Grandfather, son and grandson sitting on porch steps laughing

All About Caries Prevention, From Infants to the Oldest of the Old

Date: December 06, 2018

Author: Lisa Knowles, D.D.S

The oversimplification of yesteryear caries prevention is now hard to fathom. Advice to patients was often simply to say, "Brush your teeth. Don't eat too many sweets." What we now know about caries risk and prevention has changed this, however it can leave dental professionals overwhelmed with data and patient discussion tips.

One way to break caries prevention down into bite-sized pieces of information is to think of age-specific needs in the patient population. With a series of tips for addressing these needs, you can educate your patients efficiently and effectively.

Infants and Toddlers (ages 0-5)

  • Educational needs. For your youngest patients, help parents and guardians understand the consequences of food and beverage choices, and the need for oral hygiene and a dental visit by age 1 (or within 6 months of the first tooth coming through, if sooner). Explain how oral hygiene should be performed and introduce using a grain-sized amount of fluoride toothpaste, and floss. Familiarize parents with systemic issues that may increase caries rates such as otitis media, and acid reflux which weakens tooth structure making it more susceptible, explains Decisions in Dentistry.
  • Physical needs. Parents and guardians should start brushing their children's teeth and teaching them to brush their own once they are old enough. Provide information about basic first aid for common childhood tooth and mouth injuries and check for conditions, such as ankyloglossia. In accordance with recommendations, introduce in-office fluoride treatments for children with or at risk of early childhood caries.

Children and Teenagers (ages 6-17)

  • Educational needs. Children and teens are old enough for reminders about the consequences of unhealthy choices, and they often benefit from coaching and positive reinforcement. Teach older children about acid and tooth decay and how the oral microbiome works. Continue to emphasize an established routine of twice daily brushing and daily flossing. For older teens, you can discuss systemic considerations like the oral risks of human papillomavirus.
  • Physical needs. Kids often benefit from a disclosing solution demonstration to encourage complete plaque removal. Recommend twice-yearly dental exams, fluoride treatments for at-risk patients, and X-rays as recommended based on age and dental status. Introduce fluoride prevention strategies as needed, such as the ADA recommendation to use 5 percent sodium fluoride varnish for periodic in-office treatments and daily or weekly fluoride rinses, especially if your patient is at high risk for caries.

Young Adults (ages 18-25)

  • Educational needs. Patients in this age group are beginning to make independent choices away from home. Prepare them for the peer pressure that can lead to greater consumption of sugary foods or beverages, smoking, drinking alcohol or trying recreational drugs. Remind them that even when they move to a new city or go away to college, they still need to keep up with regular dental appointments.
  • Physical needs. Young adult patients can benefit from the continued use of a disclosing solution to check their plaque removal skills. Provide a twice-yearly dental exam, in-office fluoride treatments and consider Colgate PreviDent 5000 Plus prescription toothpaste for at-risk patients.

Adults and Middle-Aged Adults (ages 26-55)

  • Educational needs. Prepare your adult patients for potential oral health changes due to medications, environmental changes or systemic health conditions. Show them any oral changes from their previous visits with an X-ray or intraoral camera, and demonstrate how to remove plaque in changing areas of the mouth.
  • Physical needs. Adult patients still need a full dental exam, cleaning and oral cancer screening every six months to a year. If they're at risk for caries, they also still need preventive care and home use fluorides. Tailor your home care recommendations to patients' other health considerations, such as ongoing cancer treatment, pregnancy or diabetes.

Older Adults and the Oldest of the Old (ages 55-80 and up)

  • Educational needs. Older adults will need information about the continuing oral changes of aging, from hard and soft tissue changes to possible gingival recession, tooth discoloration and the side effects of medication. Some older patients may have difficulty remembering or following oral care instructions, so send patients home with a written summary to remind them of what you discussed. Alert caregivers to the importance of oral care and the increased risk of cavities for elderly patients.
  • Physical needs. Re-evaluate your oldest patients' caries risk and take X-rays as necessary to monitor for tooth decay and bone loss. Make sure at-risk patients receive preventive care and use fluoride products such as prescription-level fluoride toothpaste at home. Keep an eye out for medication-induced xerostomia and recommend a dry mouth rinse if necessary. Consider more frequent recall visits for patients who have root caries or difficulty with home care.