Dr. Patrick D. Sculley, D.D.S. (US Army, Major General, Retired)*

Dental experts recommend that the first oral examination should occur at the time the first tooth appears but not later than the age of one year. This examination should be the first in a life-long series of regular dental visits. Over the life of an individual the areas of focus will change to reflect his or her changing needs, but the underlying purpose remains constant: to preserve healthy teeth and gums for life. Below is information about the "normal" areas of focus and treatment at different stages of life; however, disease processes and abnormal development can occur. Nonetheless, the best way to detect the abnormal is through a regular dental exam.

The first examination of a young child will include guidance for the parents or caregivers. Instruction on diet and proper oral hygiene will be provided. The development of the baby teeth, which will appear over the first two years of life, should be discussed. These teeth are not only essential for proper nutrition but they also set the stage for the permanent ones that follow. Of particular note is the importance of informing the parents of the dangers of "baby bottle caries" (tooth decay). This condition usually occurs when the child is put to sleep with a bottle containing sugary liquid. Baby bottle caries can ruin the baby teeth. Fortunately it can be easily prevented with good oral hygiene and wise feeding habits. As a further preventive measure the dentist may prescribe fluoride supplements when the water supply is not adequately fluoridated.

During the toddler and pre-school years exams should focus on the preservation of the baby teeth. The teeth will be examined for early signs of decay and treated as necessary. Unfortunately, a recent report from the Centers for Disease Control indicates that decay is on the rise in children aged 2 to 5. The dentist or hygienist will provide guidance to the parents or caregivers on teaching their child good oral hygiene even though adults should continue to help the child with oral care into the school years.

The elementary school years coincide with the development of the "mixed dentition", a time when baby teeth and permanent teeth coexist. The first permanent molars come in at about the age of six. Examination may disclose the need for sealants to prevent decay on the biting surfaces of the molars and the other back teeth which will appear between ages 6 and 12. When the pits and fissures on the teeth are deep, tooth decay may occur soon after eruption even with appropriate diet and hygiene. Therefore, regular exams are exceedingly important for the prevention of decay during this age period. It is also important to monitor the timing and sequence of the loss of the baby teeth and appearance of the permanent teeth. Interventions may be required to prevent crowding and facilitate the development of proper alignment and "bite". Often children begin to participate in organized athletics during the early school years. If these activities have the potential for injury to the face and mouth, a mouth guard should be constructed.

During the middle school years cavities can become a greater problem as children have more control over their diet. They may make poor choices, substituting sugary snacks for healthy foods. The dental team should continue to provide reinforcement of proper hygiene and diet and provide treatment for cavities as necessary. At this stage some children will require orthodontic treatment (braces) to straighten their teeth. This period is also a good time for a frank discussion between dentist, patient, and parents about the negative effects of tobacco and oral jewelry. Parents and caregivers will appreciate the professional support for this important message. Additionally some children, seeking to be like their media idols, will be using home tooth-whitening products. The dentist will be alert to signs of their use and advise appropriate and supervised use only. Inappropriate use can damage teeth and gums. Also during this period gum disease begins to occur with increasing frequency. Some youngsters will get gingivitis (inflammation of the gums) during puberty due to the interaction of fluctuating hormone levels and dental plaque. Fortunately, time and good hygiene will cure this condition.

In the high school years and into early adulthood concerns continue to include tooth decay and gum (periodontal) disease. The regular reinforcement of a message of prevention including candid discussions about risky habits continues to be extremely important. At about the age of 18 the third molars (wisdom teeth) come in. Occasionally the area around these teeth can become infected or they may only come in part way or not at all. This may mean removing them to prevent further infection or other serious problems.

If regular preventive and treatment services have been a part of the individual's childhood, the adult years will be reached with few problems, healthy teeth, and a winning smile. However, many adults will face an increasing risk of gum disease. Dental examination will thus include screening for gum disease and treatment if necessary, but prevention through good home care remains the best strategy. The increasing evidence of an association between gum disease and other conditions such as diabetes, cardiovascular disease, and pre-term delivery highlights the importance of periodontal health.

Modern dentistry provides many techniques for the enhancement of the appearance of the teeth. Some people will seek cosmetic dental services to create that "perfect smile". Such treatment should be undertaken only after a thorough discussion between dentist and patient concerning the expected outcomes, time involved, costs, maintenance, and risks. A truly informed patient is in partnership with the dentist, a collaboration that will produce the best results.

As one reaches the mature adult years systemic medical conditions may compromise health. Every oral examination should include a review of the health history and medications taken, even non-prescription items. The mouth is the mirror of the body and the dentist may detect systemic disease or note changes in the progress of disease. Additionally, medications can result in oral complications or affect the body's response to oral disease. A classic example is dry mouth (xerostomia), seen in several disease states and with several medications. The dentist will be able to note this condition and can make recommendations which will relieve symptoms.

At every stage of life dental services are necessary. The focus of the examination and treatment may change with age, but the basics of good home care, proper diet, and the avoidance of bad habits remain a constant. Good dialogue between the dentist and the patient is the starting point in achieving oral health and a winning smile for life.