Evaluation of Age, Chief Complaint, Diagnosis, and Treatment Done during the First Dental Visit among Children in an Academic Dental Institution in Southern Kerala, India

ABSTRACT

Context:

A regular and timely first dental visit plays a cardinal role in the future oral health of the child. It is used to begin preventive and corrective interventions in dental care.

Aim:

To evaluate the age, chief complaint, diagnosis, and treatment done during the first dental visit among children in an academic dental institution in southern Kerala, India.

Materials and Methods:

A descriptive cross sectional retrospective survey was conducted between January and June 2022 among children in an academic dental institution in southern Kerala, India. The hospital records at the Pushpagiri College of Dental Sciences were examined to obtain the child’s age, chief complaint, diagnosis, and treatment done during the first dental visit among children. Statistical Analysis: The data were expressed in frequencies and percentages.

Results:

The records of 1000 children (680 male and 320 female) were examined. Most children (40%) who came for their first dental visit were aged between 4 and 6 years. Only 16% of children aged 0–3 years came for their first dental visit. Pain and sensitivity (50%) and tooth decay (17%) were the most common chief complaints among children. Dental caries (45%) and pulpal pathology (38%) were the most common diagnoses among children. The most common treatments done were glass ionomer cement restorations (32%), followed by prescribing medications (29%). No treatment was required for 16% of the children. Only a minority (3%) of the children received preventive treatments.

Conclusions:

The first dental visit was delayed, and most children sought treatment only during apparent acute symptoms. There is a high prevalence of oral disease burden and underutilization of preventive dental care among children. Education of parents on the value of first dental visits and the usage of preventative dental care in children is crucial.

INTRODUCTION

The gateway to good general health is good dental health. An integrated approach to general health frequently overlooks oral health.[1] A regular and timely first dental visit plays a cardinal role in the future oral health of the child. It is used to begin preventive and corrective interventions in dental care. Parental education regarding oral disease prevention and oral health promotion is possible during this appointment.[2] It also helps to instill a positive outlook on dental procedures and develop trust in the dentist.[3] In this regard, the age at which a child with unidentified oral health issues visits the dentist becomes significant. According to the American Academy of Pediatric Dentistry, the first dental visit should be scheduled at six months and no later than 12 months after the eruption of the first primary tooth.[4]

The chief complaint is a concise statement in any native language. It is frequently presented to the dentist by parents or caregivers. It reflects the child’s or parent’s perception of the need for dental care.[2] The clinical appearance of the child at the initial dental appointment is reflected in the diagnosis. It represents the level of oral care of the child during the first dental visit. It aids in building communication with the child and serves as the cornerstone of a good prognosis.[5] The treatment represents dental care for their perceived need. It is imperative to offer children top-notch and safe dental care.[6]

The aim of this research is to evaluate the age, chief complaint, diagnosis, and treatment done during the first dental visit among children in an academic dental institution in Southern Kerala, India.

MATERIALS AND METHODS

A descriptive cross-sectional retrospective survey was conducted between January and June 2022 among children in an academic dental institution in southern Kerala, India. The hospital records at the Pushpagiri College of Dental Sciences were examined to obtain the child’s age, chief complaint, diagnosis, and treatment done during the first dental visit among children. The study was conducted after obtaining approval from the college authorities without any formal institutional board review. Only, children between the ages of 0 and 12 without a history of previous dental treatment and case documents with complete data from the first dental visit were included in the study. The data were recorded using a coding taxonomy developed by various regulatory authorities.[2,7]

Statistical analysis

The data were expressed in frequencies and percentages.

RESULTS

The records of 1000 children (680 males and 320 females) were examined in the age group 0–12 years. Male children (68%) sought more treatment compared to females (32%). Most children (40%) who came for their first dental visit were aged between 4 and 6 years. Only 16% of children aged 0 to 3 years came for their first dental visit [Figure 1].

Figure 1.

Demographic details of participants

The most common chief complaint was pain and sensitivity, as reported by 50% of the children. It was followed by decayed teeth (17%) in the children. Only 4% of children visited the dentist for a dental checkup. The other chief complaints reported were very rare [Figure 2].

Figure 2.

Chief complaint of the first dental visit

Dental caries (45%) was the most common diagnosis made among children. It was followed by pulpal pathology (38%) and dentoalveolar abscess (8%) in the children [Figure 3].

Figure 3.

Diagnosis of the first dental visit

The most common treatment done was glass ionomer cement restorations (32%). It was followed by prescribing medications (29%). No treatment was required for 16% of the children. Only a minority (3%) of the children received preventive treatments like topical fluoride therapy and pit and fissure sealants [Figure 4].

Figure 4.

