Adolescent Oral Health Care


The American Academy of Pediatric Dentistry (AAPD) recognizes that the adolescent patient has unique needs. This guideline addresses these unique needs and proposes general recommendations for their management. This guideline serves as a summary document; more detailed information regarding these topics is provided in referenced AAPD oral health policies and clinical practice guidelines.


This document was developed by the Clinical Affairs Committee and adopted in 1986. This document is a revision of the previous version, last revised in 2010. The update includes an electronic search using the terms: adolescent combined with dental, gingivitis, oral piercing, sealants, oral health, caries, tobacco use, dental trauma, orofacial trauma, periodontal, dental esthetics, smokeless tobacco, nutrition, and diet; fields: all; limits: humans, English, clinical trials. The reviewers agreed upon the inclusion of 92 electronic and hand searched articles that met the defined criteria. When data did not appear sufficient or were inconclusive, recommendations were based upon expert and/or consensus opinion by experienced researchers and clinicians.


There is no standard definition of adolescent.1  Adolescents are defined very broadly as youths between the ages of 10 to 18. Using this definition, there were approximately 41.5 million adolescents in the United States in 2008, according to the U.S. Census Bureau.2  The adolescent patient is recognized as having distinctive needs3,4 due to: (1) a potentially high caries rate; (2) increased risk for traumatic injury and periodontal disease; (3) a tendency for poor nutritional habits; (4) an increased esthetic desire and awareness; (5) complexity of combined orthodontic and restorative care (e.g., congenitally missing teeth); (6) dental phobia; (7) potential use of tobacco, alcohol, and other drugs; (8) pregnancy; (9) eating disorders; and (10) unique social and psychological needs.5-8

Treatment of the adolescent patient can be multi-faceted and complex. Accurate, comprehensive, and up-to-date medical and social histories are necessary for correct diagnosis and effective treatment planning. Familiarity with the patient’s medical history is essential for decreasing the risk of aggravating a medical condition while rendering dental care. If the parent is unable to provide adequate details regarding a patient’s medical history, consultation with the medical health care provider may be indicated. The practitioner also may need to obtain additional information confidentially from an adolescent patient.9


This guideline addresses some of the special needs within the adolescent population and proposes general recommendations for their management.

Adolescence marks a period of significant caries activity for many individuals. Research suggests that the overall caries rate is declining, yet remains highest during adolescence.10,11  Immature permanent tooth enamel,12 a total increase in susceptible tooth surfaces, and environmental factors such as diet, independence to seek care or avoid it, a low priority for oral hygiene, and additional social factors also may contribute to the upward slope of caries during adolescence.1,13-16  It is important for the dental provider to emphasize the positive effects that fluoridation, professional topical fluoride treatment, routine professional care, patient education, and personal hygiene can have in counteracting the changing pattern of caries in the adolescent population.5,6

Management of caries
Primary prevention
  Fluoridation has proven to be the most economical and effective caries prevention measure. The adolescent can benefit from fluoride throughout the teenage years and into early adulthood. Although the systemic benefit of fluoride incorporation into developing enamel is not considered necessary past 16 years of age, topical benefits can be obtained through optimally-fluoridated water, professionally-applied and prescribed compounds, and fluoridated dentifrices.17,18

Recommendations:  The adolescent should receive maximum fluoride benefit dependent on risk assessment:18,19

  • brushing teeth twice a day with a fluoridated dentifrice is recommended to provide continuing topical benefits.20 
  • professionally-applied fluoride treatments should be based on the individual patient’s caries-risk assessment, as determined by the patient’s dental provider.18,20 
  • home-applied prescription strength topical fluoride products [e.g., 0.4 percent stannous fluoride gel, 0.5 percent fluoride gel or paste, 0.2 percent sodium fluoride (NaF) rinse] may be used when indicated by an individual’s caries pattern or caries risk status.20 
  • systemic fluoride intake via optimal fluoridation of drinking water or professionally-prescribed supplements is recommended to 16 years of age. Supplements should be given only after all other sources of fluoride have been evaluated.20

Oral hygiene:  Adolescence can be a time of heightened caries activity and periodontal disease due to an increased intake of cariogenic substances and inattention to oral hygiene procedures.1,21  Tooth brushing with a fluoridated dentifrice and flossing can provide benefit through the topical effect of the fluoride and plaque removal from tooth surfaces.22


  • adolescents should be educated and motivated to maintain personal oral hygiene through daily plaque removal, including flossing, with the frequency and technique based on the individual’s disease pattern and oral hygiene needs.21,22
  • professional removal of plaque and calculus is recommended highly for the adolescent, with the frequency of such intervention based on the individual’s assessed risk for caries/periodontal disease, as determined by the patient’s dental provider.22,23

Diet management:  Many adolescents are exposed to and consume high quantities of refined carbohydrates and acidcontaining beverages.13,14,16,24 The adolescent can benefit from diet analysis and modification.

