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Oral health has deservedly attracted increased attention over recent years. Cavities are the No. 1 chronic disease affecting young children, yet pediatric dentist availability is inadequate, and most pediatricians receive little education on oral health during their training. Additionally, recommendations for good oral health may be hard for parents to implement when their infant is crying for a bottle in the middle of the night or their toddler is fighting all efforts at good tooth brushing.
In my own practice, I feel very lucky to have a close partnership with an excellent pediatric dentistry department from whom I have learned a great deal. I have discovered a lot of facts, but also many practical tips that I have been able to use clinically and pass on to families. The first and most important thing I have learned from my dentistry colleagues is how important it is for pediatric primary care providers to ask about oral health at every visit. There are different ways to incorporate this into your history taking, but I typically ask when I am doing my ear, nose, and throat exam. I find this is most efficient, but also the best time to elicit parents’ questions and concerns about oral health (and also a time for me to provide positive feedback).
The second extremely helpful tip I have learned is how to get a good exam. Older patients are, of course, much more likely to be cooperative, and the very young infants also are fairly easy to examine. A mad 18-month-old, on the other hand, can be a real challenge! Again, as I was taught by my dental colleagues, I ask the parent to sit in a chair and put the child in their lap, facing them and with the child’s legs on either side of the parent’s hips. I also sit in a chair, facing the parent (at which point the child’s back is toward me). The parent then lays the child back along their legs, so that the child’s head is in front of me, and I am looking down their nose into their mouth. This is a perfect angle to be able to control the child’s mouth and get a direct look in – so I can be quick and thorough. For parents whose children really fight tooth brushing, I teach them this technique as well if there are two adults in the house available to help with the dental hygiene routine. In my experience, I find that in addition to providing control and a good angle for an exam, as long as you move them into the position slowly, young children find this a comforting position in which to have their mouth examined. They are somewhat cocooned by the parent’s legs and arms, which seems to help them feel protected and a little calmer.
Finally (and this is perhaps most based on my own experience as a parent), I talk with parents about how important it is to develop a regular routine of twice-daily brushing, even when your toddler fights it. Not every brushing will be perfect. Every parent has had those times where their child clamps down their lips, and you just don’t have the heart to really pry their mouths open to brush all corners of every last tooth. However, if a child learns that this is the routine, the fighting will become less and less with time. I tell parents it is better to get a mediocre tooth brushing in than no brushing at all. I also assure them that, particularly for younger children, they do not have to brush their teeth in the bathroom in front of the sink. As long as you are using an appropriately small amount of toothpaste, you can brush while sitting on the bed reading books or in the rocking chair. Some children do better with the routine of being in the bathroom, while others do better in a safer, feeling more comfortable environment.
Overall, as pediatric providers, we can be important partners with our dental colleagues in making sure that children – and their teeth – are healthy.
Dr. Beers is an assistant professor of pediatrics at Children’s National Medical Center and the George Washington University Medical Center, Washington. She is chair of the American Academy of Pediatrics Committee on Residency Scholarships and president of the District of Columbia chapter of the American Academy of Pediatrics. E-mail Dr. Beers at pdnews@ frontlinemedcom.com.
Oral health has deservedly attracted increased attention over recent years. Cavities are the No. 1 chronic disease affecting young children, yet pediatric dentist availability is inadequate, and most pediatricians receive little education on oral health during their training. Additionally, recommendations for good oral health may be hard for parents to implement when their infant is crying for a bottle in the middle of the night or their toddler is fighting all efforts at good tooth brushing.
In my own practice, I feel very lucky to have a close partnership with an excellent pediatric dentistry department from whom I have learned a great deal. I have discovered a lot of facts, but also many practical tips that I have been able to use clinically and pass on to families. The first and most important thing I have learned from my dentistry colleagues is how important it is for pediatric primary care providers to ask about oral health at every visit. There are different ways to incorporate this into your history taking, but I typically ask when I am doing my ear, nose, and throat exam. I find this is most efficient, but also the best time to elicit parents’ questions and concerns about oral health (and also a time for me to provide positive feedback).
The second extremely helpful tip I have learned is how to get a good exam. Older patients are, of course, much more likely to be cooperative, and the very young infants also are fairly easy to examine. A mad 18-month-old, on the other hand, can be a real challenge! Again, as I was taught by my dental colleagues, I ask the parent to sit in a chair and put the child in their lap, facing them and with the child’s legs on either side of the parent’s hips. I also sit in a chair, facing the parent (at which point the child’s back is toward me). The parent then lays the child back along their legs, so that the child’s head is in front of me, and I am looking down their nose into their mouth. This is a perfect angle to be able to control the child’s mouth and get a direct look in – so I can be quick and thorough. For parents whose children really fight tooth brushing, I teach them this technique as well if there are two adults in the house available to help with the dental hygiene routine. In my experience, I find that in addition to providing control and a good angle for an exam, as long as you move them into the position slowly, young children find this a comforting position in which to have their mouth examined. They are somewhat cocooned by the parent’s legs and arms, which seems to help them feel protected and a little calmer.
