We took our oldest daughter to her first dentist appointment right after she turned four years old. Most pediatricians recommend a first checkup and cleaning at the age of three, and some doctors are recommending first visits even younger than that. We didn’t really mean to wait until she was four; but a new baby, and a new job that didn’t include dental insurance made it easy to delay that first visit.
I was so proud of my daughter when she had her exam. She was compliant and interested in the process. I wasn’t so excited, however, when we received the results: she had seven cavities and it appeared as though three of them were bad enough to need silver caps.
For those of you who have yet to experience a disappointing first dentist visit, here are some things I’ve learned about children, teeth, and pediatric dentistry since then.
Using a bottle at night causes a condition called “bottle mouth.” Usually the front teeth are discolored or decaying with this condition. Clean your child’s (yes, even your baby’s) teeth before bed at night. Breast milk alone will not cause bottle mouth, but breast milk combined with other sugars left on the teeth will lead to that condition.
Flossing is important. I knew that flossing was important for us as adults; but I was unaware that the American Dental Association recommends flossing your children’s teeth as soon as they have two teeth close enough to touch. And that was the problem with my daughter’s teeth: most of her cavities were between her molars where brushing was not going to help.
Fluoride really helps. You can begin using fluoridated toothpaste as soon as your child learns to spit after brushing. We made this into a fun bathtub game to practice taking a small drink, and spitting it out without swallowing. The incentive to learn this new skill was the promise of pink, bubble-gum-flavored toothpaste with a picture of Disney princesses on the bottle. Most tap water is fluoridated now, but if you and your family drink mostly bottled water, you may want to ask your dentist about other sources of fluoride.
Genes count. If you or your spouse have a history of cavities and other teeth problems, chances are really good that your child will, too. Of course, if you have a sweet tooth, the chances are high that your child has inherited that tendency, and excessive sweets do lead to tooth decay, as well. Other indicators of teeth problems might be thin enamel or teeth that grow really close together.
And while I was still reeling from shame that I had neglected or even somehow caused my daughter’s tooth decay; and while I was still stunned by the sticker shock of fixing the problem teeth, the dentist brought out another piece of paper for me to sign.
This paper listed a number of “behavior management” techniques that I was allowing the dentist and his assistants to use on my child. And I was informed that neither my husband nor I would be allowed in the treatment room. The idea that someone else would be able to hold their hand over my child’s mouth to stop her screaming; or that she might be forcibly restrained by Velcro ties; or that she might be strapped to a board to immobilize her, all without the presence of her parents went completely against our parenting philosophies.
Since then, I have learned that many pediatric dentists do not allow parents in the treatment room. They cite such reasons as the child may look to the parent to rescue him; that the child is more compliant without the presence of the parent; and that crying and screaming bothers the parent worse than the dentist, who is presumably used to it.
We found those reasons unacceptable. A parent should be working in conjunction with the medical or dental professional to gain cooperation from the child. And if any restraining needs to be done, I would want her dad or I to be the one involved, not a stranger.
So it is very important to ask questions of any prospective dentist, including the policy on allowing parents in the treatment room. Don’t ever think just one pediatric dentist is the only choice, no matter how highly your play group moms have recommended this one. I called every pediatric dentist in the phone book, until I found one who actually encouraged parents to cooperate in their child’s dental care in the treatment room.
That didn’t make it easy, though. We had a total of five appointments. One was for X-rays and cleaning. Three were for pulpectomies and caps. If you are unfamiliar with these terms, that’s a good thing.
A pulpectomy is a root canal for baby teeth. It is less extensive than a root canal for adults, but because children’s teeth are so small, in a lot of cavities, the nerve must be deadened before they can fill it. And because children are prone to grinding their teeth, and the small size of children’s teeth make it difficult for large fillings to remain in place, a silver cap is placed over the tooth. This cap, unlike a crown in an adult’s tooth, does not need to be specially fitted. The cap will only be used for a few years until the tooth falls out.
Our last appointment was for one filling. But because of the memory of her previous appointments, this last one was the most difficult in gaining cooperation. Even nitrous oxide doesn’t ensure complete relaxation. So if your dentist offers to do all the work at once under general anesthesia, my advice is to consider it. We didn’t take that opportunity because it would have cost us quite a bit more. But you also don’t want a child who dreads or actively hates going to the dentist. Regular dental visits will be a part of a good health regimen his whole life.