07/30/2010 Using Anticipatory Guidance to Provide Early dental Intervention

Resident: J. Hencler
Date: 07/30/2010

Article title: Using Anticipatory Guidance to Provide Early dental Intervention

Author(s): Nowak, Casamassimo
Journal: JADA, Vol. 126, 08/1995

Major topic: Preventative Dental Intervention
Type of Article: Review

Main Purpose:
Explore and consider the need for a different new and improved preventative dentistry approach for children.

Background:
Preventative dentistry for children, which addresses reduction of caries and gingival disease, is driven by an infectious disease model. This tri-factorial model of agent (bacteria), susceptible host (child or tooth surface), and substrate (carbohydrates) still directs the preventative dental counseling approach aimed at reducing or eliminating these factors. This model remains strong, but the limitations of its application are evident in recent changes in caries patterns and consistent high rates of disease in certain pediatric populations.

Key points in the article discussion:
Preventative dental efforts related to children often include efforts to reduce baby bottle tooth decay, dental trauma, and habits such as thumb sucking. Development and inherited disorders, as well as speech and language problems are common findings of dentists who see children of all ages. Dental caries remains a primary concern of the dental profession. Dentists have their hands full with a caries epidemic affecting all ages of patients. Physicians, the first medical practitioners to see a child rarely carry out basic caries prevention strategies such as fluoride supplementation, bottle weaning, and oral hygiene. The medical approach of anticipatory guidance is the process of providing developmentally appropriate info about children to their parents in anticipation of significant physical, emotional, and psychological milestones. This info guides parents by alerting them to impending change, teaching their role in maximizing their children’s development potential and identifying their children’s special needs. The dental approach to anticipatory guidance does not use a developmental approach to prevention, but relies on the infectious-disease model for a basic and often repetitive generic message of brushing, flossing, and using fluoride. Associating the comprehensive preventative message to dental milestones not only helps parents focus their children’s attention but also helps parents and doctors address realistic situations that characterize an age period. The growing trend toward treating children before 3yo provides a great opportunity for dentists to impart info that is truly preventative. As pediatric dentist, we should include the whole range of childhood in an anticipatory guidance program for dental health by developing a content base organized around dental milestones.

Summary of conclusions:
Pediatric dentists have seen a dramatic increase in children’s dental care, which can be attributed to their tendency to see children much earlier and thus capture parents’ interest in important dental milestones. Applying anticipatory guidance to dental preventative education is an organized was for all dental providers to enjoy the attention of parents and be more successful in preventative dentistry. Early dental intervention using an individual approach such as anticipatory guidance may be an ideal and efficient path to dental caries reduction.

Assessment of article:
Good article, much helpful info relating anticipatory guidance to the different milestones. See the tables at end of article. As furure pediatric dentists, I feel we already relate preventative anticipatory guidance with milestones.
In a perfect world this would work, but some people just don’t listen or simply don’t care. How many times have we heard “well aren’t they just baby teeth, they’re just gonna fall out anyway…right?” It’s our duty as pediatric dentists to convince the “non-believer” or simply neglectful parents that “lifetime oral health” begins by instilling the values of good oral hygiene at a very young age. Time to wake up parents! No more tomfoolery!!!