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Module 4: Anticipatory Guidance, Fluoride Varnish, and Referral

4.1 Anticipatory Guidance

Doctor with Mother and Baby

Anticipatory guidance helps parents understand what to expect during their child’s current and approaching stages of development. EPSDT medical providers can provide parents with anticipatory guidance to promote children’s oral health. With this information, parents can help prevent or reduce dental caries in their children.

The provision of anticipatory guidance is based on information gathered while the EPSDT medical provider is conducting the caries risk assessment. Often, the medical provider can offer anticipatory guidance while conducting the oral health screening, during which existing issues can be addressed. (For more information about caries risk assessment, see module 3.)

Anticipatory guidance topics include oral development, tooth eruption, oral hygiene, fluoride use, Mutans streptococci infectivity, and feeding and eating practices. The three most frequently discussed topics are as follows:


A large percentage of parents are not aware that dental caries is an infectious disease and that many common practices and behaviors transmit Mutans streptococci to children. Parents must be educated about modes of transmission and the impact of Mutans streptococci transmission on the oral health of children. Encourage parents to model positive oral health behaviors.

Foods and Beverages Containing Sugar

The frequency with which children consume foods and beverages that contain sugar on a daily basis is critical to the dental caries process. (See Feeding and Eating Practices.) Eating regularly scheduled nutritious meals and snacks (rather than snacking throughout the day) reduces the length of time that teeth are exposed to acids that dissolve tooth structure. Children should never be put to sleep with a bottle or sippy cup or be allowed frequent and prolonged feedings or use of bottles or sippy cups containing beverages with sugar (e.g., fruit drinks, pop (soda), fruit juice), formula, or milk. If a child is accustomed to being put to bed with a bottle, offer a bottle with plain water.