Examination of the Infant and Toddler

An infant examination can begin with a pre-appointment assessment if possible. This can be accomplished by obtaining information from the parents through the use of a questionnaire mailed to and returned by the parents prior to the office visit. The questionnaire covers the following areas:

• Biographic Data and Family and Social History – This provides insight into the family structure and relationships that may reflect the parents' involvement in the child’s oral health.

• Prenatal, Natal and Neonatal History – The information presented aids in explaining dental abnormalities that occur in the primary dentition (i.e., high risk pregnancies, tetracycline ingestion, febrile episodes).

• Development History – Knowledge of the child’s attainment of developmental milestones assists the dentist in diagnosing significant growth alterations.

• Medical History – Helps alert the dentist to any precautions to safely manage the patient (prophylactic procedures, allergies, etc.).

• Dental History – Knowledge of the child’s history of previous dental trauma, teething difficulties, oral habits and oral home care provides a basis for future recommendations and management.

• Feeding History – An overview of the feeding history enables the dentist to determine what contribution dietary influences have on the development of current and future caries including frequency of snacks and beverages (i.e., prolonged nursing, bottle, or sippy cup use, etc.).

• Fluoride History – Is the child drinking fluoridated water and using toothpaste with fluoride.

The clinical evaluation of the patient includes:

• Extra oral examination of the head and neck for abnormalities in size, shape and symmetry of the head, lymph nodes, eyes, ears, nose, lips and mouth.

• Intraoral evaluation of the soft tissues for cysts, clefts, traumatic ulcerations, tongue and frenum lacerations, and gingivitis.

Examination of the dentition includes:

• Evaluation of the jaw relationships (overjet, overbite, midline deviations and crossbites), presence or absence of spacing,

• Presence of dental abnormalities, hypoplastic/hypocalcified enamel and dental caries.

For a more in depth discussion of conditions seen in the pediatric patient the reader is referred to the CE course Clinical Encounters in Pediatric Dentistry, in the www.dentalcare.com Continuing Education library.

After the findings are gathered, the dentist makes an assessment of the patient’s risk for dental disease. The AAPD provides resources on caries risk assessment tools, www.aapd.org. Based upon the patient’s risk assessment, appropriate recommendations for dental disease prevention techniques are made. These include parental responsibility for the following:

• Diet counseling

• Tooth and gum cleaning procedures

• Fluoride assessment

• Recall schedule