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What is a Knee-To-Knee Pediatric Dental Exam?

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The American Association of Pediatric Dentists recommends taking your child to the dentist by their first birthday, or within six months of their first tooth erupting. At their first visit, you may see the dentist perform a knee-to-knee exam, also called a lap-exam, for your little one. This is a common practice in a pediatric dental office since 1-2 year olds typically can’t sit up in the reclining dental chair yet, and we want the parents or guardians to be involved in the especially important first visit.

What Can I Expect During a Knee-to-Knee Dental Examination?

baby knee to knee exam

Knee-to-knee exams don’t typically last for more than 15 minutes. You can expect the doctor to do a visual examination of the mouth, teeth, and gums to make sure your child’s baby teeth are developing properly and check for signs of tooth decay. At your child’s first pediatric dental checkup, you’ll accompany your little one to the dental chair.

Here’s how we conduct a knee-to-knee exam:

  • You (the parent) will sit in the dental chair with your child sitting in your lap facing you while the dentist pulls up a chair. 
  • The dentist and the parent will sit knee to knee, and you’ll lean the child backwards into their lap.
  • The dentist will then conduct the knee-to-knee exam by inspecting their mouth. 


They’ll then perform a dental cleaning and your pediatric dentist will ask you a few questions about your child’s oral health habits at home. We’ll also provide any guidance or suggestions, and answer any questions you may have. 

How To Prepare For Your Baby’s First Dental Visit and Knee-to-Knee Exam

Before your visit, prepare yourself and don’t project your own fears or anxieties. Pediatric dentists are specially trained to treat infants through adolescents with a kind and caring demeanor. They understand the unique challenges and complexities in treating children and do everything they can to ensure that your child’s first dental visit is stress-free.

You can also prepare your little one for a great first visit by getting them accustomed to cleaning their teeth and gums. You don’t even need a toothbrush to start. A wet, clean washcloth can be used to clean the mouth and gums, especially after feedings and before bedtime. As teeth begin to erupt, you can use a disposable finger toothbrush or a baby toothbrush to gently clean the teeth without toothpaste. By doing this frequently with your child, the first dental exam will be less of a new experience for them.

Ready to cross ‘First Dental Visit’ off your to-do list?

Schedule your child’s dental checkup to make sure their smile is on track for a lifetime of oral health.

Sources: https://www.aapd.org/globalassets/media/policies_guidelines/bp_radiographs.pdf

Having a Successful Dental Visit with a Child with Autism

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A dental visit for a child with autism can be intimidating, which is why our pediatric dentists are trained to care for children on the autism spectrum. We know that every child is unique and our team works diligently to treat each patient with personalized care. Our ultimate goal is to get to know your child, adapt to their needs, and continue seeing them for years to come. 

child playing with blocks

You’ll find that we strive to meet each patient at their level and guide them through their dental appointment at their own pace. Our pediatric dentists complete an additional two years of training specifically to work with children, including those with autism and special healthcare needs. Whether your child has a sensory processing disorder, is non-verbal, or has other special needs, our team is trained to accommodate, listen to their cues, and make you and your child feel comfortable and cared for.

How To Prepare Your Child For A Successful Dental Checkup

Before your child comes in for their dental checkup, there are a variety of things you can do to help them prepare to have a successful visit. These small steps help set the stage for a positive experience at the dentist by what we call desensitization. This will help prepare them for the sights and sounds they’ll experience during a dental visit. Having a consistent dental routine at home will also likely reduce the time of your dental appointments and lower the risk of oral health problems in the future.

  • Book Your Child’s Dental Checkup As Young As Possible Did you know that kids are supposed to have their first dental checkup by the age of one? This is especially important for children with autism since they are at a higher risk of developing cavities! A few factors that could increase your child’s level of risk for cavities are the amount of carbohydrates and sugars in their diet, as well as their oral hygiene routine at home.

