3. CONTENTS
1. INTRODUCTION
2. PRENATAL COUNSELLING
3. GUIDELINES FOR 6 TO 12 MONTHES OF AGE
4. GUIDELINES FOR 12 TO 24 MONTHES OF AGE
5. GUIDELINES FOR 3 TO 6 YEARS OF AGE
6. GUIDELINES FOR 6 TO 12 YEARS OF AGE
7. GUIDELINES FOR ADOLESCENCE
8. SUMMARY
9. REFERANCE
4. INTRODUCTION
ANTICIPATORY GUIDANCE is a proactive development
based counselling technique that focus on the needs of a child at
each stage of life
It is a compliment to Caries Assessment Tool
The aim of AG is to address protective factors in effort to prevent
oral health problem
AG would include discussion on oral development ,diet and
nutrition, fluoride adequacy, oral habits, injury prevention, and
oral hygiene.
5. PRENATAL COUNSELLING
Parents should be educated regarding
Oral development of their child
Appropriate feeding practices
Dental disease process
Oral hygiene measures
Mothers health during pregnancy
Increased food demand during pregnancy
6. Why are the primary teeth important?
It act like the foundation stone for
permanent teeth
Maintain proper space for the permanent
teeth
Help in normal growth of jaw height and
give shape to the face
Provide a sense of self worth by
contributing to one’s appearance
Help in the first step of grinding of food ,
8. Oral development
Review pattern of eruption
Review teething fact- local discomfort, irritablity & excess salivation
Fluoride
Assess fluoride status- no more than rice sized fluoridated toothpaste used
twice daily
Determine suppliments if needed such as fluoride varnishes
Oral hygiene/health
Review oral hygiene techniques with parents
Plan for next visit based on risk assessment
Habits
Review pacifier use
Discuss thumb sucking effects on mouth
9. Nutrition and diet
Encourage weaning at the appropriate time
Weaning should occur at 4 -6 momths
Stage 1 – 4-6 months - food must be sieved, pureed or very finely minced
Stage 2 – 6-9 months – minced and mashed food includes small soft lumps
Stage 3 – 9-12 months – baby should eat similar foods to the rest of the family
Discuss the role of sugar in dental caries initiation
Injury prevention
Review what to do if patient has traumatic injury
Provide emergency number
10.
11. Milestones : completion primary dentition, occlusal
relationships establishment, arch length determined
Guidance for 12 to 24 months of age
12. Oral development
Discuss importance of space maintaining
Discuss bruxing
Fluoride
Reassess fluoride status
Discuss toxicity and how to manage accidental ingestion
Oral hygiene/health
Review home oral care procedure and compliance
Plan for next visit
13. Habits
Review non nutritive sucking
Thumb sucking and pacifiers use will lead to
Anterior open bite, maxillary constriction etc..
Nutrition and diet
Discuss carbohydrate 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
14. Milestones : loss of first primary tooth, eruption
of first permanent molar or incisor
Guidance for 2 to 6 years of age
15. Oral development
Review patterns of eruption, point out permanent incisor
Describe healthy periodontal tissue
Fluoride
Reassess fluoride status at periodic visit and determine both
supplement and age appropriate vehicle
Fluoridated toothpastes not more than a pea size
Child should brush under the supervision of parents to ensure
expectoration
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
16. Habits
If child is still sucking the thumb, discuss hoe to help him stop the
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
Review difference between primary and
permanent teeth with parents during examination
18. Oral development
Discuss about the importance first permanent
molar
Discuss the various preventive measures taken
at this stage to prevent progression of caries
Nutrition and diet
Review diet outside the home and its caries
potential
Fluorides
Application topical fluorides if needed
Regular use of tooth paste is recommended
19. Oral hygiene/health
Parents should continues to monitor brushing and flossing frequency
and adequacany
Application of pit and fissure sealants if necessary
Habits
Educate about any oral habits if it is present
Educate the parents about transitional changes in the developing
dentition and the importance of primary and permanent dentition
21. Prevention of periodontal disease become a special concern
At this age group the main process utalized are
a) Rejection of many parentral values
b) The beginning of independent struggle
c) The testing out types of behavioural experimentaion
Parents are educated that they should treat the child at this stage
very diplomatically
Parents should have a friendly approach
The child should be given enough emotional support from parents
22. Oral hygiene/health
The adolescent patient posses the fine motor skills necessary for adequate
tooth brushing and flossing
Problems in compliance are likely to be encountered
Diet
High frequency of sugar consumption
Progression of lession halted with an appropriate diet and aggressive topical
fluoride therapy
Fluorides
Systemic fluorides are no longer benefit after the last permanent tooth erupt at
about age of 13 yrs, except for patients who have functional third molars
Topical fluorides are the most effective preventive measure of smooth surface
decay
23. Orthodontics
Many Patients undergo orthodontic treatment at this stage
High risk for both gingivitis and gingival hyperplasia and for dental caries
Topical fluoride application and thorough removal of the plaque from gingival
areas
Smokeless tobacco
Peer pressure and advertising exert pressure on adolescent to establish a
habit that may result in addiction.
