Folia Medica 2010; 52(4): 56-61

Copyright © 2010 Medical University Plovdiv

doi: 10.2478/v10153-010-0018-x

AGE AT AND REASONS FOR THE FIRST DENTAL VISIT

Stanimira P. Mileva, Veselina K. Kondeva

Department of Pediatric Dentistry, Faculty of Dentistry, Medical University, Plovdiv, Bulgaria

ABSTRACT
INTRODUCTION: The ideal time for the first dental visit of a child as recommended by many
professional dental organizations across the world is by the age of one year.
The AIM of this study was to survey the age and the most common causes for the first visit
to the dental office, as well as the recommendations of dentists regarding this visit.
PATIENTS AND METHODS: The present study included 289 children visiting a dentist for the
first time. The children were divided into 5 age groups and the reasons for the visit were
categorized into 9 groups. The variables we assessed were the percentages of children in
each age group and the reasons for the first visit to the dentist.
Respondents to a questionnaire were 145 dentists. The survey included questions on gen-
der, years of professional experience, specialty, ability to work with children and recom-
mendations concerning the age of the first visit to the dentist.
RESULTS: The greatest number of children making their first dental visit were in the 3-6
year-olds (51.90 percent) and the smallest number were the children younger than 1 year
(1.73%). The most common reason for making this visit was caries and its complications
(59.86%). The second most common reason was parents’ decision to have a prophylactic
examination of their child (26.99%).
The number of dentists in this country that recommended that the first visit should be
before the age of 1 year is small (17.93%). 39.31% of the respondents recommended that
the first dental visit should take place between 1 and 2 years of age, and 31.03 percent -
between 2 and 3 years. It was only pediatric dentists that recommended a dentist appoint-
ment in the first year of life - 47.37%. This study found that it was the female dentists that
predominantly admit and treat children in their dental practices.
CONCLUSIONS: The results of the study show that in this country there is no established
practice for children to make their first dental visit before they turn one year of age. The
predominant cause to make the first visit is caries and its complications. It is necessary to
work out recommendations on the age for the first visit to the pediatric dentist and related
prophylactic measures.

Key words: first dental visit, pediatric age, tooth caries, prophylactic check-up

INTRODUCTION
during childhood.1 This visit should allow a dentist
Worldwide it is recommended that the first visit to to detect early lesions, to evaluate craniofacial and
the pediatric dentist should take place within the dental development, to advise parents on hygiene,
first age of life.1-7 nutrition and behaviour in possible traumas and
A timely first visit of a child to the dental office to motivate them for preventive-oriented events.8
is an essential part of the children’s health care. This strategy establishes the practice of prevention
These early visits recommendations aim at detecting leading to long-term benefits for the child and
and controlling the various dental pathology and in warrants that children will be free from caries9
particular the caries - a disease widespread among because age is a significant determinant for early
children and sometimes occurring immediately after childhood caries10.
teeth eruption.7 The age of the first preventive dental visit has
The main objective of the early first dental visit a significant positive effect on costs related to
is to lay the foundations of preventive education and dental health. 11
dental care in order to ensure optimal oral health Prevention of caries in the youngest children is
Correspondence and reprint request to: S. Mileva, Department of Pediatric Dentistry, Faculty of Dentistry, Medical
University, Plovdiv; E-mail: [email protected]
3 Hristo Botev blv., 4002 Plovdiv, Bulgaria
56 Received 17 June 2010; Accepted for publication 13 October 2010
Unauthenticated
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 Age at and Reasons for the First Dental Visit

