Pregnancy and Postpartum
Infancy (0-11 Months)
Early Childhood (1-4 Years)
Middle Childhood (5-10 Years)
Adolescence (11-21 Years)
Infancy (0-11 Months)
Early Childhood (1-4 Years)
Middle Childhood (5-10 Years)
Adolescence (11-21 Years)
Bright Futures Oral Health: Pregnancy and Postpartum
Pregnancy and Postpartum
Oral Hygiene
• Brush teeth thoroughly twice a day (after breakfast and before bed) with fluoridated toothpaste, and flossing daily. Spit out the toothpaste after brushing, but do not rinse with water. The small amount of fluoridated toothpaste that remains in the mouth helps prevent tooth decay.
• Rinse every night with an alcohol-free over-the-counter fluoridated mouthrinse.
• Use certain over-the-counter and prescription medications can decrease salivary flow and increase risk for dental caries and gingivitis.
• Visit a dentist for an examination and restoration of all active decay as soon as feasible. Hormonal changes (increases in estrogen and progesterone) that occur during pregnancy can increase a woman’s risk for developing gingivitis. With gingivitis, the gums become inflamed, swollen, and sensitive and tend to bleed.
Nutrition
• Eat healthy foods such as fruit, vegetables, grain products (especially whole grain), and dairy products (milk, cheese, cottage cheese, and unsweetened yogurt) during meals and snacks. Limit eating (grazing) in between.
• Eat foods containing sugar at mealtimes only, and limiting the amount.
• Frequent consumption of foods high in sugar, such as candy, cookies, cake, sweetened beverages (e.g., fruit drinks, soda), and fruit juice, increases the risk for tooth decay. In addition, frequent consumption of foods that easily adhere to the tooth surface, such as dried fruit, fruit roll-ups, and candy, increases the risk for tooth decay. When checking for sugar, look beyond the sugar bowl and candy dish. A variety of foods contain one or more types of sugar, and all types of sugars can promote tooth decay.
• Choose fruit rather than fruit juice. Drink fruit juice at mealtimes only, if at all.
• Avoid carbonated beverages during pregnancy and for the first 30 months of the infant’s life.
• Drink fluoridated water (via a community fluoridated water source) to prevent tooth decay; for families that prefer bottled water, drink a brand in which fluoride is added at a concentration of approximately 0.7 to 1.2 mg/L (ppm) is recommended.
• Once the infant is born, avoid testing the temperature of the bottle with the mouth, sharing utensils (e.g., spoons), or orally clean a pacifier or a bottle nipple. This practice helps prevent transmission of bacteria that cause tooth decay from the parent, especially the mother, to the child via saliva.
Injury Prevention
• Wear a safety belt while riding or driving in a vehicle. If you are driving, insist that your passengers also wear safety belts.
• Wear protective gear (e.g., mouth guard, face protector, helmet) when participate in physical activities or sports that could potentially result in injuries to the mouth, such as biking or playing baseball or soccer.
• Avoid oral piercings, which can damage teeth and gums.
Substance Use
• Do not smoke cigarettes or use spit tobacco.
Source: “Bright Futures Oral Health Pocket Guide” by the National Maternal and Child Oral Health Resource Center http://www.brightfutures.org/oralhealth/pdf/BFOHPocketGuide.pdf
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Before you see teeth
• Clean the infant’s gums with a clean damp cloth or toothbrush and plain water after each feeding. Use a soft-bristled toothbrush with a small head, preferably one designed specifically for infants.
When you see teeth
• If the infant has sore gums caused by tooth eruption, give the infant a clean teething ring, cool spoon, or cold wet washcloth. Other options include giving the infant a chilled teething ring or simply rubbing the infant’s gums with a clean finger.
• Brush the infant’s teeth as soon as the first tooth erupts, usually around age 6 to 10 months, twice a day (after breakfast and before bed). Use a soft-bristled toothbrush with a small head, preferably one designed specifically for infants, and plain water. Lift the lip to brush at the gum line and behind the teeth. Not giving the infant anything to eat or drink (except water) after brushing at night.
• For infants at increased risk for tooth decay, consult with a dentist or physician about brushing their teeth with fluoridated toothpaste.
• Become familiar with the normal appearance of the infant’s gums and teeth so that problems can be identified if they occur (see Tooth Eruption Chart on pages 78–79). ? Check the infant’s gums and teeth about once a month by lifting the infant’s lip to look for decay on the outside and inside surfaces of the teeth.
• Make an appointment for the infant’s first oral examination within 6 months of the eruption of the first primary tooth, and no later than age 12 months, thereby establishing a dental home.
• After the initial dental visit, make the next appointment for the infant according to the schedule recommended by the dentist, based on the infant’s individual needs or susceptibility to disease.
• For infants with special health care needs, make appointments for more frequent dental visits as directed by the dentist based on the infant’s needs or susceptibility to disease. Obtain special oral health equipment (e.g., a mouth prop) to brush the infant’s teeth.
• Give the infant age 6 months or older fluoride supplements only as recommended by a dentist or physician based on the infant’s risk for developing tooth decay and the known level of fluoride in the infant’s drinking water (see Systemic Fluoride Supplements: Recommended Dosage on page 84). ?
Nutrition
• Breastfeed the infant exclusively for approximately the first 6 months of life and continue to breastfeed until age 12 months or as long as the mother and infant wish to continue.
• For mothers who cannot breastfeed or choose not to breastfeed, feed the infant a prepared infant formula. No additional nutrients are needed.
• Avoid testing the temperature of the bottle with the mouth, sharing utensils (e.g., spoons), or orally cleaning a pacifier or a bottle nipple. This practice helps prevent transmission of bacteria that cause tooth decay from the parent, especially the mother, to the child via saliva.
• Do not put the infant to sleep with a bottle or sippy cup or allow frequent and prolonged bottle feedings or use of sippy cups containing beverages high in sugar (e.g., fruit drinks, soda, fruit juice), milk, or formula during the day or at night to prevent sugary fluids from pooling around the teeth, which can increase the infant’s risk for tooth decay.
• Hold the infant while feeding. Make sure to never prop a bottle (that is, use pillows or any other objects to hold a bottle in the infant’s mouth).
• Never add cereal to a bottle. This causes sugary fluids to pool around the teeth. Feed the infant solid foods with a spoon or fork, or, once the infant is able, to encourage self-feeding.
• Introduce a small cup when the infant can sit up without support.
• Wean the infant from the bottle as the infant begins to eat more solid foods and drink from a cup. Begin to wean the infant gradually, at about age 9 to 10 months. By age 12 to 14 months, most infants can drink from a cup.
• Do not introduce juice into infants’ diets before age 6 months. Serve the infant juice in a cup, and limit juice to 4 to 6 oz per day. Serve 100 percent fruit juice or reconstituted juice.
• For infants ages 6 months and older, serve age-appropriate healthy foods during planned meals and snacks, and limit eating (grazing) in between.
• Serve foods containing sugar at mealtimes only (not between meals), and limit the amount. Frequent consumption of foods high in sugar, such as candy, cookies, cake, sweetened beverages (e.g., fruit drinks, soda), and fruit juice, increases the risk for tooth decay. In addition, frequent consumption of foods that easily adhere to the tooth surface, such as fruit-roll-ups and candy, increase the risk for tooth decay. When checking for sugar, look beyond the sugar bowl and candy dish. A variety of foods contain one or more types of sugar, and all types of sugars can promote tooth decay.
