I recently went to a baby expo as a volunteer. Within the few hours that I was there, many interested parents and grandparents came by to ask questions regarding the oral health needs of their precious little ones. It was fantastic to be able to discuss children’s oral health with so many parents and grandparents, all desiring to protect their little ones against the detrimental consequences of poor oral health.
Some of the most frequent queries that popped up were:
- When should we take our little ones for their first dental visit? Why?
- Who should we take them to? Where can we go?
Early First Dental Visits – When and Why ?
Prevention is better than cure. When it comes to prevention, earlier is usually better, more timely and more effective. Would you agree?
Globally and nationally, paediatric dentists and professional bodies such as the Australian Dental Association, International Association of Paediatric Dentistry, American Academy of Pediatric Dentistry, and the British Society of Paediatric Dentistry are advising that the first dental visit should occur at or soon after the eruption of the first baby tooth or by the first birthday, whichever happens first.
Early dental visits not only enable the dentist to assess risks and identify any unusual signs or symptoms suggestive of potential dental problems that may not be easily detected by parents, but early visits also facilitate information exchange, anticipatory guidance and timely personalized risk-based prevention. Knowledge empowers. Support encourages. Timely prevention avoids small concerns from progressing into serious problems that lead to complicated procedures, uncomfortable dental experiences and higher costs in the future.
Establishing a dental home from an early age is advantageous for building dental confidence and reducing the risk of dental fear and anxiety, by allowing our little ones to see the same dental team in the same setting over time.
The recent figures and statistics relating to oral health of Australians paint an alarming picture (Chrisopoulos et al., 2016). The Australian Institute of Health and Welfare published in their 2016 report that 48% of 5yo Australian children, 58% of 7yo and 62% of 8yo suffer from dental decay and that decay experience among Australian children is increasing and reverting back towards 1978 figures (Chrisopoulos et al., 2016). AIHW also indicated that almost 20% of Australian 65yo and over do not have any natural teeth. These trends are not limited to Australia. Similar oral health issues apply in many parts of the world.
As adults, we are responsible for our next generation. Let us be proactive and implement changes to the way we look after our children’s oral health now, so that this same detrimental trends do not continue?
Early First Dental Visits – Is this the Norm ?
The percentage of children who have visited the dentist before the age of 4yo is low worldwide.
In 2013 the Australian Institute of Health and Welfare reported that 67.7% of children aged 2-4yo have never visited a dentist (Chrisopoulos & Harford, 2013).
Results from the National Child Oral Health Study 2012–2014 in Australia indicated that only 57% of children have been for a dental visit before the age of 5 years and that even at the age of 5-6 years, 1 in 4 children never been to a dental visit (Do & Spencer, 2016).
From these data, it appears that there is “a lost in translation” between available scientific evidence supporting early dental visits for prevention of oral diseases and everyday clinical practice.
Early First Dental Visits – What are the Common Barriers ?
1) One issue may be related to the lack of universal access of oral health services to the very young children.
Take Australia as an example, most Australian children who have visited the dentist before the age of 5years, attended private dental clinics. Children attending private dental clinics generally come from families with middle to high income.
Public oral health services are available to children in Australia but as the report of the National Advisory Council on Oral Health (2012) pointed out, eligibility, level of clinical services and service delivery models vary significantly across states and territories. For example, in Queensland, South Australia and Western Australia, pre-school aged children / children under 4yo are only eligible for public oral health service if their parents or guardians have health concession.
The Australian Child Dental Benefits Schedule (CDBS), which commenced in 2014, has helped to solve part of this access problem. Under this scheme, eligible Australian children, age of 2-17 years, can access dental care to the limit of $1000 over 2 years, in public oral health clinics as well as participating private dental practices. However, eligibility is means tested, treatment does not include dental treatment carried out in hospitals, and specific conditions apply to what treatment can be provided and claimed.
Dental access for a significant number of Australian children under the age of 2yrs remains limited - especially since these little ones are not covered by the CDBS and under 2yo children are not all eligible to be seen by public oral health services in Australia. Private dental care is an option, but this option is not readily affordable for all families.
