Module 4: Anticipatory Guidance, Fluoride Varnish, and Referral

4.1 Anticipatory Guidance

Pediatrician with parentAnticipatory guidance helps parents understand what to expect during their child’s current and approaching stages of development. Primary medical care providers can provide parents with anticipatory guidance to promote children’s oral health. With this information, parents can help prevent or reduce dental caries in their children.

The provision of anticipatory guidance is based on information gathered while the primary medical care provider is conducting the caries risk assessment of the child. Often, the primary medical care provider can provide anticipatory guidance, based on the risk assessment, while conducting the oral health screening. (For more information about caries risk assessment, see module 3).

Anticipatory guidance topics include oral development, oral hygiene, fluoride use, Mutans streptococci infectivity, dental safety, oral habits, and feeding and eating practices. The three most frequently discussed topics are as follows:


A large percentage of parents are not aware that dental caries is an infectious disease and that many common practices and behaviors transmit Mutans streptococci to children. Parents must be educated about modes of transmission and the impact of Mutans streptococci transmission on the oral health of children. Also encourage parents to model positive oral health behaviors. (For more information about transmission, see module 2.)

Foods and Beverages Containing Sugar

The frequency with which children consume foods and beverages that contain sugar on a daily basis is critical to the dental caries process. (See Feeding and Eating Practices). Eating regularly scheduled nutritious meals and snacks (rather than snacking throughout the day) reduces the length of time that teeth are exposed to acids that dissolve tooth structure. Children should never be put to sleep with a bottle or sippy cup or be allowed frequent and prolonged feedings or use of bottles or sippy cups containing beverages with sugar (e.g., fruit drinks, pop or soda, fruit juice), formula, or milk. If a child is accustomed to being put to bed with a bottle, offer a bottle with plain water.

Materials for Parents

A variety of fact sheets and brochures, designed to provide parents with information about how to ensure that their child enjoys the best possible oral health, are available from the Ohio Department of Health, Oral Health Program, and the National Maternal and Child Oral Health Resource Center.