Pediatric Dentistry // General Dentistry pedodontist

pediatric dentist

First Dental Visit

According to the American Academy of Pediatric Dentistry, the first dental visit should be no later than 12 months of age. This first visit allows the dentist to assess the newly developing dentition, behavior of the child, availability of fluoride, and anticipatory guidance to the parents. Usually these early appointment are performed in the knee-to-knee fashion. The provider and the parent/guardian place their knees together, the child straddles the parent, the parent hold the child’s hands and slowly leans the child into the provider’s lap. Most children do not like a “stranger looking around” and this age and the usual response is crying. This is completely normal and usually allows a better look around as the mouth is opened widely.

Guidelines for parents

Should your child require dental treatment due to cavities, it is important for the parent to know most children know nothing of dentistry. Often they have been coming to get their teeth cleaned by the hygienist and have no reason to be fearful of the dentist. It is imperative the parent reassure the child and regardless of the parent’s feeling about dental treatment be calm and relaxed. Also, NEVER talk about shots! Many times, with using topical anesthetic first, the child will only feel the slightest pinch (if anything); however, any talk about needles or shots will immediately make them think about that extra large booster shot at the doctor’s office. At this point, the entire dental experience is potentially ruined before it even started.

For all children (especially 8 years and younger), I strongly recommend the use of nitrous oxide (laughing gas) for dental treatment for two reasons: 1.) the benefit of relaxation from the gas greatly improves the child’s behavior during the appointment which increases the safety for the child and providers; and 2.) the mask obscures the child’s view of the procedure and decreases anxiety further.

At Rayburn General Dentistry, the parents may be in the room for dental treatment, but many times children develop a more positive repertoire with the dentist and team without the parent in the room. A good option is to remain in the room during the first part of the appointment until after the numbing medicine has been used and then wait in the lobby until the treatment is complete. This allows the parent to be reassured the teeth are asleep during treatment and also allows the dentist to build a positive relationship without the parent during treatment. Parents will be asked to leave the room in three circumstances:

  1. If the parent is obviously anxious and is transferring that anxiety to the child, the parent will be asked to leave the room. If the parent looks fearful, the child will automatically become fearful, and the child will not cooperate .

  2. Some children simply are more able to cope with the sights and sounds without the parent in the room. Children can act out thinking their parents will “save them” from this stressful situation, which can lead to an unpleasant appointment for the child. If this happens the parent will be asked to leave the room. This usually results in the child being able to cope with the situation themselves and makes for a more pleasant appointment.

  3. On children with cavities from 0-2 years old (sometimes older children as well), a papoose is needed for treatment. Children that need the use of the papoose for their safety in treatment require the dentist’s and staff’s full attention. For this reason, parents will not be allowed in the treatment area. (More on young children below).

Finally, some children just do not like the dentist. A variety of methods can be used to aid in behavior and safety. Before these methods are used, each will be discussed with the parent. For children with the most anxiety, fearfulness, and behavior issues during dental treatment, referral for sedation with a pediatric dentist will also be discussed.

Anticipated behavior during treatment by age:

0-2 years of age:

From dental cleanings to restorations, these children are simply too young to fully understand what is happening. This is called the pre-cooperative stage. They will almost all cry during any type or treatment, regardless of how simple and easy it may be.

3-4 years of age:

A patient of this age can be judged by how they handle the cleaning appointment. If they are relaxed, then dental treatment will often go smoothly. Kids of this age are coming out of their pre-cooperative stage of behavior and are beginning to cope with the sights and sounds of the dental office. Usually a little crying is anticipated at the injection, but with the help of the nitrous oxide, as treatment progress and nothing hurts, they settle down and are great patients.

5-7 years of age:

These children usually make great patients. They are old enough to cooperate and more importantly want to cooperate. The brain is finally developed enough to begin to tell the difference between pressure and pain. The vibration of the dental “drill” is very upsetting to a two year old, but for a six year old, most are fully able to see that while not necessarily the most pleasant sensation, it is one without pain (thanks to the numbing medicine, of course). Also in this age range, the child is able to tie their shoes by themselves which signals enough manual dexterity to brush their teeth by themselves with direct supervision.

8-12 years of age:

These children have already made up their mind about the dentist. They are ready for their appointment and know what is going on. For most, this means a cooperative and pleasant visit with perhaps a little tearing up at the injection of the numbing medicine. These children are readying themselves for young adulthood and usually make great patients as well; however, on rare occasions, this age can also mean they are ready for an all-out battle. Should a child of this age decide not to cooperate, the most appropriate course of action due to their size and safety concerns for child and providers is to refer to a pediatric specialist for oral sedation.

13 and older:

Dentally speaking, these patients are now adults. For most patients, the primary (baby) teeth are gone. They are mentally prepared to be adults in the dental chair as well. The problem is mainly getting them to brush and floss at home. They are old enough to do it without supervision, but at times the motivation of a teenager for home care is lacking. This is easily solved when dating becomes of interest!