Monday, March 14, 2011

Guideline on Adolescent Oral Health Care

Meghan Sullivan Walsh March 14, 2011

Literature Review - St. Joseph/LMC Pediatric Dentistry

Guideline on Adolescent Oral Health Care

Resident: Meghan Sullivan Walsh

Program: Lutheran Medical Center- Providence

Article Title: Guideline on Adolescent Oral Health Care

Authors: Clinical Affairs Committee; Council on Clinical Affairs, Committee on the Adolescent

Journal: Pediatric Dentistry Reference Manual

Volume (number), Year, Page #’s; V32/NO 6 10/11, 119-126

Major Topic: Guidelines addressing the special needs for management of the adolescent population.

Overview of Method of Research: Electronic Search of clinical trials using specific terms, limited to the last 10 years.

Findings: Adolescence is defined as youths between the ages of 10-18. This population of patients is recognized as having special needs for the following reasons:

1) high caries rate

2) increased risk for traumatic injury and periodontal disease

3) poor nutritional habits

4) increased esthetic desire and awareness

5) complex orthodontic and restorative care

6) dental phobia

7) potential use of tobacco, drugs and alcohol

8) pregnancy

9) eating disorders

10) social and psychological needs


Caries rate remains highest during adolescence due to immature permanent tooth enamel, an increase in susceptible tooth surfaces, poor diet, avoidance of care, low priority for oral hygiene and social factors.

Management: Primary prevention

Fluoride dependent on risk assessment.

1) Brush 2x daily

2) Topical fluoride based on CRA

3) Home RX based on CRA

4) Systemic fluoride or supplements up to age 16

Oral Hygiene:

Adolescence can prove to be a time of increased caries risk due to the increased intake of cariogenic substance and lack of good oral hygiene:

1) Adolescents should be educated and motivated to maintain good hygiene

2) Professional prophylaxis dependent on CRA

Diet: Adolescents are at risk for consuming high quantities on refined carbohydrates and acid containing beverages. Recommendations include:

1) Diet analysis and management

2) Sealants based on risk

Secondary Prevention

Professional Care:

1) Timing is dependent on risk indicators and needs

2) Initial and periodic radiographs accepted by the guidelines


Preservation of tooth structure is desirable as well as esthetics and the patient’s needs. Molars with extensive needs may require full coverage restorations. Restorative needs are recommended on an individual basis and a referral should be made if the work is beyond the dentist’s scope of practice


Irreversible tissue damage from periodontal disease may begin in late adolescence. In addition adolescents have a higher prevalence on gingivitis than children and adults. The rise of sex hormones is attributed to this prevalence.

Acute conditions:

Conditions such as ANUG and periodontitis is common and must be addressed immediately. Therapy is dependent on the individuals needs and appropriate referrals should be made if necessary.

Chronic conditions:

Frequently seen conditions in this population include gingivitis, puberty gingivitis, hyperplastic gingivitis, hyperplastic gingivitis related to ortho, gingival recession, drug-related gingivitis, pregnancy gingivitis, localized juvenile periodontitis and periodontitis.

Recommendations for this population include:

1) Education

2) Age appropriate oral hygiene program

3) Regular professional intervention including perio charting and radiographs

4) Evaluation for procedure to facilitate ortho ie frenectomy, tooth ext, fiberotomy...



Treatment based on professional diagnosis may include malposition of teeth, malrelationship of teeth to jaws, tooth/jaw size discrepancy or disfigurement that prevents function, esthetics, etc. Appropriate referrals should be made if the treatment is out of the dentists scope of practice.

Third molars:

Third molars can present acute and chronic conditions that merit evaluation for removal. Removing third molars by the third decade is recommended because of high probability of disease or pathology and risks associated with removal at a later time. Continuous evaluations should be made and appropriate referrals given when necessary.

TMJ problems:

Evaluation and examination of this joint should be a part of every recall. TMD appears more prevalent during adolescence.

Congenitally missing teeth:

Evaluation and management should include both immediate and long term treatment based on age, esthetics, growth potential, perio and oral surgical needs.

Ectopic eruption:

Dentist must be proactive in the diagnosis and management of ectopic eruption. Prevention may include extraction of deciduous teeth, surgery, endo, perio, etc.


Dentists should introduce a comprehensive trauma prevention program including the patient’s sport or activity, level and frequency of activity. Recommendation and fabrication of a sport specific mouth guard should be initiated.

Additional considerations:

Discolored or stained teeth:

Judicious use of bleaching may be considered based on a comprehensive diagnosis. The least invasive and most effective treatment should be rendered and monitored.


Education and appropriate counseling services should be provided. Associated pathology should be monitored and referred appropriately.

Positive youth development:

Physchological and social needs are a crucial part of this age group. A strong interpersonal relationship between the adolescent and the pediatric dentist can be influential in improving the patient’s oral health and transitioning to adult care. Recommendations are for the dentist to get involved in community organizations and schools.


Dentists must be aware of the behavioral considerations including anxiety, phobia and intellectual dysfunction. Consent, confidentiality and compliance should be addressed and a complete oral health care program is required.

Transitioning to adult care:

Educating the patient and parent on the value of transitioning to a dentist who is knowledgeable in adult oral health is important. This transition may be difficult for persons with special health care needs. Should there be no practitioner who is comfortable treating SHCN patients, the pediatric dentist can remain their dental home.

Key Points: Summary:

Adolescents have a myriad of distinctive needs. We should be aware of the social as well as health issues which affect this population and treat appropriately.

Assessment of the Article: Thorough review. As if being a teenager isn’t tough enough...

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