First tooth, first visit

January 2, 2015

This article first appeared in the May 2011 edition of WAC Magazine
published by the Washington Athletic Club

When adults of today’s generation were growing up, a visit to the dentist was almost always because of a problem. Routine prevention was not a part of life, and it was typical to think that baby teeth weren’t important. So much for that. The American Academy of Pediatric Dentistry recently rolled out its newest campaign to change this outdated assumption with the slogan, “First tooth, first visit.” Behind this new recommendation: Why it is so important that children visit the dentist at an early age.

One of the most common questions I hear as a pediatric dentist is, “Why should a child go to the dentist before all of their baby teeth have grown in?”

Preventing dental fear

It is critical that children attach a positive association with their first dental experience. This is arguably the most important reason a child should begin dental care as soon as the first teeth emerge. If you have experienced a cavity as a child, chances are you don’t have a particularly fond memory of it. It is likely the negative experience shaped the way you feel every time you go to (or even think about) the dentist. Having children experience success at the dentist’s office before they have a dental problem allows them to conquer their fear of the unknown, builds their confidence and ultimately empowers them. Admittedly, not all parts of a check up are inherently enjoyable, especially the first time, but familiarizing kids with the process at a very young age gives them a chance to build a set of emotional coping skills. The more positive and successful visits, the less likely they will ever develop anxiety over a trip to the dentist. This is a concept known as “latent inhibition” and is best described as giving a child an emotional emergency tool kit should they ever need to undergo treatment to fix a cavity or repair an injured tooth.

The outdated recommendation, to wait until a child is older, greatly increases the chance that a child’s first visit to the dentist will be the result of a problem. If a child is introduced to dental care for the first time because of an issue like a painful tooth, swollen mouth or traumatic dental injury, it attaches a negative association (e.g., pain, fear) to the experience. This reduces the effect of latent inhibition and greatly increases the risk of developing long-term phobia and dental anxiety.

Dental disease is largely preventable

Tooth decay and gum disease are, in fact, diseases. They have an overall effect on our body just the same as Type 2 diabetes, obesity or heart disease. Like these diseases, dental disease is largely preventable. The teeth and gums are connected to all the vital structures in our body by blood vessels and nerves. If bacterial invasion of a tooth (commonly known as a cavity or decay) is not prevented, and proceeds unchecked, it can spread to nearby structures. This spread occurs first in the head, host to some of the most vital structures to life, including the brain, airway, eyes, nose and ears. Most of us consider an ear infection or strep throat a very serious problem needing immediate medical attention. A cavity is no different.

An initial visit to the dentist when the first teeth come in also allows for an assessment of a child’s risk of dental disease based on examination and family history. Consequently, recommendations can be made to implement an appropriate prevention plan to minimize the risk of developing dental disease. It also educates parents on how to care for their child’s teeth and gums and how diet plays an important role in proper oral health, and provides information on other risks and developmental milestones to consider as children grow.

Emergency dental home

Young children are especially vulnerable to dental injury as they learn to walk. The most common time in our life to sustain a dental injury is between the ages of 1 and 3. Therefore, the longer a family waits to establish a dental home for their child, the more likely the first trip to the dentist is an involuntarly one due to injury. This nearly always creates a negative association with the dentist and increases the risk that kids will develop dental fear and anxiety as they grow. Also, if a child has not already established a dental home, trying to find proper and timely treatment, especially outside of regular business hours, can greatly amplify an already distressing situation. Without a place to go, children are usually referred to a hospital emergency room where wait times can be very long and dentists are not typically available to provide care.

It’s often expressed that a 1-year-old’s visit to the dentist is entirely underwhelming, but that it is a good thing! If we can have the next generation grow up feeling a visit to the dentist is just another part of their wellness routine, the new recommendation of “First tooth, first visit” will have done its job. Early visits to the dentist can eliminate dental fear, prevent the spread of serious disease and establish a health care home in case of emergencies. By creating a long-term relationship with their dentist, kids can overcome fear and live a cavity-free life.