Lupine Publishers | Journal of Pediatric Dentistry
Abstract
Mothers in the perinatal stage and infants should be identified
and evaluated for the risk of dental caries. Early childhood caries
can lead to detrimental consequences in the primary dentition. This
entails that oral health care advice regarding oral hygiene, diet,
fluoride and dental management be provided to minimize the risk
factors and optimize the protective factors to improve the longterm oral
health outcomes for both the mother and her infant.
Keywords: Perinatal Oral Health; Infant Oral Health; Early Childhood Caries
Introduction
The perinatal period is vital for the holistic well-being of
pregnant women. It is defined as a time span which commences
when the 20th to 28th week of gestation is completed and ends at 1
to 4 weeks subsequent to birth of a child [1]. Early childhood caries
(ECC) and severe form of ECC (s-ECC) start as soon as teeth start
to erupt, develop on every surface of a primary tooth, have a rapid
progression with a long-term detrimental impact on the primary
dentition [2]. The long term sequelae of ECC include a greater risk of
new carious lesions in both the primary and permanent dentitions,
[3,4] high cost of treatment, [5] hospital stay and emergency room
visits [6,7] loss of school time, [8] diminished cognitive ability [9]
and a poor oral health-related quality of life [10]. Hence the oral
health of both the mother and the future child are instrumental
in preventing and arresting the disease process to manage early
childhood caries during this phase [11].
Epidemiology
This chronic, infectious disease affects the general population
however it is 32 times more likely to occur in infants from low
socioeconomic status, with high sugar diet and whose mothers
have a low education level [12-14] It affects 1-17% children in
developed and 70% children in under-developed countries [15].
Epidemiologic evidence shows that the highest prevalence of ECC
is reported from Africa and South-East Asia [16]. The prevalence
of ECC among Indian children between 8–48 months is 44% [17].
A study from Sri Lanka reports an incidence of 23% ECC among
1-2-year old’s [18]. North American prevalence of ECC ranges from
11-72% and over 28 % children have caries by the time they reach
kindergarten [19,20]. Pakistan has a variation in prevalence of ECC
ranging 27.9% - 51% [21,22].
Anticipatory Guidance According to Caries Risk
New mothers and infants are seen by the medical health care
professionals earlier and more often than dentists. It is therefore
important that they understand the dynamic multifactorial etiology
and risk factors for ECC prevention counselling in pregnant
women/caregivers and encouraging a dental home visit at age 1
[23]. In some instances, pregnant women may defer dental care,
experience unwillingness of dentists to provide oral care [24-27]
or may be unaware of the implications of poor oral health for their
pregnancy [28,29]. Hence early identification of mothers with poor
oral health/high caries risk and timely delivery of educational
information and prevention for themselves and their unborn child
can help reduce the incidence of ECC, prevent the need for dental
rehabilitation and improve their oral health [30-32]. Caries-risk
assessment for infants allows the determination of relative risk
for
dental disease to prevent disease by identifying and minimizing
risk factors (plaque accumulation, diet, lack of topical/systemic
fluoride, high frequency of sugar containing medicines) and
optimizing protective factors (oral hygiene practices, fluoride and
fissure sealants) when the primary dentition starts to erupt [33].
The current trend shows more emphasis on prevention and arrest
of the disease processes to manage ECC. This is attributed to the
costly and high-risk restorative treatment for ECC since it often
entails the use of sedation and/or general anesthesia and a high
recurrence rate [34,35]. The chronic disease management approach
encompasses engagement of parents to facilitate preventive
measures and temporary restorations of the lesion to defer
advanced restorative care [36]. An active surveillance methodology
entails monitoring caries progression in children and setting up
prevention programs for managing incipient carious lesions [37].
An Interim therapeutic restorations (ITR) is a form of temporary
tooth restoration in young children until compliance improves and
conventional cavity preparation and restoration is possible [38].
Oral Health Care Advice to Pregnant or Lactating Mothers
Physicians, dentists, and nurses impart educational advice for
mothers during the perinatal period. The preventive advice should
include timely brushing with fluoridated toothpastes and use of
sugar free gums. The dietary advice should address the quality and
quantity of nutritional food along with food cravings that may raise
the caries risk. Dental procedures which are considered safe during
all trimesters of pregnancy include oral assessment, prophylaxis,
local anaesthetic, regular treatment and radiographs with shielding
(optimal in second trimester). If, however there is discomfort the
elective treatment may be deferred. Breast feeding of infants should
be tailored with food over a year or longer but should not be ad
libitum. It provides nutritional, developmental and psychological
health advantages with a significant decrease in the risk for acute
and chronic diseases. It may also transfer maternal medication to
infants under 6 months hence use cautiously. It provides awareness
of health consequences of tobacco use and exposure to secondhand
smoke in children [39-43].
Oral Health Care Advice for Infants
An infant should be taken for an initial evaluation to a dental
home by the age of one by the pediatricians and the general
practitioners. This attains the medical and dental history of both the
child and parents, allows oral assessment with a demonstration on
age appropriate gum and tooth cleaning, brushing the teeth twice a
day with an optimum level of fluoridated toothpaste (smear or rice
sized for children under 3), dietary advice (avoid sugar by bottle,
sippy cup, sugar between meals, 4-6 ounces of 100% fruit juice per
day for 4-6 year old children, systemically administered fluoride
(if the drinking water is unfluoridated) and professional fluoride
application if caries risk is high, injury prevention advice for facial
trauma (objects, cords, pacifiers, car seats, electric cords), advice on
teething with excessive salivation areas of intermittent discomfort
(oral analgesics, chilled teething rings, over the counter teething
gels), management of atypical frenum attachments (frenectomy or
frenuloplasty to facilitate breast feeding) and counselling regarding
non-nutritive habits such as digit or pacifier sucking, abnormal
tongue thrust or bruxism (wean before skeletal dysplasia or
malocclusion) [33,44,45].
Conclusion
It is very important to design and implement caries assessment
in order to identify the caries risk for infants and expectant
mothers/lactating mothers. This will allow effective education
on oral health via motivational interviewing techniques to help
improve oral behaviour and timely implementation of caries
preventive measures to help change the trajectory of oral health of
a mother and her infant.
