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The Importance of the Age-One Dental Appointment
First visit by first birthday
By Melissa Tennen
From the first word to the first step, many milestones are typically reached in a child’s first year of life. A first dental appointment should be one of them—first visit by first birthday.
Experts are urging prevention as key to helping to establish lifelong oral health.1 Dental visits should begin with the appearance of a child’s first tooth, typically at 6 months of age but no later than 1 year of age.2,3 Dental caries is the most prevalent infectious disease in children,4 with more than 40% of children having caries by kindergarten.4
Yet too few practices are seeing children this young; several reasons may account for this. Some caregivers may believe that because primary teeth, or baby teeth, are temporary, children do not need a dentist. The dental team must remind caregivers that healthy baby teeth are essential for mastication, speaking, and even self-esteem in early childhood development.5 Primary teeth also hold space for permanent dentition. If a child has healthy baby teeth, the chances are he or she will have healthy adult teeth, too, and the best predictor of decay in permanent teeth is decay in baby teeth.5 A recent survey noted that most American caregivers do not realize that cavities are nearly 100% preventable.5
Decay can develop any time after the teeth start to erupt, typically starting at about 6 months of age.5 Before the first tooth appears, caregivers should wipe their baby’s gums with a clean gauze pad after each feeding to remove plaque and residual food that can harm erupting teeth.6 Decay can occur rapidly in these newly erupted teeth.
Infants and young children have unique caries risk factors. Baby-bottle tooth decay (BBTD), which generally occurs between the ages 12 and 18 months of age, is a pattern of tooth decay believed to be primarily associated with the use of a bedtime bottle containing a beverage with natural or added sugars such as formula, juice, or another sugary drink.1 Almost one of five caregivers (17%) with a child 4 years or younger reports that the child goes to sleep every night with a bottle or sippy cup containing milk or orange juice.5 These actions can lead to tooth decay.
Early childhood caries (ECC) demonstrates a broader concept in infants and young children in that other causative factors are at play, including continual use of a sippy cup, at-will breastfeeding throughout the night, use of a sweetened pacifier, or when chronic illness requires the use of a sugar-based oral medication.1 An infectious disease, ECC develops within 6 months,1 affecting the upper front teeth first, which typically erupt at 8 months of age. In order for it occur, three factors must be present: a harmful agent such as bacterial biofilms, a susceptible tooth, and an oral environment that contains fermentable carbohydrates such as natural or refined sugars.1 When a child’s diet includes anything other than breast milk, erupted teeth are at risk for decay,7 making early visits crucial.
Untreated cavities in the primary dentition can cause pain, dysfunction, school absences, difficulty concentrating, and poor appearance,8 as well as affect growth, lead to life-threatening infections, and diminish quality of life.4 Tooth decay affects more than one-fourth of US children aged 2 to 5 years.8 According to the National Health and Nutrition Examination Survey, an estimated 23% of children ages 2 to 11 have never been to a dentist.9
Dentists are reporting that preschoolers at all income levels are appearing in dentists’ offices with 6 to 10 cavities or more. In some of these cases, the level of decay may require the use of general anesthesia because these children are unlikely to be able to sit still during a procedure.10 This delay in treatment may be partially attributable to parents’ mistaking cavity pain for teething.10
Other problems could be a lack of caregiver awareness about need for the age-one dental care visit, believing instead that baby teeth do not matter because they fall out. These baby teeth begin to appear when the child is 6 months.3 Most children have a full set of primary teeth by the age 3 with these teeth beginning to shed at approximately 6 years of age.3 These 20 baby teeth are eventually replaced by the 32 teeth that adults have.3
Good oral health lasts a lifetime. Research has shown a link between childhood cavities and lower-than-ideal body weight.2 Also, improper oral hygiene may increase a child’s risk of eventually having low-birth-weight babies, developing heart disease, or having a stroke as an adult.2
Not only is early preventive care a good investment in a lifetime of oral health, but it is also sound financial sense. Some caregivers may think they are saving money by not taking their child to the dentist. However, research shows that the dental costs for children who have their first dental visit before age 1 are 40% lower in the first 5 years than for those who do not see a dentist prior to their first birthday.2
Dental caries is a common transmissible chronic infection caused by tooth-adherent specific bacteria, primarily mutans streptococci (MS),1,4 which metabolize sugars to produce acid, eventually leading to tooth demineralization if left unchecked. It is theorized that MS are the principal organisms that initiate dental caries.4 The period in which the child is most likely to acquire this bacteria is brief, from 6 months through approximately 31 months of age.1 Studies have shown the tongue may harbor bacteria in infants before their teeth have erupted.4
