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Children's dentistry is so much more than just "dentistry for children." It is in early childhood where lifelong habits are learned, such as the recognition of the need for proper oral healthcare. The dentist bears a heavy responsibility for helping to form the child's first impressions of dental care, and consequently forging the attitudes toward dental treatment that will last a lifetime.

Q: When should children start seeing a dentist regularly?

A: The "company line" on this issue is to begin regular dental checkups when all 20 primary teeth have erupted; this is usually by age 2½-3. In our experience, children are usually difficult to manage below the age of 3½-4 years if anything other than a quick checkup is needed. This raises the question of whether an examination is justified if operative or therapeutic procedures, should they be determined to be necessary, cannot be performed due to inadequate patient cooperation. Some children are particularly precocious in their psychological development, and some dentists are gifted in child management skills; this may permit the successful performance of dental procedures at a very early age. Still, we recognize the traumatic nature of forcing a child into an experience before he is ready for it. We will generally advise parents to bring their child in for the first time at around age 4, but to use some discretion. If a child complains of oral symptoms or if there is something in the child's mouth that doesn't seem quite right, this merits a trip to the dentist at any age.

A: This is a question of philosophy. The eye tooth normally will erupt by age 11 or 12, but not every child conforms to the schedule. We prefer to let nature take its course and let the tooth exfoliate naturally; if this is believed to be more than 6 months in the future, it would be appropriate to fill the cavity. Occasionally, it will be determined that a primary eye tooth will be enclosed, or fused to the bone. In this case, the tooth will not loosen and exfoliate normally, and will obstruct the normal eruption of the permanent tooth. In this case, we would advocate extracting the primary tooth. The disagreement between your general dentist and orthodontist has obviously posed a dilemma, which you alone could not be expected to solve. Why don't you ask them to debate the merits of either option, so they can present you with the advantages and disadvantages of the two alternatives, based on the specifics of the case?