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Policy Statements


​The American Academy of Pediatrics published its first policy related to oral health in 2003. Since then, AAP oral health experts have published additional policies and participate in the review of the AAP's many policies on children's health. Below are the AAP policy statements related to children's oral health.

Oral and Dental Aspects of Child Abuse and Neglect (2005, revised in 2017)
The American Academy of Pediatrics (AAP) and the American Academy of Pediatric Dentistry (AAPD) released a revised report to help pediatricians and other primary care providers as well as dentists and other dental providers to identify oral and dental indicators of child abuse or neglect. Injuries indicative of physical abuse include: bruises from eating utensils during forced feedings, burns from scalding foods or liquids, cuts or skin irritation at the corners of the mouth from gags, and injuries to the back of the throat. Sexual abuse may be indicated by injuries or infections of STIs from forced oral sex. Dental neglect occurs when a parent or guardian willfully fails to seek and follow through with oral health care despite adequate access to care and knowledge of the care needed and its importance. Without treatment, dental caries lead to infections and pain that interfere with communication, eating, and sleep, all of which inhibit a child’s proper growth and development. Dental or orofacial abnormalities frequently cause a child to be a target of bullying, and the child can then face a higher risk of depression and suicidal thoughts. Victims of sex trafficking or forced prostitution often have caries, infections, and tooth loss from abuse or malnutrition.

The Primary Care Pediatrician and the Care of Children with Cleft Lip and/orCleft Palate (2017)
Care for children with cleft lip and/or cleft palate (CL/P) requires a multidisciplinary care team spanning from neonatal care into adulthood. CL/P has multifactorial causes including genetics of both the child and mother, smoking during pregnancy, and presence of other syndromes. The AAP recommends that children born with CL/P receive coordinated care through multidisciplinary cleft or craniofacial teams. Cleft teams work exclusively with CL/P, while craniofacial teams have a broader area of expertise. The teams include surgical, medical, dental, and allied health disciplines because CL/P outcomes affect surgical, sp​​eech, hearing, dental, psychosocial, and cognitive domains. These teams also play an important role in advocating for Medicaid insured children or children whose parents cannot afford payments so that these children can still obtain appropriate, timely, and equitable surgeries as well as other necessary care. Relative to the pediatric population, more children with CL/P are Medicaid insured, a marker for low socioeconomic status, the same population group at higher risk for early childhood caries (ECC). Every effort must be made to visualize the palate in the initial newborn examination to exclude the presence of cleft palate and asses for or monitor infants with Pierre Robin sequence. Breastfeeding may or may not be possible, and special feeding devices as well as assistance by a certified lactation consultant may be required.​

Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures: Update (2016)
The safe sedation of children for procedures requires a systematic approach that includes the following: no administration of sedating medication without the safety net of medical/dental supervision, careful pre-sedation evaluation for underlying medical or surgical conditions that would place the child at increased risk from sedating medications, appropriate fasting for elective procedures and a balance between the depth of sedation and risk for those who are unable to fast because of the urgent nature of the procedure, a focused airway examination for large (kissing) tonsils or anatomic airway abnormalities that might increase the potential for airway obstruction, a clear understanding of the medication's pharmacokinetic and pharmacodynamic effects and drug interactions, appropriate training and skills in airway management to allow rescue of the patient, age- and size-appropriate equipment for airway management and venous access, appropriate medications and reversal agents, sufficient numbers of staff to both carry out the procedure and monitor the patient, appropriate physiologic monitoring during and after the procedure, a properly equipped and staffed recovery area, recovery to the pre-sedation level of consciousness before discharge from medical/dental supervision, and appropriate discharge instructions.

Maintaining and Improving the Oral Health of Young Children (2014) 
Oral health is an integral part of the overall health of children. Dental caries is a common and chronic disease process with significant short- and long-term consequences. The prevalence of dental caries for the youngest of children has not decreased over the past decade, despite improvements for older children. As health care professionals responsible for the overall health of children, pediatricians frequently confront morbidity associated with dental caries. Because the youngest children visit the pediatrician more often than they visit the dentist, it is important that pediatricians be knowledgeable about the disease process of dental caries, prevention of the disease, and interventions available to the pediatrician and the family to maintain and restore health.

Fluoride Use in Caries Prevention in the Primary Care Setting (2014) 
This succinct report will help to guide pediatricians and other health professionals regarding the use of fluoride as a caries prevention agent in the primary care setting. It covers the use of fluoride toothpaste in young children, fluoride varnish application in the primary care setting, fluoride supplements for children living in non-fluoridated areas, and facts about community water fluoridation.

Management of Dental Trauma in a Primary Care Setting (2014) 
The American Academy of Pediatrics and its Section on Oral Health have developed this clinical report for pediatricians and primary care physicians regarding the diagnosis, evaluation, and management of dental trauma in children aged 1 to 21 years. This report was developed through a comprehensive search and analysis of the medical and dental literature and expert consensus. Guidelines published and updated by the International Association of Dental Traumatology are an excellent resource for both dental and nondental health care providers.

Oral Health Care for Children with Developmental Disabilities (2013)
Children with developmental disabilities often have unmet complex health care needs as well as significant physical and cognitive limitations. Children with more severe conditions and from low-income families are particularly at risk with high dental needs and poor access to care. In addition, children with developmental disabilities are living longer, requiring continued oral health care. This clinical report describes the effect that poor oral health has on children with developmental disabilities as well as the importance of partnerships between the pediatric medical and dental homes.

Early Childhood Caries in Indigenous Communities (2011) 
The oral health of Indigenous children of Canada (First Nations, Inuit, and Métis) and the United States (American Indian, Alaska Native) is a major child health issue. This statement includes recommendations for preventive oral health and clinical care for young infants and pregnant women by primary health care providers. Recommendations are also made regarding community-based health-promotion initiatives, the oral health workforce, access issues, advocacy for community water fluoridation, and fluoride-varnish program access.

Oral Health Risk Assessment Timing and Establishment of the Dental Home (2003, reaffirmed in 2009 & 2015, RETIRED)

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