Recommendations:  Diet analysis, along with professionallydetermined recommendations for maximal general and dental health, should be part of an adolescent’s dental health management.25

Sealants:  Sealant placement is an effective caries-preventive technique that should be considered on an individual basis. Sealants have been recommended for any tooth, primary or permanent, that is judged to be at risk for pit and fissure caries.6,14,26-29  Caries risk may increase due to changes in patient habits, oral microflora, or physical condition, and unsealed teeth subsequently might benefit from sealant applications.29,30

Recommendations:  Adolescents at risk for caries should have sealants placed. An individual’s caries risk may change over time; periodic reassessment for sealant need is indicated throughout adolescence.29

Secondary prevention
Professional preventive care:
  Professional preventive dental care, on a routine basis, may prevent oral disease or disclose existing disease in its early stages. The adolescent patient whose oral health has not been monitored routinely by a dentist may have advanced caries, periodontal disease, or other oral involvement urgently in need of professional evaluation and extensive treatment.


  • timing of periodic oral examinations should take into consideration the individual’s needs and risk indicators to determine the most cost-effective, disease-preventive benefit to the adolescent.19
  • initial and periodic radiographic examination should be a part of a clinical evaluation. The type, number, and frequency of radiographs should be determined only after an oral examination and history taking. Previously exposed radiographs should be available, whenever possible, for comparison. Currently accepted guidelines for radiographic exposures (i.e., appropriate films based upon medical history, caries risk, history of periodontal disease, and growth and development assessments) should be followed.31

Restorative dentistry:  In cases where remineralization of noncavitated, demineralized tooth surfaces is not successful, as demonstrated by progression of carious lesions, dental restorations are necessary. Preservation of tooth structure, esthetics, and each individual patient’s needs must be considered when selecting a restorative material.32  Molars with extensive caries or malformed, hypoplastic enamel—for which traditional amalgam or composite resin restorations are not feasible— may require full coverage restorations.29  Small noncavitated interproximal carious lesions and facial post orthodontic white spot lesions may be treated by resin infiltration.29,33,34

Recommendations:  Each adolescent patient and restoration must be evaluated on an individual basis. Preservation of noncarious tooth structure is desirable. Referral should be made when treatment needs are beyond the treating dentist’s scope of practice.29

Periodontal diseases
Adolescence can be a critical period in the human being’s periodontal status. Epidemiologic and immunologic data suggest that irreversible tissue damage from periodontal disease begins in late adolescence and early adulthood.8,35  Adolescents have a higher prevalence of gingivitis than prepubertal children or adults. The rise of sex hormones during adolescence is suspected to be a cause of the increased prevalence. Studies suggest that the increase in sex hormones during puberty affects the composition of the subgingival microflora.36  Other studies suggest circulating sex hormones may alter capillary permeability and increase fluid accumulation in the gingival tissues. This inflammatory gingivitis is believed to be transient as the body accommodates to the ongoing presence of the sex hormones.37,38

Conditions affecting the adolescent include, but are not limited to, gingivitis, puberty gingivitis, hyperplastic gingivitis related to orthodontic therapy, gingival recession that may or may not be related to orthodontic therapy, drug-related gingivitis, pregnancy gingivitis, necrotizing ulcerative gingivitis, localized aggressive periodontitis, and periodontitis.36,37,39  Personal oral hygiene and regular professional intervention can minimize occurrence of these conditions and prevent irreversible damage.

Recommendations:  The adolescent will benefit from an individualized preventive dental health program, which includes the following items aimed specifically at periodontal health:

  • patient education emphasizing the etiology, characteristics, and prevention of periodontal diseases, as well as selfhygiene skills.37,39,40 
  • a personal, age-appropriate oral hygiene program including plaque removal, oral health self-assessment, and diet. Sulcular brushing and flossing should be included in plaque removal, and frequent follow-up to determine adequacy of plaque removal and improvement of gingival health should be considered.37,39-41
  • regular professional intervention, the frequency of which should be based on individual needs and should include evaluation of personal oral hygiene success, periodontal status, and potential complicating factors such as medical conditions, malocclusion, or handicapping conditions. Periodontal probing, periodontal charting, and radiographic periodontal diagnosis should be a consideration when caring for the adolescent. The extent and nature of the periodontal evaluation should be determined professionally on an individual basis. Those patients with progressive periodontal disease should be referred when the treatment needs are beyond the treating dentist’s scope of practice.37,39,40 
  • appropriate evaluation for procedures to facilitate orthodontic treatment including, but not limited to, tooth exposure, frenectomy, fiberotomy, gingival augmentation, and implant placement.42

