The dental early detection examination is a service offered by the statutory health insurance funds for children between the 30th and 72nd month of life. It aims to detect diseases and developmental disorders in the dental, oral and maxillofacial area at an early stage and also to develop awareness of dental care and tooth-healthy nutrition among parents and children. For a tooth-healthy life, it is essential that dental care is practiced on a daily basis from the first erupting milk tooth onwards and thus becomes a ritual at an early stage. However, even the best dental care can only be insufficiently effective if the wrong dietary habits with frequent sugar consumption increase the bacterial count of cariogenic (tooth decay-causing) bacteria or if the acid contained in food and beverages regularly affects the teeth. Here, it is important to provide advice to parents and other caregivers at an early stage and to make them aware of deficits in oral hygiene and nutritional behavior to which they themselves may have become accustomed throughout their lives. A child can only develop a fear of visiting the dentist if it has bad experiences itself – or if it is taught the fear suffered by caregivers in the home environment. Through early habituation to regular visits to the dentist, which take place in a playful manner and are not linked to the elimination of already existing toothache, good own experiences should be conveyed and the visit to the dentist thus positively substantiated. Accordingly, the goals of the FU are:
- Early detection of diseases and maldevelopments in the dental, oral and maxillofacial area.
- Detect and lower the risk of caries.
- Accustoming the child to routine dental examinations.
- Developing awareness among parents and child that and how dental care must be done
- Advise parents about tooth-healthy diet
- Developing nutritional awareness in the child
The procedure
The dental screening examinations benefit children between the ages of 30 and 72 months. During this period, a maximum of 3 FU appointments can be made at intervals of at least 12 months. The following aspects are considered during a screening examination:
I. In-depth examination
- Family history – genetic predispositions e.g. for periodontal disease and many others
- Medical history of the child – systemic diseases, previous treatments, complaint pattern, and others
- Extraoral findings – asymmetries, swellings, facial profile, muscle tone of lip muscles, and others
- Intraoral findings – tooth eruption, malocclusion of the jaws and teeth, caries, findings of gingiva and mucosa (gums and oral mucosa), oral hygiene, habits (damaging habits), and others
- Speech – evidence of dyskinesia (muscular dysfunction), ankyloglossia (synonym: ankyloglosson; congenital (congenital) developmental disorder of the tongue in which the tip of the tongue is fixed to the floor of the mouth by a frenulum linguae (frenulum) that is too tight and too far forward (“grown on”))
- Breathing – mouth or nose breathing, etc.
- Nutritional history – is collected in case of increased risk of caries.
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With the examination, dental, oral and jaw diseases and maldevelopments of various genesis (origin) are recorded, which could negatively affect the tooth and jaw development. This also includes habits (harmful habits) or dyskinesias (muscular dysfunctions) such as lip sucking or pressing, thumb sucking, habitual (habitual) mouth breathing or sigmatism (circumscribed developmental disorders in speech), to name a few. Soothers also have an active and negative effect on the development of the upper and lower jaw and must therefore be addressed. Appropriate findings may necessitate collaboration with other specialties. Thus, dyskinesia can be positively influenced by speech therapy. Mouth breathing due to an organic cause may require presentation to an ear, nose and throat specialist. In selected cases, early orthodontic treatment is advisable. II. caries risk assessment
To determine the caries risk, the dmft index (caries index) is collected as part of the FU: By definition, children are divided into different age groups. The high-risk group is considered to be the respective 20% with the highest caries incidence.
- D = decayed (destroyed)
- M = missing (missing)
- F = filled (filled)
- T = teeth (teeth)
| Age | dmft index |
| 2 to 3 year olds | > 0 |
| 4-year-olds | > 2 |
| 5-year-olds | > 4 |
A two- or three-year-old child is thus already considered to be at high risk of caries at the time of the first carious lesion (cavity). This may seem surprising at first glance; however, if one takes into account the very short period of use of the deciduous teeth up to this point, it becomes clear that within a few months, a lack of dental care combined with incorrect nutritional habits have had an effect. III. nutritional counseling
If the caries risk is increased, nutritional counseling will therefore inevitably have to follow. The aim is to reduce the frequency (frequency) of sugary meals and acidic drinks offered to the child throughout the day or even at night. In this way, the number of caries-active bacteria is reduced and the remineralization phases (recovery phases for the tooth substance, in which minerals are re-stored) are extended:
III.1. Caries caused by sugar
Whether white household sugar (granulated sugar; sucrose), brown cane sugar, honey, fructose (fruit sugar) or glucose (grape sugar) – cariogenic bacteria metabolize all of them in the same way. Ultimately, acids have a damaging effect on teeth. They are formed as a bacterial metabolic product in the biofilm (bacterial plaque) that adheres to the teeth when oral hygiene is inadequate. Acids demineralize (decalcify, soften) the tooth substance. If they act at short intervals throughout the day, the tooth substance cannot recover. In the medium term, a carious lesion is the result. Caries will preferentially develop where the biofilm is particularly little disturbed by poor toothbrushing technique and can thus hold on well – i.e. in the relief of the occlusal surfaces, in interdental spaces and along the gum line. A number of foods advertise themselves as “sugar-free”. However, only sucrose is designated as “sugar” under food law, which means that glucose and fructose can be contained in the product. Only treats that bear the “tooth man” seal of approval, a smiling white tooth with an umbrella, are truly tooth-friendly.
