The Foundation of Oral Health
Providing a consistent message of prevention to pregnant women and parents can make a difference in children’s oral health.
By John R. Liu, DDS

February is National Children’s Dental Health month. In 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 settings. 

Pregnant Women and Young Children 

Poor 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 young children. 

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
provides information for pregnant
patients about encouraging oral health in their
babies and young children.

First Dental Visit 

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.

Typically, 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 ever.7 

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 health. 

Make An Impact 

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 Physician. 2008;77:1139-1144.
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. 2008;79:207-215.
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.
5. AAPD. Policy on the Dental Home. Available at: 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.
7. Pourat N, Finocchio L. Racial and ethnic disparities in dental care for publicly insured children. Health Aff (Millwood). 2010;29:1356-1363.
8. Savage MF, Lee JY, Kotch JB, Vann WF Jr. Early preventive dental visits: effects on subsequent utilization and costs. Pediatrics. 2004;114:418-423.

From Dimensions of Dental Hygiene. February 2011; 9(2): 28.

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