Initial Exam

An initial exam should happen within 6 months of the eruption of the first tooth or no later than 12 months of age.2

The initial visit should consist of the following:

  • Thorough medical (infant) and dental (mother or primary caregiver and infant) histories.
  • Intraoral and extra oral exam of the hard and soft tissues.
  • Assess the child’s risk of developing oral disease using a caries risk assessment.
  • Provide education on infant oral health.
  • Assess behavior of the child.
  • Provide anticipatory guidance regarding dental and oral development, fluoride status, non-nutritive sucking habits, teething, injury prevention, oral hygiene instruction, and the effects of diet on the dentition.
  • Determining an appropriate prevention plan and interval for periodic reevaluation based upon that assessment.
  • Plan for comprehensive care in accordance with accepted guidelines and periodicity schedules for pediatric oral health.
  • Refer patients to the appropriate health professional if intervention is necessary.

The initial exam is usually completed as a lap-to-lap exam. During this type of exam, the caregiver will sit facing the provider with both caregiver and providers knees touching. The infant will face the caregiver and the caregiver will gently lay the infant into the providers lap. The infant will most likely cry, so it is important to warn the caregiver of this. If the infant is crying, the provider should visualize the oral cavity while possible with the infants mouth open. The provider should demonstrate proper oral hygiene techniques.

Figure 2. Lap-to-lap or knee-to-knee technique.
Image: Lap-to-lap knee-to-knee technique.
Image courtesy of Erin L. Brown, DDS, Neighborhood Family Dentistry, Utica, NY.

Normal Clinical Findings in the Initial Exam:

  • No teeth present or up to 12 teeth present
  • Rugae in palate
  • Prominent bulges in upper and lower arch where primary teeth will soon erupt
    • Blue to purplish bulges may be present with the eruption of primary teeth
  • Pink and healthy tissue
  • High labial frenum

Natal/Neonatal Teeth:

Natal – present at birth

Neonatal – within the first 30 days

  • Incidence 1-2 per 6000 births8
  • 85% are mandibular primary incisors9
  • Many are very mobile due to poor root development9
  • Most occur in normal infants, some are a result of environmental cause or underlying syndrome8

Treatment: Leave if not very mobile. If mobility is severe causing tooth to be aspiration risk, then removal is indicated. If there is a sharp edge causing irritation of tongue, then the tooth can be smoothed or removed. If removing, it is important to curette the socket so that any cellular remnants are not left behind as these can develop into other abnormal structures that require future removal.9 It is also important to consult with patients’ physician regarding vitamin K shot to prevent hemorrhage.

Associated finding – Riga-Fede disease. This is a traumatic ulcer on the tongue from the tooth.

Cysts of the Newborn:

These can incorrectly be diagnosed as natal teeth.

Figure 3. Bohn Nodules (palatal cyst).
Image: Bohn Nodules
Image courtesy of Janelle Aby, MD.
  • Buccal, lingual aspects of alveolar ridges and on palate away from midline raphe
  • Remnants of mucous gland tissue8
Figure 4. Dental Lamina Cysts (gingival cyst).
Image: Dental Lamina Cysts
Image courtesy of Janelle Aby, MD.
  • Found in the crest of the alveolar ridge
  • Remnants of the dental lamina
Figure 5. Epstein Pearls (palatal cyst).
Image: Epstein Pearls
Image courtesy of Janelle Aby, MD.
  • Midpalatal raphe
  • Remnants of epithelial tissue