Initial Exam

An initial exam should happen as early as six months of age, or six months after the first tooth erupts and no later that 12 months of age. Thorough medical histories of the infant and dental histories both of the mother/caregiver and infant should be recorded. It is important to ducate the caregivers in infant oral care, provide a caries risk assessment and determine an appropriate prevention plan. Referral to specialists should be evaluated, if needed.

The initial visit should consist of the following:

  • Thorough medical (infant) and dental (mother or primary caregiver and infant) histories.
  • Thorough oral examination.
  • Assess the child’s risk of developing oral disease using a caries risk assessment.
  • Providing education on infant oral health.
  • Providing 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.
  • Planning for comprehensive care in accordance with accepted guidelines and periodicity schedules for pediatric oral health.
  • Referring patients to the appropriate health professional if intervention is necessary.

There are several techniques used for this initial exam. The one recommended is the lap-to-lap knee-to-knee where you will demonstrate oral hygiene and ask the parent to participate. Usually the child will cry and this will help in keeping the mouth open. Make sure the parent understands what you will be doing as they can be surprised.

Figure 2.
Image: Lap-to-lap knee-to-knee technique.
Lap-to-lap knee-to-knee technique.
Figure 3.
Image: Brushing infant's teeth.
Brushing infant’s teeth.

Normal Clinical Findings in the Initial Exam:

  • No teeth
  • Rugae in palate
  • Toothbud bulges
  • Tissue pink and healthy
Figure 4.
Image: Normal clinical findings.
Normal clinical findings.

Natal/Neonatal Teeth:

Natal – present at birth.

Neonatal – within the first 30 days and erupts prior to three months of age.

  • 1:2,000-3,500 frequency
  • Natal 3:1 neonatal
  • 90% are true primary teeth
  • Most are poorly formed
  • Etiology: unknown or it can be a superficially positioned toothbud

Tx: monitor; removal/smoothening of tooth

Associated finding – Riga-Fede disease which often shows a sublingual traumatic ulceration

Figure 5.
Image: Riga-Fede disease.
Figure 6.
Image: Riga-Fede disease with sublingual traumatic ulceration.
Riga-Fede disease with sublingual traumatic ulceration.
Premature Teeth Diagnosis:
Figure 7. Bohn Nodules
Image: Bohn Nodules
  • Buccal, Lingual aspects of the maxillary alveolar ridge (away from midline raphe)
  • Mucous gland tissue
Figure 8. Dental Lamina Cysts
Image: Dental Lamina Cysts
  • Found in the crest of the alveolar ridge
  • Remnants of the Dental Lamina
Figure 9. Epstein Pearls
Image: Epstein Pearls
  • Midpalatal Raphe
  • Trapped epithelial remnants
These are visible in 80% of newborns.