Occlusal considerations
Malocclusion can be a significant treatment need in the adolescent population as both environmental and/or genetic factors come into play. Although the genetic basis of much malocclusion makes it unpreventable, numerous methods exist to treat the occlusal disharmonies, temporomandibular joint dysfunction, periodontal disease, and disfiguration which may be associated with malocclusion. Within the area of occlusal problems are several tooth/jaw-related discrepancies that can affect the adolescent. Third molar malposition and temporomandibular disorders require special attention to avoid long-term problems. Congenitally missing teeth present complex problems for the adolescent and often require combined orthodontic and restorative care for satisfactory resolution.

Malocclusion:  Any tooth/jaw positional problems that present significant esthetic, functional, physiologic, or emotional dysfunction are potential difficulties for the adolescent. These can include single or multiple tooth malpositions, tooth/jaw size discrepancies, and craniofacial disfigurements.

Recommendations:  Malposition of teeth, malrelationship of teeth to jaws, tooth/jaw size discrepancy, skeletal malrelationship, or craniofacial malformations or disfigurement that presents functional, esthetic, physiologic, or emotional problems for the adolescent should be referred for evaluation when the treatment needs are beyond the treating dentist’s scope of practice. Treatment of malocclusion by a dentist should be based on professional diagnosis, available treatment options, patient motivation and readiness, and other factors to maximize progress.43

Third molars:  Third molars can present acute and chronic problems for the adolescent. Impaction or malposition leading to such problems as pericoronitis, caries, cysts, or periodontal problems merits evaluation for removal.44-48  The role of the third molar as a functional tooth also should be considered.

Recommendations:  Evaluation of third molars, including radiographic diagnostic aids, should be an integral part of the dental examination of the adolescent.31  For diagnostic and extraction criteria, refer to AAPD’s Guideline on Pediatric Oral Surgery.44  Referral should be made if treatment is beyond the treating dentist’s scope of practice.

Temporomandibular joint (TMJ) problems:  Disorders of the TMJ can occur at any age, but symptoms appear more prevalent in adolescence.49,50

Recommendations:  Evaluation of the TMJ and related structures should be a part of the examination of the adolescent. An adolescent comprehensive dental examination should include a screening evaluation of the TMJ and surrounding area. This evaluation will include a screening history for symptoms, clinical examination and evaluation of jaw movements, and if indicated, radiographic imaging. Referral should be made when the diagnostic and/or treatment needs are beyond the treating dentist’s scope of practice.44,49,50

Congenitally missing teeth:  The impact of a congenitally missing permanent tooth on the developing dentition can be significant.3,51  When treating adolescent patients with congenitally missing teeth, many factors must be taken into consideration including, but not limited to, esthetics, patient age, and growth potential, as well as orthodontic, periodontal, and oral surgical needs.43,51-53

Recommendations:  Evaluation of congenitally missing permanent teeth should include both immediate and long-term management. Referral should be made when the treatment needs are beyond the treating dentist’s scope of practice. Due to the complexity of the growing adolescent, a team approach may be indicated.51,54

Ectopic eruption:  Abnormal eruption patterns of the adolescent’s permanent teeth can contribute to root resorption, bone loss, gingival defects, space loss, and esthetic concerns. Early diagnosis and treatment of ectopically erupting teeth can result in a healthier and more esthetic dentition. Prevention and treatment may include extraction of deciduous teeth, surgical intervention, and/or endodontic, orthodontic, periodontal, and/or restorative care.55-57

Recommendations:  The dentist should be proactive in diagnosing and treating ectopic eruption and impacted teeth in the young adolescent. Early diagnosis, including appropriate radiographic examination,31 is important. Referral should be made when the treatment needs are beyond the treating dentist’s scope of practice.54

Traumatic injuries
The most common injuries to permanent teeth occur secondary to falls, followed by traffic accidents, violence, and sports.58-61  All sporting activities have an associated risk of orofacial injuries due to falls, collisions, and contact with hard surfaces.62  The administrators of youth, high school, and college organized sports have demonstrated that dental and facial injuries can be reduced significantly by introducing mandatory protective equipment such as face guards and mouthguards. Additionally, youths participating in leisure activities such as skateboarding, roller skating, and bicycling also benefit from appropriate protective equipment.63,64

