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Click on a topic of interest for more
information.
 GENERAL
TOPICS:
What is a Pediatric Dentist?
Why are the Primary Teeth
so Important?
Eruption of your Child's Teeth
DENTAL EMERGENCIES
Dental Radiographs
(X-rays)
What's
the Best Toothpaste for my Child?
Does your Child Grind his Teeth at Night? (Bruxism)
Thumb Sucking
What is Pulp Therapy?
What is the Best
Time for Orthodontic Treatment?
EARLY INFANT ORAL
CARE:
Your Child's First Dental Visit
When will my Baby Start Getting Teeth?
Baby Bottle Tooth Decay (Early Childhood
Caries)
PREVENTION:
Care of your Child's Teeth
Good Diet = Healthy Teeth
How Do I Prevent Cavities
Seal Out Decay
Fluoride
Mouth Guards
Xylitol - Reducing Cavities
ADOLESCENT DENTISTRY:
Tongue Piercing - Is it Really Cool?
Tobacco - Bad News in Any
Form
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
GENERAL TOPICS & FAQ
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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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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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. Rinse the mouth thoroughly with warm water or use dental floss to
dislodge any food that may be impacted. If the pain still exists, contact
your child's dentist. Do not place aspirin or heat 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 injured areas to help control swelling. If there is bleeding, apply
firm but gentle pressure with a gauze or cloth. If bleeding cannot be
controlled by simple pressure, call a doctor or visit the hospital emergency
room.
Knocked Out Permanent Tooth: If possible,
find the tooth. Handle it by the crown, not by the root. You may rinse the
tooth with water only. DO NOT clean with soap, scrub 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 (beside the cheek). The
patient must see a dentist IMMEDIATELY! Time is a critical factor in
saving the tooth.
Knocked Out Baby Tooth: Contact your
pediatric dentist during business hours. This is not usually an
emergency, and in most cases, no treatment is necessary.
Chipped or Fractured Permanent Tooth:
Contact your pediatric dentist immediately. Quick action can save the tooth,
prevent infection and reduce the need for extensive dental treatment. Rinse
the mouth with water and apply cold compresses to reduce swelling. If
possible, locate and save any broken tooth fragments and bring them with you
to the dentist.
Chipped or Fractured Baby Tooth: Contact
your pediatric dentist.
Severe Blow to the Head: Take your child to
the nearest hospital emergency room immediately.
Possible Broken or Fractured Jaw: Keep the
jaw from moving and take your child to the nearest hospital emergency room.
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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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What’s the Best Toothpaste for my Child?
Tooth brushing is one of the most important tasks for
good oral health. Many toothpastes, an d/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 as shown on the box and tube. 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 decreases 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:
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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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.
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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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EARLY INFANT ORAL CARE
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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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 to appear are usually the lower front (anterior) teeth and they
usually begin erupting between the age of 6-8 months. See "Eruption
of Your Child’s Teeth" for more details.
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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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PREVENTION
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
visits every six months 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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Before Sealant Applied |
After Sealant Applied |
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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:
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Too much fluoridated toothpaste at an early age.
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The inappropriate use of fluoride supplements.
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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.
Parents can take the following steps to decrease the risk
of fluorosis in their children’s teeth:
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Use baby tooth cleanser on the toothbrush of the very
young child.
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Place only a pea sized drop of children’s toothpaste on
the brush when brushing.
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Account for all of the sources of ingested fluoride
before requesting fluoride supplements from your child’s physician or
pediatric dentist.
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Avoid giving any fluoride-containing supplements to
infants until they are at least 6 months old.
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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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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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Xylitol - Reducing Cavities
The
American Academy of Pediatric Dentistry (AAPD) recognizes the benefits of
xylitol on the oral health of infants, children, adolescents, and persons
with special health care needs.
The use
of XYLITOL GUM by mothers (2-3 times per day) starting 3 months after
delivery and until the child was 2 years old, has proven to reduce cavities
up to 70% by the time the child was 5 years old.
Studies using xylitol as either a sugar
substitute or a small dietary addition have demonstrated a dramatic
reduction in new tooth decay, along with some reversal of existing dental
caries. Xylitol provides additional protection that enhances all existing
prevention methods. This xylitol effect is long-lasting and possibly
permanent. Low decay rates persist even years after the trials have been
completed.
Xylitol is widely distributed throughout
nature in small amounts. Some of the best sources are fruits, berries,
mushrooms, lettuce, hardwoods, and corn cobs. One cup of raspberries
contains less than one gram of xylitol.
Studies suggest xylitol intake that consistently produces positive results
ranged from 4-20 grams per day, divided into 3-7 consumption periods. Higher
results did not result in greater reduction and may lead to diminishing
results. Similarly, consumption frequency of less than 3 times per day
showed no effect.
To find gum or other products containing
xylitol, try visiting your local health food store or search the Internet to
find products containing 100% xylitol.
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ADOLESCENT DENTISTRY
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, blood poisoning, heart
infections, brain abscess, nerve disorders (trigeminal neuralgia), receding
gums or scar tissue. 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:
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A sore that won’t heal.
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White or red leathery patches on the lips, and on or
under the tongue.
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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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