My Kid's First Dental Visit

I get asked occassionally by friends and family, "when should lil junior get his first dental exam?" This is usually followed by, "I think he might have a cavity."

Actually, it is recommended that all newborns have their first dental visit within the first year and at least by the time their first teeth start erupting. The obvious question would be why would an infant with no teeth need to see the dentist? It's important to remember that the teeth are only half of what comprises a true oral exam. It is just as important for a trained professional to examine the head, neck, mouth, and gums for any diseases or problems.

Usually with infants, a simple exam with a mirror and cotton gauze is all that is necessary on the first visit. It is also important to tell the dentist if your child is drinking tap, bottled, or well water. This is important because some water from natural wells and most bottled waters will lack the necessary flouride to promote healthy tooth development. Most city treatment plants add the necessary flouride to help strengthen your childs teeth as they are growing. If your child does not have access to flouridate water than the dentist can prescribe some flouride supplements to help ensure your child is getting enough flouride fro their age.

For the actual exam, most dentist will utilize a "knee-to-knee" position for the exam. This is accomplished by having the child's parent hold the child facing the parent and sitting. The dentist then sits in front of the parent at the same height and touches "knee-to-knee." The parent then gently lays the childs upper torso on the dentist's lap. The dentist then has an excellent view of the head and neck, and the child has the comfort of the parent's touch as well.

Of course, most infants and young children will become anxious and unhappy in the dental office. Here at Avalon, I believe this first dental visit is the most important in shaping that child's view and behavior in all future dental visits for the rest of his or her life. Therefore, I emphasize to my team and the parent that we must take our time in introducing a new patient (regardless of age) to our office and dental care in general. For high anxiety patients, I recommend spending the first visit just introducing the patient to the sights, sounds, and smells of a dental office. This desensitizes the child to these new senses. Then I recommend bringing the child back within the next week to actually attempt an exam and cleaning. Of course, every patient is different, and we at Avalon Dental make sure we treat each patient individually.

What's Gingivitis?

So what is this gingivitis that the dentist keeps telling me about? And how is it different than periodontitis?

The simple answer would be that gingivitis is an inflammation of your gums, or gingiva. The long answer would be that gingivitis is the beginning of a disease process initiated by bacteria in your mouth, which has the potential to progress into periodontitis. I know... keep it simple right?

So to expand on the simple answer, it's important to state again that having bacteria in your mouth is normal. The first step to getting gingivitis is allowing plaque, that white stuff that forms along your gum line, to accumulate on your gums. This plaque allows the bacteria to live close to your gums and teeth. Some of these bacteria will eventually cause gingivitis and then periodontitis, and other types of bacteria will cause cavities.

Now you can see why your dentist and hygienist always stress keeping this plaque from accumulating on your teeth. The plaque itself is not particularly harmful but it allows these bacteria to stay on your teeth and gums.

Well, the bacteria that causes gingivitis start to overgrow within this plaque. Their waste-products begin to accumulate and your immune system starts to react to this build-up of bacteria and waste-products. The inflammation is actually your gums trying to fight off this bacterial infection.

If the plaque and its bacteria stay too long on your gums, the inflammation begins to spread to the bone underneath your gums. Once the inflammation reaches this stage, this bone under the gums start to recede away from their normal levels. This is basically a self-destruction of your jaw bone, that as it progresses causes your teeth to become loose. When the inflammation begins to affect the underlying bone, it is called periodontitis.

Not everybody with gingivitis will get periodontitis because this depends not only on plaque, but the person's genetics and the specific bacteria present in the plaque. Since it is nearly impossible to determine every patient's genetic make-up and its expensive to perform the lab tests necessary to identify specific bacteria in the plaque, we as dentist recommend everyone to keep plaque off their teeth and seek immediate treatment for gingivitis.

Next time, we'll get into the different treatments available for gingivitis and periodontitis.

Why A Specialist? Part II

So now I'd like to run down some common dental titles that are not true dental specialties. Remember that a true specialty requires extra schooling and a state certification. The following are just titles dentist use to describe their specific interest in the field of dentistry, but they are not allowed to imply they are "specialists" in these interests.

1) Implantologist: The implication is that they "specialize" in the placement of dental implants. Currently, there are no true specialty programs associated with US universities that teach a multi-year curriculum in only dental implants. There is no State licensing exams a dentist has to pass in order to call themselves an "implantologist."

2) Cosmetic Dentist: The implication here is that there is a difference between cosmetic and general dentistry. According to State and National licensing guidelines there is no difference. Every dentist should be a "cosmetic" dentist because all dental work has an aesthetic aspect to it. Now certain dentist have taken the time and effort to take extra continuing education programs in the field of cosmetic dentistry and expand their knowledge of this aspect of dentistry, but it is not implied that cosmetic dentistry is a separate entity from general dentistry.

3) "Practice limited to ...": Some general dentist have limited their practice to only provide treatments associated with any of the true dental specialties. For example Dr. Jon Doe whose practice is limited to endodontics, provides only root canals for his patients. It is important to note that Dr. Doe is actually a general dentist and cannot legally advertise himself as a specialist. A true dental specialist has a degree in the area of specialization and the degree would be listed in the letters following the "D.D.S. or D.M.D" in his/her title.

I should clarify that just because a dentist uses any of the titles listed above, he or she is trying to deceive the public. These are all accepted, legal titles a general dentist may use in the description of his or her practice. I am just listing these to distinguish them from the true dental specialists.

So in conclusion, why are you being referred to a specialist? Well just like our physician colleagues, there are situations where the best possible outcome available to our patients can only be achieved by a specialist in that particular field. A general dentist can legally provide treatment in all fields of dentistry, but the specialist is there as a resource for the dentist and patient for cases that are not considered "traditional" or "straight-forward."

As a general dentist, I see a wide variety of patients and every patient has a different set of dental needs. A specialist only provides one field of treatment so they have the experience and training to provide the best possible care in that field.