First Visit

The American Academy of Pediatric Dentistry (AAPD) suggests that parents should make an initial “well-baby” appointment with a pediatric dentist approximately six months after the emergence of the first tooth, or no later than the child’s first birthday.

Although this may seem surprisingly early, the incidence of infant and toddler tooth decay has been rising in recent years.  Tooth decay and early cavities can be exceptionally painful if they are not attended to immediately, and can also set the scene for poor oral health in later childhood.

The pediatric dentist is a specialist in child psychology and child behavior and should be viewed as an important source of information, help, and guidance.  Oftentimes, the pediatric dentist can provide strategies for eliminating unwanted oral habits (for example, pacifier use and thumb sucking) and can also help parents in establishing a sound daily oral routine for the child.

What potential dental problems can babies experience?

A baby is at risk for tooth decay as soon as the first tooth emerges.  During the first visit, the pediatric dentist will help parents implement a preventative strategy to protect the teeth from harm, and also demonstrate how infant teeth should be brushed and flossed.

In particular, infants who drink breast milk, juice, baby formula, soda, or sweetened water from a baby bottle or sippy cup are at high risk for early childhood caries (cavities).  To counteract this threat, the pediatric dentist discourages parents from filling cups with sugary fluids, dipping pacifiers in honey, and transmitting oral bacteria to the child via shared spoons and/or cleaning pacifiers in their own mouths.

Importantly, the pediatric dentist can also assess and balance the infant’s fluoride intake.  Too much fluoride ingestion between the ages of one and four years old may lead to a condition known as fluorosis in later childhood.  Conversely, too little fluoride may render young tooth enamel susceptible to tooth decay.

How can I prepare for my child’s first dental visit?

Pediatric dentists are required to undergo extensive training in child psychology.  Their dental offices are generally colorful, child-friendly, and boast a selection of games, toys, and educational tools.  Pediatric dentists (and all dental staff) aim to make the child feel as welcome as possible during all visits.

There are several things parents can do to make the first visit enjoyable.  Some helpful tips are listed below:

Take another adult along for the visit – Sometimes infants become fussy when having their mouths examined.  Having another adult along to soothe the infant allows the parent to ask questions and to attend to any advice the dentist may have.

Leave other children at home – Other children can distract the parent and cause the infant to fuss.  Leaving other children at home (when possible) makes the first visit less stressful for all concerned.

Avoid threatening language – Pediatric dentists and staff are trained to avoid the use of threatening language like “drills,” “needles,” “injections,” and “bleeding.”  It is imperative for parents to use positive language when speaking about dental treatment with their children.

Provide positive explanations – It is important to explain the purposes of the dental visit in a positive way.  Explaining that the dentist “helps keep teeth healthy” is far better than explaining that the dentist “is checking for tooth decay and might have to drill the tooth if decay is found.”

Explain what will happen – Anxiety can be vastly reduced if the child knows what to expect.  Age-appropriate books about visiting the dentist can be very helpful in making the visit seem fun. Here is a list of parent and dentist-approved books:

• The Berenstain Bears Visit the Dentist – by Stan and Jan Berenstain.
• Show Me Your Smile: A Visit to the Dentist – Part of the “Dora the Explorer” Series.
• Going to the Dentist – by Anne Civardi.
• Elmo Visits the Dentist – Part of the “Sesame Street” Series.

What will happen during the first visit?

There are several goals for the first dental visit.  First, the pediatric dentist and the child need to get properly acquainted.  Second, the dentist needs to monitor tooth and jaw development to get an idea of the child’s overall health history.  Third, the dentist needs to evaluate the health of the existing teeth and gums.  Finally, the dentist aims to answer questions and advise parents on how to implement a good oral care regimen.

The following sequence of events is typical of an initial “well-baby checkup”:

1. Dental staff will greet the child and parents.
2. The infant/family health history will be reviewed (this may include questionnaires).
3. The pediatric dentist will address parental questions and concerns.
4. More questions will be asked, generally pertaining to the child’s oral habits, pacifier use, general development, tooth alignment, tooth development, and diet.
5. The dentist will provide advice on good oral care, how to prevent oral injury, fluoride intake, and sippy cup use.
6. The infant’s teeth will be examined. Generally, the dentist and parent sit facing each other.  The infant is positioned so that his or her head is cradled in the dentist’s lap.  This position allows the infant to look at the parent during the examination.
7. Good brushing and flossing demonstrations will be provided.
8. The state of the child’s oral health will be described in detail, and specific recommendations will be made.  Recommendations usually relate to oral habits, appropriate kinds of toothpaste and toothbrushes for the child, orthodontically correct pacifiers, and diet.
9. The dentist will detail which teeth may appear in the following months.
10. The dentist will outline an appointment schedule and describe what will happen during the next appointment.

What questions may the pediatric dentist ask during the first visit?

The pediatric dentist will ask questions about current oral care, diet, the general health of the child, the child’s oral habits, and the child’s current fluoride intake.

Once answers to these questions have been established, the pediatric dentist can advise parents on the following issues:

• Accident prevention.
• Adding xylitol and fluoride to the infant’s diet.
• Choosing an ADA-approved, non-fluoridated brand of toothpaste for the infant.
• Choosing an appropriate toothbrush.
• Choosing an orthodontically correct pacifier.
• Correct positioning of the head during tooth brushing.
• Easing the transition from sippy cups to adult-sized drinking glasses (12-14 months).
• Eliminating fussing during the oral care routine.
• Establishing a drink-free bedtime routine.
• Maintaining good dietary habits.
• Minimizing the risk of tooth decay.
• Reducing sugar and carbohydrate intake.
• Teething and developmental milestones.

If you have questions or concerns about your child’s first dental visit, please contact our office.