Should your child see a specialist paediatric dentist?

Most parents know the basics — brush twice a day, floss, limit sugar, drink water rather than juice or soft drink, see a dentist regularly. Kids teeth cleaning tips and how to encourage your child to brush cover the home routine.

The question this page answers is a narrower one: when is a general dentist the right choice, and when is a specialist?

What paediatric dentistry is

A specialist field of dentistry providing comprehensive oral health care for children from newborns to adolescents — see paediatric dentists and children's dentistry.

A paediatric dentist focuses on growth, development, and the treatment and prevention of decay in a child's baby teeth and emerging adult teeth. The order and appearance of baby teeth sets out that timetable.

“Specialist” is a registration category, not a description

This matters when you are choosing, because the word is regulated. Paediatric dentistry is one of the 13 dental specialties in Australia approved by the Australian Health Workforce Ministerial Council — Dental Board of Australia. The others are dento-maxillofacial radiology, endodontics, forensic odontology, oral and maxillofacial surgery, oral medicine, oral and maxillofacial pathology, oral surgery, orthodontics, periodontics, prosthodontics, public health dentistry (community dentistry) and special needs dentistry.

A dentist cannot simply adopt the title. The Dental Board requires that an applicant for specialist registration hold a qualification in the specialty, have completed a minimum of two years general dental practice, and have met all other requirements for general registration as a dentist.

AHPRA publishes an online register of all dental practitioners, and that register records the specialty or specialties for dentists who hold specialist registration. It is free, it is public, and it settles the question in about a minute — which is a better use of your time than reading a practice's own description of itself.

One related registration detail is worth knowing if sedation comes up in the conversation: conscious sedation is a separate endorsement on a dentist's registration, governed by the Dental Board's own endorsement registration standard, rather than something included in general or specialist registration. If sedation is being discussed for your child, it is reasonable to ask who will be providing it and under what registration.

How a paediatric dentist differs from a general dentist

Both deal with teeth, provide oral care, treat cavities and apply fluoride treatments. The difference is training and focus. General dentistry covers the everyday side.

In Australia, to qualify as a registered specialist paediatric dentist you must:

1. Complete a general dentistry degree
2. Then complete a further three to four years of study for a masters or equivalent degree in children's dentistry

The Dental Board's registration standard adds the practice requirement noted above — a minimum of two years in general dental practice before specialist registration — so a registered specialist has worked as a general dentist as well as trained as a specialist.

They are trained to work with children specifically — making visits more manageable and easing anxiety through techniques such as Teddy Bear Therapy. Combating dental anxiety in children and how Smile Solutions helps manage a child's dental anxiety describe what that looks like in practice.

Working alongside dental hygienists, they teach correct brushing and which foods are good for teeth, and help children break habits like dummy use or thumb sucking, which can harm growing teeth if left untreated — see orofacial myofunctional therapy, and mouth breathing: the silent habit for the related one.

Because the paediatric dentists at Smile Solutions work alongside general dentists, hygienists and other specialists, a referral into the orthodontic team for early treatment or braces is straightforward — children's braces and Invisalign covers those options.

When to see a paediatric specialist

General dentists and hygiene therapists have a clear role in routine check-ups, cleans, fissure sealants and small cavities. The difference between a dental therapist and a dental hygienist explains who does what.

We recommend a paediatric specialist if your child has:

• an injury to the mouth or teeth — children's dental emergencies has the immediate steps
• severe overcrowding — orthodontics
• difficulty managing their own dental hygiene at home
• visible decay at a very young age (2–4 years) — protecting your child from dental disease
• more than one serious cavity — dental crowns for children: silver or white? covers what is often needed then
• severe toothache — emergency dentistry and tooth pain and ache
• swelling of the gums or cheeks — what is a tooth abscess?
• a fear of the dentist — dental anxiety
• any other special needs in the behavioural area — oral health care for children with special needs and caring for a child with autism

Also for complex medical needs, extreme anxiety, dental trauma, or dental developmental problems such as chalky teeth.

None of that means a general dentist is the wrong starting point. For most children, most of the time, it is the right one. The list above describes circumstances where the extra training is likely to earn its place.

The timetable a paediatric dentist works to

The first few years have a sequence to them, and knowing it makes it easier to tell an ordinary variation from something worth asking about. The Australian Dental Association's consumer guidance sets out the following.

Baby teeth often start to appear around 9 months old, though the range is 3 to 12 months, and it is normal for them to arrive in any order — the middle bottom teeth are often first. If your child has no teeth by 12 months of age, it is best to have a check-up with a dentist. All 20 baby teeth usually arrive by age 3.

The ADA recommends the first dental visit when the first teeth arrive in the mouth — in practice, when the first tooth appears or by one year of age, whichever comes first — and then at least every 12 months thereafter.

