The dental home and age 1 visit: recommendations from the American Academy of Pediatric Dentistry

We all want our children to enjoy a healthy childhood. Sadly, too many children are suffering from needless tooth decay and subsequent dental pain because they do not have a dental home.In order to show parents how to achieve optimum oral health for their children, the American Academy of Pediatric Dentistry (AAPD) has established the concept of a dental home. This is defined as the “... ongoing relationship between the dentist and the patient, inclusive of all aspects of oral health care, delivered in a comprehensive, continuously accessible, coordinated, and family-centered way.” The AAPD recommends that a dental home be established with every child before 12 months of age, including a referral to dental specialists as appropriate. The AAPD further promotes the dental home concept through anticipatory guidance. Anticipatory guidance is the process of providing practical, developmentally appropriate information about children’s health to prepare parents for the significant physical, emotional, and psychological milestones. Appropriate discussion and counseling should be an integral part of each visit. Topics to be included are oral hygiene and dietary habits, injury prevention, non-nutritive habits, substance abuse, intraoral/perioral piercing, and speech/language development. Anticipatory guidance considers all aspects of a child’s growth and helps set the stage for planning the youngster’s total care, emphasizing prevention. The various considerations are:

• Comprehensive oral health care, including acute care and preventive services in accordance with AAPD periodicity schedules; i.e., how often the youngster should be seen in light of his or her risk of getting dental disease
• Comprehensive assessment for all oral diseases and conditions, which includes diseases and conditions of the gums, cheeks, tongue, lips, throat, etc., in addition to the teeth
• An individualized preventive dental health program based upon a caries-risk assessment (cavities) and a periodontal disease risk assessment (gum conditions)
• Assessing and treating issues that can interfere with normal growth and development; e.g., finger sucking, pacifier habits, teething problems
• Interceptive and preventive orthodontic treatment to redirect untoward growth so that the jaws and bite can develop normally
• A plan for acute dental trauma; e.g., if a child knocks a tooth out during a sporting event
• Information about the proper care of the child’s teeth and gums. This would include the prevention, diagnosis, and treatment of diseases of the supporting and surrounding tissues and the maintenance of health, function, and esthetics of those structures and tissues
• Dietary counseling for cavity prevention, obesity, and other related conditions
• Counseling and treatment for teenagers with respect to smoking cessation
• Referrals to dental specialists when care cannot directly be provided within the dental home
• Considerations for parents of children with special health care needs, such as Down Syndrome, diabetes, childhood cancer, and other chronic conditions
• • Education for 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

At your child’s first visit, the pediatric dentist will go over all of these considerations. In order to best examine the very young child, he/she will be put in the knee-to-knee position. You will have your child facing you with his legs around your waist. You then lean him back into the pediatric dentist’s lap so that he can count the teeth, see the gums, and clean the teeth as needed. A coating of fluoride varnish will then be painted on the teeth to strengthen them, as well as help prevent cavities.

Children under age 2 should only have a “smear” of fluoride toothpaste on their toothbrush. From age 2 to 6, use a “pea size” amount, and after that, you can just cover the brush.

Whenever the teeth are so tight that the bristles of the brush cannot get in between, you need to use dental floss. For many parents, brushing and flossing their children’s teeth while standing at the bathroom mirror can be a challenge. If you lay your youngster down on his/her bed and sit next to him/her, mimicking the same situation your pediatric dentist has when your child is in the dental chair, then you can easily brush the child’s teeth. And since there is only a small amount of toothpaste on the brush, the mess will be minimal. While the toothpaste is still present, draw the dental floss between the tight teeth. This not only cleans better, but brings the fluoride to the tooth surfaces, since about 40% of all decay occurs in between. When you are finished with this exercise, your child can go to the bathroom and brush on his/her own ... a true team effort.

Lastly, when your child is around the age of 6 and his first permanent molars have erupted, your pediatric dentist can place cavity-preventing dental sealants on the biting surfaces of these teeth. Since the molars have rough surfaces that are often hard to clean, placing sealants fills in these areas and helps prevent the most common form of decay. The best part of placing sealants is that no numbing with Novacaine or drilling is needed.

In conclusion, the AAPD and other dental organizations, such as the American Dental Association and Academy of General Dentistry, are all in agreement with the establishment of a dental home and age 1 visit. By closely collaborating with your pediatric dentist, you will have the best chance of ensuring a healthy dental future for your child.

Warren A. Brill, DMD, MS (HYG), FAAPD, is a practicing pediatric dentist in Baltimore, Md. He is a clinical associate professor of pediatric dentistry at the University of Maryland’s School of Dentistry, and is currently the secretary-treasurer of the American Academy of Pediatric Dentistry. Dr. Brill is also a fellow of the American Academy of Pediatric Dentistry.