Infant Oral Health: The Need for Early Intervention.........

Oral health is vital for the general well being of the neonate, the primary aim being prevention, interception and management of existing condition. The dynamics of oral environment and several inhabitants makes oral cavity complicated from the moment of the birth itself, and goes for a rapid change from birth through infancy, thus making oral cavity susceptible to diseases.

Oral cavity is considered to be “Sterile” at birth and the microbial acquisition is seen as the infant is exposed to the environment. Positive cultures from the mouth are evident after first feeding and within 6 hrs of birth. Positive correlation has been established between the vaginal microflora and the infant’s oral flora suggesting that the infant’s microflora is considered to be sterile at birth and gets infected by the surrounding factors.

There are multiple reasons that are considered for the possible prenatal contamination of oral cavity (Vertical Transmission) such as infant born through C-section, infections passed on by mothers via placental transfers and ascending vaginal infections. However postnatal infection (Horizontal Transmission)occurs more due to personal habits such as thumb sucking and nail biting and practices such as putting unsterile objects (utensils, toys, pacifiers and food items)in to the oral cavity, feeding contaminated food, playing with pets and person to person transmission (via kissing, close contact)

Acquisition of cariogenic bacteria is seen around 6-24 months old children and this period is known as period of window of infectivity of oral cavity. Transmission via kissing of babies, sharing spoons, forks, glasses, candies, pacifiers which are contaminated by mothers or siblings who have multiple carious lesions in their mouth, carries a great risk for contamination during this period in an otherwise healthy infant.

Feeding practices such as bottle feeding & pacifier usage shows the significant increase in yeast & lactobacilli as compared to breast feeding mainly due to unhygienic methods. Continuation of feeding habits such as Breast/ Bottle/ Both beyond 18 months may lead to Early Childhood Caries (ECC).

Continuous Breast feeding in supine position may also lead to middle “Ear infection” of the infant At the age of 6 months, when the first teeth is likely to erupt in the oral cavity, the child may feel the itch to rub the area and feel irritated resulting in habits like biting teething rings/blanket/toys and put anything in to the mouth in an attempt to relieve the irritation that may further cause systemic illness due to transmission of micro organisms such as fever and teething diarrhea manifested as green stools.

In order to overcome these challenges, contemporary guidelines thus recommends on early professional intervention consisting of an oral examination and risk assessment of infants and providing anticipatory guidance for parents.

AIM: of primary prevention is to prevent the disease or to interfere with disease progression before treatment becomes mandatory.

Recommendations for parents on OIHC

• Ideally, infant oral health should begin with prenatal oral health counseling for parents;
• A postnatal initial oral evaluation is performed within six months of the eruption of the first primary tooth in an infant but by no later than 12 months of age.

• Infants should not be put to sleep with a bottle. Nocturnal breast feeding should be avoided after the first primary tooth begins to erupt.
• Parents should be encouraged to have infants drink from a cup as they approach their first birthday; infants should be weaned from the bottle at 12 to 14 months of age.
• Consumption of juice from a bottle should be avoided; using cup can be a better option.
• Oral hygiene measures should be implemented by the time the first primary tooth erupts.
• Infant should be avoided to share contaminated spoons, eatables, toys, pacifiers between siblings/peers.

EDUCATION ON ORAL HYGIENE AND DIETARY HABITS

Prenatal counseling: Counsel parents about their own oral hygiene habits and their effect as role models, Provide information to pregnant women about pregnancy gingivitis.

Infants (birth to 1 year of age): Counsel Parents to clean the Infant’s gums daily before eruption of the first primary tooth to help establish a healthy oral flora, using the following procedure:

• Cradle the infant with one arm.
• Wrap a moistened gauze square or washcloth around the index finger of the hand of the other arm and gently massage the teeth and gingival tissues.
• Introduce a soft-bristled toothbrush during this age only if parents feel comfortable using the toothbrush.
• Do not use dentifrice containing fluoride as fluoride ingestion is possible.

Toddlers (1 to 3 years of age):

• Introduce a toothbrush into the plaque-removal procedure
• Use dentifrice beginning around the age of 2 years; use only a pea-sized amount of toothpaste
• Encourage the child to begin rudimentary brushing; however, parents should remain the primary caregiver in oral hygiene procedures.

Preschool-age children (3 to 6 years of age)

• Remind parents' to continue their responsibility as primary providers or supervisors
• Continue to use only a pea-sized amount of toothpaste on the child's toothbrush.

Timing of the First Dental Visit: Because all children do not receive primary prevention, secondary measures such as early diagnosis and treatment can eliminate pain, infection and oral diseases. Traditionally, the recommended time for the first dental visit has been at three years of age. The rationale for choosing this later age was that children were more manageable and treatment was more efficient. By three years of age however poor oral hygiene or improper feeding habits may already have compromised oral health. Therefore it is recommended that the first oral examination occur within six months of the eruption of the first primary tooth but by no later than 12 months.

Pedodontist who provide primary care for children are in a unique position to help ensure that parents and other caregivers receive information on the prevention of oral diseases in infants and young children.