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For the past two decades, U.S. pediatric dentists have promoted the importance of having little ones get their first oral health checkup by age 1. The American Academy of Pediatric Dentistry made the recommendation official back in 2001, and the American Academy of Pediatrics followed suit the following year.
Yet dental disease rates rose among children during the most recent survey – a sign that many parents simply aren't getting the message.
Part of the problem is that some general dentists and primary care doctors haven't yet updated their old-school ways and are still advising parents that their toddlers don't need to get their teeth checked until they're 3.
"I think it's a generational thing," says Dr. Eve Rutherford, a Snohomish dentist and mother of two young children. "For a long time … general dentists just weren't taught to take on young patients."
Even some of her highly educated friends who ask her when they should take their children to the dentist sound surprised when she says by age 1. "They say, ‘Well, my dentist doesn't see anyone under 3,'" says Rutherford, who's been practicing for eight years since graduating from the University of Washington's School of Dentistry.
In some cases, when her friends have waited too long, Rutherford says their kids have sulked away from their first dentist visit with two cavities. The problem is widespread, and, despite the clear consensus that oral health screening should begin at age 1, it appears to be getting worse.
Dental disease rates among children ages 2 to 5 rose to 28 percent in the period from 1999 to 2004, compared to 24 percent in the period from 1988 to 1994, according to the National Center for Health Statistics' latest survey on dental health.
Disease rates are even worse in Washington state among low-income children. In 2005, 45 percent of poor preschoolers had dental decay compared to 38 percent in 1994.
Some theories behind the increase include night-time nursing and bottle feedings well after a baby's first teeth have come in, the growing prevalence of highly processed, high-sugar foods in children's diets, as well as juices that children drink throughout the day over long periods of time. The bacteria that live on teeth break down all that sugar into acid, and the acid breaks down the enamel on teeth, leading to tooth decay.
Rutherford surmises that dentists who still discourage parents from bringing their kids in before age 3 feel they're wasting their time unless they can do something for a patient – "like treat someone for cavities … or work on a tooth" rather than simply taking a close look inside a baby's mouth and hopefully not spotting any early signs of trouble.
"Seeing young children – though you may not be able to treat problems – it's a good opportunity to screen patients and talk to parents about the potential for problems," Rutherford says.
Some good news: A growing number of pediatricians and family practitioners are incorporating oral health screenings into their patients' age-1 well-baby checkups. And in communities like Puyallup, where drinking water isn't fluoridated, some primary care doctors are beginning to give children fluoride treatments during their checkups.
Dr. Ovidio Penalver, a longtime pediatrician in Puyallup, started giving his patients fluoride treatments a few years ago, after his office staff went through a Washington Dental Service Foundation early oral health training program. The foundation is funded by Washington Dental Service, a nonprofit dental benefits provider that serves nearly 2 million people across the state.
So far, the foundation has trained nearly 2,000 doctors and medical staff statewide on how to conduct early oral health screenings; that represents about one-quarter of the primary care medical providers that serve young children in Washington, foundation spokeswoman Dianne Riter says. It's on track to train another 150 this year and has a goal of getting all primary care providers who serve young children trained.
Penalver is a big believer in the importance of early oral health checkups. He's been including it in 1-year-old patients' well-child visits throughout his nearly three decades in practice.
"It's as important as having their annual physical and vaccinations," he says.
Elizabeth M. Gillespie is managing editor of Seattle's Child.
