Category Page: Oral HP for Infants & Preschool

In addition to the PHAC criteria for Best Practices, oral health promotion and disease prevention interventions for infants and pre-school children should consider:

• Providing access to care: Particularly to disadvantaged groups that tend to have higher disease rates and limited access to preventive and treatment services.
• Commence at an early age: Oral health promotion and disease prevention interventions are more likely to be successful if implemented before decaying starts – by age 12 months or earlier.
• Sustainable: Early Childhood Caries (EEC) is progressive and prevention of it for high risk groups need to carry on throughout the pre-school years. Therefore interventions must be sustained.
• Integrated with other health jurisdictions: Since other jurisdictions often see the infants and pre-school children more frequently that the dental profession, integrated oral health promotion interventions can be more effective and provide better access.
• Community involvement: Particularly in diverse cultural groups (Aboriginal and immigrant communities) collaboration with the community can help to provide ownership of the interventions and develop strategies that gain acceptance of the community and utilize aspects of the culture to advantage.

Resources

• Best Practice Approach: Prevention and Control of Early Childhood Tooth Decay
• Family Dental Health Scrapbook

Evidence Summary: Oral health promotion and disease prevention interventions for infants and pre-school children

Dental decay is the most common chronic and infectious disease for infants and pre-school children. It is five times more common than asthma and seven times more common than hay fever. For many of the large hospitals in the country, treatment of the effects of dental decay is the most common reason for general anaesthetics in this age group.

Severe Early Childhood Caries (S-ECC) is a particularly virulent form of dental decay, with early onset and rapid progression. EEC is defined by the American Academy of Pediatric Dentistry as “the presence of one or more primary teeth affected by decay, in a child 71 months of age or younger”

Risk factors for ECC are transmission of infectious bacteria from the caregiver, inappropriate feeding practices, poor nutrition, and poor oral hygiene.

Like in other age groups, the prevalence of dental decay is highest amongst the disadvantaged groups^[1]. While the prevalence of ECC in the general Canadian population is around 5%, in Aboriginal communities it is often higher than 80%^[2,3].

Dental decay is an infectious disease, following transmission and colonization of cariogenic bacteria, primarily Mutans Streptococci, between 6-30 months of age (mostly 18-24 months)^[4]. Therefore, oral health promotion and prevention activities are most effective if they commence before this age^[5]. Oral health promotion interventions can be effective for this group, particularly if they involve or include the application of fluoride varnish on a regular basis. A particular difficulty for this age group is getting the services to the disadvantaged groups that need them the most^[6,7].

In addition to the Public Health Agency of Canada criteria for Best Practices, oral health promotion and disease prevention interventions for infants and pre-school children should consider:

• Providing access to care – particularly to disadvantaged groups that tend to have higher disease rates and limited access to preventive and treatment services.
• Commence at an early age – oral health promotion and disease prevention interventions are more likely to be successful if implemented before decaying starts – by age 12 months or earlier.
• Sustainable – Early Childhood Caries (EEC) is progressive and prevention of it for high risk groups need to carry on throughout the pre-school years. Therefore interventions must be sustained.
• Integrated with other health jurisdictions – Since other jurisdictions often see the infants and pre-school children more frequently that the dental profession, integrated oral health promotion interventions can be more effective and provide better access.
• Community involvement – Particularly in diverse cultural groups (Aboriginal and immigrant communities) collaboration with the community can help to provide ownership of the interventions and develop strategies that gain acceptance of the community and utilize aspects of the culture to advantage.

References

1. Warren JJ, Weber-Gasparoni K, Marshall TA, et al. A longitudinal study of dental caries risk among very young low SES children. Community Dent Oral Epidemiol. 2009 Apr;37(2):116-22. Epub 2008 Nov 12.
2. Schroth R, Harrison RL, Lawrence HP, Peressini S. Oral Health and the Aboriginal Child: A forum for community members, researchers and policy-makers. J Can Dent Assoc. 2008;74(5):429-32.
3. Oral health inequalities between young Aboriginal and non-Aboriginal children living in Ontario, Canada. Lawrence HP, Binguis D, Douglas J, et al Community Dent Oral Epidemiol. 2009 Dec;37(6):495-508. Epub 2009 Sep 22.
4. Harris R, Nicoll AD, Adair PM, Pine CM. Risk factors for dental caries in young children: a systematic review of the literature. Community Dent Health. 2004 Mar;21(1 Suppl):71-85.
5. Gussy MG, Waters EG, Walsh O, Kilpatrick NM. Early childhood caries: current evidence for aetiology and prevention. J Paediatr Child Health. 2006 Jan-Feb;42(1-2):37-43.
6. Ammari, JB., Baqain, ZH., Ashley, PF. Effects of programs for prevention of early childhood caries: A systematic review. Medical Principles and Practice 2007 Vol 16,6, 437-442.
7. Bader J, Rozier G, Harris R, Lohr K. Dental Caries Prevention: The Physician’s Role in Child Oral Health; Systematic Evidence Review. Agency for Healthcare Research and Quality. Technical Support for the U.S. Preventive Services Task Force. 2004.