A dental home by age one.

Early childhood dental caries has been reported by the Centers for Disease Control and Prevention to be perhaps the most prevalent infectious disease of our nation’s children. Early childhood dental caries occurs in all racial and socioeconomic groups; however, it tends to be more prevaEditorial A Dental Home by Age One Though it is unusual for me to devote 2 editorials to the same subject, my “Year One Dental Visit– For Whose Benefit? ” editorial (Pediatr Dent. 2001;23:463) warrants additional comment. In that editorial, I described a personal experience when I referred my granddaughter for her first dental visit at age 2. I selected a pediatric dentist near her community, but surprisingly, the pediatric dentist did not see children for routine examinations until at least 2 1/2 or 3 years of age. When she finally visited that pediatric dentist, my granddaughter had 4 carious lesions. Following my initial disbelief, I examined her myself and found that, although the typical risk factors were not present, she did indeed have lesions on her second primary molars. Further investigation indicated her diet was not ideal and oral hygiene was not good. Although I do not attribute her carious lesions to the pediatric dentist who would not see her earlier, I cannot help but wonder if the caries would have formed had her parents visited the dentist much earlier. Now at age 3, the bedtime sippy cup is gone, the teeth are cleaned at least twice a day by an adult, and there are no more cariogenic snacks. I report this experience because it illustrates the importance of the Year One Dental Visit. The American Academy of Pediatric Dentistry (AAPD) has been advocating the Year One Dental Visit for many years, and it has been supported by the American Dental Association. Members of the AAPD lobbied the American Academy of Pediatrics (AAP) so pediatricians would endorse the Year One Dental Visit, but there was great reluctance to accept the recommendation. One stated reason was that pediatric dentists and general dentists were not prepared to implement early infant care programs. Finally, the AAP’s 2002-03 Section on Pediatric Dentistry changed the organization’s policy. A policy statement, which recommends oral health risk assessment by 6 months of age and establishment of the dental home for all infants by 12 months, was developed. Whereas the risk assessment could be performed by a qualified pediatrician or a pediatric health care professional, the dental home–a concept analogous to the medical home recommended by the AAP–would be available for selected infants requiring treatment at 6 months of age. Thereafter, all infants at 12 months would be referred for a dental home so as to provide an opportunity to implement a preventive dental health program for all children. That policy was published in May 2003 (Pediatrics. 2003;111:1113-1116), and with the AAP’s permission, is reprinted below. I believe this decision will be pivotal in managing the problem of early childhood caries, which affects so many infants and young children. However, the success of the policy depends on whether general dentists and pediatric dentists change their behaviors and develop early infant care programs. When pediatricians refer 1-year-old infants for examination, our members should be receptive and welcome referrals as an opportunity to prevent dental disease. I feel strongly about this issue because too often I see 2 and 3 year olds sedated to repair the ravages of early childhood caries. I also feel strongly because of my granddaughter’s experience. Her teeth are now repaired and sealants have been placed on all molars. More importantly, I hope that pediatric dentists will accept the challenge and more readily accept 1 year olds into their practices. lent in low-income children, in whom it occurs in epidemic proportions. Dental caries results from an overgrowth of specific organisms that are a part of normally occurring human flora. Human dental flora is site specific, and an infant is not colonized until the eruption of the primary dentition at approximately 6 to 30 months of age. The most Milton I. Houpt, DDS, PhD Editor-in-Chief