    Seeing patients at a young age allows for desensitization at a stage of childhood when they’re likely to be more cooperative and less fearful. The younger you bring your child to the dentist, the easier the checkup will be. Even if a child is diagnosed with ASD at a later age, if they’ve had their first dental checkup, you’ve already set them up for success!
  • Have a Consistent Dental Routine at Home Brushing your child’s teeth at home twice a day for two minutes is essential to helping your child get used to the ‘brushing sensation’ on their teeth.This way, it’s not a shock at their dental appointment. Before bed, use a manual toothbrush and let them go at their own pace. Make sure you’re using an age-appropriate toothbrush to ensure that it’s comfortable in their mouth. Each child has different levels of sensory tolerance. Some kids don’t mind the feeling or the noise of an electric toothbrush. 
  • Teach Them To ‘Open Wide’ Teaching your child how to ‘open wide’ can be really helpful to make their dental checkup go smoothly. If your child is non-verbal, you may want to try teaching them to smile when you say, “Say Cheese!” to queue them to move their mouth. Once they have that down, it may be easier to get them to open wide and you can try moving your hands around in their mouth. 
child with autism on ipad
  • Incorporate Your Child’s Communication Tablet Into Their Oral Health Routine Children with autism typically do very well on a set schedule, and communication tablets can play a pivotal role in reinforcing routines and habits both at home and when they’re getting acclimated to a new environment. If your child has a communication tablet at home, we recommend that you set up an icon on their tablet for brushing their teeth. They can use it in the mornings and before bedtime as a part of their regular routine. 

    Having this as a part of their routine will help them associate brushing their teeth with a positive experience that they’re familiar with, and when it comes time for their dental appointment, it will feel much more natural. Feel free to bring your child’s communication tablet to their dental visit so they can use it to speak with us. Using picture references and words on their tablet will make it that much easier for our team to accommodate their needs and feelings.
  • Play Videos or Music For Your Child About Dental Visits If your child enjoys music or likes watching videos, there are many visual examples and songs online that can make going to the dentist not as intimidating. Start showing your child kid-friendly videos on how to brush their teeth or what a dental checkup is like. After watching the video together, you can make it interactive and let them watch you brush your teeth, and then brush theirs! These are great ways to make oral health a fun experience.
  • Bring Items To Their Dental Checkup To Self-Soothe Incorporating items or activities that your child responds best to can help them feel more comfortable and secure throughout their dental checkup. A few go-to items you may want to bring are:
    • Stress Balls, Fidget Toys, and Stuffed Animals can help keep their hands busy and serve as a distraction to help alleviate any anxiety they may be having.
    • Communication Tablets help patients communicate their thoughts and feelings.
    • Noise-canceling headphones can be helpful for children with sensory sensitivity by blocking out distracting noises.
    • iPads are welcome for patients to watch their favorite show, game, or movie. Tablets can help keep their attention elsewhere during their dental checkup.
    • Music can be soothing for children and helps calm anxiety.

When they complete their visit, have their favorite toy or another reward ready to congratulate them for a job well done! 

What To Expect At Your Child’s Dental Visit

child at dentist

Throughout your child’s dental checkup, our staff and pediatric dentists aim to respect our patients’ boundaries and only perform what they are comfortable with. Even if we’re only able to count their teeth, get x-rays, or brush their teeth, those are all steps in the right direction! We celebrate the small victories because they add up and help your child feel more accustomed to visiting the dentist.

When we call you back and get your child settled in the dental chair, we may offer a weighted blanket or vest to help them feel relaxed and comfortable during their dental appointment. Let us know if you think these protective stabilization methods would be helpful for your child. We try our best to pair your child with the same staff member and dentist each time they see us as well as keeping a consistent room to build familiarity and consistency. 

If your child is sensory sensitive, our team may take measures to make the environment more sensory-friendly. This may include dimming the lights, shutting the door to block out noise, turning off the TV, using quieter equipment, or giving them sunglasses.

For each step in the dental appointment, we utilize the ‘Tell, Show, Do Method’ with all of our patients.

  • Tell them what we’re going to do. We explain in very plain language what’s going to happen.
  • Show them what we’re doing to do. We demonstrate the use of each tool, this helps ease anxiety and prepares them for what’s next.
  • Do what we’re going to do. We gently perform the recently demonstrated procedure or process. 