Home Sweet Home
The American Academy of Pediatric Dentists and the American Dental Association advocate the establishment of a dental home for every child by age 1.11 This means the child’s oral health is managed in “a comprehensive, continually accessible, coordinated and family-centered way by a licensed dentist.”4 The emphasis is on initiating and maintaining strategies for preventive care during infancy and providing acute care.4 The dental home should provide anticipatory guidance about growth and development, such as thumb sucking, and an individualized preventive dental health program based on a caries risk assessment and a periodontal disease risk assessment.4
Education of the caregiver is part of the foundation of a child’s dental home—caregivers should be instructed about the child’s general health, at-home strategies, prevention measures, dietary habits (eg, dietary sugars), and treatment of disease. The dental home may also make referrals to specialists when necessary.4
A dentist does not have to be a pediatric dentist in order to treat young children.12 Although pediatric dentistry is an age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral healthcare for infants and children through adolescence including those with special health care needs,”13 general dentists have a place in the care of young children.12
To become a pediatric dentist, a dentist must satisfactorily complete a minimum of 24 months in an advanced program in pediatric dentistry of full-time formal training and accredited by the Commission on Dental Accreditation of the American Dental Association.13 However, general practitioners need to see as many children as they are willing to see in order to provide as many children as possible with care.12
A practice that has a strong relationship with a family is in an ideal position to educate caregivers about the importance of the age-one visit12 and establishing the dental home. The trust and preventive care dialog between dental team and the family has already been established.
The Age-One Visit
Dental assistants can help a busy practice incorporate an age-one dental visit into its daily schedule.
Young children tend to cope better with an appointment in the morning when they are better rested. Also, a morning appointment generally has less wait time, which can make a difference with an anxious caregiver.14
Often, these age-one visits are focused more on education of the caregiver than on the dentist’s examination of the child, which consumes a small portion of the total visit time.12 The dentist will likely perform the knee-to-knee examination. The appointment may last 30 minutes, which depends on what the caregiver wants to know and needs to understand. Team members can provide anticipatory guidance, which would include showing the caregiver how to brush the child’s teeth and what plaque looks like, and asking questions about whether the baby is put to bed with a sugary drink.12
The dental team should ask open-ended questions and stress to the caregiver that they they will work with her or him to obtain the best possible care for the child.14 Assess the caregiver’s comprehension by stating: “So that I can make sure that I am explaining this to you well, please tell me what your understanding is about your child’s dental needs.”14 Inform the caregiver that most procedures will be performed with the effective tell-show-do approach, which uses age-appropriate terms.14
The team can demonstrate to the caregiver how to clean the child’s teeth properly and how to evaluate any adverse habits such as thumbsucking.3 Table 1 lists tips to share with parents. As permanent molars appear, the team might want to suggest the use of dental sealants, which are thin, plastic coatings painted on the chewing surfaces of the back teeth. Sealants will help avoid tooth decay and help supplement the protection that fluoride provides.15
Educating caregivers about avoiding saliva-sharing behaviors (such as sharing spoons or cleaning a pacifier with their mouth) can help prevent early colonization of mutans streptococci.º Caregivers with untreated caries have higher levels of bacterial biofilms in their mouths and tend to have children with high rates of decay because of the transmission of the bacteria to their children.1
A comprehensive oral health examination includes the following assessments4:
- General health/growth
- Extraoral soft tissue
- Temporomandibular joint
- Intraoral soft tissue
- Oral hygiene and periodontal health
- Intraoral hard tissue
- The developing occlusion
- Caries risk
- Behavior of the child
To help a young patient cope with the examination, a general practice setting should have books and toys available to help distract children and set them at ease. Not only is it important that the dental assistant understand how to deal with unhappy 1-year-olds, but it is also key for assistants to manage caregivers’ expectations, concerns, and questions in order to have the best experience. Part of this may include education of the caregiver through a Web site or other social media created and maintained by the practice.
