MS Muthu1, JM Farzan2, KM Prathibha3
1 Pedo Planet, Pediatric Dental Centre, Chennai, India
2 Pediatric Dental Surgeon, Chennai, India
3 Consultant Physician, Chennai, India
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|Date of Submission||09-Feb-2012|
|Date of Decision||06-Mar-2012|
|Date of Acceptance||30-May-2012|
|Date of Web Publication||19-Sep-2013|
| Abstract|| |
Oral examination of an infant forms an important first step toward a lifetime of excellent oral health. Examining an infant during the first visit and the subsequent preventive examination visits may be challenging to dentists and pediatric dentists. There are few concerns regarding the effective oral examination using the traditional "knee-to-knee" position. This paper presents a new, simple infant examination table (INFANTT) to facilitate this examination. This table has many advantages, which includes its stability and simplicity. It is non-threatening and resembles common household furniture. Various modifications of the basic design are also possible to suit the individual dentist's preferences and dental office needs. Additionally, it is possible to use this INFANTT for performing fluoride varnish applications, taking radiographs of the anterior teeth and extraction of natal, neonatal teeth and traumatized teeth.
Keywords: Anticipatory guidance, first dental visit, infant examination, infant oral care, infant oral health, knee-to-knee position
|How to cite this article:|
Muthu M S, Farzan J M, Prathibha K M. A new and simple infant assessment table. Indian J Dent Res 2013;24:515-7
The goals of pediatric dental care are primarily preventive.  Identification of dental caries and gingivitis in children as young as 12-17 months of age by Wendell and Klein indicates the need for parent education by the dentist and preventive treatment for the child at a very early age in the child's life.  In fact, some dentists prefer to counsel expectant mothers.  Also, an interest in gaining knowledge to maintain the optimal oral health of infants is noticed amongst mothers of teething infants. The early first dental visit helps the parents to adopt certain simple oral hygiene measures to improve the oral health status of the child.
The first dental visit of a child ideally should be within 6 months of the eruption of the first primary tooth or by the first birthday of the child, whichever is earlier. American Academy of Pediatric Dentistry states that every infant receive an oral health risk assessment from his/her primary health care provider or qualified health care professional by 6 months of age.  The oral examination for an infant forms the important first step toward a lifetime of excellent oral health.  This first dental examination has to be simple, brief, and yet adequate.  Examining the infant during this first visit and the subsequent preventive examination visits may be challenging to the pediatric dentist.
Infant oral examination does not require the use of dental operatory and can fairly be achieved by examining the infant in a "knee-to-knee" position where the upper legs of the parent and the doctor form the examination table. ,,, Infant examination requires adequate light and occasionally an assistant to help the consultant or the parent in handling the infant. The initial examination usually involves a visual examination and digital palpation. Any further examination or use of instruments may require the dental chair. Gentle restraint of the child is necessary toward which both the parents and the consultant can contribute. The consultant should perform an efficient but unhurried observation irrespective of the infant crying and trying to move. The assistant records the findings as per the consultant's dictation and simultaneously assists in restraining the child or shining a torch as required. At times, the parent and the consultant are seated in right angles during the examination of the infant. However, there are few concerns regarding the effective oral examination of the infant utilizing the knee-to-knee position - the closeness of the parent and provider,  and divided attention of the parent as well as the dentist to put in more effort to hold the weight of the child on their lap. Further, if the dentist is in need of exploring the oral cavity more due to parental concerns, shifting to the dental chair is the only option as the dentist has to use hand instruments.
In order to overcome such difficulties, Pedo Planet, a network of Pediatric Dental Centers, has developed a simple and innovative approach to provide dental care to infants - "INFANTT" (INFANT ASSESSMENT TABLE). This can be a very stable alternative to the conventional knee-to-knee position. The purpose of this article is to describe the design and utility of INFANTT to the pediatric dentists, dentists, and caregivers of children across the globe.
| Design|| |
INFANTT is a stable, clean, comfortable, esthetic, and colorful table [Figure 1]. The construction of INFANTT is simple. It is basically a baby seat which consists of a beam or a pillar with a wooden platform top with rounded edges. A padded cushion covered by colorful upholstery is placed on this wooden top. The total height of INFANTT is 26 inches from the floor. The cushioned top is 22 inches long and 14 inches wide and padded with two layers of 1-inch high-density foam. The cushioned top supports the child to be examined. This simple table with a seamless appearance resembles the common household furniture which puts most of the children and parents at ease while performing the examination. There are two comfortable round stools at the head and rear ends of the table with similar colorful upholstery for the dentist and the parent to be seated respectively [Figure 2]. The INFANTT need not be positioned in the dental operatory but in the dentist's private consultation room, which considerably allays the anxiety of the child. The ideal location of an INFANTT should have adequate light (preferably from the ceiling above) for a direct visual examination and digital palpation. Few toys can be suspended from the ceiling just above the INFANTT for momentary distraction of the child with sound, color, and/or lights during examination.