If your child is non-verbal, we still try to use the “Tell, Show, Do Method” in the same manner since it has the potential of making their experience a positive one. We know no child is the same and what works for some may not work for others. 

During your child’s dental examination, we’ll perform a dental cleaning and our doctor will examine their teeth. Other services, such as taking X-Rays and applying fluoride may also be performed if it’s recommended by the doctor and your child is cooperating. You’ll get a chance to speak with your pediatric dentist about any questions or concerns you may have. 

Our team is always here to help give advice to parents and support whenever you need it! Depending on your child’s individual needs and their level of risk in developing cavities, we may recommend increasing the frequency of their dental visits.

Help Us Help You!

  • Let Us Know More About Your Child and Their Needs When completing your New Patient Paperwork, the Medical History section has a place to indicate that your child has autism. We encourage parents to let us know if there are any triggers your child may have or ways that we can help make your child feel more at ease. It’s better to over-communicate than under-communicate, so make sure you let us know so we can be fully prepared for your child’s visit! Any specifics will be noted in our schedule for their visit so the staff and doctors know ahead of time. Rest assured, our team will do all they can to make your visit go smoothly and provide a safe environment for both you and your child.
  • Request a Private Room Ahead of Time When scheduling your child’s appointment, make sure to request a private room ahead of time if you want to accompany them throughout their dental checkup. Please note, private rooms are not always available, but we will do our best to accommodate.
  • Schedule a Tour of Our Office We welcome parents to schedule a tour of our office before your child’s appointment. This gives your child a chance to get more accustomed to the lights, sounds, and atmosphere of the office before coming to see us. You will get a chance to look around, meet the staff, see the rooms, and feel more at ease before your official visit. 
  • Consider the Time of Day You’re Scheduling an Appointment We see special needs patients at any time of day, but you may want to schedule your child’s checkup when the office is less busy. Feel free to give us a call and ask when the best time is to book a private room or what days and times we have less people in the office. For some of our offices, the first appointment of the day or the first appointment after lunch are lower traffic times.

You may also want to consider if there are certain times of day that your child tends to feel more comfortable or relaxed, like after lunch or after their nap. Try to schedule their appointment around this time if possible. Fitting in their appointment within their daily routine is key to having a successful, stress-free dental visit. If the location you’re looking to schedule your appointment at is limited in the times you’d prefer, we often have locations nearby that you could also consider.

Ready to get your child’s smile on track?

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Gum Disease in Children

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February is Gum Disease Awareness Month. You may be thinking to yourself, “can children get gum disease?” The answer is that though it’s not typical to find more severe forms of gum disease in children, chronic gingivitis is commonly found in kids of all ages. The good news is, parents playing an active role in their child’s oral health routine can easily prevent significant issues from ever occurring. Here are the main signs to watch out for to make sure your child isn’t in the early stages of developing gum disease.

child brushing teeth

What does gum disease look like?

The American Academy of Periodontology says that the main signs of periodontal disease are:

  • Bleeding while brushing or flossing your teeth
  • Puffiness or swelling of the gums or any indication they look irritated or inflamed
  • Bad breath (halitosis) that does not improve despite consistent brushing and flossing
  • Receding gum lines that expose the lower part of the tooth

Here are three types of gum disease that children can develop and how to prevent these oral health problems.

Gum Disease Early Stages: Chronic Gingivitis 

Did you know that gingivitis is a mild form of gum disease? If you notice that your child’s gums bleed when they’re brushing their teeth or flossing, this is a sign of the early stages of gingivitis. Luckily, this type of gum disease is easily reversible! Brushing and flossing consistently and thoroughly are the best ways to prevent gum disease. If chronic gingivitis is ignored or left untreated, it can worsen and become a much more serious form of periodontal disease, like periodontitis. 

Aggressive Periodontitis

Aggressive periodontitis is most likely to occur in kids during their teenage years. Unlike other types of gum disease, kids that suffer from aggressive periodontitis aren’t likely to see a build-up of dental plaque or tartar. Aggressive periodontitis affects the molars or incisors and is characterized by loss of alveolar bone. The alveolar bone is a part of the maxilla and mandible which supports the teeth by forming attachment for fibers of the periodontal ligament. 

