The AAPD (American Academy of Pediatric Dentistry) and the ADA (American Dental Association) recommend bringing a child for their first dental visit when the first tooth erupts, or by their first birthday at the latest. Why does bringing the first dental visit forward mark such an important step for general health and for preventing tooth decay in children?
In the past, paediatric dentistry focused mainly on treatment. Parents usually took their child to the dentist for the first time only once painful symptoms appeared, and dentists limited themselves to treating tooth decay. Many people did not consider baby teeth important because they are temporary, destined to fall out and be replaced by the permanent teeth before long.
Awareness has changed since then. As knowledge of how tooth decay develops has advanced, dentists have gradually started seeing children at ever younger ages, though generally not before their third birthday.
In some cases, however, seeing the dentist for the first time at the age of three may be too late. The risk of developing tooth decay starts very early, because oral pathogens are introduced into the child’s mouth. A visit at one year of age not only makes preventive therapy and early treatment possible, it also benefits the child and the parents by helping them establish the best eating and oral hygiene habits.
Unfortunately, most dentists are not trained to treat such young patients, who are unable to cooperate. For this reason, even though the benefits of prevention from the first year of life have been known for several years, the first visit to the dentist usually does not take place before the age of three.
A proper paediatric oral examination rests on three pillars:
- Risk assessment
- Examination of the mouth
- Preventive advice
Risk assessment
To be effective, preventive paediatric dentistry must start by assessing individual risk factors through the child’s medical, social and dental history.
Particular attention should be paid to the dental history of the child’s main caregiver (the mother or whoever takes her place). A child’s oral pathogens are in fact the result of vertical transmission from the person who looks after them. Untreated tooth decay and a high bacterial count from periodontal conditions in the parent’s or caregiver’s mouth mean that the child develops a bacterial flora that favours the development of tooth decay.
It is just as important to know the child’s eating habits from the very earliest age. Eating habits influence the risk of developing tooth decay through both what is eaten and how it is eaten.
On-demand and/or night-time feeding, for example, can cause so-called “baby bottle tooth decay”. During sleep the body’s systems slow down, and breathing and heart rate decrease. Salivary flow also drops, which reduces the natural cleansing and buffering effect of saliva. Feeding should therefore follow a schedule, and a child should never be put to bed with a bottle. The child should also be encouraged to drink some water after meals.
Finally, remember that current paediatric guidelines advise against giving children added sugars at least until the age of three, and ideally until the age of five. Among other things, diets rich in sugar are highly cariogenic. Until weaning, it is therefore important not to give any liquids other than breast milk (or, where that is not available, infant formula) and plain water; after the first year, follow-on milk can be introduced. Herbal teas, industrial fruit juices and plant-based drinks (rice, almond and so on) should also be avoided because they are high in added sugars. On this subject, we recommend watching this video interview with Raffaele Morino, in which the paediatrician and dietitian from Bambino Gesù Hospital explains which drinks to give children at different ages.
Examination of the mouth
After carefully examining the mouth and pointing out any problems, the dentist should show the parent the correct technique for cleaning the teeth using gauze, a toothbrush or a towel. The child should be introduced to the toothbrush as soon as the first tooth appears. A soft-bristled toothbrush is recommended, with an appropriate amount of fluoride toothpaste. To find out more, read this article too.
Preventive advice
Habits not related to nutrition, such as using a dummy, should also be discussed during the first visit. Persistent habits that could cause problems in the mouth should be addressed once the child is mature enough to accept giving them up. Until then, the dentist should simply monitor the habit and any resulting changes in the mouth. To learn more, read this article too.
Finally, the dentist can apply fluoride varnish to the teeth that have already come through and may decide to enrol high-risk patients in a three-monthly recall programme, to reapply the fluoride varnish and give parents further useful information.
Source: A Child’s First Dental Visit, by Orpheus L. Triplett, DDS and Larry Dormois, DDS, MS
Credits: photo by Colin Maynard on Unsplash
