Infant Dental Exams

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The AAPD handbook states; “The dental home should be established no later than 12 months of age to help children and their families institute a lifetime of good oral health. A dental home addresses anticipatory guidance and preventive, acute, and comprehensive oral health care.”

As a pediatric dentist, I’ve heard “you’re kidding, right?” from my general dentist colleagues when the subject of the first dental exam before 12 months old comes up in conversation. I explain to them that it isn’t as daunting as it may seem. Yes, infants and toddlers cry; yes they have a hard time staying still; yes they are scared of you; and yes they may even bite, but establishing a dental home at this early age is worth the time and effort. It can be a great way to gain confidence with the entire family.

Let’s start with the basics… The Exam - The easiest way to perform an infant exam is a knee to knee exam. Have the parent hug the child with one leg on either side of them (straddling the parent). The parent holds the child’s hands. The dentist places their knees against the parent’s knees. And the parent lays the child’s head on the dentist’s knees. This allows the dentist and the parent a way to calm a squirming tike. It is normal for a child to cry at this point, most of them do. This is great!! It means that their mouth is wide open and you can get a good look inside.

Eruption Sequence - When you look in an infant’s mouth you should see teeth, if they are close to one year of age. You can find primary teeth eruption charts on the internet, but I like to use the three month rule. On average, starting around six months old, new teeth generally emerge every three months … 6 month old - Mandibular Central Incisors 9 month old - Maxillary Central Incisors/Mandibular Lateral Incisors 12 month old - Maxillary Lateral Incisors 15 month old - First Primary Molars 18 month old - Canines 24 month old - Second Primary Molars (the exception to the three month rule) Obviously there are exceptions to these rules (natal/neonatal teeth and late erupters - after 1 year old), but this works as a good rule of thumb.

Things to look for in infants/newborns-

Riga-Fede - caused by natal or neonatal teeth. Abrasions to the ventral surface of the tongue. Bohn Nodules - small developmental anomalies located along the buccal and lingual aspects of the mandibular and maxillary ridges and in the hard palate. Remnants of mucous gland tissue. No treatment necessary. Dental Lamina Cysts - found along the crest of the mand. and max. ridges. Epithelial remnants of the dental lamina. No treatment necessary. Epstein Pearls - keratin-filled cysts found in the mid-palatal raphe and the junction of the hard and soft palates. No treatment necessary. Fordyce Granules - common aberrant yellow-white sebaceous glands most commonly on the buccal mucosa or lips. No treatment necessary. Ankyloglossia - abnormally short lingual frenum that can hinder tongue movement. The frenum might spontaneously lengthen as the child gets older. Surgical correction may be indicated. Oropharyngeal candidiasis - white plaques covering the oropharyngeal mucosa which, if removed, leaves an inflamed underlying surface. Usually self limiting in healthy newborn infants, but topical application of nystatin may have benefits. Primary Herpetic Gingivostomatitis - erythematous gingiva, mucosal hemorrhages, and clusters of small vesicles throughout the mouth. Accompanied by fever, malaise, lymphadenopathy, and difficulty eating and drinking. Encourage fluids to prevent dehydration. Analgesics and oral acyclovir may be beneficial.

Check Occlusion -

Posterior Crossbite - discuss the need for palatal expansion in the future Anterior Crossbite - discuss the need for possible interceptive orthodontics in the future. Open Bite - discuss non-nutritive suckling. Usually caused