• Drinking fluoridated water (via a community fluoridated water source) to prevent tooth decay; for families that prefer bottled water, drinking a brand in which fluoride is added at a concentration of approximately 0.7 to 1.2 mg/L (ppm) is recommended.
Non-Nutritive Sucking
Sucking is a natural reflex for infants. Most infants require some amount of additional sucking beyond that needed for nourishment. This type of sucking, known as non-nutritive sucking, provides emotional benefits, enabling the infant to calm himself/ herself and focus attention. If parents choose to have their infant suck a pacifier, health professionals can advise them to take certain safety precautions. The following precautions are recommended:
• Never attaching a pacifier to a ribbon or string around the infant’s neck.
• Making sure the pacifier is of sturdy, one-piece construction and that the material is flexible, firm, and not brittle.
• Keeping the pacifier clean.
• Not dipping a pacifier in sweetened foods (e.g., sugar, honey, syrup) to encourage sucking.
• Never orally cleaning a pacifier before giving it to an infant.
Injury Prevention
• Being aware that injuries to the head, face, and mouth are common among infants.
• Learn how to prevent oral injuries and how to handle oral emergencies. Because of the danger of damaging the underlying permanent teeth, never attempt to reinsert an avulsed (lost) primary tooth. It is impossible to relocate the tooth accurately, and there is danger of pushing it too far into the soft alveolar bone.
• Always keep one hand on an infant on high places such as changing tables, beds, sofas, or chairs.
• Use a rear-facing infant-only or convertible car safety seat that is reclined at the angle specified by the manufacturer in the back seat of the vehicle at all times. Infants should ride rear facing until they are at least age 1 and weigh at least 20 lbs. Most infant-only car safety seats accommodate infants up to 20 to 22 lbs, and many convertible seats allow infants up to 33 to 35 lbs to ride rear facing. Do not place an infant at any age in a shopping cart. Instead, consider using a stroller or a backpack or frontpack while shopping with an infant.
• Use safety locks on cabinets. Keep all poisonous substances, medicines, cleaning agents, health and beauty aids, and paints and paint solvents locked in a safe place.
• Keep pet food and dishes out of reach. Do not permit the infant to approach the pet while it is eating.
• Keep appliances and dangling telephone, electric, blind, and drapery cords out of reach.
• Lock doors or use safety gates at the top and bottom of stairs, and use safety locks and safety devices on windows above the ground floor. Supervise the infant on the stairs or furniture.
• Do not give toys small enough to be placed in the mouth. Make sure that toys do not have parts that can become detached. Keep toys with small parts or sharp edges out of reach.
• Make sure that playgrounds are carefully maintained and that equipment is in good condition. All playground equipment should be surrounded by a soft surface (e.g., fine, loose sand; wood chips; wood mulch) or by rubber mats manufactured for this use.
• Supervise the infant on playground equipment. Make sure infants play only on developmentally appropriate equipment. Make sure that toys are soft (e.g., balls not made with leather or hard materials).
• Do not use an infant walker with wheels.
• Provide the infant’s caregivers with the dentist’s emergency phone contacts, and ensure that the caregivers know how to handle all emergencies.
Source: “Bright Futures Oral Health Pocket Guide” by the National Maternal and Child Oral Health Resource Center http://www.brightfutures.org/oralhealth/pdf/BFOHPocketGuide.pdf
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• If the child has not yet been to a dentist, make an appointment for the child’s first dental visit, thereby establishing a dental home.
• After the initial dental visit, make the next appointment for the child according to the schedule recommended by the dentist, based on the child’s individual needs or susceptibility to disease.
• For children with special health care needs, make appointments for more frequent dental visits based on the child’s individual needs or susceptibility to disease. Obtain special oral health equipment (e.g., a mouth prop) to brush the child’s teeth.
• For children under age 2, brush the teeth with plain water twice a day (after breakfast and before bed). For children at increased risk for tooth decay, consult with a dentist or physician about brushing the teeth with a pea-sized amount (small smear) of fluoridated toothpaste.
• For children ages 2 and above, brush the teeth with no more than a pea-sized amount (small smear) of fluoridated toothpaste twice a day (after breakfast and before bed). Make sure the child spits out the toothpaste after brushing, but does not rinse with water. The small amount of fluoridated toothpaste that remains in the mouth helps prevent tooth decay.
• For effective plaque removal, make sure that a parent brushes the child’s teeth.
• Because brushing requires good fine motor control, young children cannot clean their teeth without parental help. After children acquire fine motor skills (e.g., the ability to tie their shoelaces), typically by age 7 or 8, they can clean their teeth effectively but should be supervised by a parent.
• Become familiar with the normal appearance of your child’s gums and teeth so that problems can be identified if they occur (see Tooth Eruption Chart on pages 78–79). ? Check the child’s gums and teeth about once a month.
• Give the child fluoride supplements only as prescribed by a dentist or physician, based on the risk of developing tooth decay and the known level of fluoride in the child’s drnking water (see Systemic Fluoride Supplements: Recommended Dosage on page 84). ?
• Discuss with a dentist or other qualified health professional the need to apply fluoride topically (via varnishes, gels, foams), which renews the high levels of fluoride in the outer layer of the tooth enamel. Topical fluoride may be especially effective for children at high risk for tooth decay because they have a history of decay, are not exposed to fluoridated water, snack frequently on foods containing sugar, or have a medical problem that decreases their resistance to decay.
• Discuss with a dentist or other qualified health professional the need to apply dental sealants (thin plastic coatings applied to pits and fissures on the chewing surfaces of the teeth) to prevent tooth decay by creating a physical barrier against dental plaque. Dental sealants should be applied shortly after the teeth erupt.
• If the child has sore gums caused by tooth eruption, give the child a clean teething ring, cool spoon, or cold wet washcloth. Other options include giving the child a chilled teething ring or simply rubbing the child’s gums with a clean finger.
Nutrition
• Avoid sharing utensils (e.g., spoons) or orally cleaning a pacifier or a bottle nipple. This practice helps prevent transmission of bacteria that cause tooth decay from the parent, especially the mother, to the child via saliva.
• Continue to encourage the child to drink from a cup. Wean the child from the bottle by age 12 to 14 months.
• Do not put the child to sleep with a bottle or sippy cup or allow frequent and prolonged bottle feedings or use of sippy cups containing beverages high in sugar (e.g., fruit drinks, soda, fruit juice), milk, or formula during the day or at night to prevent sugary fluids from pooling around the teeth, which can increase the child’s risk for tooth decay.
• Serve age-appropriate healthy foods during planned meals and snacks, and limit eating (grazing) in between.
• Serve fruit, vegetables, grain products (especially whole grain), and dairy products (milk, cheese, cottage cheese, and unsweetened yogurt).
• Serve foods containing sugar at mealtimes only (not between meals), and limiting the amount. Frequent consumption of foods high in sugar, such as candy, cookies, cake, sweetened beverages (e.g., fruit drinks, soda), and fruit juice, increases the risk for tooth decay.
• In addition, frequent consumption of foods that easily adhere to the tooth surface, such as fruit-roll-ups and candy, increases the risk for tooth decay. When checking for sugar, look beyond the sugar bowl and candy dish. A variety of foods contain one or more types of sugar, and all types of sugars can promote tooth decay.
• Encourage the child to eat fruit rather than drink fruit juice.
• Serve the child juice in a cup, and limiting the child’s consumption of juice to 4 to 6 oz per day. Serving 100 percent fruit juice or reconstituted juice.
• If the child drinks beverages between meals, encourage the child to drink water or milk rather than fruit juice or sweetened beverages (e.g., fruit drinks, soda).