Finally (and this is perhaps most based on my own experience as a parent), I talk with parents about how important it is to develop a regular routine of twice-daily brushing, even when your toddler fights it. Not every brushing will be perfect. Every parent has had those times where their child clamps down their lips, and you just don’t have the heart to really pry their mouths open to brush all corners of every last tooth. However, if a child learns that this is the routine, the fighting will become less and less with time. I tell parents it is better to get a mediocre tooth brushing in than no brushing at all. I also assure them that, particularly for younger children, they do not have to brush their teeth in the bathroom in front of the sink. As long as you are using an appropriately small amount of toothpaste, you can brush while sitting on the bed reading books or in the rocking chair. Some children do better with the routine of being in the bathroom, while others do better in a safer, feeling more comfortable environment.
Overall, as pediatric providers, we can be important partners with our dental colleagues in making sure that children – and their teeth – are healthy.
Dr. Beers is an assistant professor of pediatrics at Children’s National Medical Center and the George Washington University Medical Center, Washington. She is chair of the American Academy of Pediatrics Committee on Residency Scholarships and president of the District of Columbia chapter of the American Academy of Pediatrics. E-mail Dr. Beers at pdnews@ frontlinemedcom.com.
Oral health has deservedly attracted increased attention over recent years. Cavities are the No. 1 chronic disease affecting young children, yet pediatric dentist availability is inadequate, and most pediatricians receive little education on oral health during their training. Additionally, recommendations for good oral health may be hard for parents to implement when their infant is crying for a bottle in the middle of the night or their toddler is fighting all efforts at good tooth brushing.
In my own practice, I feel very lucky to have a close partnership with an excellent pediatric dentistry department from whom I have learned a great deal. I have discovered a lot of facts, but also many practical tips that I have been able to use clinically and pass on to families. The first and most important thing I have learned from my dentistry colleagues is how important it is for pediatric primary care providers to ask about oral health at every visit. There are different ways to incorporate this into your history taking, but I typically ask when I am doing my ear, nose, and throat exam. I find this is most efficient, but also the best time to elicit parents’ questions and concerns about oral health (and also a time for me to provide positive feedback).
The second extremely helpful tip I have learned is how to get a good exam. Older patients are, of course, much more likely to be cooperative, and the very young infants also are fairly easy to examine. A mad 18-month-old, on the other hand, can be a real challenge! Again, as I was taught by my dental colleagues, I ask the parent to sit in a chair and put the child in their lap, facing them and with the child’s legs on either side of the parent’s hips. I also sit in a chair, facing the parent (at which point the child’s back is toward me). The parent then lays the child back along their legs, so that the child’s head is in front of me, and I am looking down their nose into their mouth. This is a perfect angle to be able to control the child’s mouth and get a direct look in – so I can be quick and thorough. For parents whose children really fight tooth brushing, I teach them this technique as well if there are two adults in the house available to help with the dental hygiene routine. In my experience, I find that in addition to providing control and a good angle for an exam, as long as you move them into the position slowly, young children find this a comforting position in which to have their mouth examined. They are somewhat cocooned by the parent’s legs and arms, which seems to help them feel protected and a little calmer.
Finally (and this is perhaps most based on my own experience as a parent), I talk with parents about how important it is to develop a regular routine of twice-daily brushing, even when your toddler fights it. Not every brushing will be perfect. Every parent has had those times where their child clamps down their lips, and you just don’t have the heart to really pry their mouths open to brush all corners of every last tooth. However, if a child learns that this is the routine, the fighting will become less and less with time. I tell parents it is better to get a mediocre tooth brushing in than no brushing at all. I also assure them that, particularly for younger children, they do not have to brush their teeth in the bathroom in front of the sink. As long as you are using an appropriately small amount of toothpaste, you can brush while sitting on the bed reading books or in the rocking chair. Some children do better with the routine of being in the bathroom, while others do better in a safer, feeling more comfortable environment.
Overall, as pediatric providers, we can be important partners with our dental colleagues in making sure that children – and their teeth – are healthy.
Dr. Beers is an assistant professor of pediatrics at Children’s National Medical Center and the George Washington University Medical Center, Washington. She is chair of the American Academy of Pediatrics Committee on Residency Scholarships and president of the District of Columbia chapter of the American Academy of Pediatrics. E-mail Dr. Beers at pdnews@ frontlinemedcom.com.
