Dental and Oral Health Screening

Oral Health

Oral health screening by the primary care clinician is an important part of comprehensive well-child care. Oral health affects eating habits, sleep, smiling, social interactions, and the overall health of the child. In addition, poor oral health increases the risks of developing problems with drinking, eating, and speaking for children with special health care needs. [Weckwerth: 2016]
Smiling Boy with Healthy Teeth and a Confidant Smile.jpg
Because infants and young children usually have several visits with their medical home before ever seeing a dentist, the primary care clinician is often the first person to recognize and address their oral health needs; >20% of children ages 2-11 have untreated dental caries that could be identified in the medical home. [National: 2018] Caries can cause pain and increase the risk of systemic infections.

Screening and Assessment

The American Academy of Pediatrics recommends that an oral health risk assessment should be performed in the medical home starting at the 6- and 9-month well-child checks. [Bright: 2010] If the child’s family has not yet established a dental home, repeat the assessment at the 12-, 18-, 24-, and 30-month well-child checks and the 3- and 6-year checks. [Centers: 2004]
See Oral Health Risk Assessment Tool (AAP) (PDF Document 302 KB) for photos and a brief questionnaire about risk factors, protective factors, and clinical findings.
For children who receive oral health screening from programs like Early Intervention, the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), or Early Head Start, medical homes may choose to limit screening to questions about feeding problems and continue with anticipatory guidance. (Listings for these programs can be found below under Services.)

Anticipatory Guidance

Primary care clinicians can help all children by providing guidance to families such as: [Clinical: 2016]
  • Wipe the infant's gums and tongue with a wet cloth after feeding.
  • Brush twice daily using fluoride toothpaste. Once teeth erupt, all children <3 years old should use a smear of fluoride toothpaste (about the size of a grain of rice), and older children should use a pea-size amount.
  • Floss daily.
  • All family members should see a dentist twice a year for preventive care and cleaning.
  • Bottles and sippy cups should not be propped or left with infants when caregivers are not actively feeding the child.
  • Once teeth erupt, avoid nursing or feeding at night because the milk remaining in the mouth can lead to caries. The caregiver can offer water if the older infant or child is thirsty at night.
  • Wean from bottle feeding by age 12 months.
  • Discourage thumbsucking after age 4 or 5 years.
  • Provide healthy snacks (e.g., cheese, fruit, and vegetables).
  • Prevent frequent snacking on sugar- and carbohydrate-containing foods.
  • Minimize juice consumption to 0-6 ounces per day of 100% fruit juice; avoid soda, energy drinks, and other sweetened beverages.
  • Drink and cook with fluoridated tap water, if it is available.
  • Consider daily xylitol use.
  • Consider fluoride mouthwash for children ≥6 years old. [Council: 2013]
For older children, also discuss the adverse effects of:
Bright Futures Oral Health Pocket Guide
For anticipatory guidance information, a risk assessment guide, a fluoride supplement chart, and tools for improving the oral health of children from birth to young adulthood. See the Oral Health Pocket Guide (Bright Futures) (image, left, links to pdf).

Supplemental Fluoride

The recommended level for community fluoride in water supply is 0.7 mg fluoride per liter (0.7 parts per million). Fluoride occurs naturally in water supplies, so if the level is unknown (such as in well water), it should be tested to determine if supplementation is needed. [American: 2017] Fluoride content of water supplies in the United States can be found at My Water's Fluoride (CDC).
Fluoride Supplement Dosage Schedule
Fluoride Supplement Dosage Schedule
American Dental Association (Oral Health Topics)
Oral fluoride supplements for children ages 6 months to 16 years are recommended for children with suboptimal fluoridated water intake (consider drinking water, cooking water, water at school, etc.). [American: 2017] Supplementation of fluoride and vitamin D during the first year of life is associated with fewer cavities in the primary teeth. [Kühnisch: 2016] Although recommendations are from 2010, the table, left, still provides current supplementation information. Calcium and Vitamin D has information about vitamin D supplementation for children.

Fluoride dental varnish should be placed approximately every 6 months, either in the medical or dental clinician. If in the medical home, administration of the varnish may be performed by trained staff, such as a medical assistant or nurse. A 1-hour, online course, with continuing medical education credits available, can be found at Online Fluoride Varnish Training (SFL). For more information about fluoride, see The Debate Over Fluoridated Water (AAP).

Referral to a Dental Home

The medical home should talk with families about establishing a dental home by 12 months of age (and as early as 6 months of age). [American: 2005] A dental home is a primary care dental provider with a comprehensive and up-to-date approach for preventing dental problems, providing anticipatory guidance about dental issues and nutrition and behaviors that affect dental care, assessing for adequate fluoride and prescribing supplements when indicated, administering topical fluoride applications, assessing and treating dental issues, placing sealants for high-risk children, and referring to dental specialists as needed for surgery or orthodontics. [EQIPP: 2017] The primary care clinician can assist parents who have insurance in identifying a dentist who is covered. For more information about access to and funding for dental services for CYSHCN, please see Oral Health & Dental Care for CYSHCN.

Resources

Information & Support

For Professionals

Oral Health Screening Online Module (MDOH)
Learn about the primary care providers role in providing oral health screening and the Minnesota Child and Teen Checkups Program; Minnesota Department of Health.

Online Fluoride Varnish Training (SFL)
A 1-hour, free course to train medical home providers on how and when to administer fluoride varnish and other care. This is within the Access the Caries Risk Assessment, Fluoride Varnish, and Counseling module. Continuing medical education credits available; Smiles for Life National Oral Health Curriculum.

Oral Health Anticipatory Guidance List (Bright Futures)
A brief list of anticipatory guidance items for children from birth to young adulthood.

