Anticipatory guidance

guidlines for parents about the childrens dental health

1. Good after noon

2. ANTICIPATORY GUIDANCE SUBMITTED BY, SNEHAPRIYA C S FINAL YR PART 1 GOV.DENTAL COLLEGE KOTTAYAM

3. CONTENTS INTRODUCTION PRENATAL COUNSELLING GUIDELINES FOR 6 TO 12 MONTHES OF AGE GUIDELINES FOR 12 TO 24 MONTHES OF AGE GUIDELINES FOR 3 TO 6 YEARS OF AGE GUIDELINES FOR 6 TO 12 YEARS OF AGE GUIDELINES FOR ADOLESCENCE SUMMARY REFERANCE

4. INTRODUCTION ANTICIPATORY GUIDANCE is a proactive development based counselling technique that focus on the needs of a child at each stage of life It is a compliment to Caries Assessment Tool The aim of AG is to address protective factors in effort to prevent oral health problem AG would include discussion on oral development ,diet and nutrition, fluoride adequacy, oral habits, injury prevention, and oral hygiene.

5. PRENATAL COUNSELLING Parents should be educated regarding Oral development of their child Appropriate feeding practices Dental disease process Oral hygiene measures Mothers health during pregnancy Increased food demand during pregnancy

6. Why are the primary teeth important? It act like the foundation stone for permanent teeth Maintain proper space for the permanent teeth Help in normal growth of jaw height and give shape to the face Provide a sense of self worth by contributing to one’s appearance Help in the first step of grinding of food , once the infants start eating solid food

7. Milestones: the eruption of the first primary tooth Guidelines for 6 to 12 months of age

8. Oral development Review pattern of eruption Review teething fact- local discomfort, irritablity & excess salivation Fluoride Assess fluoride status- no more than rice sized fluoridated toothpaste used twice daily Determine suppliments if needed such as fluoride varnishes Oral hygiene/health Review oral hygiene techniques with parents Plan for next visit based on risk assessment Habits Review pacifier use Discuss thumb sucking effects on mouth Discuss breastfeeding’s effects on mouth

9. Nutrition and diet Encourage weaning at the appropriate time Weaning should occur at 4 -6 momths Stage 1 – 4-6 months - food must be sieved, pureed or very finely minced Stage 2 – 6-9 months – minced and mashed food includes small soft lumps Stage 3 – 9-12 months – baby should eat similar foods to the rest of the family Discuss the role of sugar in dental caries initiation Injury prevention Review what to do if patient has traumatic injury Provide emergency number

10. Milestones : completion primary dentition, occlusal relationships establishment, arch length determined Guidance for 12 to 24 months of age

11. Oral development Discuss importance of space maintaining Discuss bruxing Fluoride Reassess fluoride status Discuss toxicity and how to manage accidental ingestion Oral hygiene/health Review home oral care procedure and compliance Plan for next visit

12. Habits Review non nutritive sucking Thumb sucking and pacifiers use will lead to Anterior open bite, maxillary constriction etc.. Nutrition and diet Discuss carbohydrate and their role in plaque development Discuss the frequency of carbohydrate intake as caries factor Injury prevention Discuss electric cord safety, child proofing the house, and use of car seats Develop plans for oral trauma management for preschool and child care

13. Milestones : loss of first primary tooth, eruption of first permanent molar or incisor Guidance for 2 to 6 years of age

14. Oral development Review patterns of eruption, point out permanent incisor Describe healthy periodontal tissue Fluoride Reassess fluoride status at periodic visit and determine both supplement and age appropriate vehicle Fluoridated toothpastes not more than a pea size Child should brush under the supervision of parents to ensure expectoration Oral hygiene/health Review home oral care procedures and compliance Discuss dental sealants and describe dental radiographs Plan for next visit based on risk assessment

15. Habits If child is still sucking the thumb, discuss hoe to help him stop the habit Nutrition and diet Review diet outside the home and its caries potential Discourage the use of food as a behavioral tool Injury prevention Encourage the use of helmets, mouth guards, and car seats Develop plans for oral trauma management Review difference between primary and permanent teeth with parents during examination

16. Milestones: eruption of first permanent molar Guidance for 6 to 12 years of age

17. Oral development Discuss about the importance first permanent molar Discuss the various preventive measures taken at this stage to prevent progression of caries Nutrition and diet Review diet outside the home and its caries potential Fluorides Application topical fluorides if needed Regular use of tooth paste is recommended twice daily