• Drink fluoridated water (via a community fluoridated water source) to prevent tooth decay; for families that prefer bottled water, drinking a brand in which fluoride is added at a concentration of approximately 0.7 to 1.2 mg/L (ppm) is recommended.
Non-Nutritive Sucking
Sucking is a natural reflex for children. Most children require some amount of additional sucking beyond that needed for nourishment. This type of sucking, known as non-nutritive sucking, provides emotional benefits, enabling the child to calm himself/herself and focus attention. If parents choose to have their child suck a pacifier, health professionals can advise them to take certain safety precautions. The following precautions are recommended:
• Never attach a pacifier to a ribbon or string around the child’s neck.
• Make sure the pacifier is of sturdy, one-piece construction and that the material is flexible, firm, and not brittle.
• Keep the pacifier clean.
• Do not dip a pacifier in sweetened foods (e.g., sugar, honey, syrup) to encourage sucking.
• Never orally clean a pacifier before giving it to a child.
Injury Prevention
• Be aware that injuries to the head, face, and mouth are common among children.
• Learn how to prevent oral injuries and how to handle oral emergencies. Because of the danger of damaging the underlying permanent teeth, never attempt to reinsert an avulsed (lost) primary tooth. It is impossible to relocate the tooth accurately, and there is danger of pushing it too far into the soft alveolar bone.
• Use an appropriate car safety seat in the back seat of the vehicle at all times.
• Children should ride rear facing until they weigh at least 20 lbs; it is preferable if they ride rear facing to the highest weight and height allowed by the car safety seat. Children who weigh at least 20 lbs should ride in a forward-facing car safety seat (unless their rear-facing car safety accommodates a higher weight); most forward-facing seats have a weight limit of 40 lbs, but a few have higher weight limits. After a child reaches the weight or height limit of the forward-facing car safety seat, the child should ride in a belt-positioning booster seat with a lap and shoulder belt.
• Do not place a child of any age in a shopping cart. Instead, consider using a stroller or a backpack or frontpack while shopping with a child.
• Use safety locks on cabinets. Keep all poisonous substances, medicines, leaning agents, health and beauty aids, and paints and paint solvents locked in a safe place.
• Keep pet food and dishes out of reach. Do not permit the child to approach the pet while it is eating.
• Keep appliances and dangling telephone, electric, blind, and drapery cords out of reach.
• Lock doors or using safety gates at the top and bottom of stairs, and use safety locks and safety devices on windows above the ground floor.
• Supervise the child on the stairs and when climbing on and off furniture.
• Do not give toys small enough to be placed in the mouth. Make sure that toys do not have parts that can become detached. Keep toys with small parts or sharp edges out of reach.
• Make sure that playgrounds are carefully maintained and that equipment is in good condition. All playground equipment should be surrounded by a soft surface (e.g., fine, loose sand; wood chips; wood mulch) or by rubber mats manufactured for this use.
• Supervise the child on playground equipment. Make sure children play only on developmentally appropriate equipment.
• Make sure that toys are soft (e.g., balls not made with leather or hard materials).
• Ensure that the child wears a bicycle helmet, even on a tricycle.
• Provide the child’s caregivers with the dentist’s emergency phone contacts, and ensure that the caregivers know how to handle all emergencies.
Source: “Bright Futures Oral Health Pocket Guide” by the National Maternal and Child Oral Health Resource Center http://www.brightfutures.org/oralhealth/pdf/BFOHPocketGuide.pdf
Back to top.
• Schedule a dental visit for the child according to the schedule recommended by the child’s dentist, based on the child’s individual needs or susceptibility to disease.
• For children with special health care needs, make appointments for more frequent dental visits based on the child’s individual needs or susceptibility to disease. Provide more assistance with brushing the child’s teeth, if needed, and obtaining special oral health equipment (e.g., a mouth prop) to complete the task.
• Ensure that the child brushes his or her teeth twice a day (after breakfast and before bed) with no more than a pea-sized amount (small smear) of fluoridated toothpaste and that the child flosses daily. Make sure the child spits out the toothpaste after brushing but does not rinse with water. The small amount of fluoridated toothpaste that remains in the mouth helps prevent tooth decay. Because effective plaque removal requires good fine motor control, young children cannot clean their teeth without parental help. After children acquire fine motor skills (e.g., the ability to tie their shoelaces), typically by age 7 or 8, they can clean their teeth effectively but should be supervised by a parent.
• Become familiar with the normal appearance of your child’s gums and teeth so that you can identify problems if they occur (see Tooth Eruption Chart on pages 78–79). ? Check the child’s gums and teeth about once a month.
• Give the child fluoride supplements only as prescribed by a dentist or physician, based on the risk of developing tooth decay and the known level of fluoride in the child’s drinking water (see Systemic Fluoride Supplements: Recommended Dosage on page 84). ?
• Discuss with a dentist or other qualified health professional the need to apply fluoride topically (via varnishes, gels, foams), which renews the high levels of fluoride in the outer layer of the tooth enamel. Topical fluoride may be especially effective for children at high risk for tooth decay because they have a history of decay, are not exposed to fluoridated water, snack frequently on foods containing sugar, or have a medical problem that decreases their resistance to decay.
• Discuss with a dentist or other qualified health professional the need to apply dental sealants (thin plastic coatings applied to pits and fissures on the chewing surfaces of the teeth) to prevent tooth decay by creating a physical barrier against dental plaque, shortly after the teeth erupt.
• Discuss with a dentist the need to schedule a visit to the orthodontist to have the child evaluated for braces.
Nutrition
• Serve healthy foods such as fruit, vegetables, grain products (especially whole grain), and dairy products (milk, cheese, cottage cheese, and unsweetened yogurt) for meals and snacks. Limit eating (grazing) in between.
• Serve foods containing sugar at mealtimes only (not between meals), and limit the amount. Frequent consumption of foods high in sugar, such as candy, cookies, cake, sweetened beverages (e.g., fruit drinks, soda), and fruit juice, increases the risk for tooth decay.
• In addition, frequent consumption of foods that easily adhere to the tooth surface, such as dried fruit, fruit-roll-ups, and candy, increases the risk for tooth decay. When checking for sugar, look beyond the sugar bowl and candy dish. A variety of foods contain one or more types of sugar, and all types of sugars can promote tooth decay.
• Encourage the child to eat fruit rather than drink fruit juice.
• If the child drinks beverages between meals, encourage the child to drink water or milk rather than fruit juice or sweetened beverages (e.g., fruit drinks, soda).
• If the school has vending machines, encourage the child to choose water or milk rather than fruit juice or sweetened beverages (e.g., fruit drinks, soda).
• Drink fluoridated water (via a community fluoridated water source) to prevent tooth decay; for families that prefer bottled water, drinking a brand in which fluoride is added at a concentration of approximately 0.7 to 1.2 mg/L (ppm) is recommended.
Non-Nutritive Sucking (teeth)
Although most children discontinue nonnutritive sucking behaviors on their own before the permanent teeth begin to erupt, some continue beyond that stage. If the child regularly engages in non-nutritive sucking behaviors, gently intervene to help the child stop.
• Talk with the child. Discuss the problems caused by the habit. Sometimes this alone is enough to make the child stop sucking.
• Using reminder therapy. This approach is appropriate for children who want to stop sucking but need some help. An adhesive bandage secured with waterproof tape on the finger or thumb can remind the child not to suck. A mitten or sock placed on the hand at night can also be effective. Stress to the child that this is a reminder, not a punishment.
