Infancy • 0 – 11 Months

Health professionals should select the information in this section that is most appropriate, using clinical judgment to decide what is timely and relevant for each individual infant and family.

Family Preparation

To help prepare families for oral health supervision visits, health professionals can provide parents with a list of topics to discuss at the next visit. Topics may include the following:

• Teething and other changes in the mouth
• Oral hygiene practices (frequency, problems)
• Use of fluoridated water for drinking, cooking, or formula preparation
• Fluoride use (fluoridated toothpaste, fluoride supplements)
• Use of a bottle or cup by infant
• Feeding practices
• Nonnutritive sucking (pacifier, thumb, finger)
• Illnesses or infections
• Medications
• Injuries to the teeth or mouth
• Use of tobacco by parents

Interview Questions

Following are examples of questions that health professionals may use. In addition to asking these or other interview questions, discuss any issues or concerns the family has.

• Does Felicity have any teeth? How many?
• Do you brush Alexander's teeth? How often?
• Do you use fluoridated toothpaste? How much?
• Are you breastfeeding, bottle feeding, or both? How is feeding going?
• How well does Julia fall asleep? Do you give her a bottle in bed? What is in the bottle when you put her to bed?
• Does Thomas use a pacifier? Does he suck his thumb or finger?
• Do you put Celeste in a rear-facing car seat when she rides in a vehicle? Do you buckle her in the car seat?
• Do you have a family dentist? Did you see a dentist during your pregnancy?
• Has Carlos been to the dentist? Does he have a dental home? If not, have you made an appointment for his first dental visit?
• Has Natalie been to a health professional? If not, have you made an appointment for her first health supervision visit?

Risk Assessment

Use the risk assessment tables and caries risk assessment tools to assess the infant's risk factors for oral health issues.

Screening

Visually inspect the lips, tongue, teeth, gums, inside of the cheeks, and roof of the mouth.

Examination

The first oral examination should occur within 6 months of the eruption of the first primary tooth, and no later than age 12 months.

Anticipatory Guidance

Discuss with Parents:

Oral Health Care

• Making an appointment for the infant's first oral examination within 6 months of the eruption of the first primary tooth, and no later than age 12 months, thereby establishing a dental home.
• After the initial dental visit, making the next appointment for the infant according to the schedule recommended by the dentist, based on the infant's individual needs or risk for developing tooth decay.
• For infants with special health care needs, making appointments for more frequent dental visits as directed by the dentist based on the infant's needs or susceptibility to disease.
• Discussing with a dentist or other qualified health professional the need to apply fluoride varnish. Topical fluoride may be especially effective for infants at high risk for tooth decay, particularly those who have a history of decay, do not have access to fluoridated water, snack frequently on foods or beverages containing sugar, or have a medical problem that decreases their resistance to tooth decay.
• Giving the infant age 6 months or older at high risk for developing tooth decay dietary fluoride supplements only as prescribed by a dentist or physician (see Dietary Fluoride Supplementation Schedule for Children and Adolescents at High Risk for Developing Caries).

Oral Hygiene

• Cleaning the infant's gums with a soft clean damp cloth at least once a day. This helps the infant become comfortable with someone working in his or her mouth.
• Brushing the infant's teeth with a small smear of fluoridated toothpaste as soon as the first tooth erupts, usually around age 6 to 10 months, twice a day (after breakfast and before bed). Do not rinse the infant's mouth with water. The small amount of fluoridated toothpaste that remains in the mouth helps prevent tooth decay.
• Using a soft-bristled toothbrush with a small head, preferably one designed specifically for infants.
• Not giving the infant anything to eat or drink (except water) after brushing at night.
• For infants with special health care needs, adapting or obtaining special oral health equipment (e.g., adapting a toothbrush) to brush the teeth.
• Becoming familiar with the normal appearance of the infant's gums and teeth so that problems can be identified if they occur (see Tooth Eruption Chart). Checking the infant's gums and teeth about once a month by lifting the lip to look for decay on the outside and inside surfaces of the teeth.
• If the infant has sore gums caused by tooth eruption, rubbing the infant's gums with a clean finger or a moistened gauze pad or cool damp washcloth to try to ease the discomfort. Other options include giving the infant a chilled teething ring (made of firm rubber) or cool spoon. If the infant is especially cranky, give acetaminophen or ibuprofen, following the dosage directions for infants on the container.

