Modules

Module 4 Key Points


  • Topical fluoride is probably the most important source of prevention of dental caries. Topical fluoride is most effective when delivered at very low doses many times a day through water, foods containing fluoride, and fluoridated toothpaste.
  • If fluoride supplements are indicated, consider whether the child can chew, swish, and spit and whether parents understand the proper dosage and frequency of supplements.
  • Fluoride rinses are generally recommended only for children who can swish for 1 minute and spit.
  • Instruct parents to brush the child’s teeth at least twice a day. Demonstrate how to apply no more than a pea-sized amount (small smear) of toothpaste, and advise them to prevent ingestion of toothpaste whenever possible. For children who cannot spit, let them drool into a cup.
  • Adaptations may be needed in applying fluoride gel or foam for children who have oral motor dysfunction or oral hypersensitivity.
  • Fluoride varnish should be applied every 3 to 6 months in children who are at increased risk for dental caries. Fluoride varnish may be the best type of professionally applied fluoride for children with special health care needs.
  • Currently, use of fluoride varnish in dental caries prevention is considered “off label” by the Food and Drug Administration (FDA), since FDA has approved fluoride varnish as a “device” (rather than a preventive agent) for use as a cavity liner.
  • Xylitol can be used with other preventive measures such as fluoride, resulting in an additive dental caries preventive effect. Children over age 3 with special health care needs can use xylitol if they are able to chew gum or suck on hard small objects without choking on them.
  • Some children with chronic diseases or disorders such as leukemia, kidney failure, immune deficiencies, or Down syndrome may experience moderate to severe gingivitis or periodontitis at an early age. They may also experience more fungal infections or other opportunistic infections than other children.
  • Children who severely brux their teeth (e.g., because of cognitive disabilities, cerebral palsy, or autism) may not be candidates for dental sealants because of the flattened occlusal surfaces.
  • Some children with special health care needs develop excessive calculus caused by mouth-breathing, inadequate salivary flow, metabolic disorders, kidney failure, tube feedings, oral motor dysfunction, or inadequate oral hygiene.
  • Use of rubber prophy cups is not recommended for general plaque removal in young children, because the cups remove the outer fluoride-rich layer of enamel in primary teeth that is important for preventing dental caries and remineralization. Toothbrushing is just as effective for plaque removal.