At what age should a child first see the dentist?
The American Academy of Pediatric Dentistry (AAPD) recommends that a child establish a dental home within six months of his or her first tooth coming in or by the first birthday, whichever comes first. If you’re a parent, fellow dentist, pediatrician, or any other primary care provider and this sounds too young, this document goes into greater detail regarding the basis for the recommendation.
In my seven years in private practice thus far, I’ve diagnosed cavities in children as young as eight months old. I have also diagnosed cavities in hundreds of children between the ages of one and three years. There is no harm in introducing dentistry at an early age, and for many children, delaying initiation of dental care until age three or later can result in the child suffering, parental stress, more expensive and potentially more invasive dental treatment needs, and risk to the child’s overall health. Often, if cavities are identified early (i.e., white spot stage, see Photo 1 below), the contributing factors can be addressed and the disease process halted.
Why should the child visit the dentist at such a young age?
Tooth decay is a disease caused by bacteria. Those bacteria can be transmitted from caregiver to child even before the teeth erupt into the mouth. Once the teeth are present, which on average is six months of age, cavities can begin to form on them. Cavities start as faint white lines or spots, often along the gumline (see Photo 1 above). Depending on diet and hygiene practices, those spots can progress to yellow-brown, broken-down cavities in a matter of months (see Photo 2 below). On average, the primary incisors begin to erupt around six months of age, so a visit to the dentist by age one year will catch most children at high risk for cavity formation before any cavities have progressed to the point of needing significant intervention.
The benefits of an early first visit to the dentist include:
- The dentist can assess for any underlying familial or individual health conditions that might increase the child’s risk for cavities, including the use of certain medications
- It provides an opportunity to educate the caregiver regarding age-appropriate diet and oral hygiene practices before they’re firmly established
- It offers an in-person live demonstration of age-appropriate toothbrushing techniques
- it creates space for caregivers to ask questions related to their child’s oral healthcare
- It begins to familiarize the child with the experiences unique to a dental visit.
- If early signs of cavity formation are present, the causal factors are discussed and addressed early and in a non-invasive manner (e.g. improved diet and hygiene practices, more frequent recall exams, and topical fluoride application)
What will happen during my child’s appointment?
Young children remain with their caregivers throughout the appointment. Much like an adult dental visit, the dentist reviews the medical questionnaire and asks the caregiver pertinent questions related to the child’s oral health. Next, an assistant or hygienist completes a cleaning (often with a simple toothbrush in order to demonstrate proper brushing technique for the caregiver). The dentist then performs an exam and finishes the visit by applying a topical fluoride treatment. X-rays are not taken until all of the baby teeth have erupted and the child can tolerate them, which is typically age four to five years. Ample time is spent at that first visit answering the caregivers’ questions related to their child’s oral health, providing nutrition counseling, and demonstrating proper oral hygiene techniques. The child is then seen for recare examinations and cleanings based on his or her cavity risk, with the most common interval being every six months.
My child is older than one year and hasn’t been to the dentist yet. What should I do?
You’re reading a blog about pediatric dentistry, so that’s a great start! I love this Chinese proverb: “The best time to plant a tree was twenty years ago. The second best time is now.” Soak that in. We’re all just doing our best with the tools and knowledge that we possess at the present time. You’re here now and you’ve gained some knowledge related to your child’s oral healthcare, so let’s do something with it! Click here to find your little one a pediatric dentist in your community.
If you’re reading this and you’re a pediatrician or family medicine physician who’s been telling parents to wait until the child is three years old to be seen by a dentist, it’s okay! I’m so glad you’re here. This is a safe place to ask questions and learn, so please ask away in the comments if there’s anything else related to pediatric oral health that I can help you further understand. Now please spread the word to your friends and colleagues that the recommended age for the first dental visit is no later than one year old.