Treatment done during the first dental visit

DISCUSSION

Age

Most children experience early medical care, but not dental care. Very rarely, do parents visit the general dentist or a pedodontist. Studies have shown that most parents take their children to a physician or pediatrician for their dental care needs.[8] Therefore, it is important to raise awareness among parents and other caregivers, particularly through prenatal and vaccination clinics.[9]

Early dental visits set the stage for preventive care and more effective, less expensive dental treatments. The proposed age for the first dental visit has been put forth by a number of countries. Argentine researchers suggest that the child’s first dental visit should be during the fourth month of the mother’s pregnancy. This is because maternal oral health influences the overall oral health of the newborn.[10] In the United States, for young children from low-income families, the first dental appointment should be made at age one. For infants from middle-class to affluent families, it may be an optional procedure.[11] Some researchers recommend 12-18 months as the ideal time for the first visit.[12,13] A study in Brazil reported 14.92 months as the age of the first dental visit for children.[14]

Parental perceptions and maternal knowledge influence the timing of the first dental visit for their children. Jordanian mothers were unaware of their children’s oral health status, resulting in delayed dental treatment.[15] Malaysian parents objected that the first dental visit should occur before the child turns one.[16] Various parental surveys conducted in India reported that the first dental visit should be at 1 year of age.[17,18] Another survey reported that 59% of parents expressed the opinion that the first visit should be after the permanent tooth eruption.[19] A survey conducted in Lagos State reported that many mothers were unaware of the age of their child’s first dental visit. Parents who had taken their children for their first dental visit did so after one year of age.[9] Mothers of infants aged 11 to 14 months in China reported their intention to attend the first dental visit within the next three months.[20] In Australia, most children seek dental care only after six years.[21]

Contrary to the standard recommendations, the timing of the first dental visit varied greatly among researchers in India. According to our research, most children (40%) who came for their first dental visit were aged between 4 and 6 years. Only 16% of children aged 0–3 years came for their first dental visit. The results of our research are in agreement with prior studies.[22-27] However, dissimilar results have been reported by several Indian researchers. According to a similar study conducted at the same institution around 12 years ago, children had their first dental visit at the age of 7 years.[28] Other Indian authors reported that most children had their first dental visit between the ages of 6 and 17 years old.[29-31]

Chief complaint

Most parents and caregivers depend on emergency services to deal with their children’s dental problems. Most Indian parents believed that the child’s first dental visit should occur after he or she complained of tooth pain.[32] However, most Malaysian parents believed that a dental checkup should be the primary purpose for the first dental visit.[16]

According to our study, “pain and sensitivity” and “decayed teeth” were the two most frequently reported chief complaints. The findings of this study are consistent with previous research.[25-27,33-39] Pain followed by regular dental checkups was the most common reason for seeking dental treatment in a study conducted in India.[31] In some other studies, pain and other dental emergencies were the common reasons for seeking dental treatment.[23] However, few studies report decayed teeth as the main reason for demanding dental treatment.[29,40]

Routine dental checkups will be helpful to accustom the child to the pediatric dental care setting and the dentist. In our study, only a minority (4%) of the children visited the dentist for a dental checkup. A dental checkup was requested by 27.3% of children on their first dental visit, according to data from another study.[23] The findings of our study reveal that parents need to be made more aware of the value of routine dental checkups and preventive care.

Diagnosis

Young children may be uncooperative and a thorough dental exam may be impossible.[41] However, an inspection should be possible at one year of age to ensure good oral health for all children.[42]

The most common chronic oral condition is dental caries. The monitoring of dental caries reflects the population’s availability to preventive and therapeutic strategies.[2] Dental caries (45%) was the most common diagnosis in our study. Epidemiological research conducted in Kerala reported a 37%–69% prevalence of dental caries at 12 years of age.[43] Another Indian study found that dental caries were prevalent in 50% and 52.5% of 5 and 12-year-old children, respectively.[44] A recent research conducted in India revealed a 52% caries prevalence among children aged 3 to 18 years.[45] Dental caries (33.1%) was the second most common diagnosis in Polish children.[25]

Treatment done

The utilization of curative dental care was higher than that for preventive dental care in our study. Glass ionomer cement restorations (32%) and prescribing medications (29%) were the most commonly utilized treatments among the children. The preventive dental care modalities were underutilized (topical fluoride therapy and pit and fissure sealants) in our study.[46] A study proposed that the utilization of preventive dental care is significantly lower than preventive medical care among 3 to 4-year-old children.[47] In western China, children under the age of 7 had decreased caries prevalence rates, which were attributed to the preventative dental care they received at an early age.[22] Studies in the Brazilian population revealed that preventive dental care was most prevalent in children younger than 30 months of age, and curative dental care was utilized in older children.[14,48]

In our study, around 16% of children had good oral health and did not require any treatment. Similar results were reported in Poland, where 23.1% of the children did not require dental treatment.[25]

Limitations/future scope

The study used a small sample size and cross-sectional data from an academic dental institution over a short period of time. Hence, the study results may not be generalizable at the state and national levels. Large-scale surveys or multi-center research will give an accurate representation of the first dental visit among children in southern Kerala, India. The barriers affecting early dental care and the attitudes of parents and caregivers that differ from actual recommendations should be studied. Studies to determine the dental disease burden (diagnosis and treatment done) among children could be helpful in the strategic planning of the future dental healthcare system.

CONCLUSION

The first dental visit was delayed, contrary to the standard recommendations. Most children seek treatment only when acute symptoms such as pain are apparent. Demanding treatment at late stages may relate to dental anxiety, an uncooperative child, a lack of parent awareness and education, a lack of access to dental care, missing school, multiple visits for treatment, financial costs, and socioeconomic status.[49,50] Dental caries treated with glass ionomer cement restorations indicate a high prevalence of oral disease burden and underutilized preventive dental care among children. Education of parents on the value of first dental visits and the usage of preventative dental care in children is crucial.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.