Trends In Paediatric First Dental Visit: A Retrospective Study

Keywords

Trends; Paediatric Dental Care; Pain; Dental Care.

Introduction

Globally it has been emphasized that oral health plays an major role in general health of all age groups [1]. It is essential to provide utmost dental care to critical age groups such as children and elderly. Providing children with an early and frequent dental check-up may help them in maintaining healthy habit. Guidelines of American Academy of Paediatric Dentistry (AAPD) says that the first oral examination must be done after eruption of first primary teeth and must not be done later than 12 months [2]. According to AAPD by 6 months of age the oral health risk assessment must be done and by 12 months establishment of Dental Home must be made [3]. These protocols help in maintaining proper oral health in childhood by early detection of many other dental pathologies [4]. According to American Academy of Paediatrics (AAP), the first dental visit must be done between 6 months of age and the eruption of the first tooth [5].

The main concept of having an early dental visit is to prevent early childhood caries (ECC) and to detect and stop the progression of any incipient carious lesion. Providing patient’s parents with proper oral hygiene techniques for infants and toddlers, educating them about the importance of fluoride, helping them with how to manage, to avoid trauma that could damage the face and teeth, and the link between diet and oral health are all the some of the other of goals of having an early dental visit [5]. When the first dental visit is delayed, the child may experience further dental problems that could lead to the poor maintenance of oral hygiene. Failure to examine the caries at initial stage may lead to further infections accompanied by toothache, which in turn affects the daily routine of the child. It may also lead to expensive dental treatments and can even cause early loss of teeth. The consequences of this may extend to affect children’s overall health and development. Considering these issues, the investigation of early dental visitation is recommended [6].

The first dental visit of a child is very essential and it must be done at an early age of not more than 18 months of age. The main objective of early dental visit is not only to access the oral health but to maintain child’s oral hygiene, to counsel them with proper diet, educate them about dental caries and also factors affecting the development of malocclusions, to develop knowledge of the risks for traumatic injuries, and to aid on caries prevention [7, 8]. Information gained by the parents on their first dental visit may help them develop greater knowledge on the child’s dental health. It is important to know that the first dental visit helps the children with further dental treatments and also to make the child believe in the dentist [9, 10].

ECC is the most commonly occurring dental problem in children. Examining white spot lesion, in their early stages helps to avoid later complications such as severe lesions by taking preventive measures [11]. A change in opinion from treating patients to preventing dental care will not only improve the compliance of parents but also help the patient to improve their overall health status and development. A child who have had previous dental visit at an early age will help the child to adapt and co-operate with dental treatment in future. Socioeconomic status; [12] knowledge and awareness of general dentists regarding infant oral health; and paediatricians [13] and parent’s attitude towards early dental care are factors that influence the infants and toddlers for early dental care [14].

Considering this, the study was aimed to examine the average age at which parents first seek their children’s dental care and also to find the common reasons for seeking the first dental care which would be an initiative to inculcate preventive dental care among parents.

Objectives:

1. To determine the average age at which parents first seek their children’s dental care.

2. To find the common reasons for seeking the first dental care which would be an initiative to inculcate preventive dental care among parents.

Materials and Methods

This retrospective study was conducted in the department of Paediatric and Preventive Dentistry in a hospital based university setting in Chennai, Tamil Nadu, India. The ethical approval for the study was obtained from the review board of Institutional Ethical Committee (SRB/SDMDS3/19-20/22). This study was configured using STROBE statement [Figure-1] Digital patient records of out-patients visiting the dental institute from June 2015 to May 2019 were used for the study. Children below 17 years of age with no previous history of dental treatment were included in the present study. For eliminating selection bias, all case sheets of the children who reported to the department for dental needs were included in the study. Also a reviewer, who were blind of the study protocol, cross verified the collected data at random, to confirm the validity of the collected data. Out of 97,849 records that were retrieved, 52,615 records were excluded as they were records of adult patients. A total of 25,839 records were excluded as they were appointment and review visits. Out of the remaining 19,395 records, 1196 records were excluded as there were insufficient records on reasons for first dental visit. A total of 18,199 records were finally included for the study evaluation. The age and reason for the first dental visit were noted in a MS excel spread sheet. The records of the patients were categorised in to 4 groups based on their age as 0-3 years, 4-6 years, 7-12 years, and 13-17 years depending on the different stages of development of occlusion. The reason for first dental visit was recorded for each age group. The data regarding the reason for the first dental visit were categorized based on the following ten chief complaints.

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Figure 1:

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Figure 1. Flow diagram of retrospective case records through the study (STROBE statement).

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1. Tooth decay
2. Deposits/Bad Breath
3. Trauma
4. Pain/Sensitivity
5. Malaligned teeth
6. Missing teeth
7. Swelling
8. Habits
9. Routine check up
10. Others (cleft palate, cleft lip, mobile teeth, soft tissue lesions).

The frequency distribution and trends of children seeking their first dental visit corresponding to the above mentioned reasons from June 2015-May 2016, June 2016-May 2017, June 2017-May 2018 and June 2018-May 2019 were calculated.

Results and Discussion

Out of 18,199 case records, 9147 were females and 9052 were males. Table 1 shows that maximum age group who reported to the Department of Pedodontics and Preventive Dentistry from June 2015 to May 2019 were 7-12 years (34.39%), followed by 13-17 years (26.10%), 4-6 years (21.64%) and 0-3 years (17.85%). Figure 2 represents that there was a consistent decrease in first visit of all age groups except for 7-12 years where there was an increase in first dental visit from 2015 to 2019.