Recommendations:  Dentists should introduce a comprehensive trauma prevention program to help reduce the incidence of traumatic injury to the adolescent dentition. This prevention plan should consider assessment of the patient’s sport or activity, including level and frequency of activity.65 Once this information is acquired, recommendation and fabrication of an age-appropriate, sport-specific, and properly-fitted mouthguard/faceguard can be initiated.65  Players should be warned about altering the protective equipment that will disrupt the fit of the appliance. In addition, players and parents must be informed that injury may occur, even with properlyfitted protective equipment.65

Additional considerations in oral/dental management of the adolescent
The adolescent can present particular psychosocial characteristics that impact the health status of the oral cavity, care seeking, and compliance. The self-concept development process, emergence of independence, and the influence of peers are just a few of the psychodynamic factors impacting dental health during this period.1,5,7,17

Esthetic concerns:  Desire to improve esthetics of the dentition by tooth whitening and removal of stained areas or defects can be a concern of the adolescent. Indications for the appropriate use of tooth-whitening methods and products are dependent upon correct diagnosis and consideration of eruption pattern of the permanent dentiton.66  The dentist must determine the appropriate mode of treatment. Use of bleaching agents, microabrasion, placement of an esthetic restoration, or a combination of treatments all can be considered.67,68

Recommendations:  For the adolescent patient, judicious use of bleaching can be considered part of a comprehensive, sequenced treatment plan that takes into consideration the patient’s dental developmental stage, oral hygiene, and caries status. A dentist should monitor the bleaching process, ensuring the least invasive, most effective treatment method. Dental professionals also should consider possible side effects when contemplating dental bleaching for adolescent patients.68-70

Tobacco use:  Significant oral, dental, and systemic health consequences and death are associated with all current forms of tobacco use. These include the use of products such as cigars, cigarettes, snus, hookahs, smokeless tobacco, pipes, bidis, kreteks, dissolvable tobacco, and electronic cigarettes.71  Smoking and smokeless tobacco use are initiated and established primarily during adolescence.72-76

Recommendations: The oral and systemic consequences of all current forms of tobacco use should be part of each patient’s oral health education. For those adolescent patients who use tobacco products, the practitioner should provide or refer the patient to appropriate educational and counseling services.77-80 Supplemental medical history questions regarding tobacco use should be added to the adolescent dental record.81 When associated pathology is present, referral should be made when the treatment needs are beyond the treating dentist’s scope of practice.

Psychosocial and other considerations:  Behavioral considerations when treating an adolescent may include anxiety, phobia, and intellectual dysfunction.1 Referral should be made when the treatment needs are beyond the treating dentist’s scope of practice and consultation with nondental professionals or a team approach may be indicated.

Additional examples of oral problems associated with adolescent behaviors include, but are not limited to:

  • oral manifestations of sexually transmitted diseases.
  • effects of oral contraceptives or antibiotics on periodontal structures.
  • perimyolysis (severe enamel erosion) in bulimia.82
  • traumatic injury to teeth and oral structures in athletic or other activities (short- and long-term management).63,83-85 
  • intraoral and perioral piercing with possible local and systemic effects.86,87

The impact of psychosocial factors relating to oral health must include consideration of the following: 

  • changes in dietary habits (e.g., fads, freedom to snack, increased energy needs, access to carbohydrates).
  • use of tobacco, alcohol, and drugs.
  • motivation for maintenance of good oral hygiene.
  • potential for traumatic injury
  • adolescent as responsible for care. 
  • lack of knowledge about periodontal disease.

Physiologic changes also can contribute to significant oral concerns in the adolescent. These changes include: (1) loss of remaining primary teeth; (2) eruption of remaining permanent teeth; (3) gingival maturity; (4) facial growth; and (5) hormonal changes.


  • an adolescent’s oral health care should be provided by a dentist who has appropriate training in managing the patient’s specific needs. Referral should be made when the treatment needs are beyond the treating dentist’s scope of practice. This may include both dental and non-dental problems.88 
  • supplemental medical history topics regarding questions on pregnancy, alcohol and drug use, oral piercings, tobacco use, sexual activity and eating disorders should be included in the adolescent dental record.79 
  • attention should be given to the particular psychosocial aspects of adolescent dental care. Other issues such as assent, confidentiality, and compliance should be addressed in the care of these patients.81,89 
  • acomplete oral health care program for the adolescent requires an educational component that addresses the particular concerns and needs of the adolescent patient and focuses on:
    — specific behaviorally-and physiologically-induced oral manifestations in this age group;22
    — shared responsibility for care and health by the adolescent, paper, and provider;22 and
    — consequences of adolescent behavior on oral health.90,91

Transitioning to adult care:  As adolescent patients approach the age of majority, it is important to educate the patient and parent on the value of transitioning to a dentist who is knowledgeable in adult oral health care. The adult’s oral health needs may go beyond the scope of the pediatric dentist’s training. The transitioning adolescent should continue professional oral health care in an environment sensitive to his/ her individual needs. Many adolescent patients independently will choose the time to seek care from a general dentist and may elect to seek treatment from a parent’s primary care provider. In some instances, however, the treating pediatric dentist will be required to suggest transfer to adult care.

