Incorporating Oral Health into Wellcare Visit

Ensuring patients have good oral health is an important part of pediatrics. As a primary care provider, one is aware that dental disease is among the most prevalent chronic diseases of childhood. Children with dental disease suffer needlessly from a very highly preventable problem and are at risk for further health issues.

Healthcare professionals can make a huge impact in the lives of children by incorporating oral health into all well child visits, stressing the importance of good oral hygiene, helping to identify potential dental problems, referring children to a dental home, and giving advice on good nutrition to prevent dental disease and help kids stay healthier. Children who have untreated dental disease can be painful and costly. Preventive care can keep children out of the emergency department and eliminate the need for dental treatment in a hospital operating room.

The American Academy of Pediatrics (AAP) Children’s Oral Health Website has Oral Health Practice Tools and a free Oral Health Risk Assessment Tool

Here’s a list of a few dental topics to cover based on age and stage of development to help get you started (Bright Futures in Practice: Oral Health—Pocket Guide (2nd ed.).

0-11 months

  • Cleaning the infant’s gums with a soft clean damp cloth at least once a day. This helps the infant become comfortable with someone working in his or her mouth.
  • Brushing the infant’s teeth with no more than a smear of fluoridated toothpaste as soon as the first tooth erupts, usually around age 6 to 10 months, twice a day (after breakfast and before bed). Do not rinse the infant’s mouth with water. The small amount of fluoridated toothpaste that remains in the mouth helps prevent tooth decay.
  • Using a soft-bristled toothbrush with a small head, preferably one designed specifically for infants.
  • Breastfeeding the infant exclusively for approximately the first 6 months of life, and continuing to breastfeed until age 12 months or as long as the mother and infant wish to continue.
  • For mothers who cannot breastfeed or choose not to breastfeed, feeding the infant a prepared infant formula. Use fluoridated water (via a community fluoridated water source) or bottled water that contains fluoride for preparing infant formula.
  • Weaning the infant from the bottle as the infant begins to eat more solid foods and drink from a cup. Begin to wean the infant gradually, at about age 9 to 10 months. By age 12 to 14 months, most infants can drink from a cup.
  • For infants ages 6 months and older, serving age-appropriate healthy foods during planned meals and snacks, and limiting eating (grazing) in between.
  • Serving fewer foods high in sugar.

1 – 5 years old

  • For children under age 3, brushing the teeth with no more than a smear of fluoridated toothpaste twice a day.
  • For children ages 3 to 6, brushing the teeth with a pea-sized amount of fluoridated toothpaste twice a day.
  • For effective plaque removal, making sure that a parent brushes the child’s teeth at least once a day. Because brushing requires good fine motor control, young children cannot clean their teeth without parental help.
  • Serving a variety of healthy foods such as fruits, vegetables, whole-grain products and dairy products
  • Serving healthy foods during planned meals and snacks, and limiting eating (grazing) in between.
  • Serving fewer foods high in sugar. Frequent consumption of foods containing sugar increases the risk for tooth decay.
  • Serving water throughout the day, especially between meals and snacks. Drink fluoridated water (via a community fluoridated water source) or bottled water that contains fluoride.

5 – 10 years old

  • Ensuring that children brush their teeth with fluoridated toothpaste twice a day
  • For effective plaque removal, making sure that a parent brushes the child’s teeth at least once a day until the child acquires fine motor skills.
  • Serving a variety of healthy foods such as fruits, vegetables, whole-grain products and dairy products
  • Serving healthy foods during planned meals and snacks, and limiting eating (grazing) in between.
  • Serving fewer foods high in sugar. Frequent consumption of foods containing sugar increases the risk for tooth decay.
  • Encouraging the child to eat fruits rather than drink fruit juice.
  • If the child drinks beverages between meals, encouraging the child to drink water or milk rather than fruit juice, fruit-flavored drinks, or pop (soda).
  • If the school has vending machines, encouraging the child to choose water or milk rather than fruit juice, fruit-flavored drinks, or pop (soda).
  • Drinking water throughout the day, especially between meals and snacks.

11 – 21 years old

  • Brushing your teeth with fluoridated toothpaste twice a day. Floss daily.
  • Eating a variety of healthy foods such as fruits, vegetables, whole-grain products and dairy products
  • Eating healthy foods during planned meals and snacks, and limiting eating (grazing) in between.
  • Eating fewer foods high in sugar
  • Choosing fruits rather than fruit juice.
  • Drinking water throughout the day, especially between meals and snacks. 

Effective Communication about the importance of Oral Health

Encouraging caregivers & families to understand and prioritize oral health is a way to decrease oral disease in children.  During a well visit, providers can educate families, caregivers, and children about nutrition, brushing teeth and scheduling a visit with a dentist and creating a dental home.

What to keep in mind when speaking to caregivers & families:

  • Importance of oral health care, including age-appropriate brushing habits, early detection of decay, and good nutrition
  • Be aware of their attitudes toward dental care and address any questions or concerns they have about caring for their child’s oral health
  • Messages should be clear, short, and simple
  • Provide various methods of communication – posters, picture handouts, hands-on demonstrations
  • Urge parents to take an active role in caring for their child’s teeth at all stages
  • Motivate parents to model good oral health practices like brushing their teeth twice a day, flossing once a day, visiting a dentist regularly, and eating healthy foods
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