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DEFINITION
INFANT-Acc. To STONE & CHURCH(1975) child ranging from age 0 to 15 months is an infant HEALTH(Acc. To WHO,1948) A state of complete physical,mental and social well being and not merely the absence of disease or infirmity.
Break cycle of early childhood caries Disrupt acquisition of harmful micro flora Manage risk/benefit of habit Establish dental home for health and harm Impart optimal fluoride protection Use anticipatory guidance to arm parents in the therapeutic alliance
1.
BREAK CYCLE OF EARLY CHILDHOOD CARIESPrimary tooth caries(early childhood caries):problem for many children Early intervention prevent caries
2. DISRUPT ACQUISITION OF HARMFUL MICROFLORA Inoculation of caries initiating bacteria in infant, is by kissing,sharing food ,or other contact,with care taker, primarily mother.
3.MANAGE RISK/BENEFIT OF HABIT Infant oral health permit dentist to enter the habit continuum while it still provide a benefit to child and work with the family to migrate deleterious effect and transition of child out of the habit.
4.ESTABLISH A DENTAL HOME FOR HEALTH OR HARM (AAPD adopted in 2001 ,revised in 2004) Dental home is inclusive of all aspect of oral health that results from the interaction of patient ,parents,nondental professional and dental professionals.
5. IMPART OPTIMAL FLUORIDE PROTECTION Fluoride remain dentistrys best preventive tool and optimal fluoride exposure is tenet of early intervention
RISK ASSESSMENTIt is defined as identification of factor known or believe to be associated with a condition or disease for purpose of further diagnosis prevention or treatment Caries assessment tool(CAT) DEVELOPED by AAPD in 2002 revised in 2006 can be used by different health professionals to identify the risk
2. ANTICIPATORY GUIDANCE Defined as protective counseling of parents and patient about developmental change that will occur in the interval between health supervision
3. HEALTH SUPERVISION -is defined as the longitudinal partnership between dentist and family individualized to focus on health outcome for family and child
3. 4.
RISK ASSESSMENT ORAL EXAMINATION & ASSESSMENT OF CLINICAL RISK FACTOR RISK PROFILING ANTICIPATORY GUIDANCE
Fluoride Adequacy
Do you know the fluoride level of your water? Do you have well water? If yes, has the water been tested? Do you use bottled water? Do you use a water conditioner or filtration system? Does your child take fluoride supplements? If Yes, please list __________________ Do you use a fluoridated toothpaste for your child? Notes __________________________
Oral Habits
Does your child use a pacifier? Does your child suck a thumb or finger (s)? Does your child grind teeth day or nitht? Notes_________________________
Oral Hygiene
Do you clean your childs teeth/gums? Do you use a toothbrush to clean your childs teeth? Do you use toothpaste to clean your childs teeth? Notes __________________________
Oral Development
Does your child have any teeth? Childs age (in months) when first tooth erupted ________________. Has your child experienced teething problems? Have you noticed any oral problems in your child? Notes _______________________
Child examination differs in different ways1.Use of dental chair unnecessary 2.Parent participates as learner and immobilizer 3.Teaching about oral cavity occurs during the examination process 4. Child may cry which is desirable and useful
Natal teeth are those observable in oral cavity at birth & neonatal teeth are those that erupt during 30 days of life(MASSLER &SAVARA 1950)
Dibulin appliance
Riga-Fede Dieases
Traumatic ulceration that occur on the tongue in neonates and infant. Associated with Natal & NeoNatal teeth
6.
7.
Smooth off incisal edge of lower incisors. Modify feeding. Treat symptoms Kenalog in Orabase. Composite over the edge. Do Nothing. Extract lower incisors. Excise the Lesion
TEETHING
Eruption of deciduous teeth leads to teething in infant FEATURES: LOCAL SIGN Hyperemia Patches of erythema on cheek Flushing SYSTEMIC SIGN Crying .increase salivation .diarrhea Loss of appetite .cough .vomiting Sleeplessness .fever TREATMENT-Symptomatic treatment
RISK PROFILING
From the historical and clinical data obtained from the parents and child the dentist can create a risk profile using the same six area of anticipatory guidance Useful visual for risk profiling is also the CAT of AAPD
ANTICIPATORY GUIDANCE
1.AAPD gives a form for use in infant oral health.It is a check list of most typical recommendation for infant
Oral Habits
Thumb/finger sucking habit-Discourage buy age _____________ Pacifier use-Discourage by age ____ Use pacifier that conforms to lips and cheeks and supports the lips Bruxing or other habit ____________
Injury Prevention/Trauma
Child has experienced oral injury Childproof your home Use infant/child care seat Other protective device ___________
Fluoride Adequacy
Obtain home fluoride analysis Contact _______________________ Suggest fluoride supplementation___ Increase water intake to supplement feedings Recommended toothpaste ________
Oral Development
Total primary teeth erupted ________ Next tooth to erupt _______________ Child requires further assessment ______________________________
Oral Hygiene
Use a soft toothbrush Do not use toothpaste Use a smear/pea-sized amount toothpaste Special instructions _____________________________
of
Oral Hygiene
Mouth cleaning Streptococcus mutans testing Tooth cleaning implements Positioning and supervision
Fluoride Adequacy
Water evolution and supplementation Breastfeeding Formula feeding External sources of fluoride Safety and toxicity Dentifrice and topical agents.
