Prenatal and post natal counselling of mothers

Prenatal care:

Goals:

  • To educate parents about dental development of the child
  • To educate parents about dental disease and prevention
  • To provide a suitable environment for the child
  • To strengthen and prepare the child and dentition for life The procedure of prenatal care is divided into external and internal components, where the former means parents and later means parents and child.
External component:
  1. Parent’s education should emphasize on all aspects of dental disease and oral hygiene
  2. Changes in mother’s diet and oral health must be initiated.
  3. Pregnancy gingivitis must be explained
  4. Parent’s dental treatment should be carried out, this facilitates a positive attitude that transfers to the child.
Internal component:
  1. Parent’s education in this phase should include development of child.
  2. Habits and life style of the parent can have a direct bearing on the child.
  3. Exposure of the disease (e,g. rubella, syphilis)
  4. Knowledge of nutrition should be imparted
  5. Importance of breast feeding must be explained
  6. Fluoride supplementation
  7. Teething and its effects
  8. Non nutritive sucking
  9. Explain the importance and timing of first visit of the child to the dentist.
Post natal care:
Birth to 3 months :
  • Initial counseling focuses on diet
  • Breast feeding is the most preferred source of nutrition
  • If the infant is bottle fed the mother should hold the infant when feeding
  • Only formula milk is given in the bottle and use of fruit juices in bottle is  discouraged as it is associated with caries

 

 

 

Advantages of breast feeding :
  1. Breast milk has the ideal composition for infants needs, provided in a safe clean form at the right temperature
  2. The feeds need no preparation and there is no equipment to sterilise
  3. Breast milk contains antiinfective factors which cannot be manufactured and added to infant formulae. This has considerable health benefits for the infant both in childhood and later life
  4. Psychologist say that it is of psychological advantage to mother and child, increases bond strength and there is sense of accomplishment and indispensability to mother
  5. Child is less likely to develop arterial disease because of fat, as fats in breast milk are better emulsified
  6. Easily digestible and has low osmotic load
  7. Confers passive immunity to the baby
  8. A lack breast feeding has been associated with developmental defects of the primary dentition particularly in premature children
Antiinfective and anticariogenic agents in human milk :
  • Immunoglobulins – secretory IgA, IgM,IgG
  • Cellular – lymphoid cells, polymorphs, macrophages, plasma cells
  • Opsonic and chemotactic activities of C3 and C4 complement system
  • Unsaturated lactoferrin and transferrin
  • Lysozyme, lactoperoxidase
  • Specific inhibitors – antiviral and antistaphylococcal factors
  • Growth factors for lactobacillus bifidus
  • Paraaminobenzoic acid may afford some protection against malaria
4-6 months :
  • Increased drooling is common at this age but not necessarily associated with teething
  • Teething symptoms include increased sucking behaviour, loose stools and fever. Temperatures higher than 100.6 F are not associated with teething and should be evaluated for other causes
  • After determining the water flouride level, information about use of systemic flourides can be planned
6-12 months :
  • Generally, all children should receive appropriate systemic and topical flouride beginning at six months of age
  • If a child receives water from a nonflouridated area with less than 0.6 ppm floride supplementation should begin by six months of age
  • Fluoride supplementation should not be given with milk or milk formula which decreases its absorption
  • Parents or care takers should brush their children’s teeth twice a day using a small soft brush with peanut sized tooth paste. Brushing should be done from behind the child while supporting the child’s head. Brushing should focus on the junction of the gingiva and the teeth.
Dietary instructions:
  1. Sugar containing foods should be limited to meal times.
  2. Regular pattern of meals and set snacks should be developed
  3. Sippy cups can be introduced at six months in preparation for weaning from the bottle or breast at 12 months
  4. Drinks between meals should be limited to water and plain milk. Juice if introduced should be consumed in cups and limited during meal time
  5. Dental screening appointment scheduled at 12 months and caries risk assessment and infant examination is carried out in knee to knee position
15 months and older :
  • Dental screening should be performed every six months
  • Proper oral hygiene measures should be reinforced along with the use of flouride tooth paste for every child from 2 years of age
  • Parental assistance with tooth brushing should continue till eight years of age
  • Dietary advice should focus on limiting snacks and drinks between meals and limiting sweet and food to meal times
  • Use of systemic fluorides should be assessed and continued till age 16
  • Appropriate use of mouth guards and face shields are advocated