• Use a reward system. Under this system, the child, a parent, and the health professional agree that the child will discontinue the habit within a specified time period and will then receive a reward. The reward must be motivating to the child. Charting small successes may help (e.g., placing colored stars on a calendar for each day the child does not suck a pacifier or his or her finger or thumb).
• Physically interrupt the habit. If none of the preceding methods are successful, and the child truly wants to stop the habit, two other methods can be tried: (1) The child’s arm can be loosely wrapped in an elastic bandage during the night to prevent flexing the arm and inserting the thumb or fingers into the mouth. Stress to the parent that the bandage should not be wrapped tightly. (2) A dentist can place an appliance in the mouth that interferes with sucking.
Injury Prevention
• Learn how to prevent oral injuries and handle oral emergencies, especially the loss or fracture of a tooth.
• If a permanent tooth is knocked out, the parent or other adult should (1) find the avulsed (lost) tooth, (2) hold it by the crown (top part) only, not the root, (3) rinse it under cold water gently if the root is dirty, but do not scrub, (4) reinsert it into the socket quickly, making sure that the front of the tooth is facing you, and (5) take the child to the dentist immediately. If it is not possible to replace the tooth, place the tooth in a container of cold milk or in a cold wet cloth and take the child and the tooth to a dentist immediately.
• Because of the danger of damaging the underlying permanent teeth, never attempt to reinsert an avulsed (lost) primary tooth. It is impossible to relocate the tooth accurately, and there is danger of pushing it too far into the soft alveolar bone.
• If a tooth is fractured or chipped, the parent or other adult should (1) rinse the child’s mouth with water, (2) apply cold compresses to the cheek to reduce swelling, and (3) take the child to the dentist immediately.
• Using an appropriate car safety seat in the back seat of the vehicle at all times. Children should ride in a forward-facing car safety seat until they reach the weight or height limit of the seat, after which they should ride in a belt-positioning booster seat with a lap and shoulder belt. Children should ride in a booster seat until the vehicle’s safety belt fits properly without a booster seat— when the shoulder belt lies across the chest, not the neck or the throat, the lap belt is low and snug across the thighs, not the stomach, and the child is tall enough to reach the vehicle seat back with the legs bent at the knees and feet hanging down.
• Being aware that the risk of injury is higher during periods of rapid growth.
• Ensuring that the child wears protective gear when participating in physical activities or sports that could potentially result in injuries to the mouth, such as biking, riding a scooter, skateboarding, in-line skating, or playing baseball, soccer, or lacrosse.
• Teaching the child about injury prevention, including the need to wear protective gear such as a mouth guard, a face protector, and a helmet.
• Provide the child’s caregivers with the dentist’s emergency phone contacts, and ensuring that the caregivers know how to handle oral emergencies.
Substance Use Teach parents and children about the dangers of cigarette smoking or using spit tobacco.
Source: “Bright Futures Oral Health Pocket Guide” by the National Maternal and Child Oral Health Resource Center http://www.brightfutures.org/oralhealth/pdf/BFOHPocketGuide.pdf
Back to top.
• Schedule a dental visit according to the schedule recommended by your dentist, based on your individual needs and susceptibility to disease.
• If you have special health care needs, make appointments for more frequent dental visits based on your individual needs and susceptibility to disease.
• Obtain assistance with brushing your teeth, if needed, and obtain special oral health equipment (e.g., a mouth prop) to complete the task.
• Brush your teeth twice a day (after breakfast and before bed) with fluoridated toothpaste, and floss daily. Spit out the toothpaste after brushing, but do not rinse with water. The small amount of fluoridated toothpaste that remains in your mouth helps prevent tooth decay.
• Become familiar with the normal appearance of your gums and teeth so that you can identify problems if they occur (see Tooth Eruption Chart on pages 78–79). ?
• Take fluoride supplements only as prescribed by a dentist or physician, based on the risk of developing tooth decay and the known level of fluoride in your drinking water (see Systemic Fluoride Supplements: Recommended Dosage on page 84). ?
• Discuss with a dentist or other qualified health professional the need to apply fluoride topically (via varnishes, gels, foams), which renews the high levels of fluoride in the outer layer of the tooth enamel. Topical fluoride may be especially effective for adolescents at high risk for tooth decay because they have a history of decay, are not exposed to fluoridated water, snack frequently on foods containing sugar, or have a medical problem that decreases their resistance to decay.
• Discuss with a dentist or other qualified health professional the need to apply dental sealants (thin plastic coatings applied to pits and fissures on the chewing surfaces of the teeth) to prevent tooth decay by creating a physical barrier against dental plaque, shortly after the teeth erupt.
• Discuss with a dentist the need to establish a preventive oral health regimen, include an evaluation of the bite and third molar development.
Nutrition
• Eat health foods such as fruit, vegetables, grain products (especially whole grain), and dairy products (milk, cheese, cottage cheese, and unsweetened yogurt) for meals and snacks. Limit eating (grazing) in between.
• Eat foods containing sugar at mealtimes only (not between meals), and limit the amount. Frequent consumption of foods high in sugar, such as candy, cookies, cake, sweetened beverages (e.g., fruit drinks, soda), and fruit juice, increases the risk for tooth decay. In addition, frequent consumption of foods that easily adhere to the tooth surface, such as dried fruit, fruit-roll-ups, and candy, increases the risk for tooth decay. When checking for sugar, look beyond the sugar bowl and candy dish. A variety of foods contain one or more types of sugar, and all types of sugars can promote tooth decay.
• Choose fruit rather than fruit juice. Drink water or milk between meals rather than fruit juice or sweetened beverages (e.g., fruit drinks, soda).
• If the school has vending machines, choose water or milk rather than fruit juice or sweetened beverages (e.g., fruit drinks, soda).
• Drink fluoridated water (via a community fluoridated water source) to prevent tooth decay; for families that prefer bottled water, drink a brand in which fluoride is added at a concentration of approximately 0.7 to 1.2 mg/L (ppm) is recommended.
Injury Prevention
Learning how to prevent oral injuries and handle oral emergencies, especially the loss or fracture of a tooth.
• If a permanent tooth is knocked out, you or an adult should (1) find the avulsed (lost) tooth, (2) hold it by the crown (top part) only, not the root, (3) rinse it under cold water gently if the root is dirty, but do not scrub, (4) reinsert it into the socket quickly, making sure that the front of the tooth is facing you, and (5) go to the dentist immediately. If it is not possible to replace the tooth, place the tooth in a container of cold milk or in a cold wet cloth and go to a dentist immediately.
• If a tooth is fractured or chipped, you or an adult should (1) rinse your mouth with water, (2) apply cold compresses to the cheek to reduce swelling, and (3) go to the dentist immediately.
• Wearing a safety belt while riding or driving in a vehicle. If you are driving, insisting that your passengers also wear safety belts.
• Wearing a helmet when riding a bicycle, all-terrain vehicle, or motorcycle. Adolescents under age 16 should not ride an all-terrain vehicle or motorcycle.
• Wear protective gear when participating in physical activities or sports that could potentially result in injuries to the mouth, such as biking, skateboarding, in-line skating, or playing baseball, soccer, or lacrosse.
• Avoid oral piercings, which can damage teeth and gums.
Substance Use
Not smoking cigarettes or using spit tobacco.
