Each day, in thousands of dental offices, a pediatric dental patient enters the treatment room. Immediately there is an increase in the heart rate, elevated blood pressure, quivering knees and lips, tears rolling down cheeks. Unfortunately, this scenario can apply to both the patient and the treating dentist and dental auxiliary.

For a variety of reasons, there are dental practitioners and staff that have an aversion to treating pediatric patients, especially infants and toddlers. This is unfortunate for both the patients and the dentist. By institution of early oral health education and the application of preventive dentistry procedures, the pediatric dental patient can be insured a lifetime of dental health. For the dental practice, ignoring or rejecting the infant and toddler population results in a missed opportunity to attract new patients to the practice.

When questioned by parents as to what age a child’s first dental visit should take place, many dentists suggest the asymptomatic child be seen after age three when there is greater likelihood of cooperation for dental treatment. However, dental problems develop in a child as young as 15 months. Often, the general dentist, when faced with such a young patient, will refer them to the local pediatric dentist with the expectation the patient will return in a few years cooperative and willing to accept dental treatment. Unfortunately, by doing so, the “too quick to refer” general dentist loses a significant potential profit center for the practice.

Once parents and the pediatric dental patient are referred to a pediatric dentist many are reluctant to return to the referring dentist. Not only did the pediatric dentist treat the immediate dental problems, but also resolved fears the child had about undergoing dental treatment. Because pediatric dentists cater to them, children are happy to return to the pediatric dentist because it means playing with video games, watching their favorite TV show or movie, and picking out a gift after treatment. Pediatric dentists have great success at treating young pediatric patients because they put equal emphasis on both providing optimum clinical treatment and happy experiences. After a few years of such happy experiences at the pediatric dentist, the pediatric patient will resist switching to the general dentist who may provide clinically equivalent treatment but may not provide the happiness they experienced.

By delaying the first dental visit past age three the general dentist loses the opportunity to treat the pediatric patient who may not return to the office until a much later time.

The sensible solution to attracting and retaining patients and achieve a viable and profitable practice, is to incorporate dental patients into the practice at the earliest age possible. Since 1986, the American Academy of Pediatric Dentistry (AAPD) has been advocating for one-year dental visits, a recommendation that has been supported by the American Dental Association and the Academy of General Dentistry. Because pediatricians and other pediatric health care professionals are more likely to encounter new mothers and infants than dentists, the AAPD lobbied the American Academy of Pediatrics (AAP) to familiarize their members with the associated risk factors of early childhood dental caries and to urge them to make appropriate referrals for early intervention and treatment. The AAP endorsed the concept of one-year dental visits in 2003 and introduced the policy to AAP members in the May 2003 issue of Pediatrics.1

The policy statement recommends an oral health risk assessment by 6 months of age and the establishment of a “dental home” for all infants by 12 months. The risk assessment can be performed by a qualified pediatrician or other pediatric health care professional. Infants requiring treatment at 6 months of age and thereafter all infants at 12 months are referred to a “dental home,” or, dentist.

The concept for the dental home is derived from the AAP’s “medical home.” The AAP states, “Pediatric health care is best delivered where comprehensive, continuously accessible and affordable care is available and delivered and supervised by qualified child health specialists.” The AAPD recommends that pediatric primary dental care be delivered in a similar manner.

An oral health examination by a dentist providing care for infants and young children 6 months after the first tooth erupts or by 12 months of age establishes the child’s dental home and an opportunity to implement preventative dental health habits that meet each child’s unique needs and keep the child free from dental or oral disease.

The 2015 AAPD reaffirmation of its 2004 revision of its policy on the dental home expects the dental home to provide:

  • comprehensive oral health care including acute care and preventive services in accordance with AAPD periodicity schedules;
  • comprehensive assessment of oral diseases and conditions;
  • individualized preventive dental health programs based on caries risk assessment and a periodontal disease risk assessment;
  • anticipatory guidance about growth and development issues (i.e., teething, digit or pacifier habit);
  • a plan for acute dental trauma;
  • information about proper care of the child’s teeth and gingival. This would include the prevention, diagnosis and treatment of disease of the supporting and surrounding tissues and the maintenance of health, function and esthetics of those structures and tissues;
  • dietary counseling;
  • referrals to dental specialists when care cannot directly be provided within the dental home;
  • education regarding future referral to a dentist knowledgeable and comfortable with adult oral health issues for continuing oral health care; referral at an age determined by patient, parent and pediatric dentist.2

This policy presents a great opportunity to prevent dental disease in the youngest population. However, the success of the policy is dependent upon whether general dentists and pediatric dentists are accepting of infant patients and welcome infant referrals from pediatricians.

By eliminating or delaying the development of caries, the general dentist has the opportunity to retain the patient in the practice without the stress of providing extensive restorative procedures to a young child incapable of cooperation. The practice has the opportunity to retain the patient in the practice from infancy into adulthood, providing preventive services such as sealants, cosmetic dentistry, bleaching, and orthodontics. Should the patient remain in the community after reaching adulthood, the general dentist has the opportunity of treating the patient’s children.

By learning and using some very simple behavioral management techniques to make dental treatment for the youngest patient a pleasant experience, the dentist can take positive steps to provide the child patient a lifetime of optimum oral health and at the same time create an additional profit center for the practice. The objective of this course is to teach some basic management skills to the dental staff that makes pediatric dentistry pleasant for both the patient and staff and profitable for the practice.