When Should Your Child Visit a Pediatric Dentist?

We interviewed our pediatrician before our son was even born. He visited us in the hospital a few times the week after our son was born to give him several check-ups. Then, during our son’s first year, we visited our pediatrician’s office every few months for general check-ups, immunizations, and sick appointments.

Basically, we take our children’s pediatricians very seriously, but when are our kids supposed to go for their first dental visit? What happens at the first visit? These were valid questions a few of us concerned fathers had. So, we decided to do something about it, and get educated.

Josh K., who has a 5-year-old son that regularly visits a pediatric dentist, invited his pediatric dentist to join our NYC Dads Group for a “Pediatric Dentistry 101” session. Caryn Siegel, DMD (a Board Certified Pediatric Dentist of the American Board of Pediatric Dentistry) of NY Kids Dentistry was warm, knowledgeable, personable, and ready to tackle the issues and questions from the dads in our group. Nine dads with their kids were lounging in an indoor playroom where only 1 of the 9 had visited a pediatric dentist before. Dr. Siegel came prepared with a 3-page document detailing the most frequently asked questions (shared below), but we were dads … we could read it in our spare time. Thirsty for knowledge, we wanted to fire away the questions.

When Should Your Child Visit a Pediatric Dentist for the first time?

Dr. Siegel’s answer: “The American Academy of Pediatric Dentists (AAPD) recommends that the first dental visit should be at age one or within 6 months of getting their first baby tooth.” Many of the caring dads in the room, with children over a year old, looked around at one another — we realized we “dropped the ball” on this one.

The goal of NY Kids Dentistry is to encourage “anticipatory guidance” for parents so this becomes a “cavity-free” practice. I would like to impart some knowledge I gained:

• Cleaning a kids teeth will not harm them. We should be brushing their teeth twice a day (morning and night).
• Encourage them to brush on their own at an early age. Establish a routine, such as singing a song like “this is the way we brush our teeth.” Parents should take over at the end to make sure teethed get cleaned well.
• Do not use toothpaste or use paste without fluoride for young children.
• The 3 factors affecting your children’s teeth are diet, oral hygiene, and genetics.
• What happens during the first visit? The visit is MAINLY for the parents. During this 30-minute visit it includes an Oral Exam + Polishing Teeth + Putting some Fluoride on (this takes about 5 minutes). The child usually sits on their parent’s lap. NY Kids Dentistry is ok with the parent being in the room, unlike some other practices. The rest of the time is spent on learning best practices for healthy teeth in the future – how to handle cleaning all of he time, how to do it safely, and how to avoid accidents. Appointments for children under 2 years-old usually happens in the mornings because it goes more smoothly.
• Dr. Siegel recommends children to be off their pacifier or thumb sucking by age 4. The frequency, duration, and intensity of using a pacifier is what causes shifting, and might even impact short-term speech. After 6- 9 months of not using a pacifier/thumb, most dental shifts correct themselves so this is recommended after all of the baby teeth are in place & before the big teeth occur.
• Even though babies have their baby teeth cutting through at an early age, the permanent teeth buds are also in development at this time.
• A dry mouth could speed up the cavity process, so use lots of water – your children should drink water after meals to assist in cleaning their teeth & drink lots of water throughout the day to keep their mouth moist.
• When should our children be brushing their teeth on their own as daily habit & routine? They should be independent tooth brushers by age 6 – 7, when they are able to tie their own shoes.
• The biggest oral hygiene “no-no” – breastfeeding or bottle feeding your child to sleep because then the sugars of the milk or formula remain on the teeth while they sleep. Dr. Siegel suggests using a wet washcloth and wipe the teeth or gums before sleeping.
• How often should children visit their pediatric dentist after their first visit? Similar to most adults, “every 6 months”
• Can you give a ballpark on the cost of a pediatric dentist visit? A visit to NY Kids Dentistry is approximately $200 – $225

Please take all of the information in this posting as general guidelines. Your pediatric dentist or pediatrician might suggest otherwise. NY Kids Dentistry is just one of the numerous pediatric dentistry practices in NYC.