Pediatric dentists are concerned about decreased access to oral health care for persons with special health care needs (SHCN)92 as they transition beyond the age of majority. Pediatric hospitals, by imposing age restrictions, can create a barrier to care for these patients. Transitioning to a dentist who is knowledgeable and comfortable with adult oral health care needs often is difficult due to a lack of trained providers willing to accept the responsibility of caring for SHCN patients.

Recommendations:  At a time agreed upon by the patient, parent, and pediatric dentist, the patient should be transitioned to a dentist knowledgeable and comfortable with managing that patient’s specific oral care needs. For the SHCN patient, in cases where it is not possible or desired to transition to another practitioner, the dental home can remain with the pediatric dentist and appropriate referrals for specialized dental care should be recommended when needed.92


  1. American Psychological Association. Developing Adolescents: A Reference for Professionals. Washington, D.C.: American Psychological Association; 2002.
  2. MacKay AP, Duran C. Adolescent health in the United States, 2007. National Center for Health Statistics, 2007. Available at: “”. Accessed September 1, 2015.
  3. Studen-Pavlovich D, Pinkham JR, Adair SM. The dynamics of change. In: Casamassimo PS, Fields HW Jr., McTigue DJ, Nowak AJ, eds. Pediatric Dentistry: Infancy Through Adolescence. 5th ed, St. Louis, Mo.: Elsevier Saunders; 2012:557-617.
  4. National Institutes of Health. Consensus development conference statement: Diagnosis and management of dental caries throughout life, March 26-28, 2001. J Am Dent Assoc 2001;132(8):1153-61. 
  5. Baker SR, Mat A, Robinson PG. What psychosocial factors influence adolescents’ oral health? J Dent Res 2010;89(11):1230-5.
  6. Yu SM, Bellamy HA, Schwalberg RH, Drum MA. Factors associated with use of preventive dental and health services among U.S. adolescents. J Adolesc Health 2001;29(6):395-405. 
  7. American Academy of Pediatric Dentistry. Policy on prevention of sports-related orofacial injuries. Pediatr Dent 2015;37(special issue):71-5.
  8. U.S. Department of Health and Human Services. Oral Health In America: A Report of the Surgeon General— Executive Summary. Rockville, Md.: U.S. Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health; 2000.
  9. Ford C, English A, Sigman G. Confidential health care for adolescents: Position paper of the Society for Adolescent Medicine. J Adolesc Health 2004;35(1):1-8.
  10. Beltrán-Aguilar ED, Barker LK, Canto MT, et al. Surveillance for dental caries, dental sealants, tooth retention, edentulism, and enamel fluorosis—United States, 1988- 1994 and 1999-2002. MMWR Surveill Summ 2005;54(3):1-43. 
  11. Dye BA, Tan S, Smith V, et al. Trends in oral health status: United States, 1988-1994 and 1999-2004. National Center for Health Statistics. Centers for Disease Control and Prevention. U.S. Department of Health and Human Services, Hyattsville, Md. Vital Health Stat 2007;11(248):1-92. Available at: “”. Accessed September 2, 2015.
  12. Kirkham J, Robinson C, Strong M, Shore RC. Effects of frequency of acid exposure on demineralization/ remineralization behavior of human enamel in vitro. Caries Res 1994;28(1):9-13.
  13. Howze KA. Health for Teens in Care: A Judge’s Guide 2002. Washington, DC: American Bar Association; 2002.
  14. Majewski RF. Dental caries in adolescents associated with caffeinated carbonated beverages. Pediatr Dent 2001;23(3):198-203. 
  15. Marshall TA, Levy SM, Broffitt B, et al. Dental caries and beverage consumption in young children. Pediatrics 2003;112(3Pt1):e184-e191. 
  16. Hasselkvist A, Johansson A, Johansson AK. Association between soft drink consumption, oral health, and some lifestyle factors in Swedish adolescents. Acta Odontol Scand 2014;3:1-8. Epub 2014 Sep 3.
  17. Centers for Disease Control and Prevention. Recommendations for using fluoride to prevent and control dental caries in the United States. MMWR Recomm Rep 2001;50(RR14):1-42.
  18. Weyant RJ, Tracy SL, Anselmo TT, et al. Topical fluoride for caries prevention: Executive summary of the updated clinical recommendations and supporting systematic review. J Am Dent Assoc 2013;144(11):1279-91.
