Year : 2008 | Volume
: 26 | Issue : 6 | Page : 68--71
First dental visit of a child
R Meera1, MS Muthu2, M Phanibabu2, V Rathnaprabhu2,
1 Department of Orthodontics, Meenakshi Ammal Dental College and Hospital, Chennai-600 095, India
2 Department of Pediatric and Preventive Dentistry, Meenakshi Ammal Dental College and Hospital, Chennai-600 095, India
Department of Orthodontics, Meenakshi Ammal Dental College and Hospital, Chennai-95
Objectives: The aim of the study was to assess the common chief complaints of the Indian children and the average age group at which they report for in their first dental visit. Materials and Methods: A retrospective study was carried out using the case records of 716 children who reported to the postgraduate section of Department of Pediatric dentistry, Meenakshi Ammal Dental College, Chennai, in 2007. The age groups of the children were divided into three categories 0-3 years, 3-6 years and 6-12 years. The various chief complaints were categorised as follows, Orientation to prevention, Routine visit, Deposits / Discoloration, Habits, Unerupted / Missing or Extra Tooth, Pain, Dental caries, Malocclusion, Trauma, others. The average age group and most common complaint at the first dental visit was assessed. A prospective study was done in January 2008, were 215 children were screened. The assessment was made as explained above.
Results: Retrospective study Maximum number of children who reported for their first dental visit was between 6-12 years (59.08%). Most common chief complaint for the visit was pain (42.04%). Second common complaint being dental caries (28.49%). Prospective study Maximum number of children who reported for their first dental visit was between 6-12 years (69.77%). Most common chief complaint was dental caries (34.88%). Second common complaint being pain (27.91%). Conclusion: Children report for the first dental visit most commonly only after 6 years and for complaints like pain and dental caries. Orientation to prevention is not considered and preventive dentistry is yet to reach the common population in India.
|How to cite this article:|
Meera R, Muthu M S, Phanibabu M, Rathnaprabhu V. First dental visit of a child.J Indian Soc Pedod Prev Dent 2008;26:68-71
|How to cite this URL:|
Meera R, Muthu M S, Phanibabu M, Rathnaprabhu V. First dental visit of a child. J Indian Soc Pedod Prev Dent [serial online] 2008 [cited 2020 Jul 16 ];26:68-71
Available from: http://www.jisppd.com/text.asp?2008/26/6/68/43535
The first dental visit is an important milestone in the child's life and a timely visit should be an essential part of the child's general health care. The age of the first dental visit of the child helps in determining the quality of the preventive dental care that the child will receive and, thus, the future oral health of the child. Several studies have recommended early dental visits for children, suggesting that it should ideally be before completion of 12 months of age. ,,, The American Academy of Pediatric Dentistry also advocates a dental visit within the first year of life, which is strongly supported by the American Dental Association.  The American Academy of Pediatrics recommends oral health risk assessment by 6 months of age and establishment of Dental Home for all infants by 12 months.  An early dental visit, before completion of 12 months of age, will help the dentist to detect early lesions; evaluate craniofacial and dental development; provide anticipatory guidance, parent counseling, and diet counseling; and motivate parents towards prevention-oriented interventions. Early childhood caries (ECC) is the most common dental problem encountered in children. At this early dental visit, white spot lesions can be detected and parents can be trained to perform active preventive measures which can help avoid severe lesions later in life.
A change in perspective, from seeing only the curative aspect of dental care to appreciating its preventive and educational value, will improve the compliance of parents with dental health programs and will in turn improve the oral health status of the child. Moreover, the child is exposed to the environment of the dental clinic at an early age and this will help the child to adapt to, and cooperate with, dental treatment in the future. From several studies it is evident that the factors influencing early dental care are socioeconomic status,  awareness and knowledge regarding infant oral health among general dentists and pediatricians,  health insurance coverage, , and parents' attitude towards early dental care. 
This study was conducted in order to know the average age at which parents first seek dental care for their children and also to find the common reasons for seeking dental care at the first visit in Chennai city, India.
Materials and Methods
Present study was planned and carried out at the Department of Pediatric and Preventive Dentistry, Meenakshi Ammal Dental College, Meenakshi University, Chennai, India. The study was carried out in two phases: the first phase was a retrospective study and the second one was prospective in nature.
Patient records (case sheets) from the Department of Pediatric and Preventive Dentistry were used for the retrospective study.
In the prospective study, patients and parents reporting to the department seeking dental care were interviewed by the investigator
Phase I - Retrospective study
A total of 1100 patients' records were scrutinized, of which 716 records were considered for the study. Records that did not show the age of the patient or had inadequate details regarding the cause for the first dental visit were eliminated. From the 716 records, the age and reason for the first dental visit was noted in a data sheet. Then the patients were categorized into three groups based on the age: 0-3 years (group I), 3-6 years (group II), and 6-12 years (group III). The percentage of children in each age-group was calculated. The reasons for their visit were divided into the following ten categories:
Routine visitDental cariesDeposits / bad breathTraumaPain / sensitivityMalocclusion Missing / extra toothOrientation and preventionHabitsOthers (cleft palate, cleft lip, mobile teeth, soft tissue lesions, other reasons not mentioned above)
Phase II - Prospective study
In the second phase, 215 children were screened by the investigator in the department. Based on the age at the first dental visit, the children were separated into the three groups as in the retrospective study. Based on the reasons for the first dental visit they were categorized into one of the ten above mentioned categories. The data was recorded in a data sheet and the percentages were calculated.
