Early Childhood Oral Health

Joel H. Berg, Rebecca L. Slayton

• Publisher: Wiley-Blackwell
• Year: 2015
• ISBN:
  9781118925188
• Edition: 2
• Topic: Medicine
• Subtopic: Dentistry

Dental caries has been called a "silent epidemic" and is the most prevalent chronic disease affecting children. Though much has been written on the science and practice of managing this disease, publications are diverse in their loci, preventing easy access to the reader. Early Childhood Oral Health coalesces all the important information related to this topic in a comprehensive reference for students, academics, and practitioners. This second edition expands the scope of the first and puts an additional focus on interprofessional and global efforts that are necessary to manage the growing disease crisis and screening and risk assessment efforts that have expanded with the boom of new technologies. With updated references and incorporating the latest research, chapters address the biology and epidemiology of caries, the clinical management of early childhood caries, risk assessment, and early diagnosis. Other topics include public health approaches to managing caries worldwide, implementation of new caries prevention programs, fluoride regimens, and community programs, and family oral health education. Brand new are four chapters on the medical management of early childhood caries, considerations for children with special needs, interprofessional education and practice, and how the newest policy issues and the Affordable Care Act affect dental care. A must-read for pediatric dentists, cariologists, public health dentists, and students in these fields, Early Childhood Oral Health is also relevant for pediatricians and pediatric nursing specialists worldwide.

CHAPTER 1
Introduction: Why this book?

Joel H. Berg

University of Washington School of Dentistry, Seattle, USA

---

• Stakeholders
• Partnerships
• Dental Industry role
• Media
• Today’s children as adults
• Advocates
• The Internet
• What we hope this book will accomplish
• This book’s audience
• References

---

This book represents the second edition of the first published textbook on the topic of the name it carries—Early Childhood Oral Health. This topic has caught the attention of a large host of stakeholders, as evidence of its importance to those who encounter the youngest members of our society. We hope that after reading this book, you will agree there is nothing more important in dentistry than early intervention, with the connected comprehensive prevention and management of the prevalent early childhood caries. We have the tools available to us to prevent most dental caries in children at a very early age, yet we have seen an increase in dental caries in pre-schoolers in recent years. The chapters of this book will guide you from the epidemiology of caries in young children through ways in which preventive programs for infants and toddlers can be established in a variety of settings. You will note a prevailing theme of interaction between members of a team of providers-from a variety of healthcare delivery disciplines-to avert what is essentially a behavioral disease. You will notice that our approach in early intervention is one of managing a disease—well before it manifests itself in the form of a cavity, the way in which many children, generally later than at a toddler age, might encounter their first visit to a dentist. You will also perceive a prevailing theme of education—including the family and all related caregivers, to the community of healthcare providers, all of whom need to be educated in the prevention of early childhood caries.

There is new science related to the prevention of and management of early childhood caries that you will read in the chapters of this book. There is also repetition of science that has been known for decades, indicating what the new science confirms—that early childhood caries is essentially preventable. Only now, when various societal, academic, and political forces are properly aligned are we ready to recognize the clear value of a much earlier entry into the dental world.

Many parties are becoming aware of the costs associated with the treatment of the effects of early childhood caries. These costs have historically been apparent only after children present to their dentist, or to an emergency room somewhere, at the age of 2 or 3, with a mouthful of cavities. As a society, we have accepted the fact that children present somewhere with many cavities in their primary teeth at a young age, never having had any form of prevention attempted. Only recently have we started to ask why we cannot change the way in which the profession views the management of early childhood caries as an opportunity for prevention—versus waiting for the devastation to occur. We believe this book provides a guide to making the transition to manage the disease before it devastates the mouth and potentially beyond. We talk about the relationship between oral health and overall health. With so much more being discovered each day connecting the mouth to the body, early intervention becomes ever more important.

New in this edition is a chapter on the legal and political environment that impacts the management of ECC and specifically, the effects of the Affordable Care Act (ACA). The ACA may not affect many aspects of oral health care and delivery for adults, but it is already having an impact on children.

Another important factor that has instilled increased enthusiasm around the early management and prevention of early childhood caries is the realization by many of how rapidly an infant with no clinically evident disease can progress to a toddler with multiple caries affected teeth. Few chronic diseases persist and progress over such a long period of time, and yet so rapidly as does early childhood caries. Drs. Mouradian and Meyer describe the important role of physicians in prevention and management of early childhood caries. In the years ahead, healthcare providers form all perspectives will play a role in identification of children at the greatest risk of disease. The chapter on “referrals that work” will guide us through the ways in which existing encounters in conjunction with well-baby checkups in pediatrician and family physician offices can work in concert with referrals to dental homes to avert disease in early childhood.

