Oral Health Screening

Oral health screening by the primary care clinician is an important part of comprehensive well child care since oral conditions often affect the overall health of the child. [Low: 1999], [Sheiham: 2006], [Fakhruddin: 2008] Dental caries and injuries cause pain and affect eating habits, weight gain, sleep, smiling, and social interactions. Other common oral health issues in children include thrush in infants and tooth decay in up to 40% of children by age 5. [Hale: 2003]

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.

The American Dental Association and the American Academy of Pediatrics recommend that children have their first oral health screening by their first birthday. This first screening is considered an important first step toward a lifetime of good oral health. Some state Medicaid programs provide enhanced payments, when a modifier (EP) is applied to the claim, for clinicians for specific oral health services during well-child visits.

Primary care clinicians can help all children by:
  • providing anticipatory guidance regarding bottle feeding, nutrition, thumb sucking, oral care, flossing, and brushing
  • assessing local water fluoride levels and prescribing fluoride if necessary
  • administering dental varnish
  • assisting with access to dental care

While the primary care clinician will usually treat common conditions affecting the tongue, cheeks, and lips, a dentist should be consulted for conditions affecting the teeth and gums.

Children with special health care needs may face additional oral health challenges related to:
  • inability to perform self-care
  • medical devices that impact oral health
  • medications that have adverse effects on oral health
  • oral aversions from previous medical procedures

Other Names

Dental screening

Early Signs

During well-child or other visits as appropriate, the primary care clinician should commonly ask about feeding problems for younger children and mouth pain and dental visits for older children.

Screening should include visual inspection of the mouth for:
  • thrush
  • tooth decay
  • gum disease
  • abscesses
  • tooth discoloration
  • tongue plaques
  • canker sores
  • cold sores
  • chipped teeth
  • jaw pain
  • halitosis
  • cancer

Online training modules are available for clinicians interested in learning about how to conduct oral health screening, including positioning and assessing for oral and dental conditions. For examples, see: Oral Health Screening Online Module and Open Wide: Oral Health Training for Health Professionals. Screenings may begin by age 1 to assess for proper tooth eruption, daily oral care, and other oral health conditions. 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.

Anticipatory guidance for young children should include:
  • bottles and sippy cups should not be propped or left with infants when caregivers are not actively feeding
  • thumb sucking should be discouraged after age 4 or 5
  • nutrition should include fruits and vegetables and limit fruit juices to 6 ounces per day (see: Oral Health Pocket Guide (Bright Futures))
  • daily oral care should include cleaning infant’s gums and brushing starting once teeth erupt
  • flossing should occur daily
  • toothpaste should be fluoridated and brushing should occur twice a day
  • varnish should be applied approximately twice a year
  • teeth cleanings with dental visits should be done twice a year
  • fluoride from the local water supply should be assessed before prescribing fluoride (see: My Water's Fluoride
  • sealants should be considered for high-risk children and applied by trained health care professionals
  • bottled water use by families should be assessed to determine the need for additional fluoride
  • soda and sugary drinks should be avoided

Anticipatory guidance for older children includes discussion of about the specific information on adverse effects of:
  • energy drinks
  • illegal drugs, including methamphetamines
  • oral piercings
  • smoking/tobacco use
  • infections

Prophylactic antibiotics may be prescribed for infective endocarditis, mitral valve prolapsed with regurgitation, or indwelling catheters placed near the right side of the heart[Tong: 2000].

Anticipatory guidance materials for providers are available through: Oral Health Pocket Guide (Bright Futures). Fluoride levels for local water sources can be found through the Centers for Disease Control and Prevention at: My Water's Fluoride.

521.00, Dental caries

523.00, Gingival and periodontal diseases

784.99, Other symptoms involving head and neck (halitosis)

V07.8, Other specified prophylactic measure (e.g. sealant application)

V07.31, Prophylactic fluoride administration

V15.89, Other specified personal injury history presenting hazards to health (use as secondary diagnosis for patients lacking preventive dental care)

V20.2, Routine infant or child health check (use with V82.89 Special screening for other specified conditions (secondary))

V65.49, Other specified counseling

V72.2, Dental examination (cannot report with V20.2, report for symptomatic visits)


CDT Codes (not CPT Codes) include D1120, D1203, D1206, D1310, D1330, D1351, D0140, D0145.


Oral health risk assessment timing and establishment of the dental home. [Hale: 2003]


The Oral Health - Pocket Guide is designed for use by pediatric medical homes.

