Promoting Oral Health PDF - Bright Futures Guidelines 2017

Promoting Oral Health...

Promoting Oral Health Promoting Oral Health Oral health is critically important to the overall infection caused by dental caries can lead to prob- health and well-being of infants, children, and lems in eating, speaking, and learning.2 Twenty- adolescents. It covers a range of health promo- three percent of children aged 2 to 5 years and All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. tion and disease prevention concerns, including 56% of children aged 6 to 8 have caries, and many dental caries; periodontal (gums) health; proper school hours are lost each year because of dental development and alignment of facial bones, problems related to caries.3 jaws, and teeth; other oral diseases and condi- Dental caries is a complex disease with individual-, tions; and trauma or injury to the mouth and family-, and community-level influences.4 Several teeth. Oral health is an important issue requiring population groups are particularly vulnerable ­continued health supervision from the health to caries. For example, children and youth with care ­professional. special health care needs are at increased risk. Childhood caries is a preventable and transmis- National surveys also have demonstrated that chil- sible infectious disease caused by bacteria (eg, dren in low- and moderate-income households are Streptococcus mutans or Streptococcus sobrinus) more likely to have caries and more decayed teeth that form plaque on the surface of teeth. The bac- than are children from more affluent households. teria interact with sugar in foods and beverages, Even within income levels, children of color are turning them into acids that dissolve tooth enamel, more likely to have caries than are white children.1 causing caries. Caries is one of the most common Thus, sociodemographic status should be viewed chronic diseases in children—5 times more as an initial indicator of risk. common than asthma.1 Left untreated, pain and Copyright 2017. American Academy of Pediatrics. EBSCO Publishing : eBook Academic Collection (EBSCOhost) - printed on 10/10/2024 1:13 PM via RUTGERS UNIVERSITY LIBRARIES 205 AN: 1471774 ; American Academy of Pediatrics, Joseph F. Hagan, Judith S. Shaw, Paula M. Duncan.; Bright Futures : Guidelines for Health Supervision of Infants, Children, and Adolescents Account: s8840717.main.ehost BFG 4TH ED.indb 205 1/20/17 2:46 PM  Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents Health care professionals can teach children, The Importance of a Dental Home ­adolescents, and their families about oral hygiene, The dental home is the ongoing relationship Promoting Oral Health healthy diet and feeding practices, optimal expo- sure to fluoride, and timely referral to a dentist between the dentist and the patient, includes all (see Box 1 for useful resources). Health care pro- aspects of oral health, and is delivered in a com­ fessionals also often provide the initial response prehensive, continuously accessible, coordinated, for oral trauma. They should keep in mind that and family-centered way (Box 2).8 the differential diagnosis for oral trauma includes Three dental organizations (the American Dental intentional injury.5 Association, the Academy of General Dentistry, Box 1 Oral Health Resources Bright Futures in Practice: Oral Health Pocket Guide (2016) provides a structured and comprehensive approach to oral health anticipatory guidance for the health care professional.6 The Health Resources and Services Administration National Maternal and Child Oral Health Resource Center (www.mchoralhealth.org) also provides many valuable tools and resources for health care professionals.7 Additional information is available at the AAP Web site (www.aap.org). Abbreviation: AAP, American Academy of Pediatrics. Box 2 Responsibilities of the Dental Home9 According to the AAPD, the dental home should provide Comprehensive oral health care, including acute care and preventive services, in accordance with AAPD periodicity schedules. Comprehensive assessment for oral diseases and conditions. An individualized preventive dental health program based on a caries risk assessment and a periodontal disease risk assessment. Anticipatory guidance about growth and development issues (ie, teething, thumb- or finger-sucking behaviors, or pacifier habits). A plan for responding to acute dental trauma. Information about proper care of the child’s teeth and gingivae. This would include prevention, diagnosis, and treatment of disease of the supporting and surrounding tissues and the maintenance of health, function, and esthetics of those structures and tissues. Dietary counseling. Referrals to dental specialists when care cannot directly be provided within the dental home. Education regarding future referral to a dentist knowledgeable and comfortable with adult oral health issues for continuing oral health care. Referral at an age determined by patient, parent, and pediatric dentist. Abbreviation: AAPD, American Academy of Pediatric Dentistry. Reproduced with permission from American Academy of Pediatric Dentistry Council on Clinical Affairs. Policy on the dental home. Pediatr Dent. 2015;37(6)(Reference Manual):24-25. 