In spite of attention to the subject of early childhood oral health we hope this book will bring, the overall awareness about this most important age group as it concerns their oral health is very low. The focus therefore needs to be on the youngest of all via a unification of parties extending from parent and family to teacher and healthcare professional.

An extra course for students and practicing dentists beyond pediatric dentistry in “general” should include a discrete emphasis on early childhood oral health as is this book’s purpose. Early childhood oral health, as this book elucidates, is primarily an effort to prevent and manage early childhood caries. Although pediatric dentistry in more general terms includes a multitude of other aspects of assessing the health of children, as well as managing their oral care in a variety of ways, the emphasis in early childhood and within the pages of this book is essentially on dental caries prevention and treatment. Caries is the disease we speak of and which dominates the oral disease morbidity in early childhood. Problems that occur later in a child’s life regarding their oral health will include caries in a significant way, and will also include many other diseases and problems that are rarely seen in early childhood. The subsequent 10 chapters provide a complete landscape of views regarding dental caries and its prevention, caries management, and caries outcomes treatments in early childhood.

Many organizations tout the age one dental visit, or even earlier. The American Academy of Pediatric Dentistry as well as the American Dental Association proclaim that a child’s first dental visit should be soon after the first tooth erupts, and no later than age 1. The American Academy of Pediatrics says that the first oral health screening should take place at or around 6 months of age, likely in conjunction with a well-baby checkup already on the docket as part of the normal periodicity of examinations.

It sounds like integration of an oral assessment into an existing examination that occurs for other purposes is the right thing to do, yet historically this has not occurred. Only after the relatively recent emphasis on oral health have physicians begun to think about their own role in the comprehensive management of oral health for the children they have been seeing many times at a very young age. Physicians are now well integrated into the messages that go out to healthcare team about oral health in early childhood. Yet, the work is not yet complete. As in any “system” of healthcare delivery, access to the most appropriate care for all must target those at greatest risk as early as possible in the course of potential disease, and there must be a mechanism in place to provide continuous, comprehensive and effective preventive and surgical care where needed most. The system must facilitate not only the best possible access to care for the greatest in need, but must have the assurances in place that higher risk patients will be treated more aggressively. This would focus more attention and cost on those infants and toddlers deemed to be at the greatest risk. Dentistry as a whole is new to risk-based management of patients as it relates to dental caries. There is no better opportunity to implement a risk-based approach to caries management than in the pre-school population to avert the devastation of early childhood caries. In the chapter by Quinozez and Crall, an approach to managing the youngest children related to their dental caries risk level is described.

A decade of discussion hasn’t “tipped” the situation yet. Although many in the business of dealing with preschoolers and their oral health would say that we have reached the point of dealing with caries management effectively in the youngest children, clearly there is a long way to go. Third party payors, holding an enormous amount of influence over the determination of who gets care when and how often, are also beginning to recognize the value of early intervention—as it should occur in managing caries at the youngest possible age.

Parents are engaged early on, yet we haven’t talked with them enough and at each possible opportunity about their critical role in preventing and managing early childhood caries in their infant or toddler.

For the dental professional, bringing early childhood oral health into their practice might amount to a change in practice philosophy. Dr. Curtis tells us in his chapter how to make an infant and toddler practice work in anyone’s office. Dental practices may not yet be accustomed to the notion that patients will be treated at an age and from a perspective that most will not need restorative surgical intervention. The idea that a visit with an infant or toddler and their parent(s) will generally be without any “treatment” to deliver may be a foreign one. Clearly, however, we are moving toward a new kind of dentistry, a kind where our words and actions regarding anticipatory guidance and prevention will be the care we deliver that will be the most impactful for the child’s entire life.

Third party payors, as noted, are recognizing the problem of waiting until children are older before intervention takes place. With fewer teeth in mouth at a very young age, it is far simpler to engage parents to comply with oral hygiene regimens that can be implemented early for lifelong prevention. Drs. Nowak and Casamassimo tell us how anticipatory guidance can be brought to parents early on, to engage their enthusiasm toward better health outcomes for their child, and to demonstrate their role in preventing disease. Their other chapter talks about the blend of risk assessment and referral of the most risky to a dental home—something from which all children will benefit, and from which the most at risk will particularly benefit.

Stakeholders

What is likely to be the primary factor in “tipping” the access to care iss...