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Dr. Karen Benitez, founder & designer, board certified pediatric dentist at Chevy Chase Pediatric Dentistry is writing a series of guest posts related to adolescent dentistry and questions she frequently receives from patients that may be of interest to you. If you have a topic you’d like to see her feature, leave it in the comments. 

The first post was one that many parents wonder about; whether it is necessary for your child to visit a pediatric dentist and how the experience will differ from just taking them to the dentist you see. The second post addresses the topic of why x-rays are important for your child to have. The third post explained why your child may be referred to an orthodontist at what may seem like a young age, followed with an article all about cavities and how to proceed.The last two posts were Food and drink choice; an increased risk of cavities? and Tips on brushing and flossing.

A common question that I am asked is “When should I schedule my child’s first dental visit?”. It’s a great question and I am so happy to discuss the importance of having your child see a pediatric dentist before they turn one. The American Academy of Pediatric Dentistry (AAPD), has been lobbying and advocating for the American Academy of Pediatrics(AAP) to recommend for an infant’s first dental check-up visit by their first birthday. By 2002-03, the AAP advised finding establishing an oral health risk assessment by 6 months age and establishing a dental home by 12 months age. Why would this be so important to a community of dentists dedicated to oral health of young children? I will be frank and say that if following previous guidelines and waiting until later, more cooperative ages of 2-½ or 3 years age, it is often too late for prevention!

In our first meeting I mention two key elements surrounding oral health that the AAP and AAPD address: oral health risk assessment and a dental home. An oral health risk assessment includes the following factors for review during an exam: biological, protective and clinical findings. They are broken up into two categories of risk: high vs low. Furthermore, it is broken up into age groups. This assessment requires rather extensive examination. Various questions are posed and my assessment of the parents would be involved. The other term, a dental home, is a comprehensive, continuously accessible, family-centered established relationship with a dental provider. In other words, having and maintaining a relationship with your dental provider every 6 months.

When parents think of early check-ups with a dentist, their question is “Can my child have cavities this young?”  Let’s begin with the topic of diagnosis. Though studies show that cavities are elevated in differing socioeconomic backgrounds, I am finding decay irregardless of this. Did you know that cavities are considered a common chronic disease in children; meaning that it is continuous, occurring again and again. It is because of the chronic behavior of cavities that I am hugely insistent on regular exams, even more so after extensive dental treatment has been completed. As I had mentioned in an early blog, I look for shadows or prominent food traps. There is likely a pattern lending to a lack of access during brushing and flossing or regular food traps that if inconsistent in brushing and flossing; allowing for the process of a cavity to proceed. Check out the Colgate website indicating early signs of cavities, known as white spot lesions. These are relatively common in many patients and open up conversation about diet and hygiene modifications. When I see these, I generally increase a patient’s exam regimen to every 3 months.

I prefer that we meet early on and I help parents get comfortable in preventive measures as opposed to addressing cavity management. Most parents are very appreciative after our infant exams and feel that they can ask me various questions. Often parents express that after their infant exam they feel more comfortable in their approach, albeit still adjusting to the wiggles and temperament that accompanies this age group. I assure parents that it is ok to at times to feel like it can be frustrating because we all know that even babies and toddlers start to want to take control in this too and battle with us trying to help them. I have 3 little kids– trust me when I say I get it! It can be exhausting for such a simple task, just like changing a diaper or getting them in a car seat but it is definitely important to continue to brush their teeth.

Beyond the obvious question of cavities, is the relationship that we establish at this age. I meet some families of babies in the development of crawling or early steps. We all know how many tumbles they can take and yes, accidents can occur that involve the teeth. It does not always mean that our meeting will lend to treatment needs for injured teeth, but at least an initial meeting by their first birthday has made me somewhat familiar to both parents and baby. I prefer that you call me in the event of an injury so I can advise on how you deal with the injury and perhaps avoid unnecessary trips to the emergency department.

The early months of erupting teeth can lend to behavior changes in your baby. Parents benefit from the assurance of an exam and discussion surrounding their appropriate development and comfort management during the process. During this exam we look at the gum tissue and I guide my families to feel around with the pad of their finger to determine when the next set of teeth will be coming in. This can easily be done following brushing to keep ahead of the potential discomfort. I assess for any pathology of the gums, mostly of no concern, and for any potential eruption cysts with teeth in the process of coming in. There are various non-pharmaceutical options for teething on the market and it’s important to discuss these. I am not in preference of the use of topical anesthetic as this is not localized to the area you target, but rather can cause numbing beyond the area. It’s best to use cool materials or foods like wet washcloth or cool cucumbers or a food pouch and even frozen berries. There are various teething necklaces that can be worn by caretakers and parents. Keep in mind that your teething rings should not contain small pieces. Evaluate for a continuous form that can’t separate as a choking hazard during their use. Apply gentle massaging pressure with the pad of your finger after brushing. Babies still appreciate a good finger from mom or dad to gnaw on! Just as you would not put your baby to sleep with a bib, or a bumper guard, a necklace can pose similar risk with movement, applying pressure to their neck—an airway concern. It’s safest to use the above methods and guidance and the use of Tylenol for comfort.

It’s a great assurance for parents to come in for early check-ups since there can be many questions that arise. We are your guides in establishing good oral and dietary practices early on. This early relationship with your pediatric dentist allows you to consult with one in the time of doubt or need. Furthermore, I encourage you to seek counsel and guidance through the AAPD website. It provides a wealth of information and also allows you to find a pediatric dentist near you.

We at Chevy Chase Pediatric Dentistry welcome your child to come in and have a look. It would be our pleasure to have you!

You can also find us as Bethesda Magazine’s Face of Pediatric Dentistry, view our Top Docs video and read our stellar reviews on Yelp, Google and ZocDoc.  Follow us on Facebook to learn more about what Chevy Chase Pediatric Dentistry is all about…Focusing on your kids.

-Dr. Karen Benitez, DDS

Location: 8401 Connecticut Ave #650 Chevy Chase, MD. 20815
Phone: 301-272-1246

Courtesy of photos credited to: ADA (tooth sequence chart); Target (one balloon banner); Pinterest (natural teething cucumbers); Target (frozen food pouches).