In summary. The child's first dental visit is recommended within six months of the eruption of the first baby tooth and in any case no later than twelve months of age, according to the guidelines of the American Academy of Pediatric Dentistry. An interceptive orthodontic evaluation is indicated around the age of six-seven, when the first permanent teeth erupt: at that age, signs such as crossbite, prolonged thumb or pacifier sucking and oral breathing can be intercepted with simple and well-documented treatments in the literature.
When to take the child to the first visit to the dentist?
The guidelines of the American Academy of Pediatric Dentistry indicate the first visit within six months of the eruption of the first deciduous tooth and no later than the first year of life. It is not an excess of zeal: tooth decay can begin as soon as a tooth is present in the mouth, and the habits that favor it - nightly feeding bottles, frequent sugars, absent hygiene - are consolidated in the first two years.
The first visit of a one-year-old child does not resemble an adult dental session. It is especially useful for parents: we check that the eruption proceeds regularly, we observe the mucous membranes and the first dental surfaces, and we establish together the practical rules on hygiene, fluoride, nutrition and sucking habits. Establishing a dental reference early also has a less visible value: the child who knows the practice when healthy will not associate it with pain or urgency. Many children, however, meet the dentist for the first time when something already hurts: it is the worst condition for building trust.
How does the first visit take place? The gradual approach
The first session is short and does not involve any imposed manoeuvres: the child enters, explores the environment, touches the tools that can be touched, climbs into the armchair when he feels like it. The reference technique in pediatric dentistry is tell-show-do: first we tell what will happen with age-appropriate words, then we show the tool, only then we use it. In very young children, the exam can be carried out with the child sitting on the parent's lap, in a position that maintains physical and visual contact.
The goal of the first visit is not to complete the entire exam at any cost: it is to build an alliance. If the child does not cooperate, the visit is interrupted and rescheduled; any treatments are planned only after settling in. In our practice, the pedodontics area is followed by Dr. Sofia Preatoni, who dedicates herself to orthodontics and pedodontics, and the times of pediatric sessions are based on this gradual approach, not on the calendar.
What is baby bottle tooth decay and how can it be prevented?
Early childhood caries (in literature early childhood caries) is a rapid and aggressive form of tooth decay that affects baby teeth, typically the upper incisors, in the first years of life. Among the documented risk factors are the prolonged use of the bottle with sugary liquids (juices, sweetened herbal teas, milk with added sugars), the habit of falling asleep with the bottle in the mouth and the absence of oral hygiene after the eruption of the first teeth. During sleep, salivation decreases and sugars stagnate in contact with the enamel for hours.
Prevention is concrete and costs almost no effort: only water in the nighttime bottle; no honey or sweet substances on the pacifier; cleaning the gums with a damp gauze before the eruption and then brushing the first teeth twice a day; progressive weaning from the bottle to the cup. A decayed baby tooth is not a negligible problem "because it falls out a lot": the deciduous ones maintain the space for the permanent ones, guide the eruption and, if lost early due to decay, can favor subsequent malpositions.
Fluoride and sealants: what does the evidence say?
Fluoroprophylaxis
The basic measure is fluoridated toothpaste: the 2019 Cochrane review confirms that toothpastes with at least 1000 ppm of fluoride reduce the increase in tooth decay compared to placebo, while lower concentrations do not show an equally solid benefit. In young children, the quantity also counts: pediatric guidelines indicate a trace of toothpaste the size of a grain of rice under three years of age and the size of a pea from three to six years of age, with an adult supervising brushing to limit ingestion.
Added to this domestic basis, in children at risk of caries, is the professional application of fluoride varnishes in the study: the dedicated Cochrane review estimates a reduction in the increase in caries of 43% on the surfaces of permanent teeth and 37% on deciduous teeth compared to placebo or no treatment. The application lasts a few minutes and does not require any complex collaboration from the child.
Molar sealings
The first permanent molars erupt around the age of six, behind the last milk tooth, and often go unnoticed. Their deep grooves are difficult to clean and are the most frequent site of first decay of permanent teeth. Sealing fills these grooves with a photopolymerized fluid resin: the 2017 Cochrane review documents a reduction in occlusal caries of between 11% and 51% at 24 months compared to unsealed molars, with benefit maintained up to 48 months. The procedure does not require anesthesia or removal of dental tissue: it is one of the rare cases in dentistry where it is only added.
Interceptive orthodontics: why an evaluation within 7 years?
Around the age of six or seven the exchange has begun: the first molars and the first permanent incisors are present, and the bone bases are still actively growing. It is the window in which some anomalies are corrected with simple measures, before they become structured. The interceptive evaluation does not mean that every child will receive a device at seven years old: it means distinguishing, with a visit, what should only be observed from what should be treated early.
