You are on page 1of 27

Infant oral

health care can be understood as the foundation on which a life time of preventive education and dental care can be built up in order to help acquire optimal oral health into child and adulthood.

GOALS OF AN INFANT ORAL HEALTH CARE PROGRAM:

1. To identify, intercept and modify the potentially harmful parenting practices that may adversely affect the infants oral health. 2. Parental education right from prenatal period highlighting the importance of their role in the prevention of dental disease for their child. 3. Parent/caregiver orientation to perceive dental services as an integral part of infants overall health program. 4. Periodic evaluation of the orofacial development and oral health by the clinician.

Reasons why infant oral health care is important: 1. Infectious diseases of the oral cavity. 2. Traumatic injuries. 3. Habits. 4. Child abuse and neglect. 5. Care of the alternatively abled children. 6. Problems of speech and language.

HOW TO PROCEED FOR INFANT ORAL HEALTH CARE?


The first step should be to establish a DENTAL HOME for each infant. Dental home is the ongoing relationship between the dentist and the patient, inclusive of all aspects of oral health care delivered in a comprehensive, continuously accessible, coordinated and family centered way. Establishment of a dental home begins no later than 12months of age.

OBJECTIVES OF DENTAL HOME:

1. To enhance the dentists ability to assist children and their parents/caregivers in the quest for optimal oral health care. 2. To schedule early oral health examinations and preventive services for cost effectiveness. 3. To offer parents and caregivers resources which assist them in making the best informed choice. 4. Individual child risk assessment for dental diseases. 5. Monitoring growth and development. 6. Referrals to dental specialists when needed. 7. Interaction with early intervention programs, schools and early childhood education. 8. To make parents aware of when and how frequently should they visit a dental home.

ESSENTIALS STEPS TO BE TAKEN WHEN A PARENT/CAREGIVER APPROACH DENTAL HOME:


1. 2. 3. 4.

History Examination Risk assessment Any therapy, restorative or prophylactic measures needed should be instituted.

ROLE OF DENTIST IN PROVIDING CARE TO AN INFANT:


a)

b)
c) d)

e)
f) g)

h)

The dentist is a valuable source of information. Feeding practices. Sucking and suckling. Importance of weaning. Some important tips on bottle feeding. Use of pacifiers. Anticipatory guidance. Oral hygiene practices.

The dentist as a valuable source of information:

Answers the queries of the parents as to when do the teeth erupt.


AGE TEETH ERUPTED

6-10 months Bottom front teeth, then top front teeth or side bottom front teeth. 9-13 months Top front teeth. 13-19 months 2.5-3 years

First molars then canines, then second molars. All the teeth.

A difference of 6-12 months can be considered normal. Signs of teething should be made aware to the parent. Symptomatic treatment such as teething toys are however acceptable.

Feeding practices:
Importance of

breast feeding should be explained to the parents. On the flip side, prolonged and at will breast feeding has been associated with nursing caries.

Advantages of Breast-feeding:
1. 2. 3.

4.
5. 6.

7.
8.

Ideal composition for infants needs, provided in safe clean form at the right temperature. Needs no preparation and no equipment to sterilize. Contains anti-infective factors. Psychological advantage to both mother and child. Child is less likely to develop arterial disease as fats in breast milk are better emulsified. Easily digestible and has low osmotic load. Confers passive immunity to the baby. Lack of breast feeding has been associated with developmental defects of primary dentition particularly in premature children.

Anti-infective and anticariogenic agents in human milk:


1. 2. 3. 4.

5.
6. 7.

8.
9.

Immunoglobulins- Secretory IgA, IgG,IgM. Cellular elements- Lymphoid cells, polymorphs, macrophages, plasma cells. Opsonic and chemotactic activities of C3 and C4 complement system. Unsaturated lactoferrin and transferin. Lysozyme. Lactoperoxidase. Specific inhibitors (non immunoglobulins)- Antiviral and antistaphylococcal factors. Growth factors for Lactobacillus bifidus. Para amino benzoic acid may afford some protection against malaria.

BREAST-FEEDING FUNCTIONS: Stimulates the muscles around the mouth and tongue activity for normal growth of the teeth and jaws. Allows milk follow on demand. Allows gravity working correctly on the muscles involved in swallowing.

BOTTLE FEEDING

Muscles dont have to work hard so growth of jaws affected. Milk from bottle has a continuous flow. Bottle feeding while lying on their back keeps the tongue in an unnatural forward position to keep from drowning.
May not provide complete nutrition. Not able to digest it easily because of the nature of its fat. % is less. Do not have sufficient amount.

Nutrition: More nutritious. Easily digestible. Higher % of lactoalbumin. Higher % of certain vitamins like vitamin C and D.

Immunologic: Colostrum rich in certain antibodies like IgA and contains maternal macrophages which protect the child against infections. Others: Colostrum may contain a gut control factor and stimulate growth of GI tract. Infant controls own intake and reduces possibility of feeding. Reduced risks of ear and respiratory infections. Decreased incidence of deleterious habits.

