Adolescence • 11 – 21 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 the adolescent and family.

Family Preparation

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

Changes in the teeth or 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
Illnesses or infections
Medications
Physical activity and sports participation
Injuries to the teeth or the mouth
Adolescent's tobacco use

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. Ask the adolescent questions directly.

When do you brush and floss your teeth? Do you use fluoridated toothpaste?
Do you think your teeth look okay?
Have your wisdom teeth erupted?
When was the last time you went to the dentist?
Do you snack at school? After school? What do you eat or drink?
Does your school have vending machines? If so, do they offer healthy beverage choices such as water or milk?
Do you wear a seat belt while driving or riding in a vehicle?
Do you wear a helmet when riding a bicycle? Skateboard? An all-terrain vehicle? Motorcycle?
Do you participate in physical activities and sports that could result in injuries to the mouth? Do you wear protective gear like a mouth guard, face protector, or helmet?
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?
When was your last visit to a health professional? Is it time for your next health supervision visit?

Risk Assessment

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

Anticipatory Guidance

Discuss with Adolescent, or with Adolescent and Parents:

Oral Health Care

Making an appointment for a dental visit according to the schedule recommended by your dentist, based on your individual needs and risk for developing oral disease.
If you have special health care needs, making appointments for more frequent dental visits based on your individual needs and susceptibility to disease.
Discussing with a dentist the need to establish a preventive oral health regimen, including an evaluation of the bite and third molar development.
Discussing with a dentist or other qualified health professional the need to rinse daily with a non-alcohol-based fluoride mouthrinse or to receive fluoride varnish applications. Topical fluoride may be especially effective for adolescents at high risk for tooth decay, particularly if they 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 adolescent up to age 16 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.
Discussing with a dentist the need to schedule a visit to the orthodontist to have the adolescent evaluated for braces.

Oral Hygiene

Brushing your teeth with fluoridated toothpaste twice a day (after breakfast and before bed). Spit out the toothpaste after brushing, but do not rinse with water. The small amount of fluoridated toothpaste that remains in your mouth helps prevent tooth decay. Floss daily.
For adolescents with special health care needs, adapting or obtaining special oral health equipment (e.g., adapting a toothbrush) to brush your teeth, if needed.
Becoming familiar with the normal appearance of your gums and teeth so that you can identify problems if they occur (see Tooth Eruption Chart).

Nutrition

Eating 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.
Eating healthy foods during planned meals and snacks, and limiting eating (grazing) in between.
Eating 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.
Choosing fruits rather than fruit juice.
If drinking beverages between meals, choosing water or milk rather than fruit juice, fruit-flavored drinks, flavored water, energy drinks, or pop (soda).
If the school has vending machines, choosing water or milk rather than fruit juice, fruit-flavored drinks, flavored water, energy 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.

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, you or an 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) go 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 go to a dentist with the tooth immediately.
- If a tooth is fractured or chipped, you or an adult should (1) rinse your 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) go to the dentist with the broken piece(s) immediately.
Using a seat belt while riding in or driving a vehicle. Adolescents ages 12 and under should sit in the back seat of the vehicle. If you are driving, insist that your passengers also wear seat belts.
Wearing a helmet when riding a bicycle, skateboard, all-terrain vehicle, or motorcycle. Adolescents under age 16 should not ride all-terrain vehicles or motorcycles.
Wearing protective gear (e.g., mouth guard, face protector, helmet) 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.
Not getting oral piercings, which can damage teeth and gums.

Substance Use

Not smoking cigarettes (cigarettes or e-cigarettes) or using chewing tobacco. Avoid secondhand smoke.

Outcomes

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

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