Promoting oral health for children, especially children under the age of three, is key to preventing chronic oral disease. Although most American's do not view oral disease as a disease similar to diabetes or heart disease, oral disease (diseases effecting the teeth, gums and mouth) is the number one childhood chronic condition - five times more common than asthma and seven time more common than hay fever. Dispelling the myth that oral health is strictly a cosmetic issue is important to children's future, especially to spare them from a life-long struggle with chronic disease and pain. Addressing oral health as part of a broader health policy or children's agenda allows for a greater focus on understanding and influencing the infrastructure or systems that affects many, not just one individual at a time.

Background
Disparities in children’s oral health and access to care are a significant public health problem. Children experiencing oral health disparities are from poor and/or minority families or have special health care needs. The impact of untreated dental disease on children is substantial, and disadvantaged children are disproportionately affected. Despite the decline in cavity rates achieved in recent decades with the use of fluorides, disease rates remain high in these populations. Since dental decay can start as soon as teeth erupt, to be effective, preventive oral health strategies need to target children early when transmission of oral bacteria from mother to infant commences and eating habits are established. Since infants and children are seen by their primary care (medical) providers frequently during the first two years of life, there is an opportunity for these practitioners to promote oral health and refer children for dental care. However, primary care providers receive limited training in prevention of oral disease, while general dentists may not be trained to care for your infants and young children. Pediatric dentists care for young children, but their small numbers (3,500 nationwide) make such services unavailable to most children. Although high-risk children usually have dental insurance through Medicaid or similar programs, the percentage of dentists participating in Medicaid is low, and only one in five children covered by Medicaid actually receives preventive dental care. Dental and public health associations such as the American Academy of Pediatric Dentistry, American Dental Association, and American Public Health Association have recommended a first dental visit at age one, and the American Academy of Pediatrics recently recommended oral health risk assessment by age six months.

Preventive Measures
The American Academy of Pediatric Dentistry (AAPD) encourages professional and at-home preventive measures, including age-appropriate feeding practices that contribute to a child's teeth maintenance. These include the implementation of oral hygiene measures no later than the time of the onset of the first primary tooth:

• If an infant falls asleep while feeding, the teeth should be cleaned before placing the child in bed.

• Tooth brushing of all children should be performed twice daily with a fluoridated toothpaste and a soft, age-appropriate sized toothbrush. Parents should use a ‘smear’ of toothpaste to brush the teeth of a child less than 2 years of age. For the 2-5 year old, parents should dispense a ‘pea-size’ amount of toothpaste and perform or assist with their child’s tooth brushing.

• Flossing should be initiated when the sides of the tooth surfaces cannot be cleansed by a toothbrush.

Preventive measures to avoid the onset of cavities should start early:

• Establish a dental home within 6 months of eruption of the first tooth and no later than 12 months of age.

• On-demand breast-feeding should be avoided after the first primary tooth begins to erupt and other dietary carbohydrates are introduced.

• Encourage your to baby drink from a cup as they approach their first birthday.

• Infants should be weaned from the bottle at 12 to 14 months of age.

• Repetitive consumption of any liquid containing sugar from a bottle or no spill training cup should be avoided.

• Between-meal snacks and prolonged exposures to foods and juice or other beverages containing sugar should be avoided.

Sources:
Journal of Dental Education August 2003. pdf
Children’s Health Project

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