Anticipatory GuidanceAnticipatory Guidance

February 2, 2005February 2, 2005

Joseph McManus, DMD,MS,MHA,MBAJoseph McManus, DMD,MS,MHA,MBA

““Using Anticipatory Guidance Using Anticipatory Guidance To Provide Early Dental To Provide Early Dental

Intervention”Intervention”byby

Arthur Nowak, , DMD, MAArthur Nowak, , DMD, MAPaul Casamassimo, DMD,MSPaul Casamassimo, DMD,MS

ininJADA, Vol. 126, August 1995JADA, Vol. 126, August 1995

Classic Preventive Dentistry for Classic Preventive Dentistry for ChildrenChildren

Reduce caries and periodontal disease.Reduce caries and periodontal disease. Driven by the infectious disease model proposed by Driven by the infectious disease model proposed by

Keyes.Keyes.

Tri-factorial modelTri-factorial model 1. Agent (bacteria)1. Agent (bacteria) 2. Host (tooth)2. Host (tooth) 3. Substrate (carbohydrate)3. Substrate (carbohydrate)

POINTS OF VIEWPOINTS OF VIEW

The Old ParadigmThe Old Paradigm A child’s first visit occurs at age 3.A child’s first visit occurs at age 3.

The New ParadigmThe New Paradigm The child’s first visit will occur no later than her first The child’s first visit will occur no later than her first

birthday.birthday.

THE 80/20 RULETHE 80/20 RULE

Caries among U. S. children seem to be Caries among U. S. children seem to be concentrated in about 20-25 percent of the child concentrated in about 20-25 percent of the child population. population.

20 percent of your patients will cause 80 percent 20 percent of your patients will cause 80 percent of the problems in your practice and in your of the problems in your practice and in your professional life.professional life.

FACTSFACTS

There are limitations in the infectious-disease There are limitations in the infectious-disease model in comprehensive preventive oral care for model in comprehensive preventive oral care for children.children.

There is a need for dentists to examine children There is a need for dentists to examine children for oral conditions other than caries and for oral conditions other than caries and periodontal disease.periodontal disease.

There is an evolving role of the dentist acting as There is an evolving role of the dentist acting as an early interventionist.an early interventionist.

Anticipatory Guidance provides a Anticipatory Guidance provides a framework for prevention that goes framework for prevention that goes beyond caries to address all aspects beyond caries to address all aspects

of children’s oral health!of children’s oral health!

THE MEDICAL APPROACHTHE MEDICAL APPROACH

WHAT’S UP DOC??WHAT’S UP DOC??

CHILDREN ARE NOT BORN CHILDREN ARE NOT BORN WITH A SET OF INSTRUCTIONS WITH A SET OF INSTRUCTIONS

WRITTEN ON THEIR CHESTWRITTEN ON THEIR CHEST

PARENT’S ARE USUALLY PARENT’S ARE USUALLY CLULESSCLULESS

MOM & DAD THIS IS WHAT’S UPMOM & DAD THIS IS WHAT’S UP

In pediatric health care anticipatory guidance is In pediatric health care anticipatory guidance is the process of providing the process of providing practicalpractical health health information to parents ininformation to parents in anticipation anticipation of of significant, physical, emotional and psychological significant, physical, emotional and psychological milestone.milestone.

Alerting them to impending change.Alerting them to impending change. Teaching them their role in maximizing their Teaching them their role in maximizing their

children’s development.children’s development.

