24 Sep Age One Visit Introduction
The Need for the Age One Dental Visit
It’s a disease that is entirely preventable, and yet more than 40 percent of our children will suffer from it before they reach kindergarten.1,2
It is the most common chronic disease of childhood.3 It is more common than asthma, obesity and diabetes.
It is early childhood caries (ECC).
According to the American Academy of Pediatric Dentistry, ECC is an infectious, multifactorial disease process initiated by bacteria (primarily Streptococcus mutans) that can begin as early as the teeth begin to emerge (around 6 months or so). It often progresses rapidly, and can cause great pain to the child. It is five times more common than asthma, four times more common than early childhood obesity, and 20 times more common than diabetes. Left untreated, it can destroy the child’s teeth, and have a strong, lasting effect on a child’s overall general health. In addition to causing great pain and infection, ECC can lead to insufficient physical development and affect speech and communication, eating and dietary nutrition, sleeping, learning, playing and quality of life, even into adulthood. Many children with ECC require costly, restorative treatment in an operating room under general anesthesia.4
IDA member Dr. Caroline Derrow is a board certified pediatric dentist and fellow of the American College of Dentists who believes that ECC is the greatest dental health crisis facing our country. According to Dr. Derrow, ECC is preventable through anticipatory guidance for mothers and caregivers and the implementation of Age One Dental Visits.5
Both the American Dental Association (ADA) and American Academy of Pediatric Dentists (AAPD) have been long-time advocates of the Age One Dental Visit. Because baby teeth are vulnerable to tooth decay from their very first appearance, which occurs on average between the ages of 6 and 12 months,6 both organizations recommend parents take their children to see the dentist within six months of the first tooth erupting, or no later than the child’s first birthday.
Aside from diagnosing the child’s oral health, the early visit is an important opportunity for dental providers to underscore the importance of establishing good dental habits and dietary practices. Such habits and practices are established early in the child’s life, and they can have a significant impact on the child’s future oral health. For instance, high-risk dietary practices, especially consumption of sugary drinks (including many fruit juices) that are bad for teeth, appear to be established by the time the child is 1 year old, and they are often maintained throughout early childhood.7,6
Postponing an oral exam beyond the first year, even if it’s just until the child is two or three years old, can have negative impact on the child’s dental health. In fact, children do not have a dental exam until age 2 or 3 are more likely to require restorative and emergency visits, according to a scientific paper in the journal Pediatric Dentistry.8 Children having their first dental visit at 4 years of age or older had mean dmft scores (a way to measure the impact of caries by assessing the condition of the teeth) twice that of children younger than age 4 who were screened.9 The longer the wait before diagnosis and treatment once ECC takes root in the child’s mouth, the more extensive and costly the required care will be.10,11 For instance, lack of dental care among infants is a main reason for early emergency visits related to teeth problems.12
“The influence of maternal oral pathogens during the period of infant flora development (window of infectivity) is well established. A dental home and the age one visit are time-critical opportunities to provide anticipatory guidance regarding the bacterial aciduric shifts that occur from poor nutrition practices in the mother and child, establish preventive health practices and thereby reduce a child’s risk of preventable dental/oral disease—especially when delivered in the context of an ongoing, previously established relationship,” according to Dr. Derrow. “It is so much harder when a child presents already infected at five years old with ECC and all the preventive information about bottle and nursing caries and consumption of sugary beverages and snacks and caries transmission is too little too late.”5
In their report The State of Little Teeth, the AAPD states “One of the key reasons a preventable disease, like caries, is becoming an increasingly significant threat to the health, welfare and future of the youngest members of our society is that children are not seeing the dentist early enough.”6
“That’s a mindset we’ve got to change,” says IDA member Dr. Chuck Poland, retired pediatric dentist and staunch advocate of the Age One Dental Visit. “There are steps parents and dentists can take to get newborn children started down the road to good dental health.”13
While the ADA and AAPD have long standing policies encouraging the Age One Dental Visit, Dr. Poland explains, “Many general dentists and some pediatric dentists have been slow about putting the policies into practice. They are either uncomfortable seeing very young children, or they simply don’t understand why those early visits are important.”13
“There will never be enough pediatric dentists to provide care to all infants and preschool children. That’s why we have to have the help of the state’s general dentists,” says Dr. Poland. “In order to make an impact in early caries, general dentists need to incorporate infants and young children into their regular family practices.”13
According to the American Dental Association, there are approximately 114 practicing pediatric dentists in the state of Indiana. “We pediatric dentists need your help!” says Dr. Derrow. “We cannot see all the children. Effective control of the caries epidemic will only occur with the involvement and participation of all family dentists, pediatric dentists and pediatric medical providers.”5
“A lot of general dentists, myself included, have to change our attitude toward early childhood dental visits,” says Dr. Mark Stetzel, a general dentist and past president of the Indiana State Board of Dentistry. “We now know more about the dental disease process. It starts at a very early age unless relatively simple preventive steps are taken by the parent and the dentist.”5
Dr. Stetzel believes the Age One Dental Visit is a relatively simple process for general dentists to follow. He explains, “It’s basically a well baby visit. The stage is set for the risk assessment, a review of home care procedures, and developmental guidance, followed by a brief oral exam and fluoride varnish when indicated. The knee-to-knee examination involves the parent in the treatment process, allows for an easy relatively stress free exam for baby, parent and dentist.”13
According to Dr. Stetzel:
[su_quote]The Age One visit is a no brainer. This has been the easiest and best practice building technique that we have added to our practice ever. I see general dentists adding ortho, implant placement, botox, and all kinds of complex procedures to grow their practices, yet they refuse to talk with a new mother about the oral health her child? Simply follow the brief conversation with a knee to knee exam by looking around an open, often crying infant’s mouth, and probably applying some fluoride varnish. That’s it; this simple process is outlined in detail. The result is an engaged, loyal caregiver who also understands that it is important for mom to have good oral health in order to help her child to develop a healthy oral flora. In practice, when identified the expectant mother is educated about her responsibilities to her yet unborn child. This should routinely occur in the family practice setting. Moms are much more willing to invest in their own oral health when they realize it will also benefit their child. If you are unable to comfortably perform an age one exam and the administration of fluoride varnish you must refer to a dentist who is comfortable. Furthermore, if you are uncomfortable performing these services, as a general dentist, you are tremendously limiting the scope of your care and you should no longer consider yourself a family dentist. Age one visit, with anticipatory guidance and risk assessment should be the corner stone of your new patient introduction to your office. If you are not offering this service, don’t complain about slow practice growth, or less than loyal patients.5[/su_quote]