Let's Make This a Happy Visit

Let's Make This A Happy Visit

    

The first visit to the pediatric dentist should be easy and fun, both for the child and the parent.  It is really important to get a thorough medical history from the parent.  The medical and sometimes family history will enable the pediatric dentist to learn a great deal about the patient.  Besides written documentation, a meaningful conversation with the parent is really essential in understanding the patient.  Many intake forms are lacking the personal touch which a young child and parent need. Usually, behavior, diet, familial medical and dental history are better related through a conversation.  The family can express in their own words their expectations as well as offer information on the child's development.  I have found that parents, when given the opportunity to express their views, are happy to be brought into the examination and treatment process.  As the parents become more relaxed the child will often relax as well.

Your child's lifetime of preventive care starts now.  My earlier blogs discussed several topics which are important in understanding the need for routine dental visits.  We want to make "going to the dentist" a routine and  pleasant experience for everyone, even fun.  I recently took a continuing education lecture given by The American Academy of Pediatric Dentistry.  One of the topics discussed was prevention with Pre-Natal counseling for the expectant mother. It's not too early to learn about preventing dental disease for your child. Also discussed  in the lecture was the concept of risk assessment for the young developing child.  That is why we must have a frank and informative conversation with parents.


So what is going to happen in those first early visits to the pediatric dentist?   The most important part of the initial exam is allowing the parent to part of the process.  Getting parents on board really helps the child feel comfortable.  It is the parent's understanding of their child's health needs and the nature of dental disease, especially early childhood caries, that will allow their child to accept and respect the dental exam as part of the prevention of disease.   These first examinations are often performed with the child sitting on the parents lap,  talking and explaining, with the least amount of instrumentation as possible.  I found that plastic mirrors work best.  They are not cold and also do not fog up quickly.  They also come in colors! But first let's just try to look at your child and into your child's mouth.   Gauze or cotton rolls are soft and can clean surface debris.  Besides checking teeth, we must also examine the soft tissues, gums, cheeks and tongue.  The visit for these young children will be non-invasive.  Nothing "bad" happened and they got a present, toy, toothbrush or both.  If the first visit is performed early enough,  performed on a regular basis, and the preventive care followed, cavities can be largely prevented.

Parents are the most important factor in preventive dental care.  They should be an active participant and advocate for their children, even prenatally.

On that first happy "visit to the dentist" a plan for preventive care and possibly modifying diet and behavior will be designed to best help your child.





Thank you all for your positive feedback and suggestions.  I received some great comments from other pediatric dentists describing how they go about making the first dental visit easy for their patients.

Restoring (repairing) primary (baby) teeth

Sometimes children get cavities.  All parents want to prevent teeth from becoming decayed, but some children still get cavities.  Over my years, in practice I have noticed a sharp drop in caries incidence. However, once a cavity starts, the decay process can spread rapidly in that child.  That is because cavities main culprit is germs and the germs can spread from tooth to tooth.  Please review my previous posts which describe the causes and the prevention of cavities.

The bacteria that cause cavities is microscopic and they are only visible with a high powered microscope.  The pediatric dentist has only a limited number of methods  available to detect decay.  The most obvious is a visual clinical examination.  The other most common method is through the use of radiographs (x-rays).  Many cavities are not clinically visible, they cannot be seen just by looking, and many cavities can not be seen on the radiographs, therefore both an exam and radiographs are necessary for a thorough evaluation.  There are several other electronic devices that can be used to check for cavities.  These devices are as yet not widely used.

Obvious decay in Primary Molars

The pediatric dentist will discuss with the child's parents the necessity for treating your child. The front primary teeth last until 5 or 6 years of age.  The back primary teeth usually last till 11 or 12 or even longer.  The permanent molars (6 year molars) erupt behind the baby teeth at around age 6.  They form behind the last baby molars, no teeth fall out for them to erupt.  

Sometimes no treatment may be indicated when teeth may be soon falling out.   Sometimes there are areas too small to repair and in the pediatric dentist's opinion may not decay further, and they are put on a "watch" basis.  When it becomes necessary to restore the primary teeth, you should discuss the treatment option with your pediatric dentist.  Most routine cavities are repaired using composite (white) fillings today.  The newer materials are strong, long lasting and easy to place.  Many fillings will be hard to detect from natural teeth, both children and parents like them.

However, cavities that have large areas of breakdown, even into the nerve, will require more extensive repair.  Some may require nerve treatments (pulpectomy or pulpotomy), and caps or crowns.  The pediatric dentist can explain the types of treatment to you.

It is important to repair decayed baby teeth.  The necessity for restoring primary teeth to normal form and function is an essential health component.  Decayed teeth, if left to continue to rot, will lead to pain, infection and loss of teeth.  A child in pain is something we want to prevent. A severe infection, in rare cases, can affect the entire body and hospitalization may be needed. Some teeth, if lost prematurely, will cause shifting and orthodontic problems in the future.  Also, in young children, the front teeth may require restoration to allow the young children to have a happy smile.  Esthetics are just as important for the developing child.

