1. Anticipatory Guidance February 2, 2005 Joseph McManus, DMD,MS,MHA,MBA

2. “Using Anticipatory Guidance To Provide Early Dental Intervention” by Arthur Nowak,, DMD, MA Paul Casamassimo, DMD,MS in JADA, Vol. 126, August 1995

3. Classic Preventive Dentistry for Children Reduce caries and periodontal disease. Reduce caries and periodontal disease. Driven by the infectious disease model proposed by Keyes. Driven by the infectious disease model proposed by Keyes. Tri-factorial model Tri-factorial model 1. Agent (bacteria) 1. Agent (bacteria) 2. Host (tooth) 2. Host (tooth) 3. Substrate (carbohydrate) 3. Substrate (carbohydrate)

4. POINTS OF VIEW The Old Paradigm The Old Paradigm A child’s first visit occurs at age 3. A child’s first visit occurs at age 3. The New Paradigm The New Paradigm The child’s first visit will occur no later than her first birthday. The child’s first visit will occur no later than her first birthday.

5. THE 80/20 RULE Caries among U. S. children seem to be concentrated in about 20-25 percent of the child population. Caries among U. S. children seem to be concentrated in about 20-25 percent of the child population. 20 percent of your patients will cause 80 percent of the problems in your practice and in your professional life. 20 percent of your patients will cause 80 percent of the problems in your practice and in your professional life.

6. FACTS There are limitations in the infectious-disease model in comprehensive preventive oral care for children. There are limitations in the infectious-disease model in comprehensive preventive oral care for children. There is a need for dentists to examine children for oral conditions other than caries and periodontal disease. There is a need for dentists to examine children for oral conditions other than caries and periodontal disease. There is an evolving role of the dentist acting as an early interventionist. There is an evolving role of the dentist acting as an early interventionist.

7. Anticipatory Guidance provides a framework for prevention that goes beyond caries to address all aspects of children’s oral health!

8. THE MEDICAL APPROACH WHAT’S UP DOC??

9. CHILDREN ARE NOT BORN WITH A SET OF INSTRUCTIONS WRITTEN ON THEIR CHEST

10. PARENT’S ARE USUALLY CLULESS

11. MOM & DAD THIS IS WHAT’S UP In pediatric health care anticipatory guidance is the process of providing practical health information to parents in anticipation of significant, physical, emotional and psychological milestone. In pediatric health care anticipatory guidance is the process of providing practical health information to parents in anticipation of significant, physical, emotional and psychological milestone. Alerting them to impending change. Alerting them to impending change. Teaching them their role in maximizing their children’s development. Teaching them their role in maximizing their children’s development.

12. Child’s Developmental Age Range Child’s Developmental Age Range Milestones Milestones Content Area Content Area Oral Development Oral Development Fluoride Fluoride Oral Hygiene/Health Oral Hygiene/Health Habits Habits Nutrition and Diet Nutrition and Diet Injury Prevention Injury Prevention Dentist’s Actions Dentist’s Actions

13. Child’s Developmental Age Range 6-12 months Milestone: The Eruption of the first primary tooth

14. 6-12 months Oral Development Oral Development Review pattern of eruption Review pattern of eruption Review teething facts Review teething facts Fluoride Fluoride Assess fluoride status Assess fluoride status Determine supplements if needed Determine supplements if needed Oral Hygiene/Health Oral Hygiene/Health Review oral hygiene techniques with care giver Review oral hygiene techniques with care giver Plan for next visit based on risk assessment Plan for next visit based on risk assessment Habits Habits Review pacifier use Review pacifier use Discuss thumb-sucking’s effects on the mouth Discuss thumb-sucking’s effects on the mouth Discuss breastfeeding’s effects on the mouth Discuss breastfeeding’s effects on the mouth Nutrition and Diet Nutrition and Diet Encourage weaning at the appropriate time Encourage weaning at the appropriate time Discuss the role of sugar in dental caries initiation Discuss the role of sugar in dental caries initiation Injury Prevention Injury Prevention Review what to do if patient has traumatic injury Review what to do if patient has traumatic injury Provide emergency number Provide emergency number

15. Child’s Developmental Age Range: 12-24 months Milestones: Completion of primary dentition, occlusal relationships established, arch length determined

16. 12-24 months Oral Development Oral Development Discuss importance of space maintenance Discuss importance of space maintenance Discussing Bruxing Discussing Bruxing Fluoride Fluoride Reassess fluoride status Reassess fluoride status Discuss toxicity and how to manage accidental ingestion Discuss toxicity and how to manage accidental ingestion Oral Hygiene/Health Oral Hygiene/Health Review home oral care procedures and compliance Review home oral care procedures and compliance Plan for next visit based on risk assessment Plan for next visit based on risk assessment Habits Habits Review non-nutritive sucking Review non-nutritive sucking Nutrition and Diet Nutrition and Diet Discuss carbohydrates and their role in plaque development Discuss 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 Prevention Injury Prevention Discuss electric cord safety, child proofing the house and use of car seats Discuss electric cord safety, child proofing the house and use of car seats Develop plans for oral trauma management for preschool and child care Develop plans for oral trauma management for preschool and child care

17. Child’s Developmental Age Range: 2-6 years Milestones: Loss of first primary tooth, eruption of first permanent molar or incisor

18. 2-6 years Oral Development Oral Development Review patterns of eruption. Point out permanent molar anatomy Review patterns of eruption. Point out permanent molar anatomy Describe healthy periodontal tissue Describe healthy periodontal tissue Fluoride Fluoride Reassess fluoride status Reassess fluoride status Oral Hygiene/Health Oral Hygiene/Health Review home oral care procedures and compliance Review home oral care procedures and compliance Discuss dental sealants and describe dental radiographs Discuss dental sealants and describe dental radiographs Plan for next visit based on risk assessment Plan for next visit based on risk assessment Habits Habits 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 Diet Nutrition and Diet Review diet outside the home and its caries potential Review 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 Prevention Injury 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.

19. Available Literature American Academy of Pediatrics American Academy of Pediatrics American Academy of Pediatric Dentistry American Academy of Pediatric Dentistry American Dental Association American Dental Association