Newborns: How Hygienists Plant the Seeds of Oral Care before Birth

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Much emphasis has been given to prenatal oral care of patients, which is essential because 60% to 75% of pregnant women have gingivitis, and one in four pregnant women have untreated caries.2 However, with so much emphasis on the dental care of the mother, what happens when the baby arrives?

The mother doubtlessly is busy thinking about clothing, bedding, strollers, and the like. It is the dental hygienist’s job to bring the mother’s attention to the oral care of the newborn.

We often tell parents to bring the baby to the dentist when the first tooth appears. This appointment is generally used to discuss the care of teeth and nutrition. However, the average child has their first tooth erupt around six months, long after patterns of care have been established in the home. It would be much more productive to inform parents of healthy oral care before the child arrives instead of trying to correct behavior at the first dental visit.

Setting the Stage

Most expecting mothers are eager to talk about plans for the new arrival. At their hygiene appointment, show a personal interest in the patient by asking about possible names, nursery decorations, or due dates. Then go into the oral implications of pregnancy for the mother. At that point, it is an easy transition to talk about the baby’s oral care.

If the parent has oral disease themselves, they may be interested to know that such conditions are contagious and can be passed on to their baby. Help them understand that caries and periodontal diseases are caused by bacteria, which can easily be introduced to the baby’s mouth by sharing spoons or cups. Parents are usually the first source of infectious bacteria because of intimate contact with the child in the first years of life.3

Therefore, we can emphasize the importance of the parents’ own oral care to reduce their bacterial load and talk about strategies to reduce the risk of infection, such as not sharing utensils.

Feeding Infants

Another topic that the parent should be thinking about at this point is initial nutrition. If possible, breastfeeding has distinct advantages for oral health. It has been shown to encourage proper tooth alignment, helping to avoid such problems such as open bites and severe overbites. Also, the risk of early childhood caries is greatly reduced with breastfeeding when compared to bottle feeding because the infant is less likely to hold the liquid in their mouth.

However, breastfeeding is not a cure-all; do make sure the parent knows that breast milk also contains sugars and can still cause decay.1

If they are going to bottle feed, stress that only formula, breast milk, or water should be in the bottle. Some parents have been known to dip pacifiers in sugar or honey, introducing unnecessary sugar that should be discouraged.

After feedings, whether bottle or breastfed, the mouth needs to be cleaned. Within a few days after birth, a small, clean washcloth or gauze can be used to clean off the gingiva after feedings. This accomplishes a couple of things. While it certainly helps maintain cleanliness, it also gets the child used to the sensation of cleansing well before teeth erupt, so they are more likely to be cooperative later.

Possible Strategy

Often medical doctors gift a prenatal patient a care pack, including basic necessities for their new arrival. This idea could be a nice way to open a discussion with the patient about infant dental care also. It could include a finger brush, small soft washcloth, teething ring, baby toothpaste, and maybe a sippy cup. We could go through the supplies and explain the uses and reasoning behind our recommendations. When incorporating this into the prenatal hygiene visit, we allow patients time to think about their baby’s oral care and answer any questions.

By relaying this important information at prenatal visits, problems can be avoided before they start. We can empower patients to make good choices about their children’s oral care instead of trying to correct behavior and repair damage after the fact. During the prenatal visit, parents are often open to information and curious about what lies in their future. This is in contrast to the possibly defensive position parents may take at their child’s exam when they might feel like we are criticizing their parenting. We foster a good working relationship with the patient by being proactive and setting them up for success.

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References

  1. Breastfeeding: 6 Things Nursing Moms Should Know About Dental Health. (n.d.). Mouth Healthy. Retrieved from https://www.mouthhealthy.org/en/az-topics/b/breastfeeding
  2. Oral Health Campaign Toolkit. (2019, Feb 19). American Academy of Pediatrics. Retrieved from https://www.aap.org/en/news-room/campaigns-and-toolkits/oral-health/
  3. Damle, S.G., Yadav, R., Garg, S., et al. Transmission of Mutans streptococci in Mother-child Pairs. The Indian Journal of Medical Research. 2016; 144(2): 264–270. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5206879/