Dental Topics

A pediatric dentist has completed two additional years of specialized training following 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.  A pediatric dentist is best trained to meet these needs.

The American Academy of Pediatric Dentistry recommends your child visit the dentist by his/her 1st birthday.  You can make the first visit to the dentist enjoyable and positive.  An older 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 specific detail given 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.

It is very important to maintain the health of the primary (baby) 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 cosmetic appearance.  While the front 4 baby teeth are present until 6-7 years of age, the back baby teeth (cuspids and molars) aren’t lost until age 10-13.

Radiographs (x-rays) are a vital and necessary part of your child’s dental diagnostic process.  Without them, certain dental conditions are not diagnosed, and a complete dental examination is not performed.

X-rays detect much more than cavities.  For example, x-rays allow dentists to diagnose and treat health conditions that cannot be detected during a clinical examination.  If dental problems are diagnosed and treated early, dental care is more comfortable for your child.

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.  In addition, at periodic intervals it is recommended to obtain a panoramic x-ray.

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 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.  Digital x-rays and proper shielding assure that your child receives a minimal amount of radiation exposure.

Begin daily brushing as soon as the child’s first tooth erupts by using a rice-grain amount of toothpaste.   By age 5, children should be able to brush their own teeth twice a day with supervision, until about age 7 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 the toothbrush at a 45-degree angle, start along the 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 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.  Alternatively, dental flossers or floss on a handle can be used to floss your child’s 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 healthy foods.  Frequent consumption of simple carbohydrate snacks 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.  Choose low sugar and nutritious foods such as fresh vegetables and fruits, yogurt, and cheese which are healthier and better for children’s teeth.

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.  The number of simple carbohydrate snacks and sweet drinks should be limited.

The American Academy of Pediatric Dentistry recommends visits every 6 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.

A sealant is a clear or tooth-colored coating 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.

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 child to bed for a nap or at night with a bottle or sippy cup containing a liquid other than water can cause serious and rapid tooth decay.  Sugar containing 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 or sippy cup 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.

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.

Children’s teeth begin forming before birth.  Sometimes as early as 4 months, the first primary (baby) teeth to erupt through the gums are the lower central incisors (front teeth), followed closely by the upper central incisors.  Although all 20 primary teeth usually appear by age 3, the timing and order of their eruption varies.

Permanent teeth begin appearing around age 6, starting with the first molars and lower central incisors (front teeth).  This process continues until approximately age 14.

Adults have 28 permanent teeth, or up to 32 including the third molars (wisdom teeth).

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 the 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 your child to the hospital emergency room.

Knocked out PRIMARY Teeth:  Primary teeth which are knocked out are NOT reimplanted.

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 gauze or paper towel.  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.

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 infants, toddlers and preschool-aged children can lead to dental fluorosis, which is a chalky white to 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.  Parents can take the following steps to decrease the risk of fluorosis in their children’s teeth:

Use infant, non-fluoridated toothpaste on the toothbrush in the very young child.

Place no more than a pea-size 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 1 year old.

Obtain fluoride level test results for your drinking water before giving fluoride supplements to your child (check with local water utilities).

Tooth brushing is one of the most important tasks for good oral health.  Many toothpastes and/or tooth polishes, however, can damage young smiles.  Some toothpaste 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.

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 “rice grain size” amount of toothpaste.

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, changes at school, etc. can influence a child to grind their teeth.  Another theory relates to pressure in the inner ear or sinuses 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 the 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.

Sucking is a natural reflex, and infants and young children may suck on thumbs, fingers, pacifiers and other objects.  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 by four to five years of age.  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.

You might not be surprised 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.

Tobacco in any form can jeopardize an individual’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.

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 cause death.

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.

Developing malocclusions (spacing issues) 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 is 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 habits such as finger or thumb sucking.  Treatment initiated in this stage of development is often very successful and at times, though not always, can eliminate the need for future orthodontic/orthopedic treatment.

Stage II is Mixed Dentition:  This period covers the ages of 6-12 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 is Adolescent Dentition:  This stage deals with the permanent teeth and the development of the final bite relationship.

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 or displaced teeth, and injuries to the lips, tongue, face or jaw.  An individual should wear a mouth guard when participating in contact sports.  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.