One home-care point sits alongside this and is often missed: parents should assist with brushing children's teeth until age eight (Australian Dental Association NSW). A seven-year-old who has been brushing unsupervised for two years is not doing anything wrong; they are simply not yet able to do it thoroughly.

Why it matters

The prevention window

A child's age, cognitive development and personality all need to be taken into account when they are introduced to the dental environment.

Familiarising children young is crucial to forming their belief about seeing the dentist — while their minds are still open. When should a child first visit the dentist? answers the timing question, and your child's first visit describes the appointment. A child who is comfortable, or even enthusiastic, about routine visits makes a preventative approach possible: reducing the chance of a cavity forming at all, or detecting one early, before pain starts. Can you reverse tooth decay? explains how narrow that early window is.

The first visit is where this is most often lost. In the ADA's consumer survey of 25,000 people, a third of parents — 32% — reported that their child's first dental visit was for pain or a problem. The ADA's own comment on that finding is the argument for going earlier: a first visit for a toothache may create a negative first experience, and that is not the introduction you want.

The scale of the problem: in Australia, half of all healthy children have cavities between their teeth by age 6. How does sugar affect your dental health?, protect your kids from the sugar bandits and limiting sugar at Halloween address the main driver.

What the national data shows

Independent figures, from the ADA's Children and Young People Oral Health Tracker and its consumer survey, put some scale on all of this:

• Nearly 11 in every 1,000 children aged 5 to 9 — 10.8 per 1,000 — are hospitalised each year for potentially preventable problems arising from dental conditions. For Indigenous children the figure rises to 14.3 per 1,000.
• Only 56% of children visit the dentist before age 5.
• 34% of children aged 5 to 6 have experienced decay in their primary or baby teeth, and 27% of children aged 5 to 10 have untreated tooth decay in primary teeth.

The hospitalisation figure is the one worth sitting with. Hospital is not where anyone expects children to have dental treatment, and the ADA's point is that most of those conditions could have been prevented. It is also the category the Child Dental Benefits Schedule does not cover, because dental services provided in hospital are excluded from the scheme — how the schedule operates sets out the rest of the rules.

Why baby teeth matter

Some people take the view that baby teeth fall out anyway, so decay in them does not count. Three reasons that is mistaken:

1. Pain, now. When children develop pain before the tooth is ready to fall out, they become frightened. Children today should not have to bear dental pain when eating, or go to school with black front teeth.

2. The wait is long. If a toddler has sore baby teeth, they suffer until the back teeth fall out — around ages 9 to 12. That is years, not months. Should I pull out my child's loose tooth? covers the natural end of that process.

3. Baby molars guide the adult teeth. They play a role in guiding the eruption of adult teeth, so losing them too early matters. When one is lost early, space for the adult tooth to erupt is sacrificed, creating problems in the teenage years.

That third point is the one parents most often have not heard, and it is why early decay in a baby molar can turn into orthodontic treatment a decade later.

The underlying principle

Healthy children's teeth are the healthy adult teeth of the future.

What a paediatric dentist offers, with hygienist support, is the ability to tailor the sequence to the child — teaching a child to clean their own teeth, then teaching them to cope with a dentist cleaning their teeth — rather than applying an adult appointment to a child.

Common questions

How do I check for myself that someone actually holds specialist registration?

Look them up on the AHPRA public register. It is free, it takes about a minute, and it is the only answer that does not depend on anyone's marketing.

The register lists all dental practitioners and records the specialty or specialties for those who hold specialist registration. If paediatric dentistry is not recorded against the name, the person does not hold specialist registration in it — whatever any website or brochure says. The Dental Board's own requirements for that registration are a qualification in the specialty, a minimum of two years general dental practice, and all the requirements for general registration as a dentist.

What the register does not tell you is just as worth knowing:

• It does not rank anyone. It records a registration category, not skill, experience with your child's particular problem, or how good they are with frightened four-year-olds.
• It does not tell you how long they have held it, or what they do day to day.
• It does not tell you about fees.

So treat the register as a floor, not a recommendation. It answers "is this title real?" — and then the questions that actually decide the appointment are the ordinary ones: how often do you see this problem, what would you do first, and what happens if that does not work.

Does a specialist cost more, and does the CDBS still apply?

Expect specialist fees to be higher than general dentistry fees, and ask for the figure in writing before you agree to anything. Fees are set by each practice and are not regulated, so nobody can quote you a number from a page — the price guide lists published fees and understanding your treatment explains how a plan is set out and costed.

On the Child Dental Benefits Schedule, three things matter here.