  19. American Academy of Pediatric Dentistry. Guideline on caries-risk assessment and management in infants, children, and adolescents. Pediatr Dent 2015;37(special issue):132-9.
  20. American Academy of Pediatric Dentistry. Guideline on fluoride therapy. Pediatr Dent 2015;37(special issue):176-9.
  21. Macgregor ID, Balding J, Regis D. Tooth-brushing schedule, motivation, and ‘lifestyle’ behaviours in 7,770 young adolescents. Community Dent Health 1996;13(4):232-7. 
  22. Dean JA, Hughes CV. Mechanical and chemotherapeutic home oral hygiene. In: Dean JA, Avery DR, McDonald RE, eds. McDonald and Avery’s Dentistry for the Child and Adolescent. 9th ed. Maryland Heights, Mo.: Mosby Elsevier; 2011:205-22.
  23. American Academy of Pediatric Dentistry. Guideline on periodicity of examination, preventive dental services, anticipatory guidance, and oral treatment for children. Pediatr Dent 2015;37(special issue):123-31.
  24. Freeman R, Sheiham A. Understanding decision-making process for sugar consumption in adolescents. Community Dent Oral Epidemiol 1997;25(3):228-32. 
  25. American Academy of Pediatric Dentistry. Policy on dietary recommendations for infants, children, and adolescents. Pediatr Dent 2015;37(special issue):56-8.
  26. Feigal RJ. The use of pit and fissure sealants. Pediatr Dent 2002;24(5):415-22.
  27. Ahovuo-Saloranta A, Hiiri A, Nordblad A, Worthington H, Makela M. Pit and fissure sealants for preventing dental decay in the permanent teeth of children and adolescents [review]. Cochrane Database Syst Rev 2004;3:CD001830. 
  28. Macek MD, Beltrán-Aguilar ED, Lockwood SA, Malvitz DM. Updated comparison of the caries susceptibility of various morphological types of permanent teeth. J Public Health Dent 2003;63(3):174-82.
  29. American Academy of Pediatric Dentistry. Guideline on restorative dentistry. Pediatr Dent 2015;37(special issue):232-43.
  30. Ahovuo-Saloranta A, Forss H, Walsh T, et al. Sealants for preventing dental decay in the permanent teeth. Cochrane Database of Syst Rev 2013;3:CD001830.
  31. American Academy of Pediatric Dentistry. Guideline on prescribing dental radiographs for infants, children, adolescents, and persons with special health care needs. Pediatr Dent 2015;37(special issue):319-21.
  32. Donly K. Pediatric Restorative Dentistry Consensus Conference April 15-16, 2002, San Antonio, Texas. Pediatr Dent 2002;24(5):374-6. 
  33. Meyer-Lueckel H, Bitter, K, Paris S. Randomized controlled clinical trial on proximal caries infiltration: Three-year follow-up. Caries Res 2012;46(6):544-8.
  34. Senestraro SV, Crowe JJ, Wang M, et al. Minimally invasive resin infiltration of arrested white-spot lesions. J Am Dent Assoc 2013;144(9):997-1005. 
  35. Keels MA, Tatakis DN. Periodontal disease in children: Associated systemic conditions. Literature review current through August 2015. Available at: “”. Accessed September 2, 2015.
  36. Beck JD, Arbes SI Jr. Epidemiology of gingival and periodontal disease. In: Newman MG, Taki HH, Klokkevold PR, Carranza FA, eds. Carranza’s Clinical Periodontology. 10th ed. St. Louis, Mo: Saunders Elsevier; 2006:117-9.
  37. Wilson TG Jr, Kornman KS. Fundamentals of Periodontics. 2nd ed. Hanover Park, Ill.: Quintessence Publishing; 2003:196-7.
  38. Cole E, Ray-Chaudhuri A, Vaidyanathan M, Johnson J, Sood S. Simplified basic periodontal examination (BPE) in children and adolescents: A guide for general dental practitioners. Dent Update 2014;41(4):328-30, 332-4, 337.
  39. Modeer T, Wondimu B. Periodontal diseases in children and adolescents. Dent Clin North Am 2000;44(3):633-58.
  40. Grossi SG, Zambon JJ, Ho AW, et al. Assessment of risk for periodontal disease. I. Risk indicators for attachment loss. J Periodontol 1994;65(3):260-7. 
  41. Grossi SG, Genco RJ, Machtei EE, et al. Assessment of risk for periodontal disease. II. Risk indicators for alveolar bone loss. J Periodontol 1995;66(1):23-9.
  42. American Academy of Periodontology. Periodontal therapy. J Periodontol 2001;72(11):1624-8.