Preventive Dental Care

Preventing dental disease is an important area for a pediatric dentist and parents want to be is involved. Parents want to know how they can prevent cavities.

Cavities are caused by germs, specifically bacteria and therefore cavities are a form of dental disease. The germs are always present in the oral cavity and when they find a susceptible tooth with a favorable environment the decay process will begin.  Streptococcus mutans is the most notable bacteria causing cavities.

Keeping baby teeth healthy is important for chewing, speaking and appearance.  Baby teeth are at risk for decay as soon as they begin to erupt.  Decayed baby can be painful and lead to serious infections. Parents should play an active role in caring for their child's teeth and preventing decay.

Probably the most important first step in controlling decay, is to keep your child's mouth clean.  After feedings, use a gauze or washcloth to wipe away plaque and food that accumulate on the gum and erupting teeth.  As the teeth start to erupt, brushing gently can begin.  Use a child size brush and toothpaste to clean away plaque and debris.  Toothpaste helps foam away the plaque and bacteria on the teeth and gums.  Parents should supervise brushing and assist them as they get older and can hold a brush on their own.

Having a healthy smile and a happy child can only take a few moment each day.  

Remember that the germs that cause cavities like sugary and acidy foods. Avoid having your child get used to sugary acidy foods and drinks as snacks and as rewards.  Try to limit snacking between meals, and to use water when your child is thirsty in the bottle or cup.  Sugary acidy drinks in bottles and sippy cups can be a risk factor.  Encourage your child to use a cup by the first birthday.  Many parents are surprised to learn of the effects on teeth of sugary, sticky, acidy foods and drinks that they do not consider as "snack" food.  A healthy balanced diet is really important.

At your babies first visit to the pediatric dentist your oral health concerns and more information will be discussed.  Ask the your children's dentist about your concerns for your child.  An oral health plan for your child as well as tooth brush instruction based on your child development can be started.  The can be considered a "well baby visit" and a preventive visit too.

Our goal is a lifetime and healthy smiles.

Growth and Development (Will my Child Need Braces?)

The pediatric dentist is uniquely trained to recognize and treat early problems, and to evaluate the development and growth of children into adulthood.  Parents want to know what is going on in their child's appearance and to learn about future issues.  The teeth, facial bone structure, heredity, disease and the patient's habits all play a role in facial appearance.The second most common question, after cavities, parents ask is, "Will my child need braces?"  With this question parents commonly  ask, "When should we start braces?"

To understand the development of teeth in children we must always keep in mind that there is a lot of variability from child to child.  The age date given for eruption and growth is only an average estimate and can be as much as a year off, and is different from patient to patient.  I have seen patients that did not get their first tooth till 15 months, yet had perfect teeth into adulthood.

The primary (baby-milk) teeth normally start to erupt at around 6 months.  Usually the lower front teeth come in first followed by the upper front teeth.  There are normally 20 primary teeth that erupt, 10 upper and 10 lower teeth.  By age 3, for the average child,  all the primary teeth have should have erupted.

Also around the child's 3rd birthday some patterns may be apparent. such as crowding, over-bite, cross- bite, under bite, missing teeth or extra teeth.  Spacing between teeth is important at this age, called normal developmental spacing, as spacing in the baby teeth allows room for the permanent teeth to grow in. It is important to repair decay in the primary to prevent space loss.  Teeth lost prematurely may need space maintenance to prevent teeth from shifting. Parents should discuss these growth issues with the pediatric dentist.  Some habits at this early age are not treatable because of the child's age.  Most habits self correct themselves as the child grows.

By age six the front teeth start to fall out and the permanent teeth begin to grow in.  Also the "6" year molars begin to erupt behind the primary molars.  The back primary molars stay in till around 12. They guide the "6" year molars into position.  I have found that the age range for the front teeth growing in, starts at around four and a half years to ten.  This is quite a variation but is normal.  During this transitional period the child's growth pattern begins to become established enough so that in most cases a pediatric dentist can reasonably evaluate the future patterns.

A good age to evaluate the average child for orthodontic issues is  between 6 and 8 years of age. This is the age when parents first see the permanent teeth erupting and want to see what their child needs.

Many minor rotations and tilting may correct themselves as part of normal development.  Sometimes minor orthodontic appliances may be used to correct problems and allow growth to take its course.   Early appliance therapy may be recommended when there are esthetic issues that are readily apparent. Functional problems that cause the jaws to bite improperly such as cross-bites may also require early treatment.  In a large number of children it may be better to have more permanent teeth to erupt to  allow for proper esthetic facial development.  Parents should discuss their child's dental, facial and esthetic development with the pediatric dentist.