1. The scheme follows the service, not the provider's title. Services Australia lists what is covered — check-ups, X-rays, cleaning, fissure sealing, fillings, root canals and extractions. A covered item is covered.
2. The cap is per child, not per dentist. Services Australia sets it at up to $1,158 for each eligible child over two calendar years, indexed on 1 January, and the balance is shared across everyone who claims against it.
3. Hospital is excluded outright. Services Australia excludes "any dental services in a hospital" — which is the exclusion most likely to bite, because a young child with extensive decay is exactly the case in which hospital treatment gets proposed.

The question to ask before the first appointment is not "do you take the CDBS?" but "which items in this plan are claimable, what is the expected gap in dollars, and would any of this be done in hospital?" How the schedule operates has the rest of the rules, and eligibility is decided by Services Australia rather than by any practice.

Treatment under sedation or general anaesthetic has been suggested. What should I be asking?

Start with who is providing it and under what registration, because in Australia that is a legal question with a short answer.

The Dental Board of Australia is unambiguous: "Only dentists, including dental specialists, whose registration is endorsed for conscious sedation can use this technique in their practice." Conscious sedation is a separate endorsement, not something that comes with general or specialist registration — and it appears on the AHPRA register, so you can check it the same way you check the specialty. Endorsed dentists must also "complete an approved competency based course in dental sedation and medical emergencies before applying to renew their registration."

The words used in marketing are not the words used in the standards. The Australian Dental Association's policy on conscious sedation defines four distinct levels, and consumer phrases like "sleep dentistry", "twilight sedation" and "happy gas" appear in none of them:

• Minimal sedation — "a drug-induced state of diminished anxiety, during which patients are conscious and respond purposefully to verbal commands or light tactile stimulation"
• Moderate sedation — "a drug-induced state of depressed consciousness during which patients retain the ability to respond purposefully to verbal commands and tactile stimulation," which "includes the use of intravenous sedation"
• Deep sedation — "a drug-induced state of depressed consciousness during which patients are not easily roused and may respond only to noxious stimulation"
• General anaesthesia — "a drug-induced state of controlled unconsciousness accompanied by a partial or complete loss of protective reflexes"

So ask which of those four is being proposed, by name. The ADA's position is that dentists with sufficient training and experience may use minimal sedation, while moderate sedation requires the Board's endorsement — and that "availability of Conscious Sedation services cannot replace the need for access to general anaesthesia services in hospitals for dental purposes."

And ask where it will happen, because that determines the funding. Hospital dental services are excluded from the CDBS entirely.

Any medicine involved is a matter for the treating practitioner, and nothing on this page is guidance on its use.

Do we have to leave our general dentist?

No. In most families the two run alongside each other rather than replacing one another.

The list above is a list of circumstances, not a verdict on your general dentist. Routine check-ups, cleans, fissure sealants and small cavities sit squarely within general practice, and continuity with someone your child already knows is worth something in itself — particularly for a child who is anxious, where a familiar face is part of the treatment rather than a nicety.

Where a referral genuinely helps is for a defined problem: trauma, decay in a very young child, several serious cavities, a developmental enamel problem, complex medical needs, or anxiety that has stopped treatment being possible. Often that is a defined episode — the specialist deals with the problem and routine care goes back to where it was.

Two practical points. Ask for the plan and the radiographs to be shared in both directions, so nothing is repeated unnecessarily and nobody is working from a partial picture — and remember that every claim, wherever it is made, draws on the same CDBS balance. Ask who is doing the recall reminders, because that is the thing that quietly falls between two practices.

Related reading

• Baby teething: signs, symptoms and treatments
• Should my child wear a mouthguard?
• How does the Child Dental Benefits Schedule operate?
• The role of fissure sealants in children's teeth
• The benefits of fluoride
• Preventing dental decay

Practical details

Smile Solutions, Level 1, 220 Collins Street, Manchester Unity Building, Melbourne VIC 3000 — getting here. Phone 13 13 96, contact us, or theteam@smilesolutions.com.au. Monday–Friday 8.00am–6.00pm, Saturday 8.30am–1.30pm, Sunday by appointment.

You can verify any practitioner's specialist registration on the AHPRA register, or by calling 1300 419 495. The practice's registered specialists are identified as such within the full team. Eligible children may be able to use the Child Dental Benefits Schedule; check with Services Australia. Published fees are in the price guide.

Published 9 November 2018. Specialty and registration requirements are attributed to the Dental Board of Australia; sedation levels and positions to the Australian Dental Association's Policy Statement 6.17; eruption timing and first-visit guidance to the Australian Dental Association and its consumer site teeth.org.au; supervision-to-age-eight guidance to the Australian Dental Association NSW; national prevalence and hospitalisation figures to the ADA's Children and Young People Oral Health Tracker and ADA Consumer Survey; Child Dental Benefits Schedule rules and amounts to Services Australia as published at the time of writing, which change over time. General information only; it does not replace advice from your treating practitioner.

Smile Solutions trades under ABN 28 193 514 103.