Pediatric dentistry is one of the eight specialties recognized by the American Dental Association. In the early 1900s, children were treated as “little adults” and the focus of routine dentistry was to treat the effects of dental decay, such as pulpitis, and resultant pain from this condition. Initially, dental decay resulted in extraction and restorative treatment with emphasis on space maintenance and arch integrity. Since the early 1900s, tremendous improvements have taken place in restorative and preventative techniques. Today, pediatric dentistry is prevention oriented. The cornerstone of prevention-based pediatric dentistry is early referral to the dentist and routine follow-up visits.

For many years, the American Academy of Pediatrics has recommended that children make their first dental visit after their third birthday. The Academy of Pediatric Dentistry, on the other hand, has recommended that children be seen by the age of 1 year. The goal of a pediatric dental practice is to emphasize the importance of oral health to the child and the child's parents. Behavior management is still very much the backbone of the specialty. A primary goal of the treatment-oriented pediatric dental profession is behavior management. A prevention-oriented pediatric dental profession concentrates on educating the parents of very young children on the dental milestones seen in the pediatric population, proper diet, and other issues that prevent dental disease. Given the etiology, pathogenesis, and the treatment of dental diseases, prevention is the only true cure, although realistically, restorative treatment will always be a significant component to the specialty. The preventive component will become a larger emphasis of the specialty if preventive strategies are initiated earlier than 3 years of age. By educating patients and families and by recognizing and appropriately referring dental pathology pediatricians have a central role to the promotion of dental health in infants and children (Figure 1) Pediatricians are typically the first to examine intraoral and extraoral structures and soft and hard tissues postnatally. Intraoral and extraoral clinical examination should focus on symmetry of the maxillary and mandibular arches, the gingiva, and mandibular and maxillary lip support. The palate, tongue, and frenal attachment should be thoroughly examined. Palatal integrity and the depth of the palate should be noted, and tongue should be observed for any restriction in range of motion. Maxillary, labial, and frenal attachments are typically prominent in children. Two epithelial layers, enclosing a loose, vascular connective tissue and, many times, muscle fibers, make up the attachment. This attachment should be noted and monitored because surgical intervention may be necessary to improve orthodontic relationships of the dentition. Any clinical appearance indicating suspicious asymmetry or abnormal soft or hard intraoral or extraoral structures should be referred to a dentist as soon as detected.