Therapy recommendations for ages 0–5

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Low risk

Low-risk patients’ caregivers should be aware of the risks associated with dental disease and share the information with other family members and caregivers, maintaining good home care habits with preventive dental care products such as gels (CTx3 Gel) and sprays (CTx2 Spray). Preventive products should contain pH neutralization, xylitol, and remineralization agents such as nanohydroxyapatite whenever possible. The dental practitioner will advise on the use of fluoride-containing oral care products based on the age and risk of the child. Caregivers should be aware if they live in a water-fluoridated community as drinking fluoridated water is a protective factor.

Moderate risk

Moderate risk patients’ caregivers should be aware of the risks associated with dental disease and share the information with other family members and caregivers. If possible, caregivers should consider the benefit of eliminating the risk factor placing the child at risk. Maintaining good home care habits with preventive dental care products such as tooth wipes for infants and toddlers and gels and sprays for all ages. Preventive products should contain pH neutralization, xylitol, and remineralization agents such as nano hydroxyapatite whenever possible. The dental practitioner will advise on the use of fluoride containing oral care products based on the age and risk of the child. Caregivers should be aware if they live in a water-fluoridated community as drinking fluoridated water is a protective factor.

High risk

High-risk patients’ caregivers should be aware of the risks associated with dental disease and share the information with other family members and caregivers. If possible, caregivers should consider the benefit of eliminating the risk factor(s) placing the child at risk. For high-risk patients aged 0–2, caregivers should brush the child’s teeth/gums at least 2 times daily with a gel that contains pH neutralization, xylitol, and nanoparticles of hydroxyapatite. Such products are safe to swallow. Caregivers should also use xylitol wipes infused with pH neutralization 3–4 times daily after every meal/bottle. Based on the clinician’s judgment, a small smear of gel that contains a small amount of fluoride can be used along with pH neutralization, xylitol, and nanoparticles of hydroxyapatite as a toothpaste replacement for the gel which does not contain fluoride.^[3] Use caution when using fluoride products on infants and toddlers. A smear of gel with pH neutralization, xylitol, and nanoparticles of hydroxyapatite should also be applied and left on at bedtime.^[3] Fluoride varnish should be performed at initial dental visits and at 3-month recalls.

Caregivers of patients aged 0–2 should also consider adding products with 0.05% neutral sodium fluoride, antibacterials (0.2% sodium hypochlorite), pH neutralization, and xylitol, along with toothpaste/gel with pH neutralization, fluoride (1.1% NaF), xylitol, and nanoparticles of hydroxyapatite to their home care regimen. A change to professional/prescription home care therapy products for the caregiver(s) may reduce the risk of vertical transmission of the cavity-causing bacterial species.^[3]

High-risk patients’ caregivers should be aware of the risks associated with dental disease and share the information with other family members and caregivers. If possible, caregivers should consider the benefit of eliminating the risk factor(s) placing the child at risk. For high-risk patients aged 3–5, caregivers should brush the patients’ teeth/gums at least 2 times daily with a small smear of gel that contains a small amount of fluoride (0.243%), along with pH neutralization, xylitol, and nanoparticles of hydroxyapatite as a toothpaste. Use caution when using fluoride products on infants and toddlers. Caregivers should also use oral wipes and mouth sprays infused with xylitol and pH neutralization, 3–4 times daily after every meal/bottle. A smear of gel with pH neutralization, xylitol, and nanoparticles of hydroxyapatite should also be applied and left on at bedtime.^[3] Fluoride varnish should be performed at initial dental visits and recalls.^[6]

Caregivers of patients aged 3–5 should also consider adding products such as 0.05% neutral sodium fluoride, antibacterials (0.2% sodium hypochlorite), pH neutralization, and xylitol, along with toothpaste/gel with pH neutralization, fluoride (1.1% NaF), xylitol, and nanoparticles of hydroxyapatite, to their homecare regimen. A change to professional/prescription home care therapy products with xylitol for the caregiver(s) may reduce the risk of vertical transmission of the cavity-causing bacterial species.^[3]

Other recommendations

Depending on the severity of the patient’s risk and the clinical judgment of the dentist, some clinicians have also added additional recommendations to those above for children aged 3–5. The FDA recommends that all 0.05% neutral sodium fluoride rinses be prescribed only to children aged 6 and up.^[7] Antibacterial rinses such as the 0.2% sodium hypochlorite and 0.05% fluoride also fall under this category. But for children that are capable of rinsing and spitting, some practitioners have recommended adding such rinses for a patient in the 3–5 age group home care regimen. In order to reduce the risk of swallowing, it is sometimes recommended that the caregiver brush the rinse on with a toothbrush and have the child spit every 5 to 10 seconds. Clinicians will only make these types of other recommendations when they feel the benefit outweighs the risk. Children that have had to undergo anesthesia in a hospital setting in order to have dental treatment due to decay may fit this category.

Sealants

Clinicians should follow all ADA and AAPD guidelines on sealants, and glass ionomer–based materials are recommended on all deep pits and fissures. ^[3]

1. B. A. Dye, O. Arevalo, and C. M. Vargas, “Trends in Pediatric DentalCaries by Poverty Status in the United States, 1988–1997 and 1994–2004,” Int J Paediatric Dent 20, no. 2 (2010): 132–43.
2. American Academy of Pediatric Dentistry, “Policy on the DentalHome,” AAPD Reference Manual 31, no. 6: 22–3.
3. Francisco Ramos-Gomez and Man-Wai Ng, “Into the Future: KeepingHealthy Teeth Caries Free: Pediatric CAMBRA Protocols,” J Calif DentAssoc 39, no. 10 (2011): 723–33.
4. S. Gajendra and J. V. Kumar, “Oral Health and Pregnancy: A Review,”NY State Dent J 70, no. 1 (2004):40–4.
5. American Dental Association Council on Scientific Affairs,“Professionally Applied Topical Fluoride: Evidence-Based ClinicalRecommendations,” JADA 137, no. 8 (August 2006 ): 1151–1159.
6. J. L. Sintes, C. Escalante, B. Stewart, et al., “Enhanced AnticariesEfficacy of a 0.243% Sodium Fluoride/10% Xylitol/Silica Dentifrice:3 Year Clinical Results,” Am J Dent 8, no. 5 (1995): 231–5.
   
7. “Anticaries Drug Products for Over-the-Counter Human Use,” Codeof Federal Regulations, title 21, vol. 5, 21 CFR 355.