Oral Care for Children

Overview
A common question new parents have is "When should my child first see a dentist?"

The short answer is "First visit by first birthday," according to the American Academy of Pediatric Dentistry. America's pediatricians agree. The American Academy of Pediatrics suggests that children who are at risk of early childhood cavities should visit a pediatric dentist by age 1. Although the idea of such early dental visits is still surprising to many new parents, the infant visit is endorsed by leading national public health groups.

More than 1 in 4 children in the United States have cavities by the time they are 4 years old, sometimes as early as age 2. To prevent early childhood cavities, parents first have to find out their child's risk of developing cavities, then learn how to manage diet, hygiene and fluoride to prevent problems before they start.

But cavities aren't all that parents need to learn about their child's dental health. The age 1 dental visit lets parents discuss:

• How to care for an infant’s or toddler's mouth
• Appropriate use of fluoride for your child
• Oral habits, including finger and thumb sucking
• Ways to prevent oral and facial accidents and trauma
• Teething and developmental milestones
• The relationship between diet and oral health

After this first visit, the dentist will suggest a schedule of follow-up visits. In the past, dentists typically recommended follow-up visits every six months. Now, dentists are increasingly tailoring children's visits to their individual needs and risks. As your child grows, the dental team can share information that will help you prevent common oral problems.

Choosing a Dentist for Your Infant
In recent years, most dental schools have prepared new graduates to provide care to young children. But many dentists are less familiar and less comfortable with infants and toddlers.

Here are two ways to find a dentist who cares for young children:

• Call the dentist's office and ask, "At what age does your office recommend that children be seen for their first dental visit?" Look for an office that suggests your child be seen when the first tooth appears or by his or her first birthday.
• Look for a pediatric dentist who specializes in the care of young children. To find a pediatric dentist, ask your family dentist for a name, check your local phone book or go to the Web site of the American Academy of Pediatric Dentistry at www.aapd.org and click on "Find a Pediatric Dentist."

Preparing for the Age 1 Dental Visit
The age 1 dental visit is all about learning about your child's oral health and how to best care for your child's unique needs. It is about establishing a relationship with a dental office you feel comfortable with and trust and having your questions answered.

The best way to prepare for your child's age 1 visit is to consider what you want to know, what you want to look for and what you should expect.

Be prepared to ask about any concerns you may have. Be prepared to look for an office that is:

• Child and parent friendly
• Knowledgeable about young children's oral health, growth and development
• Responsive to you
• Gentle and kind toward your child even if your child creates a fuss when the dentist or hygienist looks in your child's mouth
• Focused on your specific child's needs
• Specific about recommendations about how to care for your child's mouth and teeth and shows you how to do so

The right office for you and your child will also:

• Tell you how to reach the office in case of an accident or dental emergency
• Make specific recommendations about regular follow-up care
• Tell you about what will happen next in your child’s oral development
• Help you to guard and promote your child's oral health

Dentists and pediatricians are calling this type of office a child's "dental home."

Also be prepared to hear your child fuss during the oral examination and toothbrush demonstration. However, parents are often surprised at how often infants are very passive and quiet and appear to enjoy the attention and novelty of the visit.

If possible, ask another adult to come with you to the visit, especially one who shares responsibility for caring for your child. Since you want to be free to talk comfortably with the dentist or hygienist and to focus attention on your child, it is best to not bring other children along at this first visit. Bring along an extra diaper and snack for your child, as well as a favorite toy, blanket or other familiar object that helps your child know that the dental office is a comfortable and safe place for him or her.

To save time and make the first visit easier, ask the dental office to mail you all the office forms you will need to fill out. The forms may offer the chance to list questions or concerns you may want to discuss at the visit.

What To Expect at the Office
The age 1 care visit is similar to a well-baby check at the physician's office.

At the visit, you should expect the dentist or hygienist to:

• Review your child's history
• Respond to your questions and concerns
• Talk with you about your child's overall oral health, including:
  • Development
  • Teething
  • Bite (how your child's teeth will come together)
  • Soft tissues such as gums and cheeks
  • Oral habits such as sucking
  • Cavity risk factors such as diet, hygiene practices, fluoride use and whether others in the family have had cavities
  • How to prevent trauma to your child's mouth
• Thoroughly examine your child's mouth in the knee-to-knee position. You and the dentist sit on chairs facing each other. Your child sits on your lap, facing you. You then lay your child back with his or her head in the dentist's lap so that both you and dentist can see clearly into your child's mouth and your child can look up at the parent.
• Demonstrate how to clean your child's teeth and give you a chance to practice
• Make specific recommendations about home care, including hygiene, diet and use of fluorides (including toothpaste)
• Tell you what to expect as your child grows and develops in the coming months
• Suggest a schedule for follow-up care

The dentist or hygienist may also clean your child's teeth, particularly if your child's teeth have a stain that commonly appears in infants. The dentist or hygienist may also apply a topical fluoride preparation, particularly if your child has a higher risk of developing cavities.

Before leaving the office, you should have a clear idea about your child's development, your responsibilities and follow-up care by the dentist. You should have your questions answered, have a good idea of your child's likelihood of having a problem with cavities and bite, and know what you and your child's dentist can do together to make sure your child has excellent oral health.

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Reviewed by the faculty of Columbia University College of Dental Medicine