206 EBSCOhost - printed on 10/10/2024 1:13 PM via RUTGERS UNIVERSITY LIBRARIES. All use subject to https://www.ebsco.com/terms-of-use BFG 4TH ED.indb 206 1/20/17 2:46 PM  Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents and the American Academy of Pediatric Dentistry oral fluoride supplementation effective at reducing [AAPD]) are united in encouraging parents to caries incidence.13,14 Promoting Oral Health establish a dental home for their child no later Additional types of fluoride may be used as a than 12 months of age.9 As children and adoles- primary preventive measure and, generally, are cents mature into adulthood, a dental home also recommended for infants, children, and adoles- can ensure that they receive oral health education cents who are deemed to be at high risk of caries. and counseling, preventive and early intervention Research has shown that the primary caries pre- measures, and treatment, including treatment for vention effects of fluoride result from its topical periodontal care, orthodontic services, trauma, contact with enamel and through its antibacterial and other conditions. actions.12 The USPSTF also found new evidence Efforts to establish a dental home offer an oppor­ to support the effectiveness of fluoride varnish tunity for partnerships and foster a connection in infants and children, starting at first primary with the community. A partnership among health tooth eruption through age 5.13,14 care professionals in primary care, dental health, Even if indicated, additional or combination of flu- public health, early care and education (including oride intake should be used judiciously in children child care and home visiting), and school settings to minimize the risk of fluorosis from the overex- can help ensure access to a dental home for each posure to fluoride. Fluoride varnish is not a risk child during the early childhood, middle child- factor for fluorosis. Fluorosis can come from swal- hood, and adolescent years. lowing too much toothpaste that contains fluoride, drinking water with higher than recommended Fluoride fluoride levels, and taking fluoride supplements Fluoride plays a key role in preventing and con- when other sources of fluoride are available.15 To trolling caries. Fluoride helps reduce the loss of prevent fluorosis, if noncommunity water sources, minerals from tooth enamel (demineralization) such as wells and other natural sources, are the and promotes the replacement of minerals primary water sources, they must be tested before (remineralization) in dental enamel that has parents are advised to supplement with fluoride.16 been damaged by acids produced by bacteria in For all children and adolescents, optimal fluoride plaque. Regular and frequent exposure to small levels in drinking water combined with fluoride- amounts of fluoride is the best way to protect the containing preparations, such as toothpastes, gels, teeth against caries. This exposure can be readily varnishes, and rinses, have significantly reduced accomplished through drinking water that has dental decay, but caries risk remains high during been optimally fluoridated10 and brushing with childhood.3,14 Children and adolescents at high risk fluoride toothpaste twice daily.11 of caries should be risk assessed and ­evaluated for Fluoride supplementation typically is not needed topical fluoride beyond that provided by water in the first 6 months of life. Children who do not supply and a fluoridated toothpaste. drink fluoridated water should begin taking flu- Fluoridated toothpaste also is recommended for oride supplements (ie, drops or chewable tablets) all children from the time the first tooth erupts. at 6 months of age.12 Parents can purchase bottled Children’s teeth should be brushed with fluoride water that contains fluoride, as an alternative to toothpaste twice a day, after breakfast and before fluoride supplements. Evidence reviewed by the US bed. Use a soft toothbrush made for young chil- Preventive Services Task Force (USPSTF) found dren. Infants and children younger than 3 years 207 EBSCOhost - printed on 10/10/2024 1:13 PM via RUTGERS UNIVERSITY LIBRARIES. All use subject to https://www.ebsco.com/terms-of-use BFG 4TH ED.indb 207 1/20/17 2:46 PM  Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents should use a small smear (ie, no larger than a grain of rice); ­children aged 3 to 6 should use a pea-sized Promoting Oral Health amount of toothpaste (Figure 1).17 Children and Youth With Special Health Care Needs Children with special health care needs present a unique set of concerns for oral