Parents should be instructed / counseled not to rag or punish the
adolescent as it may further worson the habit
Discuss the health risk in smoking
Instruct parents to avoid smoking infront of the children
Discuss nicotine replacement and medication
24.
25. PREVENTION OF DENTAL INJURIES
Dental injuries can lead to discoloration,
malformation and even loss of tooth
Primary care clinicians are in a unique position to
help families prevent accidental trauma, including
oral trauma, by providing anticipatory guidance at
routine visits
Most injuries to primary teeth occurs within
toddlers 12 to 30 months of age
The best approach to take active measures to
prevent injuries
26. AVULSION
Do NOT re-implant a primary tooth, as this may damage the underlying
permanent tooth. Instead, refer to a dentist within 24 hours.
•Avulsion should be managed as follows:
1. Gently rinse off debris with saline or milk. Hold tooth by crown only.
2. Avoid touching the root. Do not clean or rub it. It is important to
preserve the periodontal ligament for tooth survival.
3. Re-implant an avulsed permanent tooth immediately, ensuring
correct orientation. The tooth should be re-implanted within 20
minutes, but the best outcome is with teeth replaced within 5
minutes.
4. Instruct patient to bite on gauze or a handkerchief or to hold the
tooth in place.
27. 5. Send to a dentist or maxillofacial surgeon immediately for
radiographs, splinting, and antibiotic prophylaxis.
6. If the tooth cannot be re-implanted on scene, transport it
(ordered by preference) in: a tooth storage solution, warm milk,
saline, or saliva.
7. A tooth should not be transported dry or in plain water, as this
significantly decreases the chance of ligament survival.
8. Never suggest a child hold the damaged tooth in his or her
mouth
28. Accident Prevention
Suggestions for accident prevention specifically related to oral
trauma:
1. Advise parents about possible injury to developing permanent teeth
from trauma if a primary tooth is injured.
2. Review and anticipate developmental milestones.
3. Counsel about the risks of walkers and trampolines.
4. Discuss childproofing the home.
5. Review safety measures for outdoor activities and sports.
6. Stress the importance of adequate supervision at all times, especially on
furniture, stairs, at the playground, and at athletic events or practices.
7. During trauma if the tooth is avulsed, parents should be instructed to
keep the avulsed teeth under tongue of child or store the tooth in saline
or milk and contact dentist
29. Sports and Protective Gear
Sports participation poses a significant risk for trauma
The highest risk sports for oral trauma are baseball,
soccer, football, basketball, and hockey.
Skateboarding, rollerblading, and bicycling injuries
are also common.
Helmet and face masks should be properly fitted and
worn during all games and practices for the sports in
which they are recommended.
Statistically, children are more often injured in
practice than during a game, so all protective gear
should be worn during practice as well.
30. Mouth Guards
Mouth guard use is mandatory for football, ice hockey,
lacrosse, field hockey, and boxing.
Several states have passed regulations mandating mouth
guards for soccer, basketball, and wrestling
31. SUMMARY
Anticipatory guidance is to providing an insight into the
development of a child will involve the parent , with a much more
foccused stratergy
At every stage it is essential that the dentist takes into
consideration the various milestones of dental development
Such AG makes the parents more at ease during childhood dental
visit, these pointers are also essential in preventing many of the
possible dental problems in childrens
32.
33. REFERANCE
Textbook Of Pedodontics, Shoba Tandon
Textbook Of Paedodontics , Nikhil Marwah
Textbook Of Pediatric Dentistry , Pinkham
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