Cleaning teeth and preventing cavities are important, but regular dental care for children is about much more than that. A variety of issues, such as how teeth are aligned, can cause lasting problems unless they are caught and addressed early on, said Dr. Cary Sun, Cigna’s chief dental officer.

The Cigna Newsroom spoke with Dr. Sun in early February, which is National Children’s Dental Health Month in the United States. To learn more about pediatric dental health and the dos and don’ts of oral health for children from infancy through their teenage years, read Dr. Sun’s comments below addressing some of the most common questions parents and caregivers might have.

When should I take my child to the dentist?

Children should start seeing a dentist when that first tooth starts appearing – or no later than their first birthday. That allows parents or caregivers to be educated about how to start caring for their child’s teeth.

It also provides an opportunity for the child to get used to dental care at the dental office, especially early on, when the dentist or staffers are just looking in the child’s mouth and there’s no pain involved. That makes their trip to see the dentist a little more pleasant.

What do dentists look for during children’s oral exams?

Similar to exams for adults, we’re checking their teeth and looking for decay. Depending on their age, one of the key things is evaluating how their teeth are erupting and how they are aligned. When there’s misalignment, we may need to put in some sort of appliance to move some of those teeth. The earlier we address that, the more likely that we can avoid major problems or more severe orthodontics or braces later.

X-rays show us if permanent teeth are developing and their position underneath the baby teeth. If a permanent tooth is coming in and the baby tooth is not loose, we may want to facilitate the baby tooth coming out.

We’re also looking for habits like thumb sucking. When children suck their thumbs, this extended habit may cause their teeth to flare out a bit as they erupt, causing what we call an open bite. That creates a situation that affects the way they talk.

What should I expect from my child’s first dental visit?

You can expect to begin by meeting the office staff and filling out a new patient form for your child. Next, you’ll move to the treatment room. Most dental offices will welcome the parent to join their child for the initial evaluation.

Once your child is settled into the chair, the dental team will explain and demonstrate what they will be doing, so that there will be no surprises. Depending on the age of the child and how they are responding, the dentist will determine the need for x-rays and/or cleaning.

Before you leave, the staff will teach you and your child about how to care for their teeth, and you’ll be asked to set up the next appointment.

How often should my child see the dentist?

Generally, once every six months, although that frequency really depends on what the dentist is seeing. A lot of what the dentist is doing is trying to get a sense of what is going on: the child’s diet, how much the caregiver is brushing the child’s teeth, whether the parent is using the right methods to clean the teeth. If we’re seeing a lot of plaque buildup, if we’re seeing decay, that may be an indicator that we need to have the parent and the child come in more frequently to make sure we’re teaching them how to care for the child’s teeth as well as taking care of any treatment needs.

How can I prepare my child for a first trip to the dentist?

First, you as a parent need to be the example. Children need to see that their parents go to the dentist and get checkups to understand it’s an important aspect of caring for themselves.

Before the visit, demonstrate what the visit will be like in simple way, so they know what to expect with no surprise. Pretend you’re the dentist and have them lean back in a chair and ask them to open wide. Shine a bright light in their mouth, explaining that it helps you see their teeth. Clean their teeth with a toothbrush, look in their mouth with a little mirror, and count their teeth. When you’re done, trade places and let your child do the same to you.

Also, remember that children generally do better during morning appointments, when they’re fresh and energetic.

Books and videos can reduce their anxiety and provide assurance if your children are fearful or worried about going to the dentist. You can find lots of good children’s books with favorite characters going to the dentist, and lots of YouTube videos for children.

I recommend these books – many of which have accompanying videos:

• “Curious George Visits the Dentist” by H.A. Rey
• “Just Going to the Dentist,” by Mercer Mayer
• “Doctor De Soto,” by William Steig
• “Show Me Your Smile! A Visit to the Dentist” (Dora the Explorer), by Christine Ricci
• “Daniel Goes to the Dentist” (Daniel Tiger’s Neighborhood), by Alexandra Cassel Schwartz
• “Dentist Trip” (Peppa Pig)

And these videos for parents:

• A New Day for Dentistry (good general resource on oral health)
• Child's First Visit With a Pediatric Dentist 
• Your Child’s First Dental Visit – How To Prepare

How do I choose a dentist for my child?

Oral health is just one part of our total health, so keep in mind that you’re looking for an individual who’s going to be part of your child’s health care team. It’s important that your dentist really listens to you and your child, and that the dental team takes the time to show your child what is going to happen. You don’t need any surprises there.

You should look for an office that makes going to the dentist fun for children and is intentional about making sure children feel comfortable. Anything that is welcoming, and more pleasing for children, is a good thing.

Finally, if you have dental insurance, look for someone who is in your network.

Are pediatric dentists better for children?

Parents should weigh what the child would be most comfortable with. There are general dentists who are very good at treating children. Sometimes children are acquainted with an office and want to see the same dentist their parent sees.

Pediatric dentists, who limit their practices to children, have additional years of specialty training that focuses on the treatment of children and people with additional needs. When children have specific health care needs, such as autism spectrum disorder or a physical disability, a pediatric dentist may have more experience, skills and the means to manage their care. That’s a typical part of their specialty training.

If my child sees a pediatric dentist, when should they switch to an adult practice?

It’s really a case-by-case determination. All children are different, and their oral health, overall health history, and any conditions they have may influence when they feel comfortable transitioning to a general dentist. It’s best to talk with both the pediatric dentist and the general dentist they’re thinking of seeing before making a final decision.

How common are cavities among children? Do they always need to be filled?

Even though we’ve done a lot to prevent tooth decay, the Centers for Disease Control (CDC) reports that by the age of 8, a little over half of children have a cavity in one of their primary teeth. The decision to fill a cavity for children depends on the extent of decay and the condition of the primary or permanent tooth. Newer materials can help stop tooth decay, especially if the tooth is coming out soon.

We want to keep teeth as long as we can, even baby teeth, which set the stage for the position of the permanent teeth. Loosing teeth early also affects children’s ability to chew and eat, their speech, and their ability to make certain sounds. That’s very important for children and their confidence.

How else does dental health effect children’s mental health?

Dental care is a building block of physical and mental health. When children’s teeth hurt or they lose a tooth prematurely, they may not be able to eat well, preventing them from having the nutrition they need to grow. It also affects their ability to speak, eat, and smile, and they may be bullied as a result. That really plays into the child’s confidence, because having the ability to smile and feel comfortable smiling is a key component to our well-being.

In addition, children with poor oral health are nearly three times more likely to miss school and are more likely to perform poorly in school.

Is the dental office safe during the COVID-19 pandemic?

During the early part of the pandemic, the dental profession essentially limited care to emergency treatment. That caused many individuals to delay seeing the dentist, as did a natural concern about how easily COVID can spread.

However, the dental profession took a lot of steps early on to follow the CDC’s infection control guidelines to provide a safe environment for care. A study published in the Journal of the American Dental Association found that 99.7% of practices put enhanced safety features in place early in the pandemic. They implemented screening measures, social distancing, physical barriers, and masking, along with other enhanced infection control procedures. Only 0.9% of the surveyed dentists reported any confirmed or probable diagnoses of COVID-19.