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ISSUES IN PEDIATRIC ORAL HEALTH

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Concept of the Dental Home

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Analogous to the American Academy of Pediatrics' (AAP) concept of a "medical home," the American Academy of Pediatric Dentistry (AAPD) has promoted the concept of a "dental home." A dental home is best established by referring a child for oral health examination to a dentist who provides care for infants and young children (ie, pediatric dentist) 6 months after the first tooth erupts or by 12 months of age. The primary goal of the dental home is to encourage good oral healthcare habits that will allow the child to grow up free from dental disease. In partnership with the caregivers, the pediatric dentist develops a comprehensive, personalized preventive healthcare program based on an accurate risk assessment for dental disease. The pediatric dentist provides education on age-appropriate oral hygiene techniques and a tooth-friendly diet. Other functions of the dental home include provision of anticipatory guidance on growth and development, provision of comprehensive routine and emergency dental care, and referral to other dental specialists as needed. The dental home has the benefit of promoting continuity of care in a family-centered and culturally appropriate environment, and is associated with fewer emergency visits and reduced treatment costs. A child is less likely to develop dental anxiety if a number of positive experiences precede a less pleasant appointment.

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AAPD policies and guidelines: http://www.aapd.org/policies/. Accessed December 26, 2013.
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American Academy of Pediatric Dentistry (AAPD): Policy on the dental home. Pediatr Dent 2013;35 (Reference Manual):24–25.

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Perinatal Factors & Oral Health

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The perinatal period offers a unique opportunity for oral health counseling from various healthcare providers aimed at women's self-care as well as future child care. Mothers may be unaware of the consequences of their own poor oral health or that of their children. Cariogenic bacteria can be transmitted vertically from mother to child by licking a pacifier or sharing eating utensils or horizontally between siblings of similar age, from the father, and from children in day care centers. Colonization of the infant with mutans streptococci (MS) is more likely when maternal salivary MS levels are high. The mother's oral hygiene, snacking habits, and socioeconomic status all have an influence on the infant's colonization with MS. Anticipatory guidance and dental treatment of the expectant mother can significantly reduce the child's risk of acquiring MS. Prenatal dental counseling should include education on the importance of regular dental visits and the role of fluoride in maternal and childhood oral health, counseling on appropriate maternal diet, and advice on reduction of MS colonization. Maternal MS levels and the risk of transmission to infants can be reduced by twice-daily rinsing with chlorhexidine digluconate 0.12% for 2 weeks followed by chewing 100% xylitol gum for 5 minutes 3–5 times/d (total dose of xylitol 6–10 g/d) for several weeks.

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Delayed dental development is characteristic of preterm infants ...

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