My patient, Nina, is a delightful little girl, but when I first met her at age two, she was a child in extreme pain -- unable to sleep through the night, play or even eat proper meals because of dental cavities. For months, her parents tried numbing her teeth with a gel and weren’t sure if they should take Nina to her pediatrician or a dentist. Unfortunately, when they finally did go to a dentist, he lacked experience working with very young children and did not recommend treatment. Nina suffered rapid progression of her tooth decay.

The combination of their prior poor dental experiences, their lack of understanding about dental health, limited income, and fear of submitting their daughter to risky general anesthesia, led Nina’s parents to further delay her treatment. The problem could no longer be ignored when Nina woke up with a swollen face and had to be rushed in for a traumatizing emergency tooth extraction. Fortunately, Nina ended up receiving the care she needed, but her fear of dentists is now well ingrained, and her parents face substantial medical bills.

Sadly, Nina’s story is not as rare as one might think. According to the 2011-2016 National Health and Nutrition Examination Survey, approximately 21% of children aged 2 to 5 years had dental caries in their baby teeth. (1) Many parents may not be aware that dental health starts this early. If there’s a silver-lining to this story, it’s that Nina’s parents aren’t about to let the same thing happen to Nina’s younger brother. I now see both of their children for regular preventative checkups. They’ve made it a point to share their story with their friends and family about the importance of bringing children as young as one years old in for regular checkups, where dental problems can be diagnosed early to avoid high-risk, costly treatments.

Pediatricians are a trusted resource for families and can help ensure early referrals for dental care. Both the American Academy of Pediatric Dentistry and the Academy of Pediatrics recommend establishing a dental home at age one. (2) After witnessing the dental challenges Nina and many other toddlers are enduring, Nina’s pediatrician now routinely refers children for dental checkups by their first birthday. Since children visit their pediatrician regularly throughout their first year of life, pediatricians are in an ideal position to help guide families to access early dental care. (3) Just as vaccines and good nutrition are a vital part of preventative medicine, an early dental exam can jumpstart a child’s dental health and prevent poor outcomes from dental disease.

1. Fleming E, Afful J. Prevalence of total and untreated dental caries among youth: United States, 2015–2016. NCHS Data Brief, no 307. Hyattsville, MD: National Center for Health Statistics. 2018.
2. The evidence. From the First Tooth. https://www.fromthefirsttooth.org/resource/pediatrics/the-evidence/. Published August 21, 2019. Accessed June 6, 2022.
3. dela Cruz GG, Rozier RG, Slade G. Dental screening and referral of young children by pediatric primary care providers. Pediatrics. 2004 Nov;114(5):e642-52. doi: 10.1542/peds.2004-1269. PMID: 15520094.

Dr. Gila C. Dorostkar is a pediatric dental specialist in private practice in Marin County, California. She serves as the Immediate Past President of the California Society of Pediatric Dentistry and as a Trustee on the Board of the American Academy of Pediatric Dentistry. Dr. Dorostkar is fully dedicated to her many roles in advancing the best dental health for all children.