Click on a topic of interest for more
information.
 What is a Pediatric Dentist?
Your Child's First Dental Visit
Why are the Primary Teeth
so Important?
Dental Radiographs (X-rays)
Care of your Child's Teeth
Good Diet = Healthy Teeth
How Do I Prevent Cavities
Preventive Resin Restorations
Baby Bottle Tooth Decay (Early Childhood
Caries)
When will my Baby Start
Getting Teeth?
Eruption of your Child's Teeth
Dental Emergencies
Fluoride
What is Pulp Therapy?
What's the Best Toothpaste for
my Child?
Does your Child Grind his Teeth at Night? (Bruxism)
Thumb Sucking
Tongue Piercing - Is
it Really Cool?
Tobacco - Bad News in Any Form
What is the Best
Time for Orthodontic Treatment?
Mouth Guards
For information on special oral health care needs, we've provided links
to the following sites:
National Institute of Dental
& Craniofacial Research
Resource & Information on Cleft Lip
& Palate
National Foundation for Ectodermal Dysplasias
What Is A
Pediatric Dentist?
The pediatric dentist has an extra two
to three
years of specialized training after dental school, and is dedicated to the oral health of children from infancy
through the teenage years. The very young, pre-teens, and teenagers all need different
approaches in dealing with their behavior, guiding their dental growth and development,
and helping them avoid future dental problems. The pediatric dentist is best qualified to
meet these needs.
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Your Child’s First Dental Visit
According to the American Academy of Pediatric
Dentistry (AAPD), your child should visit the dentist by his/her 1st
birthday. You can make the first visit to the dentist enjoyable and positive. Your child
should be informed of the visit and told that the dentist and their staff will explain all
procedures and answer any questions. The less to-do concerning the visit, the better.
It is best if you refrain from using words around your child that
might cause unnecessary fear, such as needle, pull, drill or hurt. Pediatric dental
offices make a practice of using words that convey the same message, but are pleasant and
non-frightening to the child.
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Why Are The Primary Teeth So
Important?
It is very important to maintain the health of the primary teeth.
Neglected cavities can and frequently do lead to problems which affect developing
permanent teeth. Primary teeth, or baby teeth are important for (1) proper chewing and
eating, (2) providing space for the permanent teeth and guiding them into the correct
position, and (3) permitting normal development of the jaw bones and muscles. Primary
teeth also affect the development of speech and add to an attractive appearance. While the
front 4 teeth last until 6-7 years of age, the back teeth (cuspids and molars) aren’t
replaced until age 10-13.
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Dental
Radiographs (X-Rays)
 Radiographs (X-Rays) are a vital and necessary part of your child’s
dental diagnostic process. Without them, certain dental conditions can and
will be missed.
Radiographs detect much more than cavities. For example, radiographs may be
needed to survey erupting teeth, diagnose bone diseases, evaluate the
results of an injury, or plan orthodontic treatment. Radiographs allow dentists
to diagnose and treat health conditions that cannot be detected during a
clinical examination. If dental problems are found and treated early, dental
care is more comfortable for your child and more affordable for you.
The American Academy of Pediatric Dentistry recommends radiographs and examinations every six months for children with a high risk of tooth decay.
On average, most pediatric dentists request radiographs approximately once a
year. Approximately every 3 years it is a good idea to obtain a complete set
of radiographs, either a panoramic and bitewings or periapicals and
bitewings.
Pediatric dentists are particularly careful to minimize the exposure of
their patients to radiation. With contemporary safeguards, the amount of
radiation received in a dental X-ray examination is extremely small. The
risk is negligible. In fact, the dental radiographs represent a far smaller risk
than an undetected and untreated dental problem. Lead body aprons and
shields will protect your child. Today’s equipment filters out unnecessary
x-rays and restricts the x-ray beam to the area of interest. Digital
Radiography, used in our office,
and proper shielding assure that your child receives a minimal amount of
radiation exposure.
