Your Child's First Visit

The American Academy of Pediatric Dentistry recommends your child's first visit to the dentist to occur by his/her first birthday. The ideal time for your child's first dental visit is by twelve months of age. By starting early, we can enable your child to enjoy the lifelong benefits of a healthy mouth. The earlier the visit, the better the chances of preventing tooth decay and other problems. Some dental problems unfortunately begin very early in life. A primary concern is Baby Bottle Tooth Decay, a serious dental condition caused by long, frequent exposure to liquids such as milk (including breast milk), formula and fruit juice. Putting a baby to bed for a nap or at night with a bottle other than with just water can cause serious and rapid tooth decay. These liquids pool around the teeth thereby giving plaque bacteria an opportunity to produce acids that attack enamel. Often times the parent is not aware of this process because it occurs on the inside of the upper front teeth where it is not easily visible.

In addition this is an opportunity for parents to gain information on diet and prevention and oral hygiene. You are encouraged to ask questions.
With your help we can make this initial visit the most positive experience possible!

For your convenience, before your child's first appointment please read the Welcome letter for more information about the first visit. Also, Please print out the pdf form, fill it and bring it to your appointment so you and your child can spend more time enjoying the office. If you experience any problems submitting the form, please print it and bring it with you to your appointment.

Here are a few suggestions to prepare your youngster for the initial visit:

• Inform your child of the appointment. Tell your child that the dentist wants to get to know him/her; present this visit as an exciting experience for yourself and for your child. One way to convey good feelings to your child about dental visits is to remind them that going to the dentist is a sign that they are growing up.
• Tell your child that we will “count,” “brush,” and “take pictures” of his/her teeth. By explaining the exam and the cleaning in these terms, your child will better understand the situation.
• Be incredibly positive about this experience. Avoid negative words such as “hurt,” “drill,” “pull,” and “shot.” Please do not tell your child that the "dentist will not hurt you" as this may never have entered his/her mind. Instead, you may wish to assure your child that the dentist and her helpers will be gentle and friendly. Talk about dentistry with a positive attitude. This initial examination involves nothing uncomfortable and should be perceived by the child as non-threatening.
• Discuss dentistry honestly with your child when he/she asks you questions. Children listen to your tone of voice and can detect your feelings very easily. If your child has questions that are difficult for you to answer, please refer him/her to our pediatric dental team for the proper answer and discussion.
Bring only the child that is to be seen for the dental visit so that both the parent and dental staff can concentrate on that child’s needs.
• We welcome the parent(s) presence during examination appointments. However, this privilege will be evaluated according to each child's behavior. The parent(s) should be a passive observer at all times during the child's dental visit.
• If your child requires treatment, we ask that you allow them to accompany our staff, by themselves, through the dental experience. We are all highly experienced in helping children overcome anxiety. Separation anxiety is not uncommon in children, so please try not to be concerned if your child exhibits some negative behavior. This is normal and will soon diminish.
Studies and experience have shown that most children react more positively when permitted to experience the dental visit on their own and in an environment designed especially for children. Our purpose is to gain your child's confidence and overcome apprehension. Our office can only achieve a successful relationship with your child when the parents show that they have confidence in our dental care.
• After the appointment, compliment your child’s good behavior at the dentist's office in the presence of other members of the family.

FAQs

What Can Be Done About Thumb Sucking Habits?
The survival of a newborn baby depends on instinctive nutritive sucking, which allows for essential nourishment. Infants also engage in nonnutritive sucking of their fingers and thumbs, which provides them with a sense of well being, comfort, and security. Thumb sucking, however, can also have negative influences on both dental development and speech. After the age of four, correction of a thumb habit may involve using psychological and/or physical preventive measures. The ultimate goal, however, should be to correct the cause of the habit, rather than the habit itself.

The mouth provides a baby's first contact with the external world, and sucking is an infant's first coordinated muscular activity. Babies even suck their thumb before they are born. Prolonged thumb sucking can deform a child's upper dental arch, cause a crossbite, protrude teeth, and create an open bite. The extent of these negative consequences are affected by the duration of the habit, the daily frequency of the habit, and the manner in which the thumb is placed into the mouth.

