Guideline 15

Guideline 15: Oral Health Screening for Infants and Children

Purpose
Having a healthy mouth and teeth plays a vital role in developing and maintaining the overall health and wellness of children, and good oral health starts with a child's baby teeth. Having healthy primary teeth allows a child to chew and eat properly; speak more clearly; guides adult teeth into place; helps to shape a child's face; and keeps future dental costs to a minimum. The purpose of a screening is to identify normal versus abnormal oral conditions and to make referrals for dental care.

Process

A basic oral assessment for newborns is important and should be done as part of the newborn history and physical assessment. Starting at birth to evaluate soft structures which can impact feeding, and then continuing at 4-6 months when teething may begin, perform an oral health screening. Recommended screening tools include those endorsed by the Oregon Oral Health Coalition (e.g., The First Tooth Caries Risk Assessment), the American Dental Association, the American Academy of Pediatric Dentistry, or the American Academy of Pediatrics.
An oral health screening is comprised of two parts:

Reviewing oral health history/risk assessment
Performing a physical examination of the child's teeth and gums

The oral health history review should cover a child's and his/her caregiver's past and current oral health practices and experiences to help discover risk for oral problems. This review can include the following:

Maternal oral health history (including history of cavities)
Previous oral problems
Diet and nutrition
Fluoride intake (recommended intake will depend on community water fluoridation status, supplementation recommended if none in water at 6 months of age, refer to provider for amount)
Primary source of drinking water
Past fluoride treatment
Fluoride supplements (e.g. tablets or liquid)
Orla health home, Dental visit history
Medications that affect the mouth
Baby bottle or sippy cup use
Tooth brushing practices

An oral health screening involves a physical examination of a child's mouth, including the lips, tongue, teeth, gums and tissues. For a child less than 3 years of age: the home visitor and the caregiver should sit facing each other with their knees touching. Lay the child on the home visitor's lap with his/her head securely nestled against the screener's abdomen. With gloved hands, the screener should lift the child's lips, feel the soft tissues, check the physical condition of the teeth and gum and look throughout the mouth. For “tongue tie" evaluation the TABBY screening tool is useful as a visual assessment. Scores below 5 indicate a need for referral to the primary provider, IBCLC, and/or ENT (see AAP guidelines on ankyloglossia- https://publications.aap.org/pediatrics/article/154/2/e2024067605/198022/Identification-and-Management-of-Ankyloglossia-and?autologincheck=redirected). For a child 3 years of age or older, the child can be checked while sitting close and across from the screener. A tongue depressor can be used to move the lips to view the teeth and gums.

Interventions

Provide age and culturally appropriate anticipatory guidance. See parent handouts from My Children's Teeth for specific guidance on birth to school age.
If drinking non-fluoridated water, ensure family has supplemental fluoride and are administering.
If local protocols are in place, apply fluoride varnish. This website provides a training on varnish application.
Ensure parents are regularly brushing any and all teeth with a fluoride toothpaste.
Refer children for regular dental care or immediate care if assessed to be at increased risk for oral disease. Every child should have a dental visit by age 1. OHP covers dental care from birth.

Guideline 15

Guideline 15: Oral Health Screening for Infants and Children

Process

Interventions

References:

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