The Toddler Dental Exam, Knee to Knee and On the Stool Techniques

The Baby & Toddler First Dental Exam and the Knee to Knee and On the Stool Techniques

The American Academy of Pediatrics recommends having your child’s first oral exam by age one or within six months of the eruption of the first teeth. Of course, this may seem daunting for most parents! “How is anyone going to get my 1-2 year old to cooperate for a dental check-up?!”

But the age one dental check-up is a very important step towards assuring that your child will not ever develop the most common chronic disease affecting children, tooth decay! Children typically have not developed the cooperations skills necessary for a dental exam until about age three, by which time they have their full set of 20 primary teeth.  The last of these milk teeth are not exfoliated until the child’s early teens. But if a child has a high risk of caries, he or she could have a mouth full of decay by age three that can lead to dental pain and infection requiring invasive treatments that may require sedation and or even general anesthesia. Therefore, the age one dental visit is the key step towards avoiding all this and helping your child have a healthy smile that is caries free.

This visit itself can be completed within five minutes for most children. It begins with taking the medical and dental history of the child and the primary caregiver. This information is the basis for a caries risk assessment that can help predict the child’s likelihood of developing tooth decay. Eating habits and oral hygiene regiment are then reviewed and the proper use of a fluoridated toothpaste (no more than the size of a grain of rice) is demonstrated as the Dr. performs the dental exam followed by application of a protective varnish when indicated.

For most children, age 6-18 months, the actual dental and oral examination is most often and conveniently performed in a “knee-to-knee” position, where the child sits in his/her parent’s lap and leans back into the lap of the dentist for an examination as demonstrated below. For children nearing two years of age (19-30 months), the modified on “on the stool dental exam” seems to work much better. By this age, children are a bit more independent and many are able to cooperate for much of the visit if they are allowed to maintain some sense of control. In this approach, the child sits on a baby stool in front of the caregiver and leans his or her head back on the caregiver’s lap. We find that this approach is very effective in getting an otherwise apprehensive child to become very cooperative and in fact enjoy the visit with confidence. Most children that are over 30 months are able to sit in a normal dental chair for the typical exam and cleaning.

Many parents are concerned that their infant or toddler may cry at the first visit. While we make every effort possible to ensure that your infant or toddler’s visit is as comfortable as possible, some children will still cry which is often completely normal. It is always helpful to prepare a child for the dental visit. This is particularly true for toddlers who have the potential to cooperate for much of the visit. There are many books and videos (Turner House demo of knee to knee exam, Peppa Pig Visits the Dentist, good reads for first dental visit) that walk through this process that can be helpful for both the parents and children.

Here are some important hints that can make your child’s first visit a success:

1. Get an early appointment! Children are at their best earlier in the day after a full night’s sleep; avoid appointments later in the day or just before naptime.

2. Easy on breakfast! Avoid eating heavy meals or give the child a full milk feeding before the visit. This makes the child more susceptible to vomiting.

3. Is your child ready for a new experience? If the child is ill or in recovery from an illness (flu/common cold, earache, sore throat, cold sore, etc.), make efforts to wait until the child has fully recovered before the child’s first appointment. Also, children who have recently had a traumatic or difficult event (vaccination, hospitalization, a bad fall/accident or even have witnessed a traumatic incident) should be allowed up to six to eight weeks to have recovered from that event.

4. Roleplay! We can not overemphasize how well children respond to having been prepared for the visit. Talk about the planned visit, read books, watch videos and do role play with the child and even better child’s favorite doll or stuffed animal. Of course, don’t ever use the visit to the dentist as a threat or punishment!!!

5. It does not all have to happen today! We realize that everyone is busy and that getting the child’s first dental visit is just another one the many chores you need to complete. But children’s behavior can be unpredictable at times and even with all the preparation mentioned, it may not be the right time for your child to complete a visit. We, in fact, offer “happy visits” where the goal is just to get the child familiar with our space and team. Children tour the office, give high five to the Dr, and get a prize! At times such visit may turn into the actual dental exam and at other times the child may need several such visits to gain the confidence to be able to cooperate and have a successful visit. This may not be most convenient for all parents, but it certainly can help the more apprehensive child get off to the right start with respect to going to the dentist!


On the Stool Dental Exam

knee to knee

Knee to Knee Dental Exam


Use a smear (left) of fluoridated toothpaste on your baby’s teeth as soon as they erupt, and a pea-sized dollop (right) between ages 3 to 6, say new recommendations from the American Dental Association.


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