Conversations about pediatric dental care can begin before the baby’s even born. Here, we recap the topics to discuss, according to the patient’s age
by Dr. Jonelle Anamelechi
I have a deep passion for the dental industry and the contribution each of us makes to our patients’ health and well-being. That’s why I serve on public policy boards that focus on children with special needs and their access to care. I’m also committed to nurturing the next generation of dentists, so I’ve been a professor at Children’s National Hospital in Washington, D.C., for seven years and am an adjunct faculty member at MedStar Georgetown University Hospital with the Department of Pediatrics and the School of Law and Equity. I did my undergraduate degree in cultural anthropology at Duke University, which opened my eyes to how people from other cultures interact with health care. While earning my master’s in maternal and child health, it became clear to me that good health starts in the womb. I had a “light bulb moment” when I realized that pediatric dentistry would allow me to help children begin a lifetime of positive oral health habits and support those born with certain risk factors.
Today, my scope of interest has expanded, and I see oral health from a variety of perspectives, including overall public health, the cultural and nutritional environment of our patients, and the developmental growth and needs of the individual child sitting in my chair. I also view it as a mother of two children myself.
Everything starts in the womb
The more I’ve learned and practiced, the more it’s evident that pediatric dentistry is about more than baby teeth. Children born to mothers who have poor oral hygiene or are in poor health may be at risk for a variety of future general and oral health problems. Moreover, while a child’s diet is responsible for 95% of caries, some oral problems have their root cause in utero. As dentists, we need to monitor these problems and collaborate with our cohorts in the health care community to manage their treatment.
You can draw a straight line between the mother’s health and the future health, growth and development of the child she is carrying, because the baby’s teeth begin to develop in utero at just six weeks.
How family dentists can help
Family dentists have an opportunity to support both women of reproductive age and expectant moms by making sure they understand that their overall health—including their oral health—has a direct impact on their baby’s teeth.
When the opportunity arises, dentists can chat about everything from the roles of nutrition and lifestyle to how a lactation consultant can help a mom through breastfeeding challenges. They can provide guidance about teething and let parents know that they can reach out to a pediatric dentist, who has a wealth of resources to offer.
It isn’t unusual for parents to ask their family dentist about their worries. Dentists are often the first people to hear about teething, sleeping or feeding concerns, or that teeth might be missing or are erupting in an abnormal pattern. General dentists also have first-mirror knowledge of the parent’s dental history. Any time a general dentist hears about teeth concerns with a child or red flags in genetic history, it is an opportunity to engage and refer the patient to a pediatric dental specialist.
General dentists have the opportunity to remind those in their patient care teams about the importance of oral health for children and that the first dental visit should take place at just 1 year of age. As dentists, working together to address comprehensive family health concerns is a required component of our job as part of a larger medical community. We’re not just the “teeth doctors”!
Questions about infants
One thing that’s unique about my practice is my work in releasing tethered ties through laser frenectomy. This procedure is used to release a tongue or lip tie to help children feed, speak and breathe more clearly and cleanse their mouth better.
Because of the proven health benefits of breastfeeding, frenectomy is, at times, a necessary procedure for moms looking to improve nursing for their newborn. This has become a hot topic in the new mom community, and families may look to their general dentists for guidance and reassurance. The important message to get across is that this procedure should be explored as a team, which may include a lactation consultant, a pediatric dentist and possibly an infant chiropractor or bodyworker.
In fact, any time families talk about infants is a teaching moment! Most families need guidance understanding the life cycle of teeth, how the introduction of solids increases the need to have an oral health routine and how common dental trauma is at such a young age, especially as young children are learning to walk. I find that most parents are receptive to this guidance because parenting books often lack detailed information about the topic of oral care.
Baby’s first visit to the dentist
Generally speaking, a child’s first dental visit should be as close to age 1 as possible. Exceptions to this rule include children born with teeth or those born with craniofacial abnormalities, who should be under a pediatric dentist’s care earlier. At that first appointment, I’m looking at the child’s oral development and seeking information on a range of topics from birth and family dental history to sleep problems and respiratory issues such as snoring.
Parents are often surprised by the amount of time we spend talking about feeding, swallowing, nutrition and their functional relationship to oral health. In truth, the entire conversation is geared toward identifying risk areas and potential future concerns.
Let’s talk about kids and sugar
Toddlers, preschoolers and grade-school children need to see a dentist every six months to closely monitor their growth and development. Our conversations in the treatment room range from brushing and flossing to feeding, nutrition and how to avoid sugar.
