Dental Care Through Their Ages, Part 1: Pediatric Dental Care for Ages 0-6
DATE: Nov 15, 2018
AUTHOR: Mirissa D. Price, Harvard DMD '19
Pediatric dental care begins before our littlest patients have teeth. Unfortunately, according to Frontiers in Pediatrics, up to 80 percent of children in some countries and underprivileged groups experience caries. In the United States, the National Institute of Dental and Craniofacial Research reports 28 percent of children ages 2 to 5 experience caries. Our job as dental practitioners is to foster prevention, monitor dental development and provide advice and dental care for our young patients.
Caring for our youngest patients begins during the expectant mother's pregnancy. Bacterial species associated with caries development have been shown to pass from a parent/caregiver to a child by kissing or any transfer of saliva, according to the American Academy of Pediatric Dentistry. So, it is important to emphasize daily brushing and flossing and regular cleanings for expectant parents. Pregnant dental patients can receive treatment and take in anticipatory guidance for their coming newborn's oral health. It is generally recommended that non-urgent dental care be performed during the second trimester or early phase of the third trimester. For scaling and root planing, treatment early in the second trimester is recommended.
Birth to 6 Months
Baby in hand, it's time to teach parents to use a clean, moist cloth to gently massage their baby's gums and clear them of debris. Advise against offering a bottle to a child already in bed to help prevent caries.
When a child begins teething, typically at around 6 months, explain the possibility of swollen gums, fussiness and drool rash. A clean, chilled teething ring or oral analgesic can provide relief.
6 to 18 Months
At age 1 or within six months of the first tooth erupting — whichever happens first — it's time to visit the dentist! It's also time to use a soft-bristled toothbrush two to three times daily with a rice grain-sized smear of fluoride toothpaste, in addition to massaging the surrounding gums. Recommend a baby toothbrush like the Colgate My First Toothbrush that is specially sized for small children.
Educate families about cariogenic foods and drinks, and explain the appearance of decay so caregivers can monitor their children's teeth between visits. All children should have regular check-ups, and children at risk for caries may need a regular fluoride treatment like Colgate PreviDent Varnish.
18 Months to Age 6
By 30 months, most children have all their primary teeth. Teach parents to floss teeth that touch each other mesially and distally. Children need help and supervision when brushing. Use a pea-sized amount of fluoride toothpaste from the age of 3. Up until age 3, a smear of toothpaste no larger than a grain of rice should be used. Toddlers and small children can get more involved in oral hygiene routines. Resources like a fun brushing app can get little ones excited to brush.
Appointments should be engaging and brief. Involve the child in simple decisions, such as picking the color of their toothbrush. You can help prepare parents for common dental issues such as a tongue bites, tooth luxation or avulsion, and teach them what to do if it happens. If a patient is 4 years old and still sucks their thumb or uses a pacifier, ask parents to help discourage this habit as it can affect the developing jaw and teeth.
Parents may not know that at around age 6, the first permanent molars erupts in the back of children's mouths without them losing any baby teeth at the back first. Parents need to be aware of the need to pay extra attention to this area and understand that treatment with sealants can help protect these teeth. The American Academy of Pediatric Dentistry describes how at this age dentists can apply sealants to protect the deep, hard-to-reach grooves of the back teeth and start evaluating for abnormal tooth development and the need for interceptive orthodontics.
While your adult patients might need some encouragement to bring their babies in for an appointment, a lifetime of good oral health truly begins at birth. With simple guidance for families, you can help to ensure proper pediatric dental care for your youngest patients.
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