In 2001 we initiated an Infant Visit program to make an effort to educate parents of very young children about oral health care. There are many aspects to consider in this type of program and the following are merely my thoughts and ideas about how we created a program that is successfully working for us.
 
 

We have worked out an educational program that our trained Dental Assistants present to the parent regarding:

1. The use of fluoride supplements (our community does not have fluoride in the water)
2. The importance of home care-- brushing or, at a minimum, wiping the teeth clean after each feeding
3. Avoiding bottles at night time with anything other than water (and how other liquids can effect the teeth)
4. Nursing and its relationship to primary tooth decay
5. The impact of oral habits, such as pacifiers or fingers

When requested, the assistant also demonstrates home care by using the knee-to-knee technique for holding the infant and having a second person involved in the cleaning. We demonstrate this with the use of a toothbrush, but also encourage the parents to use anything the child will tolerate, including Q-Tips or "Tenders," which we give them in a packet during the visit. We explain that the brush is optimum, but if the child resists or fights it, using anything is better than using nothing. We also emphasize the importance of cleaning the teeth after each feeding.
 
 

To encourage participation, we have NO CHARGE for this visit. It is a fairly short visit (about 10-15 minutes) and it requires no doctor time. This is by design and is emphasized when the appointment it made. When parents ask about the visit, we make it very clear to them that:

1. This is NOT an examination visit-- it is educational in nature
2. The doctor will NOT be involved in the visit-- a trained dental assistant will conduct the visit
3. There is NO CHARGE for the visit

The importance of the first two cannot be overstated. In most states it is illegal for anyone other than a licensed DDS or DMD to diagnose in a dental office. If any auxiliary (including dental hygienists) examines and offers an opinion about what she/he has seen, it can be construed as a diagnosis and can lead to legal problems. As a result, our auxiliaries are carefully instructed to provide information only and to NOT perform anything that might be considered an examination. If the parent requests that "something be checked," our assistants are trained to inform the parents that if they wish an examination, they can be appointed for one, but then it would be a visit with the doctor and would entail a fee. It is NOT done "on the spot." It is rescheduled.

We do not make an entire patient chart for the infants. We have an abbreviated medical history form on a 5x7 card which we keep in a file box solely for the purpose of knowing that the child has been in the office. We also avoid writing fluoride prescriptions because these are not yet "patients of record." If the parents requests fluoride, we recommend they get them from their pediatricians, who often want the fluoride include in a multi-vitamin, such as Tri-Vi-Fluor or Poly-Vi-Fluor. We prefer to not become involved in those decisions.
 
 

For each parent that brings a child into the office, we provide a packet in a small plastic bag with our logo on it. In the packet are several items, most of which were ordered from the ADA:

1. A growth and development chart showing average eruption times for primary and permanent teeth
2. Fluoride information
3. Nursing and bottle feeding information
4. Nutrition and its relationship to decay
5. A toothbrush
6. A "Tender" as an alternative to to a toothbrush for cleaning

These packets have also been distributed to the local pediatricians' offices with a request to encourage parents to bring their 6-12 month old children into a dental office for information. The local pediatricians have been fairly supportive and only requested that our office's logo not be on the bag so that they would not appear to be promoting one particular dental office. We felt that was reasonable and included in the packet a listing of all the participating offices in our area. Because we feel this is a actually more of a public service than specifically a promotional concept for our office, we had no problem with their request.
 
 

1. How do you create time for this in your busy schedule?
    Because the doctor is not involved, it has literally NO impact on his time. Even with the promotion of this
    program, we are yet to be inundated with requests. We are currently doing perhaps 2-3 per month
2. Why don't you charge a fee?
    We do not want finances to be a factor in peoples' decision to obtain helpful information. Because it is not
    a major time-sink in our office, we feel the more people we can reach, the better and it is not hurting our
    financial well-being.
3. Aren't you "singing to the choir?" (Only the intelligent parents will bring their children in)
    There is undoubtedly truth in this, but we believe that we must begin somewhere. One generation ago,
    people only went to the dentist to have problems solved-- that is, there was no such thing as a "preventive
    visit." Now, people routinely come into dental offices each six months for checkups and it is considered
    perfectly normal. It has been an enormous boon to the dental health of our entire society and programs
    involving infants may require years to become "mainstream," but without a beginning there can be no
    hope for developing that new mindset.
4. Do you believe this has really had an impact?
    It's too early to say. We have only been doing it since 2001, but we know that other offices and other
    groups have adopted the concept and that it IS spreading. As a pediatric practitioner, I spent the first
    25 years of my career wringing my hands and lamenting the problem of nursing caries and baby bottle
    syndrome and wondering why these parents didn't know any better. It eventually occurred to me that
    I could continue on that path, thus ensuring that I had continued doing nothing constructive about it or
    that I could make an effort that may only be a ripple in the ocean, but at least something. I have opted
    for the latter in hopes of touching whomever we can in our office and that the concept will catch on and
    continue to grow.