18. Oral hygiene/health Parents should continues to monitor brushing and flossing frequency and adequacany Application of pit and fissure sealants if necessary Habits Educate about any oral habits if it is present Educate the parents about transitional changes in the developing dentition and the importance of primary and permanent dentition

19. Guidance for adolescent

20. Prevention of periodontal disease become a special concern At this age group the main process utalized are Rejection of many parentral values The beginning of independent struggle The testing out types of behavioural experimentaion Parents are educated that they should treat the child at this stage very diplomatically Parents should have a friendly approach The child should be given enough emotional support from parents

21. Oral hygiene/health The adolescent patient posses the fine motor skills necessary for adequate tooth brushing and flossing Problems in compliance are likely to be encountered Diet High frequency of sugar consumption Progression of lession halted with an appropriate diet and aggressive topical fluoride therapy Fluorides Systemic fluorides are no longer benefit after the last permanent tooth erupt at about age of 13 yrs, except for patients who have functional third molars Topical fluorides are the most effective preventive measure of smooth surface decay

22. Orthodontics Many Patients undergo orthodontic treatment at this stage High risk for both gingivitis and gingival hyperplasia and for dental caries Topical fluoride application and thorough removal of the plaque from gingival areas Smokeless tobacco Peer pressure and advertising exert pressure on adolescent to establish a habit that may result in addiction. Parents should be instructed / counseled not to rag or punish the adolescent as it may further worson the habit Discuss the health risk in smoking Instruct parents to avoid smoking infront of the children Discuss nicotine replacement and medication

23. PREVENTION OF DENTAL INJURIES Dental injuries can lead to discoloration, malformation and even loss of tooth Primary care clinicians are in a unique position to help families prevent accidental trauma, including oral trauma, by providing anticipatory guidance at routine visits Most injuries to primary teeth occurs within toddlers 12 to 30 months of age The best approach to take active measures to prevent injuries

24. AVULSION Do NOT re-implant a primary tooth, as this may damage the underlying permanent tooth. Instead, refer to a dentist within 24 hours. Avulsion should be managed as follows: 1. Gently rinse off debris with saline or milk. Hold tooth by crown only. 2. Avoid touching the root. Do not clean or rub it. It is important to preserve the periodontal ligament for tooth survival. 3. Re-implant an avulsed permanent tooth immediately, ensuring correct orientation. The tooth should be re-implanted within 20 minutes, but the best outcome is with teeth replaced within 5 minutes.   4. Instruct patient to bite on gauze or a handkerchief or to hold the tooth in place.

25. 5. Send to a dentist or maxillofacial surgeon immediately for radiographs, splinting, and antibiotic prophylaxis.   6. If the tooth cannot be re-implanted on scene, transport it (ordered by preference) in: a tooth storage solution, warm milk, saline, or saliva. 7. A tooth should not be transported dry or in plain water, as this significantly decreases the chance of ligament survival. 8. Never suggest a child hold the damaged tooth in his or her mouth

26. Accident Prevention Suggestions for accident prevention specifically related to oral trauma : Advise parents about possible injury to developing permanent teeth from trauma if a primary tooth is injured. Review and anticipate developmental milestones. Counsel about the risks of walkers and trampolines. Discuss childproofing the home. Review safety measures for outdoor activities and sports. Stress the importance of adequate supervision at all times, especially on furniture, stairs, at the playground, and at athletic events or practices. During trauma if the tooth is avulsed, parents should be instructed to keep the avulsed teeth under tongue of child or store the tooth in saline or milk and contact dentist

27. Sports and Protective Gear Sports participation poses a significant risk for trauma The highest risk sports for oral trauma are baseball, soccer, football, basketball, and hockey. Skateboarding, rollerblading, and bicycling injuries are also common. Helmet and face masks should be properly fitted and worn during all games and practices for the sports in which they are recommended. Statistically, children are more often injured in practice than during a game, so all protective gear should be worn during practice as well.

28. Mouth Guards Mouth guard use is mandatory for football, ice hockey, lacrosse, field hockey, and boxing. Several states have passed regulations mandating mouth guards for soccer, basketball, and wrestling

29. SUMMARY Anticipatory guidance is to providing an insight into the development of a child will involve the parent , with a much more foccused stratergy At every stage it is essential that the dentist takes into consideration the various milestones of dental development Such AG makes the parents more at ease during childhood dental visit, these pointers are also essential in preventing many of the possible dental problems in childrens

30. REFERANCE Textbook Of Pedodontics , Shoba Tandon Textbook Of Paedodontics , Nikhil Marwah Textbook Of Pediatric Dentistry , Pinkham Www.Isojournals.Com