Generalized Aggressive Periodontitis 

Generalized aggressive periodontitis occurs around the age of puberty and can affect your child’s entire mouth. You’re likely to see inflammation of the gums, large amounts of plaque, and tartar if aggressive periodontitis has developed. This is a much more serious form of gum disease and can cause early tooth loss.

How To Prevent Periodontal Disease

By keeping a consistent oral health routine at home, kids can prevent gingivitis from ever occurring. Parents should monitor their child’s brushing until the age of 8 to ensure that they’re exercising healthy habits daily and brushing and flossing properly. If you keep that up, their smile will be on the right track! 

Though it may be tempting for kids to skip a night and go to bed without brushing, an inconsistent oral health routine can lead to issues down the road. If brushing at bedtime is a challenge for your kids, have them brush right after dinner, so long as no snacks follow. If you wait until right before bed or after storytime, kids can be so comfortable or tired that they forget to brush.

By keeping up with routine dental checkups, your pediatric dentist will be able to identify if any signs of periodontal disease are present. Your pediatric dentist will be able to recommend a treatment plan based on the severity of the symptoms. 

Treatment for Gum Disease

Gum disease won’t go away on its own. If your child develops an early stage of gingivitis, it can be treated with regular dental checkups and by implementing a consistent oral hygiene regimen at home. If their gum disease has already progressed to a more serious stage, more frequent dental checkups, like deep cleanings every three months, may be necessary. 

We hope this post helps make you more aware of how gum disease impacts children and how you, as parents, play a vital role in preventing it. 

Sources: https://www.sciencedirect.com/topics/medicine-and-dentistry/alveolar-bone
https://www.perio.org/consumer/gum-disease-and-children

Ready to get your child’s smile on the right track?

Schedule your child’s dental checkup to make sure their smile is on track for a lifetime of oral health.

Toothbrush & Toothpaste Timeline for Children

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You may be wondering what size toothbrush is most appropriate for your child to use based on their age. Though each child is different and their oral development is unique, we’ll walk you through which toothbrush your child should use as they grow up and how much toothpaste to use!

toothbrush timeline for kids

0-3 Years Old: Finger Slip or Infant Toothbrushes for Babies 

There are several options parents can consider when choosing a toothbrush for their baby or toddler between the ages of 0 to 3 years old. One option many pediatric dentists recommend is a finger slip toothbrush. This baby-friendly toothbrush made of textured silicone is a great way to remove any sugar or milk build-up on your child’s gums and is easy to use. This is a more practical alternative to wiping down your baby’s gums with a damp washcloth. 

Slip the toothbrush over your index finger. It should fit snugly. We recommend brushing much more frequently at this age, ideally after each feeding. Doing so will prevent bacterial growth from occurring before your child’s teeth come in. Be sure to clean your baby’s toothbrush after each use. Some baby toothbrushes even come with a case for safe storage when you’re done brushing. 

You don’t need to use toothpaste until their first tooth erupts! When their first tooth emerges, use a rice-sized amount of toothpaste. Use a pea-sized amount of toothpaste after their third birthday!

3-5 Years Old: Kid-Sized Toothbrush

You know they’re growing up fast when it’s officially time to buy a big-kid toothbrush! These toothbrushes look just like adult-sized toothbrushes but are smaller so they can fit in little hands more easily. We recommend using a soft-bristled toothbrush while they’re still in the early stages of getting used to brushing their teeth. Soft bristles are gentle on the gums and still get the job done in a more kid-friendly manner. 

We always recommend that children be fully supervised while brushing until the age of 8 to ensure that they’re doing it properly. A good rule of thumb is that until they can tie their own shoes, an adult should supervise and assist as needed.

6-9 Years Old: Kid-Sized Toothbrush or Electric Toothbrush

Once they’re old enough to understand the importance of brushing and the basics of using proper technique, it may be appropriate to introduce an electric toothbrush to your child. This can be a great way to get them excited about brushing twice a day if they need some extra motivation. 

