Sunday, August 09, 2009

Infant and Child Oral Care

UT Dentistry Studies the outcome of educating parents and caregivers on the Oral Health of Infants starting at birth.
By Angela Whatley, RN, CCE, CLD

Published in the July 2009 issue of the CAPPA Quarterly.

Did you know that Dental Caries is an infectious disease and is caused by bacterial organisms in the adult mouth? These organisms are called streptococcus mutans and lactobacillus species, they are part of normal flora within saliva. But with poor mouth care they will overgrow and cause carious lesions that lead to cavitations of the dentin (teeth). Babies are not born with this bacteria, it is passed to them.

Like most of our germs and bacteria we innocently pass it on to our children by sharing utensils, toothbrushes, or in this case to the infant by putting utensils, nipples or a pacifier in your mouth, and then the infant’s mouth. Or by letting the infant place hands in your mouth, and then back into its own mouth. The passing of these organisms is preventable, and those in related health care should start educating parents during pregnancy about how they can keep from passing them on to their children. Prevention of passing on these bacteria within the first 6 months of a child’s life will prevent 80% of cavities in his or her lifetime.

It is important that family members have good dental hygiene practices. You can educate parents through childbirth classes, doula services, or during postpartum care. There are 4 major ways we can prevent Early Dental Caries; Nutrition, Cleaning the mouth, Scheduled dental exams, and Fluorides.
1) Nutrition: Carbohydrates break down into sugars. After eating within seconds our PH in the saliva drops and this weakens our teeth and acid starts attacking. It takes 20 minutes if you do nothing for the saliva to neutralize. Normal body defense in neutral saliva will heal itself. You want to limit high sugar diets with snacks and drinks.

Breastfeeding helps to reduce caries. If parents are bottle-feeding, the only fluids fed to baby should be breast-milk, formula or water; no other drinks should be given to the baby, such as, juices or punch. Give the bottle only at meal time, do not feed ad lib. Do not put the baby to sleep with a bottle; this lets the milk stay in the mouth overnight and causes a constant battle in the flora that can lead to tooth decay when the teeth begin to erupt. A good practice is to drink water after meals, this helps to neutralize the oral flora quicker.

2) Cleaning the mouth before and after teeth eruption begins: Start this early during the first months of life. Clean gums with 2x2 gauze, fingercot or a baby washcloth twice daily; cheeks, gums and tongue should be wiped with water, after each feeding. This routine should continue up to the first molars arrive, between 12-14 months of age. The molars are grooved therefore an object like a broom is needed to sweep them clean; this is the time to introduce a soft bristled toothbrush. And, gentle circular motions should be used to massage the gums, teeth and tongue clean. Dental floss can also be used at this point to clean between adjacent teeth. The brush should be washed and dried after each use. Do not touch the toothbrush to the tube of paste, it will contaminate the tube. And, everyone should have their own tube. Toothbrushes should also not be shared, and the brush should be stored in between each use.

The toothbrush should be thrown away every 3 months; and after a respiratory infection, cold or cough. Oral care should be carried out in a well-lit place so the gums can be seen clearly. Hand washing is also an important role in practicing hygiene and setting an example. And, hands should be washed every time bottles or meals are being prepared, and before oral care begins. Encourage your clients to start and maintain good oral hygiene; starting as early as birth is best, as this sets recognition and acceptance of the procedure. It also helps to be more open to dental visits, which brings us to the third subject in prevention.

3. Scheduled dental exams: This should begin by 6-12 months of age when teeth begin to erupt; the earlier the better it reduces fear and establishes a report. Early exams help identify risks and caries. If caries are found they need to be removed early to decrease the risk of infecting other teeth. Parents should look for a pediatric dental group that starts preventive visits by age 1; which is a new recommendation from the Pediatric Dental Academy.

4. Fluorides: Are the families you work with living in a fluoridated area? Fluoride is in city or community water. Infants need to be a year old before introducing a fluoridated toothpaste, and the infant will need to be able to expectorate (spit) it out and not swallow it. This is usually accomplished around age 3 or 4. Toothpaste should be ADA (American Dental Association) approved. Because fluoride binds to calcium, dairy products, and formula supplements, should not be eaten an hour before or after brushing. Due to calcium in infant formula, a formula fed baby will not absorb much of the fluoride; rinsing with a mouthwash that contains 0.05% sodium fluoride at night, age appropriate, helps to re-mineralize the dentin.

American Academy of Pediatric Dentistry. Dental Care for Your Baby

Clinical Guidelines Reference Manual 2006-2007.
University of Tennessee Department of
Pediatric Dentistry College of Dentistry. Sandford Fenten, DDS, MDS. Introduction to Pediatric Dentistry January 12, 2007.
American Academy of Pediatric Dentistry Foundation TEACH: Teaching Early Awareness of Child Health by Henry Schein, Inc. Parent Kit Pilot Study 2006-2008.

How Pacifiers and Thumb Sucking Affect Oral HealthThumb sucking and Pacifier Habits. Are they good?
By Angela Whatley, RN, CCE, CLD

Published in the July 2009 issue of the CAPPA Quarterly

Both thumb sucking and pacifiers are a matter of security for babies and young children. Normally they outgrow the habits by the age of 2. Although after the age of 4 aggressive thumb-sucking can cause problems and parents will need to seek advice from a dentist. Parents should make sure their child’s pacifier has an approved seal from the ADA. Some pacifiers have come apart, if this happens it can cause choking.

Eruption Sequence: Birth to 14 months of age; if it starts later, they will catch up.

The typical pattern is:
Front to back
Lowers before uppers
Canines come in after molars

Normal signs of teething:
Excess drooling
Chewing and biting
Fussy and irritable
Slight swelling in the gums
Low grade fever (below 101)

Usually babies like to chew on a cold/frozen cloth or teether. This helps the gums.

Parents should report the following to the pediatrician:
High fever (above 101)
High pitched cry
Pulling on ears
Runny nose

If parents have concerns they should call their child’s pediatric dentist or pediatrician.

Reference: American Academy of Pediatric Dentistry Foundation.
TEACH: Teaching Early Awareness of Child Health by Henry Schein, Inc. Parent Kit Pilot Study 2006-2008.

Author Disclosures
Angela Whatley, RN, CLD, CCCE, CAPPA Faculty, is the Coordinator of the Childbirth Programs at Crittenden Regional Hospital in West Memphis, Arkansas with the Perinatal Support Program. Angela says, “Being a Labor Doula and trainer with CAPPA has been so rewarding and a different and refreshing side of healthcare that is so needed today.”


Stef said...

Parents must help their children become involve in sports activities to keep their body fit and right.

Michelle said...

Hi Steph,

I agree that being active is one thing we all can do to help improve our health or maintain good health.

Thank you for sharing.