health because they are particularly prone to developing caries. Because dental care for these children is often difficult and sometimes risky, the health care ­professional should refer the child to a dentist as early as possible for vigilant preventive oral health care, which may alleviate the need for future sur­ gical ­intervention. Oral diseases also may have a direct and devastat- ing effect on the general health of children with certain systemic or developmental problems or conditions. Children with compromised immu- Figure 1: Recommended Amounts of Toothpaste nity or certain cardiac, kidney, or liver conditions Reproduced with permission from Lewis CW. Fluoride and dental may be especially vulnerable to the effects of oral caries prevention in children. Pediatr Rev. 2014;35(3). Figure 5. diseases. Children with cognitive disabilities or developmental or neuromuscular conditions who should receive regular dental care and be encouraged do not have the ability to understand and assume to take as much responsibility as possible for their responsibility for or adhere to preventive oral own oral hygiene.18,19 health practices may be at higher risk for complica- tions or systemic infections from oral diseases.18 Promoting Oral Health: Children and youth with special health care needs Infancy—Birth Through 11 Months may require more help with their oral self-care Even though a infant’s teeth do not begin to appear routines (ie, brushing and flossing) than other until the middle of this developmental period, oral children. Health care professionals should advise health is still a concern because caries can develop parents or caregivers to supervise and intervene as during the first year of life. Exclusive breastfeeding needed to help their children with brushing and has been associated with a reduction in ­malocclusion.20 flossing if their special needs prevent them from doing a thorough job. As with all other children, Oral Hygiene and Feeding Practices That ­ the child with special needs should begin dental Promote Oral Health care in the first year and visit the dentist every Even before the baby’s birth, parents and other 6 months or more frequently, as needed. caregivers should make sure their own mouths are Adolescents with special health care needs may as healthy as possible to reduce transmission of face difficulties because of their physical condition, caries-causing harmful bacteria from their saliva to malformations, medicines, or nutrition. They the newborn’s mouth.21 Health care professionals 208 EBSCOhost - printed on 10/10/2024 1:13 PM via RUTGERS UNIVERSITY LIBRARIES. All use subject to https://www.ebsco.com/terms-of-use BFG 4TH ED.indb 208 1/20/17 2:46 PM  Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents should educate family members in the following For infants and children younger than 3 years, ways to promote the adult’s oral health and prevent brush the teeth with a small smear (ie, no larger Promoting Oral Health the transmission of caries-causing bacteria from than a grain of rice) of fluoride toothpaste adult to infant: twice a day (after breakfast and before bed). Practice good oral hygiene and seek oral The child should not spit out the toothpaste or health care. rinse with water. The small amount of tooth- Do not share utensils, cups, spoons, or paste that remains in his mouth helps prevent ­toothbrushes with the infant. ­dental ­caries.11,17 Do not put the child’s pacifiers in their To help prevent early childhood caries, parents also own mouths. Clean pacifiers with mild soap should take advantage of this developmental stage and water. to establish lifelong nutritious eating patterns for Consult with an oral health professional about the family that emphasize consumption of vege- the use of xylitol gum or lozenges (if the adult’s tables, fruits, whole grains, lean meats, and dairy oral health is a concern). This gum may have a products and that minimize consumptions of foods positive effect on oral health by decreasing the and beverages containing added sugars. (For more bacterial load in an adult’s mouth.22,23 information on this topic, see the Promoting Healthy The primary teeth begin to erupt at different ages Nutrition theme.) during the first year of life. An infant is suscepti- Oral Health Risk Assessment ble to tooth decay as soon as the first teeth come Since 2003, the American Academy of Pediatrics into his oral cavity if he has a sufficient bacterial (AAP) has recommended that health care pro- load already present in his mouth and prolonged fessionals conduct an oral health risk assessment exposure to sugars. Chalky white areas on the teeth when an infant is 6 months of age.24 In 2012, the are the first sign of dental decay. Both inadequate AAP refined the risk factors and developed an oral hygiene and inappropriate feeding practices Oral Health Risk Assessment Tool for caries risk that expose