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Importance of The Dental Home

I work in a family dental practice that will see children only beginning at age 5. I know the American Academy of Pediatric Dentistry (AAPD) recommends children visit their dental provider by their first birthday. How should I approach my dentist about making this change?

I work in a family dental practice that will see children only beginning at age 5. I know the American Academy of Pediatric Dentistry (AAPD) recommends children visit their dental provider by their first birthday. How should I approach my dentist about making this change?

Many general dentists do not feel comfortable seeing very young children. They are concerned that the child will exhibit noisy and disruptive behavior (although the behavior may be age appropriate for the child in an unfamiliar environment) and cause distress to other patients in the office and to the dental team. If your dental team members are afraid of a little noise and a few tears, this can be an issue that would need to be addressed. But, I would like to make the case that the ends are worth the effort! Indeed, seeing young children fulfills family dentists’ ethical obligation to their patients. And, as an added benefit, the policy change may attract new patients to the practice from either the family or from friends of the family.

The American Academy of Pediatrics, American Dental Association and AAPD all recommend that a child establish a dental home by 12 months of age. An infant oral exam can easily be done knee-to-knee with the dentist/dental hygienist and a parent/caregiver with the child’s head in the oral health professional’s lap. If the child cries a bit, it just makes it easier to obtain an intraoral view!

Hopefully, no oral disease is detected during the first dental visit; whatever the outcome, the appointment offers a great preventive educational opportunity to parents/caregivers to help them ensure the child remains dentally healthy. Unfortunately, 42% of children younger than age 5 from low-income families have dental caries.1 If dental disease is detected, it can be addressed while the child is still small. If the general dentist is not comfortable or experienced in management of very young children, the child and family should be referred to a pediatric dentist for comprehensive care. But, the general dentist can provide a great service to the child and family by serving as the initial screener and educator. By raising oral health awareness, the prevention, early detection, and management of dental, oral, and craniofacial tissues can become integrated into general healthcare, community-based programs, and social services. The goal of oral health counseling is to improve oral health behaviors. 

The initial oral exam for the young child and parent/caregiver should include:1

  • Review of the child’s medical and dental history, thorough oral examination, demonstration of age-appropriate tooth and gum cleaning, and application of fluoride varnish if indicated.
  • Assessment of the infant’s risk of developing caries and anticipatory guidance regarding the effects of diet on the dentition.
  • Injury-prevention counseling to prevent orofacial trauma.
  • Counseling regarding teething.
  • If appropriate, discussion of atypical frenum attachments that may be associated with breastfeeding problems.
  • Education on non-nutritive oral habits (eg, digit or pacifier sucking) and potential impact on the developing dentition.

REFERENCE

  1. The Reference Manual of Pediatric Dentistry. Chicago: American Academy of Pediatric Dentistry; 2020:39-42;43-44;252-256.
The Ask the Expert column features answers to your most pressing clinical questions provided by Dimensions of Dental Hygiene’s online panel of key opinion leaders, including: Jacqueline J. Freudenthal, RDH, MHE, on anesthesia; Nancy K. Mann, RDH, MSEd, on cultural competency; Claudia Turcotte, CDA, RDH, MSDH, MSOSH, on ergonomics; Van B. Haywood, DMD, and Erin S. Boyleston, RDH, MS, on esthetic dentistry; Michele Carr, RDH, MA, on ethics and risk management; Erin Relich, RDH, BSDH, MSA ,on fluoride use; Kandis V. Garland, RDH, MS, on infection control; Mary Kaye Scaramucci, RDH, MS, on instrument sharpen­ing; Kathleen O. Hodges, RDH, MS, on instrumentation; Karen Davis, RDH, BSDH, on insurance coding; Cynthia Stegeman, EdD, RDH, RD, LD, CDE, on nutrition; Olga A.C. Ibsen, RDH, MS, on oral pathology; Martha McComas, RDH, MS, on patient education; Michael W. Roberts, DDS, MScD, on pediatric dentistry; Timothy J. Hempton, DDS, on periodontal therapy; Ann Eshenaur Spolarich, RDH, PhD, on pharmacology; and Caren M. Barnes, RDH, MS, on polishing.Log on to dimensionsofdentalhygiene.com/​​asktheexpert to submit your question.

From Dimensions of Dental Hygiene. February 2021;19(2):46.

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