The current recommendation is for children to have their first dental appointment when their first teeth erupt and before 12mths of age. Given that first teeth generally erupt around 7mths of age, many more infants and toddlers are expected to experience their first dental visits very young. This is great news! Best oral care begins at age zero – earlier dental visits allow for establishment of a dental home, risk assessment, anticipatory guidance, early prevention and dental confidence building, all important for lifelong oral health (which contributes to better general health).
This mean, what happens in the first dental appointment may not be what you expect. Traditionally, dentists have tried to provide dental check-ups for children in a similar way as they do adults…no wonder so many children developed dental anxiety! Now with greater understanding of child development and behaviour, dental check-ups for young children will not be the same as dental check-ups for older children or adults, and first dental visits for infants and toddlers will not be the same as for young children.
So, what to expect?
For infants and toddlers, i.e. the under 3yo, the first dental appointment is more an opportunity for the parents / carers to ask questions and find out how to look after the oral health of the children. Extensive examination and dental cleaning cannot be expected.
Generally, for infants and toddlers, the actual dental examination will last a few minutes at the most. Parents are generally asked to sit with or hold their infants and toddlers for the first dental examination. The dentist or oral health practitioner may repeatedly examine your child in 10 seconds “windows of opportunities”, looking at different areas of the mouth each time. Many children will display their dismay by crying or struggling. When the dental examination is performed by an experienced practitioner, It is very unlikely to cause pain, unless there are conditions already present in the mouth e.g. ulcers, sore gums. When your child is being examined, It is helpful to sooth your child by singing or quiet talking, gently holding onto your child’s hands, and/or supporting their neck and head.
For children older than 3yo, dental examination will last longer. It may resemble the dental check-up that you are used to as an adult a little more, but the processes will be simplified. The goal of the first dental visit for young children, is to provide a positive dental experience. How much a child can cope varies greatly. Some will love new experiences and want to do more. Others will not cope with more than a sit in the dental chair and a quick look.
How to prepare for that first dental visit?
For infants and toddlers, try to book the first dental visit at a time when they are generally happy, such as after a sleep. Try to avoid an appointment immediately before or after a feed. In the waiting room, check that baby’s nappy is not soiled. Bring a change of nappy and clothes, and your soother e.g. pacifier, blanket if they use one, to the dental visit.
For children 3yo and older, preparing them for their dental visit by reading or watching positive stories about dental experiences of other children, pretend play a visit at the dentist at home, or visiting the dental clinic when a sibling or parent is having their check-up, can assist in familiarizing children and minimizing worries. A little bit of preparation is helpful but beware of overemphasizing the dental visit or going through too much details, as sometimes that can result in anticipatory anxiety. Avoid making emotive suggestions such as, “You have to be brave at the dentist”, “You are a big boy, you can’t be scared.”, which are unhelpful as these pre-empt something difficult or scary. Also, children’s mood and willingness to engage can change abruptly, so helping them warmed up quickly is important. To help the dental team establish rapport with your child quickly, It is also useful to let the dental team know a little about your child before their first dental appointment, both likes and dislikes. For example, “My son prefers to be called Ollie. Likes: PJ Mask, cars and trucks. Dislikes: toothbrush, people touching his hair.”
So, what NOT to expect?
In short, try not to have too high an expectation of your child. Expect the unexpected. Sometimes, no matter how well you prepare for the first dental visit, things may still turn out different to your expectations
Keep the following in mind…
The child’s age – the younger the child, the less is done at any one appointment. The dental practitioner may suggest several short appointments, focussing on one or two goals per appointment, over a longer appointment that addresses multiple goals.
The child’s anxiety / ability to cope – every child is unique in the way they experience and react to new situations. Young children who are wary of strangers or more risk aware may take longer to feel comfortable at a dental appointment. Some children may be able to cope with a lot of instruction but not another. Some children may cooperate with sitting in the dental chair but refuse to wear protective glasses. Others may be fine with everything but dislike the sensation or taste of gloves in their mouths. The first dental visit is very much an opportunity to explore your child’s likes, dislikes and coping abilities in the dental setting. For children who are significantly anxious or fearful, desensitization may be recommended to facilitate dental examination and/or other procedures.
Acceptance of mirror and light during dental examination – this is a positive indicator. If your child is comfortable with having a dental mirror in the mouth and a bright dental light overhead, more equipment / instruments may be introduced at the first dental visit. For example, intraoral cameras may be used to take photos, engage the child and facilitate education and discussion. If your child refuse to wear protective glasses or cannot tolerate light or mirror, then for their safety, other instruments such as dental probe, periodontal probe, scalers, suction, triplex water and air, are generally not used, until they are able to cope with mirror, light and glasses.
Dental cleaning – this is not always needed. If the teeth are good and healthy and there are no stains, no calculus, no heavy plaque, dental cleaning (or a “prophy”) may not benefit your child. Dental cleaning for children may also use different instruments. For example, an ultrasonic scaler or a rotary handpiece for cleaning teeth may or may not be used. In addition, whether a dental cleaning is recommended at the first visit, will also depend on how well your child cooperates during the visit and the length of the first dental appointing booking. Often times, practitioners prefer to provide dental cleaning at another visit to allow more time to engage with your child and/or provide oral health education.
Fluoride treatment – concentrated topical fluoride is an important preventive strategy, but it is not critical and therefore may or may not be recommended to your child at the first dental visit. If your child is relaxed and engaged, the dental practitioner may recommend an application towards the end of the first dental appointment. However, if your child is overwhelmed or unable to cope with having fingers or instruments in their mouth, fluoride treatment may not be suggested until a later appointment.
Intraoral dental x-rays – usually this is not done in young children at the first dental appointment, unless dental injuries or pathologies are of concern. Having intraoral dental x-rays taken, is not an easy task even for adults. The film or sensor that sits inside the mouth does feel strange. For some children, their gag reflex may be triggered, making them feel uncomfortable. Several appointments may be needed for young children to relax in the dental setting and develop confidence and trust. Attempting x-rays too soon, before children are comfortable with the dental team and environment, may contribute to future dental anxiety.
So, there is no right or wrong in terms of what happens in a first dental appointment. Doing less in the first dental appointment and having more frequent dental visits during the early years are actually positive strategies for minimizing anxiety and establishing trust and confidence in young children.
In addition, optimize your child’s first dental visit by seeing a dental team experienced in caring for infants and young children. It’s definitely worth finding someone you trust, to provide positive dental experiences in the critical early years of your child’s growth and development.
For more information on your child’s first dental visit, go to:
American Academy of Pediatric Dentistry: http://mouthmonsters.mychildrensteeth.org
American Dental Association:
Australian Dental Association: