SECTION 3 Pediatric Dentistry
A child’s first visit to the dentist should be at a much earlier age than most parents think. The first dental visit should occur by age 1 or when the first teeth erupt. During this visit we will teach you how to care for your child’s teeth and what preventive measures you should be taking for your infant at this early stage. Many dental problems can be prevented when we have the opportunity to examine your child and visit with you in the early developmental stages. For example, early childhood tooth decay can be prevented by applying fluoride varnish to the baby teeth when they erupt.
The first cleaning for your child (pedodontic prophylaxis) should be done at about 1 year of age. At about 2 to 2 1⁄2 years of age, depending on the child’s behavior, your child can sit in the dental chair for teeth cleaning and fluoride application. It is important to note that this should not be the first time the child visits our office. Before this visit we would like the child to come in with a parent or caregiver who is receiving professional dental hygiene care. We have many toys, books, and children’s movies that can be fun. In this way children come to know the dental office as a very pleasant, nonthreatening place. It is hoped that by the time they come for their own care they have been to the office several times. They know the dentist, the dental hygienist, and the way the office and dental equipment looks. They will have a good idea of what will be expected of them. They will have had only good experiences with people at this location. Usually, infants and toddlers introduced to dentistry in this manner are very excited about having their own dental appointments.
It is important for parents and caregivers to always talk positively about going to a dental appointment as well as about the appointment after it has occurred. Children are very smart. They may not know what some of the words mean, but they can understand how you feel about it. You should try not to use any words around them that might have an unpleasant connotation: toothache, drill, pull, hurt, pain, unhappy, and so on. Always talk about how happy you are to go to the dentist and what a great experience it was. If your appointment was stressful, talk about it in private where children cannot overhear. If necessary, and if your child asks, tell him or her about how glad you are that the dentist or dental hygienist is making your mouth feel good again, without mentioning any of the discomfort.
It is also important to ensure that the children are not threatened by the dentist or dental hygienist and to avoid making the dentist or dental hygienist appear to be the “heavy.” Don’t tell children, for example, that if they eat candy, they will have to go to the dentist to get their teeth drilled and filled. Children will then think of the dentist’s office as a place where you get punished for doing something bad. We want children to be completely comfortable and to not worry when it is time for a dental appointment.
By the time the child has a dental procedure performed, at the age of 2 to 21⁄2 years, it will usually be very simple, quick, and entirely painless. Of course, we assume you have followed all the preventive suggestions we have given you: using fluoride supplements, if appropriate; brushing the child’s teeth with a fluoride toothpaste; having fluoride varnish “painted” on the teeth twice a year; putting nothing in a night bottle but water; and so forth.
First, we will spend time with the child in a show-and-tell mode. We will show the child the various instruments: polishers, mirrors, “Mr. Thirsty” (saliva ejector), the wind and water jet (air-water syringe), and so on. The dental hygienist will also begin to instruct the child in proper brushing techniques. At this young age, children do not manipulate dental floss and a brush properly. This is a responsibility for the parent or caregiver. Because children admire and try to imitate adults, your good example of brushing and flossing each day will help tremendously in this area. Children will see that it is something you do, which they will then try to imitate.
Also during this visit, the dentist or dental hygienist will “count” the child’s teeth while looking for decay or other problems. Then the dental hygienist will “tickle” (clean and polish) the teeth. Stains and plaque that might have accumulated will be removed. It is very unusual for a child to have periodontal problems.
If the child is prepared correctly, the first treatment visit at the dentist will be anticipated with no anxiety, proceed smoothly, and make the child excited about coming again. What you do at home in preparation for this first visit is most important to its success. There are children’s books that can be borrowed from the public library that can also help the child understand. Good luck!
Early childhood caries, which used to be called “baby bottle tooth decay” and “nursing caries,” is a severe form of dental decay found in very young children who presumably are put to sleep with any liquid other than water in a bottle. Children who have experienced prolonged breast-feeding will have the same type of tooth decay patterns. Many times, the decay is very advanced before the parent notices the problem. This is another reason that we want to see your child for his or her first dental visit while those new teeth are still in the eruption phase and before the child’s first birthday.
The teeth most affected by early childhood caries are the upper front teeth. As the child falls asleep with a bottle containing any liquid other than water (or at the breast), pools of the liquid collect against the tooth surfaces. sugars in the liquid feed the bacteria found in bacterial plaque to produce an acid, which starts the decay process. When the demineralization process is not stopped through proper prevention, the crowns of the teeth can be destroyed to the gum line; abscesses can develop, and the child can experience severe pain, discomfort, and dental disability.
When children are given acidic and sugary drinks for a prolonged period of time, the result can be very damaging to tooth structure. Similarly, when oral bacteria are fed small amounts of sugared or acidic beverages nonstop over a day’s time, the results can be quite damaging to tooth structure.
We believe the best prevention for this type of problem begins with an understanding of the decay process and how you can prevent it before it even starts. We recommend that you bring your children to the dentist before the first birthday so that we can perform an infant oral examination and discuss oral care, including the following points: