Introduction
The timing of a child’s first dental visit is a significant topic in dental public health and paediatric dentistry, sparking debate among professionals, policymakers, and parents. The notion that the first dental visit should occur only after the full primary dentition—comprising all 20 deciduous teeth—has been established, typically around the age of three, has been both supported and contested. Proponents argue that earlier visits are unnecessary and resource-inefficient, while opponents highlight the preventive and educational benefits of early dental consultations. This essay explores the arguments for and against delaying the initial dental visit until full primary dentition, critically examining the implications for child oral health, parental education, and healthcare systems. It will first outline the rationale for delayed visits, focusing on practicality and resource allocation, before presenting counterarguments that emphasise early intervention and prevention. The essay concludes with a reasoned preference for one approach, grounded in evidence and consideration of long-term oral health outcomes.
Arguments in Favour of Delaying the First Dental Visit
One primary argument for postponing the initial dental visit until the full primary dentition is established centres on the practicality of assessing oral health at a later stage. By the age of three, all deciduous teeth are typically in place, allowing dental professionals to conduct a comprehensive examination of tooth structure, occlusion, and potential developmental anomalies (Royal College of Surgeons of England, 2018). Prior to this, with only a few teeth erupted, the scope of assessment is limited, and some argue that such visits yield minimal diagnostic value. For instance, detecting early signs of caries or malocclusion is arguably less feasible in infants under 18 months, when only incisors may be present. This perspective prioritises efficiency, suggesting that waiting until a complete set of primary teeth is visible maximises the clinical benefit of the consultation.
Furthermore, delaying the first visit may align better with resource allocation in strained healthcare systems such as the UK’s National Health Service (NHS). Dental care resources, including appointment slots and clinician time, are often limited, and prioritising children with fully erupted dentition could ensure that interventions are targeted where they are most needed (NHS England, 2019). Early visits, particularly for infants without apparent dental issues, might be perceived as an inefficient use of resources, especially when many such consultations result in no immediate treatment. This viewpoint is particularly relevant in areas with long waiting lists for paediatric dental care, where focusing on older children with established dentition could address more pressing clinical needs.
Another argument supporting delayed visits is the behavioural readiness of the child. Dental visits can be intimidating, and children under three may not possess the cognitive or emotional maturity to cooperate during examinations (American Academy of Pediatric Dentistry, 2020). A lack of cooperation may render the visit counterproductive, causing stress for both the child and the parent without achieving meaningful outcomes. Waiting until the child is older and better able to engage with the dentist may therefore result in a more productive interaction, fostering a positive early experience with dental care that can influence lifelong attitudes towards oral health.
Arguments Against Delaying the First Dental Visit
Contrarily, there is substantial evidence advocating for earlier dental visits, often recommended as early as the eruption of the first tooth or by the age of one, as supported by major dental associations (American Academy of Pediatric Dentistry, 2020). One compelling argument is the preventive potential of early intervention. Early childhood caries (ECC), a prevalent condition among young children, can develop rapidly if risk factors such as poor feeding practices or inadequate oral hygiene are not addressed (Tinanoff et al., 2019). An initial dental visit during infancy provides an opportunity to identify these risks and offer tailored advice to parents, potentially averting the onset of decay before it becomes severe. For example, educating parents on the dangers of prolonged bottle use or sugary diets during a visit at 12 months can significantly reduce the incidence of ECC, a benefit that may be lost if the visit is delayed until age three.
Moreover, early dental visits serve as a critical platform for parental education, which is essential for establishing lifelong oral health habits. Many parents lack awareness of appropriate oral hygiene practices for infants, such as the importance of cleaning gums before teeth erupt or avoiding cariogenic bedtime routines (Public Health England, 2020). A consultation within the first year allows dentists to address misconceptions and equip parents with practical skills, such as correct brushing techniques, long before dental issues manifest. Delaying this interaction until full primary dentition risks missing a crucial window for behavioural change, potentially leading to preventable dental problems.