The best documented case is the posterior crossbite, present according to the literature in 4-17% of children and adolescents between Europe and America: the upper teeth close inside the lower ones, often with a functional deviation of the jaw. The 2021 Cochrane review shows, with high certainty evidence, that in children between 7 and 11 years of age, devices such as the quad-helix and expansion plates correct the crossbite in a way that is significantly superior to simple observation. Treating it in early mixed dentition prevents functional asymmetry from accompanying growth.
The other signs that deserve evaluation without waiting are protracted non-nutritive sucking (thumb or pacifier that persists into advanced preschool age), for which the literature documents the effectiveness of orthodontic and behavioral interventions dedicated to the cessation of the habit, and habitual oral breathing: a child who sleeps with his mouth open, snores or keeps his lips separated at rest should also be observed on an ENT level, because the way of breathing influences the development of the palate and the position of the tongue. In these cases the process is coordinated with the pediatrician and, when indicated, with the ENT specialist.
When we need to document the arches, in children we useoptical impression with intraoral scanner 3Shape TRIOS instead of impression pastes: a few minutes, no material in the mouth, a digital model to think about together with the parents.
Frequently asked questions
At what age should the first visit to the dentist be made?
Within six months of the eruption of the first baby tooth and in any case no later than twelve months of age, according to the guidelines of the American Academy of Pediatric Dentistry. The first visit at that age is above all a prevention meeting and practical instructions for parents.
My child is scared: is it better to postpone?
No. Postponing increases the probability that the first meeting will take place urgently, with pain, i.e. in the worst condition. A visit scheduled when healthy, with a gradual approach and without imposed maneuvers, allows you to build familiarity in favorable conditions. If there is no collaboration, the session is interrupted and rescheduled.
Should baby teeth be treated even if they fall out?
Yes. Deciduous teeth maintain space for permanent teeth and guide their eruption; an untreated cavity can cause pain, infections and early loss of the element, with possible malposition of the permanents. Treatment of baby teeth follows the same step-by-step approach as the examination.
Are seals invasive?
No. Sealing applies a fluid resin into the molar grooves without anesthesia and without removal of tooth tissue. The literature documents a reduction in occlusal caries between 11% and 51% at 24 months compared to non-sealed molars.
Is fluoride safe for children?
Yes, in the recommended ways: toothpaste with at least 1000 ppm of fluoride in a minimum quantity (a grain of rice under three years old, a pea between three and six years old) and brushing supervised by an adult. Professional applications of fluoride paint are reserved for risk profiles identified during the visit.
When is an orthodontic evaluation necessary?
Around six-seven years of age for all children, and earlier if specific signs are present: crossbite, prolonged thumb or pacifier sucking, habitual oral breathing, early loss of milk teeth. The evaluation does not imply a treatment: in many cases the indication is only periodic observation.
For an evaluation of your child's specific case, the first specialist visit includes the complete diagnostic analysis.
Sources
- American Academy of Pediatric Dentistry. Periodicity of Examination, Preventive Dental Services, Anticipatory Guidance/Counseling, and Oral Treatment for Infants, Children, and Adolescents. Pediatr Dent. 2018;40(6):194-204. PubMed.
- American Academy of Pediatric Dentistry. Fluoride Therapy. Pediatr Dent. 2018;40(6):250-253. PubMed.
- Walsh T, Worthington HV, Glenny AM, Marinho VC, Jeroncic A. Fluoride toothpastes of different concentrations for preventing dental caries. Cochrane Database Syst Rev. 2019;3(3):CD007868. doi:10.1002/14651858.CD007868.pub3. PubMed.
- Marinho VC, Worthington HV, Walsh T, Clarkson JE. Fluoride varnishes for preventing dental caries in children and adolescents. Cochrane Database Syst Rev. 2013;2013(7):CD002279. doi:10.1002/14651858.CD002279.pub2. PubMed.
- Ahovuo-Saloranta A, Forss H, Walsh T, Nordblad A, Mäkelä M, Worthington HV. Pit and fissure sealants for preventing dental decay in permanent teeth. Cochrane Database Syst Rev. 2017;7(7):CD001830. doi:10.1002/14651858.CD001830.pub5. PubMed.
- Anil S, Anand PS. Early Childhood Caries: Prevalence, Risk Factors, and Prevention. Front Pediatr. 2017;5:157. doi:10.3389/fped.2017.00157. DOI.
- Ugolini A, Agostino P, Silvestrini-Biavati A, Harrison JE, Batista KB. Orthodontic treatment for posterior crossbites. Cochrane Database Syst Rev. 2021;12(12):CD000979. doi:10.1002/14651858.CD000979.pub3. PubMed.
- Borrie FR, Bearn DR, Innes NP, Iheozor-Ejiofor Z. Interventions for the cessation of non-nutritive sucking habits in children. Cochrane Database Syst Rev. 2015;2015(3):CD008694. doi:10.1002/14651858.CD008694.pub2. PubMed.