  43. Richardson G, Russell KA. Congenitally missing maxillary incisors and orthodontic treatment considerations for the single tooth implant. J Can Dent Assoc 2001;67(1):25-8.
  44. American Academy of Pediatric Dentistry. Guideline on management considerations for pediatric surgery and oral pathology. Pediatr Dent 2015;37(special issue):279-88.
  45. Song F, O’Meara S, Wilson P, Goldner S, Kleijnen J. The effectiveness and cost-effectiveness of prophylactic removal of wisdom teeth. Health Technol Assess 2000;4(1):1-55.
  46. Haug R, Perrott D, Gonzalez M, Talwar R. The American Association of Oral and Maxillofacial Surgeons agerelated third molar study. J Oral Maxillofac Surg 2005;63(8):1106-14.
  47. Pogrel M, Dodson T, Swift J, et al. White paper on third molar data. American Association of Oral and Maxillofacial Surgeons. March 2007. Available at: “”. Accessed September 2, 2015. 
  48. American Academy of Pediatric Dentistry. Guideline on acquired temporomandibular disorders in infants, children, and adolescents. Pediatr Dent 2015;37(special issues):272-8. 
  49. American Academy of Orofacial Pain. General assessment of the orofacial pain patient. In: de Leeuw R de, Klasser GD, eds. Orofacial Pain: Guidelines for Assessment, Diagnosis, and Management. 5th ed. Chicago, Ill.: Quintessence Publishing Co. Inc.; 2013:25-46.
  50. Wahlund K, List T, Dworkin SF. Temporomandibular disorders in children and adolescents: Reliability of a questionnaire, clinical examination, and diagnosis. J Orofac Pain 1998;12(1):42-51.
  51. Behr M, Driemel O, Mertins V, et al. Concepts for the treatment of adolescent patients with missing teeth. Oral Maxillofac Surg 2008;12(2):49-60. 
  52. Garg AK. Treatment of congenitally missing maxillary incisors: Orthodontics, bone grafts, and osseointegrated implants. Dent Implantol Update 2002;13(2):9-14.
  53. Wexler G. Missing upper lateral incisors: Orthodontic considerations in young patients. Ann R Australas Coll Dent Surg 2000;15:136-40. 
  54. American Academy of Pediatric Dentistry. Guideline on management of the developing dentition and occlusion in pediatric dentistry. Pediatr Dent 2015;37(special issue):253-65.
  55. Chaushu S, Sharabi S, Becker A. Dental morphologic characteristics of normal versus delayed developing dentitions with palatally displaced canines. Am J Orthod Dentofacial Orthop 2002;121(4):339-46.
  56. Kojima R, Taguchi Y, Kabayashi H, Noda T. External root resorption of the maxillary permanent incisors caused by ectopically erupting canines. J Clin Pediatr Dent 2002;26(2):193-7. 
  57. Ericson S, Kurol PJ. Resorption of incisors after ectopic eruption of maxillary canines. Angle Orthod 2000;70(6):415-23.
  58. Kurol J. Early treatment of tooth eruption disturbances. Am J Orthod Dentofacial Orthop 2002;121(6):588-91. 
  59. Rocha MJdC, Cardoso M. Traumatized permanent teeth in Brazilian children assisted at the Federal University of Santa Catarina, Brazil. Dent Traumatol 2001;17(6):245-9. 
  60. deFranca Caldas A Jr, Burgos MEA. A retrospective study of traumatic dental injuries in a Brazilian dental trauma clinic. Dent Traumatol 2001;17(6):250-3.
  61. Skaare AB, Jacobsen I. Dental injuries in Norwegians aged 7-18 years. Dent Traumatol 2003;19(2):67-71.
  62. Gassner R, Bösch R, Tuli T, Emshoff R. Prevalence of dental trauma in 6,000 patients with facial injuries: Implications for prevention. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;87(1):27-33.
  63. Tesini DA, Soporowski NJ. Epidemiology of orofacial sports-related injuries. Dent Clin North Am 2000;44(1):1-18. 
  64. Ranalli DN. Prevention of sport-related dental traumatic injuries. Dent Clin North Am 2000;44(1):19-33. 
  65. Ranalli DN. A sports dentistry trauma control plan for children and adolescents. J Southeast Soc Pediatr Dent 2002;8:8-9.
  66. Sarrett DC. Tooth whitening today. J Am Dent Assoc 2002;133(11):1535-8.
  67. Donly KJ. The adolescent patient: Special whitening challenges. Compend Contin Educ Dent 2003;24(4A):390-6.
  68. American Academy of Pediatric Dentistry. Policy on use of dental bleaching for child and adolescent patients. Pediatr Dent 2015;37(special issue):76-8.
