Pediatric Clinics of North America

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Self-Applied Fluoride Compounds

Fluoride gels with a concentration of 0.5% sodium fluoride (5000 mg/kg) or 0.4% stannous fluoride (1000 ppm) are available as prescription agents for patient self-application using custom-made dental trays or simply by toothbrush. Although the evidence supporting the caries-protective benefits of 0.5% NaF is good, no clinical trials have documented the efficacy of 0.4% stannous fluoride, which has the same fluoride concentration as does dentifrice. The stannous ion, however, has been shown to have some antimicrobial effects. [24] Self-applied gels are primarily reserved for short-term use in individuals at high risk for caries.


Pediatricians can do much to make parents more aware of the importance of preventing dental disease in their children. Pediatricians interested in promoting good oral health should identify demographic and socioeconomic risk factors for dental caries and flag high-risk children as being in need of more intensive preventive counseling.

Pediatricians should include a brief dental screening as part of the routine examination of well children. The mouth should be inspected, noting the number of erupted teeth, their color, spacing, enamel quality, presence of dental restorations, and obvious dental caries. Patients with caries should be referred to a dentist immediately for treatment.

Practitioners should consider including the following educational aspects in the anticipatory guidance that they provide to all parents:

Nutritional counseling. Before the eruption of teeth, parents should be taught basic information about the role of diet in promoting good oral health, and dietary factors that can lead to dental decay. Pediatricians should advise parents about appropriate foods and snacks.

Feeding practices. Inappropriate use of nursing bottles and "tippy" cups as pacifiers should be discussed. Prolonged at-will breastfeeding or use of a nursing bottle at sleeptimes should be discouraged. Parents should be apprised of the dental effects of the prolonged use of high-sugar liquids and foods.

Oral and dental cleaning. The pediatrician or office staff member should demonstrate methods of cleaning the oral cavity and, when erupted, the teeth. Parents should be instructed to clean the infant's mouth routinely after feedings. This practice ingrains in the child and parent the need for regular tooth brushing when the child is older. Parents of toddlers and preschool-aged children should be reminded to perform tooth cleanings for their children, introducing fluoridated toothpaste when the child has some control of the swallowing reflex, or earlier for high-risk children. Parents should be cautioned to use a pea-sized dab of toothpaste and to guard against swallowing excessive amounts of dentifrice.

Review of medications. High-sugar medications that a child is taking long term should be identified, and parents should be cautioned to clean the child's teeth after ingestion. Physicians should consider sugar-free alternatives, if available.

Determination of fluoride status. Physicians should determine the fluoride content of the primary drinking water source. Dietary supplemental fluoride should be prescribed as appropriate. Physicians should educate parents about the benefits and provide instructions on proper administration.


Pediatricians should assist parents in establishing a dental home for their children by referral to a pediatric dentist or family dentist for an initial evaluation and consultation. The American Academy of Pediatric Dentistry [6] and the American Public Health Association [7] recommend that a child's first dental visit occur within 6 months after the eruption of the first tooth, typically at 1 year of age. If a family does not have access to dental care, physicians should refer to a community dental clinic or health department for care and treatment as needed.

Finally, pediatricians and dentists should work together for the benefit of the child. Promoting good oral health is as critical as is any other aspect of pediatric care in promoting good overall health.


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Figure 1. Pit and fissure sealants in place on two permanent upper molars. The sealant is adhesively bonded to the tooth enamel and prevents fermentable carbohydrate from entering the narrow pits and fissures in which cariogenic bacteria reside.
Figure 2. A white spot lesion on the mesial proximal surface of primary lower molar now visible because of the exfoliation of the adjacent primary molar. The white spot represents an area of enamel that has been demineralized by the organic acids produced by plaque bacteria. As long as the surface enamel remains intact, as it is in this example, it is possible to remineralize the lesion.
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