Components of Oral Health Supervision

Optimal oral health supervision for pregnant and postpartum women, infants, children, and adolescents should contain the following components:

Components of Oral Health Supervision provided by Oral Health Professionals Other Health Professionals
Family preparation
Interview questions
Risk assessment
Examination, including assessment of risk for developing oral disease  
Screening, including recognizing and reporting suspected abuse or neglect
Preventive procedures, such as application of fluoride varnish
Anticipatory guidance
Measurable outcomes
Referrals, as needed

 

Family Preparation

Just as health professionals prepare for oral health supervision visits, families need to prepare, too. An oral health supervision visit is any dental or medical visit where oral health services are provided. Families can gather health information, prepare questions, and complete forms in anticipation of the visit. This step is an essential component of oral health supervision, and health professionals should give the family information in a culturally and linguistically appropriate manner about how to prepare for the visit.

Interview Questions

The interview addresses key issues (e.g., oral development, teething and tooth eruption, oral hygiene, feeding and eating practices, exposure to fluoride, injury prevention, pregnancy gingivitis) during the oral health supervision visit. The interview should review and discuss information gained from previous oral health supervision visits and address current issues specific to the age and development of the infant, child, adolescent, or pregnant or postpartum woman. Health professionals need to assess whether the child, adolescent, or their parents and pregnant and postpartum women have assumed responsibility for oral health and demonstrate mastery and consistent use of preventive oral health care techniques. As the child, and later the adolescent, becomes more responsible, health professionals should discuss these issues directly with the child or adolescent.

Risk Assessment

Oral health risk assessment, which can be conducted by oral health professionals and other health professionals, is based on the premise that not all infants, children, adolescents, and pregnant and postpartum women are equally likely to develop oral health problems. Thus, individuals at higher risk for oral disease will likely need more complex preventive oral health care and treatment than those at lower risk. Oral health risk assessment involves identifying the risk factors that may impact an individual's oral health. Use the risk assessment tables to assess the infant's, child's, adolescent's, or pregnant or postpartum woman's risk for oral health issues.

Health professionals may refer to the caries risk assessment tools developed by the American Academy of Pediatric Dentistry, the American Academy of Pediatrics, and the American Dental Association to assist in classifying risk for tooth decay in infants, children, and adolescents based on environmental, physical, and overall health factors (see caries risk assessment tools).

Screening

Health professionals can perform a screening of the lips, tongue, teeth, gums, inside of the cheeks, and roof of the mouth to identify oral disease, especially tooth decay, or other oral conditions (e.g., delayed tooth eruption or premature tooth loss, abscesses, trauma, pregnancy gingivitis) and to provide guidance for management. An oral health screening takes only 2 or 3 minutes.

Screenings are not examinations and do not involve making diagnoses that lead to treatment plans. Only an oral health professional (a dentist or a dental hygienist who is qualified according to state practice acts or regulations to perform examinations) has the education and training needed to conduct oral examinations.

A dental chair is not needed to perform a screening. For infants and children under age 3, the health professional and the parent should sit face to face with their knees touching, with the child placed in the health professional's and the parent's lap.

The child's head should be nestled securely against the health professional's abdomen, with the child facing the parent. By age 3, children are able to lie flat on an examination table or to sit in front of the parent, with both the child and the parent facing the health professional so that the parent can help position and steady the child. For older children and adolescents, the parent's assistance is not necessary.

With gloved hands, the health professional lifts the lip, views and feels the soft tissues, and views the teeth and the entire mouth. Almost any type of lighting, such as a flashlight, a portable gooseneck lamp, an examination light, or a headlamp, will work for a screening. A tongue depressor or toothbrush can be used to move the tongue and view the teeth. A dental mirror or other similar-sized mirror can make it easier to see behind the teeth and to perform a more thorough screening, but such a mirror is not necessary.

When performing the oral health screening, health professionals should

Health professionals should document oral health history, clinical findings, and recommended follow-up in the infant's, child's, or adolescent's oral health record.

Examination

An oral examination includes a dental history, a clinical oral assessment, and diagnostic procedures such as X-rays. The examination also includes an assessment of the pregnant or postpartum woman's, infant's, child's, or adolescent's risk for developing oral diseases; establishment of a prevention and/or treatment plan; and determination of the interval for periodic reevaluation based on that assessment. Another appointment will be scheduled if other treatment needs exist.

Preventive Procedures

Health professionals, as approved by state practice acts or regulations, can assess the pregnant or postpartum woman's, infant's, child's, or adolescent's exposure to systemic and topical fluoride, apply fluoride varnish, and prescribe systemic fluoride supplements, if indicated.

Anticipatory Guidance

Anticipatory guidance is the process of providing practical, developmentally appropriate information (e.g., about oral development, teething and tooth eruption, oral hygiene, feeding and eating practices, exposure to fluoride, injury prevention) to the family about the pregnant or postpartum woman's, infant's, child's, or adolescent's current oral health and what to expect during the next period. The guidance should be modified based on risk assessment responses. When providing anticipatory guidance, health professionals are encouraged to discuss risk factors. Working in partnership with the family, health professionals can be effective in promoting oral health. Creating opportunities for thoughtful dialogue between families and health professionals is one of the best ways to establish trust and build partnerships that promote oral health and prevent oral disease and injury. Older children and adolescents, as they mature, should actively participate in health partnerships and should assume increasing responsibility for their own oral health.

Measurable Outcomes

The success of oral health supervision can be measured by whether the pregnant or postpartum woman or parent(s), infant, child, or adolescent has achieved certain outcomes. Outcomes are important measurable health indicators that both health professionals and families can identify and track. Outcomes also help oral health professionals determine the periodicity for subsequent visits and help health professionals provide anticipatory guidance. Examples of outcomes are (1) parents understand and practice good oral hygiene and feeding and eating behaviors, (2) child has no oral disease or injury, (3) child practices safety behaviors, and (4) pregnant or postpartum woman and child are under the care of an oral health professional.

Referrals

Because pregnant and postpartum women, infants, children, and adolescents often do not visit oral health professionals on a regular basis, it is critical that other health professionals who have frequent contact with pregnant and postpartum women, infants, children, and adolescents be able to help prevent or reduce their risk for oral disease, especially tooth decay, and to provide referrals to dentists for intervention or treatment.

Conversely, oral health professionals may be the "first line" in assessing the overall health and well-being of pregnant and postpartum women, infants, children, and adolescents. Oral health professionals can make referrals to other health professionals and can reinforce preventive messages about oral hygiene, nutrition, injury prevention, and other health issues such as tobacco and other substance use prevention.

 

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