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Table 1. Frequency and percentage of age group of children with first dental visit.

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Figure 2. Trend of common age for first dental visit.

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Most common reason for first dental visit among all age groups was pain and or sensitivity (45.96%), followed by deposits and or bad breath (23.88%) and tooth decay (8.74) from 2015-2019. Habits (0.05%), others such as cleft lip and palate; mobile teeth, soft tissue lesions (0.66%), swelling (1.7%) and routine check-up were the least common reasons for first dental visit among all age groups which are presented in Table 2. The trend of most common reasons for first dental visit from 2015-2019 shows a drastic decrease in pain and or sensitivity with a slight increase in deposits and or bad breath which is represented in Figure 3.

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Table 2:

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Table 2. Frequency and percentage of reasons for seeking dental care at first visit.

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Figure 3:

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Figure 3. Trends of most common reasons for first dental visit.

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Dental fear among children is foreseen; particularly when they interpret that they might be exposed to conceivably alarming situations [15]. This retrospective study showed that most of the parents or caregivers take their children to the Paediatric dentist for curative and not for preventive dental procedures. Also the present study showed a low level of awareness among parents since most of the children were brought to dentist for their first visit at the age of 7-12 years. Though the trend of reasons for first dental visit showed a decrease for pain and sensitivity, first visit for dental caries remains unchanged. Different perspectives of age and reasons of first dental visit vary with different ethnicities. Table 3 shows a compiled view of different age and reasons among different cultures. National guidelines recommended by Royal College of Surgeons of England has stated that dental caries is the most common disease in children which requires early detection and prevention [11].

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Table 3:

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Table 3. A compiled report on various age and reasons for first dental visit across the world.

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One study reported high percentage of children seeking medical care at an early age compared to dental care [8]. A Study by Furze and Basso have stated that first dental visit should be around fourth month of intrauterine life where there is a chance to elucidate the significance of dental visit at 6 months of age and enlighten the mother on eruption of teeth and preventive measures [4]. A study in North Carolina reported that Paediatric primary care providers tend to under-refer, and 70% of children with dental problem only received a referral [39]. Among children between birth to 3 years, Only 2% of the parents reported that their child had a dental visit by 1 year of age according to an Iowa Fluoride Study [40].

Epidemiological studies governed by the Ministry of Health exhibit that more than 60% of children aged 3 years and about 25% of children aged 5 have never been to the dentist. A study by Grzesiak and Kaczmarek in 1.5-3-year-olds reported that 33% of children made their first visit to the dentist at a mean age of 2.7 years [30]. Another study had established that 22% of 4-6-yearolds have never been to the dentist, and the mean age at the time of the first visit was 2.9 years [41]. Nainar and Straffonanalysed children from Iowa, USA, younger than 3 years, and announced that only 2% of them visited the dentist before age 1, 11% before age 2, and 31% before age 3 [42]. A Brazilian study stated that most common reason for infants to seek Paediatric dentist was the parents’ want for orientation and prevention following an awareness program carried out by the Baby Clinic [43]. However, pain followed by dental caries was the most common reason for the first dental visit among Saudi, Nepal and Bulgaria children [22, 26, 38] Similar scenario regarding reason for first dental visit exists in India. [11, 34, 35] The present study in consistency with the above mentioned study showed that pain and decay were the most common reasons for the children’s first dental visit. This study also reported that deposits/bad breath was the next most common reason for first dental visit which showed an increase in the distribution through 2015 to 2019.

Parents or care takers often postpone dental treatment as they ponder their children’s oral diseases as simple ‘‘stains” requiring brushing, rather than as bacterial infections challenging restorative treatment [44]. The noted delay in or non-occurrence of dental check-up visits in low-income communities can be foreseen due to the high expense of dental treatment and caregivers’ preference in spending their incomes. Information about maintenance of oral hygiene, eating habits, traumatic injuries and malocclusion to parents can only be provided through early dental visit which will help in providing preventive dental care awareness among Indian parents. Thus, attempt to gain alertness of the significance of a child’s first dental appointment among parents and healthcare givers are strongly suggested. Health-care givers meet parents in the initial stages of children’s lives (e.g., for immunization and check-ups), which places them in a prime situation to cultivate parents, harmonize with them, and assign their children to Paediatric dentists for dental check-ups at an appropriately early age. Parents who attain dental knowledge from medical masters or pharmacists are mostly able to do so because they are familiar or convenient with these providers [45]. Headlining the concern for children’s early exposure to the dental surroundings will give Paediatric dentists the opportunity to educate new parents and expectant mothers regarding early intervention techniques and materials. Such education would include guidance to avoid saliva transfer from parents or caregivers to children through such actions as sharing spoons, kissing babies on the mouth, and orally cleansing dropped pacifiers or toys, which would help prevent early colonization of Streptococcus mutans in infants. S. mutans levels in parents and primary caretakers have been associated positively with the risks of transmission to infants and ECC [46, 47]. The results of the present study demonstrate a clear lack of dental knowledge and unawareness of the significance of first dental visit among parents of the study participants.

Strength of the present study is that this is the first study which reported the trends in age and reasons for the first dental visit of children through four years (2015 to 2019). The external and internal validity were high for the present study. However, this study failed to report socio-economic status and parents’ attitude towards preventive dental care as these factors could have provided a wider view on the children’s early dental visit.

Conclusion

Between 2015 to 2019, the most common reasons for the first dental visit were pain and dental caries. The most common age of children visiting for the first dental visit was 7-12 years. There was a necessity for awareness regarding preventive dental care and earlier dental visits among the South-Indian population.

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