|Figure 2: Schematic diagram depicting the design and dimensions of INFANTT|
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It is possible to modify the basic design of INFANTT to suit the individual dentist's preferences and dental office needs. Addition of an adjustable light for enhanced visibility with the facility of folding the light beneath the cushioned top may be useful. Lockable wheels at the base of the INFANTT facilitate easy movement of the table to a desired location. Adding Velcro straps from the base of the cushioned top can help the dentist to restrain the child during examination (if necessary) which will, however, require parents' consent. Further, provisions for adjusting the height of the cushioned top to suit the height of the dentist/parent are possible. An adjustable head portion of the top (say, to an angulation of 45°) will prevent aspiration in children. Also, a drawer below the top can serve as a storage area for the basic necessities required during an infant examination like cotton, gauze, and diagnostic instruments. Finally, it is also ensured that there are no protruding sharp parts or edges which might hurt the child. The INFANTT is also easy to clean and requires less maintenance.
| Utility|| |
The primary purpose of the INFANTT is to perform an adequate and thorough oral examination of infants during their first dental visit and the subsequent preventive care visits until they are old enough to be seated on the conventional and/or pediatric dental operating chairs. INFANTT helps the dentist and his team to offer a non-threatening approach toward examining the infant in a manner which is comfortable to the child, parent, and dentist, and thereby an overall positive environment prevails. INFANTT provides good visibility of the teeth with incipient white spot lesions wherein the plaque can be easily wiped and dried with a piece of gauze. The use of INFANTT helps the dentist gain the undivided attention and confidence of the parent as the child is comfortably and safely placed in contrast to the knee-to-knee position wherein a lot of attention and energy is used up in stabilizing the child. The child also lays comfortably without apprehension on the colorful cushioned top and is distracted by the sound and light from the moving toys hung from the ceiling. Both the dentist and the parent are also seated comfortably in their stools. It gives an excellent opportunity for the dentist to educate the parent on the normal oral structures as well as to give instructions for performing oral hygiene measures at home like cleaning gum pads and using a finger brush. Also, the disadvantage of the closeness of parent and dentist as mentioned by Pinkham can be overcome by this table.  INFANTT also provides a good platform for examining a child after traumatic injuries (to be careful if there is any loose tooth). Additional uses of INFANTT include extraction of the natal or neonatal teeth and traumatized teeth, performing fluoride varnish applications, and taking radiographs of anterior teeth. INFANTT can also be used by the parents at home to practice oral hygiene measures, administer medicines (syrups or suspensions), or administer nasal or ear drops to the child in a comfortable and safe manner. Infants with special needs can be comfortably restrained with the help of Velcro straps attached to the cushioned top. The assistant can also provide additional help in safely positioning the child, while the dentist examines the infant and explains to the parents.
| Conclusion|| |
Regular infant examinations help the children to develop a positive attitude toward dental visits and oral health. INFANTT is an economic, safe, and child-friendly investment in dental practice where the aim is to give the highest standards of comfort and care to the child. INFANTT benefits the dentist by simplifying and making infant examinations more efficient. Further, it allays the anxiety of the parents, thereby helping them gain more from the dentist during their child's dental visit.
| References|| |
|1.||McDonald RE, Avery DR. Dentistry for the child and adolescent. 5th ed. St Louis: The CV Mosby Co; 2001. p. 14. |
|2.||Weddell JA, Klein AI. Socioeconomic correlation or oral disease in 6-36 month children. Pediatr Dent 1981;3:306-10. |
|3.||American Academy of Pediatric Dentistry. Guideline on infant oral health care. Pediatr Dent 2008;32(Suppl):114-8. |
|4.||Pinkham JR. Pediatric dentistry - infancy through adolescence. 2nd ed. Philadelphia: WB Saunders Co; 1994. p. 183. |
|5.||Snawder KD. Handbook of clinical pedodontics. 1st ed. St Louis: The CV Mosby Co; 1980. p. 11. |
|6.||Muthu MS, Sivakumar N. Pediatric dentistry - principles and practice. 1st ed. Noida: Elsevier India Pvt Ltd; 2008. p. 171. |
K M Prathibha
Consultant Physician, Chennai
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2]