Prevention of dental disease - The role of the pediatrician

Oral and dental health are integral parts of good overall health, and dental caries is the most common chronic infectious disease of childhood. A child with severe dental caries may experience chronic oral pain and infection, be malnourished, frequently absent from school, and suffer from low self-esteem because of missing or defective teeth. Evidence in the dental literature increasingly suggests that, to be successful in preventing dental disease, clinicians must begin risk-factor determination, preventive counseling, and preventive interventions within the first year of life (infant oral health care is discussed in detail in the article by Nowak and Warren later in this issue). Pediatricians are well positioned to begin this process as they see their patients for well-baby visits and as they provide anticipatory guidance to parents and other caregivers. Pediatricians are also in a good position to see that every child has a dental home in addition to the medical home. This article provides information to pediatricians that will enable them to provide practical, targeted, and effective advice to parents about preventing dental disease. A full review of the pathogenesis of dental caries can be found in the article by Caufield and Griffen earlier in this issue. This article focuses on reviews of etiologic factors, the evidence to support preventive measures for each factor, and recommendations that can be made to parents. Risk factors for dental disease are presented to enable pediatricians to identify infants and toddlers at high risk for caries. The role of fluoride in caries prevention is discussed, with emphasis on dietary fluoride supplements, which are often prescribed by pediatricians. Finally this information is brought together in a section on anticipatory guidance and other interventions that enable pediatricians to begin the process of dental disease prevention before referral for an initial dental evaluation. As explained elsewhere in this issue, transmission of the bacterial etiologic agent for caries, mutans streptococci (MS), occurs in infancy. Thus, true prevention can occur only in infants who have not yet been infected. When the transmission of MS has occurred, pediatricians and dentists must consider ways to suppress the caries activity through the medical management of dental caries.(15) Medical, or nonsurgical, management can be used up to and including the point at which tooth caviation occurs. As illustrated in Table 1, surgical management (i.e., excavation and replacement of carious tooth structure) must be used at some point to deal with the symptoms of dental caries, that is, cavities.(14) This schema also indicates that treatment becomes mole expensive as it becomes more invasive. Prevention and early diagnosis are just as important in managing dental caries as in managing any disease.