, as well as educating parents about age-appropriate use of fluoridated toothpaste.

Fluoridated toothpaste recommendations:

  • use for all children, regardless of age, as soon as the first tooth erupts
  • a small smear for children under age 3
  • a pea-sized amount for children ages 3 to 6
  • parents should dispense the paste and supervise brushing

Should fluorosis be a concern?

A common worry regarding fluoride supplementation is the risk of fluorosis. But physicians can confidently reassure parents that fluorosis is a cosmetic condition and has a low likelihood of occurring.

“If you look at the population studies, very few children are affected by fluorosis,” Chase says. “In the United States, the rates of fluorosis are less than 1 percent for severe fluorosis, 2 to 3 percent for moderate fluorosis, and less than 5 percent for mild fluorosis. Most of the population is unaffected.”

Clinical hallmarks of fluorosis include:

  • mild: snowflake, bright white discoloration
  • moderate: tan or light brown discoloration
  • severe: mottled, brown discoloration

Brief interventions can make a big impact on dental health

Chase says a fast risk assessment and brief education can help put parents on the right track, including:

  • An easy non-invasive exam: Lift the upper lip to assess the front teeth. If there’s a coating of plaque on the maxillary incisors, scrape a bit off with a gloved finger to show parents where they can improve with brushing.
  • Stress to parents that anything in the bottle or sippy cup other than water, particularly at bedtime, can put the child at a significantly higher risk of cavities.
  • Remind parents to brush baby teeth with a fluoridated toothpaste. It may seem obvious, but often parents aren’t aware that brushing baby teeth is important.
  • Encourage the establishment of a dental home by the child’s first birthday.

Parents often look to primary care providers for expert health care advice, and a healthy mouth is an important factor for overall physical health. Pediatricians can make a lasting impact on a child’s oral health, using the AAP’s Campaign For Dental Health tools as their guide.

Learn more about Boston Children’s Hospital’s Department of Dentistry.