February is national children’s dental health month. How important is children’s dental health? According to the American Academy of Pediatrics web site(www.AAP.org), “Dental caries is the most common chronic disease affecting children in the United States. It is 5 times more common than asthma and 7 times more common than hay fever.” That is why the AAP and the American Academy of Family Physicians (www.AAFP.org) instructs their members to refer children to a dentist by their first birthday. (The American Dental Association recommend the first tooth or first birthday whichever is first.)
You may take your child to your dentist for their first examinations. Some general dentists relish this episode in the continuum of care of their patients’ families. Other dentists and parents prefer for children to be cared for by a specialist. Pedodontists are dentists who have special training to work with patients from the youngest to the late teens. Dr. Golnaz Movafaghi, who will begin practicing in Malden, Massachusetts, spoke of her specialty,
“Unfortunately, many parents do not realize that the specialty of Pediatric Dentistry exists. In addition to the 4 years of dental school, Pediatric Dentists train in a full-time, 2-3 year residency in Pediatrics. The current guidelines from the AAPD recommend that a child’s first dental visit should be when the first tooth erupts and no later than 1 year of age. If a toddler sees a pediatric dentist before the age of 1 and then at 6 months recalls, the parent will know how to prevent tooth decay and the child will be very well adjusted to the dental environment by the age of 2-3. During our pediatric training, we are trained to diagnose and treat conditions related to children. We learn many behavior management techniques. We provide interceptive [early] orthodontics by evaluating growth and development to help minimize or prevent the need for braces in the future. We provide treatment for sports/trauma related injuries. And the list continues.”
What will that first dental appointment be like for a one year old? Of course, there are the all important registration forms. The pedodontist will want to know all about your child’s health. Who is their medical doctor? Are they disabled? Does your child have a chronic illness? What medications do they take? All of these issues have a direct relation to your child’s dental health.
How often do you brush your child’s teeth. Do you give them fluoride tablets or fluoridated tooth paste? Does your water have fluoride in it? (Some tap water does not and some bottled water does.) Do you floss your child’s teeth? Do they still drink formula, milk or other beverages from a bottle? At this age, it is important to transition to a sippy cup and then a regular cup.
The pedodontist will talk with you about how nutrition effects dental health. Most people know that putting a child to bed with a bottle of formula insures a childhood of decay, pain and dental appointments. Sticky sweets like fruit snacks, raisins, dates and dried apricots hold sugar in close contact with teeth for long periods. That may cause more decay. All carbonated beverages, including sugar free, are very cariogenic (decay inducing). The problem with soda is that it is very acidic. Even sugar free soda will cause tooth decay. Children and adults who drink soda every day, often develop cavities at a surprising rate. There are other health effects of high consumption of soft drinks such as empty calories and weak bones.
Your child’s dental check up is your chance to ask the dentist any questions you may have about children’s dental health. When can my child have tooth paste with fluoride? (When they are able to rinse and spit without swallowing so much of the tooth paste.) When do I start brushing my child’s teeth? (When they have their first tooth.) When may my child brush without my help? (When they are able to tie their own shoes they have the manual dexterity they need to brush thoroughly. That could be 6 years old for some kids. Well, parenting is quite a commitment.)
After all the questions, the dentist will want to examine the little one. Young ones may object to a stranger looking in and poking around their mouth. Don’t worry if they are a little upset. Many adults feel uncomfortable in the dental office. We have well developed superegos that allow us to control our emotions. Children may cry or complain, but most times, they are less concerned than they appear. When the appointment is over, older toddlers often bounce up and become friendly with their new dentist.
The dentist will examine your child’s head, face and neck. Does everything appear normal? Are the eyes, ears, nose and mouth proportionate and symmetrical? Does your child appear alert and oriented?
Inside the mouth, the dentist will check for unusual sores, growths and blemishes. Is the tongue able to move freely? Are the teeth erupting (coming in) on schedule? Do the teeth appear normal in color, shape and texture? Is plaque accumulating on the teeth? Some dentists will recommend other procedures including testing for the presence of bacteria that cause tooth decay, and using x-ray, laser or electronic cavity detection.
The dentist will evaluate the risk of tooth decay for each patient. Some risks include children who have decay from a young age, have parents with high decay rates due to their own dental habits, and poor home oral care (brushing and flossing). Dentists should prescribe more frequent professional fluoride applications for patients with higher risk of decay. Finally, the pedodontist will decide if it is necessary to polish the teeth and apply fluoride.
Who is the best dentist for your child, your family dentist or a children’s specialist? Ask your dentist and your child’s physician for their recommendations. What is so special about pedodontists? It may be their education. It may be their ability to care for the very young. It may be that they dedicate their professional lives to the dental care of all of our children. As Dr. Movafaghi says, “… you take your child to a Pediatrician and not your own primary-care Doctor. So why would you not take your child to a Pediatric Dentist, instead of your own General Dentist?”