Nutrition

• Breastfeeding the infant exclusively for approximately the first 6 months of life, and continuing to breastfeed until age 12 months or as long as the mother and infant wish to continue.
• For mothers who cannot breastfeed or choose not to breastfeed, feeding the infant a prepared infant formula. Use fluoridated water (via a community fluoridated water source) or bottled water that contains fluoride for preparing infant formula.
• Avoiding testing the temperature of the bottle with the mouth, sharing utensils (e.g., spoons), or orally cleaning a pacifier or a bottle nipple. This practice helps prevent transmission of bacteria that cause tooth decay from the parent, especially the mother, to the child via saliva.
• To prevent sugary fluids from pooling around the teeth, which can increase the infant's risk for tooth decay, not putting the infant to sleep with a bottle or sippy cup. Also, do not allow prolonged bottle feedings or use of sippy cups with beverages containing sugar (e.g., fruit drinks, pop (soda), fruit juice), milk, or formula during the day or at night.
• Holding the infant while feeding. Make sure to never prop a bottle (that is, use pillows or any other objects to hold a bottle in the infant's mouth).
• Never adding cereal to a bottle. This causes sugary fluids to pool around the teeth. Feed infants solid foods with a spoon or fork, or, once they are able, encourage self-feeding.
• Introducing a small cup when the infant can sit up without support.
• Weaning the infant from the bottle as the infant begins to eat more solid foods and drink from a cup. Begin to wean the infant gradually, at about age 9 to 10 months. By age 12 to 14 months, most infants can drink from a cup.
• Not introducing juice into infants' diets before age 12 months.
• For infants ages 6 months and older, serving age-appropriate healthy foods during planned meals and snacks, and limiting eating (grazing) in between.
• Serving fewer foods with added sugar, such as candy, cookies, cake, fruit-flavored drinks, and pop (soda). Many foods contain one or more types of sugar, and all types of sugar can promote tooth decay. To help choose foods low in sugar, read food labels.

Nonnutritive Sucking

• If parents choose to have their infant suck a pacifier, advising them to take certain safety precautions. The following precautions are recommended:
  • Never attaching a pacifier to a ribbon or string around the infant's neck.
  • Making sure the pacifier is of sturdy, one-piece construction and that the material is flexible, firm, and not brittle.
  • Keeping the pacifier clean.
  • Not dipping a pacifier in sweetened foods (e.g., sugar, honey, syrup) to encourage sucking.
  • Never orally cleaning a pacifier, then giving it to the infant.

Injury Prevention

• Being aware that injuries to the head, face, and mouth are common among infants.
• Learning how to prevent oral injuries and how to handle oral emergencies. Because of the danger of damaging the underlying permanent teeth, never attempt to reinsert an avulsed (lost) primary tooth. It is impossible to relocate the tooth accurately, and there is danger of pushing it too far into the soft alveolar bone and damaging the permanent tooth developing below the primary tooth.
• Always keeping one hand on an infant on high places such as changing tables, beds, sofas, or chairs.
• Using an appropriate car seat in the back seat of the vehicle at all times. Buckle the infant into a rear-facing car seat.
• Not placing an infant in a shopping cart. Instead, consider using a stroller, a wagon, or a frontpack while shopping with an infant. If an infant is placed in a shopping cart, follow these safety rules:
  • Place the infant in a safety belt or harness at all times while in the cart.
  • Do not place an infant carrier on top of the shopping cart.
  • Never leave the infant alone in the shopping cart.
• Using safety locks or latches on cabinets and drawers. Keep all sharp knives or other sharp utensils, poisonous substances, medicines, cleaning agents, health and beauty aids, and paints and paint solvents in a safe place.
• Keeping pet food and dishes out of reach. Do not permit the infant to approach the pet while it is eating.
• Keeping electric appliance cables and dangling telephone, electric, blind, and drapery cords out of reach of infants (e.g., wrap blind and drapery cords onto cleats so infants cannot access them).
• Locking doors and using safety gates at the tops and bottoms of stairs, and using safety locks and safety devices on windows above the ground floor.
• Supervising the infant on stairs or furniture.
• Making sure that playgrounds are carefully maintained and that equipment is in good condition. All playground equipment should be surrounded by a soft surface (e.g., fine, loose sand; wood chips; wood or rubber mulch) or by rubber mats manufactured for this use.
• Supervising the infant on playground equipment. Make sure infants play only on developmentally appropriate equipment.
• Not giving toys small enough to be placed in the mouth. Make sure that toys do not have parts that can become detached. Keep toys with small parts or sharp edges out of reach.
• Making sure that toys are soft (e.g., balls not made with leather or hard materials).
• Not using an infant walker with wheels.
• Providing the infant's caregivers with the dentist's emergency phone contacts, and ensuring that the caregivers know how to handle all emergencies.

Substance Use

• Avoiding exposing the infant to secondhand smoke.

Outcomes

• Parents and infant are under the care of an oral health professional.
• Parents are informed of oral development issues.
• Parents understand and practice good oral hygiene, feeding, and eating behaviors.
• Parents establish a safe environment and practice safety behaviors.
• Infant has no oral disease or injury.

 

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