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Basic Techniques for Management of the Infant and Toddler Dental Patient

Course Number: 54

Parental Responsibility

The role of the parent is not limited to supervising oral hygiene procedures in the child. Parents are instructed that they can be the source of the child’s cariogenic bacteria through transference of their oral bacteria via direct vertical contact (kissing, sharing of utensils, orally cleansing pacifiers, etc.) during infancy. Reducing the transfer of oral bacteria from the parent to the child by reducing the bacteria of the parents’ oral flora is accomplished by adopting the following practices:

  • Oral hygiene – The parent should be instructed to brush thoroughly twice daily (morning and evening) and to floss at least once every day.

  • Diet – The parent should be instructed to consume fruit juices only at meals and to avoid all carbonated beverages during the first 30 months of the infant’s life.

  • Fluoride – The parent should be instructed to use a fluoride toothpaste approved by the ADA and rinse every night with an alcohol-free, over-the-counter mouthrinse with 0.05% sodium fluoride.

  • Caries removal – Parents should be referred to a dentist for an examination and restoration of all active decay as soon as possible.

  • Delay of colonization – Parents should be educated to prevent early colonization of dental flora in their infants by refraining from the sharing of utensils (i.e., shared spoons, cleaning of dropped pacifier with saliva, etc.).

  • Xylitol chewing gums – Recent evidence suggests the use of xylitol chewing gum (6 grams) by the parent can significantly reduce the parent’s and child’s caries rates.

Parental responsibility for the young child (0 to 3 years of age) includes the following:

  • Oral hygiene – The parent should begin to brush the child’s teeth as soon as they erupt (twice daily, morning and evening) and floss between the child’s teeth once every day as soon as teeth contact one another.

  • Diet – After the eruption of the first teeth, the parent should provide primarily water to drink and formula/milk during meals only. Carbonated beverages should be excluded from the child’s diet. Infants should not be placed in bed with a bottle containing anything other than water. Ideally, infants should have their mouths cleansed with a damp cloth after feedings.

  • Fluoride – All children should have optimal exposure to topical and systemic fluoride. Caution should be exercised in the administration of all fluoride-containing products. The specific considerations of the judicious administration of fluoride should be reviewed and tailored to the unique needs of each patient.

  • Recall schedule – The recall schedule is based upon the clinical findings, feeding practices and dental development. Depending upon the child’s history or potential for developing dental disease, the recall appointment schedule may vary depending on the child’s caries risk.2

The fee for performing the above services will vary with the marketing strategies of the dentist. Some dentists feel that offering the introductory visit for free or at substantial discount is an effective marketing tool for attracting new patients to the practice. Others feel that a charge should be imposed since the dentist allocated time and expertise for the visit. An appropriate fee would be what the dentist charges for a new patient examination and fluoride varnish application. As a rubber cup prophylaxis is usually not performed on infants, unless staining is present as is occasionally found with iron fortified cereals and formulas. Charging a fee for a toothbrush prophy would be at the discretion of the dentist, but it is recommended for demonstrating technique and positioning for the parent.