Child first dental visit

Child First dental visit and management

1. CHILD’S FIRST DENTAL
VISIT
Presented by
Dr. Prashant Karasu
Pg student
DEPT OF PEDODONTIA

2. Introduction: - Children are the adult dental patients of future
and good ground work in the early years of dental monitoring and
treatment planning will pay dividends both in short and long term.

In the past children visited a dentist only after a
problem was severe enough to be noticed by a parent .This is
now an outdated approach which is no longer appropriate in the
age of preventive health. The infant’s oral health visit is now the
foundation upon which a lifetime of oral and dental health can be
built.
First impression usually has a lasting effect and so a
child’s introduction to dentistry should leave a favorable
impression and so it is helpful if children begin attending when
they have no immediate treatment need as a child who visits /
attends in pain and who may require operative treatment at that
visit will have a very different first impression from the one who
attends symptoms free and only requires dental examination. The
first dental visit should be primarily a “fun, getting to know you
session” for the child with the dentist

3. Beneficial to give children a morning appointment as both the
dentist and the child are relatively fresh more positive and
receptive and this can make the visit more productive.
The clinic set up also plays an important role and care
should be taken to make the practice environments as child-
friendly as possible. Bright decorations, good lighting, simple toys
/ games in the waiting room can also make a good impression on
the child.
It is ideal that a child shouldn’t be kept waiting but if unavoidable
toys, storybooks appropriate videos will be useful to make the wait
more pleasant.
For a new young patient it is much less intimidating if the
dentist instead of a dental nurse greets the child in the waiting
room with an accompanying adult close at hand and then escorts
the child into the operatory.
It is important that eye contact is very important
particularly at first meeting and so it may be necessary for the
dentist to bend / knees down to make eye contact with the child.

4. AAPD / ADA / Canadian Dental
Association recommends that a child
should visit the dentist within 6 months of
eruption of first primary tooth and no
later than 12 months of age with an aim
to detect and control the different
pathologies, particularly dental caries.

5. Visit before the child’s birth: - [Pre-birth visit]
The visit is needed as it is essential to establish a first
contact between the health professional and the parent
with the object of imparting information and initiating a
bond of trust. As the pregnant women is concerned
with her own health and keen to deliver a healthy
baby, she is receptive to suggestions that will effect
the health of her child and so this presents the best
possible moment to present here with principals of
health education and explain her that the baby’s teeth
are beginning to form at her current stage of
pregnancy. Also it has been proved that the infant
acquires the mutans streptococcus from his mother
(i.e.) earlier the acquisition higher the risk of caries in
primary dentition and so mother’s oral health also
needs attention and care.

6. The first visit for an expecting mother should include the
following:
• It is the appropriate time to explain an expectant mother
how she may ensure that the teeth erupt healthy and the
care that needs to be taken to maintain dental health after
eruption.
• Should help to identify high risk situation and to indicate
and provide preventive procedures for both parent and child
where these are needed.
• Should aim to intimate the need for an appointment when
the baby is 6 months old.
• This pre-birth visit should thus be designed to achieve
positive, conscious and responsible attitudes and behavior
in the parents, as the key to effective oral health promotion
and disease prevention lies in anticipatory guidance and
education, early detection and timely referral for appropriate
intervention.

7. Child’s first dental visit at 6 months age:
Goals: -
1. Behavioral:-
• Early exposure to and familiarization of the child with the
dental environment are an important measure in reducing
dental anxiety in young children.
• It provides an important occasion for the parent to address
his or her own anxiety and fear of dental care which in turn
may reflect on the child.
• Also the clarification of the parent’s role in supporting the
child emotionally before, during, after future dental visit is an
important goal.

8. 2. Preventive:-
• Improvement of the child’s oral hygiene.
• Correction of improper dietary and eating habits.
• Improve knowledge about the role of non-nutritive sucking
on development of malocclusion.
• Improved knowledge of risks for traumatic injuries
including where, when and how to seek emergency care.
•3. Therapeutic:
• A careful dental examination is not possible in very young
child but inspection of teeth and gingival is often possible
as early as one year of age.
• Help to identify children with thick plaque accumulation
which is a risk factor for caries in young children.
• Makes it possible for interceptive intervention aimed at
arresting the progression of caries lesion.

9. Do’s and Don’ts for the parent before getting their child to a
dental check up
• Don’t wait until your child needs dental care to plan the first
dental visit. If she is frightened or in pain it’s difficult for the
dentist to gain the child’s trust.
• Young children are very perceptive and can pick up and
react to any anxiety the parent might have before the visit.
• Don’t talk about specific procedures or use words like
drilling/injection/needle that can frightened the child.
• Take some time to play dentist with the child at home and
pretend to count his teeth then also allow the child to play the
role of dentist.
• Read your child a story or show him some pleasant pictures
in relation to a dentist and dental clinic. An excellent book to
read to the child would be “GOING TO THE DENTIST” by
FREDS ROGERS
• Inform the dentist about any medical or systemic problems
the child is suffering from and openly discuss the concerns,
doubts and questions with the dentist.

