First Dental Visit of a Child at Age 1: A Policy Proposal

Richa Khanna¹

Department of Paediatric and Preventive Dentistry, Faculty of Dental Sciences, King George’s Medical University, Lucknow, Uttar Pradesh, India

Corresponding Author: Richa Khanna, Department of Paediatric and Preventive Dentistry, Faculty of Dental Sciences, King George’s Medical University, Lucknow, Uttar Pradesh, India, e-mail: richakhanna@kgmcindia.edu

How to cite this article: Khanna R. First Dental Visit of a Child at Age 1: A Policy Proposal. J South Asian Assoc Pediatr Dent 2024;7(1):1–2.

Source of support: Nil

Conflict of interest: None

It is well established that dental caries start in early childhood for most of the children and continue to remain in the mouth from primary to permanent dentition. Early childhood caries (ECC) also affects the quality of life of children and families due to pain, loss of function, irritability, and inability to chew food, thereby affecting the growth and development of jaws and functions like speech, etc.¹ The occurrence of caries in early childhood has also been linked with increased chances of caries in adolescence and adulthood.²^-⁴

Recent data shows that ECC prevalence is in the range of 46–50%.⁵^,⁶ Therefore, we should attempt to not only prevent the disease but also target various determinants of the disease so that long-term results can be achieved. As it’s known that ECC is a multifactorial disease, we need to explore a multipronged practical approach to control the burden of ECC as well as its effects on quality of life.

As per the above estimates, almost 130 crore children are affected by ECC at any given point in time in India, and the healthcare system does not have adequate manpower and resources to tackle this burden.⁷ It is necessary to think about a long-term, sustainable solution to reduce the burden of ECC. India has successfully controlled several communicable diseases and reduced early childhood diseases by introducing an essential immunization program for children.⁸ In line with this, the solution proposed by pediatric dentists is about a ”mandatory visit of the child to dental operatory at the age of 1 year.” This visit will not only give a chance for preventive counseling of parents but also help in primordial prevention through simple methods like oral hygiene, diet/feeding modifications to reduce decay of teeth, and warning signs when the parents should bring the child to a dental facility.

Various evidences about determinants of ECC necessitate a child’s visit to the dental office at the age of 1 year or within 6 months of eruption of the first primary tooth. The same has been recommended by the American Academy of Pediatric Dentistry.⁹^,¹⁰ The objective of the recommendation is clear—to implement early and periodic screening of children for oral health problems as soon as possible. These recommendations, however, do not give directions for the specific interventions/actions that can be implemented at the individual/population level for overall oral health promotion in children worldwide. Hence, there is a dire need for a uniform, standardized policy targeted at the ”first visit of a child to the dentist at age 1” that holistically includes all aspects of an infant’s oral health.

Implementation of this policy shall require the following steps at the level of policymakers in the Health Ministry, academia, and individual dental professionals.

Recommendations for the Ministry of Health:

Facilitate the first dental visit of the child at the age of 1 year as part of universal immunization.
Arrange for a sufficient number of dental professionals or auxiliaries to provide instructions related to primordial prevention and examine the oral cavity.
Arrange for integration of this program into the existing healthcare system.

Recommendations for the academia:

Augment the curriculum in such a way that each dental graduate passing out of dental school can undertake the counseling related to the first dental visit at age 1.
Arrange for training of existing dental professionals and auxiliaries through various professional associations so that they can gear up for this policy.
Create systems to document the evidence of the effectiveness of this policy so that the effectiveness can be measured through surveillance systems as well as demonstration projects.

Recommendations for individual dental professionals:

The dental profession needs to be informed about it and prepare its manpower to deliver these simple instructions to parents effectively.
The healthcare manpower as per the locality can be aligned with this policy in that they facilitate the visit of children at age 1 to a dental professional.

The benefits of the ”age 1” policy can include an ”age 1” visit to a dental office, which shall be an opportunity for dental healthcare professionals to provide anticipatory guidance for various significant dimensions of the oral health of the child. It may include and may not be limited to providing education and awareness regarding oral hygiene methods, age-specific feeding practices/nursing behaviors of the mother, the importance of fluoride in toothpaste and topical application for prevention of ECC, choices of dietary options and their influence on oral health, especially relationship of sugars and ECC, the significance of regular dental attendance, and guidance regarding follow-ups for preventive maintenance of oral health of their child.

