2025 Catalog: General Courses

Oral health care for Infants and during the perinatal time period is an integral component of the child’s overall health and serves as a formative foundation for a lifetime of sound oral health and oral disease prevention.
Pertinent topics encompassed in perinatal and infant oral health care include:
1]   Pregnancy and perinatal oral health of the expecting mother
2]   Establishment of a Dental Home
3]   Clinical oral examination
4]   Caries risk assessment
5]   Anticipatory guidance
•   Caries etiology and caries prevention
•   Oral Hygiene Instruction [to the parent of caregiver]
•   Dietary Modification and Nutrition Counseling
•   Oral Habits and nonnutritive sucking
•   Dental Trauma
6]   Periodicity of Recall Examination
a.   Based on risk assessment
b.   Desensitization purposes

Pregnancy and Perinatal Oral Health of the Expecting Mother
•   Mothers’ poor oral health is associated with poor oral health of their offspring. Promotion of expecting mothers to seek and complete dental care during pregnancy, prior to giving birth, will improve the newborn’s opportunity for sound oral health.

•   Education regarding the vertical transmission of Mutans streptococci [MS] from mother to infant and strategies to prevent, delay, or minimize this transmission.

Establishment of a Dental Home
•   A child’s first examination is recommended at the time of the eruption of the first tooth and no later than 12 months of age. This timing typically falls between 6 months of age and the first birthday.

•   Implementing evidence-based prevention strategies, early detection of caries, and management of caries/oral conditions can improve a child’s oral and general health, well-being, and school readiness.

•   A dental home for pediatric patients should provide: safe, culturally-sensitive, individualized, comprehensive, continuous, accessible, coordinated, compassionate, patient- and family-centered care regardless of race, ethnicity, religion, sexual or gender identity, medical status, family structure, or financial circumstances.

•   When necessary treatment cannot be directly provided within the dental home, referral to the necessary dental specialists should be provided.

Clinical Oral Examination
Components of a comprehensive clinical examination include:
?   general health/growth assessment [e.g., height, weight, BMI calculation, vital signs];
?   pain assessment
?   extraoral soft tissues examination
?   temporomandibular joint assessment
?   intraoral soft tissues examination
?   oral hygiene and periodontal-risk assessment
?   intraoral hard tissue examination
?   assessment of the developing occlusion
?   radiographic assessment, if indicated
?   caries-risk assessment
?   assessment of cooperative potential/behavior of child

Common Oral Conditions in newborns and infants.

?   Palatal cysts of the newborn
o   Bohn’s nodules- remnants of salivary gland epithelium and located or most commonly on the buccal and lingual aspects of the alveolar ridges, and less commonly at the junction of the hard and soft palates. These are benign lesions that require no treatment and usually disappear within a few months after birth.
o   Epstein pearls- keratin-filled cysts that are the remnants of trapped epithelial tissue that are found along the mid-palatal raphe
?   Gingival cysts of the newborn [Dental Lamina Cysts]- found on the crests of the maxillary and/or mandibular ridges of neonates.

?   Fordyce granules- aberrant yellow-white sebaceous glands most often found on the buccal mucosa or the lips.

Note: No treatment is necessary for palatal or gingival cysts of the newborn or for Fordyce granules. These developmental remnants typically disappear shortly after birth.


?   Cleft lip with cleft palate or cleft palate alone. Clefts may be unilateral or bilateral and may involve the alveolar ridge. Isolated cleft palate occurs in the midline and may involve only the uvula or may extend into or through the soft and hard palates to the incisive foramen. Typically involves specialized treatment and therapy and provided by a specialized craniofacial team.

?   Fungal and viral infections are common due to the infants developing immune system. Common conditions include oropharyngeal candidiasis [fungal] and primary herpetic gingivostomatitis [viral]. Less common conditions that may be observed are coxsackievirus infections including herpangina and hand-foot-mouth disease.


The interval of examination should be based on the child’s individual needs or caries risk status and/or their susceptibility to disease; some patients may require examination and preventive services at more or less frequent intervals, based upon historical, clinical, and risk assessment findings.


Caries-risk assessment [CRA]
Risk assessment is a key element of contemporary preventive care. CRA should be performed as soon as the first primary tooth erupts and be reassessed periodically and frequently by dental providers.



Anticipatory guidance
Anticipatory guidance is the process of providing practical and developmentally-appropriate information about children’s health to prepare parents for significant physical, emotional, and psychological milestones.

Topics should include oral hygiene practices, oral/dental development and growth, speech/language development, nonnutritive habits, diet and nutrition, and injury prevention.
•   Oral hygiene counseling: involves the parent and patient. Initially, oral hygiene is the responsibility of the parent. As the child develops, home care can be performed jointly by parent and child. The effectiveness of home care should be monitored at every visit and includes a discussion on the consistency of daily oral hygiene preventive activities, including adequate fluoride exposure. Parents should brush their child’s teeth at a minimum 2 times per day with a fluoridated toothpaste, and floss interproximal contacts between teeth once every day.

