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Start them early: Dentists advise visiting sooner

Laura Barker holds her 2-year-old son
Laura Barker holds her 2-year-old son, Camdon, while pediatric dentist Gaurav Agarwal starts an examination. The knee-to-knee method allows the parent to be present during the exam, which is comforting for the child. Dennis Grundman/Daily (Buy photo)

Agarwal reaches for 21/2-year-old Josie Russell
Agarwal reaches for 21/2-year-old Josie Russell, held by her mother, Erin during a knee-to-knee procedure. Dennis Grundman/Daily (Buy photo)

Camdon looks up
Camdon looks up while Agarwal examines his teeth. Dennis Grundman/Daily (Buy photo)

By Alex Bridges - abridges@nvdaily.com

WINCHESTER -- How early is too early for a child's first trip to the dentist?

Up until recently, dentists recommended parents have their child make their first visit at age 4 or 5.

But now some experts say that first visit should come much earlier. An initiative called "Get It Done Before Year One" pushes for that first exam by the child's 12-month birthday.

A recent study sponsored by the American Academy of Pediatric Dentistry indicated 97 percent of mothers polled didn't know a child needed to visit a dentist in the first year, according to a news release issued by the organization. Failing to take children to see a dentist in the early stage of life leaves a large number of infants vulnerable to tooth decay and disease, the release states. Tooth decay can begin as early as 6 months when teeth start to emerge. If left untreated, decay can destroy teeth and lead to pain, infection, tooth loss, increased health care costs and consequences later in life, according to the release.

Winchester-based pediatric dentist Gaurav Agarwal agrees with the initiative. The dentist recommends parents bring their child in for an exam either at 12 months or when the first tooth starts to appear -- whichever comes first.

"You talk about coaching the parents on hygiene, habits, on fluoride, on diet," Agarwal said. "Hygiene. Habits. Fluoride. Diet and trauma."

Agarwal's practice, Valley Pediatric Dentistry on Cedar Creek Grade, features equipment designed specifically for young patients. For patients under 3, Agarwal and the assistants use a smaller room where they can conduct "knee-to-knee" exams on young patients. The dentist or assistant sits with his or her knees to the parent's. The child lies down facing the parent and the dentist or assistant looks at the patient's mouth, upside down, to examine the teeth.

"While I'm looking [at the teeth] the parents are looking 'cause sometimes that's the first time they've looked in their child's mouth is when I'm looking in their mouth," Agarwal said.

As Agarwal explained, this kind of approach helps keep the child from feeling "separation anxiety" that may occur if taken away from the parent. But children, as they can look at their parent face to face and are holding hands, still may put up a fuss and, sometimes, even scream, Agarwal said. So the room is built with soundproofing material, he said, though some noise can creep out. With children as young as 2, many do complain, cry or scream, he said.

A parent cannot always rely on a child to maintain their own dental care.

"I see parents come in with 2-year-olds and saying 'he brushes his teeth every day,' and you can't expect a 2-year-old to clean their own teeth," Agarwal said. "Sometimes you can't expect a 10-year-old to keep his teeth clean, let alone a 2-year-old."

"I typically tell parents when you can trust them to keep your kitchen floors clean or when you can trust them to do dishes is when you can trust them to keep their teeth clean," Agarwal said.

Parents also need to make sure their children use fluoride, the dentist advised. Those who rely on well water may need to check the levels and add fluoride if necessary, he noted. Other residences on well water may see too much fluoride.

The new push to see teeth at a younger age has its critics.

"There are quite a few general dentists that were trained to say that the first visit needs to be at age 3, 4, even 5," Agarwal said. "By then it's sometimes too late ... I can show you teeth that I've had to, on children 2 years of age where I've had to extract 10 teeth out of 20 of their teeth."

"You can't save them and baby teeth are so thin, the enamel is so thin that once decay starts it progresses very rapidly, and a matter of a couple of months, a few months, can mean the difference between being able to save a tooth versus extracting a tooth," the dentist said.

At 1 a child may still eat baby food. But no matter what the consistency, the food contains sugar or carbohydrates that can eventually break down into sugar, Agarwal said. Left in the mouth or on a child's tooth, the sugar can cause decay, the dentist warned.

"Milk is the No. 1 culprit on baby teeth that causes decay because it has sugars, and it'll break down in the mouth," Agarwal said.

Dentists dubbed the problem they saw with children as "baby-bottle decay" or "baby-bottle rot." Some parents also give their children juice to drink from their bottles or sippy cups. Agarwal said he tells parents to dilute juice with water, usually half of each, because of the high sugar content.

When treating younger patients, Agarwal said one out of every three usually requires anesthesia because of their age.

"Extractions, you'd be surprised, I can usually do while they're awake because it's not technique sensitive," Agarwal explained. "Basically you just have to get them numb. I just kind of hold their head a little bit and the parents help hold their hand."

"But trying to do fillings or crowns or something, or if it's multiple extractions, then we end up putting them to sleep," Agarwal added.

Baby teeth have to make way for adult teeth eventually. When asked what the point is behind taking so much care of baby teeth, Agarwal had at least one reason.

"But if the decayed teeth don't get treated, they can turn into abscesses," Agarwal warned, pointing out examples in a model.

Another model showed examples of crowns and spacers the dentist said he has had to give some patients.

Pediatric dentistry, a relatively new approach to oral health, requires more education for certification, according to Agarwal. His practice recently added orthodontics to its offerings.

Agarwal also sees patients who have damaged their teeth, often by falling and hitting the mouth on a hard surface. At the same time, Agarwal sees children who, through sucking their thumb or their pacifier, started to create an overbite. The suction over time forces the top front teeth to push out and those on the bottom to move inward, Agarwal explained. The jaw also can shift and worsen the problem, he warned, and showed a model that illustrates the effect of thumbsucking on the mouth. Given a choice, dentists prefer pacifiers to thumbs, Agarwal said.

"It's normal and natural for most kids to have a habit but we say you want them to stop by age 2 before it starts ... affecting their open bite," the dentist said. "So it has bad outcomes if it's left in too long."

On a recent visit, 21⁄2-year-old Josie Russell hugged her mother, Erin Russell, tight as the dentist tried have the child lie down so he could conduct his knee-to-knee exam. It took some coaxing, but eventually Agarwal was able to examine the child's teeth.

"We thought she was doing great," Russell said after the checkup. "She had six cavities."

Getting a child to relax, lie down and keep his or her mouth open long enough for an exam is tough, she admitted. But the mother said she still recommends parents start taking children to the dentist early.

"Anything you can do to prevent cavities."


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