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February 15, 2016

Over the years, the concept of dentistry for children and adolescents has changed dramatically.  It has shifted from a “crisis management” attitude to one of “preventative maintenance and wellness visits.”  This shift in thinking has paralleled the broader shift to preventative maintenance in medicine as well.  This change in thinking has been hugely beneficial for children and parents

.In years past, a child’s first dental visit may have been prompted by a toothache or by a baby tooth that just “wouldn’t fall out.”  This first visit may not have coincided with any particular age of the child or any specific developmental milestone.  Rather, it was scheduled in response to some acute need.  Once this initial crisis was addressed by the dentist, it often set the tone for how all dental treatment would come to be perceived by the child: painful, unplanned, unpredictable, and generally disruptive.  In addition, many parents came to see baby teeth as “expendable.”  Little care would go into maintaining these teeth, and problems (tooth decay, infection, abscess) would ensue.  Many children would come to have low expectations from dental care.  Of course, these attitudes sometimes carry over into adulthood, setting up the individual for a lifetime of unmet expectations.

Fortunately, this has in large part been reversed.  The American Dental Association, state dental associations, and other organizations have worked hard to change not only treatment recommendations but also public perceptions about child dentistry.  Many school systems now provide topical fluoride varnishes in school, and this has become a powerful prevention against tooth decay.  Also, school systems will not allow a child to start school in the fall without a note from their family dentist stating that the child is under care.  The term “sealant” has entered the public’s vocabulary: a thin layer of filling material placed, without drilling or anesthetic, into the deep groves of the biting surface of the tooth to “seal out” tooth decay.  Now, parents ask for them routinely.  The recommendation for when children first see a dentist has been moved, from three years old to one year old.  Local pediatricians are now starting children on fluoride supplements when they are one year old, so that child is already under preventative maintenance by the time they reach the dentist.  

This first dental visit for a child of one year old has shifted from a “crisis management” visit to a “meet and greet visit.”  The child can meet the hygienist, the assistants, and the doctor in a non-threatening, pleasant setting.  We play games, we wear sunglasses to protect against the bright light, and we make animal balloons.  All the while, we are really working: screening the child for tooth decay, reviewing diet, oral hygiene, sugar intake, and fluoride exposure with Mom and Dad.  The child leaves with a pleasant experience and diminished fear; the parents leave with increased confidence in dental prevention and treatment.  Often, this experience will help a child find a “dental home” for years to come.  The child can grow from one year old, through childhood and adolescence, in one dental office.   The child will grow with a healthy attitude towards dentistry and preventative care, and this mindset will accompany the patient for life.  Nothing makes me happier then to see smiling children and families who have had successful preventative care and good treatment experiences.