Injury Prevention
Child abuse and neglect Car safety Child proofing Electric cord safety Emergency instructions.
Habits
Nonnutritive sucking Pacifiers
Compositon of Breast Milk Iodine Lactose Iron Protien Vitamin A Caesin Vitamin D Fat Tocopherol Sodium Thiamine Potassium Riboflavin Chloride Vtamin B6 Calcium Nicotinic Acid Phosphorus Vitamin B12 Magnesium Folic Acid Copper Vitamin C Zinc Lactoalbumin Lacto Peroxidase Complement C3 & C5
Provide more attention to child Remove bottle immediately after feeding Substitute the milk or non-sweetened juices with plain boiled water Encourage baby to stay in upright position with a bottle Use bottle with a nipple that has a small hole to enable the infant to work with his muscle activity to get milk from bottle Introduce a cup to drink as soon as possible Bottle feeding be allowed at interval It should not be used as pacifier Give water after feeding with the bottle and clean the mouth soon after feeding
QUANTITY OF FEEDING
(GHOSH 2005)
COMPOSITION OF MILK/100 ml
(GHOSH 2005)
SARAS MILK
Composition of SARAS Milk (100 ml) Carbohydrates 4.6 gm Protein 3.2 gm fat 3.0 gm Energy K.cal 58 Cholesterol Traces Phosphorus 85 mg Calcium 122 mg Vitamin A 54 iu Vitamin B .05 mg
Pacifier
ADVANTAGE Satisfies suck need Provide comfort Decrease thumb sucking Help in sleeping DISADVANTAGE Interfere with breastfeeding Dental caries Increase candida infection Orthodontic problems Interfere speech developmant
Types of pacifier
nonphysilogic
Improper
ANTICIPATORY GUIDANCE
Providing an insight into the development of a child will involve the parent with much more focused strategy
Prenatal counseling
Purpose
To educate parents about dental development of the child To educate parents about dental disease and prevention To provide a suitable environment for the child To strengthen and prepare the child and dentition for life
Content
External Component (Parents) Parents education concerning dental disease and oral hygiene Parents motivation for plaque removal program Changes in mothers oral health Intake of sweets
Methods
Education concerning development, prevention, and disease Demonstration of oral hygiene procedures Counseling to instill preventive attitudes and motivation Evaluation of learning, acceptance, and needs
Prenatal counseling
Internal component (Parents and child)
Parents education/development of child Effect of life-style on child Habits (smoking, alcohol consumption) Intake of sweets Exposure to disease (e.g., rubella, syphilis) Effect of drugs on child (e.g., tetracycline's) Nutrition Calcium Vitamins
Fluorides Essential nutrients Childs needs after birth Breastfeeding versus bottle feeding Fluoride supplementation Teething Hygiene Nonnutritive sucking First Visit
GUM PAD-
TEETH
Tooth brush Tooth mouse Dentifrices Tooth wipe provide an effective method of plaque removal before the eruption of primary molar Tooth wipe are highly accepted by infant and caregiver especially after night feeding practices
(Anna Galganny-Almeida et al 2007)
ROLE OF PEDIATRICIAN
1 st health care providers & can act to evaluate their oral health status
Points needed to be discussed1.Tooth eruption 2.Preventive oral hygiene 3.Orofacial development 4.Fluoridation 5.Diet
Prenatal classes by gynecologist Neonatologist counsel the parents regarding any congenital defect Importance of breast feeding can be emphasized by medical persons Importance of mothers on oral hygiene
CONCLUSION
Industrialized countries may claim of a reduction in caries incidence. Developing countries such as India face a uphill task as the caries incidence is still on increase .in attempt to strike at root of problem INFANT ORAL HEALTH CARE is valuable fundamental step.
REFERRENCES
PEDIATRIC DENTISTRY 4th edi. PINKHAM DENTISTRY FOR THE CHILD AND ADOLESCENT 8 th edi.MC.DONALD AVERY TEXT BOOK OF PEDODONTICS BY SHOBHA TANDON ESSENTIAL OF PREVENTIVE &COMMUNITY DENTISTRY ,SOBEN PETER NUTRITION & DIET BY GHOSH NATAL & NEONATAL TEETH ,Review of literature,ROBSON FREDERICO CUNHA et al,pediatric dent.23:158-162,2001 EFFECTIVENESS OF A NOVEL INFANT TOOTH WIPE IN HIGH CRIES RISK BABIES 8-15 MONTH OLD,Anna galgannyAlmeida,pediatric dent.2007;29:337-42
AAPD GUIDELINES 2007 Steptococcus mutans ,early childhood caries & new opportunity,Harold c.slavkin,DDS,JADA Dec.1999 Nutritive and nonnutritive sucking habit: A review- Huguette Turgeon etall.ASDC Dec-1996 Modern Management of the Cleft Lip and Palate Patient.- Allan R. Thom. Dental Update Dec 1990 Treatment alternative for Sublingual traumatic ulceration- Riga-Fede Disease. Rebecca L slayton. Pediatric Dentistry 2000
THANK YOU
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