Introduction

The Bright Futures project was initiated in 1990 by the Health Resources and Services Administration's (HRSA's) Maternal and Child Health Bureau (MCHB). The mission of the Bright Futures project is to promote and improve the health and well-being of pregnant and postpartum women, infants, children, and adolescents. This is achieved by developing educational materials and fostering partnerships. Bright Futures provides comprehensive, culturally effective, family-centered, community-based health supervision guidelines consistent with the needs of families and health professionals. The Bright Futures guidelines provide are foundation of coordinated series of educational materials for health professionals and families.

Recognizing oral health as a vital component of health, HRSA’s MCHB sponsored the development of Bright Futures: Oral Health—Pocket Guide. This pocket guide is designed to be a useful tool for a wide array of health professionals including oral health professionals (e.g., dentists, dental hygienists) and other health professionals (e.g., physicians, physician assistants, nurse practitioners, nurses, dietitians) in addressing the oral health needs of pregnant and postpartum women, infants, children, and adolescents.

The pocket guide offers health professionals an overview of preventive oral health supervision for five periods—pregnancy and postpartum, infancy, early childhood, middle childhood, and adolescence. Although groupings are designed to take advantage of naturally occurring milestones, many oral health issues cut across multiple periods. The information presented in the pocket guide is intended as an overview rather than as a comprehensive description of oral health. The information does not prescribe a specific regimen of care but builds upon existing guidelines and treatment protocols such as those recommended by the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of Pediatric Dentistry, the American Academy of Pediatrics, and the American Dental Association.

Optimal oral health for pregnant and postpartum women, infants, children, and adolescents can be achieved through effective partnerships among families, oral health professionals, and other health professionals. Health professionals need to help families understand the causes of oral disease, especially dental caries (tooth decay), and how to prevent or reduce oral disease and injury. By including prevention and early intervention as part of comprehensive oral health care, it may be possible to prevent or reduce future oral disease.

Resistance to tooth decay in pregnant and postpartum women, infants, children, and adolescents is determined partly by physiology and partly by behavior. The younger the child when tooth decay begins, the greater the risk for future decay. Because untreated tooth decay increases in severity, necessitating more extensive and costly treatment secondary to postponing care, timely intervention reduces overall cost associated with treatment. Preventing and/or delaying the onset of tooth decay may reduce the risk for decay. For this reason, the time to begin preventing oral disease, especially tooth decay, is before teeth begin to erupt.

The first oral examination should occur within 6 months of the eruption of the first primary tooth and no later than age 12 months. Thereafter the child or adolescent should be seen according to a schedule recommended by the dentist, based on the child's or adolescent's individual needs and susceptibility to disease.

When an oral examination by a dentist is not possible, an infant should receive an oral health risk assessment by age 6 months by a pediatrician or other qualified oral health professional (e.g., dental hygienist) or other health professional. Infants within one of the risk groups listed below should be referred to a dentist as soon as possible.

• Mother or other primary caregiver has active caries
• Parent or other caregiver has low socioeconomic status
• Child receives more than three between meal foods or beverages containing sugar per day
• Child is put to bed with a bottle or a sippy cup with beverage containing sugar
• Child has special health care needs
• Child is a recent immigrant
• Child has white spot lesions or enamel defects
• Child has visible cavities or fillings
• Child has plaque on teeth

All pregnant and postpartum women, infants, children, and adolescents need dental homes. A dental home is the ongoing relationship between the dentist and the patient, inclusive of all aspects of oral health care delivered in a comprehensive, continuously accessible, coordinated, and family-centered way. Establishment of the dental home begins no later than age 12 months and includes referrals to dental specialists when appropriate.

A dental home should be able to provide the following:

• Comprehensive oral health care including acute care and preventive services in accordance with accepted guidelines and periodicity schedules
• Comprehensive assessment for oral diseases and conditions
• Individualized preventive oral health program based on risk assessment and periodontal disease risk assessment
• Anticipatory guidance about growth and development issues (e.g., teething, digit or pacifier habits)
• Plan for acute dental-trauma management
• Information about proper care of teeth and gums
• Dietary counseling
• Referrals to dental specialists when care cannot be directly provided within the dental home

If the pregnant or postpartum woman, infant, child, or adolescent does not have a dental home, help the woman or parents find a source of care by doing the following:

• Provide a referral to a dentist in your community. Contact your state or local dental society or pertinent national organizations for a list of such dentists. The following national organizations may be helpful in locating dentists:
  

  American Academy of Pediatric Dentistry
  211 East Chicago Avenue, Suite 1700
  Chicago, IL 60611-2637
  Phone: (312) 337-2169
  Website: To find a pediatric dentist

  American Dental Association
  211 East Chicago Avenue
  Chicago, IL 60611-2678
  Phone: (312) 440-2500
  Website: To find a dentist

• Work with state and local agencies to determine the pregnant or postpartum woman's, infant's, child's, or adolescent's eligibility for public assistance programs such as Medicaid or the Children's Health Insurance Program (CHIP), obtain dental insurance through the Health Insurance Marketplace, or find other sources of funding for oral health care. With this information, help pregnant and postpartum women and parents enroll their child in these programs, get dental insurance, or obtain funding for care.

To learn more about Medicaid and CHIP and how to enroll, contact your state's Medicaid agency or call (877) KIDS–NOW (543–7669).

To find information about health insurance through the Health Insurance Marketplace:

Phone: (800) 318-2596
Website: https://www.healthcare.gov

To find a dentist:
Website: https://www.insurekidsnow.gov

 

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