Screen early
Early screening for dental-related issues can help prevent problems, and a medical home can help coordinate proper evaluation and treatment.

Dental home
Establish a dental home by 12 months old or earlier, starting at 6 months old based on risk and/or 6 months after the first tooth eruption.

Fluoride
Supplemental fluoride is recommended for those without adequate fluoride in community water supply.

Davidson K.
Prevention of dental caries in children younger than 5 years: screening and interventions.
JAMA. 2021; https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/pr...

Bright Futures.
Promoting oral health: implementation tip sheet.
Guidelines for Health Supervision of Infants, Children, and Adolescents, 4th Edition. 2020. / Full Text

American Academy of Pediatric Dentistry.
Antibiotic prophylaxis for dental patients at risk for infection.
The Reference Manual of Pediatric Dentistry.. 2022;Chicago, Ill:500-6. / Full Text

The American Academy of Pediatrics recommends an oral health risk assessment in the medical home starting at the 6- and 9-month well-child checks. [Bright: 2010] If the child’s family has not yet established a dental home, repeat the assessment at the 12-, 18-, 24-, and 30-month well-child checks and the 3- and 6-year checks. [Centers: 2004] See Oral Health Risk Assessment Tool (AAP) ( 302 KB) for photos and a brief questionnaire about risk factors, protective factors, and clinical findings.

For children who receive oral health screening from programs like Early Intervention, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), or Early Head Start, medical homes may choose to limit screening to questions about feeding problems and continue with anticipatory guidance. (Listings for these programs can be found below under Referrals and Services.)

Primary care clinicians can help all children by providing guidance to families such as: [Clinical: 2016]

• Wipe the infant's gums and tongue with a wet cloth after feeding.
• Brush twice daily using fluoride toothpaste. Once teeth erupt, all children <3 years old should use a smear of fluoride toothpaste (about the size of a grain of rice), and older children should use a pea-sized amount.
• Floss daily.
• All family members should see a dentist twice a year for preventive care and cleaning.
• Bottles and sippy cups should not be propped or left with infants when caregivers are not actively feeding the child.
• Once teeth erupt, avoid nursing or feeding at night because the milk remaining in the mouth can lead to caries. The caregiver can offer water if the older infant or child is thirsty at night.
• Wean from bottle feeding by age 12 months.
• Discourage thumb-sucking after age 4 or 5 years.
• Provide healthy snacks (e.g., cheese, fruit, and vegetables).
• Prevent frequent snacking on sugar- and carbohydrate-containing foods.
• Minimize juice consumption to 0-6 ounces per day of 100% fruit juice; avoid soda, energy drinks, and other sweetened beverages.
• Drink and cook with fluoridated tap water if available.
• Consider daily xylitol use.
• Consider fluoride mouthwash for children ≥6 years old. [Council: 2013]

For older children, also discuss the adverse effects of:

• Energy drinks and sweetened beverages
• Smoking/tobacco use
• Illegal drugs, including methamphetamines (for a discussion of their overall health effects, see Intoxication, Chronic, and Withdrawal Effects of Commonly Abused Drugs ( 258 KB))
• Oral piercings
• Infections, including risk of sexually transmitted illnesses that can affect the lips, mouth, and throat

The recommended level for community fluoride in water supply is 0.7 mg fluoride per liter (0.7 parts per million). Fluoride occurs naturally in water supplies, so if the level is unknown (such as in well water), it should be tested to determine if supplementation is needed. [American: 2023] Fluoride content of water supplies in the United States can be found at My Water's Fluoride (CDC).

Oral fluoride supplements for children ages 6 months to 16 years are recommended for children with suboptimal fluoridated water intake (consider drinking water, cooking water, water at school, etc.). [American: 2023] Supplementation of fluoride and vitamin D during the first year of life is associated with fewer cavities in the primary teeth. [Kühnisch: 2016] Although recommendations are from 2010, the table to the left still provides current supplementation information. Calcium and Vitamin D has information about vitamin D supplementation for children.

Fluoride dental varnish should be placed approximately every 6 months, either by the medical or dental clinician. If in the medical home, administration of the varnish may be performed by trained staff, such as a medical assistant or nurse. A 1-hour online course, with continuing medical education credits available, can be found at Online Fluoride Varnish Training (SFL). For more information about fluoride, see The Debate Over Fluoridated Water (AAP).

The medical home should talk with families about establishing a dental home by 12 months of age (and as early as 6 months of age). [American: 2005] A dental home is a primary care dental provider with a comprehensive and up-to-date approach for preventing dental problems, providing anticipatory guidance about dental issues and nutrition and behaviors that affect dental care, assessing for adequate fluoride and prescribing supplements when indicated, administering topical fluoride applications, assessing and treating dental issues, placing sealants for high-risk children, and referring to dental specialists as needed for surgery or orthodontics. [EQIPP: 2017] The primary care clinician can assist parents with insurance in identifying a covered dentist.

Early Intervention for Children with Disabilities/Delays (see NV providers [31])
Early intervention (EI) are services provided through a family coaching method to help children with disabilities or delays meet goals in areas of development.

WIC Assistance (see NV providers [55])
Provides nutrition and breastfeeding services and supplemental foods to pregnant women, mothers, infants, and children up to their 5th birthday.

Head Start/Early Head Start (see NV providers [66])
Head Start provides comprehensive education, health, nutrition, and family services to poverty-level children and their families. Local grantees receive federal funding for Head Start (HS), Migrant/Seasonal Head Start (MSHS), and Early Head Start (EHS) programs, the latter serving children from birth to age three and expectant mothers.

Healthcare, Dental > … (see NV providers [34])
A directory of providers, addresses, and contact information.

What Is Infective Endocarditis? (AHA) ( 571 KB)
A fact sheet about this condition and the importance of treatment; American Heart Association.