The American Academy of Pediatrics has released a milestone clinical report addressing adolescent oral health from the pediatrician’s perspective.
Pediatricians Should Integrate Oral Health into Medical Checkups
- Break down medical silos: Pediatricians are being urged to integrate oral health screenings directly into regular medical checkups, treating the mouth as an essential part of the whole body.
- Understand high-risk behaviors: Puberty, increased autonomy, sugar-sweetened beverages, eating disorders, and orthodontic changes create a vulnerability window during adolescence.
- Prevent adult disease: Poor oral health in childhood is the leading risk factor for adult dental disease, which is linked to risks for diabetes, stroke, dementia, and kidney disease.
Bridging the Divide Between Pediatrics and Dentistry
Reflecting the growing medical consensus regarding how deeply oral wellness, overall well-being, and chronic illnesses are linked, a new clinical report has been issued by the American Academy of Pediatrics (AAP) and published in Pediatrics. Authored under the direction of Susan A. Fisher-Owens, MD, MPH—a professor of pediatrics as well as preventive and restorative dental sciences at the University of California, San Francisco—the new guidelines point out that teenager dental neglect can lead to psychological distress, physical discomfort, school absenteeism, diminished nutrition, lower general wellness, self-consciousness, and reduced social participation.
“Many in pediatrics still are not aware that oral health problems are the most common chronic condition of childhood and also that oral disease prevention plays a well-studied and effective role that the pediatric provider can integrate easily into practice. In fact, it is second only to vaccination!” said Fisher-Owens. Medical and oral care should not remain separate silos, according to the report, which aims to provide doctors with practice-based skills for building oral care into regular medical visits.
Pubertal Hormones and Adolescent Autonomy
As children enter puberty and adolescence, age-specific concerns emerge. “The third molars, or ‘wisdom teeth,’ erupt, and adolescence is a time of orthodontia,” Fisher-Owens said. Adolescents also experience increasing autonomy, which can lead to riskier health behaviors without balancing preventive habits—such as consuming more sugar-sweetened beverages paired with less frequent tooth brushing.
Teeth can suffer harm from adolescent-onset eating disorders, alongside risky behaviors such as drug consumption, cigarette smoking, and engaging in sexual activity without barrier protection. “Having poor oral health as a child is the leading risk for having poor oral health as an adult—the infection stays in the mouth even when teeth fall out,” Fisher-Owens added. Adults then incur more expensive dental care and face greater risk for diabetes, stroke, dementia, kidney disease, poor pregnancy outcomes, and lower chances of being hired in the workplace.
“Girls are at greater risk since emerging female hormones change blood flow in the gums, making them more susceptible to infections,” Fisher-Owens noted.
| Adolescent Oral Condition | Primary Risk Factor / Mechanism | Clinical Management Strategy |
|---|---|---|
| Gingivitis | Plaque accumulation and elevated steroid hormones during puberty | Reversible with improved hygiene; professional referral if lasting over 2 weeks |
| Temporomandibular Conditions | Joint laxity from elevated estrogen, trauma, or stress | Early diagnosis, specialist care, and custom-fitted night guards |
| Bruxism | Special healthcare needs, stress, or stimulant medications | Night guards to prevent wear on the teeth |
Clinical Recommendations for Pediatric Providers
Alongside an accompanying technical literature review, the clinical guidance addresses a broad spectrum of issues, including ways to prevent oral sports injuries, cosmetic and orthodontic concerns, and actions that lead to dental neglect. Promoters of oral conditions in this age group include hormone levels, certain medications, and gastrointestinal reflux disorder. “Although consistent oral health assessment and guidance in the medical office improves dental outcomes in younger children, less emphasis has been placed on pediatricians’ continued support of positive oral health in adolescence,” Fisher-Owens and colleagues wrote.
General, family, or pediatric dentists may recommend orthodontic treatment for tooth malocclusion, malalignment, or mouth deformities. Before starting orthodontic therapy, adolescents should be evaluated to rule out active caries or periodontal disease. Halitosis can be managed with tooth brushing, flossing, tongue cleaning, and adequate hydration after exclusion of underlying issues.
Joseph Brofsky, MD, chief of pediatric dentistry at Cohen Children’s Medical Center in Hillside Manor, New York, who was not involved in the report, said, “We now realize dental health is a big part of our overall health, and this is especially important in teenagers, so this is a very timely and useful report.” Stressing that the developmental shifts and hormonal fluctuations of the teenage years present genuine dangers, Brofsky noted that this phase represents a critical window for dietary guidance and securing a permanent dental home.
Patients with Active Caries Require Professional Evaluation
Patients with active caries or periodontal disease should be evaluated before starting orthodontic therapy. Gingivitis that persists beyond 2 weeks or presents with bleeding and pain requires professional dental referral. Temporomandibular conditions should be diagnosed early by a specialist to prevent pain, permanent physiologic remodeling, and damage to the jaw.
Medicine Must Re-Center the Mouth in the Body
“There has long been a divide between medicine and dentistry, but given the significant impact of oral health on systemic health, medicine needs to re-center the mouth in the body,” Fisher-Owens said. The AAP and sister organizations are providing training and leadership on oral health integration, incorporating these topics into training curricula and board standards. This report was commissioned by the AAP and had no external funding. Fisher-Owens disclosed serving as a data safety monitoring board member for Colgate-Palmolive Company, while all other authors and Dr. Brofsky reported no relevant competing relationships.
References
- American Academy of Pediatrics. Clinical Report: Adolescent Oral Health. Pediatrics.
- Fisher-Owens SA, et al. Technical Literature Review on Pediatric and Adolescent Oral Health Integration.
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