A while back we mentioned our intention to periodically address some common dental “Frequently Asked Questions” (FAQs)…or, for most patients, frequently UNASKED questions due to a hesitancy to actually speak-up while in the dental chair. Let’s face it, all of that technical terminology ensconced in an equipment-filled room and supervised by folks in lab coats and PPE, can be downright intimidating! So in our second installment, we’re answering one of THE most-frequent queries from parents, grandparents, and anyone else with a young child.
How soon is too soon – or too late – for a child’s first dental visit?
This one is EASY…but getting folks to wrap their head around the answer can be QUITE “challenging!” The American Academy of Pediatric Dentistry recommends scheduling that first visit around six months of age. Yes, even if they don’t have any teeth showing yet! However, this can be sooner if you’ve noticed an unusual issue. And, yes, even newborns can have dental “anomalies.” First, let’s talk about Natal Teeth, from Stanford Medicine Children’s Health:
What are natal teeth?
Natal teeth are teeth that are present when a baby is born. The teeth are often not fully developed and may have a weak root.
Natal teeth are not common. They are not the same as neonatal teeth that erupt in the child’s mouth during the first month of life.
What causes natal teeth?
The cause of natal teeth is unknown. But they may be more likely to occur in children with certain health problems that affect growth. This includes Sotos syndrome. The condition can also be linked to chondroectodermal dysplasia (Ellis-van Creveld syndrome), pachyonychia congenita, and Hallermann-Streiff syndrome.
What are the symptoms of natal teeth?
Natal teeth may sometimes look like normal teeth. But they are often 1) Small…2) Loose…3) Brown or yellow
How are natal teeth diagnosed?
Your child’s healthcare provider or dentist can often diagnose natal teeth with a physical exam of your child’s mouth. Your child may also need X-rays. An X-ray makes images of internal tissues, bones, teeth, and organs. An X-ray may show a tooth root that is not fully formed.
How are natal teeth treated?
Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.
Your child’s dentist or healthcare provider may decide no treatment is needed. In other cases, natal teeth may be loose because the root is not fully developed. The teeth may then be removed. This is done to lower the risk of your child breathing in the tooth into his or her airways. Or the teeth may be removed if they are damaging your baby’s tongue. Another choice may be to smooth the top edges of the teeth. This prevents damage to your child's tongue.
What are possible complications of natal teeth?
Complications that may happen as a result of natal teeth are:
Problems with breastfeeding. This is because you baby may accidentally bite you while breastfeeding.
Injury to your child’s tongue
Possible risk of your child inhaling the tooth into his or her airway and lungs if the tooth breaks free
Key points about natal teeth
Natal teeth are teeth that are present when a baby is born
They are not common. They are not the same as neonatal teeth that erupt in the child’s mouth during the first month of life
Natal teeth are often not fully developed and may have a weak root
They may be small, loose, and discolored
The cause of natal teeth is unknown
Your child’s healthcare provider or dentist may recommend having them removed if they may cause a problem
Now, the important thing to note, this is EXTREMELY rare, and can be addressed easily with a…YES, you know this was coming…visit to your dental office. So, you may be wondering when you DO need to take your child for their first dental visit – and, WHY! The American Academy of Pediatric Dentistry lays it all out:
The American Academy of Pediatric Dentistry (AAPD) recommends that infants (and parents) be scheduled for an initial oral evaluation visit within six months of the eruption of the first primary tooth but by no later than 12 months of age…(and here is) information to help health care professionals understand the rationale behind this recommendation.
Health Supervision vs. Disease Treatment
For many years, the approach to oral disease (dental caries, periodontal disease and acquired or hereditary oral conditions) has been to treat destructive effects and then initiate a preventive program. Contemporary guidelines recommend more emphasis on early professional intervention consisting of an oral examination, risk assessment of infants and anticipatory guidance for parents. The goal of primary prevention is to stop the onset of disease or to interfere with its progression before treatment becomes necessary. With early professional intervention, it may be possible to reduce or even eliminate oral disease.
Onset of Dental Caries
The prevalence of dental caries among children has declined steadily since the 1940s. However, dental caries remains the single most common disease of childhood that is not self-limited or amenable to a course of antibiotics. By the age of nine years, 56 percent of U.S. schoolchildren have dental caries. Even though a continuing decline in the prevalence of dental caries in permanent teeth has been shown, there has been no decline in its prevalence in the primary teeth of children living in industrialized countries. In addition, the incidence of tooth decay appears to vary considerably in different ethnic and socioeconomic populations.
By the age of 12 months, infants begin to establish an oral environment that places them at risk for dental caries. It has been shown that dental caries is an infectious, transmissible disease. The mutans streptococci (i.e., Streptococcus mutans and Streptococcus sobrinus) have been implicated as the principal bacteria responsible for the initiation of dental caries in humans. Because colonization requires the presence of a hard, nondesquamating surface, infants do not harbor these organisms until sometime after teeth emerge.
Infants acquire mutans streptococci primarily from their mothers. The initial acquisition of these bacteria appears to occur during a well-delineated age range (window of infectivity), estimated to be 19 to 31 months of age. Earlier acquisition of the bacteria has been associated with certain risk factors, including sibling caries, maternal caries, feeding habits, dietary habits, fluoride exposure and oral hygiene practices. Therefore, infants should receive early intervention before the established window of infectivity, and parents should be given appropriate recommendations concerning oral health care for their infants.
Feeding Practices
To cause dental caries, oral bacteria require the presence of a particular environment. Prolonged bottle or breast feeding provides the substrate (i.e., the presence of fermentable carbohydrates) that produces an oral environment favorable to bacterial proliferation and the formation of acidogenic plaque. This plaque environment lowers oral pH, promoting demineralization of dental enamel, and can eventually lead to caries formation.
Early childhood caries, also termed “nursing caries,” “baby-bottle tooth decay” and “bottle caries,” is a specific dental disease occurring in very young children. This disease affects primary dentition, is characterized by rapid and extensive dental caries and is often associated with prolonged bottle or breast feeding. Early childhood caries affects an estimated 1 to 11 percent of infants in the urban population.
To reduce the incidence of dental caries, parents and other caregivers should be counseled about proper feeding practices during infancy and the preschool years. One such measure is limiting the intake frequency of foods and liquids that promote acid production.
Education on Oral Hygiene and Dietary Habits
Poor oral hygiene and poor dietary habits are associated with the development of caries in infants and young children. Because children are not able to control these factors, their dental health is greatly influenced by the amount of education and subsequent practices of parents and other caregivers.
Mothers appear to be the primary source of a child's dental knowledge. Therefore, failure to adequately educate mothers at an early stage can lead to subsequent dental problems in chilren. Nutritional and lifestyle counseling (i.e., alcohol and tobacco use), medication warnings and advice concerning breast feeding and postnatal care can also have a positive influence on oral health in children.
Timing of the First Dental Visit
Because all children do not receive primary prevention, secondary measures such as early diagnosis and treatment can eliminate pain, infection and oral diseases. Traditionally, the recommended time for the first dental visit has been at three years of age. The rationale for choosing this later age was that children were more manageable, and treatment was more efficient.
By three years of age, however, poor oral hygiene or improper feeding habits may already have compromised oral health. Therefore, the AAPD recommends that the first oral examination occur within six months of the eruption of the first primary tooth but by no later than 12 months of age.
So, back to our original question, depending upon your child it’s almost NEVER too early to schedule that first dental visit, and YES, it can be too late to save your child a lifetime of oral health problems. And, we’ll address other questions, in future FAQs.