Source: “Bright Futures Oral Health Pocket Guide” by the National Maternal and Child Oral Health Resource Center http://www.brightfutures.org/oralhealth/pdf/BFOHPocketGuide.pdf
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• Brush teeth thoroughly twice a day (after breakfast and before bed) with fluoridated toothpaste, and flossing daily. Spit out the toothpaste after brushing, but do not rinse with water. The small amount of fluoridated toothpaste that remains in the mouth helps prevent tooth decay.
• Rinse every night with an alcohol-free over-the-counter fluoridated mouthrinse.
• Use certain over-the-counter and prescription medications can decrease salivary flow and increase risk for dental caries and gingivitis.
• Visit a dentist for an examination and restoration of all active decay as soon as feasible. Hormonal changes (increases in estrogen and progesterone) that occur during pregnancy can increase a woman’s risk for developing gingivitis. With gingivitis, the gums become inflamed, swollen, and sensitive and tend to bleed.
Nutrition
• Eat healthy foods such as fruit, vegetables, grain products (especially whole grain), and dairy products (milk, cheese, cottage cheese, and unsweetened yogurt) during meals and snacks. Limit eating (grazing) in between.
• Eat foods containing sugar at mealtimes only, and limiting the amount.
• Frequent consumption of foods high in sugar, such as candy, cookies, cake, sweetened beverages (e.g., fruit drinks, soda), and fruit juice, increases the risk for tooth decay. In addition, frequent consumption of foods that easily adhere to the tooth surface, such as dried fruit, fruit roll-ups, and candy, increases the risk for tooth decay. When checking for sugar, look beyond the sugar bowl and candy dish. A variety of foods contain one or more types of sugar, and all types of sugars can promote tooth decay.
• Choose fruit rather than fruit juice. Drink fruit juice at mealtimes only, if at all.
• Avoid carbonated beverages during pregnancy and for the first 30 months of the infant’s life.
• Drink fluoridated water (via a community fluoridated water source) to prevent tooth decay; for families that prefer bottled water, drink a brand in which fluoride is added at a concentration of approximately 0.7 to 1.2 mg/L (ppm) is recommended.
• Once the infant is born, avoid testing the temperature of the bottle with the mouth, sharing utensils (e.g., spoons), or orally clean a pacifier or a bottle nipple. This practice helps prevent transmission of bacteria that cause tooth decay from the parent, especially the mother, to the child via saliva.
Injury Prevention
• Wear a safety belt while riding or driving in a vehicle. If you are driving, insist that your passengers also wear safety belts.
• Wear protective gear (e.g., mouth guard, face protector, helmet) when participate in physical activities or sports that could potentially result in injuries to the mouth, such as biking or playing baseball or soccer.
• Avoid oral piercings, which can damage teeth and gums.
Substance Use
• Do not smoke cigarettes or use spit tobacco.
Source: “Bright Futures Oral Health Pocket Guide” by the National Maternal and Child Oral Health Resource Center http://www.brightfutures.org/oralhealth/pdf/BFOHPocketGuide.pdf
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Bright Futures Oral Health in Infants
Infancy (0-11 months)
Oral HygieneBefore you see teeth
• Clean the infant’s gums with a clean damp cloth or toothbrush and plain water after each feeding. Use a soft-bristled toothbrush with a small head, preferably one designed specifically for infants.
When you see teeth
• If the infant has sore gums caused by tooth eruption, give the infant a clean teething ring, cool spoon, or cold wet washcloth. Other options include giving the infant a chilled teething ring or simply rubbing the infant’s gums with a clean finger.
• Brush the infant’s teeth as soon as the first tooth erupts, usually around age 6 to 10 months, twice a day (after breakfast and before bed). Use a soft-bristled toothbrush with a small head, preferably one designed specifically for infants, and plain water. Lift the lip to brush at the gum line and behind the teeth. Not giving the infant anything to eat or drink (except water) after brushing at night.
• For infants at increased risk for tooth decay, consult with a dentist or physician about brushing their teeth with fluoridated toothpaste.
• Become familiar with the normal appearance of the infant’s gums and teeth so that problems can be identified if they occur (see Tooth Eruption Chart on pages 78–79). ? Check the infant’s gums and teeth about once a month by lifting the infant’s lip to look for decay on the outside and inside surfaces of the teeth.
• Make an appointment for the infant’s first oral examination within 6 months of the eruption of the first primary tooth, and no later than age 12 months, thereby establishing a dental home.
• After the initial dental visit, make the next appointment for the infant according to the schedule recommended by the dentist, based on the infant’s individual needs or susceptibility to disease.
• For infants with special health care needs, make appointments for more frequent dental visits as directed by the dentist based on the infant’s needs or susceptibility to disease. Obtain special oral health equipment (e.g., a mouth prop) to brush the infant’s teeth.
• Give the infant age 6 months or older fluoride supplements only as recommended by a dentist or physician based on the infant’s risk for developing tooth decay and the known level of fluoride in the infant’s drinking water (see Systemic Fluoride Supplements: Recommended Dosage on page 84). ?
Nutrition
• Breastfeed the infant exclusively for approximately the first 6 months of life and continue to breastfeed until age 12 months or as long as the mother and infant wish to continue.
• For mothers who cannot breastfeed or choose not to breastfeed, feed the infant a prepared infant formula. No additional nutrients are needed.
• Avoid testing the temperature of the bottle with the mouth, sharing utensils (e.g., spoons), or orally cleaning a pacifier or a bottle nipple. This practice helps prevent transmission of bacteria that cause tooth decay from the parent, especially the mother, to the child via saliva.
• Do not put the infant to sleep with a bottle or sippy cup or allow frequent and prolonged bottle feedings or use of sippy cups containing beverages high in sugar (e.g., fruit drinks, soda, fruit juice), milk, or formula during the day or at night to prevent sugary fluids from pooling around the teeth, which can increase the infant’s risk for tooth decay.
• Hold the infant while feeding. Make sure to never prop a bottle (that is, use pillows or any other objects to hold a bottle in the infant’s mouth).
• Never add cereal to a bottle. This causes sugary fluids to pool around the teeth. Feed the infant solid foods with a spoon or fork, or, once the infant is able, to encourage self-feeding.
• Introduce a small cup when the infant can sit up without support.
• Wean the infant from the bottle as the infant begins to eat more solid foods and drink from a cup. Begin to wean the infant gradually, at about age 9 to 10 months. By age 12 to 14 months, most infants can drink from a cup.
• Do not introduce juice into infants’ diets before age 6 months. Serve the infant juice in a cup, and limit juice to 4 to 6 oz per day. Serve 100 percent fruit juice or reconstituted juice.
• For infants ages 6 months and older, serve age-appropriate healthy foods during planned meals and snacks, and limit eating (grazing) in between.
• Serve foods containing sugar at mealtimes only (not between meals), and limit the amount. Frequent consumption of foods high in sugar, such as candy, cookies, cake, sweetened beverages (e.g., fruit drinks, soda), and fruit juice, increases the risk for tooth decay. In addition, frequent consumption of foods that easily adhere to the tooth surface, such as fruit-roll-ups and candy, increase the risk for tooth decay. When checking for sugar, look beyond the sugar bowl and candy dish. A variety of foods contain one or more types of sugar, and all types of sugars can promote tooth decay.
• Drinking fluoridated water (via a community fluoridated water source) to prevent tooth decay; for families that prefer bottled water, drinking a brand in which fluoride is added at a concentration of approximately 0.7 to 1.2 mg/L (ppm) is recommended.