Lacks natural defence against infection.

Does not contain colostrum. No control on overfeeding and gain weight during first year of life which is not desirable. More common. Incidence is high.

Sucking and suckling:


Parents

should be told the difference between sucking and suckling to prevent the onset of deleterious habits. Suckling at breast is good for infants jaw and tooth development. Bottle fed infants use their tongue in opposite manner to that of breast fed baby. Flow of milk through the rubber nipple is produced by the tongue thrusting motion with each suck, and infants lips create a negative pressure in the oral cavity, thus suctioning the milk from bottle.

Breast fed baby

places the tongue over the lower jaw, where it remains throughout the nursing session and draws the nipple by suction well into the mouth upto the junction of hard and soft palate. As each suckling cycle is initiated, the infants jaws compress the milk sinuses, pinching of bolus of milk and propelling it toward the posterior pharynx. This movement begins at the anterior tip of the tongue and progresses towards its base. The jaw muscles are strenuously exercised, encouraging the development of well formed jaws.

Importance of weaning: Weaning is a process of expanding the diet to include foods and drinks other than breast milk or milk formulae. Should occur between 4 and 6 months. Babies are not ready to be weaned at an earlier age for several reasons: 1. Do not have neuromuscular coordination needed to move food from tip of tongue to back of the mouth. 2. GIT is immature to digest and absorb the food as gastric, intestinal and pancreatic enzymes are not fully developed. 3. Their kidneys cannot regulate the high solute load. By the age of 6 months, diet of breast milk only is inadequate in supplying one or more of energy, protein, vitamins A and D, iron and zinc.

Stages of weaning: 3 stages


Stage 1: 4-6months Stage 2: 6-9months Stage 3: 9-12months

Some important tips on bottle feeding: Parents should be instructed toa) Provide more attention to the child. b) Remove bottle immediately after feeding. c) Substitute milk or non-sweetened juices with plain boiled water. d) Encourage your baby to stay in upright position with bottle. e) Use a bottle with a nipple that has a small hole to enable the infant to work with his muscles activity to get the milk from bottle. f) Introduce a cup to drink as soon as possible. g) Bottle feeding be allowed at intervals. h) Should not be used as pacifier. i) Give water after feeding with bottle and clean the mouth soon after feeding.

Use of pacifiers: Several disadvantages have been found1. Those dipped in honey or sugars can cause increased caries. 2. Malocclusion. 3. Unhygienic conditions leading to infections and GIT disorders.

Anticipatory guidance: Described as a proactive, developmentally based counseling technique that focuses on the needs of a child at each stage of life. (Nowak, 1995) Providing an insight into the development of a child will involve the parent, with a much more focused strategy. Such a guidance can make the parents more at ease during childhood dental visit, these pointers are also essentials in preventing many of the possible dental problems children would otherwise often face.

Oral hygiene practices:


The cleaning of

gumpads started as early as within first

week of birth. Cleaning the infants mouth: a) Lay down the baby with his/her head in your lap. b) Open the babys mouth. c) Take a small gauze (22) between thumb and forefinger and wipe vigorously over the ridge of the babys top and bottom jaws. d) Clean atleast twice a day. e) Spend 2-3 minutes in cleaning.

Are the first health care providers. Following topics needed to be discussed with the pediatrician:

Tooth eruption Preventive oral hygiene Orofacial development Fluoridation Diet

Johnson discussed the interaction with the pediatrician at the time of weaning.

When the child is 10months, the assertiveness of the child may make the parents to give in by giving a sleep time bottle.

A solution is gradual dilution of the liquid. 1 week 1/3bottle water 2nd week 2/3bottle water 3rd week only water
Weaning foods free of, or low in non-milk sugars should be recommended. Pediatrician should be made aware of the dentists in the vicinity for referral purposes.

Nurses, midwives can provide guidance and referral if anticipated at the time of newborn screening. Gynecologist or obstetrician can emphasize the need for tooth brushing or cleaning with a gauze as soon as the first tooth erupts. Neonatologists can advise and counsel the parents about congenital defects like cleft lip and palate. Importance of breast feeding. Information about transmission of antibodies via breast-milk and their effect on dental health. Importance of mothers own hygiene is equally important.

Bring

their child for first dental visit at least by the age of 6 months. Breast feed the baby but do not indulge at will. Avoid frequent use of bottle with sugared milk. Instead give the child more attention. Do not put the child to bed with bottle and take away the bottle immediately after feeding. Dilute milk gradually in bottle and end with plain water. Feeding should be supervised all the times. Semi-solid foods started at 5-6months. Do not use pacifiers dipped in honey or sugar.

Avoid

extended use of sugared medicines. Clean the gums and later teeth with cloth or soft brush after every meal or before sleep. Parents should brush or clean their babys teeth everyday till the child is old enough to manage himself. Contact the dentist immediately if there is accident or trauma to babys teeth. Should know about the benefits of fluoride and its proper use. Half yearly visits to the dentist should be routine.

You might also like