Your next question in your risk assessment of Jessie is:

Is Jessie taking any medications or does she have any health conditions that would impact dental treatment?

At this point, her mother tells you that Jessie has frequent ear infections.While she can't remember the name of the medicine Jessie is taking, she knows it has sugar as one of its primary ingredients as she read that on the label.

Your response to Betsy could be:

Children receiving sucrose-containing medications have demonstrated a higher incidence of dental decay and gingivitis than children not receiving medication. The frequency of administration combined with chronic dosing and the low pH caused by the sucrose-containing medication contribute to the caries susceptibility of these children. Educate Betsy about the need for cleaning Jessie's teeth after each dose of medicine. Bedtime doses should be given prior to Jessie's nightly toothbrushing ritual.

Reference can be made to the "Pediatric Dosage Handbook" which has a 6-page Sugar-Free Alternative Appendix.