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First Dental Visit: Why the Change from 3 Years Old to 1 Year Old?

By Amy Regen, D.M.D., Chestnut Dental January 16, 2020


Originally published in the Mass Dental Journal

The Academy of Pediatric Dentistry (AAPD), Massachusetts Dental Society (MDS), American Dental Association (ADA) Massachusetts Academy of Pediatric Dentistry (MAPD) and American Academy of Pediatrics (AAP) all recommend the "age-one dental visit", with the goal of scheduling a baby's first visit to the dentist within six months of the eruption of the first tooth and no later than the child's first birthday. (1)

Why, then, do many dentists wait until at least three years of age to see patients for the first exam? According to Casamassimo and Warren, "this practice was most likely based on the inevitability of caries in most children, the reluctance of general dentists to see very young children, and the difficulty of managing dental disease if found... A generation ago, little was known about risk assessment. prevention of detal caries beyond that caused by nighttime bottle use, and the impact of early dental caries on subsequent caries risk." (2) The old philosophy was that by age three, all primary teeth have erupted and the patient will more likely be cooperative in the dental setting. Furthermore, many pediatricians claimed "responsibility for the oral health of children younger than 36 months," thus waiting to refer patients until 3 years of age to a dentist. (2)

So, why the change from age 3 to 1? Why should an infant see a dentist when he or she has so few teeth? Unfortunately, the prevalence of dental caries in children under the age of five is on the rise. Many children already have cavities by age 3. Dental caries remains the single most common chronic disease of childhood -- five times more common than asthma and seven times more common than hay fever. (3)  Waiting until age 3 to see the dentist is no longer sufficient to prevent dental disease. The dental profession has learned a lot over the years about prevention, caries risk, and caries susceptibility. We can no longer rely on pediatricians to screen for dental disease and relay proper oral health information to families. Dentists need to be on the front line in educating parents about caries prevention. 

Since 1986, the AAPD has held the position that all infants should establish a dental home by 12 months of age. (4) Twenty-six years later, the shift to the age-one visit still meets resistance. 

The age-one dental visit is analogous to a "well visit" with the pediatrician. The focus is on parental education and caries prevention. It gives the dental team the opportunity to educate the parents on proper home care, including brushing techniques, review of diet, proper feeding recommendations, and a discussion of high versus low cariogenic foods. It is also a good time to discuss the etiology of caries and perform a caries risk assessment. Anticipatory guidance is another aspect of the age-one visit; this allows for discussion of oral and dental development, oral habits, appropriate flouride exposure, and oral trauma prevention. in addition, it establishes a "dental home" that the parents can turn to for all future dental needs for their child. 

The goal is to promote good oral health, create an individualized caries prevention plan, and provide each child with a dental home. An early visit to the dentist also helps establish a comfort level with the dentist and office staff, builds good rapport, and lays the foundation for trust among the child, parent and dental team.

References

1. American Academy of Pediatric Dentistry. Guideline on periodicity of examination, preventive dental services, and anticipatory guidance/counseling, and oral treatment for infants, children, and adolescents. American Academy of Pediatric Dentistry oral health policies and clinical guidelines. Available from: http://www.aapd.org/media/policies_guidelines/g_periodicity.pdf

2. Casamassimo PS, Warren JJ. Examination, diagnosis, and treatment planning of the infant and toddler. in Pinkham JR, Casamassimo PS, McTigue DJ, Fields HW. Nowak AJ, eds. Pediatric Dentistry: infancy through adolescence. 4th ed. St Louis (MO): Elsevier Saunders; 2005. p. 206.

3. U.S. Department of Health and Human Services. Oral health in America: a report of the Surgeon General--executive summary. Rockville (MD): U.S. Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health; 2000. Available from: http://www.nidcr.nih.gov/datastatistics/surgeongeneral/report/executivesummary.htm

4. American Academy of Pediatric Dentistry. Guideline on infant oral health care. American Academy of Pediatric Dentistry oral health policies and clinical guidelines. Available from: http://www.aapd.org/media/policies_guidelines/g_infantoralhealthcare.pdf  


Benefits of an Age-One Dental Visit

Educates families on oral health, proper diet, and proper home care

Reviews etiology of caries and discusses caries prevention

Provides a caries risk assessment and a resulting prevention plan

Reviews flouride status and offers appropriate recommendations

Provides anticipatory guidance: discussion of habits, trauma prevention, and oral and dental development

Establishes a dental home for all future dental needs 

Establishes good rapport and trust for the parent and child


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