Provincial and national professional dental hygiene and dental associations recommend that children receive their first dental visit by or shortly after the eruption of the child’s first tooth or by the child’s first birthday, whichever comes first.
As oral health care workers (OHCWs,) are we consistently making this recommendation to our clients, the parents of these infants and toddlers? How do we address the surprising concerns about this being “too early?” And of course, how can OHCWs in a general practice setting effectively welcome these new, little clients into our practices in an effective, nonthreatening, and successful manner?
The foundation of this recommendation lies in the concept of primary disease prevention: preventing disease before it starts. By seeing a child so young, we are able to examine the oral cavity for any signs of disease, trauma, abuse, or neglect. Parental education about oral self care, dietary considerations, strategies to reduce early childhood caries, and accident/injury prevention can also be emphasized.
Parents of small children can be reassured about an early first visit to an OHCW through education about the importance of early examination of the child’s oral cavity and newly erupting primary dentition. Insight into what will occur at the first visit will help to reassure the parents, by reducing the fear of the unknown. A discussion with the parent about the importance of the primary teeth with regards to oral development, diet, speech maturation, aesthetics, and self-esteem can further assist to create value for that early, first dental or dental hygiene visit.
‘Conditioning’ of the young child prior to the first dental visit can greatly assist with it’s success. Conditioning involves suitable preparation to make the visit easier and the client more manageable. For example, parents may be instructed to only discuss the dental office in a positive light such as “it’s going to be fun” or “the dental hygienist is our friend.” Unfortunately, children struggle to understand the concept of a double-negative and saying to the child “there’s nothing to be scared of” may have the opposite effect and might encourage the child to be scared. Parents can also practice with the young children what might happen in the dental office, by having the child lie of the sofa, open their mouth, turn their head to the left and right, perhaps with the parent shining a small flashlight into the child’s mouth.
Upon arrival of the child in the dental office, the use of positive terminology only is to be continued by both the parent and the OHCW. Smiling will help to diffuse fear and promote relaxation for all individuals, including the parent. Children tend to follow the parent’s lead, so a relaxed parent is likely to result in a relaxed child; an anxious, frightful parent is likely to result in an anxious, frightful child.
A medical and dental history review of small children is likely to be brief, but is still an important aspect of assessment. Insight gathered regarding medication use, illness/infection history, previous head and neck injury, and overall parental attitude towards oral health will help to guide the rest of the process of care.
A few options exist for examining the small child’s oral cavity. First, the child may lie on the parent’s abdomen while the parent lies in the dental chair; the parent may then securely and comfortably wrap their arms around the child. Another option is for the parent and OHCW to sit knee-to-knee while the child lies on their thighs, with the parent’s arms crossed firmly over the child and the child’s head towards the OHCW for examination.
Of course, not all first dental visits, especially of infants and toddlers, are completed smoothly or according to our hope and intention. Sometimes the first dental visit might simply be a ride in the dental chair and a discussion with the parents regarding their child’s oral health; this could be considered a success over that of no dental visit at all. By scheduling another appointment in six months, there will likely be a gradual increase in both comfort and compliance. An early dental visit can also provide insight into whether a child might require a referral to a qualified specialist.
Oral health care of infants and toddlers may seem daunting and certainly presents with a unique set of challenges. Our greatest success lies with our patience, compassion, and early intervention as we open our practices and hearts to these small but special clients.
References
Darby, Michelle Leonardi, and Margaret M. Walsh. Dental Hygiene Theory and Practice Third Edition. St. Louis, MO: Saunders Elsevier, 2010.
Newborns and Infants. 2010. Ontario Dental Association. 6 Sept. 2010. <http://www.oda.on.ca/newborns-a-infants.html#baby>
Oral Health for Children – A Parent’s Guide. 2009. Ontario Dental Hygienists’ Association. 6 Sept. 2010. <https://www.odha.on.ca/PDFs/5childrenWeb.pdf>
Oral Health Matters for You and Your Baby. Smile City.ca brought to you by CDHA. 6 Sept. 2010. <http://www.smilecity.ca/parents_resources.asp>
Wilkins, Esther M., Clinical Practice of the Dental Hygienist 10th Edition. Baltimore, MD: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2009.
Your Child’s First Visit. 10 Apr. 2005. Canadian Dental Association. 6 Sept. 2010. <http://www.cda-adc.ca/en/oral_health/cfyt/dental_care_children/first_visit.asp>
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