A dental team should have a variety of behavioral approaches to their patients and caregivers. Through effective and thorough communication, the dental team can help alleviate fear and anxiety and guide the child to be cooperative. Information provided to the caregiver prior to an appointment will help set expectations. The interaction of the dental assisting team with a young patient is crucial—a positive interaction in the age-one visit helps initiate in the child a good lifelong attitude toward dentistry.
Many milestones are reached in the first year of life, and sometimes the importance of an age-one dental appointment is overlooked. However, its significance in helping to prevent a host of problems is key in maintaining oral health for a lifetime. Education is a cornerstone in care in this vulnerable pediatric population.
1. Berg JH, Domoto PK. The “age-one” dental visit—preventing early childhood caries. Inside Dentistry. 2007;3(3):38-44.
2. CDC report highlights importance of pediatric dental visits. Research links early dental care to long-term health benefits [press release]. Chicago, IL: American Academy of Pediatric Dentistry; December 2005.
3. For the dental patient: baby’s first teeth. J Am Dent Assoc. 2002;133(2):255.
4. American Academy of Pediatric Dentistry reference manual 2011-2012. Pediatr Dent. 2011;33(6 reference manual):1-349.
5. Dentalaegis Web site. Top 7 reasons why a baby’s oral health should begin at birth. www.dentalaegis.com/community/dental-assisting/12/03/01/507. Accessed March 18, 2012.
6. Parents. American Dental Association Web site. http://www.ada.org/2844.aspx. Accessed March 18, 2012.
7. Dental care for your baby. American Academy of Pediatric Dentistry Web site. http://www.aapd.org/publications/brochures/babycare.asp. Accessed March 18, 2012.
8. Oral health. Preventing cavities, gum disease, tooth loss, and oral cancers at a glance 2011. Centers for Disease Control and Prevention Web site. www.cdc.gov/chronicdisease/resources/publications/AAG/doh.htm. Accessed March 18, 2012.
9. Treatment needs in children (2 to 11). National Institute of Dental and Craniofacial Research Web site. http://www.nidcr.nih.gov/DataStatistics/FindDataByTopic/TreatmentNeeds/Children.htm. Accessed March 18, 2012
10. Saint Louis C. Preschoolers in surgery for a mouthful of cavities. The New York Times. http://www.nytimes.com/2012/03/06/health/rise-in-preschool-cavities-prompts-anesthesia-use.html?pagewanted=all. March 6, 2012. Accessed March 20, 2012.
11. The dental home. It’s never too early to start. The American Academy of Pediatric Dentistry Foundation. http://www.aapd.org/foundation/pdfs/DentalHomeFinal.pdf. Accessed March 18, 2012.
12. Neuman L. Once upon a time. Inside Dentistry. 2008;4(5):110-123.
13. American Dental Association Commission on Dental Accreditation. Accreditation standards for advanced specialty education programs in pediatric dentistry. http://www.ada.org/sections/educationAndCareers/pdfs/ped.pdf. Accessed March 20, 2012.
14. Soxman J. Parenting the parents of pediatric patients. Compend Contin Educ Dent. 2006;27(11):630-634.
15. Seal out tooth decay. National Institute of Dental and Craniofacial Research Website. www.nidcr.nih.gov/oralhealth/topics/toothdecay/sealouttoothdecay.htm. Accessed March 18, 2012.