  69. Giachetti L, Bertini F, Bambi C, Nieri M, Scaminaci Russo D. A randomized clinical trial comparing at-home and in office tooth whitening techniques: A nine month follow up. J Am Dent Assoc 2010;141(11):1357-64.
  70. Li Y. Tooth bleaching using peroxide containing agents: Current status of safety issues. Compend Contin Educ Dent 1998;19(8):783-6, 790. 
  71. Johnston LD, O’Malley PM, Bachman JG, Schulenberg JE. Monitoring the Future National Results on Adolescent Drug Use: Overview of Key Findings, 2013. Ann Arbor, Mich.: University of Michigan, Institute for Social Research, 2014.
  72. U.S. Department of Health and Human Services. Preventing Tobacco Use Among Young People: A Report of the Surgeon General. Atlanta, Ga.: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 1994. Available at: “”. Accessed September 2, 2015.
  73. Centers for Disease Control and Prevention. Cigarette use among high school students-United States, 2011 and 2012. MMWR Morb Mortal Weekly Rep 2013;62(45):893-7. Erratum MMWR Morb Mortal Weekly Rep 2013;62(46):940.
  74. U.S. Department of Health and Human Services. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Office on Smoking and Health, 2012. Available at: ‘”. Accessed September 1, 2015.
  75. Campaign for Tobacco-Free Kids. The path to tobacco addiction starts at very young ages. Campaign for Tobacco-Free Kids, Washington D.C., 2015. Available at: “”. Accessed September 1, 2015.
  76. Johnson CC, Myers L, Webber LS, Boris NW. Profiles of the adolescent smoker: Models of tobacco use among 9th grade high school students. Prev Med 2004;39(3):551-8.
  77. American Dental Association. Summary of policy and recommendations regarding tobacco: 1964-present. ADA Resolution 1H-1992. In: ADA Transactions 1992. Chicago, Ill.: ADA; 1993:598. 
  78. American Cancer Society, National Cancer Institute, National Institutes of Health. How to Help Your Patients Stop Using Tobacco: A National Cancer Institute Manual for the Oral Health Team. Bethesda, Md.: National Institutes of Health, U.S. Department of Health and Human Services, Public Health Service; 1998. NIH publication No. 98-3191.
  79. American Academy of Pediatric Dentistry. Policy on tobacco use. Pediatr Dent 2010;32(special issue):49-52.
  80. Centers for Disease Control and Prevention. Best Practices for Comprehensive Tobacco Programs-2014 Atlanta. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014. Available at: “”. Accessed September 1, 2015.
  81. American Academy of Pediatric Dentistry. Guideline on record-keeping. Pediatr Dent 2015;37(special issue):307-14.
  82. Christensen GJ. Oral care for patients with bulimia. J Am Dent Assoc 2002;133(12):1689-91.
  83. Cortes MI, Marcenes W, Sheiham A. Impact of traumatic injuries to the permanent teeth on the oral healthrelated quality of life in 12- to 14-year-old children. Community Dent Oral Epidemiol 2002;30(3):193-8. 
  84. Gassner R, Tuli T, Hächl O, Moreira R, Ulmer H. Craniomaxillofacial trauma in children: A review of 3,385 cases with 6,060 injuries in 10 years. J Oral Maxillofac Surg 2004;62(4):399-407.
  85. Barnett F. Prevention of sports-related dental trauma: The role of mouthguards. Pract Proced Aesthet Dent 2003;15(5):391-4. 
  86. American Academy of Pediatric Dentistry. Policy on intraoral and perioral piercing. Pediatr Dent 2015;37(special issue):69-70. 
  87. Janssen KM, Cooper BR. Oral piercing: An overview. Internet J Allied Health Sci Practice 2008;6(3):1-3. Available at: “”. Accessed September 1, 2015.
  88. Larson RW. Toward a psychology of positive youth development. Am Psychologist 2000;55(1):170-83.
  89. American Academy of Pediatric Dentistry. Guideline on informed consent. Pediatr Dent 2015;37(special issue):315-7.
  90. Romito L, McDonald JL Jr. Nutritional considerations for the dental patient. In: Dean JA, Avery DR, McDonald RE, eds. McDonald and Avery’s Dentistry for the Child and Adolescent. 9th ed. Maryland Heights, Mo.: Mosby Inc.; 2011:223-40.
  91. Macgregor ID, Balding JW. Self-esteem as a predictor of toothbrushing behavior in young adolescents. J Clin Periodontol 1991;18(5):312-6.
  92. American Academy of Pediatric Dentistry. Guideline on management of dental patients with special health care needs. Pediatr Dent 2015;37(special issue):166-71.