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Health and Environmental Issues for Children Under Six

Child Care Oral Health

While the family is the focus for health supervision, an increasing number of South Carolina's youngest children are receiving routine daily health supervision at childcare centers. Interventions by oral health professionals are important but represent only a small part of a child's life and environment. Ultimately, family priorities will determine the success of oral health prevention. Professionals must work with families to fit oral health in its proper place for individual children and their families. Childcare workers can reinforce developmentally keyed oral health issues during their health supervision activities with the children.

Innovations in Oral Health Supervision

  • Early Intervention
    Emphasized beginning with prenatal counseling and a first dental visit by age one. Because the decay process may be initiated by age one, guidelines recommend early intervention by age one to prevent early childhood caries and to achieve optimal fluoride intake during the critical development period.
  • Risk Assessment
    All children are not equally likely to develop decay. Risk assessment helps to identify individual plans for preventive and treatment needs. This assessment makes it easier to create more successful and cost-effective interventions.
  • Oral Health Outcomes
    We are presenting a model for measuring educational, behavioral and physical aspects of oral health supervision. This guide helps professionals identify outcomes for individual children.

Oral Health Supervision Guidelines


Oral health supervision begins during pregnancy. For our purposes, we will only provide this brief message on the importance of prenatal oral health care here.


The childcare worker assists in oral health supervision during the first year.

  • Screening for obvious oral health problems
  • Recognition and reporting of suspected child abuse/neglect
  • Education and guidance for parents on bottle use, teething, cleaning, injury prevention and dietary habits
  • Refer as needed to a dental professional

Some examples of suggestions may include the following:

  • Help the parents wean the child from the bottle by 12 months.
  • If there is a history of baby bottle tooth decay then the worker can suggest increased frequency of dental/healthcare visits.
  • Reinforce the proper use of appropriate safety measures (car safety seats etc.).

At six months:

  • Begin to offer a cup for water or juice.
  • Clean infant's teeth with a soft brush or cloth, once a tooth is present.
  • Give fluoride as recommended by health professional.

At nine months:

  • Encourage infant to drink from a cup. Begin weaning from the bottle.

Infancy Outcomes

  • Parents and caregivers are informed of and practice preventive oral health care including brushing child's teeth with a pea-sized amount of fluoride toothpaste.
  • Infant rides in car safety seat.
  • Environment is safeguarded to protect against oral facial injuries.
  • Infant is not put to bed with a bottle.
  • Infant receives appropriate fluoride supplement.
  • Infant has no active decay.
  • Infant has healthy oral soft tissues.

Early Childhood

At 12 months:

  • Brush toddler's teeth with a pea-sized amount of fluoride toothpaste.
  • Encourage first dental visit by first birthday.
  • Do not put child to bed with bottle.
    Encourage toddler to drink from cup. Wean from the bottle.
  • Seek medical help to substitute for frequent medicines that contain sugar.

At 15 and 18 months:

  • Continue to brush with fluoride toothpaste.
  • Schedule toddler's first dental visit if it has not taken place.
  • Reduce number of snacks in a day to 3 or less.

At Three Years:

  • Begin teaching the child to brush teeth with a pea-sized amount of fluoride toothpaste.

At Four Years:

  • Assure that child brushes teeth twice a day with a pea-sized amount of fluoride toothpaste.
  • Supervise brushing activity.
  • If child regularly sucks pacifier, fingers, or thumb begin to help child stop the habit.

Early Childhood Outcomes:

  • Parents and child practice preventive oral health care.
  • Child receives appropriate fluoride supplement.
  • Child uses car safety seat.
  • Child wears proper play protective gear (bicycle helmet etc).
  • Child is under the care of a dentist.
  • Child has no active decay.
  • Child has healthy oral soft tissue.
  • Child has functioning bite (occlusion).

Middle Childhood

Throughout Middle Childhood:

  • Ensure child wears a safety belt at all times in the car.
  • Child brushes teeth twice daily with a pea-sized amount of fluoride toothpaste.
  • Regularly supervised tooth brushing.
  • Child gets proper fluoride supplement.
  • Child wears helmet when riding bicycle.
  • Assure that caregiver knows how to handle dental emergencies and has contact.
  • Be familiar with the normal appearance of your child's mouth.
  • Schedule dental appointments according to the recommendation of the dentist based on the child's individual needs.

At 6 years old:

  • Teach child about sports safety, mouth guards and face protectors.
  • If child regularly sucks fingers or thumb intervene gently to help child stop.

At 8 years old:

  • Teach child how to floss.
  • Teach child how to handle dental emergencies.
  • Teach child not to smoke or use spit tobacco.

At 10 years old:

  • Help child understand dangers of smoking, spit tobacco, and other drugs.

Middle Childhood Outcomes:

  • Parents and child know and practice preventive oral health care.
  • Child wears safety belt.
  • Child wears appropriate play and athletic protective gear.
  • Child does not suck fingers or thumb.
  • Child does not use tobacco or other drugs.
  • Child receives appropriate fluoride.
  • Child has been assessed for dental sealants.
  • Child is under the care of a dentist.
  • Child has no active decay.
  • Child has healthy oral soft tissue.
  • Child has functional occlusion.