Parents who say their children never eat candy are always surprised when I remind them that there may be hidden culprits that contribute to caries, including acidic fruits and granola bars, which may use honey or another sugar substrate to bind them. Because of the high sugar content, these should be an occasional treat rather than an everyday snack. Reading labels for both nutritional content and tooth friendliness is essential! Gummy vitamins are another unexpected source of cavity-causing sugar. They get stuck in teeth and cause problems.
General practice dentists can do their part to reinforce good nutrition when they speak with their adult patients. Sugar is a problem at all ages and the benefits of good nutrition helps grown-ups and kids alike.
Thumbs, fingers and pacifiers warrant intense discussion in the pediatric dentist’s office. The use of pacifiers for infants reduces the risk of sudden infant death syndrome (SIDS) in infants up to 6 months of age, but prolonged use can create changes in the mouth’s shape and cause misaligned teeth.
When it comes to finger sucking, things can get a little trickier because you can’t take fingers away. It takes patience, and I have several gentle tricks from finger ointments to appliances.
In most cases, braces can reverse alignment problems caused by sucking, but heading off this issue prevents a lifetime of malalignment. According to the American Academy of Orthodontics, evaluations for braces start when a child is around 7 years old. For the most part, treatment may not begin this early, but the assessment allows parents to prepare mentally and financially. It also gives the child time with the pediatric dentist to develop the brushing and flossing skills they’ll need to keep braces clean.
Discussing dental trauma
One of the most challenging parts of treating children is watching for neglect, trauma or abuse. This is a vulnerable population, and these patients can’t always speak for themselves.
Toppling over while learning to walk or ride a bike is a normal part of growing up but can result in dental trauma. Even what looks like a little bump on the chin can make baby teeth smash into the unformed adult teeth below, causing them to emerge crooked in the years to come.
General dentists, pediatricians and other health professionals should encourage families to take their little ones to see a pediatric dentist any time they have had dental trauma. Any event forceful enough to chip a baby tooth could also damage the adult tooth nested beneath.
A holistic approach to care
A team approach is central to my philosophy. Not long ago, I noticed a young boy was grinding his teeth. Nighttime mouthguards aren’t appropriate for children this age because all their growth occurs while they sleep.
I engaged the sleep specialist on my team and we ruled out stress. Then we invited the child’s pediatrician to collaborate. We discovered he had a vitamin deficiency; the boy was grinding because his teeth were struggling to grow.
In fact, as the pandemic has deepened, pediatric dentists across the country are reporting an increase in stress-related behaviors such as grinding and thumb-sucking. Even the youngest children sense tension in the adults around them.
Older children’s routines are disturbed. They can’t see their friends and may be worried Mom, Dad or their grandparents will die. The family’s entire health care team needs to be watchful for the signs and symptoms of stress, depression and other conditions.
Despite the pandemic, regular dental appointments are vital to uncovering problems as well as monitoring the development of fast-growing mouths. During this time, I’ve been a lot more lenient and do everything I can to be flexible and make our families feel safe. From video and telehealth appointments to bringing snacks and coloring books to families waiting in cars to a 15-point safety protocol, we’ve taken pandemic precautions to the max.
Caring for the big kids
Working with older children, tweens, teens and young adults means finding ways to share the same messages about brushing, flossing and nutrition in a manner that resonates so we can help them begin to take care of themselves. I’ve discovered that a follow-up text or even a daily call to young people who refuse to brush can encourage them to adopt good habits. So far, parents have been happy to give permission.
My go-to tactic is to find out what interests or worries them and use that information to influence the decisions they make about their health. It is incredibly humbling when they trust me enough to open up. I’ve had memorable conversations with my teen patients about everything from exam worries to a gender transition to how difficult it is to try out for cheerleading.
I have a library of photos and brochures to show young people the oral consequences of recreational drugs, smoking and vaping. Whenever I get the chance, I use all my persuasive powers to dissuade them from getting tongue and lip piercings.
By the time these young people age out of pediatric care and into the hands of my general dental colleagues, I’d like to believe that they’ve learned the habits and skills they need to take care of themselves.
Final thoughts
I think the most important thing we can all do as dentists is to be mindful of how we communicate and reinforce advice for good health with our patients and their families. Building relationships, developing trust and finding ways to influence and motivate is the secret sauce needed to help children grow up to enjoy the best health possible.
I love my work and the opportunities I have to shape health policy, teach pediatric dentistry and influence my own families in practice one tooth at a time. I’ve built a great team around me. I feel genuinely honored to be part of a national and international “parent squad,” and I am optimistic that I am influencing a generation of families that know the mouth-body connection.
