Middle Childhood • 5 – 10 Years

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 child 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:

• Changes in the teeth and the mouth
• Oral hygiene practices (frequency, problems)
• Use of fluoridated water for drinking or cooking
• Fluoride use (fluoridated toothpaste fluoridated mouthrinse, fluoride supplements)
• Dental sealant use
• Eating practices
• Nonnutritive sucking (pacifier, thumb, finger)
• Illnesses or infections
• Medications
• Physical activity and sports participation
• Injuries to the teeth or mouth
• Use of tobacco by parents or child

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. As the child becomes more mature, ask the child questions directly.

To parent:

• How often does Sarah brush or floss her teeth? Does she use fluoridated toothpaste?
• Is Jee brushing and flossing his teeth without being reminded?
• Does your child with special health care needs require more assistance or special equipment when brushing her teeth?
• Has Andrea lost any teeth yet?
• Does Mark comment about his teeth and how they look?
• How often does Selena see the dentist? When was her last dental appointment?
• Is your water fluoridated? Do you have any questions about fluoride supplements, fluoride varnish, or dental sealants?
• Does Justin eat snacks at school? After school? What types of snacks are available for Justin to eat?
• Does the school have vending machines? If so, do they offer healthy beverage choices such as water or milk?
• Do you and your family members wear seat belts when riding in a vehicle?
• Do you wear a helmet when riding a bicycle, skateboard, or snowboard?
• Does Mary participate in physical activities and sports that could result in injuries to the mouth? Does she wear protective gear like a mouth guard, face protector, or helmet?
• Do you understand what to do if Jon knocks out one of his teeth?
• When was Elisa's last visit to a health professional? Is it time for her next health supervision visit?

To child:

• When do you brush your teeth? Floss? Do you use fluoridated toothpaste?
• Do you think your teeth look okay?
• Do any of your teeth hurt?
• How many teeth have you lost?
• When was the last time you went to the dentist?
• Do you snack at school? After school? What do you eat?
• Do you wear a seat belt in a car, van, truck, taxi, or other vehicle?
• What sports do you play? Do you wear protective mouth gear when you participate in contact sports? Do you wear a helmet when riding a bicycle, skateboard, or snowboard?
• What do you think about smoking? Chewing tobacco? Did you smoke any cigarettes (cigarettes or e-cigarettes) in the last month? Use chewing tobacco? How often?

Risk Assessment

Use the risk assessment tables and caries risk assessment tools to assess the child'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 child should be seen according to a schedule recommended by the dentist, based on the child's individual needs and susceptibility to disease.

Anticipatory Guidance

Discuss with Parents (as child becomes more mature, direct discussion toward the child):

Oral Health Care

• Making an appointment for a dental visit for the child according to the schedule recommended by the child's dentist, based on the child's individual needs or risk for developing oral disease.
• For children with special health care needs, making appointments for more frequent dental visits based on the child's individual needs or susceptibility to disease.
• Discussing with a dentist the need to schedule a visit to the orthodontist to have the child evaluated for braces.
• Discussing with a dentist or other qualified health professional the need to apply fluoride varnish. Topical fluoride may be especially effective for children 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 decay.
• Giving the child 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).
• Discussing with a dentist or other qualified health professional the need to apply dental sealants to prevent tooth decay, shortly after the teeth erupt.

Oral Hygiene

• Ensuring that children brush their teeth with fluoridated toothpaste twice a day (after breakfast and before bed). Make sure the child spits out the toothpaste after brushing but does not rinse with water. The small amount of fluoridated toothpaste that remains in the mouth helps prevent tooth decay.
• For effective plaque removal, making sure that a parent brushes the child's teeth at least once a day until the child acquires fine motor skills. Because brushing requires good fine motor control, young children cannot clean their teeth without parental help. After children acquire fine motor skills (e.g., the ability to tie their shoelaces), typically by age 7 or 8, they can clean their teeth effectively but should be supervised by a parent.
• For children with special health care needs, adapting or obtaining special oral health equipment (e.g., adapting a toothbrush) to brush the child's teeth, if needed.
• Becoming familiar with the normal appearance of the child's gums and teeth so that problems can be identified if they occur (see Tooth Eruption Chart). Checking the child's gums and teeth about once a month.