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Care of Your Child’s Teeth
Begin daily brushing as soon as your child’s first
tooth erupts. The first few teeth can be cleaned with a soft cloth, gauze or
finger brush. As the molar teeth erupt, a toothbrush is needed to clean the
grooves thoroughly. The average child does not develop the small motor
skills and coordination for thorough brushing until about age seven. However
they will not develop these skills without practice. It is recommended that
your child’s teeth are brushed morning and night. Once a day, your child may
brush by themselves. The other brushing should be done by a parent. Even
beyond age seven there should be occasional adult supervision. Each child is
different and your dentist can help you determine your child’s skill level.
Use a pea sized amount of fluoride toothpaste and encourage your child to
spit out the excess. If you child is under three years old, you may want to
use a non fluoride toothpaste if they tend to swallow during brushing.
Proper brushing removes plaque from the inner, outer and chewing
surfaces. When teaching children to brush, place toothbrush at a 45 degree angle;
start along gum line with a soft bristle brush in a gentle circular motion. Brush the outer
surfaces of each tooth, upper and lower. Repeat the same method on the inside surfaces and
chewing surfaces of all the teeth. Finish by brushing the tongue to help freshen breath
and remove bacteria.
Click here to
watch a video on brushing techniques.
Flossing removes plaque between the teeth where a toothbrush
can’t reach. Flossing should begin when any two teeth touch. You should
floss
the child’s teeth until he or she can do it alone. Use about 18 inches of floss,
winding most of it around the middle fingers of both hands. Hold the floss lightly between
the thumbs and forefingers. Use a gentle, back-and-forth motion to guide the floss between
the teeth. Curve the floss into a C-shape and slide it into the space between the gum and
tooth until you feel resistance. Gently scrape the floss against the side of the tooth.
Repeat this procedure on each tooth. Don’t forget the backs of the last four teeth.
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Good Diet = Healthy Teeth
Healthy eating habits lead to healthy teeth. Like the rest of the
body, the teeth, bones and the soft tissues of the mouth need a well-balanced diet.
Children should eat a variety of foods from the five major food groups. Most snacks that
children eat can lead to cavity formation. The more frequently a child snacks, the greater
the chance for tooth decay. How long food remains in the mouth also plays a role. For
example, hard candy and breath mints stay in the mouth a long time, which cause longer
acid attacks on tooth enamel. If your child must snack, choose nutritious foods such as
vegetables, low-fat yogurt, and low-fat cheese which are healthier and better for
children’s teeth.
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How
Do I Prevent Cavities?
Good oral hygiene removes bacteria and the left over food particles that
combine to create cavities. For infants, use a wet gauze or clean washcloth
to wipe the plaque from teeth and gums. Avoid putting your child to bed with
a bottle filled with anything other than water. See "Baby
Bottle Tooth Decay" for more information.
For older children, brush their teeth at least twice a day. Also,
watch the number of snacks containing sugar that you give your children.
Try to avoid liquid sugars, such as juices, sodas and sports drinks. Water
is the best hydration for your body. It also helps in cleansing the mouth
between meals.
Your pediatric dentist may also recommend a prescription or over the counter
home fluoride treatment, if they feel it is appropriate for your child.
The American Academy of Pediatric Dentistry recommends six month visits
to the pediatric dentist beginning at your child’s first birthday. Routine
visits will start your child on a lifetime of good dental health.
Your pediatric dentist may also recommend protective sealants or home
fluoride treatments for your child. Sealants can be applied to your child’s
molars to prevent decay on hard to clean surfaces.
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Preventive Resin Restorations
The deep grooves of the molar and bicuspid teeth are the most vulnerable to
decay. These grooves often have pits and fissures where bacteria harbor and
the toothbrush bristles cannot reach. There is often very minimal enamel at
the bottom of these grooves. This is the most common cavity in dentistry.
A preventive resin restoration prevents a cavity in its early stages by
filling in these deep grooves with a composite resin. There is minimal
prepping to the tooth and the material used is very wear resistant to
chewing forces. This procedure, although it is similar to a sealant,
provides significantly longer protection for the tooth.
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Baby Bottle Tooth Decay (Early
Childhood Caries)
One serious form of decay among young children is baby bottle tooth
decay. This condition is caused by frequent and long exposures of an infant’s teeth
to liquids that contain sugar. Among these liquids are milk (including breast milk),
formula, fruit juice and other sweetened drinks.
