Section 2 - Child health checks

Health check recommendations

• All children between 6 months and 15 years at each scheduled health check

1. Procedure

• Ask the parent or child the age appropriate questions. See Table 1.
• Perform a visual oral check
• Determine if the child requires a referral according to the answers and place on a follow-up and recall register

1. Visual oral check
   • Involves looking at all aspects of the oral cavity; teeth, gums and cheeks
   • Ensure room is well lit or use a torch and position the child comfortably
   • Don gloves
   • Lift the upper lip and lower the bottom lip to inspect surfaces of the outer teeth
   • Use a tongue depressor to inspect the back of the oral cavity
   • Observe teeth for alignment, frosting (early decay), brown decay (active) or black decay (inactive)
   • Observe gums for colour, receding edges or bleeding
   • Observe inner cheeks for colour, ulcers or trauma

2. Results

1. Questions results
   • Answers should be answered positively e.g. child or parent does brush teeth twice a day, child does not have painful or bleeding gums
2. Visual oral check results ^2–4
   • Baby teeth (deciduous) usually erupt:
     • by 6 months of age but times vary
     • in lower teeth before upper
     • in girls before boys
     • in both jaws usually in pairs
     • all by 3 years of age
   • Sometimes babies are born with a neonatal tooth and lost soon after birth
   • Teeth should be white, free of brown spots (active decay) or black spots (old decay)
   • Gums should be pink with clearly defined and tight margins around each tooth, free of inflammation, swelling, bleeding, pain or tenderness
   • Loose teeth or gums that bleed spontaneously or during brushing are a sign of Dental caries and periodontal disease
   • The inside of the cheeks should be pink, red, smooth and moist
   • If a child’s oral health is poor, provide brief intervention and make a referral

3. Brief intervention

1. Children all ages ^1–7
   • Dental caries and periodontal disease affects > 40% of Australian children due to inability to self care; Rates are higher for Aboriginal and Torres Strait Islander children. See Resource 2.
   • A parent is responsible for cleaning a child’s teeth < 8 years of age as children lack motivation or manual dexterity to do so
   • Keep toothpaste out of reach of children. Children should not dispense toothpaste without supervision
   • The tooth brushing method is a circular or jiggling motion on both the inside and outside surfaces of the tooth, along the gum margins, then a scrubbing motion along the chewing surfaces
   • Encourage the child to spit toothpaste out once finished; do not rinse mouth
   • Develop a regular tooth brushing routine for children
   • Replace toothbrushes every 3–4 months or sooner if bristles become frayed
   • Do not share toothbrushes, food utensils or place baby bottles or dummies in adult mouths. Harmful adult oral bacteria spreads to children causing decay
   • Everyone in the family should maintain their dental hygiene
   • Breastfeeding is best for baby’s teeth
   • If bottle feeding, put only breast milk, formula or water in the bottle
   • Prop feeding or putting a baby to bed with a bottle can cause tooth decay
   • Any fluids (besides water) or food left in the mouth of a child > 12 months predisposes their teeth to decay
   • Provide healthy Diet and nutrition:
     • only provide water to drink. Avoid fruit juices, sports or fizzy drinks or cordials
     • choose fruit (apples and bananas) and vegetable (carrots and tomatoes) snacks. Avoid sugary or acidic snacks and takeaway processed foods
   • Encourage annual dental visits. Children should have a dental assessment by 2 years of age. See Resource 1.
   • Dental practitioners can provide advice about access to alternate sources of fluoride such as mouth rinses and high fluoride toothpastes
2. Children aged < 5 years ^2–4,6,7
   • Plaque forms as soon as teeth erupt; clean infant’s teeth using a damp cloth
   • Children aged 6–18 months should have their teeth brushed by a parent twice a day with a small soft toothbrush:
     • without toothpaste in areas with fluoridated water
     • with a small pea sized amount of low fluoride toothpaste (0.4 to 0.55 mg/g) in areas with unfluoridated water
   • Children aged 18 months to 5 years should have teeth brushed by a parent twice a day with a small soft toothbrush with a small pea sized amount of low fluoride toothpaste
3. Children aged > 5 years ^2–4
   • Using a soft toothbrush the teeth should be cleaned twice a day or more frequently with standard fluoride toothpaste
   • Brush before going to bed as protective saliva reduces while sleeping. Decay causing bacteria attacks dry tooth surfaces
   • Introduce dental floss or interdental cleaning products to clean between the teeth

4. Referral

• For any concerns identified in Table 2. refer to:
  • the Primary Clinical Care Manual
  • a government funded dental service. See Resource 1.
  • a private dentist using the Child Dental Benefits Schedule entitlement
• See Dental caries and periodontal disease

5. Follow-up

• Place the child on a recall register if required
• Ensure all referrals are actioned
• Provide the parent with details for the next scheduled follow-up appointment

6. References

• All Chronic Conditions Manual references are available via the downloadable References PDF

7. Resources

1. Child Dental Benefits Schedule (CDBS) eligibility details or Queensland Government public dental services details
2. Queensland Health oral health promotion and resources