possible if they have their visit to the dentist before 2. To study the recommendations of dentists for
or soon after the eruption of the first teeth.4 For the first visit to the dental office.
this reason, in the UK parents are offered to make
an appointment for their children with the dentist PATIENTS AND METHODS
immediately after the breaking out of the first This study was planned and conducted at the Depart-
deciduous teeth, i.e. about 6 months of age.4 ment of Pediatric Dentistry at the Faculty of Den-
The importance of an early visit to the dental tistry, Medical University - Plovdiv. It included 289
office is highlighted by reports of oral coloniza- children who visited the department between 2008
tion of Streptococcus mutans in six-month-old – 2010 for their first dental visit. The children were
predentate infants with their mothers as a source divided into 5 age groups: up to 1 year, 1-2 years,
of the infection.12 Some authors even advise that 2-3 years, 3-6 years and over 6 years. The reasons
the first visit concerning the dental health of the for the first visit were categorized as follows: pro-
child should take place during 4th month of the phylactic examination; dental caries/complications;
pregnancy.7 As a major source of Streptococcus pain, discoloration of teeth/unaesthetic depositions/
mutans, the mother’s oral health is a risk factor bad breath; trauma; malocclusion; missing/ super-
for the oral health of the newborn. A visit before numerary tooth: bad habits/other. The proportions
birth is essential for the establishment of the first of children in each age group and the reasons for
contact between the dentist and the parents and to the first dental visit have been assessed.
acquire information and trust between both parties. 145 dentists answered the anonymous direct
The time is adequate to teach the pregnant mother questionnaire. The survey included questions on
the principles of health education and to explain to gender, work experience, specialty, ability to work
her that the first teeth of her baby begin to form with children and recommendations concerning the
during this stage of pregnancy. Visits to the dental age for the first visit to the dentist. The percent-
office can provide the mother with information what ages of respondents giving different responses to
care must be taken to ensure the normal eruption the questions were calculated.
of the teeth of her child, and how to maintain The results were analysed using the alternative
dental health after teeth eruption. It also makes it analysis, χ2 criterion and the Student’s t-test. The
possible for hazardous situations to be identified level of significance for the null hypothesis was
and to prescribe caries-preventive agents such as p ≤ 0.05.
fluoride. This visit is also suitable to plan the
first visit of the future child at about the age of 6 RESULTS
months.7 This health strategy is easily realisable, Only 1.73% of the children had their first dental
economically viable and efficient. Thus a positive, visit before the age of one year, 15.92% - between
conscious and responsible behaviour is achieved 1 and 2 years, and 22.84% - between 2 and 3 years
providing for the oral health of the child. (Fig. 1). The largest number of children made their
Regarding the recommendations of professional visit to the dentist at age 3 - 6 years (51.90%). The
organizations for the first appointment of children first appointment with a dentist for 7.61% of the
with the dentist before the age of 1 year, some study contingent was after the age of 6 years.
universities have develop public health programs The distribution of children by reason for the
associated with the oral health of the youngest first visit to the dental office is presented in Tab-
population.13 le 1. Statistically significant is the highest propor-
Studies on the awareness of dentists on the tion of children who have visited a dental surgery
importance of early first dental visit show differ- because of caries and its complications (59.86%;
ent data on the number of those familiar with the р < 0.001, t = 5.99). The next most common rea-
recommendations that children visit dental offices son is the desire of parents to have prophylactic
before the age of 1 year.14-16 examination of their child (26.99%). In 16.26%
There has been no study of the first dental visit of the children the predominant cause for the
and the reason for it in Bulgaria which motivated visit was pain. Relatively small is the number of
the conduction of the present study. patients with trauma (2.77%), unaesthetic staining
AIM (2.42%), malocclusion (1.04%), missing tooth or
supernumerary teeth (0.69%). Other reasons for
1. To survey the age and the most common reasons the first dental visit (7.61 percent) were aphthous
for the first visit to the dentist; stomatitis, physiologic replacement of teeth and

Folia Medica 2010; 52(4): 56-61

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S. Mileva et al

for the first dental examination. The largest is the

proportion of dentists with another specialty that are
of the opinion that the first visit should be between
2 and 3 years of age (44.26%) (Fig. 3).

DISCUSSION
A change in the prospective from seeing only the
healing aspect of dental care to the evaluation of
its preventive and informative value will lead to
improvement of the oral status of the child.8
Dental treatment is stressful for all ages but
Figure 1. Distribution of children by age at their first especially it is so for children. To minimize the
visit to the dentist. unpleasant moments during treatment it is important

Table 1. Reasons for the first visit of children (n = 289) to a dentist

Reasons n % Sp
Prophylactic examination 78 26.99 2.61
Tooth caries/complications 173 59.86 2.88
Pain 47 16.26 2.17
Trauma 8 2.77 0.97
Stains/unaesthetic deposits/bad breath 7 2.42 0.90
Malocclusion 3 1.04 0.60
Missing/above-the-number tooth 2 0.69 0.49
Bad habits 0 0 0
Other 22 7.61 1.56

complications during teeth eruption. Table 2. Characteristics of the surveyed dentists

