When Should a Child First See a Dentist?

Most parents guess age three. Some were told to wait until all the baby teeth are in, and a few assume the pediatrician has it covered. The actual recommendation is earlier than nearly everyone expects, and the reasons behind it are practical, not fussy.

What age should a child first go to the dentist?

For most babies the first tooth shows up around six months, though anywhere from four months to a year is normal. So "first tooth or first birthday" usually means a visit somewhere between six and twelve months old. The ADA's patient site, MouthHealthy, gives the same guidance.

If your child is already two or four and has never been, you haven't failed. You're starting now. Our children's dentistry visits are planned around whatever age a child walks in at, and nobody is keeping score.

Why waiting until all the baby teeth are in backfires

The full set of 20 baby teeth is usually in place by about age three. Waiting for that milestone sounds logical. It also hands decay a head start of roughly two years.

A tooth can begin to decay as soon as it breaks through the gum. The upper front teeth are among the first to arrive, and they are exactly the ones bathed in milk or juice when a baby falls asleep with a bottle. Early decay on those teeth doesn't look like a cavity. It looks like a chalky white line along the gumline — easy to miss at bath time, obvious to a dentist in seconds. Caught at that stage, it can often be halted with fluoride and a change in routine. Missed, it turns brown, then breaks down.

There's a second cost that has nothing to do with enamel. A child whose first appointment is a calm look-around at age one learns that the dentist is a slightly boring place where someone counts your teeth. A child whose first appointment happens at three and a half, because a molar hurts, learns something very different, and that first impression is hard to undo. Extensive treatment on a very young child can also mean sedation or a hospital setting, which is a far bigger undertaking than the checkups that might have prevented it.

The CDC counts tooth decay among the most common chronic diseases of childhood. Most of it is preventable, and prevention at this age is mostly a matter of coaching parents early. We go further into the stakes in why cavities in baby teeth still matter.

Age by age: what changes at each stage

The visit a one-year-old has barely resembles the one a seven-year-old has. Here is how it shifts.

What happens at a first dental visit for a 1-year-old?

Less than you'd think. The hands-on portion usually lasts a few minutes inside a visit of perhaps half an hour.

The standard technique for babies and young toddlers is the knee-to-knee exam. You and the dentist sit facing each other, knees touching, so your laps form one flat surface. Your child sits on your lap facing you, legs around your waist, then leans back until their head rests in the dentist's lap. They can see your face the whole time. You hold their hands. The dentist looks straight down into the mouth with a light and a small mirror.

A typical first visit runs in this order:

1. Questions for you. Feeding, bottles and sippy cups, night waking, pacifier or thumb, your water source, and your own family's history with cavities.
2. The lap exam. Teeth, gums, tongue, the roof of the mouth, the lip and tongue attachments, and how the jaws meet.
3. A quick clean. Often just a soft toothbrush, which doubles as a brushing demonstration on your own child.
4. Fluoride varnish, if indicated. It is painted on in seconds and sets on contact with saliva.
5. A plan. What to change at home, what is coming next developmentally, and when to return.

Many one-year-olds cry through the exam. That's fine. Frankly, it helps: a crying mouth is a wide-open mouth. It doesn't mean the visit went badly. They are protesting being held still, the same way they protest a diaper change, and most have recovered by the time they reach the parking lot.

How is a first visit different for a 3-year-old?

A three-year-old can follow instructions and has opinions. The approach shifts to what dentists call tell-show-do: explain the mirror, let them hold it, then use it. The suction becomes a "straw." The polisher is a spinning toothbrush that tickles. Most children this age will sit in the chair by themselves, or on your lap in the chair, and tolerate a real cleaning.

The honest drawback of starting at three is that you've arrived at peak stranger-wariness and peak "no." Some children climb right up. Others won't open their mouths at all on day one. A good office treats that as normal, does what the child allows, and brings them back in a few weeks instead of forcing it. If you're still deciding where to go, our guide to choosing a dentist for your child covers what to look for.

How do I prepare a toddler for the dentist?

Keep it short and dull. Tell them the day before or that morning: "Someone is going to count your teeth and brush them." That is the whole briefing. Days of build-up signal that something big is coming.

• Book a morning slot when you can, and never across nap time. A tired two-year-old is a different patient. Our office opens at 9 AM on Fridays and 8 AM on Saturdays, which tends to suit small children.
• Play dentist at home. Count their teeth with a toothbrush, then let them count yours.
• Bring them along to a sibling's checkup, or your own, so the room is already familiar.
• Feed them beforehand. Hungry toddlers don't negotiate.
• Bring the comfort object. Nobody minds the stuffed rabbit.

