Expert Advice About When to Start Kids' Dental Visits Lacking

Marcia Frellick

February 23, 2018

Experts recommend that all children have their first dental visit by age 1, but fewer than half of parents are getting that message from their children's doctor or dentist, according to a national poll.

The University of Michigan's CS Mott Children's Hospital National Poll on Children's Health found that among those who did not receive the advice only 35% believed the checkups should start by the time a child turns 1.

Additionally, the poll found that parents with higher incomes and more education and those with private dental insurance were more likely to have received guidance on when to start the visits, a particular problem because children in low-income families have higher rates of early tooth decay, the authors note.

The poll results, released Monday, included responses from 790 parents with at least one child aged 0-5.

"Our poll finds that when parents get clear guidance from their child's doctor or dentist, they understand the first dental visit should take place at an early age," poll codirector Sarah Clark said in the report. "Without such guidance, some parents turn to family or friends for advice. As recommendations change, they may be hearing outdated information and not getting their kids to the dentist early enough."

The American Academy of Pediatrics (AAP) and the American Dental Association both recommend that all children have their first checkup by age 1, as do several other major medical organizations.

The visits can help spot early decay in baby teeth, and offer an educational opportunity for parents on oral care.

However, 40% of parents in the poll answered that their child had not been to the dentist. Among reasons they gave were thinking the child is not old enough (42%), his or her teeth are healthy and don't need a checkup (25%), the child would be scared of the dentist (15%), and dental visits cost too much (10%).

Numbers "Disappointing" and "Disturbing"

David Krol, MD, MPH, chair of the AAP's Section on Oral Health, told Medscape Medical News that the numbers that illustrate that a large number of parents aren't getting the message about the 1-year visit were "disappointing."

"The one thing that was even more disturbing was the disparity between suggestions made to high- and low-income families," he said. "It shows that we as pediatricians, family physicians, nurse practitioners, dentists and dental hygienists have a lot of work to do in educating families and facilitating the connections with families to dental homes."

AAP policies include telling pediatricians that such guidance is an integral part of comprehensive patient counseling, Dr Krol notes.

"We have to do a better job," he said.

He acknowledged that the message can get lost when pediatricians also need to talk with parents about so many other things, such as breastfeeding, development, and keeping the house safe.

That's why the message has to become a standardized part of practice, he says. In the federally qualified health center where he practices, Dr Krol says, reminders about oral health discussions and connecting the patient with a dental home are part of the electronic health record.

"We've tried to make it as foolproof as possible that both the physicians and pediatric residents are learning that," he said.

Dr Krol said he was also surprised that concerns about costs of visits were not among the main reasons given for not seeing a dentist. He hears that reason in his own practice.

The good news, he says, is that the number of children covered by Medicaid has been increasing, though he acknowledged Medicaid policies and the Children's Health Insurance Program are undergoing change. More kids at least have insurance because it's part of Medicaid's Early and Periodic Screening, Diagnostic, and Treatment benefit.

However, even that coverage doesn't mean a child can see a dentist, because some dentists don't accept Medicaid or families may have access challenges.

When parents get insurance through their employers, sometimes the plan doesn't cover the kids or requires too much out-of-pocket spending.

"We Are the Experts in Child Health"

Pediatricians have a clear role in improving children's oral health, Dr Krol said: "We are the experts in child health and that means the whole child, not just everything but the child's mouth."

That includes giving advice on health and diet, weaning from the bottle, and oral health hygiene.

There are also other opportunities for prevention, such as applying fluoride varnish.

However, he emphasized, "That's not the solution, because there are still kids who have challenges, so pediatricians should try to connect the kids with a dental home."

Some Dentists Not Comfortable Treating the Very Young

A. Conan Davis, DMD, MPH, assistant dean for community collaborations and public health at the University of Alabama School of Dentistry in Birmingham and an adviser to the Health Resources and Services Administration Committee on Training for Primary Care Medicine and Dentistry, told Medscape Medical News that part of the gap may come from limited access to pediatric dentists in some areas and resistance from some dentists, particularly older dentists, who may not be comfortable treating very young children.

Even if pediatricians are engaged in the recommendations, they may find referrals difficult if dentists in the area haven't had that training or are uncomfortable conducting a 1-year visit, he said.

The first visit is important for reasons beyond purely clinical reasons, Dr Davis said. That first visit is usually a pleasant experience for the child and it can set up a habit of good oral healthcare for the family, he says.

"As they grow older and have to have something more invasive, like a filling, then it's not as difficult or scary for them," he said.

The authors note that early visits are also used to talk to parents about correct brushing, limiting sugary drinks, and the need to avoid putting children to bed with a bottle.

Dr Krol adds that if parents aren't hearing the message from their providers they should feel free to bring up the subject.

"Hopefully as the separation of medicine and dentistry becomes less and less," Dr Krol says, "we'll work more closely together and that communication collaboration connection will be second nature in the future."

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