- As few sugary snacks as possible – even a sweet drink is a snack!
- No sugar from the teat bottle – offer only water and unsweetened herbal tea (no instant products) to quench thirst.
- Tooth-friendly are only products with the “tooth man”.
- Watch out for hidden sugars even in supposedly healthy foods (cereal bars, dried fruit and many others).
III.2 Erosion by acids
Reducing sugary meals should curb acid production by cariogenic bacteria. In this case, the acid effect on the teeth begins somewhat delayed. However, with soft drinks, fruit juices – also in the form of spritzers diluted with water – the teeth are immediately surrounded by acid. If a child is given small sips of fruit juice, whether diluted or not, from a bottle throughout the day, the teeth are continuously demineralized (decalcified). Acid erosion is the result – a removal of substance from the teeth that is not due to caries.
- Offer fruit juice in a glass as a temporary snack, not for self-supply of the child from the all-time ready teat bottle!
- After acid exposure wait 30 minutes with the toothbrushing – so long the tooth structure needs at least to recover through remineralization (storage of minerals from saliva) to the extent that it is not worn away by the toothbrush superficially
- Also pay attention here to the “tooth man” – because appropriate foods and beverages have neither cariogenic nor erosive potential
- Pay attention to hidden acids
IV. Oral hygiene advice
IV.1 Choosing the right toothpaste.
For children under six years of age, the recommendation is to use a special children’s toothpaste with a fluoride content of 500 ppm (parts per million, 0.05%). Fluorides have a caries-inhibiting effect via various mechanisms occurring in the oral environment and are therefore the most important pillar of caries prophylaxis (prevention of tooth decay).The low dosage does justice to the greater likelihood that young children will swallow toothpaste residues instead of spitting them out. A small pea-sized amount of toothpaste is brushed once a day for the first two years of life, and twice a day after the second birthday. IV.2 Tooth brushing techniques
Dental care from the first tooth is of fundamental importance. Toddlers are taught tooth brushing and the proper timing as a daily ritual by their parents. At the age of two to three, they begin to learn the systematic brushing technique increasingly on their own. All attempts by the child to brush independently should be praised and supported. However, they will not be able to brush completely independently, without systematic daily brushing by their parents, until they have mastered handwriting, which is much later than parents sometimes assume. The most important tool for efficient brushing is the toothbrush. Children need a child-friendly version with a short head and a thickened handle. The rounded bristles must be in tightly standing tufts (multi tufted). Scientifically, manual toothbrush and electric toothbrush are equally recognized. Splitting is recommended to learn how to use both brushes. To reach all tooth surfaces when brushing, young children are taught the KAI system:
- K = occlusal surfaces first
- A = then the outer surfaces of the upper and lower teeth together with closed dentition in circular motions.
- I = lastly the inner surfaces of the upper and lower row of teeth individually
With the horizontal method or “scrubbing technique” succeeds small children the introduction to dental care, because it is the only one that meets the child’s movement pattern. The bristles are here vertically on the outer surfaces of the closed rows of teeth or chewing surfaces, the brush is moved horizontally back and forth by the child. Inner surfaces can only be cleaned very inadequately. This is the responsibility of the parents during subsequent brushing. From the age of four, a more complex method should gradually be learned as fine motor skills improve. The rotation method, in which small circular movements are made, is a good choice. Alternatively, the red and white method can be used, in which the toothbrush is pulled from the gum (red) to the tooth (white) with a rolling motion from the wrist. Cross brushing is called for with the eruption of the six-year molars, the first permanent molars: For a long time, these are hidden behind the last milk teeth during the eruption phase. Until they reach the chewing plane, they cannot be reached by the brushing of the occlusal surfaces practiced in the primary dentition. Therefore, they are targeted with the toothbrush, coming transversely from the opposite side. IV.3 Aids for daily oral hygiene
Dental floss is used to clean the interdental spaces (spaces between teeth) and is also recommended for children. For easier handling, the trade also offers it mounted on small carriers (e.g. Oral B Flossette). Colorful handles based on animal motifs increase acceptance. V. Caries prophylaxis with fluorides
The appropriate use of fluorides for caries protection in an age-dependent dosage of between 0.25 mg and 1 mg daily is now scientifically considered to be effective and absolutely safe. However, like any active ingredient, fluoride can be harmful if overdosed. Therefore, before recommending fluorides, the first step is to take a fluoride history, i.e., to record all sources of fluoride through which the child is supplied with fluoride. These include:
- Drinking water
- Mineral water consumed regularly
- Fluoridated table salt
- Diet food
- Sea fishes
- Fluoride tablets
With consistent fluoride history, overdose can be ruled out. For children up to six years is considered basic prophylaxis with fluorides:
- The use of a children’s toothpaste with a fluoride content of 500 ppm (see above).
- In conjunction with fluoridated table salt.
- Further fluoride administration is usually not necessary without the presence of increased caries risk.
If there is an increased risk of caries, a professional application of fluoride can also be made as part of the dental check-up appointments.