What should I not say before a dental visit?

Most dental fear in small children is borrowed from adults. These are the usual ways it gets handed over, almost always with good intentions:

• "It won't hurt." Your child wasn't thinking about hurting until you raised it. The same goes for "don't be scared" and "be brave."
• "Shot," "needle," "drill," "pull." Leave the vocabulary to the dental team, who have gentler words and know when to use them.
• The dentist as a threat. "If you don't brush, the dentist will have to give you a shot" turns a routine visit into a punishment.
• Your own war stories. Children are listening when you describe your root canal to another adult. Grandparents and older siblings do this too.
• Negotiated bribes. A toy promised in advance for "being good" tells a child there is something to endure. A sticker afterward is fine.
• Constant apologizing. "I'm so sorry, I know, it's almost over" during a routine exam confirms that something bad is happening.

If you are anxious about dentistry yourself, mention it quietly to the staff, and consider letting the calmer parent bring the child. Kids read a parent's face faster than they hear any words.

How often should a child see the dentist after the first visit?

Every six months is the usual rhythm. Baby-tooth enamel is thinner than adult enamel, so a small spot can become a large cavity quickly. A year between looks is too long for most young children.

Some children are asked back every three or four months: those with early white-spot lesions, a previous cavity, constant snacking or sipping, enamel that formed weakly, or a medical condition or medication that affects the mouth. That schedule isn't a judgment. It is what keeps a watch-and-wait spot from becoming a filling. Using the same family dental office as the rest of the household also makes it easier to line up everyone's checkups in one trip.

When do fluoride toothpaste, flossing, X-rays and sealants start?

Fluoride toothpaste

From the very first tooth. The ADA recommends a smear the size of a grain of rice until age three, then a pea-sized amount from three to six. The older advice to use fluoride-free "training" paste until a child can spit has been retired; a rice-grain smear is small enough that swallowing it isn't a concern.

Flossing

As soon as any two teeth touch. For many children that means the back molars at around two or three. Front baby teeth often have gaps and don't need it. Floss picks are easier than string on a squirming child.

X-rays

There is no birthday for X-rays. They are ordered by risk. Many children have their first set between four and six, when the back teeth close up against each other and the dentist can no longer see between them. A child with visible decay or an injury may need one earlier; a low-risk child with spaced teeth, later. If radiation worries you, read our explanation of dental X-ray safety for families and raise it at the visit.

Sealants

Sealants go on permanent molars, so they enter the picture around age six. The first permanent molars erupt behind the last baby teeth. No tooth falls out to make room, which is why parents often don't notice them. A second set arrives around twelve. The deep grooves on these teeth are a common starting point for cavities, and a dental sealant closes them off with a thin protective coating. No numbing and no drilling.

Signs your child should be seen before the next checkup

Don't wait for the six-month mark if you notice:

• White, chalky lines or brown spots near the gumline
• A tooth that has turned grey or dark after a fall
• Wincing when chewing, or suddenly avoiding one side
• A pimple-like bump on the gum above a tooth
• Bad breath that persists despite good brushing

One detail that surprises parents: a knocked-out baby tooth should not be pushed back in, because that can damage the permanent tooth forming underneath. Still call, so the area can be checked.

What does a child's first dental visit cost?

Usually less than parents fear, because it is a preventive visit. Dental plans commonly cover children's exams, cleanings and fluoride at a high level, and Medi-Cal Dental covers checkups for enrolled children. What shifts the out-of-pocket amount is your specific plan, whether X-rays are needed, and whether anything is found that needs treatment. We accept most PPO and HMO plans along with Denti-Cal and Medi-Cal; have your child's plan information ready when you book so the benefits can be checked. Families without coverage can ask about our in-house membership plan.

Questions worth asking at the first visit

• Is my child's cavity risk low, moderate or high, and why?
• Is our tap water fluoridated, and does that change what you recommend?
• Are there any spots you are watching?
• Is the thumb or pacifier habit affecting the bite yet?
• Can you show me how to brush on my own child?
• When do you want to see us again?

If your baby has a tooth, or has blown out a first birthday candle, it's time. Rio Hondo Dental sees children and their parents at 8514 Paramount Blvd. in Downey, and our team is bilingual — se habla español. Request a first visit or call (562) 928-5559, and tell us your child's age so we can plan the right kind of appointment.