Dental Visits for the Diaper Set
Lauren Kilpatrick’s dentist had assured her that children didn’t need a dental checkup until they were about 5 years old.
But after learning of a pediatric dentist in the area last year, Kilpatrick decided to take her children in anyway.
She is glad she did.
Her son Devon, just 3 then, had already developed a cavity that the dentist said could have affected his gums and permanent teeth had it not been discovered.
“It was pretty traumatic,” said Kilpatrick, of Cromwell, Conn. “I kind of felt like it was my fault.”
She was so upset, she changed dentists.
“I just really think telling a parent not to bring their child in until 5 or 6 is a really old-school way of thinking,” she said.
The American Academy of Pediatric Dentistry agrees.
The Chicago organization has been spreading its “first visit by first birthday” message far and wide for several years.
Nevertheless, it has been slow to reach everyone, and the change is still being debated by some dentists and physicians.
“A lot of dentists don’t really know about the changes in pediatric dentistry,” said Dr. Bert Pelletier, a pediatric dentist who practices in Putnam, Conn., and sees about 30 infants a month. “That’s why it’s difficult for general dentists to want to see children at that age or even refer them to us.”
Dentists said it is important to bring children in early to prevent tooth decay and gum disease. Recent studies show that nearly half of 2- and 3-year-olds have at least mild inflammation of gum tissues.
The biggest misconception, dentists said, is that primary teeth are less important than permanent ones.
“Actually, even before they are visible, primary teeth are developing under an infant’s gums,” said Dr. Monica Cipes, a West Hartford, Conn., pediatric dentist. “They begin to appear at 6 months, and even though they eventually fall out, taking care of primary teeth is important because they can determine the future of a child’s oral health.”
Primary teeth reserve space in the jaw for permanent teeth to come in. Permanent teeth usually begin to appear at 6 to 8 years, with most teeth in place by age 13. Wisdom teeth usually don’t erupt until the late teens.
A first dental visit by age 1 is a difficult concept for many parents.
Although early visits are catching on with some parents, not all dentists or doctors agree with the recommendation adopted by the pediatric dental academy in 1995.
The American Academy of Pediatrics suggests taking children in for a first dental visit at age 3, or when all 20 baby teeth are present.
“I just think 3 is a more receptive age for that situation,” said Dr. Felicia Wilion, a pediatrician with the Children’s Medical Group in Bloomfield and Rocky Hill, Conn. “At 1 and 2, the child is still pretty fearful of situations unfamiliar to them.”
And, Wilion said, pediatricians talk to parents about prevention and oral health care as well.
“So, I’m not sure how much different [the pediatric dentist’s] role is from ours,” she said.
Still, many pediatric dentists hope the “first visit by first birthday” movement catches on.
“The move really comes from dentists seeing an increasing amount of 2- and 3-year-olds with gum problems and tooth decay that could have been prevented had a dentist seen the child,” Cipes said. “If we can reach a child early, we can prevent much of what happens.”
Dentists call the visits, which can cost up to $50, more educational than clinical. Many dental insurance policies cover these visits.
But how do dentists get a baby to open wide?
“A lot of times,” Cipes said, “I just try to get the child to smile so that I could see into their mouth.”
“A lot of dentists think that if the child cries that the visit is a complete failure,” Pelletier said. “They almost expect them to act like little adults, but pediatric dentists know that kids will be kids, and we do whatever it takes to get them to feel comfortable. . . . The real goal here isn’t so much an intensive checkup as much as one of discovery and education.”
Before children get their first teeth, pediatric dentists say, a baby’s mouth and gums should be cleaned with a soft and damp washcloth. This, dentists say, will remove excess food and bacteria and will acquaint the child with daily oral hygiene. When the teeth erupt, dentists suggest cleaning the child’s teeth at least twice a day with a soft-bristled brush and a pea-size amount of toothpaste.
Fluoride is also important. It makes teeth enamel resistant to cavities. Children older than 6 months need a fluoride supplement if their drinking water does not contain the ideal amount of fluoride. They can take fluoride drops or in combination with prescription vitamins.
Over the years, however, the biggest concern among dentists who treat children has been “baby bottle tooth decay.”
Pediatric dentists now say that a combination of factors, not just putting a baby to bed with a bottle of milk or juice, actually contribute to early tooth decay.
Labeling the bottle as the primary culprit is an oversimplification, many say. Bacteria, malnutrition and iron deficiency can also contribute to tooth decay.
A recent study showed that 80% of American children are still occasionally put to bed with a bottle, but only 10% suffer from early tooth decay. That discovery prompted a recommendation at the American Dental Assn.’s recent annual session to reexamine the baby bottle issue.
Many dentists now say frequent eating causes more tooth decay than the type of food consumed.
For example, Cipes said, “a baby who snacks, has a bottle in their mouth or who nurses continuously will likely be more prone to tooth decay than a baby who doesn’t snack between meals.”
But some dentists are unwilling to let the bottle off the hook.
“Yes, not every kid who sleeps with a bottle has decay,” said Dr. Glenn Koehler, a pediatric dentist in Manchester, Conn. “But in my experience, if you get rid of the bottle then you get rid of a lot of tooth decay.”
Things can get a little confusing, which is why dentists say they want to see children and parents earlier. “Parents need to come in and find out what’s right for them and their children,” Cipes said.
