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Child And Parent At Dentist

Tough but necessary: Preventive care for young patients

Feb. 22, 2022
When Kari Carter-Cherelus, RDH, became a parent, she could speak from experience about treating young patients. That day-to-day experience really helps.

Becoming a new parent often leads to an abundance of complex emotions. As a clinician with 23 years of experience, my most urgent concern as a new parent was caring for my infant son’s gums and teeth. Before becoming a parent, I told pregnant patients and parents of young children how to care for their children’s oral health. Although the information was factual, I now realize I did not have day-to-day experience in the task. Now that I’m a parent, I recognize that it can be challenging to care for pediatric teeth, even when you know in theory what should be done.

Prevention is key

Inform parents that caring for their infant’s primary teeth begins before eruption and should continue after eruption. Prior to the teeth erupting, it’s important to wipe down the infant’s gums with a soft washcloth or disposable mouth wipe in the morning after the first feeding and right before bed. Wiping down the gums and tongue helps remove bacteria and sugars, and helps the child become accustomed to oral care.

To prevent decay, parents should brush their child’s teeth at least twice a day, morning and night, with a soft toothbrush and a nonfluoridated toothpaste. Fluoridated toothpaste is typically not recommended until after age two. Ideally children should begin seeing a dentist by age one or within six months after the eruption of their first primary teeth. These visits help reinforce the caregiver’s preventive care.

Ask for tips from experienced colleagues

When seeking advice for my infant son I reached out to An Chih Angelo Do (@thepediatricrdh). An Chih said it’s critical to teach parents how to care for their child’s teeth. She emphasized that children do not have good hand dexterity until the age of eight, therefore they don’t have the dexterity to do a thorough job themselves. Many parents mistakenly expect their child to have the skills to be able to brush well independently at a young age.

She recommends that offices offer a one-month complimentary follow-up appointment to provide positive reinforcement after the initial visit. The child’s initial visit should include a caries risk assessment, individualized preventive strategies, guidance for subsequent visits, and possible application of fluoride varnish. Caregivers should receive information about teething, diet, nutrition, pacifier use, ways to help prevent dental decay, and possible tongue or lip tie issues.

Build relationships built on trust

Clinicians are often most successful providing office care for children ages six months to three years by positioning the child knee to knee. This positioning allows the child to see their caregiver during the procedure while also allowing the caregiver to observe oral hygiene instruction and the clinical exam while comforting the child. Throughout the appointment, the clinician explains what they’re doing by using the tell-show-do method. This helps keep the child calm and be involved in their treatment, and helps the parent be observant throughout the appointment.

Challenges caregivers face

There is often a lack of understanding among caregivers about dietary impact on a child’s teeth. Parents may tell the clinician they give their child fruits or watered-down juices. These still expose the child to acid and sugars that increase their risk for carious lesions. If a young patient consumes snacks, that also contributes to decay due to the exposure to cariogenic foods.

Parents who have had negative dental experiences often transfer their own anxiety and fear to their children regarding dental treatment. One of the most important factors in prevention is that the caregiver is actively involved in the child’s daily oral home care. If the child has risk factors or is undergoing ortho treatment, home fluoride use is strongly encouraged, as well as more frequent dental visits.

Continue to learn

There’s a reason pediatric dentistry is a specialty because there is so much to learn! It’s important that as parents and clinicians, we help form the foundation for our pediatric patients so they will have good oral health that will help them have good overall health. To accomplish this successfully, we must be committed to lifelong learning and improving our skills so as to best be able to help our pediatric patients.