teeth to natural or refined sugars for determination (Figure 2).6,25 This assessment con- prolonged periods contribute to the development sists of the health care professional asking parents of early childhood caries. Health care professionals about their and the child’s oral health practices should educate parents in the following ways to and examining the child’s mouth to assess the risk keep teeth clean and remove plaque: of caries. Fluoride varnish may be applied in the Minimize exposure to natural or refined sugars primary care medical home every 6 months, begin- in the infant’s mouth. ning when the first tooth erupts until age 5 years. –– Avoid frequent exposure to foods that can The AAP recognizes that, even today, some chil- lead to dental caries. dren live in communities that lack pediatric den- –– Hold the infant while feeding. Never prop a tists or general dentists who are able to see infants bottle (ie, use pillows or any other object to and young children. Therefore, health care pro- hold a bottle in the infant’s mouth). fessionals who care for these children may have –– Do not allow the infant to fall asleep with a to continue to perform periodic oral health risk bottle that contains milk, formula, juice, or assessments even after 6 to 12 months of age. These other sweetened liquid. assessments allow health care professionals to –– Avoid dipping pacifiers in any sweetened identify children at the highest risk of oral health ­liquid, sugars, or syrups.16 209 EBSCOhost - printed on 10/10/2024 1:13 PM via RUTGERS UNIVERSITY LIBRARIES. All use subject to https://www.ebsco.com/terms-of-use BFG 4TH ED.indb 209 1/20/17 2:46 PM  Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents Promoting Oral Health Figure 2: Oral Health Risk Assessment Tool25 Reproduced with permission from Oral Health Risk Assessment Tool. American Academy of Pediatrics Children’s Oral Health Web site. http://www2.aap.org/oralhealth/docs/RiskAssessmentTool.pdf. Accessed November 20, 2016. problems so they can be referred to whatever lim- hygiene habits. Early childhood also is a good ited resources are available.26-29 In addition, public time for parents, caregivers, and health care pro- health professionals often assist health care profes- fessionals to build positive dietary habits as they sionals and families to link to a dental home. introduce new foods and the child establishes taste preferences. Parents may have questions during Promoting Oral Health: this period about pacifiers and thumb- and finger- sucking behaviors that are related to teeth and Early ­Childhood—1 Through 4 Years jaw alignment. The key oral health priorities of this developmental stage are the same as those of infancy—namely, preventing caries and developing healthy oral 210 EBSCOhost - printed on 10/10/2024 1:13 PM via RUTGERS UNIVERSITY LIBRARIES. All use subject to https://www.ebsco.com/terms-of-use BFG 4TH ED.indb 210 1/20/17 2:46 PM  Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents Oral Hygiene, Fluoride, and Feeding remains in her mouth helps prevent tooth decay. Practices That Promote Oral Health Children can be taught to floss if recommended Promoting Oral Health Parents and caregivers can do much to prevent the by the dental professional. development of caries and promote overall oral Make sure the child drinks fluoridated water or health during this period. As noted earlier, caries is takes prescribed fluoride supplements. an infectious disease, and parents should make sure Early childhood is a time in which children are their oral hygiene and diet meet the standards out- exposed to new tastes, textures, and eating experi- lined here. Health care professionals should educate ences. It is an important opportunity for parents the family and caregivers in the following ways to and caregivers to firmly establish healthful eating promote the adult’s oral health and ­prevent trans- patterns for the child and her family. These patterns mission of bacteria from the adult to the child: should emphasize consumption of vegetables, fruits, Practice good oral hygiene and seek oral whole grains, lean meats, and dairy products and health care. minimize consumptions of foods and beverages Do not share utensils, cups, spoons, or tooth- containing added sugars. (For more information on brushes with the child. this topic, see the Promoting Healthy Nutrition theme.) Do not put the child’s pacifiers in their own mouths. Clean pacifiers with mild soap and water. Oral Health Risk Assessment Consult with an oral health care professional As recommended by the AAPD, by 12 months about the use of gum or lozenges containing of age, a child should be seen by a dentist every xylitol (if the adult’s oral health is a concern). 