Putting a baby to bed for a nap or at night with a bottle other than
water can cause serious and rapid tooth decay. Sweet liquid pools around the child’s
teeth giving plaque bacteria an opportunity to produce acids that attack tooth enamel. If
you must give the baby a bottle as a comforter at bedtime, it should contain only water.
If your child won't fall asleep without the bottle and its usual beverage,
gradually dilute the bottle's contents with water over a period of two to
three weeks.
After each feeding, wipe the baby’s gums and teeth with a damp
washcloth or gauze pad to remove plaque. The easiest way to do this is to sit down, place
the child’s head in your lap or lay the child on a dressing table or the floor.
Whatever position you use, be sure you can see into the child’s mouth easily.
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When
Will My Baby Start Getting Teeth?
Teething, the process of baby (primary) teeth coming through the gums
into the mouth, is variable among individual babies. Some babies get their
teeth early and some get them late. In general the first baby teeth are
usually the lower front (anterior) teeth and usually begin erupting between
the age of 6-8 months. See "Eruption
of Your Child’s Teeth" for
more details.
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Eruption Of Your Child’s
Teeth
Children’s teeth begin forming before birth. As early as 4
months, the first primary (or baby) teeth to erupt through the gums are the lower central
incisors, followed closely by the upper central incisors. Although all 20 primary teeth
usually appear by age 3, the pace and order of their eruption varies.
Permanent teeth begin appearing around age 6, starting with the
first molars and lower central incisors. This process continues until approximately age
21.
Adults have 28 permanent teeth, or up to 32 including the third
molars (or wisdom teeth).
TOOTH DEVELOPMENT
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Dental Emergencies
Toothache: Clean the area of the affected tooth thoroughly.
Rinse the mouth vigorously with warm water or use dental floss to dislodge impacted food
or debris. If the pain still exists, contact your child's dentist. DO NOT place aspirin on the gum or on the aching tooth.
If the face is swollen
apply cold compresses and contact your dentist immediately.
Cut or Bitten Tongue, Lip or Cheek: Apply ice to bruised
areas. If there is bleeding apply firm but gentle pressure with a gauze or cloth. If
bleeding does not stop after 15 minutes or it cannot be controlled by simple pressure,
take the child to hospital emergency room.
Knocked Out Permanent Tooth: Find the tooth. Handle the tooth
by the crown, not the root portion. You may rinse the tooth but DO NOT clean or handle the
tooth unnecessarily. Inspect the tooth for fractures. If it is sound, try to reinsert it
in the socket. Have the patient hold the tooth in place by biting on a gauze. If you
cannot reinsert the tooth, transport the tooth in a cup containing the patient’s
saliva or milk. If the patient is old enough, the tooth may also be carried in the patient’s mouth. The patient
must see a dentist IMMEDIATELY! Time is a critical factor in saving the tooth.
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Fluoride
Fluoride is a naturally occurring substance that is essential to the
development of strong, healthy teeth and vital to the prevention of
cavities. A balanced diet that does not include fluoridated water will not
meet the needs of a growing child.
Fluoride is available in two forms, topical and systemic. Topical fluorides
strengthen teeth that are already present in the mouth, making them more
decay resistant. Examples of topical fluorides are fluoride toothpastes,
mouth rinses containing fluoride and prescription fluoride gels. Topical
fluorides are not meant to be swallowed. If your child is too young to spit
out excess toothpaste, use a non fluoride brand until they develop this
skill. A small pea sized amount of toothpaste is all that is recommended
when brushing.
Systemic fluorides are ingested into the body and become incorporated in the
formation of the tooth structure. Examples of systemic fluoride are
prescription fluoride supplements in drops or tablet form. Your pediatric
dentist can help you determine the dosage that is appropriate for your
child. If you live in an area with a fluoridated water supply systemic
fluorides are not necessary.
Dental fluorosis, a minor cosmetic condition that is not harmful to your
health, is characterized by lacy white lines or specks on the surfaces of
the permanent teeth. Fluorosis is caused by excessive fluoride ingestion at
a young age while the teeth are still forming. Always follow directions on
fluoride products to avoid ingestion of too much fluoride.
The American Dental Association and the American Academy of Pediatrics have
reviewed the use of fluoride toothpastes, rinses and supplements. Their
findings were that children living in communities without fluoridated water
may benefit greatly from fluoride supplements. Fluoride is like any other
nutrient, it is safe and effective when used appropriately.