•   Growth and Development: Educating parents regarding tooth development and chronology of eruption can help them better understand the implications of delayed or accelerated tooth emergence. Parents also need to be informed about the benefits of topical fluorides for newly erupted teeth which may be at greater risk of developing caries, especially during the post-eruption maturation process.

•   Nutrition: The development of dietary habits and childhood food preferences appears to be established early and may affect the oral health as well as general health and well-being of a child. The establishment of a dental home no later than 12 months of age allows dietary and nutrition counseling to occur early. This helps parents to develop proper oral health habits early in their child’s life, rather than trying to change established unhealthy dietary habits later.

•   Diet and Sugar Consumption: During infancy, counseling should focus on breastfeeding, bottle or no-spill cup usage, concerns with nighttime feedings, frequency of in-between meal consumption of sugar-sweetened beverages [e.g., sweetened milk, soft drinks, fruit-flavored drinks, sports drinks] and snacks, as well as special or prescribed diets.

•   Oral habits: Examples are nonnutritive sucking that include digit sucking and pacifier use, bruxism, tongue thrust swallow and abnormal tongue position, and self-injurious/self-mutilating behavior. These habits may apply forces to teeth and dentoalveolar structures. Although early use of pacifiers and digit sucking are considered normal, pacifier use beyond 18 months can influence the developing orofacial complex. Studies indicate that children having a nonnutritive sucking habit beyond age three have a higher incidence of malocclusions.

•   Dental Injuries and Trauma: Traumatic dental injuries in the primary dentition occur with great frequency with a prevalence of one-third of preschool children and one-fourth of school-age children. Dental practitioners should provide age-appropriate injury prevention counseling for orofacial trauma. Initial discussions should include advice regarding play objects, pacifiers, car seats, and electrical cords.

Periodicity of Recall Examination
•   According to the AAPD, children who exhibit higher risk of developing caries benefit from recall appointments at greater frequency than every six months, every three months is an appropriate interval between preventive dental visits.
•   Recall appointments every 3 months allows increased professional fluoride therapy application, professional assessment of oral hygiene, and opportunity to foster improvement of oral health by demonstrating proper oral hygiene techniques, antimicrobial therapy reapplication, and reevaluating behavioral changes for effectiveness
•   Children who exhibit moderate or low caries risk by assessment should receive preventive recall appointments every 6 months.
•   Reevaluation and reinforcement of preventive activities contribute to improved instruction for the caregiver of the child, continuity of evaluation of the patient’s health status and caries risk, and help to diminish anxiety and fear for the apprehensive child

For more in depth information and CDE credit please review the following American Academy of Pediatric Dentistry Reference Manual articles:

1]   AAPD Best Practices: Policy on the Dental Home https://www.aapd.org/media/policies_guidelines/p_dentalhome.pdf

2]   AAPD Best Practices: Periodicity of Examination, Preventive Dental Services, Anticipatory Guidance/Counseling, and Oral Treatment for Infants, Children, and Adolescents
https://www.aapd.org/globalassets/media/policies_guidelines/bp_periodicity.pdf

3]   AAPD Policies and Guidelines: Perinatal and Infant Oral Health
https://www.aapd.org/globalassets/media/policies_guidelines/bp_perinataloralhealthcare.pdf

1]   Know how to establish a dental home
2]   Learn properly how to do a caries risk assessment.
3]   Know the basics of risk asessment.

The speaker has no conflicts of interest to report.

It is the policy of the Indian Health Service, Division of Oral Health, that faculty/planners disclose any financial or other relationships with commercial companies whose products may be discussed in the educational activity. The Indian Health Service, Division of Oral Health, also requires that faculty disclose any unlabeled or investigative use of pharmaceutical products and medical devices. Images that have been falsified or manipulated to misrepresent treatment outcomes are prohibited.

None of the faculty/planners for this activity has a conflict of interest, and there is no use of unlabeled or investigative pharmaceutical products or medical devices. No images have been falsified or manipulated to misrepresent treatment outcomes.The educational objectives, content, and selection of educational methods and instructors are conducted independent of any commercial entity.

The IHS Division of Oral Health is an accredited sponsor of continuing education under the American Dental Association Continuing Education Recognition Program (CERP). ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. Concerns or complaints about a CE provider may be directed to the IHS at IHS CDE Coordinator or to the Commission for Continuing Education Provider Recognition at CCEPR.ada.org

Please Make Checks Payable to: Indian Health Service.

Tuition must be paid in full 8 weeks prior to the start date of any course. Request for refunds must be received in writing at least two weeks before the course begins. For each refund request, there will be an administrative charge of $100. No refunds will be made to registrants who fail to attend a course. If IHS CDE program cancels a course, then 100% of the tuition will be refunded.