6 months or according to a schedule recommended Health care professionals also should educate by the dentist, based on the child’s individual needs parents about ways to keep their child’s teeth clean and susceptibility to disease.30 If a dental home is and ensure sufficient fluoride intake. unavailable, the primary care professional should apply topical fluoride varnish to patients every Brush children’s teeth with fluoride toothpaste 6 months. As noted by the AAP, in the absence of twice daily as soon as teeth erupt. Because young a dental home program that is able to see a child children do not have the manual dexterity to between the ages of 1 and 4, the primary care pro- brush their teeth well until they are able to tie fessional should continue to perform oral health their own shoes (­usually around age 7 or 8 years), risk assessments. The AAPD also recommends an adult should brush or help children brush their that health care professionals use the AAP Oral teeth. For children younger than 3, brush the Health Risk Assessment Tool (see Figure 2). teeth with a small smear (ie, no larger than a grain of rice) of fluoride toothpaste twice a day Other Oral Health Issues (after breakfast and before bed). The child should The health care professional should be prepared to not spit out the toothpaste or rinse with water. discuss the use of pacifiers and thumb- or finger The small amount of toothpaste that remains in sucking. Finger sucking often fills an emotional her mouth helps prevent dental caries.11,17 need, but it can lead to malocclusion, including For children aged 3 to 6, brush the teeth with anterior open bite (top teeth do not overlap the no more than a pea-sized amount of ­fluoride bottom teeth) and excess overjet (top teeth pro- toothpaste twice a day (after breakfast and trude relative to the bottom teeth). The intensity, before bed). The child should spit out the tooth- duration, and nature of the sucking habit can be paste after brushing but not rinse her mouth used to predict the amount of harm that can occur. with water. The small amount of toothpaste that Positive reinforcement, including a reward system 211 EBSCOhost - printed on 10/10/2024 1:13 PM via RUTGERS UNIVERSITY LIBRARIES. All use subject to https://www.ebsco.com/terms-of-use BFG 4TH ED.indb 211 1/20/17 2:46 PM  Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents or reminder system, is the most effective way to Using a pea-sized amount of fluoridated tooth- discourage finger sucking. paste to clean the child’s teeth. The child should Promoting Oral Health spit out the toothpaste after brushing but not Promoting Oral Health: rinse his mouth with water. The small amount of toothpaste that remains in his mouth helps Middle Childhood—5 Through 10 Years prevent tooth decay.11,17 During the early part of middle childhood, a Make sure the child drinks fluoridated water. child loses his first tooth, and the first permanent Children who do not drink fluoridated water teeth (maxillary and mandibular incisors and first and are at high risk of caries should take pre- molars) start to erupt. By the end of middle child- scribed fluoride supplements. hood, many of the permanent teeth have erupted. For the child, these are exciting signs of getting As children begin school and expand their hori- older. Middle childhood also is a good time for zons beyond the immediate circle of home and parents and caregivers to reinforce oral hygiene, family, they are increasingly exposed to eating optimal fluoride exposure, proper protection to ­habits and foods that put them at increased risk avoid oral traumatic injuries, and the positive of caries. Media, especially television (TV), likely dietary habits they pursued in early childhood. play a role in this increasing risk. Studies of the content of TV programming show that advertise- The history and physical examination performed ments directed at children are heavily weighted by the health care professional should include toward foods high in added sugars, such as sweet- oral health and, as necessary, an oral health risk ened breakfast cereals, fruit juice, soft drinks, assessment (see Figure 2). The child should see the snacks, and candy.31 dentist every 6 months or according to a schedule recommended by the dentist, based on the child’s Parents continue to have the most influence on individual needs and susceptibility to disease. their children’s eating behaviors and attitudes When the permanent molars erupt, the dentist toward food. To the extent possible, parents should should evaluate the child’s teeth to determine the make sure that nutritious foods are available to their need for sealants that protect the teeth from caries. children, and they should continue to emphasize healthful eating patterns. It is important to avoid The key oral health issues for this developmen- the frequent consumption of sugar-sweetened tal stage are preventing caries and gingivitis and beverages and snacks. (For more information on this ensuring proper development of the mouth and topic, see the Promoting Healthy Nutrition