Baby Look. Baby Listen. Baby Like You. Baby Be Back.

July 1, 1999
By meeting the newest members of the community, you minimize caries among pediatric patients, and, who knows, maybe the child will grow along with the practice.

By meeting the newest members of the community, you minimize caries among pediatric patients, and, who knows, maybe the child will grow along with the practice.

Steven Schwartz, DDS

As the reduction of caries in the patient population continues, dentists scramble to keep their practices busy and attract new patients. For many, the strategy has been lower fees, dental panels, capitation plans, and bigger and bolder newspaper ads. Unfortunately, dentists frequently overlook a potential source of patients who already exist in their practices - the infant patient.

When questioned by parents about a child`s first dental visit, most dentists suggest that the assymptomatic child should be seen after age three. At that age, children are more likely to cooperate for dental treatment. However, dental problems can develop in a child as young as 15 months. The general dentist who is faced with young children exhibiting dental problems will refer them to a local pediatric dentist, anticipating that the patients will return in a few years - cooperative and willing to accept dental treatment. Unfortunately, the "too quick to refer" general dentist overlooks an important characteristic of consumers.

Consumers are looking for happiness. Whether they are consumers of cars, food, clothes, video games, dolls, vacations, or dentistry, they are looking for happiness. Whether they are child or adult dental patients, they are not seeking fillings, crowns, or deep scalings. They are looking for a pleasant and healthy smile, as well as a good feeling about how they`ve been treated to achieve the desired outcome. They are more concerned about what they`ve experienced while receiving treatment than the treatment they received.

This is especially true for pediatric patients. Very young children have no concept of what a cavity is or the treatment needed to correct the problem. They may have visions of "cavity bugs" eating away at their teeth, but they can`t understand the consequences of neglecting the problem. They don`t care how adept the dentist is at placing a filling or a stainless steel crown. As long as they have not experienced discomfort, they are happy to go to the dentist because it means playing with video games, watching their favorite TV show or movie, and picking out a gift after treatment.

Pediatric dentists report great success at treating young patients because they put equal emphasis on both providing optimum clinical treatment and happy experiences. After a few years of such happy experiences at the pediatric dentist, young patients resist switching to the general dentist. The equivalent of excellent clinical treatment may be present at the general dentist`s office, but where did the "happy" experiences go?

By delaying the first dental visit to until past age three, the general dentist loses the opportunity to treat the pediatric patients who may not return to the office at a later time.

The sensible solution to attracting and retaining patients to achieve a viable and profitable practice is to incorporate dental patients into the practice at the youngest age possible. In 1986, the Academy of Pediatric Dentistry issued a policy statement recommending that a child`s first visit occur soon after the eruption of the first primary incisors or at least by 12 months. After some initial resistance, most pediatric dentists embraced the concept of infant dental care. The concept virtually guaranteed a cavity-free future for the patient. It also made financial sense for the practice and reduced the stress associated with treating young children with caries.

When first introduced to the concept of infant dental care, the dental practitioner usually asks three questions:

- How will the practice profit by instituting an infant care program?

- What services can I provide for the infant patient and how do I manage the child?

- How do I attract infant patients to the practice?

Here are the answers:

n How will the practice profit by instituting an infant care program? By integrating the infant patient into the practice by 12 months of age, the general dentist and staff can institute an early intervention program and prevent the formation of caries in the infant. The program analyzes the child`s medical, social, and family history; feeding and oral health practices; and oral and dental development. As a result, the dentist can provide parents with preventive counseling, making recommendations that will eliminate the possibility of future caries and developmental problems.

The elimination or delaying of minor caries allows the general dentist to retain the patient in the practice without the stress of providing extensive restorative procedures to the young child who is incapable of cooperation. The practice has the opportunity to retain the patient in the practice from infancy into adulthood, providing preventive services such as sealants and cosmetic dentistry (bleaching and orthodontics, for example).

Should the patient remain in the community after reaching adulthood, the general dentist has the opportunity of treating the patient`s children.

n What services can I provide for the infant patient, and how do I manage the child? The infant`s first visit to the dentist should provide a foundation of pleasant experiences and attitudes about future oral health care. The examination is performed in a nonthreatening area outside the dental operatory, such as a private office or quiet reception area.

The most effective and comfortable position for the patient, parent, and dentist is the Oknee to kneeO position. The dentist and parent sit opposite each other with knees touching. The child sits in the parent?s lap and faces the parent. The child?s legs embrace the parent?s lap, and the parent holds the patient?s hand. The child then lays backward until the head rests in the dentist?s lap. This position enables the child to see and feel the parent while the dentist performs the examination with minimal restraint. The position allows for excellent visualization of the oral cavity by both the parent and dentist.

The evaluation of the patient begins with an extraoral examination, which includes inspection of the head and neck for abnormalities, as well as lymph nodes, eyes, ears, nose, lips, and mouth. The intraoral examination includes evaluation of the soft tissues for cysts, clefts, traumatic ulcerations, tongue and frenum lacerations, and gingivitis. Examination of the dentition includes evaluation of the jaw relationships (overjet, overbite, midline deviations, and crossbites), presence or absence of spacing, presence of dental abnormalities, hypoplastic/ hypocalcified enamel, and dental caries.

In the examination position, the dentist or the hygienist can demonstrate to the parent the proper positioning and technique for tooth and gum cleaning.

After the findings are gathered, the dentist makes an assessment of the patient?s risk for dental disease. Based upon the assessment, appropriate recommendations for techniques that prevent dental disease are made. The recommendations also address:

Y Parent?s role

Y Diet counseling

Y Tooth and gum cleaning procedures

Y Fluoride assessment

Y Recall schedule ? six, nine, or 12 months

The fee for performing the above services will vary with the marketing strategies of the dentist. Some dentists feel that offering the introductory visit for free or at a substantial discount is an effective marketing tool for attracting new patients to the practice. Others feel that a charge should be provided, since the dentist allocated time and expertise for the visit. An appropriate fee may be similar to the one for a new patient examination. Since a rubber cup prophylaxis is usually not performed on infants, there would be no fee for that procedure. Charging a fee for a toothbrush or applied topical fluoride treatment would be at the discretion of the dentist.

Instituting a dental care program for infants greatly reduces a child?s chances of experiencing dental caries. The program also allows the dentist to institute highly profitable preventive procedures on a new source of patients who may remain with the practice for many years. It provides a win/win/win situation for the child, parent and dentist.

How to attract infant patients

The marketing strategy involved in attracting infant patients is very simple. Educate parents about the benefits of dental care for infants and to your ability and willingness to provide such benefits. This can be accomplished by:

* Distribution of in-office literature - Placing literature where parents have access to them will solicit comments and questions about infant dental care. You or your staff should personally hand such material to parents who are pregnant or are accompanied by an infant during a visit to the office. Information can be obtained through the American Academy of Pediatric Dentistry and the American Society of Dentistry for Children.

* Pediatricians and obstetricians - Ask local pediatricians and obstetricians to distribute information on infant dental care in their offices. By developing a close relationship with these professionals, they might permit you to attach your business card or imprint your name on the literature.

* Prenatal classes and parent support groups - Establish yourself as an authority on infant dental care by addressing parents who attend prenatal classes at your local hospital. Arrange for presentations for parent support groups at nursery schools and day care centers, especially if a pediatric dentist is not providing such a service.

* Birth announcements - Peruse the local newspapers for birth announcements. Send congratulatory packets to the new parents. The packets can contain information about dental care for infants, as well as samples of oral health supplies (gum swabbing pads and debriding solutions). If compatible with your practice philosophy, enclose a coupon for a free consultation any time before the infant`s first birthday.