Non-Nutritive Sucking
Sucking is a natural reflex for infants. Most infants require some amount of additional sucking beyond that needed for nourishment. This type of sucking, known as non-nutritive sucking, provides emotional benefits, enabling the infant to calm himself/ herself and focus attention. If parents choose to have their infant suck a pacifier, health professionals can advise them to take certain safety precautions. The following precautions are recommended:
• Never attaching a pacifier to a ribbon or string around the infant’s neck.
• Making sure the pacifier is of sturdy, one-piece construction and that the material is flexible, firm, and not brittle.
• Keeping the pacifier clean.
• Not dipping a pacifier in sweetened foods (e.g., sugar, honey, syrup) to encourage sucking.
• Never orally cleaning a pacifier before giving it to an infant.
Injury Prevention
• Being aware that injuries to the head, face, and mouth are common among infants.
• Learn how to prevent oral injuries and how to handle oral emergencies. Because of the danger of damaging the underlying permanent teeth, never attempt to reinsert an avulsed (lost) primary tooth. It is impossible to relocate the tooth accurately, and there is danger of pushing it too far into the soft alveolar bone.
• Always keep one hand on an infant on high places such as changing tables, beds, sofas, or chairs.
• Use a rear-facing infant-only or convertible car safety seat that is reclined at the angle specified by the manufacturer in the back seat of the vehicle at all times. Infants should ride rear facing until they are at least age 1 and weigh at least 20 lbs. Most infant-only car safety seats accommodate infants up to 20 to 22 lbs, and many convertible seats allow infants up to 33 to 35 lbs to ride rear facing. Do not place an infant at any age in a shopping cart. Instead, consider using a stroller or a backpack or frontpack while shopping with an infant.
• Use safety locks on cabinets. Keep all poisonous substances, medicines, cleaning agents, health and beauty aids, and paints and paint solvents locked in a safe place.
• Keep pet food and dishes out of reach. Do not permit the infant to approach the pet while it is eating.
• Keep appliances and dangling telephone, electric, blind, and drapery cords out of reach.
• Lock doors or use safety gates at the top and bottom of stairs, and use safety locks and safety devices on windows above the ground floor. Supervise the infant on the stairs or furniture.
• Do not give toys small enough to be placed in the mouth. Make sure that toys do not have parts that can become detached. Keep toys with small parts or sharp edges out of reach.
• Make sure that playgrounds are carefully maintained and that equipment is in good condition. All playground equipment should be surrounded by a soft surface (e.g., fine, loose sand; wood chips; wood mulch) or by rubber mats manufactured for this use.
• Supervise the infant on playground equipment. Make sure infants play only on developmentally appropriate equipment. Make sure that toys are soft (e.g., balls not made with leather or hard materials).
• Do not use an infant walker with wheels.
• Provide the infant’s caregivers with the dentist’s emergency phone contacts, and ensure that the caregivers know how to handle all emergencies.
Source: “Bright Futures Oral Health Pocket Guide” by the National Maternal and Child Oral Health Resource Center http://www.brightfutures.org/oralhealth/pdf/BFOHPocketGuide.pdf
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Bright Futures Oral Health in Early Childhood
Early Childhood (1-4 years)
Oral Hygiene• If the child has not yet been to a dentist, make an appointment for the child’s first dental visit, thereby establishing a dental home.
• After the initial dental visit, make the next appointment for the child according to the schedule recommended by the dentist, based on the child’s individual needs or susceptibility to disease.
• For children with special health care needs, make appointments for more frequent dental visits based on the child’s individual needs or susceptibility to disease. Obtain special oral health equipment (e.g., a mouth prop) to brush the child’s teeth.
• For children under age 2, brush the teeth with plain water twice a day (after breakfast and before bed). For children at increased risk for tooth decay, consult with a dentist or physician about brushing the teeth with a pea-sized amount (small smear) of fluoridated toothpaste.
• For children ages 2 and above, brush the teeth with no more than a pea-sized amount (small smear) of fluoridated toothpaste twice a day (after breakfast and before bed). Make sure the child spits out the toothpaste after brushing, but does not rinse with water. The small amount of fluoridated toothpaste that remains in the mouth helps prevent tooth decay.
• For effective plaque removal, make sure that a parent brushes the child’s teeth.
• Because brushing requires good fine motor control, young children cannot clean their teeth without parental help. After children acquire fine motor skills (e.g., the ability to tie their shoelaces), typically by age 7 or 8, they can clean their teeth effectively but should be supervised by a parent.
• Become familiar with the normal appearance of your child’s gums and teeth so that problems can be identified if they occur (see Tooth Eruption Chart on pages 78–79). ? Check the child’s gums and teeth about once a month.
• Give the child fluoride supplements only as prescribed by a dentist or physician, based on the risk of developing tooth decay and the known level of fluoride in the child’s drnking water (see Systemic Fluoride Supplements: Recommended Dosage on page 84). ?
• Discuss with a dentist or other qualified health professional the need to apply fluoride topically (via varnishes, gels, foams), which renews the high levels of fluoride in the outer layer of the tooth enamel. Topical fluoride may be especially effective for children at high risk for tooth decay because they have a history of decay, are not exposed to fluoridated water, snack frequently on foods containing sugar, or have a medical problem that decreases their resistance to decay.
• Discuss with a dentist or other qualified health professional the need to apply dental sealants (thin plastic coatings applied to pits and fissures on the chewing surfaces of the teeth) to prevent tooth decay by creating a physical barrier against dental plaque. Dental sealants should be applied shortly after the teeth erupt.
• If the child has sore gums caused by tooth eruption, give the child a clean teething ring, cool spoon, or cold wet washcloth. Other options include giving the child a chilled teething ring or simply rubbing the child’s gums with a clean finger.
Nutrition
• Avoid sharing utensils (e.g., spoons) or orally cleaning a pacifier or a bottle nipple. This practice helps prevent transmission of bacteria that cause tooth decay from the parent, especially the mother, to the child via saliva.
• Continue to encourage the child to drink from a cup. Wean the child from the bottle by age 12 to 14 months.
• Do not put the child to sleep with a bottle or sippy cup or allow frequent and prolonged bottle feedings or use of sippy cups containing beverages high in sugar (e.g., fruit drinks, soda, fruit juice), milk, or formula during the day or at night to prevent sugary fluids from pooling around the teeth, which can increase the child’s risk for tooth decay.
• Serve age-appropriate healthy foods during planned meals and snacks, and limit eating (grazing) in between.
• Serve fruit, vegetables, grain products (especially whole grain), and dairy products (milk, cheese, cottage cheese, and unsweetened yogurt).
• Serve foods containing sugar at mealtimes only (not between meals), and limiting the amount. Frequent consumption of foods high in sugar, such as candy, cookies, cake, sweetened beverages (e.g., fruit drinks, soda), and fruit juice, increases the risk for tooth decay.
• In addition, frequent consumption of foods that easily adhere to the tooth surface, such as fruit-roll-ups and candy, increases the risk for tooth decay. When checking for sugar, look beyond the sugar bowl and candy dish. A variety of foods contain one or more types of sugar, and all types of sugars can promote tooth decay.
• Encourage the child to eat fruit rather than drink fruit juice.
• Serve the child juice in a cup, and limiting the child’s consumption of juice to 4 to 6 oz per day. Serving 100 percent fruit juice or reconstituted juice.
• If the child drinks beverages between meals, encourage the child to drink water or milk rather than fruit juice or sweetened beverages (e.g., fruit drinks, soda).
• Drink fluoridated water (via a community fluoridated water source) to prevent tooth decay; for families that prefer bottled water, drinking a brand in which fluoride is added at a concentration of approximately 0.7 to 1.2 mg/L (ppm) is recommended.
