Good dental care early in a person's life can be vital to their health later. That's why treating infants and toddlers is a very special job. Dentists who choose to treat infants and toddlers work to prevent tooth decay, including baby bottle tooth decay, treat dental injuries, recognize the signs of child abuse and promote a healthy mouth into adulthood. This article just brushes (no pun intended), the surface of this huge topic. Here we discuss the first dental visit, facts associated with children's oral health and baby bottle tooth decay.

Parents, pediatricians and dentists have conflicting ideas about when a child's first dental visit should occur. According to the American Academy of Pediatric Dentistry (AAPD), many family dentists may tell parents the first dental visit should occur after a child has all primary teeth (age two or three). Sometimes parents are told to wait until age six. The parent of a fearful or uncooperative child may even be told to wait until their child is old enough to sit still.

The AAPD recommends an initial postnatal oral evaluation within six months of the eruption of the first primary tooth and no later than 12 months of age. The oral examination at this early age is usually accomplished with the parent present in the office. It is most often a visual exam. The child may sit in the parent's lap with his or her head in the dentist's lap (knee-to-knee position).

During the first dental visit, a new chart should be started for the child with a thorough medical and dental history. The risks associated with developing early oral and dental disease and the need for fluoride supplementation should be discussed with the parent during this visit. Finger sucking, pacifier, oral hygiene and effects of diet on the dentition should also be addressed.

A dentist should also assess the child's oral and dental development. Parents will commonly ask when they can expect to see the rest of the child's teeth develop. Generally, the lower central incisors followed by the upper central incisors usually erupt at about six months of age. All lower incisors and all upper incisors have usually erupted by 12 months of age. Parents should be aware that eruption times vary from child to child.

Your top priority is giving your patients the best dental care possible, and sometimes referring a patient to another doctor such as a pediatric dentist, is part of that care. Consider referring a patient if...

• treating children is not part of your practice philosophy.
• a parent prefers to see a doctor who specializes in pediatric dentistry.
• a patient's special needs impedes your treatment.

Nursing bottle caries, nursing caries, bottle caries, and infant caries are all terms for baby bottle tooth decay. This decay occurs when children are improperly fed juice, milk, formula, or any other liquid sweetened with fermentable carbohydrates. Parents should never dip their infant's pacifier in honey or give soda in a bottle.

Fortunately, overall water fluoridation and other methods of fluoride application have reduced caries rates over the years. However, caries is still a problem that plagues many children. Early intervention is essential to its successful treatment and prevention. Here are some tips by the AAPD and the ADA for parents to decrease their child's risk of developing caries:

• Never allow a child to fall asleep with a bottle containing milk, formula, fruit juice or sweetened liquids. Infants should not be put to sleep with a bottle containing liquid other than water.
• After each feeding, wipe the baby's gums with a clean gauze pad.
• Never give your child a pacifier dipped in any sweet liquid.
• Begin brushing your child's teeth when the first tooth erupts. Clean and massage gums in areas that remain toothless, and begin flossing when all the baby teeth have erupted, usually by age 2.

For information on how to treat the young patient with caries, and to view photos of children with this disease, please visit http://home.flash.net/~dkennel/bottle.htm.

From time to time, the use of restraints may become unavoidable. Restraints are often used with special needs patients and emergency cases. If you are not trained in the use of restraints or they are not a normal part of your practice, consider referring the patient to a doctor who is more adept at this practice. If you do choose to restrain a child for treatment, an informed consent form must be presented, discussed and signed by the child's parent or guardian, before you proceed.

The American Academy of Pediatric Dentistry is a valuable source of information about a variety of topics surrounding the pediatric patient. Please visit their web site at www.aapd.org.

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