Oral Health Inclusion in General Health Programs during the First Three Years of Life: Are there Public Health Policies to Prevent Early Childhood Caries in South-America?

Background: Early childhood caries (ECC) prevalence is very high in South America. Considering the limited resources available for ECC treatment in this region, it is important to see what efforts have been made to prevent ECC and promote infant oral health (IOH).

Aim: to assess OH inclusion in norms and guidelines related to routine check-up during the first three years of life.

Methods: A systematic search was made in Ministry of Health websites for all South American countries. These key words, in the country`s official language, were used: child, infant, infant health, child health, child development, child check-up and primary health care for children. Technical norms, guidelines, manuals and protocols related to infant check-up were included. Information regarding oral health for children under 3 years old was extracted and analysed. Additionally, IOH guidelines were searched on each website.

Results: Eight out of twelve countries have official documents related to child check-up. Six (75%) of those eight documents include OH aspects. Oral exam as part of general examination, performed by nurses and doctors during check-ups, is clearly recommended in four countries. Most IOH recommendations were not evidence-based (gauze to clean the mouth before tooth eruption, use of low-fluoridated toothpaste). Four countries recommend sugar avoidance till 24 months-old, following OMS guidelines. Age for referrals to the dentist varies from 6 to 24 months-old. Three countries have IOH clinical practice guidelines that recommend fluoridated toothpaste 1000-1500 ppm for all children, only in one case this recommendation is included in the technical norm for child check-up.

Conclusion: IOH is not clearly included in documents aimed towards non-dental health professionals. Pediatric dentists need to be involved in public health to properly include ECC prevention in primary health care settings. Adequate norms and evidence-based guidelines are the basis to address ECC as a public health problem.