Non-Nutritive Sucking
Sucking is a natural reflex for children. Most children require some amount of additional sucking beyond that needed for nourishment. This type of sucking, known as non-nutritive sucking, provides emotional benefits, enabling the child to calm himself/herself and focus attention. If parents choose to have their child suck a pacifier, health professionals can advise them to take certain safety precautions. The following precautions are recommended:
• Never attach a pacifier to a ribbon or string around the child’s neck.
• Make sure the pacifier is of sturdy, one-piece construction and that the material is flexible, firm, and not brittle.
• Keep the pacifier clean.
• Do not dip a pacifier in sweetened foods (e.g., sugar, honey, syrup) to encourage sucking.
• Never orally clean a pacifier before giving it to a child.
Injury Prevention
• Be aware that injuries to the head, face, and mouth are common among children.
• Learn how to prevent oral injuries and how to handle oral emergencies. Because of the danger of damaging the underlying permanent teeth, never attempt to reinsert an avulsed (lost) primary tooth. It is impossible to relocate the tooth accurately, and there is danger of pushing it too far into the soft alveolar bone.
• Use an appropriate car safety seat in the back seat of the vehicle at all times.
• Children should ride rear facing until they weigh at least 20 lbs; it is preferable if they ride rear facing to the highest weight and height allowed by the car safety seat. Children who weigh at least 20 lbs should ride in a forward-facing car safety seat (unless their rear-facing car safety accommodates a higher weight); most forward-facing seats have a weight limit of 40 lbs, but a few have higher weight limits. After a child reaches the weight or height limit of the forward-facing car safety seat, the child should ride in a belt-positioning booster seat with a lap and shoulder belt.
• Do not place a child of any age in a shopping cart. Instead, consider using a stroller or a backpack or frontpack while shopping with a child.
• Use safety locks on cabinets. Keep all poisonous substances, medicines, leaning agents, health and beauty aids, and paints and paint solvents locked in a safe place.
• Keep pet food and dishes out of reach. Do not permit the child to approach the pet while it is eating.
• Keep appliances and dangling telephone, electric, blind, and drapery cords out of reach.
• Lock doors or using safety gates at the top and bottom of stairs, and use safety locks and safety devices on windows above the ground floor.
• Supervise the child on the stairs and when climbing on and off furniture.
• Do not give toys small enough to be placed in the mouth. Make sure that toys do not have parts that can become detached. Keep toys with small parts or sharp edges out of reach.
• Make sure that playgrounds are carefully maintained and that equipment is in good condition. All playground equipment should be surrounded by a soft surface (e.g., fine, loose sand; wood chips; wood mulch) or by rubber mats manufactured for this use.
• Supervise the child on playground equipment. Make sure children play only on developmentally appropriate equipment.
• Make sure that toys are soft (e.g., balls not made with leather or hard materials).
• Ensure that the child wears a bicycle helmet, even on a tricycle.
• Provide the child’s caregivers with the dentist’s emergency phone contacts, and ensure that the caregivers know how to handle all emergencies.
Source: “Bright Futures Oral Health Pocket Guide” by the National Maternal and Child Oral Health Resource Center http://www.brightfutures.org/oralhealth/pdf/BFOHPocketGuide.pdf
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Bright Futures Oral Health in Adolescence
Middle Childhood (5-10 years)
Oral Hygiene• Schedule a dental visit for the child according to the schedule recommended by the child’s dentist, based on the child’s individual needs or susceptibility to disease.
• For children with special health care needs, make appointments for more frequent dental visits based on the child’s individual needs or susceptibility to disease. Provide more assistance with brushing the child’s teeth, if needed, and obtaining special oral health equipment (e.g., a mouth prop) to complete the task.
• Ensure that the child brushes his or her teeth twice a day (after breakfast and before bed) with no more than a pea-sized amount (small smear) of fluoridated toothpaste and that the child flosses daily. Make sure the child spits out the toothpaste after brushing but does not rinse with water. The small amount of fluoridated toothpaste that remains in the mouth helps prevent tooth decay. Because effective plaque removal requires good fine motor control, young children cannot clean their teeth without parental help. After children acquire fine motor skills (e.g., the ability to tie their shoelaces), typically by age 7 or 8, they can clean their teeth effectively but should be supervised by a parent.
• Become familiar with the normal appearance of your child’s gums and teeth so that you can identify problems if they occur (see Tooth Eruption Chart on pages 78–79). ? Check the child’s gums and teeth about once a month.
• Give the child fluoride supplements only as prescribed by a dentist or physician, based on the risk of developing tooth decay and the known level of fluoride in the child’s drinking water (see Systemic Fluoride Supplements: Recommended Dosage on page 84). ?
• Discuss with a dentist or other qualified health professional the need to apply fluoride topically (via varnishes, gels, foams), which renews the high levels of fluoride in the outer layer of the tooth enamel. Topical fluoride may be especially effective for children at high risk for tooth decay because they have a history of decay, are not exposed to fluoridated water, snack frequently on foods containing sugar, or have a medical problem that decreases their resistance to decay.
• Discuss with a dentist or other qualified health professional the need to apply dental sealants (thin plastic coatings applied to pits and fissures on the chewing surfaces of the teeth) to prevent tooth decay by creating a physical barrier against dental plaque, shortly after the teeth erupt.
• Discuss with a dentist the need to schedule a visit to the orthodontist to have the child evaluated for braces.
Nutrition
• Serve healthy foods such as fruit, vegetables, grain products (especially whole grain), and dairy products (milk, cheese, cottage cheese, and unsweetened yogurt) for meals and snacks. Limit eating (grazing) in between.
• Serve foods containing sugar at mealtimes only (not between meals), and limit the amount. Frequent consumption of foods high in sugar, such as candy, cookies, cake, sweetened beverages (e.g., fruit drinks, soda), and fruit juice, increases the risk for tooth decay.
• In addition, frequent consumption of foods that easily adhere to the tooth surface, such as dried fruit, fruit-roll-ups, and candy, increases the risk for tooth decay. When checking for sugar, look beyond the sugar bowl and candy dish. A variety of foods contain one or more types of sugar, and all types of sugars can promote tooth decay.
• Encourage the child to eat fruit rather than drink fruit juice.
• If the child drinks beverages between meals, encourage the child to drink water or milk rather than fruit juice or sweetened beverages (e.g., fruit drinks, soda).
• If the school has vending machines, encourage the child to choose water or milk rather than fruit juice or sweetened beverages (e.g., fruit drinks, soda).
• Drink fluoridated water (via a community fluoridated water source) to prevent tooth decay; for families that prefer bottled water, drinking a brand in which fluoride is added at a concentration of approximately 0.7 to 1.2 mg/L (ppm) is recommended.
Non-Nutritive Sucking (teeth)
Although most children discontinue nonnutritive sucking behaviors on their own before the permanent teeth begin to erupt, some continue beyond that stage. If the child regularly engages in non-nutritive sucking behaviors, gently intervene to help the child stop.
• Talk with the child. Discuss the problems caused by the habit. Sometimes this alone is enough to make the child stop sucking.
• Using reminder therapy. This approach is appropriate for children who want to stop sucking but need some help. An adhesive bandage secured with waterproof tape on the finger or thumb can remind the child not to suck. A mitten or sock placed on the hand at night can also be effective. Stress to the child that this is a reminder, not a punishment.