theme.) jaw. Reducing the risk of injury or trauma to the mouth and teeth and avoiding risky behaviors that Other Oral Health Issues negatively affect oral health also are important. Finger or other sucking habits sometimes con- tinue into middle childhood. These habits should Oral Hygiene, Fluoride, and Nutrition be stopped when the permanent teeth begin to Practices That Promote Oral Health erupt. As the child begins to grow, the mouth Health care professionals should educate parents in grows, and the child should be evaluated by a the following ways to help their child keep his teeth ­dentist if malocclusion is seen. clean and remove plaque: Some children begin using tobacco during mid- Helping with, and supervising, the brushing of dle childhood. Therefore, the child should be their child’s teeth at least twice a day for 2 min- encouraged not to smoke or use smokeless tobacco utes and flossing once a day before bedtime. because smoking increases the risk of periodontal 212 EBSCOhost - printed on 10/10/2024 1:13 PM via RUTGERS UNIVERSITY LIBRARIES. All use subject to https://www.ebsco.com/terms-of-use BFG 4TH ED.indb 212 1/20/17 2:46 PM  Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents disease and oral cancer and poses substantial risks for adult oral health by preventing destructive to overall health. periodontal disease and dental caries. Avoiding Promoting Oral Health As children mature and begin to play with traumatic injury to the mouth is another continu- increased strength and vigor, in free play and ing priority. Other issues are new. For example, organized sports, the risk of injury to the mouth adolescence brings increased susceptibility to irre- increases. The child and parent should know what versible periodontal or gum disease that may be to do in the event of an emergency, especially if a related to hormonal and immunologic changes. A tooth is visibly broken (chipped or fractured), dis- comprehensive oral hygiene regimen of brushing placed (luxated), or knocked completely out of the and flossing combined with regular professional socket (avulsed). In these cases, the child should be care can manage this response. referred to a dentist immediately. An avulsed per- Oral Hygiene, Fluoride, and Nutrition manent tooth needs to be reimplanted as quickly as Practices That Promote Oral Health possible, but an avulsed primary tooth should not The adolescent should be responsible for her own be reimplanted, because it likely would cause dam- preventive oral health care and should have an age to developing permanent teeth.5 established dental home. She should see the den- Mouth guards worn during sports and other tist every 6 months or according to a schedule athletics greatly reduce the severity of uninten- recommended by the dentist, based on individual tional trauma to individual teeth by distributing needs and susceptibility to disease. The dental pro- the forces of impact to all of the teeth and jaws. fessional also may consider diet analysis, topical Custom adaptations range from softening a generic fluoride applications, antimicrobial regimens, and plastic mouth guard in boiling water and biting dental sealants for high-risk patients or those with into it to register a custom bite to fabricating a significant dental disease.1,3,32,33 guard on a custom mold. Both types work well to Although preventive therapy has resulted in prevent oral trauma; they differ only in cost and increased numbers of adolescents with healthy comfort. The protection afforded by any type teeth, caries is still common in adolescents and of guard mandates use in both organized and untreated caries is higher among adolescents and leisure-time sports activity. young adults aged 16 to 19 years compared with adolescents aged 12 to 15.3 Promoting Oral Health: Adolescents’ risk of caries may be increased by Adolescence—11 Through 21 Years Susceptible tooth surfaces caused by immature Adolescence is characterized by the loss of the enamel in newly erupted permanent teeth. remaining primary teeth and complete eruption of Indifference to oral hygiene, which allows all the permanent teeth, including the third molars plaque to accumulate and mature. or wisdom teeth in late adolescence. Growth spurts Frequent and unregulated exposure to high of the facial bones occur early and then taper off quantities of sugars, a feature of many adoles- as adolescence progresses. The end result is a fully cent diets, which provides the perfect medium established bite. for caries to develop.34 Several oral health issues from earlier developmen- Frequent consumption of acidic drinks, such tal stages continue to be important in adolescence. as juices, and acid-producing drinks, such as For example, vigilant oral hygiene and positive sugar-sweetened beverages, which can directly dietary habits can strengthen a sound foundation erode the enamel.35 213 EBSCOhost - printed on 10/10/2024 