First dental visit

Introduction:
• Children are the adult dental patients of future and good
ground work in the early years of dental monitoring and
treatment planning will pay dividends both in short and
long term.
• In the past children visited a dentist only after a problem
was severe enough to be noticed by a parent .This is now
an outdated approach which is no longer appropriate in
the age of preventive health.
• The infant’s oral health visit is now the foundation upon
which a lifetime of oral and dental health can be built.
• The ideal time as recommended by the American
Academy of Pediatric Dentistry, the American Dental
Association and the Academy of General Dentistry is at
approximately one year of age. This is an ideal time for
the dentist to carefully examine the development of your
child's mouth. Because dental problems often start early,
the sooner the visit the better.
• To safeguard against problems such as baby bottle tooth
decay, teething irritations, gum disease, and prolonged
thumb sucking, the dentist can provide or recommend
special preventive care.

When a child should first

see a dentist
• AAPD / ADA / Canadian Dental Association
recommends that a child should visit the dentist within 6
months of eruption of first primary tooth and no later
than 12 months of age with an aim to detect and control
the different pathologies, particularly dental caries.
 Visit before the child’s birth: - [Pre-birth
visit]
• The visit is needed as it is essential to establish a first contact
between the health professional and the parent with the object of
imparting information and initiating a bond of trust.
• As the pregnant women is concerned with her own health and
keen to deliver a healthy baby, she is receptive to suggestions
that will effect the health of her child and so this presents the
best possible moment to present here with principals of health
education and explain her that the baby’s teeth are beginning to
form at her current stage of pregnancy.
• Also it has been proved that the infant acquires the mutans
streptococcus from his mother (i.e.) earlier the acquisition
higher the risk of caries in primary dentition and so mother’s
oral health also needs attention and care.
 The first visit for an expecting mother should
include the following:

• It is the appropriate time to explain an expectant mother

how she may ensure that the teeth erupt healthy and the
care that needs to be taken to maintain dental health after
eruption.
• Should help to identify high risk situation and to indicate
and provide preventive procedures for both parent and
child where these are needed.
• Should aim to intimate the need for an appointment when
the baby is 6 months old.
• This pre-birth visit should thus be designed to achieve
positive, conscious and responsible attitudes and behavior
in the parents, as the key to effective oral health
promotion and disease prevention lies in anticipatory
guidance and education, early detection and timely
referral for appropriate intervention.
Child’s first dental visit at 6
months age:
Goals: -
1. Behavioral:-
• Early exposure to and familiarization of the child with the
dental environment are an important measure in reducing
dental anxiety in young children.
• It provides an important occasion for the parent to address
his or her own anxiety and fear of dental care which in
turn may reflect on the child.
• Also the clarification of the parent’s role in supporting the
child emotionally before, during, after future dental visit is
an important goal.
 2. Preventive:-
• Improvement of the child’s oral hygiene.
• Correction of improper dietary and eating habits.
• Improve knowledge about the role of non-nutritive sucking on
development of malocclusion.
• Improved knowledge of risks for traumatic injuries including where,
when and how to seek emergency care.
3. Therapeutic:
• A careful dental examination is not possible in very young child but
inspection of teeth and gingival is often possible as early as one year of
age.
• Help to identify children with thick plaque accumulation which is a risk
factor for caries in young children.
• Makes it possible for interceptive intervention aimed at arresting the
progression of caries lesion.
 Do’s and Don’ts for the parent before getting
their child to a dental check up