2) The other issue may be related to the lack of interest or dental expertise in managing the very young patients.
Dental training in Australian universities aim to equip student dentists for general dental practice. Much time is spent on mastering skills needed for the care of adult patients. Experience in treating the very young patients vary from training program to training program. Some dental students may graduate having never performed a dental procedure in a preschool-aged child. Graduates who had limited exposure to the very young children while training, are likely to be less comfortable or less interested with managing the very young children in their dental practice and more likely to delegate these patients to the Oral Health Therapist or Dental Therapist, or refer the patients to Specialist Paediatric Dentists, in both public or private dental services.
While General Dentists can refer the very young dental patients to Specialist Paediatric Dentists, who are trained in the care of the very young dental patients, there are not very many paediatric dentists in Australia and so access to service may be limited by distance. Seeing a private paediatric dentist also usually involves higher costs compared to seeing a general dentist.
There are a small number of paediatric dentists who work in public services or tertiary institutions in Australia, but the waiting lists to see them may be long, limited by various eligibility criteria and the type of services provided may not be as diverse as when seeing a private paediatric dentist. In a tertiary institutional setting, treatment for the very young patients may be performed by students under supervision of general dentists and paediatric dentists, instead of the qualified practitioners.
3) A third issue may be related to the lack of perceived need.
Families are often under the impression that dentists only check teeth and so when there aren’t too many erupted teeth in the mouth, it is difficult to be convinced, why a dental check-up at 1yo is recommended.
The contemporary view embraced by health professionals is that dental health is part of general health, and poor dental health compromises general health and overall well-being. Many dental problems are preventable. An early dental visit, ensures that “the mouth is put back into health” and avoids preventable oral diseases from causing detrimental effects to learning, speaking, eating, growth and social development and quality of life.
For example, developmental enamel defects can affect baby teeth adversely. The affected areas may not be obvious to the untrained eye but render tooth enamel structurally weaker and at much greater risks of sugar and acid attacks, plaque build-up, sensitivity, pain and rapid breakdown. Early detection of developmental enamel defects allows early appropriate management, leading to best long term outcomes. Children with developmental enamel defects affecting their baby teeth are also more at risk of developmental enamel defects affecting their permanent teeth – putting in place a customized risk-based prevention plan early may save years of painful and costly dental experiences.
Early First Dental Visits – What Can We Do ?
Remember that the first dental check-up by the first birthday is recommended.
Visit our own dentist while pregnant to make sure our own oral health is good and to obtain information on how to best look after baby’s oral health right from the start.
Clean our little ones’ mouths daily from birth, check for any unusual changes in the mouth (including lifting the lip up and looking under the tongue) and if unsure, seek dental advice early.
Decide to take our children for their first dental visit (private vs. public, oral health therapist / dental therapist vs. general dentist vs. paediatric dentist) and contact the dental practice for information on how best to prepare our children and ourselves e.g. is a pre-visit available? any useful media resources?
Be positive about dental visits and oral health as a family. Teach the importance of good oral hygiene habits as life skills to our children from as young as possible. Obtain regular advice from our dental / oral health practitioner to ensure what we are doing for our children, is up to date and effective.
Share what we know with those around us, so all children can benefit. Advocate for children's oral health. Because, children's oral health is important.
AIHW. Chrisopoulos S, Harford JE. 2013. Oral health and dental care in Australia: key facts and figures 2012. Cat. No. DEN224. Canberra: Australian Institute of Health and Welfare.
AIHW. Chrisopoulos S, Harford JE & Ellershaw A. 2016. Oral health and dental care in Australia: key facts and figures 2015. Cat. no. DEN 229. Canberra: Australian Institute of Health and Welfare.
Do LG & Spencer AJ (Editors). 2016. Oral health of Australian children: the National Child Oral Health Study 2012–14. Adelaide: University of Adelaide Press.
National Advisory Council on Dental Health. 2012. Final report of National Advisory Council on Dental Health. Australian Government: Department of Health.