A lot happens at the age-1 dental visit — and much of it involves no tools in the mouth.
Because baby teeth are at risk of decay as soon as they emerge, the infancy dental visit is a critical opportunity for dentists to identify disease early and manage caries using conservative, nonsurgical techniques, such as silver diamine fluoride and fluoride varnish. Early caries management reduces both the likelihood that infants with caries in their primary teeth will develop caries in their permanent teeth and the likelihood that untreated dental disease will eventually require surgical intervention.
Dental caries remains the most common chronic disease of childhood according to the Centers for Disease Control and Prevention, and the evidence to support the need for early intervention and education is strong.
Whether any treatment is needed, the age-1 dental visit is an equally critical and first opportunity for dentists to educate and inform the parent or caregiver about children’s oral health. This includes providing guidance on preventing dental injury and establishing and maintaining good oral health habits.
Dentists who lack experience or are new to seeing infant patients have support from CDA. The online C.E. program “TYKE: Treating Young Kids Everyday” is designed specifically to increase dentists’ confidence to see babies and young children and is free for CDA members.
Dentists who still prefer not to see children for the age-1 dental visit should always refer the parent or caregiver to a pediatric or other dentist who sees young children.
After the first oral health visit by age 1, regular visits should continue for the young patient to establish a “dental home” for the patient. In fact, California law requires that every public school child in the state receive an oral health assessment by a dentist or dental professional by their first year of school.
Odds of having caries significantly increases each year care is delayed
Evidence increasingly suggests that to successfully prevent dental disease, the preventive interventions must begin within the first years of a child’s life. With every year that dental visits are delayed after age 1, for example, dental disease is more likely to require surgical intervention rather than being prevented or arrested.
“If appropriate measures are applied sufficiently early — in infancy — it may be possible to raise a cavity-free child,” the authors write in “The Importance of the Age One Dental Visit,” published in 2019 by the American Academy of Pediatric Dentistry’s Pediatric Oral Health Research and Policy Center.
The authors cite a 2018 multicenter study of over 2,000 children, which found that children who have a first dental visit at age 5 have “nearly 20 times the odds of having caries at their first dental visit compared to a child whose first dental visit was at age one.”
Huong Le, DDS, MA, chief dental officer of Asian Health Services in Oakland, says pediatricians at the health center are encouraged to apply fluoride varnish on their infants’ teeth and refer the patients to a dentist at the center no later than their first birthday.
“This policy is written in our clinical protocol and business plan so that all of us are reminded to make referrals as recommended,” Dr. Le says. “Our slogan is ‘All babies should receive their first dental exam by the age of 1, because two is too late!’”
Opportunity to conduct a caries risk assessment, build trust, prevent surgery
Children’s primary teeth typically start coming in between ages 6-12 months, but teething can begin sooner and continue past the first year. Many caregivers may be surprised to learn that baby teeth are susceptible to decay as soon as they appear. Here is where the dentists’ role in explaining the connection between oral health and overall health is vital and offering techniques for proper self-care is essential.
The dentist has an opportunity to not only communicate with caregivers about infants’ oral health needs but to demonstrate techniques for effective gum-cleaning and teeth brushing, for example.
By seeing patients at age 1, dentists can:
- Counsel caregivers in infant oral hygiene, healthful dietary practices and fluoride therapies for application at home and in the dental office.
- Introduce children and their families to prevention to head off the development of dental problems.
- Conduct a caries risk assessment.
- Apply, if needed, conservative therapies as needed to delay or prevent the need for surgical intervention.
- Reduce, through early intervention, a caregiver’s costs and patient’s discomfort related to restorative care and emergency treatment secondary to infection.
- Establish a dental home early in the child’s life to build foundational trust in the patient-provider-caregiver relationship and increase utilization of care.
As noted above, early-age dental visits can save families significant expense because untreated dental disease necessitates more extensive and costly restorative or emergency-room treatment as the disease increases in severity.
A study published in the journal Pediatrics found that children who had their first preventive dental visit by age 1 were more likely to have subsequent preventive visits but were not more likely to have subsequent restorative or emergency visits. And a study published in 2019 in the Journal of the American Dental Association found that use of emergency department services was increasing nationally, with an “estimated 2.4 million dentally related ED visits occurring in 2014 at an average cost of $971 per visit for children younger than age 18.”
C.E. course increases dentists’ confidence to see babies and young children
Dental offices should be prepared to respond appropriately to parents and caregivers who call to schedule an examination for their infant. Dentists who are educating their pregnant patients about good pediatric oral health habits have already counseled the patient about the importance of baby’s first dental exam and can anticipate scheduling these appointments.
Dentists who would like to build their confidence in seeing babies and young children can do so through a CDA-developed program that more than 9,200 dentists to date have completed.
The course, “TYKE: Treating Young Kids Everyday,” provides education and training to support dental teams in using caries risk assessment, disease prevention and early interventions to reduce tooth decay among children ages birth to 6 years.
Dentists who complete the course will earn 2 units of continuing education and learn how to:
- Recognize how early childhood caries affects children’s oral health.
- Perform caries risk assessments to individualize interventions and recall.
- Implement the 6-Step Infant Oral Care Visit process in their practice.
- Promote early prevention and intervention techniques.
- Implement motivational interviewing and goal setting.
- Promote healthy daily family behaviors.
- Complete appropriate documentation and effective follow-up.
The course is free for CDA members and dentists enrolled as Medi-Cal providers.
Here are some resources dentists can start using immediately:
Dentists’ role in the Kindergarten Oral Health Care Requirement
Many children, especially those in California’s more vulnerable populations, will not have an age-1 dental visit, and many won’t be seen prior to starting school. The need to establish a dental home for these children is vital, as is the dentist’s continuing role in early prevention.
In California, children entering public school are instructed to have their oral health assessed by a dental professional by May 31 of their first school year — either kindergarten or first grade — as part of the state’s Kindergarten Oral Health Care Requirement that took effect in 2007.
The California Society of Pediatric Dentistry explains more about the law’s requirements, including how dentists should respond to caregivers’ requests for the assessment, and a CDA article published in February discusses the recently streamlined oral health assessment form.
As trusted health care providers, dentists are on the frontline for preventing or arresting dental disease early and inspiring patients and caregivers to begin a lifelong commitment to oral health care. For the child’s best oral health outcomes, the dentist’s education, evaluation and any necessary conservative treatment should begin soon after baby’s teeth have emerged — at or shortly before age 1.