Whether your child loves princesses, puppies, or superheroes, you can find an electric toothbrush that will make brushing twice a day more enjoyable for kids. By adding the fun elements of sounds, lights, or characters, your kids may actually look forward to brushing their teeth. If you want to keep it simple and continue using a kid-sized manual toothbrush instead of making the switch to an electric toothbrush, they both will do the trick!

10 Years and Older: Adult Toothbrush or Electric Toothbrush

Every child is different, but around the age of 10 years old, your child’s mouth should be large enough for an adult toothbrush to fit comfortably. An electric toothbrush is also a great alternative if your child builds up plaque easily or if there are visible stains on their teeth. In addition to an appropriately sized toothbrush, make sure that floss, mouthwash, and toothpaste with fluoride are in supply. 

We hope that this toothbrush timeline was helpful to break down what size toothbrushes are appropriate for your child at each stage as they grow!

Ready to get your child’s smile on track?

Schedule your child’s dental checkup to make sure their smile is on track for a lifetime of oral health.

Why Flossing Your Child’s Teeth Is So Important

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Flossing your child’s teeth is an incredibly important, yet often overlooked, part of a dental health routine. We know brushing at least twice a day is the standard, but brushing alone doesn’t take away all the plaque on your child’s teeth. Dental floss cleans the hard-to-reach places between their teeth and under their gums. 

Many parents are hesitant to floss their children’s teeth or don’t know when to start. Teaching your children how to use floss at home starts them on this healthy habit at an early age. Here are some handy tips about flossing your child’s teeth.

flossing tools

When should I start to floss my child’s teeth?

You should start to floss your child’s teeth once two of their teeth begin to touch. This usually happens once their primary molars erupt, around the age of 2 or 3. Begin to floss your toddler’s teeth once a day for a couple of minutes. Even if your child’s teeth don’t quite touch yet, you can still introduce the concept of flossing in addition to a good brushing routine. Getting your child used to the feeling of flossing can make the transition easier later on. The earlier healthy habits start, the better!

How should I floss my child’s teeth?

Plenty of adults don’t like to floss, so imagine what it’s like for your child. A gentle touch and patience is the key. When flossing your child’s teeth, floss gently to avoid damaging your child’s teeth or gums. If you’re using traditional dental floss, wrap a length between your index fingers or thumbs. Gently floss between the teeth and move it up and down along the surface of each tooth and down to the gumline.

If you’re having trouble using regular floss, try floss picks. They are more kid-friendly, more comfortable to hold, and come in all sorts of shapes, colors, and flavors. We recommend flossers that have two strands of floss instead of one because it picks up more food debris. 

child flossing

Why is flossing baby teeth so important?

Flossing cleans where the toothbrush can’t, like in between teeth! Removing food particles between teeth every day helps prevent cavities, bad breath, and most importantly, gum disease. Food trapped between teeth turns into a breeding ground for bacteria- gross! Flossing reaches those tricky spots, reduces the amount of bacteria and plaque in the mouth, and lowers the risk of cavities developing. 

What should I expect when flossing?

If your child’s gums bleed at first, don’t worry! This is common when flossing isn’t a part of your daily routine but can be a sign of gingivitis, especially with older kids. The more you floss your child’s teeth, the less bleeding you’ll see. Your child may initially complain that flossing is uncomfortable, but their gums will become healthier and less sensitive the more consistently you floss. As flossing becomes a daily habit, these symptoms will fade.

What are some helpful tips to get started?

Remember to be patient and flexible. Try finding what works best for your child to make flossing fun! 

If your child is having a hard time understanding the concept of flossing, have them watch you floss your own teeth! Explain to your child why flossing is something they need to do consistently. Don’t be discouraged if it’s hard at first. Flossing just one spot every night is still a success if you’re just starting off. When your child reaches the age of 8 to 10 years old and has developed enough manual dexterity, they should be ready to floss on their own!

We hope this encourages you to keep flossing your children’s teeth each night as you help your kids form healthy habits that will last a lifetime! Read more helpful tips here.

Ready to get your child’s smile on track?