Children’s Oral Care: When Should Dental Visits Start?

A recent national poll revealed that without a doctor or dentist’s guidance, some parents don’t follow national recommendations for early dental care for their children. One in six parents who did not receive advice from a health care provider believed children should delay dentist visits until age four or older, which is years later than what experts recommend according to the C.S. Mott Children’s Hospital National Poll on Children’s Health.

The American Academy of Pediatrics and the American Dental Association both recommend starting dental visits around age one when baby teeth emerge. “Visiting the dentist at an early age is an essential part of children’s health care,” says Mott poll co-director Sarah Clark. “These visits are important for the detection and treatment of early childhood tooth decay and also a valuable opportunity to educate parents on key aspects of oral health. Our poll finds that when parents get clear guidance from their child’s doctor or dentist, they understand the first dental visit should take place at an early age. Without such guidance, some parents turn to family or friends for advice. As recommendations change, they may be hearing outdated information and not getting their kids to the dentist early enough.”

The poll was based on responses from 790 parents with at least one child aged less than one year to five. More than half of parents did not receive guidance from their child’s doctor or a dentist about when to start dentist visits. Among parents who were not prompted by a doctor or dentist, only 35 percent believed dentist visits should start when children are a year or younger as is recommended. Over half of parents reported their child has had a dental visit with most parents believing the dentist visit was worthwhile. Among the 40 percent of parents whose child had not had a dental visit, common reasons for not going were that the child is not old enough, the child’s teeth are healthy, and the child would be scared of the dentist. Experts say starting dental visits early helps set children up for healthy oral hygiene, with parents learning about correct brushing techniques, the importance of limiting sugary drinks, and the need to avoid putting children to bed with a bottle.

Early Tooth Decay

Early childhood caries - dental decay in baby teeth - may also be detected at young ages, allowing for treatment of decay to avoid more serious problems. A quarter of parents who had delayed dental visits said their child’s teeth are healthy but it is unlikely that a parent could detect early tooth decay. “Parents may not notice decay until there’s discoloration, and by then the problem has likely become significant,” Clark added. “Immediate dental treatment at the first sign of decay can prevent more significant dental problems down the road, which is why having regular dentist visits throughout early childhood is so important.”

Healthcare recommendations for early childhood are often focused on well-child visits with medical providers, which can be another factor that may delay dental care. “Parents often hear clear guidelines on when they should begin well-child visits for their child’s health and often schedule the first visit before they even bring their baby home from the hospital,” Clark said. “Doctors typically prompt parents to stick to a standard schedule for immunizations and other preventive care. Parents get much less guidance, however, on when to start taking their child to the dentist, with less than half saying they have received professional advice. This lack of guidance may mean many parents delay the start of dental visits past the recommended age.”

Parents with higher income and education, and those with private dental insurance, were more likely to report that a doctor or dentist provided guidance on when to start dental visits. “Our poll suggests that families who are low-income, less educated, and on Medicaid are less likely to receive professional guidance on dental care,” Clark said. “This is particularly problematic because low-income children have higher rates of early childhood tooth decay and would benefit from early dental care. Providers who care for at-risk populations should dedicate time to focus on the importance of dental visits. Parents should also ask their child’s doctor or their own dentist about when to start dentist visits and how to keep their child’s teeth healthy.”

Link Between Food Choices At School And Healthier Teeth

While it's normal for adult teeth to show up at very different times, should we expect the same good oral health conditions for all children at all times? In Québec there has been no impact study on oral health promotion since provincial guidelines were published in 2005. A team of Montréal researchers, including Dr. Tracie Barnett of INRS, took a look at schools in Greater Montréal to see how oral health was being promoted and what incidence this had on cavity rates in children. Published in the American Journal of Preventive Medicine, this study concluded that prevention programs are important, but that school food environments play a leading role in the appearance of cavities in kids ages eight to 10.

Food choices in and around schools vary greatly and affect the general health of children. It's an environment often carefully observed to understand its impact on obesity prevalence, but rarely in relation to cavities. The data gathered for the study – referred to as a family study on the prevention of cardiovascular disease and Type 2 diabetes in kids and teens - was ideal for verifying children's dental health.

Over a period of two years, the research team analyzed various factors affecting 330 students at 200 schools, including socioeconomic factors, school food environments, and cavity prevention programs. Programs promoting healthy eating and good dental hygiene had a positive but relatively modest impact compared to children's food and socioeconomic environments.

Because cavities remain a public health concern, the researchers suggest making this component part of health promotion programs alongside obesity. Policies promoting healthy eating environments could have a greater impact on children's oral health than school programs run in isolation to encourage kids to take good care of their teeth.


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