• Don’t wait until your child needs dental care to plan the
first dental visit. If she is frightened or in pain it’s difficult
for the dentist to gain the child’s trust.
• Young children are very perceptive and can pick up and
react to any anxiety the parent might have before the visit.
• Don’t talk about specific procedures or use words like
drilling/injection/needle that can frightened the child.
• Take some time to play dentist with the child at home and
pretend to count his teeth then also allow the child to play
the role of dentist.
• Read your child a story or show him some pleasant
pictures in relation to a dentist and dental clinic.
• Inform the dentist about any medical or systemic
problems the child is suffering from and openly discuss
the concerns, doubts and questions with the dentist.
• Before any form of treatment is initiated knowledge regarding
the attitude of the parent towards dentistry and dental treatment
along with family history of dental needs must be gathered to
provide a useful baseline for treatment planning.
• It is helpful to establish a rapport around a subject of interest to
each individual child.
• A few moments discussing non-dental topics such as siblings,
school, favorite toys, TV programmes, etc provide information
and a note of these can come handy at a 6 month recall.
• At the first visit particularly for an anxious child, optimum
time to stop may come with in a few minutes letting the
patient leave the surgery with a sense of achievement which
can be a powerful incentive for the child to come back.
• For some children just sitting in dental chair and allowing an
examination is a mile stone.
• Children have inquisitive minds and lively imagination. They
benefit from being given a clear understanding of what is
about to happen and an opportunity to ask questions. Giving
small children dental mirror to hold, allow them to look at
their own teeth and counting the teeth with them are some of
the helpful strategies.
 History
• Any presenting complaint should be established at the
onset as this is often the reason for attendance.
• It is also very helpful to establish what the child thinks
for the visit to a dentist as they may have a different
perspective from every one else.
• Medical history is often straight forward as majority of
children have no significant illness nor they are on any
medication.
 Clinical examination
• It initially provides an idea of child’s attitude towards
the examination process and the prospect of treatment.
• Very young / frightened children are best examined on
the parent’s knee. The dentist sits directly facing the
parent with their knees almost touching. The child is
then laid backwards on the dentist knee but can still
clearly see the parent who can help with reassurance and
physical contact.
• An older child with behavioral problems can be
examined on the parent’s knee or it may be necessary to
postpone the first detailed examination unless symptoms
dictate that early intervention is required.
• Children are susceptible to viral infections of oral soft
tissues like Primary herpes; Herpangina and also to
Recurrent apthous ulceration
• Hence the intra-oral examination should include soft
tissue examination before the examination of teeth and
occlusion.
• It is important to record a detailed dental charting in
children as their dentition changes dramatically over time
and delayed eruptions / congenital absence may otherwise
be mis-used.
Caries risk assessment:-
• Caries most commonly determines the tooth quality in a young
patient. Occasionally other factors like Erosions.
• Amelogenesis Imperfecta will have a profound effect on tooth
quality.
Risk assessment for dental caries based on 3 key factors.
• Clinical findings
• Dental development
• Other findings.
Various risk factors include
• Considerable amount of plaque.
• Hypoplastic teeth
• Bottle feeding during night.
• Improper dietary habits
• Mother has high caries rate.
• Visit. 1:
• • Carry out examination in chair.
• • Give dietary advice, tooth brushing
• instruction.
• • Demonstrate 3 in 1 syringe, saliva ejector.
• Visit. 2:
• • Reinforce oral hygiene and dietary advices
• • Demonstrate slow speed hand piece
• • Introduce the patient to light cure.
• Visit.3:
• • Apply fissure sealant using the equipment earlier
• demonstrated.
• • Give fluoride mouth wash.
• • Introduce topical anesthetics.
• Visit 4:
• • Apply topical anesthetics:
• • Infiltrate local anesthetics;
• • Complete restoration with slow speed / high speed
• hand piece
• • Restore with light cure compomer
• Beneficial to give children a morning appointment as
both the dentist and the child are relatively fresh more
positive and receptive and this can make the visit more
productive.
• The clinic set up also plays an important role and care
should be taken to make the practice environments as
childfriendly as possible.
• Bright decorations, good lighting, simple toys/ games in
the waiting room can also make a good impression on the
child.

SETTING UP OF PEDIATRIC
DENTAL PRACTICE
• It is ideal that a child shouldn’t be kept waiting but if
unavoidable toys, storybooks appropriate videos will be
useful to make the wait more pleasant.
• For a new young patient it is much less intimidating if the
dentist instead of a dental nurse greets the child in the
waiting room with an accompanying adult close at hand
and then escorts the child into the operatory.
• It is important that eye contact is very important
particularly at first meeting and so it may be necessary for
the dentist to bend / knees down to make eye contact with
the child.

SETTING UP OF PEDIATRIC
DENTAL PRACTICE