TMPPM 2008 > Texas Medicaid Services > Texas Health Steps (THSteps) > Clinical Information

43.2.3.10 Dental Screening

Dental Screening Guidelines for THSteps Medical Providers

The following information provides guidelines for THSteps medical providers in performing the initial dental screening as required within a comprehensive THSteps medical check up.

The applicable periodicity schedule for THSteps dental assessment follows the standards as adopted by the American Academy of Pediatric Dentistry. The oral screening by the medical provider, as required within the comprehensive THSteps medical check up, must occur at all THSteps medical check ups. The medical check up provider must initiate the referral for a comprehensive THSteps dental check up by a THSteps participating dentist, starting at 1 year of age and at six-month intervals thereafter (unless unusual circumstances dictate more frequent referrals).

Early Childhood Caries (ECC)

To reduce the risk of ECC, the parent/guardian should always be counseled in proper feeding practices, including the following:

•Never put a child to bed with a bottle containing any liquid other than water.

•Recommendations for decreasing the frequency and duration of bottle feeding.

•Bottle contents (water is recommended in the bottle other than at regular feeding times). Feedings should be followed by gentle cleansing of the oral structures with a clean, damp cloth or soft brush.

•Establish a goal to have the child to begin drinking from a cup at 6 months of age.

Early signs of ECC often present as chalky white spots, particularly on the lingual surfaces of maxillary incisors. These signs, or any indication of more advanced caries, should prompt an immediate referral to appropriate dental care providers for evaluation.

Primary Teeth

The 20 primary teeth are also called deciduous teeth or baby teeth. Besides functioning in mastication, they also serve roles in speech development, jaw development, and eventually, in the position of the permanent dentition. Premature loss of the primary teeth can lead to permanent space loss within the dental arch and significant problems with alignment and function of the permanent teeth. If a primary tooth is lost prematurely, it is important that the client be evaluated within the next few weeks by a dentist, and that a determination is made for space supervision. Delayed exfoliation of the primary teeth may also have a harmful effect on the permanent dentition and calls for a dental evaluation.

Permanent Teeth

The first permanent tooth is the 6-year molar, which is the sixth tooth from the mid-line between the central incisors. There are four of them, that erupt when a child is between 5 and 6 years of age. The first permanent molar is often mistaken for a primary tooth because no tooth is lost. These teeth are termed the keystones of the dental arches because they help guide the subsequent teeth into proper alignment.

Caries (Cavities)

Clients with developing primary or mixed (primary-permanent) dentition should be evaluated for caries (cavities).

Oral Soft Tissues

Oral soft tissues should be examined for any abnormalities. Consultation with a dental provider, where a differential diagnosis may apply, is highly recommended.

Sealants

Many studies have shown that dental sealants can protect teeth from decay when properly applied.

Client Dental Education

This education should include the following:

•The need for thorough daily oral hygiene practices.

•Education in potential gingival manifestations for clients with diabetes and clients under long-term medications therapy.

•Utilization of the THSteps eligibility for dental services.

Smokeless Tobacco

The use of smokeless tobacco is expanding in many population groups and is strongly correlated with an increase in the prevalence of oral cancer. Early intervention and education can play a significant role in reducing risks. The following steps should be taken:

•Assess patterns of use.

•Offer assistance in cessation, if appropriate.

•Evaluate oral hard and soft tissues particularly the mucobuccal folds, cheeks, and sublingual areas.

•Refer all suspected lesions to appropriate providers for evaluation and follow-up.

Dental Disease Prevention

Perhaps the two most important interventions are:

•Early and periodic dental check ups.

•Parent education that stresses to parents the important role they can play in preventing dental disease in their children.

Regularly-positioned teeth with normal occlusion add symmetry and harmony to the facial appearance and are an important aspect of the expression of emotion and personality.

Refer to: "THSteps Medical and Dental Administrative Information" for more information.