Nutrition

• Serving a variety of healthy foods such as fruits, vegetables, whole-grain products (cereals, bread, or crackers), and dairy products (milk, cheese, cottage cheese, and unsweetened yogurt). Meats, fish, chicken, eggs, beans, and nuts are also good choices for meals and snacks.
• Serving 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). Frequent consumption of foods containing sugar increases the risk for tooth decay. 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.
• Encouraging the child to eat fruits rather than drink fruit juice.
• If the child drinks beverages between meals, encouraging the child to drink water or milk rather than fruit juice, fruit-flavored drinks, or pop (soda).
• If the school has vending machines, encouraging the child to choose water or milk rather than fruit juice, fruit-flavored drinks, or pop (soda).
• Drinking water throughout the day, especially between meals and snacks. Drink fluoridated water (via a community fluoridated water source) or bottled water that contains fluoride.

Nonnutritive Sucking

• If the child regularly engages in nonnutritive sucking behaviors, gently intervene to help the child stop. Intervention strategies include:
  • Talking with the child. Use basic words to tell the child why to stop sucking (e.g., sucking can change the shape of the child's mouth and teeth) and that the child can stop.
  • Using reminders. Put a bandage on the child's finger or thumb to remind the child not to suck.
  • Using rewards. The child and parent agree on a plan (e.g., if the child does not suck for a specified time period, then the child receives a reward). The reward must be motivating to the child. Charting small successes may help (e.g., placing colored stars on a calendar for each day the child does not suck).
  • Physically interrupting the habit. If none of the preceding strategies are successful, and the child wants to stop the habit, two other strategies can be tried:
    • Cover the child's hand at night (e.g., cover the hand with a mitten or sock, dress the child with a special shirt with the sleeves sewn closed).
    • A dentist can place an intra-oral appliance in the child's mouth to prevent sucking. The appliance is removed after the child no longer engages in nonnutritive sucking.

Injury Prevention

• Learning how to prevent oral injuries and handle oral emergencies, especially the loss or fracture of a tooth.
  • If a permanent tooth is knocked out, the parent or other adult should (1) find the avulsed (lost) tooth, (2) hold it by the crown (top part) only, not the root, (3) rinse it under cold water gently if the root is dirty, but do not scrub, (4) reinsert it into the socket as soon as possible, making sure that the front of the tooth is facing you, and (5) take the child to the dentist immediately. If it is not possible to replace the tooth, place the tooth in a container of cold milk or in a cold damp cloth and take the child and the tooth to a dentist immediately.
  • 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.
  • If a tooth is fractured or chipped, the parent or other adult should (1) rinse the child's mouth with water, (2) apply cold compresses to the cheek to reduce swelling, (3) if possible, find chipped or fractured piece(s) of the tooth, and (4) take the child and broken piece(s) to the dentist immediately.
• Using an appropriate car seat in the back seat of the vehicle at all times. Once children reach the upper weight or height limit of the forward-facing car seat, they should be buckled in a belt-positioning booster seat until the seat belt fits properly.
• Wearing a helmet when riding a bicycle or skateboard. Children under age 16 should not ride all-terrain vehicles or motorcycles.
• Being aware that the risk for injury is higher during periods of rapid growth.
• Ensuring that the child wears protective gear when participating in physical activities or sports that could result in injuries to the mouth, such as biking; riding a scooter; skateboarding; in-line skating; or playing football, baseball, soccer, or lacrosse.
• Ensuring that the child does not ride an all-terrain vehicle of any size.
• Teaching the child about injury prevention, including the need to wear protective gear (e.g., mouth guard, face protector, helmet).
• Providing the child's caregivers with the dentist's emergency phone contacts, and ensuring that the caregivers know how to handle oral emergencies.

Substance Use

• Teaching the child about the dangers of cigarette smoking (cigarettes or e-cigarettes) or using chewing tobacco. Avoid secondhand smoke.

Outcomes

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

 

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