Date: 16MAR11
Region: Providence
Article title: Guideline on Periodicity of Examination, Preventative Dental Services, Anticipatory Guidance/Counseling, and Oral Tx for Children, and Adolescents
Author(s): Clinical Affairs Committee
Journal: Pediatric Dentistry Reference Manual
Page #s: 93-100
Vol:No Date: 2010
Major topic: Periodicity of various services.
Minor topic(s): None
Type of Article: Guidelines
Main Purpose: This guideline is meant to help practitioners make clinical decisions concerning preventative oral health interventions, including anticipatory guidance and preventative counseling, for infants, children, and adolescents.
Key points in the article discussion:
I. General:
A. The AAPD recommends initiating professional oral health intervention in infancy and continuing through adolescence and beyond.
II. Clinical Oral Examination:
A. Components of a comprehensive oral examination include assessment of:
1. General health, pain, extraoral soft tissue, TMJ, intraoral soft tissue, OH, perio health, intraoral hard tissue, occlusion, caries risk, behavior.
2. 6mo interval is typical however frequency may be increased based on clinical need.
III. Caries Risk Assessment:
A. KEY element of preventative care.
B. Prevention by identifying causative factors and optimizing protective factors.
C. Risk assessment must be repeated regularly due to changes in habits and development of the child.
IV. Prophylaxis and Topical Fluoride Treatment.
A. Many patients lack the skill or motivation to become and remain plaque-free for a significant time.
B. Hormonal changes can effect oral microflora.
C. Caries risk changes with age and eruption pattern.
D. Prophylaxis and fluoride treatment is typically 6mo intervals however each patient must have an individual treatment plan.
1. Moderate risk: every 6mo
2. High risk: more frequent
V. Fluoride Supplementation:
A. The AAPD encourages optimal fluoride exposure for every child, recognizing fluoride in the community water supplies as the most beneficial and inexpensive preventive intervention. Supplementation should be considered when exposure is not optimal. Supplementation should be in accordance with the jointly recommended guidelines of AAPD, AAP, ADA and CDC.... in my opinion, THIS IS A COP-OUT STATEMENT.
VI. Anticipatory Guidance:
A. Thorough discussion should occur at every appointment through the patient's life. This is the only way to properly keep track of the changes in habits and risk factors in order to discourage risky behavior and promote proper oral health.
B. High risk dietary habits begin by 1yo.
C. Include injury-prevention counseling.
D. Non-nutritive sucking habits encouraged to stop by 3yo
E. Speech referals if needed.
F. Smoking and smokeless tobacco use becomes an issue later in childs life.
G. Let's not forget INTRAORAL PIERCINGS! ... bad bad bad
VII. Radiographic Assessment:
A. Timing should not be based on age. Instead review of dental history and full exam.
B. ALARA
VIII. Tx of Disease:
A. Immediate and timely intervention (just like St. Joseph!)
IX. Ts of Malocclusion:
A. Early Tx of malocclusion.
1. Reversing adverse growth
2. Preventing dental and skeletal disharmonies
3. improving aesthetics of the smile
4. improving self image
5. improving occlusion
X. Sealants:
A. Reduce the risk of pit and fissure caries in susceptible teeth and are cost-effective when maintained.
XI. Third Molars:
A. Pan or PA assessment is indicated during late adolescent life. Decision to remove should be made before mid-twenties.
XII. Referral for Regular and Periodic Dental Care:
A. Proper education and transition to an adult dentist. Don't just leave the patient hanging.
B. Until the Pt has found appropriate adult dental care, he/she should maintain relationship with pedo for emergency services.
XIII. Recommendations by Age:
Assessment of Article: It's the reference Manual. It's the "standard of care". Know it. Love it.
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