• Use a reward system. Under this system, the child, a parent, and the health professional agree that the child will discontinue the habit within a specified time period and will then receive a reward. The reward must be motivating to the child. Charting small successes may help (e.g., placing colored stars on a calendar for each day the child does not suck a pacifier or his or her finger or thumb).
• Physically interrupt the habit. If none of the preceding methods are successful, and the child truly wants to stop the habit, two other methods can be tried: (1) The child’s arm can be loosely wrapped in an elastic bandage during the night to prevent flexing the arm and inserting the thumb or fingers into the mouth. Stress to the parent that the bandage should not be wrapped tightly. (2) A dentist can place an appliance in the mouth that interferes with sucking.
Injury Prevention
• Learn how to prevent oral injuries and handle oral emergencies, especially the loss or fracture of a tooth.
• If a permanent tooth is knocked out, the parent or other adult should (1) find the avulsed (lost) tooth, (2) hold it by the crown (top part) only, not the root, (3) rinse it under cold water gently if the root is dirty, but do not scrub, (4) reinsert it into the socket quickly, making sure that the front of the tooth is facing you, and (5) take the child to the dentist immediately. If it is not possible to replace the tooth, place the tooth in a container of cold milk or in a cold wet cloth and take the child and the tooth to a dentist immediately.
• Because of the danger of damaging the underlying permanent teeth, never attempt to reinsert an avulsed (lost) primary tooth. It is impossible to relocate the tooth accurately, and there is danger of pushing it too far into the soft alveolar bone.
• If a tooth is fractured or chipped, the parent or other adult should (1) rinse the child’s mouth with water, (2) apply cold compresses to the cheek to reduce swelling, and (3) take the child to the dentist immediately.
• Using an appropriate car safety seat in the back seat of the vehicle at all times. Children should ride in a forward-facing car safety seat until they reach the weight or height limit of the seat, after which they should ride in a belt-positioning booster seat with a lap and shoulder belt. Children should ride in a booster seat until the vehicle’s safety belt fits properly without a booster seat— when the shoulder belt lies across the chest, not the neck or the throat, the lap belt is low and snug across the thighs, not the stomach, and the child is tall enough to reach the vehicle seat back with the legs bent at the knees and feet hanging down.
• Being aware that the risk of injury is higher during periods of rapid growth.
• Ensuring that the child wears protective gear when participating in physical activities or sports that could potentially result in injuries to the mouth, such as biking, riding a scooter, skateboarding, in-line skating, or playing baseball, soccer, or lacrosse.
• Teaching the child about injury prevention, including the need to wear protective gear such as a mouth guard, a face protector, and a helmet.
• Provide the child’s caregivers with the dentist’s emergency phone contacts, and ensuring that the caregivers know how to handle oral emergencies.
Substance Use Teach parents and children about the dangers of cigarette smoking or using spit tobacco.
Source: “Bright Futures Oral Health Pocket Guide” by the National Maternal and Child Oral Health Resource Center http://www.brightfutures.org/oralhealth/pdf/BFOHPocketGuide.pdf
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Bright Futures Oral Health in Adolescence
Adolescence (11-21 years)
Oral Hygiene• Schedule a dental visit according to the schedule recommended by your dentist, based on your individual needs and susceptibility to disease.
• If you have special health care needs, make appointments for more frequent dental visits based on your individual needs and susceptibility to disease.
• Obtain assistance with brushing your teeth, if needed, and obtain special oral health equipment (e.g., a mouth prop) to complete the task.
• Brush your teeth twice a day (after breakfast and before bed) with fluoridated toothpaste, and floss daily. Spit out the toothpaste after brushing, but do not rinse with water. The small amount of fluoridated toothpaste that remains in your mouth helps prevent tooth decay.
• Become familiar with the normal appearance of your gums and teeth so that you can identify problems if they occur (see Tooth Eruption Chart on pages 78–79). ?
• Take fluoride supplements only as prescribed by a dentist or physician, based on the risk of developing tooth decay and the known level of fluoride in your drinking water (see Systemic Fluoride Supplements: Recommended Dosage on page 84). ?
• Discuss with a dentist or other qualified health professional the need to apply fluoride topically (via varnishes, gels, foams), which renews the high levels of fluoride in the outer layer of the tooth enamel. Topical fluoride may be especially effective for adolescents at high risk for tooth decay because they have a history of decay, are not exposed to fluoridated water, snack frequently on foods containing sugar, or have a medical problem that decreases their resistance to decay.
• Discuss with a dentist or other qualified health professional the need to apply dental sealants (thin plastic coatings applied to pits and fissures on the chewing surfaces of the teeth) to prevent tooth decay by creating a physical barrier against dental plaque, shortly after the teeth erupt.
• Discuss with a dentist the need to establish a preventive oral health regimen, include an evaluation of the bite and third molar development.
Nutrition
• Eat health foods such as fruit, vegetables, grain products (especially whole grain), and dairy products (milk, cheese, cottage cheese, and unsweetened yogurt) for meals and snacks. Limit eating (grazing) in between.
• Eat foods containing sugar at mealtimes only (not between meals), and limit the amount. Frequent consumption of foods high in sugar, such as candy, cookies, cake, sweetened beverages (e.g., fruit drinks, soda), and fruit juice, increases the risk for tooth decay. In addition, frequent consumption of foods that easily adhere to the tooth surface, such as dried fruit, fruit-roll-ups, and candy, increases the risk for tooth decay. When checking for sugar, look beyond the sugar bowl and candy dish. A variety of foods contain one or more types of sugar, and all types of sugars can promote tooth decay.
• Choose fruit rather than fruit juice. Drink water or milk between meals rather than fruit juice or sweetened beverages (e.g., fruit drinks, soda).
• If the school has vending machines, choose water or milk rather than fruit juice or sweetened beverages (e.g., fruit drinks, soda).
• Drink fluoridated water (via a community fluoridated water source) to prevent tooth decay; for families that prefer bottled water, drink a brand in which fluoride is added at a concentration of approximately 0.7 to 1.2 mg/L (ppm) is recommended.
Injury Prevention
Learning how to prevent oral injuries and handle oral emergencies, especially the loss or fracture of a tooth.
• If a permanent tooth is knocked out, you or an adult should (1) find the avulsed (lost) tooth, (2) hold it by the crown (top part) only, not the root, (3) rinse it under cold water gently if the root is dirty, but do not scrub, (4) reinsert it into the socket quickly, making sure that the front of the tooth is facing you, and (5) go to the dentist immediately. If it is not possible to replace the tooth, place the tooth in a container of cold milk or in a cold wet cloth and go to a dentist immediately.
• If a tooth is fractured or chipped, you or an adult should (1) rinse your mouth with water, (2) apply cold compresses to the cheek to reduce swelling, and (3) go to the dentist immediately.
• Wearing a safety belt while riding or driving in a vehicle. If you are driving, insisting that your passengers also wear safety belts.
• Wearing a helmet when riding a bicycle, all-terrain vehicle, or motorcycle. Adolescents under age 16 should not ride an all-terrain vehicle or motorcycle.
• Wear protective gear when participating in physical activities or sports that could potentially result in injuries to the mouth, such as biking, skateboarding, in-line skating, or playing baseball, soccer, or lacrosse.
• Avoid oral piercings, which can damage teeth and gums.
Substance Use
Not smoking cigarettes or using spit tobacco.
Source: “Bright Futures Oral Health Pocket Guide” by the National Maternal and Child Oral Health Resource Center http://www.brightfutures.org/oralhealth/pdf/BFOHPocketGuide.pdf
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