10. Parent in (or) out of the operatory
The pros and cons of having parents in the surgery
PROs
• increases parent-dentist
communication.
• Parent witnesses first hand
the
child’s behavior
• Time saved answering
questions.
• Children aged 3 and under
benefit psychologically from
the parents presence.
Cons
Parent often repeats orders to the
annoyance to both dentist and child.
The parent can act as barrier to a good
communication between dentist and
child.
The child divides his attention between
the parents and dentist.
The dentist divides his attention
between the parents and child.
The dentist may not be able to use
stern voice.
Parental anxiety can have a negative
effect on child’s behavior.

11. Before any form of treatment is initiated
knowledge regarding the attitude of the parent
towards dentistry and dental treatment along with
family history of dental needs must be gathered
to provide a useful baseline for treatment
planning.
It is helpful if the initial conversation is
informal with a brief introduction to the child. It is
helpful to establish a rapport around a subject of
interest to each individual child. A few moments
discussing non-dental topics such as siblings.
school, favorite toys, TV programmes, etc
provide information and a note of these can
come handy at a 6 month recall.

12. At the first visit particularly for an anxious child,
optimum time to stop may come with in a few
minutes letting the patient leave the surgery with a
sense of achievement which can be a powerful
incentive for the child to come back. For some
children just sitting in dental chair and allowing an
examination is a mile stone.
Children have inquisitive minds and lively
imagination. They benefit from being given a clear
understanding of what is about to happen and an
opportunity to ask questions. Giving small children
dental mirror to hold, allow them to look at their own
teeth and counting the teeth with them are some of
the helpful strategies.

13. There are 2 groups of children and it is very helpful to
quickly identify which groups an individual young
patient belongs to provide the information.
a) Children with an internal locus of control : They
believe they can control what happens to them and are
more likely to take preventive actions and be
responsible for their own care. Lot of details of
forthcoming treatment helps them to feel in control.
b) Children with an external locus of control: They
believe that what happens to them is by chance / luck
and it can be influenced by some one other than
themselves. They respond best to being given only an
outline of the treatment; giving them too much detail
makes them feel more anxious

14. History
Any presenting complaint should be established
at the onset as this is often the reason for
attendance.
It is also very helpful to establish what the child
thinks for the visit to a dentist as they may have a
different perspective from every one else.
Medical history is often straight forward as
majority of children have no significant illness nor
they are on any medication.

15. Clinical examination
It initially provides an idea of child’s attitude towards the
examination process and the prospect of treatment.
Very young / frightened children are best examined on the parent’s
knee. The dentist sits directly facing the parent with their knees
almost touching. The child is then laid backwards on the dentist
knee but can still clearly see the parent who can help with re-
assurance and physical contact.
An older child with behavioral problems can be examined on the
parent’s knee or it may be necessary to postpone the first detailed
examination unless symptoms dictate that early intervention is
required.
Children are susceptible to viral infections of oral soft tissues
like Primary herpes; Herpangina and also to Recurrent apthous
ulceration
Hence the intra-oral examination should include soft tissue
examination before the examination of teeth and occlusion.
It is important to record a detailed dental charting in children as
their dentition changes dramatically over time and delayed
eruptions / congenital absence may otherwise be mis-used.

16. Caries risk assessment:-
Caries most commonly determines the tooth quality in a young
patient. Occasionally other factors like Erosions.
Amelogenesis Imperfecta will have a profound effect on tooth
quality.
Risk assessment for dental caries based on 3 key factors.
Clinical findings
Dental development
Other findings.
Various risk factors include
• Considerable amount of plaque.
• Hypoplastic teeth
• Bottle feeding during night.
• Improper dietary habits
• Mother has high caries rate.

17. Treatment planning:- An important feature in successful
treatment planning in pediatric dentistry is incorporation of 3
key factors which need to be introduced in a hierarchical
manner. The factors are:
• Prevention
• Acclimatization
• Operative techniques.
The treatment plan should facilitate hierarchy of treatment (i.e.)
allow the young patients to gradually adapt to more
demanding treatment.
Care should also be taken to consider
• Parent’s motivation
• Child’s likely compliance
• Access to dental services like GA, sedation.
• Although the hierarchical approach is time consuming it will
save significant time in longer term and produce a relaxed and
co-operative patient for future.

18. Visit. 1:
• Carry out examination in chair.
• Give dietary advice, tooth brushing
instruction.
• Demonstrate 3 in 1 syringe, saliva ejector.
Visit. 2:
• Reinforce oral hygiene and dietary advices
• Demonstrate slow speed hand piece
• Introduce the patient to light cure.

19. Visit.3:
• Apply fissure sealant using the equipment earlier
demonstrated.
• Give fluoride mouth wash.
• Introduce topical anesthetics.
Visit 4:
• Apply topical anesthetics:
• Infiltrate local anesthetics;
• Complete restoration with slow speed / high speed
hand piece
• Restore with light cure compomer

20. THANK YOU