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Emily Hahn, DDS: Hi, I'm Dr. Emily Hahn, a Board Certified Pediatric Dentist at St. Louis Children's Hospital, and I'm a Mom Doc.

Melanie Cole, MS (Host): Many children and adults for that matter, worry about going to the dentist. Today we're offering tips for dealing with your child's anxiety and we adults might learn something ourselves. Welcome to Mom Docs, the podcast from St. Louis Children's Hospital. I'm Melanie Cole and Dr. Hahn, I'm so glad to have you with us cause this is really a great topic. Can you start with, cause I always like sort of a table setting thing; the importance of keeping regular dental schedules with our little kiddos, when we should start seeing the dentist in the first place.

Emily Hahn, DDS: Absolutely. So the recommendation from the American Academy of Pediatric Dentistry, as well as the American Academy of Pediatrics is to start seeing the dentist at age one, and many people look at me very aghast that that is something that we would recommend. And the reason is is to avoid these dental phobias. Early intervention and early desensitization to the dentist leads to a lifetime of easier dental visits because it's just part of your daily routine. In addition, we all know going to those pediatrician visits, especially during the first year, are overwhelming and it's just another member of a healthcare team to have. And so by getting a dentist and ideally a pediatric dentist, but there are not as many of us, to get in there, talk about the mouth and talk about things so that your kids aren't scared, is a great first start.

Melanie Cole, MS: Well, it sure is. And excellent advice, Dr. Hahn, to get our kids in early so that they're not so afraid because it's really not so scary. And as somebody who actually likes to have my teeth cleaned, and I love the way that feels, getting our kids to understand the importance and that it doesn't really hurt. So now tell us about that anxiety that many adults and certainly many kids face. What is that?

Emily Hahn, DDS: So dental anxiety, it's the same as any other anxiety, but really it just comes from the fear of the unknown or the fear of hurt. And when people hear of the word dentist, we don't have the greatest reputation in history and honestly, the worst, the people who put that into kids minds are usually parents. Something that starts, and I hear it in my office, if you don't brush your teeth, you're going to get a cavity and they're going to have to drill in your teeth and give you a shot. How terrifying does that sound? My number one piece of advice with the dental phobia and dental anxiety, is to not use us as a threat. That is the number one piece of advice for me regarding dental anxiety, because dental anxiety is the fear of stress surrounding the dentist. And if you use this as a fear point, it's going to cause issues.

Melanie Cole, MS: Well, it certainly is, and you're right, using it as a fear factor or even a punishment. If you don't brush your teeth, you know the dentist is going to give you that big shot. That's just terrible. And I know that some parents feel like that's the only way to get their kids to do these things, but you're going to give us really good, positive tips to get our children to want to brush their teeth. Tell us a little bit about some of the signs and symptoms. What are we looking for as far as avoidance, tantrums, and what do we do about it when it happens?

Emily Hahn, DDS: With the tantrums. So the first thing is consistency. Just like we want you to see the dentist every six months, it's very important to make sure that toothbrush hits that mouth from the get-go, from that first tooth at six months or a little bit older of age. So if we can get a toothbrush in the mouth every single night right before bedtime, that makes a huge difference.

Another thing is, is that know that it's normal for kids to not want you to mess with them, especially during that time when they're trying to assert independence. So around usually 18 months to, I would say about three, in some kids four, they don't want you doing anything. That's their time to assert their independence, and they're wanting to do that on their own with other things, if you think about it, putting their shoes on, putting their pants on, getting themselves dressed. So I always say morning is a great time for kids to brush their own teeth, and then at nighttime it's a good idea for you to do it. Another tip is maybe try a different toothpaste. Some kids just don't like the sensation or the sensitivity of different toothpastes, and so if we can try to use different flavors or even just use a fluoride mouth rinse where you can dip it, that really helps.

Brushing your teeth and getting that to be a part of routine makes dental visits way easier too, because they're used to someone else's mouth, no, sorry, someone else's hands in their mouth.

Melanie Cole, MS: That's true. I remember those days. I loved those days of brushing my kids' teeth and I remember turning it over to them and saying, okay, now you guys got to do it. And watching them and looking in the mirror, it's really a sweet time. So tell us a little bit about working with our kids to instill those really good habits. I mean, we're going to have to take them to the dentist and we're going to get into more about pediatric dentistry, but I'd like you to give us some really good tips about getting our kids to have those healthy dental habits right from the get-go.

Emily Hahn, DDS: It's as simple as starting early. That's starting early, making sure you have that part of a nightly routine. Kids do very, very well with structure, and so if we make sure that toothbrush hits that mouth every single night, that's huge. Morning is it good for building independence. And nighttime is a good time for you to get in there. So consistency is key.

Melanie Cole, MS: Consistency is definitely key. Now, as far as pediatric dentistry, we hear about fluoride, we hear about all of these different things, Dr. Hahn, can you tell us just a little bit about what we can expect as parents, especially for parents taking their kids to the dentist for the first couple of years. For the first couple times, and in through their toddler and tweens. What does it mean when you give them fluoride? What are you doing at the dentist for our kids?