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What
is Pulp Therapy?
The pulp of a tooth is the inner central core
of the tooth. The pulp contains nerves, blood vessels, connective
tissue and reparative cells. The purpose of pulp therapy in Pediatric
Dentistry is to maintain the vitality of the affected tooth (so the tooth is
not lost).
Dental caries (cavities) and traumatic injury
are the main reasons for a tooth to require pulp therapy. Pulp therapy
is often referred to as a "nerve treatment", "children's root canal", "pulpectomy"
or "pulpotomy". The two common forms of pulp therapy in children's
teeth are the pulpotomy and pulpectomy.
A pulpotomy removes the diseased pulp tissue
within the crown portion of the tooth. Next, an agent is placed to
prevent bacterial growth and to calm the remaining nerve tissue. This
is followed by a final restoration (usually a stainless steel crown).
A pulpectomy is required when the entire pulp
is involved (into the root canal(s) of the tooth). During this
treatment, the diseased pulp tissue is completely removed from both the
crown and root. The canals are cleansed, disinfected and in the case
of primary teeth, filled with a resorbable material. Then a final
restoration is placed. A permanent tooth would be filled with a non-resorbing
material.
What’s
the Best Toothpaste for my Child?
Tooth brushing is one of the most important tasks for good oral health.
Many toothpastes, and/or tooth polishes, however, can damage young smiles.
They contain harsh abrasives which can wear away young tooth enamel. When
looking for a toothpaste for your child make sure to pick one that is
recommended by the American Dental Association. These toothpastes have
undergone testing to insure they are safe to use.
Remember, children should spit out toothpaste after brushing to avoid
getting too much fluoride. If too much fluoride is ingested, a condition
known as fluorosis can occur. If your child is too young or unable to spit
out toothpaste, consider providing them with a fluoride free toothpaste,
using no toothpaste, or using only a "pea size" amount of
toothpaste.
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Does Your Child Grind His Teeth
At Night? (Bruxism)
Parents are often concerned about the nocturnal grinding of teeth
(bruxism). Often, the first indication is the noise created by the child grinding on their
teeth during sleep. Or, the parent may notice wear (teeth getting shorter) to the
dentition. One theory as to the cause involves a psychological component. Stress due to a
new environment, divorce, changes at school; etc. can influence a child to grind their
teeth. Another theory relates to pressure in the inner ear at night. If there are pressure
changes (like in an airplane during take-off and landing when people are chewing gum, etc.
to equalize pressure) the child will grind by moving his jaw to relieve this pressure.
The majority of cases of pediatric bruxism do not
require any treatment. The good news is most children outgrow bruxism. The
grinding becomes less between the ages of 6-9 and children tend to stop
between the ages of 9-12. If grinding continues into the permanent
dentition, (age 12 and up) a night guard may be indicated to prevent wear to
the permanent teeth. Your pediatric dentist can help determine if a night
guard is appropriate for your child.
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Thumb
Sucking
Sucking is a natural reflex and infants and young children may use
thumbs, fingers, pacifiers and other objects on which to suck. It may make them feel
secure and happy or provide a sense of security at difficult periods. Since
thumb sucking
is relaxing, it may induce sleep.
Thumb sucking that persists beyond the eruption of the permanent
teeth can cause problems with the proper growth of the mouth and tooth alignment. How
intensely a child sucks on fingers or thumbs will determine whether or not dental problems
may result. Children who rest their thumbs passively in their mouths are less likely to
have difficulty than those who vigorously suck their thumbs.
Children should cease thumb sucking by the time their permanent front
teeth are ready to erupt. Usually, children stop between the ages of two and four. Peer
pressure causes many school-aged children to stop.
Pacifiers are no substitute for thumb sucking. They can affect the
teeth essentially the same way as sucking fingers and thumbs. However, use
of the pacifier can be controlled and modified more easily than the thumb or finger habit.
If you have concerns about thumb sucking or use of a pacifier, consult your pediatric
dentist.
A few suggestions to help your child get through thumb
sucking:
- Instead of scolding children for thumb sucking, praise them when they
are not.