Oral Health - Pocket Guide

Description: Provides risk assessment guides, anticipatory guidance information, fluoride supplement chart, and other tools for improving the oral health of children.

Source: Bright Futures, American Academy of Pediatrics. Free for download.

Citations: Oral Health Pocket Guide (Bright Futures)

Response to a Positive Screen

Primary Care

The primary care clinician clinician could assist parents in identifying a dentist who is covered through their insurance plan: see all General Dentistry for Children services providers (6) in our database. For those families without dental insurance, the primary care clinician should provide information for a local publically-funded or charity-care dental office: see all Dental Care Expense Assistance services providers (3) in our database.

Specialty Care

A general dentist can provide care for most conditions affecting the teeth and gums of most children. A pediatric dentist has received special training in meeting the needs of infants, children and adolescents, particularly children with special health care needs who may have complex oral health challenges. Rarely, an oral surgeon is required to provide care for severe conditions.


Information & Support

For Professionals

Children's Oral Health (PDF Document 2.8 MB)
Report identifies impact the problem of poor oral health, how it affects children, and recommendations to improve the situation, from the Schuyler Center for Analysis and Advocacy.

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

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

Top Problems in Your Mouth Slideshow
Images and descriptions of common oral health problems from WebMD.

Oral Health Screening Online Module
An overview of oral health screening from the Minnesota Department of Health

Open Wide: Oral Health Training for Health Professionals
Detailed information about tooth decay, risk factors, prevention, and anticipatory guidance from the National Maternal and Child Oral Health Resource Center.

For Parents and Patients

Oral Health (Mayo Clinic)
A brief overview of conditions that may be caused or affected by poor oral health from the Mayo Clinic.

Parent's Checklist for Good Dental Practices in Child Care (PDF Document 1023 KB)
A one-page checklist with additonal resources for parents with information about foods, brushing, preventing tooth decay, safety issues, and dental emergencies.

Your Oral Health (PDF Document 7.6 MB)
An educational presentation developed by members of the Utah Dental Hygienists' Association that contains information about preventive care for infants, children, and teens; cavities; brushing; fluoride and sealants; and oral health during pregnancy. The presentation includes information about risks from smoking, drugs, piercings, energy drinks, and diseases.

2-1-1 Dental Resources Salt Lake County
A list of dental resources compiled by Utah 2-1-1. Dated December 2011.


Dental Care Expense Assistance

See all Dental Care Expense Assistance services providers (3) in our database.

General Dentistry for Children

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

Oral Surgery

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


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.

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

Helpful Articles

Acs G, Lodolini G, Kaminsky S, Cisneros GJ.
Effect of nursing caries on body weight in a pediatric population.
Pediatr Dent. 1992;14(5):302-5. PubMed abstract

Elice CE, Fields HW.
Failure to thrive: review of the literature, case reports, and implications for dental treatment.
Pediatr Dent. 1990;12(3):185-9. PubMed abstract

Filstrup SL, Briskie D, da Fonseca M, Lawrence L, Wandera A, Inglehart MR.
Early childhood caries and quality of life: child and parent perspectives.
Pediatr Dent. 2003;25(5):431-40. PubMed abstract


Compiled and edited by: Alfred Romeo, RN, PhD - 6/2011
Content Last Updated: 6/2011

Page Bibliography

Fakhruddin KS, Lawrence HP, Kenny DJ, Locker D.
Impact of treated and untreated dental injuries on the quality of life of Ontario school children.
Dent Traumatol. 2008;24(3):309-13. PubMed abstract

Hale KJ.
Oral health risk assessment timing and establishment of the dental home.
Pediatrics. 2003;111(5 Pt 1):1113-6. PubMed abstract / Full Text
An American Academy of Pediatrics Policy Statement. Optimal practices of diet, oral hygiene, and fluoride exposure can significantly and positively impact a child’s predisposition to early childhood caries. Pediatricians and pediatric health care professionals should perform oral health risk assessments on all patients beginning at 6 months of age. A dental home should be established by 1 year of age for children deemed at risk.

Low W, Tan S, Schwartz S.
The effect of severe caries on the quality of life in young children.
Pediatr Dent. 1999;21(6):325-6. PubMed abstract

Sheiham A.
Dental caries affects body weight, growth and quality of life in pre-school children.
Br Dent J. 2006;201(10):625-6. PubMed abstract / Full Text

Tong DC, Rothwell BR.
Antibiotic prophylaxis in dentistry: a review and practice recommendations.
J Am Dent Assoc. 2000;131(3):366-74. PubMed abstract / Full Text