The Foundation of Oral
Providing a consistent message of
prevention to pregnant women and parents can make a difference in children’s
By John R. Liu,
February is National Children’s Dental Health
commemoration, various local, state, and national organizations host events to
either raise awareness about the importance of children’s oral health or to
actually provide dental screenings and dental services for children.
The attention and activities
of National Children’s Dental Health month are wonderful, but the importance of
children’s oral health is a message that needs to be communicated all year long.
Although most dental hygienists work in general dental practices where they may
not see children on a regular basis, they often provide community-based
education on oral health care. Dental hygienists can make a difference in
children’s oral health throughout the year, regardless of their practice
Pregnant Women and Young
oral health among pregnant women has negative overall health effects on both
women and their unborn children. The American Academy of Pediatric Dentistry
(AAPD) website has two important resources available to dental hygienists on the
topic of perinatal oral health care. The first is “Guideline on Perinatal Oral
Health Care,” which was adopted in 2009 and is available by clicking here. The guideline
states: “AAPD recognizes that perinatal oral health, along with infant oral
health, is one of the foundations upon which preventive education and dental
care must be built to enhance the opportunity for a child to have a lifetime
free from preventable oral disease.” The research that supports this guideline
clearly indicates a strong link between periodontal diseases and poor outcomes
in pregnancy, including preterm deliveries, low-birth-weight babies, and
preeclampsia.1-3 Evidence also confirms that mothers with poor oral
health are at greater risk of having children with poor oral health through
direct transmission of their bacteria to their children.4 By becoming
familiar with the evidence, dental hygienists can serve as credible and
effective communicators and motivators to pregnant patients and/or parents of
The second resource is a
product of the AAPD’s project on promoting perinatal oral health, which was
funded by the Health Resources and Services Administration’s Maternal and Child
Health Bureau. It is a 1-page fact sheet titled “How To Protect Your Baby’s Teeth From Cavities”. This document
information for pregnant
patients about encouraging oral health in
babies and young children.
Since 1986, the AAPD has
emphasized the importance of the age 1 dental visit, as well as the
establishment of a dental home for infants. We are pleased that this guideline
has now been adopted by both the American Dental Association and the American
Academy of Pediatrics. A dental home is defined by AAPD as “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 12 months of age and includes referral to dental specialists when
appropriate.” The relationship aspect of the dental home is emphasized in the
AAPD Dental Home Policy, which states, “The dental home is inclusive of all
aspects of oral health that result from the interaction of the patient, parents,
nondental professionals, and dental professionals. Establishment of the dental
home is initiated by the identification and interaction of these individuals,
resulting in a heightened awareness of all issues impacting the patient’s oral
health.”5 The age 1 dental visit and the establishment of a dental
home provide the following:6
1. Proper assessment of the
infant’s risk of caries.
2. Ability to tailor preventive services for the
infant based on the level of risk for caries.
3. Ability to monitor the
infant over time to assess the effectiveness of the preventive services and home
oral health care.
4. Dissemination and reinforcement of age-appropriate
information about children’s oral health to parents.
experience information overload when a child is added to the family, resulting
in much of the visit’s advice/tips being forgotten. By having a dental home
firmly in place where the infant is seen on an ongoing basis, information is
consistently provided to the parents.
If the aim of dental
professionals is truly to improve the oral health of children, we need to place
our attention and efforts on preventing any child from ever needing restorative
dental care. A recent study by the University of California, Los Angeles, Center
for Health Policy Research found that one in four children have never seen a
dentist. Even more disturbing is the fact that many children covered by
government insurance plans, such as Medicaid and Children’s Health Insurance
Program, did not visit the dental office regularly, if
Clearly, we need to impart
and reinforce the importance of oral health to parents. A study done in North
Carolina compared children enrolled continuously in Medicaid from birth until
age 5 who had their first preventive dental visit by age 1 to Medicaid-enrolled
children who didn’t have their first dental visit until age 2 or 3.8
The children who had their first dental visit by age 1 were more likely to have
ongoing preventive dental visits instead of restorative or emergency visits.
Those who did not have their first visit until they were 2 or 3 years of age
were more likely to need restorative and emergency care.8 This study
shows the importance of early and ongoing dental visits to provide children with
the best possible chance of achieving and maintaining good oral
It is my sincere hope that
this guest editorial will encourage dental hygienists to further explore how
they can dramatically impact children’s oral health all year long. Only by
working together to advance and improve the oral health literacy of pregnant
women and parents of infants and toddlers can we make certain that every child
is able to establish a foundation for a lifetime of oral health.
|John R. Liu, DDS,
is president of the American Academy of Pediatric Dentistry (AAPD). He has a
private practice in Issaquah, Wash, and has been an AAPD member for 22 years.
Liu has served as the AAPD’s vice president (2008-2009), secretary-treasurer
(2007-2008), and trustee at large. He is a diplomate of the American Board of
Pediatric Dentistry and a fellow of the American College of Dentists and the
Pierre Fauchard Academy.
1. Silk H,
Douglass AB, Douglass JM, Silk L. Oral health during pregnancy. Am Fam
2. Xiong X, Buekens P, Fraser WD, Beck J,
Offenbacher S. Periodontal disease and adverse pregnancy outcomes: A systematic
review. BJOG. 2006; 113:135-143.
3. Siqueira FM, Cota LO, Costa JE,
Haddad JP, Lana AM, Costa FO. Maternal periodontitis as a potential risk
variable for preeclampsia: A case-control study. J Periodontol.
4. Ramos-Gomez FJ, Weintraub JA, Gansky SA, Hoover CI,
Featherstone JD. Bacterial, behav - ioral and environmental factors associated
with early childhood caries. J Clin Pedi Dent. 2002; 26:165-173.
AAPD. Policy on the Dental Home. Available at: www.aapd.org/media/Policies_Guidelines/P_Dental Home.pdf.
Accessed January 13, 2010.
6. Nowak AJ, Casamassimo PS. The dental home: A
primary oral health concept. J Am Dent Assoc. 2002;133:93-98.
Pourat N, Finocchio L. Racial and ethnic disparities in dental care for publicly
insured children. Health Aff (Millwood). 2010;29:1356-1363.
Savage MF, Lee JY, Kotch JB, Vann WF Jr. Early preventive dental visits: effects
on subsequent utilization and costs. Pediatrics.