Community Water Fluoridation FAQs (CDC)
Information about guidelines, scientific reports, and frequently asked questions about fluoride in wells and bottled water; Centers for Disease Control and Prevention.

For Parents and Patients

Campaign for Dental Health (AAP)
Created to ensure that people of all ages have access to the most effective, affordable, and equitable way to protect teeth from decay; American Academy of Pediatrics.

Dental Exam for Children (MayoClinic)
Discusses why dental exams are important for children, how they are performed, what to expect from the assessment.

The Debate Over Fluoridated Water (AAP)
Pros, cons, facts, and myths about fluoride; American Academy of Pediatrics.

Practice Guidelines

Casamassimo P, Holt K.
Bright Futures: Oral Health—Pocket Guide, 3rd edition.
2016; 3rd. Washington, DC: National Maternal and Child Oral Health Resource Center.

Moyer VA.
Prevention of dental caries in children from birth through age 5 years: US Preventive Services Task Force recommendation statement.
Pediatrics. 2014;133(6):1102-11. PubMed abstract / Full Text

Patient Education

What Is Infective Endocarditis? (AHA) (PDF Document 571 KB)
A fact sheet about this condition and the importance of treatment; American Heart Association.

Tools

My Water's Fluoride (CDC)
A user-friendly, searchable database that allows consumers to learn about the fluoride levels in their drinking water; Centers for Disease Control and Prevention.

Oral Health Pocket Guide (Bright Futures)
Anticipatory guidance information, risk assessment guides, a fluoride supplement chart, and tools for improving the oral health of children from before birth to young adulthood.

Oral Health Practice Tools (AAP)
Many tools in Spanish and English to help with setting up your practice to include oral health, applying fluoride varnish, performing a risk assessment and an oral exam, helping families find a dental home, and providing patient education; American Academy of Pediatrics.

Oral Health Risk Assessment Tool (AAP) (PDF Document 302 KB)
A PDF to aid in the implementation of oral health risk assessment during health supervision visits. Contains photos and a brief questionnaire about risk factors, protective factors, and clinical findings; American Academy of Pediatrics.

Services in Rhode Island

Select services for a different state: ID, MT, NM, NV, UT

Early Intervention for Children with Disabilities/Delays

See all Early Intervention for Children with Disabilities/Delays services providers (12) in our database.

General Dentistry

See all General Dentistry services providers (6) in our database.

Head Start/Early Head Start

See all Head Start/Early Head Start services providers (6) in our database.

Oral Surgery

We currently have no Oral Surgery service providers listed; search our Services database for related services.

Orthodontics

We currently have no Orthodontics service providers listed; search our Services database for related services.

Pediatric Dentistry

See all Pediatric Dentistry services providers (10) in our database.

WIC Clinics

See all WIC Clinics services providers (11) in our database.

For other services related to this condition, browse our Services categories or search our database.

Authors & Reviewers

Last update/revision: February 2019; initial publication: June 2018
Current Authors and Reviewers:
Author: Jennifer Goldman-Luthy, MD, MRP, FAAP
Authoring history
2018: update: Jennifer Goldman-Luthy, MD, MRP, FAAPA
2017: first version: Jennifer Goldman-Luthy, MD, MRP, FAAPA
AAuthor; CAContributing Author; SASenior Author; RReviewer

Page Bibliography

American Academy of Pediatric Dentistry Council on Clinical Affairs.
Policy on the dental home.
Pediatr Dent. 2005;27(7 Reference):18-9. PubMed abstract / Full Text

American Dental Association.
Fluoride: Topical and Systemic Supplements.
(2017) http://www.ada.org/en/member-center/oral-health-topics/fluoride-supple.... Accessed on January 2019.

Bright Futures.
Bright Futures Medical Screening Reference Table 2 to 5 Day (First Week) Visit.
American Academy of Pediatrics; (2010) https://brightfutures.aap.org/Bright%20Futures%20Documents/MSRTable_In.... Accessed on January 2019.

Centers for Disease Control & Prevention.
The National Health and Nutrition Examination Survey (NHANES).
National Institute of Dental and Craniofacial Research. 2004; https://www.nidcr.nih.gov/DataStatistics/FindDataByTopic/DentalCaries/...

Clinical Affairs Committee.
Guideline on Antibiotic Prophylaxis for Dental Patients at Risk for Infection.
Pediatr Dent. 2016;38(6):328-333. PubMed abstract / Full Text

Council on Clinical Affairs.
Guideline on caries-risk assessment and management for infants, children, and adolescents.
Pediatr Dent. 2013;35(5):E157-64. PubMed abstract / Full Text

EQIPP.
Oral Health Online Course.
2017; American Academy of Pediatrics; https://shop.aap.org/eqipp-oral-health/

Kühnisch J, Thiering E, Heinrich-Weltzien R, Hellwig E, Hickel R, Heinrich J.
Fluoride/vitamin D tablet supplementation in infants-effects on dental health after 10 years.
Clin Oral Investig. 2016. PubMed abstract

National Institute of Dental and Craniofacial Research.
Dental caries in children (age 2 to 11).
National Institutes of Health; (2018) https://www.nidcr.nih.gov/DataStatistics/FindDataByTopic/DentalCaries/.... Accessed on January 2019.

Weckwerth SA, Weckwerth GM, Ferrairo BM, Chicrala GM, Ambrosio AM, Toyoshima GH, Bastos JR, Pinto EC, Velasco SR, Bastos RS.
Parents' perception of dental caries in intellectually disabled children.
Spec Care Dentist. 2016;36(6):300-306. PubMed abstract