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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
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
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
Articles - This section contains an
ever-growing repository of useful articles related to
Children's Dentistry and the Dentistry profession.
Proper
Care after a Tooth is Knocked Out
The
Baby Teeth Myth
How
to Brush and Maintain your Teeth
Breaking
your Child's Thumb Sucking Habit
Care
of Teeth During Pregnancy
Dental
Infections Linked to Clogged Arteries
Links - For information
on Special Oral Health Care Needs, we've provided links to the
following sites:
AboutSmiles (Oral Health
Educational Site)
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. High-speed film and proper shielding assure
that your child receives a minimal amount of radiation
exposure.
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Top
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 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.
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. 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
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 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. Another
source of fluoride can be found in soft drinks at fast food
restaurants, when blending the syrup and carbonation with the
city water supply.
Parents can take the following steps to
decrease the risk of fluorosis in their children’s
teeth:
- Use baby tooth cleanser on the
toothbrush of 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 at least 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 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. 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.
[Back to Top]
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.
[Back to Top]
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. | 
