Anticipatory Guidance- Our Role as Practitioners

by Keith Titley, BDS, MScD, FRCD(C)

By definition anticipatory guidance is a proactive developmentally based counseling technique that focuses on the needs of a child at each stage of life. By providing practical and contemporary health information to parents before significant physical, emotional and psychological milestones, parents will anticipate impending changes, maximize their child’s developmental potential and identify their child’s special needs.1

During the first year of life infants will routinely see a paediatrician or physician several times for ‘well baby’ check ups or any other incidents of ill health that might affect them. However, it has been reported that the majority of paediatricians and physicians feel they were insufficiently trained in paediatric dental care. Although very few infants younger than one year of age have oral problems that require intervention, almost all have an oral environment that is at risk for oral diseases.1 As a result, paediatricians and physicians can play an important role by recommending that an infant should see a dentist by one year of age.

A little over three years ago, the American Academy of Pediatric Dentistry (AAPD) adopted its policy on the dental home based on the construct of the medical home described by the American Academy of Pediatrics (AAP) in 1992.2 The process as outlined by the AAP included education, anticipatory guidance, counseling and round-the-clock availability to manage emergent situations. The dental home proposed by the AAPD was designed to ensure that each child will receive the care that will optimize his or her oral health. The dental home coordinates with other providers, both specialists and generalists alike, to enable the child to achieve the highest level of oral health possible with the emphasis being on access to care.3

Included in the AAP medical home proposal is the recommendation that oral health risk assessments begin at six months of age and that infants, in particular at risk groups, be referred to a dentist between six to 12 months of age. It has been reported that paediatricians in many communities are having difficulty in finding dentists who will accept patients at this age.3

At the age of one, few, if any, of the primary teeth have erupted. This is the ideal time for advice to be given in prevention of dental disease so that its effects will never have to be dealt with. Of particular concern are medically compromised children for whom the treatment and sequelae of active dental disease represents a life threatening risk. Information should be given on the colonization of the oral cavity with bacteria, early childhood caries (ECC), oral hygiene, feeding management and fluoride usage. This should be imparted in terms that parents can readily grasp and understand.

Advantage should be taken of the many pamphlets, audio visual (AV) aids made available by the Canadian Dental Association (CDA), Provincial Dental Associations, Canadian Faculties of Dentistry and companies in allied health fields.

In the Paediatric Dental Department at the University of Toronto, Associate Professor Gajanan Kulkarni with former MSc student Dr. Lisa Alsada and current MSc student Dr. Lyn Poranganel have produced an AV aid for improving infant oral care through primary caregiver education. They are currently testing its efficacy as a tool in parental attitudes to ECC and improving both access to care and infant oral health.4,5

The AV-aid is currently available as a DVD or VHS tape in English, French and Arabic. It has also been translated into Spanish, Portugese and Tamil and funding is currently being sought to have it recorded in these languages. A description of the development of the AV-aid, its aims and objectives and its effectiveness as an educational tool are included in this issue of Oral Health.**

In our increasingly multi-lingual society it is important that the transfer of basic information for the maintenance of optimal health be presented in terms that parents can readily understand and assimilate.


1.Nowak AJ. Rationale for the timing of the first oral evaluation. Paediatr Dent (1997); 19: 8-11.

2.American Academy of Paediatrics Ad Hoc Task Force on Definition of the Medical Home. The medical home. Paediatrics (1992); 90: 774.

3.Adair SM. Editorial: The Dental Home — Why the Delay? Paediatr Dent (2005); 27: 4.

4.Alsada LH. Development and testing of an audio-visual aid for improvement of infant oral health through primary caregiver education. MSc Thesis (2004), University of Toronto.

5.Porangannel L, Titley KC, Kulkarni G. Establishing a dental home: A program for promoting comprehensive oral health starting from pregnancy through childhood. Oral Health (2006), current issue.

**For readers who may wish to purchase the AV-aid contact: Dr. G. Kulkarni at 416-979 4900 ext 4460, e-mail: