Introduction

Each day, in thousands of dental offices, a pediatric dental patient enters the treatment room. Immediately there is an increase in the heart rate, elevated blood pressure, quivering knees and lips, tears rolling down cheeks. Unfortunately, this scenario can apply to both the patient and the treating dental team.

For a variety of reasons, there are dental practitioners and staff that have an aversion to treating pediatric patients, especially infants and toddlers. This is unfortunate for both the patients and the dentist. By institution of early oral health education and the application of preventive dentistry procedures, the pediatric dental patient can be insured a lifetime of dental health. For the dental practice, ignoring or rejecting the infant and toddler population results in a missed opportunity to contribute to improved oral health for the overall population, establish dental homes early, and attract new patients to the practice.

When questioned by parents as to what age a child’s first dental visit should take place, many dentists suggest the asymptomatic child be seen after age three when there is greater likelihood of cooperation for dental treatment. However, dental problems can develop in a child as young as 6 months, right after teeth begin to erupt.¹ Often, the general dentist, when faced with such a young patient, will refer them to the local pediatric dentist with the expectation the patient will return in a few years cooperative and willing to accept dental treatment. There are more children than there are pediatric dentists to see them. General dentists can play a vital role in early dental screenings, application of fluoride varnish, anticipatory guidance, establishing positive dental experiences and perceptions, and can refer patients requiring treatment beyond their clinical abilities/comfort level to a specialist when and if necessary. Data has shown that early dental visits result in a lower rate of dental caries in young children.²

Once parents and the pediatric dental patient are referred to a pediatric dentist many are reluctant to return to the referring dentist. Not only did the pediatric dentist treat the immediate dental problems, but also resolved fears the child had about undergoing dental treatment. Pediatric dentists cater to children in a variety of ways by creating inviting experiences and environments. Children are happy to return to the pediatric dentist because it means playing with video games, watching their favorite TV show or movie, and picking out a prize after treatment. Pediatric dentists have great success at treating young pediatric patients because they put equal emphasis on both providing optimum clinical care and happy experiences. After a few years of such happy experiences at the pediatric dentist, the pediatric patient will resist switching to the general dentist who may provide clinically equivalent care but may not provide the happiness and “fun” they experienced at the pediatric dentist.

By delaying the first dental visit past age three, the general dentist loses the opportunity to treat the pediatric patient who may not return to the office until a much later time.

The sensible solution to attracting and retaining patients and achieve a viable and profitable practice, is to incorporate dental patients into the practice at the earliest age possible. Since 1986, the American Academy of Pediatric Dentistry (AAPD) has been advocating for one-year dental visits, a recommendation that has been supported by the American Dental Association (ADA), the Academy of General Dentistry (AGD), and the American Public Health Association (APHA).³ Since pediatricians and other pediatric health care professionals are more likely to encounter new mothers and infants than dentists, the AAPD lobbied the American Academy of Pediatrics (AAP) to familiarize their members with the associated risk factors of early childhood dental caries and to urge them to make appropriate referrals for early intervention and treatment. The AAP endorsed the concept of one-year dental visits in 2003 and introduced the policy to AAP members in the May 2003 issue of Pediatrics.⁴

The policy statement recommends an oral health risk assessment by 6 months of age and the establishment of a “dental home” for all infants by 12 months. The risk assessment can be performed by a qualified pediatrician or other pediatric health care professional.

The concept for the dental home is derived from the AAP’s “medical home.” The AAP states, “Pediatric health care is best delivered where comprehensive, continuously accessible and affordable care is available and delivered and supervised by qualified child health specialists.” The AAPD recommends that pediatric primary dental care be delivered in a similar manner.

An oral health examination by a dentist providing care for infants and young children 6 months after the first tooth erupts or by 12 months of age establishes the child’s dental home and an opportunity to implement preventative dental health habits that meet each child’s unique needs and keep the child free from dental or oral disease.

The 2018 revision of its policy on the dental home expects the dental home to provide:

• Comprehensive, continuous, accessible, family-centered, coordinated, compassionate, and culturally-effective care for children, as modeled by the AAP.

• Comprehensive evidence-base oral health care including acute care and preventive services in accordance with AAPD periodicity schedules.

• Comprehensive assessment of oral diseases and conditions.

• Individualized preventive dental health programs based on caries risk assessment and a periodontal disease risk assessment.

• Anticipatory guidance about growth and development issues (i.e., teething, digit or pacifier habit).

• Management of acute/chronic oral pain and infection.

• Management of and long-term follow up for acute dental trauma.

• Information about proper care of the child’s teeth, gingiva, and other oral structures. This would include the prevention, diagnosis and treatment of disease of the supporting and surrounding tissues and the maintenance of health, function and esthetics of those structures and tissues.

• Dietary counseling

• Referrals to dental specialists when care cannot directly be provided within the dental home.

• Education regarding future referral to a dentist knowledgeable and comfortable with adult oral health issues for continuing oral health care; referral at an age determined by patient, parent and pediatric dentist.⁵

• Recommendations and coordination of uninterrupted comprehensive oral health during the transition from adolescence to adulthood.

• Referral, at an age determined by patient, parent, and pediatric dentist, to a dentist knowledgeable and comfortable with managing adult oral health care needs.

This policy presents a great opportunity to prevent dental disease in the youngest population. However, the success of the policy is dependent upon whether general dentists are accepting of infant patients and welcome infant referrals from pediatricians.

By eliminating or delaying the development of caries, the general dentist has the opportunity to retain the patient in the practice without the stress of providing extensive restorative procedures to a young child incapable of or with limited ability to cooperate. The practice has the opportunity to retain the patient in the practice from infancy into adulthood, providing preventive services such as pit and fissure sealants, cosmetic dentistry, and orthodontics if necessary. Should the patient remain in the community after reaching adulthood, the general dentist has the opportunity of treating their patient’s children.

By learning and using some very simple behavioral guidance techniques to make dental treatment for the youngest patient a pleasant experience, the dentist can take positive steps to provide the child patient a lifetime of optimum oral health. The objective of this course is to teach some basic management skills to the dental staff that makes pediatric dentistry pleasant for both the patient and staff for the practice.