Dental healthcare professionals can have one-to-one communication sessions with the parents and a brief extraoral/intraoral examination of the infant during the ”age 1” visit. Age-appropriate topical fluoride options can be introduced to the parents at this stage. The duration and quality of parent-supervised toothbrushing can be emphasized. Weaning from maternal feeding can be emphasized with the shift to healthy, semisolid dietary choices. Diet chart analysis can be proposed at this visit and further in follow-up visits to eliminate factors contributing to ECC. Caries likelihood determination and caries risk determination should be done at the ”age 1” visit and in all follow-ups. Early incipient carious lesions identification, especially on smooth surfaces and plaque accumulation identification can be red flags toward a high caries risk profile of the child. Parents should be advised about risk-based home care and in-office interventions. The parents can also be provided anticipatory guidance about primary teeth dental trauma and its management and development of primary teeth.

The National Oral Health Program (NOHP) in our country was developed with one of the primary objectives of ”improving the determinants of oral health” and targeting various dimensions of oral health.¹¹ If the NOHP can embrace this policy, then it can be a game changer for society in terms of dental caries prevention.

The short-term benefits shall include an improved awareness in parents and responsiveness with responsibility towards their child’s oral health by joining hands with dental healthcare professionals. Long-term benefits shall include an overall improvement in children’s oral health parameters. Dental caries increment may decrease, and the overall disease burden may reduce, and this will help India match its resources with the treatment needs. Overall improvement in oral health-related quality of life of this young population.

REFERENCES

1. Uribe SE, Innes N, Maldupa I. The global prevalence of early childhood caries: a systematic review with meta-analysis using the WHO diagnostic criteria. Int J Paediatr Dent 2021;31(6):817–830. DOI: 10.1111/ipd.12783

2. Cortellazzi KL, Tagliaferro EP, Pereira SM, et al. A cohort study of caries incidence and baseline socioeconomic, clinical and demographic variables: a Kaplan-Meier survival analysis. Oral Health Prev Dent 2013;11(4):349–358. DOI: 10.3290/J.OHPD.A30480

3. Saethre-Sundli HB, Wang NJ, Wigen TI. Do enamel and dentine caries at 5 years of age predict caries development in newly erupted teeth? A prospective longitudinal study. Acta Odontol Scand 2020;78(7):509–514. DOI: 10.1080/00016357.2020.1739330

4. Li Y, Wang W. Predicting caries in permanent teeth from caries in primary teeth: an eight-year cohort study. J Dent Res 2002;81(8):561–566. DOI: 10.1177/154405910208100812

5. Ganesh A, Muthu MS, Mohan A, et al. Prevalence of early childhood caries in India - a systematic review. Indian J Pediatr 2019;86(3):276–286. DOI: 10.1007/s12098-018-2793-y

6. Devan I, Ramanarayanan V, Janakiram C. Prevalence of early childhood caries in India: a systematic review and meta-analysis. Indian J Public Health 2022;66(Supplement):S3–S11. DOI: 10.4103/ijph.ijph_1078_22

7. Suresh KS, Kumar P, Javanaiah N, et al. Primary oral health care in India: vision or dream? Int J Clin Pediatr Dent 2016;9(3):228–232. DOI: 10.5005/jp-journals-10005-1369

8. Lahariya C. A brief history of vaccines & vaccination in India. Indian J Med Res 2014;139(4):491–511.

9. American Academy of Pediatric Dentistry. Risk assessment and management of periodontal diseases and pathologies in pediatric dental patients. The Reference Manual of Pediatric Dentistry. Chicago, Illinois: American Academy of Pediatric Dentistry; 2023. pp. 508–526.

10. American Academy of Pediatric Dentistry. Policy on the dental home. The Reference Manual of Pediatric Dentistry. Chicago, Illinois: American Academy of Pediatric Dentistry; 2023. pp. 35–37.

11. National Oral Health Programme (NOHP): Ministry of Health and Family Welfare: GOI (no date) Ministry of Health and Family Welfare | GOI. Available at: https://main.mohfw.gov.in/Major-Programmes/Non-Communicable-Diseases-Injury-Trauma/Non-Communicable-Diseases1/National-Oral-Health-Programme-NOHP (Accessed: 06 April 2024..

________________________
© The Author(s). 2024 Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.