Children tend to suck their thumb when they are tired, bored, under stress, or in need of comfort. Taking away the soothing effects of a thumb habit may result in poor conduct by the child. Preventing a thumb habit, against the wishes of a child, may result in learning problems, bed wetting, sleep disorders, initiation of a new habit, or persistence of the old habit. Evaluation by a psychologist, pediatrician, and pediatric dentist may be necessary for the eventual resolution of the problem.

Psychological techniques for correcting a thumb habit include: reminder therapy, distraction therapy, and reward systems. Reminder therapy is useful for children who are ready to discontinue the habit. Nagging a child about a habit will most likely prolong it. Distraction therapy can involve providing a long hug, or offering a comfort object to the child - such as a blanket, favorite toy, or even a pacifier. It is important to note that pacifiers do less damage to the oral structures than a thumb habit. Reward systems usually involve the use of a calendar, on which is star is placed forever day in which no thumb habit is observed. A reward is given to the child after a certain number of stars have been earned.

Physical preventive measures should be used only in children who want to stop the habit, and in whom there are no psychological contraindications. These preventive measures include dental appliance therapy, as well as an assortment of nondental measures. Dental appliance therapy is usually the last resort, and involves wearing an appliance in the mouth, which decreases the pleasure provided by thumb sucking. These dental options include: the palatal crib, the Bluegrass appliance, the vertical crib, as well as other appliances. These intraoral appliances are also the most expensive option for the parents. They are worn for two to six months.

Nondental preventive measures include: placing a bandage around the thumb, placing a mitten on the hand, or placing an Ace Bandage around the elbow at night. In the Ace Bandage technique, an elastic bandage is wrapped around the elbow at bedtime. As the child falls asleep, the pressure from the bandage removes the thumb from the mouth. The disadvantages of this last technique are: possible decreased blood flow to the arm, and a lower success rate than with appliance therapy.
A recent dental journal article discusses the Ace Bandage technique of managing nighttime digit habits:
Adair, SM: The Ace Bandage approach to digit-sucking habits. Pediatric Dentistry 21:451-454, 1999.

Treatment For Displaced Baby Teeth Due To Trauma Trauma to a child's teeth is one of the most distressing events which can befall a youngster. Such an incident may be even more distressing to the child's parents and other family members. Many of these misadventures occur during the first three years of life, since it is during this time that a child is learning how to be independent and mobile.

Due to the soft and resilient nature of the bone which supports the primary (baby) teeth, it is common for young children to have their teeth displaced and loosened after a traumatic fall - as apposed to having teeth fractured. Luxations (displacement) of primary teeth account for up to 91% of all dental injuries in young children.

Luxation injuries of primary teeth affect the supporting alveolar bone, periodontal ligaments, and structural fibers in the gingiva - as well as the health of the pulp tissue inside of the teeth. Under the right circumstances, dental splinting of the displaced baby teeth for two weeks, antibiotic therapy, baby root canal treatment, and good oral hygiene - may preserve the health of these luxated teeth until it is time for them to exfoliate (fall out) naturally.

Root canal treatment (pulpectomy) may be necessary in order to preserve the health of the luxated teeth. A pulpectomy is needed when inflammation, infection, or degenerative changes have progressed into the root canal portion of the teeth. In this procedure, the diseased tissue is completely removed from the inside of the crown and root. Then, the root canal is cleansed, enlarged, disinfected, and filled with a resorbable material.

Parents should take the following steps when baby teeth have been displaced:
1. First, in a situation involving head or facial injury, take your child to a physician to rule out neurologic damage or airway obstruction. The physician will provide a tetanus toxoid booster or antitoxin injection, if necessary.
2. Next, take your child to a pediatric dentist for an evaluation. He/she may need to use gentle restraint to examine your child's teeth and oral structures. Your child may need to sit on your lap when dental radiographs are taken. You may also be called upon to provide gentle restraint during the examination and x-ray procedures. The dentist may need to take an "occlusal" radiograph of the teeth.
3. The dentist may elect to preserve or extract the displaced baby incisors, depending on clinical findings.
4. Parents should always request periodic dental re-evaluations for a child who has had a traumatic dental injury.
5. Parents should brush and clean their child's teeth every day, especially around the displaced teeth.

A recent dental journal article discusses a conservative method of treating displaced primary teeth:
Holan G: Conservative treatment of severely luxated maxillary primary central incisors. Pediatric Dentistry. 21:459-462, 1999.