Infant Oral Health Care
First Dental Visit
Science has provided a clear understanding that tooth decay is an infectious, transmissible, destructive disease caused by acid-forming bacteria acquired by toddlers from their mothers shortly after their first teeth erupt (generally around six months of age). In its early stages, the effects of dental caries are largely reversible through existing interventions (e.g., fluorides) that promote replacement of lost minerals from the outer layer of the tooth (enamel). These findings, combined with epidemiological data on the occurrence of tooth decay in infants and young children, suggest that true primary prevention must begin in the first to second year of life. This evidence also suggests that particular attention should be paid to the oral health of expectant and new mothers.
In early childhood there is tremendous growth and development of the face and mouth, with dentition-associated disturbances that may require the attention of dental professionals. Other common oral conditions of childhood (in addition to tooth decay) include: gingivitis and mucosal (soft tissue) infections; accidental and intentional trauma; developmental disturbances associated with teething or tooth formation; poor alignment of teeth or jaws; and craniofacial abnormalities (including clefts of the lip and/or palate). Additionally, parents frequently request information on a diverse array of concerns including: sucking habits; fluoride usage; tooth alignment; timing and order of tooth eruption; and discolored teeth.
Infant Oral Health Care
Infant oral health care begins ideally with prenatal oral health counseling for parents, a service that should be provided by knowledgeable health care providers such as obstetricians, family physicians, pediatricians and nurse practitioners, as well as dental providers. Actual infant oral health care visits focusing on relevant history taking, clinical examination of oral structures, risk assessment, counseling, anticipatory guidance and necessary follow-up interventions should begin early, ideally before dental diseases are established. This early involvement is viewed as the foundation on which a lifetime of positive oral health and dental care experiences can be built, thus minimizing costs associated with treatment of dental diseases.
First Dental Visit
Despite growing recognition of the above, a discrepancy exists between dental and public health organizations' versus the American Academy of Pediatrics' recommended age for a first dental visit. American Academy of Pediatric Dentistry (AAPD) policy, as reflected in its "Periodicity of Examination, Preventive Dental Services, and Oral Treatment for Children," ... recommends that children be seen by a dentist following the eruption of the first tooth, but not later than 12 months of age. The AAPD recommendation is embraced by the Bright Futures consortium of 28 child health organizations and is consistent with the policies of the dental and public health groups including the American Dental Association, American Dental Hygienists Association and the American Public Health Association. In contrast, the American Academy of Pediatrics (AAP) recommends that every child should begin to receive oral health risk assessments by 6 months of age from a pediatrician or a qualified pediatric health care professional, and that infants identified as having significant risk of caries or being in a high-risk group should be entered into an aggressive anticipatory guidance and intervention program provided by a dentist between 6 and 12 months of age. NOTE: Under the Medicaid program, states are required to develop their own dental periodicity schedules after appropriate consultations with dental groups involved in child health care or states may adopt a nationally recognized dental periodicity schedule.