- Children often suck their thumbs when feeling insecure. Focus on
correcting the cause of anxiety, instead of the thumb sucking.
- Children who are sucking for comfort will feel less of a need when
their parents provide comfort.
- Reward children when they refrain from sucking during difficult
periods, such as when being separated from their parents.
- Your pediatric dentist can encourage children to stop sucking and
explain what could happen if they continue.
- If these approaches don’t work, remind the children of their
habit by bandaging the thumb or putting a sock on the hand at night. Your pediatric
dentist may recommend the use of a mouth appliance.
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Tongue
Piercing – Is it Really Cool?
You might not be surprised anymore to see people with
pierced tongues, lips or cheeks, but you might be surprised to know just how
dangerous these piercings can be.
There are many risks involved with oral piercings
including chipped or cracked teeth, blood clots, or blood poisoning. Your
mouth contains millions of bacteria, and infection is a common complication
of oral piercing. Your tongue could swell large enough to close off your
airway!
Common symptoms after piercing include pain, swelling,
infection, an increased flow of saliva and injuries to gum tissue.
Difficult-to-control bleeding or nerve damage can result if a blood vessel
or nerve bundle is in the path of the needle.
So follow the advice of the American Dental
Association and give your mouth a break – skip the mouth jewelry.
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Tobacco
– Bad News in Any Form
Tobacco in any form can jeopardize your child’s
health and cause incurable damage. Teach your child about the dangers of
tobacco.
Smokeless tobacco, also called spit, chew or snuff, is
often used by teens who believe that it is a safe alternative to smoking
cigarettes. This is an unfortunate misconception. Studies show that spit
tobacco may be more addictive than smoking cigarettes and may be more
difficult to quit. Teens who use it may be interested to know that one can
of snuff per day delivers as much nicotine as 60 cigarettes. In as little as
three to four months, smokeless tobacco use can cause periodontal disease
and produce pre-cancerous lesions called leukoplakias.
If your child is a tobacco user you should watch for
the following that could be early signs of oral cancer:
- A sore that won’t heal.
- White or red leathery patches on the lips, and on
or under the tongue.
- Pain, tenderness or numbness anywhere in the mouth
or lips.
- Difficulty chewing, swallowing, speaking or moving
the jaw or tongue; or a change in the way the teeth fit together.
Because the early signs of oral cancer usually are not
painful, people often ignore them. If it’s not caught in the early stages,
oral cancer can require extensive, sometimes disfiguring, surgery. Even
worse, it can kill.
Help your child avoid tobacco in any form. By doing
so, they will avoid bringing cancer-causing chemicals in direct contact with
their tongue, gums and cheek.
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What
is the Best Time for Orthodontic Treatment?
Developing malocclusions, or bad bites, can be
recognized as early as 2-3 years of age. Often, early steps can be taken to
reduce the need for major orthodontic treatment at a later age.
Stage I – Early Treatment: This period of treatment
encompasses ages 2 to 6 years. At this young age, we are concerned with
underdeveloped dental arches, the premature loss of primary teeth, and
harmful habits such as finger or thumb sucking. Treatment initiated in this
stage of development is often very successful and many times, though not
always, can eliminate the need for future orthodontic/orthopedic treatment.
Stage II – Mixed Dentition: This period covers the
ages of 6 to 12 years, with the eruption of the permanent incisor (front)
teeth and 6 year molars. Treatment concerns deal with jaw malrelationships
and dental realignment problems. This is an excellent stage to start
treatment, when indicated, as your child’s hard and soft tissues are
usually very responsive to orthodontic or orthopedic forces.
Stage III – Adolescent Dentition: This stage deals
with the permanent teeth and the development of the final bite relationship.
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Mouth
Guards
When a child begins to participate in recreational
activities and organized sports, injuries can occur. A properly fitted mouth
guard, or mouth protector, is an important piece of athletic gear that can
help protect your child’s smile, and should be used during any activity
that could result in a blow to the face or mouth.
Mouth guards help prevent broken teeth, and injuries
to the lips, tongue, face or jaw. A properly fitted mouth guard will stay in
place while your child is wearing it, making it easy for them to talk and
breathe.
Ask your pediatric dentist about custom and
store-bought mouth protectors.
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