Characteristic features of the surveyed dentists
are presented in Table 2. The proportion of female Characteristics n = 145 (%)
dentists who treat children is significantly higher Sex
(90.22%), while for males the percentage of those Male 53 (36.55)
who do not work with children is slightly higher. Female 92 (63.45)
As a whole, the number of dentists who receive
Work experience
children in their practices remains roughly the same
regardless of their work experience. Up to 10 years 67 (46.21)
Only 17.93 percent of the dentists are famil- Above 10 years 78 (53.79)
iar with the recommendation the first visit to be Specialty
before the age of 1 year (Fig. 2). 39.31% of the Without any specialty 65 (44.83)
respondents recommend the first dental visit to
Pediatric dentistry 19 (13.10)
take place between the age of 1 and 2 years, and
31.03% - at the age of 2 to 3 years. There are Other specialty 61 (42.07)
doctors who prefer to examine children after the Treatment of children
age of 3 years (11.72%) (Fig. 2). Yes 110 (75.86)
The majority of pediatric dentists recommend No 35 (24.14)
the first visit to take place before the age of one Consultation of pregnant women on the oral health
(47.37%) or two years (42.11%) (Fig. 3). There of their children
is not a significant percentage of dentists without Yes 100 (68.97)
recognised specialty who recommend a specific age No 45 (31.03)

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 Age at and Reasons for the First Dental Visit

the USA the children who have visited the dental

11.72% 17.93% surgery at the age of 2-4 years is 32%.3 Slayton
et al.17 report that only 2% of children under the
age of 3 visit the dentist during their first year
of life. Similar figures are available for Bulgarian
children with a first dental visit by the age of 1
year (1.73%). These data suggest that there is still
31.03% no established practice for parents to take their
39.31% children to an early visit to the dentist.
In this country, as shown by literature data8,18,19,
the most common reason that prompts the first
> 1 yr 1 - 2 yrs 2 - 3 yrs 3 - 6 yrs dental visit is caries. Despite the high percentage
of caries and its complications, only in 16.26% of
Figure 2. Distribution of respondents according to their the children the leading cause was pain. This can
recommendations on age for first dental visit. be explained by decreased sensitivity of deciduous

100%
90% 16.92%
36.92% 27.69%
80%
11.48%
70% 18.46%

60%
34.43% Without any specialty
50%
Another specialty
44.26%
40%
47.37% Pediatric dentistry
30%
20% 42.11% 9.84%
10% 10.53%
0% 0.00%
< 1 yr 1 - 2 yrs 2 - 3 yrs > 3 yrs

Figure 3. Distribution of respondents by specialty and recommendations for the first visit to the dentist.

that there is trust between the child and the dentist. teeth due to changes that have occurred in the pulp.
Trust-building is a tough and gradual process. A This means that the pain should not be regarded as
timely first visit to the dental office without the an objective signal for the severity of the lesions.
need for treatment, and regular contacts between Age should be the criterion, which requires the
child and dentist, would facilitate the conduct of preliminary examination and the dental care.
treatment, if necessary in future. However, there are authors who report results
The results of this study indicate that in this different from ours. Study of the population in
country most parents take their children for the first Brazil shows that in most cases the reason that
time to the dental office between 3 and 6 years of parents seek dental care for children is prophylactic
age. These data do not match those reported for examination and prevention.20 This encouraging re-
India. The average age at which children there see sult may be due to the fact that this study followed
the dentist for the first time is over 6 years.8 Between an educational program conducted at a clinic for
6% and 8% of Indian children had their first visit newborn in the dental school in Aracatuba.
before the age of 3 years. Data for Australia show The analysis of the questionnaire results shows
that most children do not see the dentist before that in our country the number of dentists who
starting pre-school, i.e. about 5 years of age.5 In recommend the first visit to be before the age of

