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Pediatric groups issue early childhood caries recommendations

In a new joint policy statement published in the June issue of Pediatrics, the American Academy of Pediatrics and the Canadian Paediatric Society offer recommendations for preventing early childhood caries in indigenous children in the U.S. and Canada.

Image: Dr. Irvine
Dr. Irvine

“Early Childhood Caries in Indigenous Communities” offers recommendations for the prevention of dental disease in young children and pregnant women of First Nations, Inuit and Métis populations in Canada and American Indian and Alaska Native populations in the United States through collaboration with primary health care providers, policymakers and public health practitioners in indigenous communities. The statement can be found online at

“The influence of early childhood caries on overall childhood health and well-being goes well beyond the mouth, and many of our indigenous children have not benefitted fully from the many advances to improve oral health in North American children,” said James Irvine, M.D., co-author of the statement. “In fact, there are remarkable similarities in health issues and living circumstances of indigenous children in the U.S. and Canada. This position statement places emphasis on the reduction in health disparities in both the U.S. and Canada.”

AAP and CPS recommendations include:

  • using well child visits to educate parents and caregivers of infants and children on proper oral hygiene and diet;
  • promoting supervised use of fluoridated toothpaste in all indigenous and other high-risk children after the first tooth has erupted;
  • providing pregnant indigenous women access to prenatal screening for dental health and referral for dental care if needed;
  • ensuring that indigenous children have access to fluoride varnish programs and other oral health prevention and treatment services.

Image: Dr. Holve
Dr. Holve
ADA policy adopted by the House of Delegates in 2004 calls for only “dentists, physicians and their properly supervised and trained designees” to provide preventive dental services to infants and young children and that those providers “should have completed an appropriate educational program on oral health, common oral pathology, dental disease risk assessment, dental caries and dental preventive techniques for this age group.” (2004:301). House policy also states that “risk assessments, screenings or oral evaluations of infants and young children by nondentists are not to be considered comprehensive dental exams” and “that it is essential that nondentists who provide preventive dental services to an infant or young child notify a dentist of the custodial parent/legal guardians choosing as to what services were rendered and refer the patient for a comprehensive examination” (2004:303).

In 2008, the ADA Foundation awarded a $300,000 grant to the AAP to train pediatricians to conduct oral health risk assessments, including oral screening exams, teach families about oral health and prevention and refer children to a dental home.

“Many physicians continue to view early childhood caries as a dental problem to be treated by dentists,” noted Steve Holve, M.D., another co-author. “We want to emphasize that early childhood caries is an infectious disease, knowing that infectious diseases are problems in which pediatricians and primary care providers are experts. The skills of our dental colleagues are highly valued, but we hope to shift the focus of treatment for early childhood caries to primary care providers and preventive measures such as topical fluoride varnishes.”

The statement outlines the health status of indigenous children, risk factors for ECC, access to care and the role of primary health care providers and recommendations for clinical care, community-based initiatives, workforce and access issues and advocacy.

Image: Dr. Hebl
Dr. Hebl
“AAP and CPS statements are read not only by pediatricians, but also by family physicians, nurse practitioners, community health nurses, physician assistants and other health professionals,” said Dr. Irvine. “The role that primary care pediatricians and other providers play in various indigenous communities in North America place them in a unique position to complement the work of our dental health professional colleagues.”

The ADA held its second Symposium on Early Childhood Caries in American Indian and Alaska Native Children Oct. 20-22, 2010, in Rapid City, S.D. Several participants from Canada also attended, comparing notes with their U.S. colleagues on disease burden in indigenous populations and strategies for success in prevention and research.

Dr. Monica Hebl, a dentist in Milwaukee and member of the ADA Council on Access, Prevention and Interprofessional Relations, said, “CAPIR remains committed to addressing the oral health of American Indian and Alaska Native people, many of whom suffer disproportionately from caries.”

The summary report and presentations for the symposium are available on,

The symposium was co-hosted by the ADA Council on Access, Prevention and Interprofessional Relations and the American Academy of Pediatrics. The meeting was co-sponsored by Oral Health America with support from the DentaQuest Foundation.