Characteristics and influencing factors of the first dental visit among children in Bangkok, Thailand: a cross-sectional study

The first dental visit should take place at the time of the first tooth eruption and not later than 12 months of age, as stated by the widely used worldwide pediatric dentistry guidelines [1‐3]. This seems like a long way to go for children in Bangkok. According to the present study, the mean ages of FDV were 5.57 ± 2.88 years, which was about four times later than the recommended age, and only 2.42% that straightly followed the recommendation. However, this result was in the midst of other studies from various countries: Poland (3.79 ± 1.82) [7], Turkey (3.64 ± 1.32) [13] and Bulgaria (51.9% at range of 3–6 years of age) [15], Nigeria (7.9 ± 3.7) [9], India (57% at range 6–9 years of age) [5] and Nepal (52.7% at range 7–11 years of age) [14]. The reason for the quite low number from the first two countries could be that the first study was conducted in a private dental clinic, not a government hospital like other studies and the following one included only preschool children, which both referred to a different group of samples from the current study. In keeping with the mean ages at FDV, the percentage of children who had FDV not later than 12 months of age was not much different when compared to Nigeria (0.8%) [9] and Turkey (2.9%) [13] and Bulgaria(1.73%) [15]. Nonetheless, these numbers were far less than the study performed in Brazil (10.1%) which focused only on the infants’ group in urban areas with a ten times larger number of samples [16]. Furthermore, the oral health status at FDV in our study was comparable to the earlier study in a developed country with good public dental services like Poland: 5.02 ± 4.14 vs. 4.50 ± 3.80 and 1.38 ± 2.12 vs. 0.50 ± 1.00 in primary and permanent dentition, respectively [17]. The presence of dental caries was noticeably associated with late FDV. It could imply that the earlier the children come, the better oral health they can have, as FDV is able to establish good oral hygiene due to the proper anticipatory guidance and disease management that will be provided in time by the dental practitioners.

The most common reason for FDV was a dental check-up without any symptoms or chief complaints, which corresponded to earlier studies [13, 17, 18]. Meanwhile, the reason for dental pain (14.2%) was less than half when compared with Mika et al. [7] (60.0%), Meera et al. [8] (42.04%), Olatosi et al. [9] (33.1%), and Ghimire et al. [14] (32.4%). This signified that most of the parents in this study still have concern for their child’s oral health and would not wait until the child had pain, even though it was quite late compared to the recommended age. In addition, it was obvious that having no symptoms did not mean there was no dental caries, as 54.3% of children came for a dental check-up without knowing that caries had already occurred. According to age groups, the youngest age group mostly came only for a check-up without symptoms, while caries could be detected more in older age groups. This could infer that caries might turn into a late stage as parents can detect it themselves, along with symptoms in some cases. Thus, if children had early FDV regardless of the caries presence, the severity would be less and the proper treatments could be provided in time, which would also be able to establish a good attitude in children rather than waiting until the symptoms showed up and negatively affected their behavior, which was in agreement with Rantavuori et al. [19] and Lin et al. [20]. Likewise, malocclusions that were mostly found in children in oldest age group with early mixed dentition, which is normal, would decrease in number if the child had an earlier FDV and a regular dental check-up.

Considering the socio-demographic factors that influence the proper age for FDV, it was found that parental age was a strong predictor, as a tendency toward late FDV was detected in parents with older ages, which was supported by the previous study [21]. Children who did not have siblings tended to have FDV at earlier ages compared to children with siblings. This could be due to the fact that attention and carefulness would be gained more from only-child parents and would not be shared by other children in the family. In addition, it was unsurprising that only 58.8% knew that they should bring their child for FDV since the first tooth has erupted, and it was also lower among parents in Puducherry, India (25%) [5], and Riyadh, Saudi Arabia (15.5%) [6]. This result confirms that the guidelines for FDV have not properly reached parents throughout the world. In contrast, parents with higher oral health attitude scores seemed to take their children earlier for FDV. Thus, providing and reinforcing a child’s good oral health attitude to parents as early as possible with continuity since the pregnancy period, especially in advanced maternal age, could potentially help them reach the goal of the proper age for FDV as recommended by the guidelines.

Moreover, it was interesting that there was a huge misunderstanding that having no symptoms of the child meant it was normal to not have FDV, as it was the most common reason for deferring the FDV, not a barrier of socioeconomic status like a financial or time problem. Some parents thought that the child’s noncooperation was one of the FDV barriers, which agreed with parents in Saudi Arabia [6]. This result indicated that it was necessary that the oral health practitioners inform and assure the parents about the level of cooperation related to the age of the children, as it is usual for children to be uncooperative in the early years of live.

The limitation of the present study was that different recorders might influence the obtainable data. Moreover, even though the pediatric dental clinic of Mahidol University included the most diverse socio-demographics of patients and parents throughout Bangkok, the fact that this was the only setting might limit the findings of this study, and some factors should have been considered, such as health insurance benefits. Future studies should focus on an effective campaign to promote an early first dental visit in the prenatal period, especially in advanced maternal age.