12 Dec, 2022

How To Proceed With Infant Oral Health Care?

The first step should be to establish a "Dental Home" for each infant. The dental home is the ongoing relationship between the dentist and the patient, inclusive of all aspects of oral healthcare delivered in a comprehensive, continuously accessible, coordinated, and family-centered way.

Recommendations for the first dental examination and to establish a "Dental Home" include the following

1. Immediate referral of infants with an apparent dental problem due to trauma, disease, or developmental abnormality.

2. Examination at no later than 6 months or when the first tooth erupts.

Objectives of a dental home:

1. To enhance the dentist's ability to assist children and their parents/caregivers in the quest for optimum oral health care. 

2. To schedule early oral health examinations and preventive services for cost-effectiveness.

3. To offer parents and caregivers resources which assist them in making the best-informed choice.

4. Individual child risk assessment for dental diseases

5. Monitoring the growth and development

6. To make the parents aware of when and how frequently should they visit a dental home for their child.

Role of dentist in providing care to an infant

1. The dentist is a valuable source of information on a one-to-one basis or in small gatherings. On a large scale, the dental association can be involved in teaching the masses regarding the timing of the first visit.

The age at which teeth erupt varies greatly between children and a difference of 6 to 12 months can be considered normal

At the age of 6 to 10 months, bottom front teeth, then top front or side bottom front teeth

•   9 to 13 months - second top front teeth
• 13 to 19 months -first molars then canine, then second molar.
• Two and a half  to 3 years - all the teeth will erupt

2. Feeding practices:

From the nutritional point of view, breast milk has several systemic and immunologic advantages over proprietary formulas.

The dentist will explain the importance of breastfeeding to parents.

On the flip side, prolonged and at-will breastfeeding, beyond the weaning time of the child, especially throughout the night can lead to the development of nursing caries.

3. Sucking and suckling:

Suckling is different from regular sucking, suckling at the breast is good for an infant's tooth and jaw development whereas bottle-fed infants, do not have to exercise their jaws and light suckling itself produces the rapid flow of milk. Hence, breastfeeding encourages the development of well-formed jaws and straight healthy teeth.

4. Importance of weaning:

Weaning is the process of expanding the diet to include food other than breastmilk or infant formula. It is a gradual process, weaning should occur between 4 and 6 months.

Dentists would counsel the parent regarding the right way to start weaning.

Stages of weaning :

Stage 1 (4-6 months):

The first choice of weaning food depends on the local diet and food availability.

At this stage, all food must be pureed or very finely minced.

If cereal is used, it should be reconstituted with breast milk or infant formula.

If pureed fruits or vegetables are used, they should be prepared without adding salt and sugar.

Initially, one or two tablespoons is adequate but the quantity increases as the baby's appetite increases.

As the baby becomes accustomed to taking food from a spoon, the consistency should become thicker.

Stage 2  (6-9 months):

The child will now be able to chew, and minced and mashed food that includes small lumps can be given.

Some of the foods the rest of the family eats can be mashed with a spoon and given.

Foods like steamed fruits, soft-cooked vegetables such as carrots,  and finger foods such as toast can be introduced.

Babies must never be left alone while eating for the risk of choking.

They should not be given hard nuts or sweets for risk of accidental inhalation.

Stage 3 (9-12 months) :

By the end of this stage, babies should be eating foods similar to the rest of the family with three main meals and either milk or snacks between them.

Food need not be mashed and they should be encouraged to feed themselves, with supervision.

5. Tips on bottle feeding:

•    Provide more attention to the child
•    Remove the bottle immediately after feeding
•    Do not use a milk bottle to pacify the baby when crying.
•    Encourage your baby to stay in an upright position.
•    Use a bottle that has a nipple with a smaller hole to enable the infant to work their muscles harder
•     Introduce a cup to drink as soon as possible.
•     Give water and clean their mouth after feeding.

6. Use of Pacifiers:

Avoid using pacifiers since several disadvantages have been found with their usage.

• Those dipped in honey can cause caries.
• The child may have malaligned or crooked teeth in the future.
• Unhygienic conditions can lead to infections.

7. Anticipatory guidance:

The dentist anticipates and provides the right guidance which would prevent many of the dental problems children would otherwise face.

8. Important Oral Hygiene Practices :

Many parents would not be aware that oral hygiene practices can be essential at this age.

The parents should bring their child for his/her first dental visit early, at least by the time baby is six months of age.

If the child has been brought to the dentist early the proper technique for tooth cleaning would be demonstrated.

Cleaning the infant gum pads can be started as early as the first week of birth.

The baby can be made to lie down with his head up on your lap, open the baby's mouth and slide the forefinger inside along the cheek, and press down on the backside lowergumpad.

Take a small gauze between the thumb and forefinger and wipe vigorously over the ridge of the baby's top and bottom jaws.

use adequate pressure just to remove the film that covers the child's jump. clean at least every day twice after morning and the last feed in the night.

Once the infant has teeth, the teeth should be brushed twice every day until the child can manage himself.

Guidelines to parents

Children are our most precious resource. Their optimal oral health should be provided not only on a therapeutic but also on a preventive basis early in life itself. Parents should be educated at the earliest possible time by not only a dentist but also a general practitioner to provide them with a disease-free environment.

The parents should bring their child for his /her first dental visit early, at least by the time the baby is 6 months of age.

Breastfeed the baby but don't indulge at will

Avoid frequent use of the bottle with sugared milk or drinks as this can lead to nursing bottle caries. Instead, give the child more attention

Do not put the child to bed with the bottle or at the breast, take the bottle away immediately after feeding

Dilute the milk gradually in the bottle and end with plain water

Feeding should be supervised at all times

Start the child on semisolids by 5 to 6 months and reduce the use of bottles or breastfeeding

Don't use pacifiers or dummies dipped in honey or other sugar items

Avoid extended use of sugared medicines such as syrups

Clean the gums and later teeth with a cloth or soft brush after every meal or before sleep.

Parents should brush or clean their baby's gums/teeth every day till the child is old enough to manage himself.

Contact the dentist immediately if there is any accident or trauma to the baby's teeth.

Parents should know the benefits of fluoride and its proper use such as that used in infant formulas and denitrifies.