Why Dental Hygienists Examine Infants
Dental hygienists see infants to prevent early childhood caries through early risk assessment, anticipatory guidance to parents, and application of preventive treatments like fluoride varnish starting with the first tooth eruption—because waiting until age two is too late for effective prevention. 1, 2
The Critical Window for Prevention
Dental caries is an infectious, transmissible disease that begins as soon as teeth erupt, typically at 6-8 months of age. 1, 3 The bacteria responsible (Streptococcus mutans) colonize teeth immediately after eruption and establish a "window of infectivity" between 19-31 months of age. 1, 2 By 12 months of age, infants have already established an oral environment that places them at risk for dental caries. 1
The most compelling reason for early dental hygienist involvement is that dental caries remains the single most common chronic disease of childhood—affecting 56% of children by age 9 years—and it is neither self-limited nor amenable to antibiotics. 1, 2 When intervention is delayed, extensive carious lesions can develop by age 3 years. 2
What Dental Hygienists Do During Infant Visits
The first dental examination should occur within 6 months of first tooth eruption but no later than 12 months of age. 2, 3 During these visits, dental hygienists perform several critical functions:
Risk Assessment and Screening
- Examine teeth for early signs of demineralization or cavities 4
- Assess risk factors including maternal caries (mothers are the primary source of cariogenic bacteria transmission), sibling caries, feeding practices, dietary habits, fluoride exposure, and oral hygiene practices 1, 2
- Identify high-risk infants who may acquire bacteria earlier than the typical 19-31 month window 1
Preventive Interventions
- Apply fluoride varnish starting with first tooth eruption, then every 3-6 months thereafter 1, 2, 3
- Provide anticipatory guidance on proper oral hygiene techniques 1, 2
- Educate parents about twice-daily brushing with fluoridated toothpaste (rice grain-sized portion for children under 36 months) starting at first tooth eruption 1, 2, 3
Parental Education on Risk Factors
- Counsel on discontinuing bottle use by 12-24 months to prevent prolonged exposure to fermentable carbohydrates 2
- Advise against allowing children to sleep with bottles containing anything other than water 2
- Educate about limiting sugar consumption to less than 10% of total energy intake (ideally less than 5%) 2
- Recommend restricting total eating occasions to four or fewer per day 2
Why Primary Care Providers Alone Are Insufficient
While physicians see infants more frequently than dentists in the first year of life and can provide basic oral health screening, 2 dental hygienists possess specialized training in oral health assessment and preventive techniques that physicians typically lack. 5 Current approaches to educating low-income adults about caries prevention through medical providers alone are insufficient to prevent early childhood caries. 5
The evidence shows that even after continuing education programs, only 42% of dental professionals actually increased the number of children under 3 years old they examine, and only 27% followed through on contacting local physicians about early oral health care. 6 This highlights the critical need for dental hygienists to directly engage with infants rather than relying solely on interprofessional referrals.
Special Considerations for High-Risk Populations
For Indigenous children and other high-risk populations, the concept that "two is too late" is particularly important. 1, 3 These children may experience earlier tooth eruption, acquire cariogenic bacteria at younger ages, and develop severe early childhood caries more rapidly than the general population. 1, 3 In these communities, dental hygienists play an even more critical role in providing early preventive services, as newly erupted teeth are most vulnerable to caries and early bacterial colonization occurs soon after eruption. 3
Common Pitfalls to Avoid
- Do not wait until 24 months for the first dental visit—this outdated recommendation conflicts with current best practice guidelines recommending evaluation by 12 months. 2, 3
- Do not assume breastfeeding is always protective—while breastfeeding up to 12 months reduces caries risk by half, breastfeeding beyond 24 months (especially at-will nighttime feeding) increases caries risk 2.4-fold. 2
- Do not prescribe fluoride supplements without first testing drinking water fluoride levels—supplements should only be given when water fluoride is suboptimal. 2
- Do not underestimate the role of maternal oral health—mothers with poor oral hygiene and high caries rates directly transmit bacteria to their infants and serve as the primary source of dental knowledge. 2