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 X-Rays
Care of your Child's Teeth
Good Diet = Healthy Teeth
How Do I Prevent Cavities
Seal Out Decay
Baby Bottle Tooth Decay (Early Childhood
Caries)
When will my Baby Start
Getting Teeth?
Eruption of your Child's Teeth
Dental Emergencies
Fluoride
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 more information on
oral health care needs, please visit the website for the
American Academy of Pediatric Dentistry.
What Is A Pediatric Dentist?
The pediatric dentist
has an extra two years of specialized training 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
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's 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 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.
X-Ray’s detect much more than cavities. For example, X-Rays may be needed
to survey erupting teeth, diagnose bone diseases, evaluate the results of an
injury, or plan orthodontic treatment. X-Rays 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 X-rays 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 X-rays 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. High-speed film
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 the child’s first
tooth erupts. A pea-size amount of fluoride toothpaste can be used after the
child is old enough not to swallow it. By age 4 or 5, children should be
able to brush their own teeth twice a day with supervision until about age
seven to make sure they are doing a thorough job. However, each child is
different. Your dentist can help you determine whether the child has the
skill level to brush properly.
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.
Flossing removes plaque between the teeth where a
toothbrush can’t reach. Flossing should begin when any two teeth touch. You
may wish to 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.
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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Seal Out Decay
A sealant is a clear or shaded plastic material that
is applied to the chewing surfaces (grooves) of the back teeth (premolars
and molars), where four out of five cavities in children are found. This
sealant acts as a barrier to food, plaque and acid, thus protecting the
decay-prone areas of the teeth.
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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.
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).
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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. DO NOT place aspirin on
the gum or on the aching tooth. If face is swollen apply cold compresses.
Take the child to a dentist.
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 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 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. 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 an element, which has been shown to be
beneficial to teeth. However, too little or too much fluoride can be
detrimental to the teeth. Little or no fluoride will not strengthen the
teeth to help them resist cavities. Excessive fluoride ingestion by
preschool-aged children can lead to dental fluorosis, which is a chalky
white to even brown discoloration of the permanent teeth. Many children
often get more fluoride than their parents realize. Being aware of a child’s
potential sources of fluoride can help parents prevent the possibility of
dental fluorosis.
Some of these sources are:
- Too much fluoridated toothpaste at an early age.
- The inappropriate use of fluoride supplements.
- Hidden sources of fluoride in the child’s diet.
Two and three-year olds may not be able to expectorate
(spit out) fluoride-containing toothpaste when brushing. As a result, these
youngsters may ingest an excessive amount of fluoride during tooth brushing.
Toothpaste ingestion during this critical period of permanent tooth
development is the greatest risk factor in the development of fluorosis.
Excessive and inappropriate intake of fluoride
supplements may also contribute to fluorosis. Fluoride drops and tablets, as
well as fluoride fortified vitamins should not be given to infants younger
than six months of age. After that time, fluoride supplements should only be
given to children after all of the sources of ingested fluoride have been
accounted for and upon the recommendation of your pediatrician or pediatric
dentist.
Certain foods contain high levels of fluoride,
especially: powdered concentrate infant formula, soy-based infant formula,
infant dry cereals, creamed spinach, and infant chicken products. Please
read the label or contact the manufacturer. Some beverages also contain high
levels of fluoride, especially: decaffeinated teas, white grape juices, and
juice drinks manufactured in fluoridated cities. Blending the syrup,
carbonation with the city water supply often makes soft drinks at fast food
restaurants – so if fluoride is in the water – this is another source.
Parents can take the following steps to decrease the
risk of fluorosis in their children’s teeth:
- Use baby tooth cleanser on the toothbrush in the
very young child.
- Place only a pea-sized drop of children’s
toothpaste on the brush when brushing.
- Account for all of the sources of ingested fluoride
before requesting fluoride supplements from your child’s physician or
pediatric dentist.
- Avoid giving any fluoride-containing supplements to
infants until they are 6 months old.
- Obtain fluoride level test results for your
drinking water before giving fluoride supplements to your child (check
with local water utilities).
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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. If excessive wear of the teeth (attrition) is
present, then a mouth guard (night guard) may be indicated. The negatives to
a mouth guard are the possibility of choking if the appliance becomes
dislodged during sleep and it may interfere with growth of the jaws. The
positive is obvious by preventing wear to the primary dentition.
The good news is most children outgrow bruxism. The
grinding gets less between the ages 6-9 and children tend to stop grinding
between ages 9-12. If you suspect bruxism, discuss this with your
pediatrician or pediatric dentist.
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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 your lips, and on
or under your tongue
- Pain, tenderness or numbness anywhere in the mouth
or lips
- Difficulty chewing, swallowing, speaking or moving
your jaw or tongue; or a change in the way your 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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