City Health Information
Volume 32 (2013) New York City Department of Health and Mental Hygiene No. 1; 1-6



Promoting Oral Health
  • Caries and periodontal disease can largely be prevented by limiting sugar intake, brushing teeth twice daily, and flossing daily.

  • Examine the mouth for signs of oral disease and assess oral health risks, such as poor oral hygiene and alcohol or tobacco use.

  • Educate patients about good oral hygiene and regular dental visits and make referrals as appropriate.

Oral health is an important part of overall health (1). Despite the advances made over the past half-century in oral health in the United States (US), oral diseases are still a public health problem, with a higher burden among low-income, minority, and older populations (1). The most common threats are periodontal disease (gingivitis and periodontitis) and caries (tooth decay) (1).

Nearly 60% of adult New Yorkers are at increased risk for oral health problems due to behavioral or medical risk factors (Box 1), and 40% of these adults had not visited a dentist in the past year, according to a 2007 survey (2). Among all New Yorkers, 1 in 4 children aged 2 through 12 years (2009 data) and 1 in 3 adults aged 18 years and older (2007 data) did not have a preventive dental visit in the past year (2,3). People with lower incomes are less likely to visit a dentist (4). In New York City (NYC), 52% of adults in the lowest-income households (<100% federal poverty level) had a dental visit in the past year, compared with 77% in the highest-income households (>600% federal poverty level) (2).

Primary care providers can improve their patients' oral health by encouraging good oral hygiene and regular preventive dental visits. Ask patients about their most recent routine dental visit and refer all patients to a dentist if they do not already have one. Explain the importance of brushing with fluoridated toothpaste, flossing, visiting a dentist regularly, and eating a diet high in fiber-rich fruits and vegetables while limiting sugary and starchy snacks (4,5). Examine the mouth for signs of early oral cancers; early detection can improve cancer prognosis (see Oral and Throat Cancer) (6).

Dental care is particularly important for children, who should be referred to a dentist by age 1 (7-9). In the US, only 2% of infants and 1-year-olds have annual dental visits, while 87% have annual office-based physician visits (10).

Pediatricians should educate parents about preventive care for their children (Box 2), assess the child's risk for caries, and apply fluoride varnish (reimbursable by Medicaid for children aged 7 and younger). See Guideline on Caries-risk Assessment and Management for Infants, Children, and Adolescents and Early Childhood Oral Health for information on assessing caries risk for different age groups and applying fluoride varnish.

Diet high in sugar Caries
Smoking Oral cancer, periodontal disease
Heavy alcohol use Oral cancer
Poor oral hygiene Periodontal disease, caries
Diabetes Periodontal disease
Pregnancy Gingivitis

PDF version of Box 1

image of child toothpaste sample

Left: Smear, for children younger than 2 years at risk for caries. Right: Pea-sized, for all children aged 2 to 5 years.


PDF version of Figure

For babies and young children
  • Wipe the baby's gums and teeth with a damp cloth after each feeding, especially before bedtime and naps and after any nighttime feedings (8).
  • Start brushing your baby's teeth when the first tooth erupts. Brush twice a day with a soft, child-sized toothbrush and water. Use a smear of fluoridated toothpaste if your child is younger than 2 years old, particularly if your child is put to bed with a bottle containing natural or added sugar or already has cavities or fillings (9).
  • Don't put your infant to bed with a bottle of milk, formula, or juice. If your child needs a bottle to help him sleep, give only water (8).
  • Don't pass a spoon, a piece of food, a pacifier, or other objects from your mouth to your child's mouth, because cavity-causing bacteria can be passed through saliva (7).
  • Take your child to a dentist by age 1 (7-9).
For all children
  • Brush your child's teeth twice a day. Use fluoridated toothpaste for children aged 2 years and older; use a pea-sized amount for children aged 2 to 5 years (Figure) (9). Assist and supervise children until they can brush well on their own (7-9).
  • Promote healthy eating behaviors. Limit sugary foods and drinks, including fruit drinks, soda, and sports drinks, especially between meals. If drinking juice, children should drink at most 4 to 6 oz of 100% fruit juice per day (7-9).
  • Have your child drink tap water to increase fluoride intake (7-9), since NYC water is fluoridated.
  • Be sure your child visits the dentist every 6 months (7-9).
  • Ask the dentist or pediatrician about fluoride varnish, a protective coating painted onto the teeth, recommended for children up to age 7 (Resources--Early Childhood Oral Health brochure).
  • Ask the dentist about sealant for teeth that are at risk for cavities in children aged 6 years and older. A sealant is a thin plastic coating that blocks cavity-causing bacteria and food particles (11,12).
  • Have your child wear a mouth guard when playing contact sports to prevent mouth injuries (13,14).

PDF version of Box 2

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