Results [Table 1],[Table 2]
Even in developed nations most parents still take their children to the dentist for curative and not for preventive treatment. A great barrier remains to be overcome in order to achieve a large-scale reduction in the incidence of caries among children. The Royal College of Surgeons of England reported in their national guidelines that dental caries is the most common disease in children. Hence it is essential to detect these lesions early and prevent them. Many national associations recommend that the first dental visit for a child should be by the age of 1 year or as soon as the first primary tooth erupts.
The preventive goals during an early dental visit may include improvement of oral hygiene and eating habits, informing parents about the risks posed by non-nutritive sucking for development of malocclusions, educating parents regarding traumatic injuries and how to seek emergency care, etc. The ultimate aim is to educate and motivate the parent to take all measures to promote oral hygiene and prevent early dental disease.
According to Furze and Basso, the first dental visit should be around the fourth month of intrauterine life. During this visit by the expectant mother, the dentist has an opportunity to explain the importance of the dental visit at 6 months of age, educate the mother on eruption of teeth and preventive procedures, and to provide parent counseling. Nainar and Straffon in their study showed that the first dental visit should be performed at 1 year of age for all children from a low socioeconomic background. However, it can be an elective visit for infants from middle- to high socioeconomic status families. This study showed that in the United States only 32% of children aged 2-4 years had a dental visit in the past 12 months. Slayton et al. in their Iowa Fluoride Study reported that among children between birth to 3 years only 2% of the parents reported that their child had a dental visit by 1 year of age.  A study by Pierce and coworkers in North Carolina, showed that pediatric primary care providers tend to under-refer, and only 70% of children with evidence of dental disease received a referral. Dela Cruz et al. reported that most children are exposed to medical care at an early age but not to dental care.  A study by Cunha in a Brazilian population revealed that, following an awareness program carried out by the Baby Clinic of the Dental School of Aracatuba, the most common reported reason for infants to seek dental care was the parents' desire for orientation and prevention. 
A Scandinavian study by Poulsen showed that the prevalence of caries (initial lesions included) at the age of 1 year was close to zero, but increased to 8% at the age of 2 years.  A study by Douglass et al. reported that among 3-4 year olds, only 26% received the recommended preventive dental care, whereas 80% received the recommended medical well-child visits. Although over 90% of report that dental counseling and examination should be a part of the well-child visit, 37% of family practice residents reported no dental health education in medical school and 42% reported that they received no training during residency. According to the guidelines of the Australian Academy of Pediatric Dentistry (2002), the first oral examination should follow the eruption of the first primary teeth and be no later than 12 months of age. During first 12 months of the child's life, parents / care givers should receive counseling on appropriate oral hygiene procedures, fluoride supplementation, and feeding practice as well as general dietary counseling related to oral health; they should also be counseled regarding trauma and general injuries and oral habits. It has also been reported that in the Australian context it is evident that most children do not seek dental care till they go to school at 5 years of age.
Present study showed a low awareness level in the population, as the majority of the children were brought for the first dental visit at 6-12 years of age and the commonest reason for seeking dental care was pain and dental caries [Figure 1] and [Figure 2]. It is also evident that parents bring their child for a dental visit only when the disease is moderate to severe. Only 8.52% and 6.51% of subjects reported for the first dental visit before 3 years of age in the retrospective and prospective studies, respectively [Figure 3] and [Figure 4].
It is evident that the awareness level regarding the importance of the first dental visit is very low in the Indian population, with an average age of the child's first dental visit being at > 6 years of age. The commonest reason for seeking dental care at the first visit is found to be pain and dental caries.
|1||Widmer R. The first dental visit: an Australian perspective. Int J Paediatr Dent 2003;13:270. |
|2||Rayner JA. The first dental visit: A UK viewpoint. Int J Paediatr Dent 2003;13:269.|
|3||Nainar SM, Straffon LH. Targeting of Year One dental visit for United States children. Int J Paediatr Dent 2003;13:258-63.|
|4||Douglass JM, Douglass AB. Infant oral health education for pediatric and family practice residents. Pediatr Dent 2005;27:4.|
|5||Policy of Dental Home, Oral Health Policies, AAPD - Reference Manual 2004-2005. |
|6||Houpt MI. A dental home by age one. Pediatr Dent 2003;25:4.|
|7||Al-Hadi A, Warren JJ. Oral health behaviors of Children in low and high socioeconomic status families. Pediatr Dent 2006;28:4.|
|8||Brickhouse TH, Unkel JH. Infant oral health: A survey of general dentists, pediatric dentists and general pediatricians in Virginia. Pediatr Dent 2008;30:2. |
|9||Furze H, Basso M. The first dental visit: An argentine point of view. Int J Paediatr Dent 2003;13:266-8.|
|10||Waldman BH, Perlman SP. In 1999, the number of children (and adults) without dental insurance decreased, but. J Dent Child 2001;68:211. |
|11||Slayton RL, Warren JJ, Levy SM, Kanellis MJ, Islam M. Frequency of reported dental visits and professional fluoride application in a cohort of children followed from birth to 3 years. Pediatr Dent 2002;24:64-8.|
|12||Dela Cruz GG, Rozier RG. Dental screening and referral of young children by pediatric primary care providers. Pediatrics 2004;114:5.|
|13||Frederico R. Dentistry for babies: Why do parents seek dental care. J Clin Pediatr Dent 2004;28:193-4.|
|14||Poulsen S. Child's first dental visit. Int J Pediatr Dent 2003;13:264-5.|