This month, Amaris is excited to feature expert insight from our Pillar Mom, Dr. Wendy Zhu.

At my practice, we love when babies come to see us! We see pediatric patients of all ages, but it is always an exciting visit when it is baby’s first time. Of course, it is up to the parents when they are ready to make that initial appointment for their child. In my opinion, earlier is always better! The American Academy of Pediatric Dentistry recommends the first dental visit around the time teeth first start to erupt (around six months, on average), or by the time the child is one year of age. I do notice most first visit patients at my office are around four years old. Although you might feel silly making the appointment when your baby barely has any teeth, the first visit is really just for education and to have your child acclimate to this new environment. 

What to Expect at the first visit:

When your baby is still an infant, we won’t be taking any x-rays. We won’t push the baby to do anything that makes you or them uncomfortable. We will try our best to perform an oral exam which includes checking baby’s first teeth, gums, and oral tissues. And, if baby will let us, we will do a cleaning! Sometimes this will involve just a toothbrush, or if baby is really brave, then we can use our special cleaning tools! We will usually apply fluoride at parent’s request. The first visit will be a shorter one, around fifteen minutes for baby’s exam, then add time for any questions that you may have. In my office, we aim to start taking x-rays when the child reaches four years of age. The reason for this is because all the baby molars will be there, and they tend to tighten at this age, creating a risk for cavities between the teeth. The x-rays that we take are important because they will allow us to see cavities that are not visible when we look in the mouth. Detecting these in-between cavities early is important so that they can be treated with minimally invasive methods.

What are we looking for during these visits?

Healthy teeth will be free of stains, discolorations, or white spots that might indicate early cavities. Of course we also want healthy tissues, so ensuring no suspicious lesions or injuries. 

We also educate parents on healthy practices including brushing twice a day. We recommend a floss pick when you see any teeth touching. This ensures no food or bacteria is getting trapped between the teeth.

In my practice, fluoride is recommended and is safe for all ages, as long as we use an appropriate amount. For babies, just a tiny rice-sized smear of fluoride toothpaste is adequate. Once children are three years of age, we can graduate to a pea-size amount. For parents who choose to remain fluoride-free, I see no issues with this, as long as we maintain best practices at home in order to mitigate risks.  

As a new or seasoned mom, you might have a lot of questions about your child’s oral health. 

For instance, what causes cavities and how can I prevent them? 

Forming cavities is multifactorial, a combination of diet, bacteria in the mouth, and frequency of snacking. Believe it or not, babies are born without the cavity-forming bacteria in their mouths. They can acquire this bacteria through you, as a means of vertical transmission. Thus, we recommend not to share utensils, blow on baby’s food, or kiss them on the mouth. Of course, I am a new mom too and I find these guidelines impossible to follow sometimes. I try my best to lower my baby’s risks as best as I can. This means avoiding added sugars, including fruit juice, and brushing teeth, especially before bed (yes, even if my son is fighting me). Also, drinking water after snacks helps too! If your child still nurses at night, it is recommended to wipe the teeth after you are finished to ensure that no milk residue sits overnight. I definitely don’t think it is realistic for moms to brush their children’s teeth every time! However, night time is the highest risk for bacteria to create cavities because our mouths are drier (less saliva = less acid buffering = more decay).

Should I visit a general dentist or a pediatric dentist?

This is ultimately up to you, and it is also up to the dentist what age they will accept. Many general offices will refer all children, some may accept examinations but refer treatment. If your needs are complicated, or suspect your child’s behavior warrants more specialized attention, then we recommend making an appointment with a pediatric dentist. A specialist will have staff who are trained for behavior challenges, and they are also equipped with sedation options should you go that route. 

Is there anything I can prepare before my child’s first visit?

You definitely don’t have to do anything to prepare and we don’t expect you to. Don’t worry about overbrushing beforehand. And yes, we can tell when patients don’t floss so you don’t need to start at the last minute! For some toddlers who may be fearful, it may help to discuss with them what they can expect. There are cartoons that depict an easy visit to the dentist. You can even role play at home, pretend to be the dentist, have them sit in a chair and count your child’s teeth. 

I can see cavities in my child’s mouth - what can be done?

First things first, don’t panic! Treatment will depend on the extent of the cavity. If detected early enough, a white spot on the tooth or a small finding on the x-ray, this can be prevented. Fluoride treatment and improved hygiene can prevent this cavity from growing. If treatment is necessary, the dentist will discuss with you whether a filling, crown or extraction is needed, and what sedation options are. Typically, most children perform well under nitrous oxide, also known as laughing gas. For younger children or children with extreme anxiety, we may recommend a deeper sedation or general anesthesia. After treatment is completed, then we will discuss further prevention. Diet counselling is key which means no sticky candy! Gummies, juice, and soda are usually the worst culprits. The more frequent the consumption, the higher the risk of tooth decay. Even snacks like crackers can contribute to cavities, so making smart food choices really helps.

Of course, I can’t emphasize enough how important it is to brush with fluoride toothpaste twice a day and floss nightly. For patients twelve and under, we recommend a visit to the dentist every six months. The goal of pediatric dentistry is to form good habits, so that our children can grow to become healthy adults. We hope that they will enjoy their experience at the dentist and become comfortable patients in the future. This creates easier appointments over time and reduces dental anxiety. 

-Dr. Wendy Zhu DDS