Child’s Developmental Age RangeChild’s Developmental Age Range MilestonesMilestones Content AreaContent Area

Oral DevelopmentOral Development FluorideFluoride Oral Hygiene/HealthOral Hygiene/Health HabitsHabits Nutrition and DietNutrition and Diet Injury PreventionInjury Prevention

Dentist’s ActionsDentist’s Actions

Child’s Developmental Age RangeChild’s Developmental Age Range6-12 months6-12 months

Milestone: The Eruption of the first Milestone: The Eruption of the first primary toothprimary tooth

6-12 months6-12 months Oral DevelopmentOral Development

Review pattern of eruptionReview pattern of eruption Review teething factsReview teething facts

FluorideFluoride Assess fluoride statusAssess fluoride status Determine supplements if neededDetermine supplements if needed

Oral Hygiene/HealthOral Hygiene/Health Review oral hygiene techniques with care giverReview oral hygiene techniques with care giver Plan for next visit based on risk assessmentPlan for next visit based on risk assessment

HabitsHabits Review pacifier useReview pacifier use Discuss thumb-sucking’s effects on the mouthDiscuss thumb-sucking’s effects on the mouth Discuss breastfeeding’s effects on the mouthDiscuss breastfeeding’s effects on the mouth

Nutrition and DietNutrition and Diet Encourage weaning at the appropriate timeEncourage weaning at the appropriate time Discuss the role of sugar in dental caries initiationDiscuss the role of sugar in dental caries initiation

Injury PreventionInjury Prevention Review what to do if patient has traumatic injuryReview what to do if patient has traumatic injury Provide emergency numberProvide emergency number

Child’s Developmental Age Range: Child’s Developmental Age Range: 12-24 months12-24 months

Milestones: Completion of primary Milestones: Completion of primary dentition, occlusal relationships dentition, occlusal relationships

established, arch length determinedestablished, arch length determined

12-24 months12-24 months Oral DevelopmentOral Development

Discuss importance of space maintenanceDiscuss importance of space maintenance Discussing BruxingDiscussing Bruxing

FluorideFluoride Reassess fluoride statusReassess fluoride status Discuss toxicity and how to manage accidental ingestionDiscuss toxicity and how to manage accidental ingestion

Oral Hygiene/HealthOral Hygiene/Health Review home oral care procedures and complianceReview home oral care procedures and compliance Plan for next visit based on risk assessmentPlan for next visit based on risk assessment

HabitsHabits Review non-nutritive sucking Review non-nutritive sucking

Nutrition and DietNutrition and Diet Discuss carbohydrates and their role in plaque developmentDiscuss carbohydrates and their role in plaque development Discuss the frequency of carbohydrate intake as caries factor Discuss the frequency of carbohydrate intake as caries factor

Injury PreventionInjury Prevention Discuss electric cord safety, child proofing the house and use of car seatsDiscuss electric cord safety, child proofing the house and use of car seats Develop plans for oral trauma management for preschool and child careDevelop plans for oral trauma management for preschool and child care

Child’s Developmental Age Range:Child’s Developmental Age Range:2-6 years2-6 years

Milestones: Loss of first primary Milestones: Loss of first primary tooth, eruption of first permanent tooth, eruption of first permanent

molar or incisormolar or incisor

2-6 years2-6 years Oral DevelopmentOral Development

Review patterns of eruption. Point out permanent molar anatomyReview patterns of eruption. Point out permanent molar anatomy Describe healthy periodontal tissueDescribe healthy periodontal tissue

FluorideFluoride Reassess fluoride statusReassess fluoride status

Oral Hygiene/HealthOral Hygiene/Health Review home oral care procedures and complianceReview home oral care procedures and compliance Discuss dental sealants and describe dental radiographsDiscuss dental sealants and describe dental radiographs Plan for next visit based on risk assessmentPlan for next visit based on risk assessment

HabitsHabits If child is still sucking the thumb, discuss how to help him D/C habit If child is still sucking the thumb, discuss how to help him D/C habit

Nutrition and DietNutrition and Diet Review diet outside the home and its caries potentialReview diet outside the home and its caries potential Discourage the use of food as a behavioral tool Discourage the use of food as a behavioral tool

Injury PreventionInjury Prevention Encourage the use of helmets, mouth guards, and car seats. Encourage the use of helmets, mouth guards, and car seats. Develop plans for oral trauma management . Develop plans for oral trauma management .

Available Literature Available Literature

American Academy of PediatricsAmerican Academy of Pediatrics

American Academy of Pediatric DentistryAmerican Academy of Pediatric Dentistry

American Dental AssociationAmerican Dental Association