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Knee-to-Knee Examination Steps*

  1. Have the parent sit in a chair with the child in his/her lap. Interact warmly with the infant/toddler and the parent.
  2. Give the child a toothbrush that has been removed from packaging.
  3. Determine if the parent or another adult helps the child with tooth brushing by asking “How do you take care of your child’s teeth?” If the parent helps a child with brushing, give praise and approval as you have them demonstrate what they do at home. If they don’t help with brushing, encourage them to.
  4. Assume the “knee-to-knee” posture. If you can, hold the child “face to face” and place the child’s legs around your hips. Lower the child’s head onto the parent’s lap. Ask the parent to continue brushing the child’s teeth. While this is happening, observe the child’s mouth and teeth as much as possible as you supervise the tooth cleaning activity. If you are unable to complete this step, proceed to Step 7.
  5. Continue to praise the parent for what they’re doing well.
  6. Reverse the position of the child by asking the parent to take the child from you. Say, “Give your child a hug now and put her/his legs around your hips.” Now gently lower the youngster’s head onto your lap.
  7. The parent can help you by holding the child’s hands as you complete the examination.
  8. Use the child’s toothbrush and quickly assess the child’s oral condition.
  9. Use a dental mirror and continue to assess the child’s oral condition and record findings.
    Advise the parent of oral findings and recommendations for follow-up.
*Adapted from Knee-to-Knee Examination Procedure, an article by Peter K. Domoto, DDS, Professor and Chair, Pediatric Dentistry, University of Washington School of Dentistry and Donna Oberg, RD, MPH, Seattle/King County Public Health, in WSDA News, February 1998.

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