Anticipatory Guidance

	February 2, 2005
	Joseph McManus, DMD,MS,MHA,MBA

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

Classic Preventive Dentistry for Children

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

POINTS OF VIEW

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

THE 80/20 RULE

	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.

FACTS

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

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

THE MEDICAL APPROACH

	WHAT’S UP DOC??

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

PARENT’S ARE USUALLY CLULESS

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.
	Alerting them to impending change.
	Teaching them their role in maximizing their children’s development.

"Child’s Developmental Age Range"

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

Child’s Developmental Age Range
6-12 months

Milestone: The Eruption of the first primary tooth

6-12 months

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

Child’s Developmental Age Range:
12-24 months

Milestones: Completion of primary dentition, occlusal relationships established, arch length determined

12-24 months

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

Child’s Developmental Age Range:
2-6 years

Milestones: Loss of first primary tooth, eruption of first permanent molar or incisor

2-6 years

	Oral Development
		Review patterns of eruption. Point out permanent molar anatomy
		Describe healthy periodontal tissue
	Fluoride
		Reassess fluoride status
	Oral Hygiene/Health
		Review home oral care procedures and compliance
		Discuss dental sealants and describe dental radiographs
		Plan for next visit based on risk assessment
	Habits
		If child is still sucking the thumb, discuss how to help him D/C habit
	Nutrition and Diet
		Review diet outside the home and its caries potential
		Discourage the use of food as a behavioral tool
	Injury Prevention
		Encourage the use of helmets, mouth guards, and car seats.
		Develop plans for oral trauma management .

Available Literature

	American Academy of Pediatrics
	American Academy of Pediatric Dentistry
	American Dental Association