Additionally, early visits facilitate the establishment of a ‘dental home’—a concept endorsed by professional guidelines that emphasises continuity of care (American Academy of Pediatric Dentistry, 2020). Familiarising a child with the dental environment from a young age can reduce anxiety and build trust, contrasting with the potential stress of a first visit at age three when a child may already have developed fears or negative associations. Indeed, evidence suggests that children introduced to dental care early are more likely to exhibit cooperative behaviour during subsequent visits, which can enhance treatment outcomes (Jones & Walker, 2017). This long-term psychological benefit challenges the notion that early visits are a waste of time, positioning them instead as an investment in future compliance.
Lastly, from a public health perspective, early dental visits can contribute to health equity by addressing disparities in oral health outcomes. Children from disadvantaged backgrounds are at higher risk of dental caries due to socioeconomic factors, yet they are often the least likely to access dental care promptly (Public Health England, 2020). Encouraging visits by age one, integrated with other health checks such as vaccinations, ensures that at-risk populations receive timely guidance and intervention. Postponing visits until later may widen these inequalities, as preventable conditions could progress unchecked in the interim, placing additional burdens on both families and the healthcare system.
Critical Evaluation of the Debate
Evaluating these arguments reveals a tension between short-term practicality and long-term preventive benefits. Delaying the first dental visit until full primary dentition offers a logical appeal in terms of clinical efficiency and resource management, particularly in the context of NHS constraints. However, this approach risks overlooking the foundational role of prevention and education in paediatric dentistry. The evidence supporting early visits, particularly in mitigating ECC and fostering positive dental attitudes, appears more robust, especially when viewed through the lens of lifelong oral health outcomes (Tinanoff et al., 2019). Moreover, while behavioural readiness is a valid concern for early visits, strategies such as play-based desensitisation techniques can often address this challenge, reducing the weight of this argument against early intervention (Jones & Walker, 2017).
It is also worth noting the limitations of the delayed-visit perspective in addressing individual variability. Not all children develop primary dentition on the same timeline, and waiting for all 20 teeth to erupt may mean that some children with early dental issues—such as developmental defects or trauma—miss critical intervention windows. Conversely, early visits must be carefully designed to avoid becoming tokenistic; without meaningful content, such as tailored parental education, they could indeed be perceived as resource-intensive with limited impact. Balancing these considerations requires a nuanced approach, guided by evidence and prioritising child-centric outcomes.
Conclusion
In conclusion, while the argument for delaying the first dental visit until full primary dentition is established holds merit in terms of efficiency and practicality, it is outweighed by the substantial benefits of early intervention. Early visits, ideally by the age of one or upon the eruption of the first tooth, offer critical opportunities for prevention, education, and the establishment of positive dental experiences, which are instrumental in combating prevalent conditions like ECC and reducing long-term oral health burdens. The potential strain on healthcare resources can be mitigated through targeted policies, such as integrating dental checks with existing child health programmes, rather than postponing care altogether. Therefore, this essay advocates for early dental visits as the preferred option, recognising their role in fostering equitable, preventive, and sustainable oral health outcomes for children. This stance aligns with current professional guidelines and underscores the importance of early engagement in shaping a generation with healthier dental habits.
References
- American Academy of Pediatric Dentistry. (2020) Guideline on Periodicity of Examination, Preventive Dental Services, Anticipatory Guidance/Counseling, and Oral Treatment for Infants, Children, and Adolescents. American Academy of Pediatric Dentistry.
- Jones, K., & Walker, P. (2017) Behavioral management in pediatric dentistry: A review of desensitization techniques. Pediatric Dental Journal, 27(3), 112-118.
- NHS England. (2019) NHS Dental Services: Commissioning Standard Operating Procedures. NHS England.
- Public Health England. (2020) Oral Health Survey of 5-Year-Old Children 2019. Public Health England.
- Royal College of Surgeons of England. (2018) The State of Children’s Oral Health in England. Royal College of Surgeons of England.
- Tinanoff, N., Baez, R. J., Diaz Guillory, C., Donly, K. J., Feldens, C. A., McGrath, C., … & Twetman, S. (2019) Early childhood caries epidemiology, aetiology, risk assessment, societal burden, management, education, and policy: Global perspective. International Journal of Paediatric Dentistry, 29(3), 238-248.
