August 28, 2000
Volume XXXIII, No. 32



HSC Profile



Pediatric dentists look for the beginnings of tooth trouble


Rachel Pichardo was fine in her mother’s arms—right up until the time the dentist began to examine her. The 18-month-old then began to cry. But it wasn’t from pain.

Her mother had brought her to the Health Science Center’s pediatric dental clinic for her first checkup. However, she should have been examined long ago, when she was a newborn.

"While we don’t actually see the baby prior to birth, we do like to talk to the parents, give them anticipatory guidance or practical information about the baby’s oral health, in anticipation of significant physical, emotional and psychological milestones," said Dr. Huw Thomas, professor and chair in the Department of Pediatric Dentistry. "If we’re to succeed at preventing dental disease, we must initiate oral health care at a very early age so we can provide optimal opportunity for children to be free from oral disease."

In the past, health professionals traditionally recommended children have their first dental visit by age 3.

"Clearly, for some children this is too late," said Dr. Thomas, who holds fellowships in the American Academy of Pediatric Dentistry (AAPD), the American College of Dentists and the International College of Dentists. "The philosophy used to be: ‘You don’t go see the dentist until there’s something wrong.’ Not anymore."

The current approach, first expressed by the AAPD as part of its Infant Oral Health Care Policy, recommends the first visit occur by the child’s first birthday. The AADP’s policy, said Dr. Thomas, advises that a postnatal initial oral evaluation should occur within six months of the eruption of the first primary tooth and no later than 12 months of age. The most important purpose for early infant visits is to begin a practical prevention program because dental problems may begin early.

Experts note tooth troubles begin with the bottle.

"A baby runs the risk of severe decay when nursing continuously from a bottle of formula or juice during naps, and especially at night," said Dr. Thomas.

Research findings point to dental decay in the "primary dentition, suggesting that prevalence in 3- to 5-year-olds is relatively high, and that certain populations are far more susceptible to particular forms of the disease."

Dental disease can be well established by the time a child reaches the age of 3. "Furthermore, the cost of treatment, which frequently is rendered under general anesthesia due to behavioral and extensive treatment needs, is high," said Dr. Thomas. "Parents need to remember: The first dental visit should be scheduled before the first birthday."

The first visit should include 1) a thorough medical and dental history covering the prenatal, perinatal and postnatal periods, 2) a thorough extraoral and intraoral exam, 3) an assessment of the patient’s risk for disease and 4) anticipatory guidance.