1:13 PM via RUTGERS UNIVERSITY LIBRARIES. All use subject to https://www.ebsco.com/terms-of-use BFG 4TH ED.indb 213 1/20/17 2:46 PM  Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents Eating disorders, such as bulimia, which can ontinue to counsel the adolescent about these non-­ result in a characteristic erosion of the dental dietary behavioral factors that affect oral health. Promoting Oral Health enamel by repeated exposure of the teeth to ­gastric acids. Periodontal Conditions Use of certain drugs, specifically methamphet- Evidence suggests that irreversible tissue damage amine, which has a detrimental effect on oral from periodontal disease begins in late adolescence health. Methamphetamine use is associated and early adulthood. Early diagnosis, prevention, with rampant decay that is attributed to some and treatment can, in most cases, prevent irrevers- combination of the acidic nature of the drug, ible damage to the periodontal structures in adult- decreased saliva, tooth grinding and clenching, hood.39 Preventing this damage obviates the need poor oral hygiene, and drug-induced cravings for dental restorations, which require lifelong care for high-calorie carbonated beverages.36 and monitoring. Health care professionals should educate adoles- Traumatic Injury to the Mouth cents to keep their teeth clean and remove plaque Adolescents’ risk of traumatic injury to the mouth by following a comprehensive, daily home care may be increased by regimen, including a minimum of twice-daily brushing with fluoride toothpaste and once-daily High-risk behaviors that may involve trauma flossing. It is recommended that the adolescent to the head and neck spit out the toothpaste but not rinse with water. Driving crashes This regimen should be customized to each patient Injuries that occur because of participating in according to risk factors. Adolescents also should organized and leisure-time sports follow nutritious eating patterns that include only Family or peer violence modest consumption of foods and beverages high Health care professionals should make sure that in added sugars and should drink fluoridated parents and adolescents know what to do and who water. (For more information on this topic, see the to call if an injury occurs and a tooth is fractured Promoting Healthy Nutrition theme.) If necessary, or avulsed. prescribed fluoride supplements until the age of 16 years are appropriate.37 Orthodontics Genetically related abnormal development, prema- Other Oral Health Issues ture primary tooth loss or extraction, or thumb- or Adolescence is a period of experimentation and finger sucking all can result in significant crowd- making choices. Added freedom and extension of ing and malalignment of the teeth, which can boundaries are characteristic of appropriate super- adversely affect oral health, function, and aesthet- vision, but certain behaviors can lead to oral health ics. Preventing premature tooth loss early in life problems. Substance use, including tobacco and has a significant effect on minimizing space loss drugs, can affect soft and hard tissues of the oral and the resultant crowding in adolescence. cavity and is linked to oral cancer.38 Oral piercing can cause local and systemic infection, tooth frac- ture, and hemorrhage. Sexual behaviors can lead to infectious and traumatic consequences to the mouth. The health care professional should 214 EBSCOhost - printed on 10/10/2024 1:13 PM via RUTGERS UNIVERSITY LIBRARIES. All use subject to https://www.ebsco.com/terms-of-use BFG 4TH ED.indb 214 1/20/17 2:46 PM  Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents References Promoting Oral Health 1. Dye BA, Li X, Beltrán-Aguilar ED. Selected oral health indicators 15. Levy SM, Broffitt B, Marshall TA, Eichenberger-Gilmore in the United States, 2005-2008. NCHS Data Brief. 2012;(96):1-8. JM, Warren JJ. Associations between fluorosis of permanent http://www.cdc.gov/nchs/data/databriefs/db96.pdf. Accessed incisors and fluoride intake from infant formula, other dietary September 14, 2016 sources and dentifrice during early childhood. J Am Dent Assoc. 2. Jackson SL, Vann WF Jr, Kotch JB, Pahel BT, Lee JY. Impact 2010;141(10):1190-1201 of poor oral health on children’s school attendance and 16. American Academy of Pediatrics Committe on Nutrition. performance. Am J Public Health. 2011;101(10):1900-1906 Kleinman RE, Greer FR, eds. Pediatric Nutrition: Policy of the 3. Dye BA, Thornton-Evans G, Li X, Iafolla TJ. Dental caries and American Academy of Pediatrics. 7th ed. Elk Grove Village, IL: sealant prevalence in children and adolescents in the United States, American Academy of Pediatrics; 2014 2011-2012. NCHS Data Brief. 2015;(191):1-8. http://www.cdc.gov/ 17. Wright JT, Hanson N, Ristic H, Whall CW, Estrich CG, nchs/data/databriefs/db191.pdf. Accessed September 17, 2016 Zentz RR. 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