Below is the “Pediatric Dentistry 101” Document shared with our NYC Dads Group by Dr. Caryn Siegel, DMD on behalf of NY Kids Dentistry. With her permission, I am posting this resource for other parents:

PEDIATRIC DENTISTRY 101
Caryn Siegel, DMD
Board Certified Pediatric Dentist of the American Board of Pediatric Dentistry
http://www.nykidsdentistry.com/

FIRST DENTAL VISIT: AAPD recommends that the first dental visit should be at age one or within 6 months of getting the first baby tooth

What happens at first visit?

Treatment: Examination, cleaning (dental prophylaxis), topical fluoride application, x-rays if needed

Discuss: growth and development, age appropriate oral hygiene practices, dietary recommendations, non-nutritive habits, caries prevention, oral trauma and injury prevention, fluoride issues, teeth grinding, future need for orthodontics

GROWTH AND DEVELOPMENT:
20 primary (“baby”) teeth: 1st tooth at 6 months of age
Central incisors: 6 months
Lateral incisors: 9 months
1st molars: 12 months
Canines: 18 months
2nd molars: 24-36 months
Primary teeth develop in utero, permanent teeth develop after birth
Color differences
Spacing is desired
Exfoliation (“falling out”) of primary teeth: girls: age 6 years old, boys: age 6.5 yrs old; last tooth can fall out as late as 12.5-13 years of age or later
All 20 primary teeth fall out and get replaced by a permanent tooth, 6 yr and 12 yr molars
Decay (“cavities”):IF PRIMARY TEETH DEVELOP DECAY THEY HAVE TO BE TREATED (in most cases)
Risk of decay: oral hygiene, diet, genetics

ORAL HYGIENE: must effectively remove plaque buildup on all surfaces of teeth
AM and PM brushing by a parent, proper brushing technique
Flossing if needed
Non-fluoridated toothpaste if unable to spit out
Fluoride mouth rinse if indicated

DIETARY RECOMMENDATIONS:
minimize the length of time sugary substances are in the mouth
Bottle/breastfeeding: not as child falling asleep, not “at will”
Water vs. milk: lactose is a sugar
Avoid foods with high sugar content that stay in the mouth for an extended period of time: sticky consistency or sucked on: dried fruit, raisins, Skittles, Starburst, fruit snacks, ice pops, and lollipops
Snacks and sweets which are better: chocolate, cookies, chips, ice cream

GENETICS: bacterial content of parent’s oral cavity passed on directly to child
Magnitude
Type/species

NON-NUTRITIVE SUCKING HABITS:
Pacifier and finger sucking
Can change position of teeth: top front teeth flare and pushed up, narrow palate, change posterior occlusion
Stop by age 4
Thumbguard, cemented habit appliance

GRINDING:
common in children
Not related to stress (as in adults)
usually a subconscious response to falling in and out of deep sleep
Flatten edges of teeth, usually not a concern with primary teeth, usually not a problem with permanent teeth
Usually children “grow out of it” around age 8-9

INJURY PREVENTION:
Age 2-4, Age 8-11
Mouth guards, helmets

DENTAL EMERGENCIES:
· Only true dental emergencies are:
1: avulsion (tooth out of mouth) of permanent tooth
2: luxation (tooth in wrong position) of permanent tooth
· Chipped teeth: size of fracture determines treatment needs: no treatment, smooth out the tooth’s chipped edge, repair/bond chipped edge, root canal?

FLUORIDE: a naturally occurring element
Topical: over the counter toothpaste, mouth rinse (ACT), dentist application twice a year
Systemic: NYC tap water

o Substituted into the enamel matrix of developing permanent teeth during their development

o One of the top 10 health advances of the 20th century, significant reduction of decay rate

Supplementation?
Fluorosis

X-RAYS:
Taken to visualize surfaces unable to see clinically
Assess proper growth and development
Rule out pathologic conditions
· AAPD recommendations

ORTHODONTICS:
Earlier treatment
2 phases
Genetic predisposition

PREVENTION:
Sealants on permanent molars
appropriate fluoride recommendations
x-rays taken appropriately
routine dental visits

Websites:
http://www.aapd.org/
http://www.ada.org/
http://www.nykidsdentistry.com/
http://www.thumbguard.com/