Folia Medica 2010; 52(4): 56-61

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S. Mileva et al

1 year is low (17.93%). The percentage of their experience of dentists and their willingness to treat
counterparts in Canada is higher (58%)14 and also children.
in Iowa, the USA (76%)15, who are well aware of Examination and treatment of young children
the recommendations of the professional organisa- poses a challenge for any dentist, even for profes-
tions for first dental appointment before the age of sionals. Hardwick describes a detailed technique for
1 year. Although informed, only 11% of dentists in the first examination.23 The author focuses on the
Iowa15 and 12% of general practitioners in Virginia16 conversation between the dentist or their assistant
assume that the first visit to the dentist should be with parents and clarification of the procedures
between the age of 0 and 11 months. The majority that lie ahead. Another point is the examination
of them (66%)15 as well as predominant number of itself that is easiest to perform in position knee-
Canadian dentists14 think that children must visit a to-knee.23
dentist before the age of 2 years. In this country
also the highest is the percentage (39.31 percent) CONCLUSIONS
of respondents recommending the first dental visit Respondent dentists are not likely to recommend
between the age of 1 and 2 years, followed by to parents early visit to the dental office, which is
those (31.03%) who considered age 2-3 years as confirmed by the high percentage of children who
more appropriate. Only pediatric dentists most have visited the dentist for the first time after the
often recommend a dentist appointment in the age of 3 years. Leading cause for the first visit
first year of life - 47.37% in Bulgaria and 100% is caries and its complications, which shows that
of respondents in Virginia, USA.16 parents do not seek prevention of dental diseases,
The proportion of respondents who answered and respond only if there is a visible problem.
positively to the question whether they advise Many dentists see and treat children in their
pregnant women on the oral health of their chil- practices, which requires them to be informed and
dren is high. This result is inconsistent with the in turn acquaint parents with the importance of the
rest of the results. The question arises whether early first visit to the dental office.
such consultations are meaningful and purpose- Unfortunately, there is no professional debate on
ful. There is the routine practice pregnant women the age of the first visit of children to the dental
to attend the dentist in relation to their own oral surgery. Professional organizations in Bulgaria do
status. These visits should be directed to inform not recommend any age for the first dental visit.
expectant mothers on the preventive oral health Given the lack of sufficient information to
care of their children. general dental practitioners, pregnant women and
Questionnaires conducted among pediatricians, parents, it is desirable to have recommendations
including questions on the oral health of their pa- for the right age of the first visit to the pediatric
tients, show that they believe that the first dental dentist, techniques for carrying out the first screen-
visit should be about the age of 3 years21 and only ing and the preventive measures to safeguard the
5% of them recommend it to be done before 1 dental health of adolescents.
year of age.16 The authors of these surveys con-
clude it is necessary to increase the knowledge of REFERENCES
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7. Furze H, Basso M. The first dental visit: an Argentine oral health care: a survey of general dentists, pedi-
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К ВОПРОСУ О ВОЗРАСТЕ И ПРИЧИНАХ низкий - среди детей до первого года жизни

ПЕРВОГО ВИЗИТА ДЕТЕЙ В КАБИНЕТ (1.73%). Самая часто встречаемая причина визита
ДЕНТАЛЬНОГО ВРАЧА - это зубной кариес и его осложнения (59.86%),
за ней следует желание родителей провести
С. Милева, В. Кондева профилактический осмотр их ребенка (26.99%).
У нас процент дентальных врачей, рекомен-
РЕЗЮМЕ дующих осуществить визит к стоматологу до
ВВЕДЕНИЕ: Ряд профессиональных дентальных орга- исполнения первого года жизни, незначителен
низаций в мире рекомендуют осуществить первое (17.93%). Большинство анкетированных врачей
посещение детей в кабинет дентального врача до (39.31%) рекомендуют осуществить визит в
исполнения первого года жизни. возрасте 1 - 2 года, а 31.03% - в возрасте 2 -
ЦЕЛЬ: Работа ставит себе целью установить 3 года. Единственно детские дентальные врачи
возраст и самые частые причины первого посещения рекомендуют осуществить первую встречу детей с
детей в кабинет стоматолога, как и рекомендации врачом в течение первого года жизни (47.37%).
врачей относительно времени первого визита. Настоящее исследование установило, что пре-
МАТЕРИАЛ И МЕТОДЫ: Исследование охватывает имущественно дентальные врачи женского пола
289 детей, впервые посетивших зубного врача. Дети занимаются лечением детей.
разделены на 5 возрастных групп, а по причинам ЗАКЛЮЧЕНИЕ: Полученные результаты показы-
визита - на 9 групп (отмечен процент детей по вают, что у нас не наблюдается практика раннего
отношению к возрасту и к причинам визита). первого визита (до первого года жизни) в кабинет
Анкетировано 145 врачей. Анкета содержит стоматолога. Зубной кариес и его осложнения
вопросы относительно пола, трудового стажа, являются основной причиной посетить врача.
специальности, возможности работать с детьми, Вот почему необходимы рекомендации со стороны
как и относительно рекомендаций, относящихся к дентальных врачей относительно подходящего
возрасту первого визита к зубному врачу. возраста для первого визита в кабинет врача, как
Р ЕЗУЛЬТАТЫ : Самый высокий процент детей, и рекомендации относительно профилактических
посетивших впервые врача, наблюдается среди мероприятий.
возрастной группы 3 - 6 лет (51.90%), а самый

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