Emily Hahn, DDS: Fluoride is a mineral is basically something, it's an element that we put on the teeth and what it does is it allows our teeth to withstand our diet. It allows our teeth, if once fluoride is incorporated into the tooth structure, it allows our body to be able to have those not so healthy foods. Cause let's be real, it's not fair to never have anything that has a little bit of sugar or to snack a little bit.

That's just not realistic. So by fluoride being integrated into the tooth structure of the tooth, it has a much better chance of withstanding all of those foods and drinks that we don't like are not. We all really, really like. It's just that it's not maybe the best thing for our teeth. So by having fluoride put on there, it's just one of the many tools in a dentist's toolbox to make sure that you don't get cavities, and so that we can try to maintain an infection free and healthy mouth.

Melanie Cole, MS: What else do you do for kids to make them comfortable at the dentist?

Emily Hahn, DDS: Introduce them to everything. It's called Tell Show Do. So the first thing is, to show them, at least in my office, something they're familiar with. And I start with a toothbrush. A toothbrush, hopefully most kids have seen before. And most little guys, if we're brushing every single night with that consistency, they open their mouths right up with that toothbrush.

And so when we start with a toothbrush, that's the first thing. So showing them a toothbrush, then I floss, I actually show floss. And that's a good conversation starter for parents to know. Okay, so yeah, we can start flossing and see which teeth are touching and then we just show them the mirror. We show them how soft it is.

And then the last thing is fluoride. The other thing is, is that we don't necessarily need to lean a child back on those first visits. Many first visits, kids are sitting up. They can be sitting on mom and dad's lap, or they may be sitting up on the big chair. Or they may do something called Need a Knee, which is where the kid is facing mom and dad on their lap, and they lean back into the dentist lap.

This is a really good opportunity actually for parents to see what's going in their mouth. Sometimes they cry, but honestly crying helps us get a really good look and helps the parents see what's going on as well.

Melanie Cole, MS: What about sealants? That's something that I remember my dentist charged extra for. It wasn't part of an insurance thing, but what are sealants? Is that something kids need?

Emily Hahn, DDS: Many kids do need it, and most insurances do cover it at a hundred percent under preventive services, so it definitely is something to ask about, and it is preventive. It's to prevent cavities. The most common place for cavities to occur, especially around six or seven, is the biting surface of your permanent back molars.

Now there are some baby teeth that would definitely benefit. My own five year old, I wish I could get sealants on his two year molars. They just have really deep grooves, and there are some people and some families where the anatomy of their teeth, so the shape of their teeth are just more prone to cavities.

And so those back molars have those grooves, those peaks and those canyons. We like filling those canyons in with a filling material that's rather flowable and we just put a light cure on it to make sure that there aren't any cavities that are developing on that biting surface of the tooth. And most dentists recommend that around the age of six.

And then when we get our 12 year molars, we often recommend those. But it's definitely something to ask your dentists or their office staff about regarding insurance coverage. But I'll tell you this much, I would love to be able to seal every single one of my kiddo's teeth because I've seen the great effects it has.

Melanie Cole, MS: Wow. What passion you have for your profession, Dr. Hahn, and I can tell that you are just probably the most awesome dentist for our little kiddos. What else would you like to tell parents about taking our kids to the dentist, getting those regular, at least twice a year visits for the cleanings, fluoride?

Anything we need to be doing with our kids to keep that healthy mouth because it is so important. And you know, as an adult, we all look back with regret that why didn't we. Why didn't we do better as kids with our dentists? But we have that opportunity to do that with our kids now. What would you like us to know?

Emily Hahn, DDS: Start early. Starting early can make the world of a difference for the kids' perspective. And finding a healthcare provider you really like and you feel that you can communicate with. The worst thing that can happen is when you wait to bring your kid to a dentist until they are have an emergency or they're in pain because their affiliation is going of pain and the dentist.

So the dentist didn't put the pain there. It's because, and sometimes kids fall and that that may be the first time and that's okay, but for other kids and talk to your other mom friends or your dad friends, starting early and having that dentist to call if there is an emergency is so beneficial.

Melanie Cole, MS: Well it is, and I really want to do another podcast with you on dental emergencies, because that's an important one that I don't think a lot of parents know what to do in the case of some of those dental emergencies. So you are going to join us again and we'll talk about that. But thank you, Dr. Hahn. What great, great advice you've given all of us parents today for keeping healthy teeth for our little kiddos, and I hope as parents, we learned a thing or two here today about dental anxiety and why we shouldn't feel that anxiety because going to the dentist is so, so beneficial. Thank you so much again for joining us. And for more advice and articles, check out the Mom Docs website at children'smd.org. That concludes another episode of Mom Docs with St. Louis Children's Hospital. I'm Melanie Cole. Thanks so much for listening,