Doctors Beware: The Dilemma of Infant Oral Care

by M-Reza Nouri, DMD, Dip.Paedo., FRCD(C)

I recently had the opportunity to examine a five-year-old boy as a new patient in my office. The medical history was non-contributory other than seasonal asthma and the fact that he had undergone three surgeries for cleft lip and palate.

The ravages of caries had turned every primary tooth in his mouth into root stumps with multiple fistulas and abcesses. It was hard to believe that any health professional had ever had the opportunity to look into his mouth other than to have performed the surgeries on his cleft lip and palate.

The dilemma is that we come across similar cases far too often. It appears that some of our medical colleagues continue to remain ambivalent to the contribution of the role of good oral health in the overall health of children. Even more disturbing is that some dental professionals have not adopted any means of managing the oral health needs of infants and young children. This is despite recent guidelines that the first oral health assessment of an infant should occur within six months of the eruption of the first tooth or by one year of age. Health professionals should be aware of the legal implications of these guidelines since they may be found liable in such instances where management of existing oral disease has been unnecessarily delayed.

For the first time ever, this year the U. S. Surgeon General’s workshop focused on children’s oral health. This is primarily due to the alarming statistic that dental treatment for early childhood caries is the number one reason why children undergo general anaesthesia in many regions of North America.

The challenge of managing the early childhood caries should be tackled on two fronts. Public education about this preventable disease should be the first goal. This may be achieved through the dissemination of appropriate feeding and oral health guidelines to the expectant parents of all children. Secondly, educators in health sciences should emphasize the relevance of good oral health to the overall health of children. The primary goal of infant oral health care is the recognition of any abnormalities. The amount of time required to disseminate this information in any professional program is minimal.

It is time for national and provincial regulatory bodies to establish educational guidelines for the health care professionals in all fields of child care in order that they may be familiarized with the importance of the early detection of oral disease, including childhood caries. Although it may be argued that a dental professional is the only person qualified to assess the oral health status of any patient, the fact remains that educators and health care providers in pre-natal and neo-natal settings remain the dental profession’s best means of reaching this portion of society. Indeed, a preliminary oral exam and provision of educational pamphlets should become part of every infant’s first medical assessment.

Dental undergraduate programs must emphasize the importance of the early diagnosis and management of any oral abnormalities in children. Post-graduate training programs in paediatric dentistry can also make a significant contribution by strengthening their sedation programs. In this way the present overuse of general anaesthetic for the provision of dental treatment in children will be reduced.

One of the dental profession’s essential responsibilities to the public is that it must stay current and act upon the new guidelines as they are produced. We must be cognizant of this responsibility and take appropriate steps in managing the dilemma of infant oral care.