Pediatric Dentistry

Pediatric dentistry (formerly Pedodontics/Paedodontics) primarily focuses on children from birth through adolescence. The American Dental Association (ADA), recognizes pediatric dentistry as a specialty, and therefore requires dentists to undertake two or three years of additional training after completing a general dentistry degree. At the end of this training, the American Board of Pediatric Dentistry issues a unique diploma (Diplomate ABPD). Some pediatric dentists (pedodontists) opt to specialize in oral care for children with special needs, specifically children with autism, varying levels of mental retardation, or cerebral palsy.

One of the most important components of pediatric dentistry is child psychology. Pediatric dentists are trained to create a friendly, fun, social atmosphere for visiting children, and always avoid threatening words like “drill,” “needle,” and “injection.” Dental phobias beginning in childhood often continue into adulthood, so it is of paramount importance that children have positive experiences and find their “dental home” as early as possible.

What Does a Pediatric Dentist Do?

Pediatric dentists fulfill many important functions pertaining to the child’s overall oral health and hygiene. They place particular emphasis on the proper maintenance and care of deciduous (baby) teeth, which are instrumental in facilitating good chewing habits, proper speech production, and also hold space for permanent teeth.

Education – Pediatric dentists educate the child using models, computer technology, and child-friendly terminology, thus emphasizing the importance of keeping teeth strong and healthy. In addition, they advise parents on disease prevention, trauma prevention, good eating habits, and other aspects of the home hygiene routine.

Monitoring growth – By continuously tracking growth and development, pediatric dentists are able to anticipate dental issues and quickly intervene before they worsen. Also, working towards earlier corrective treatment preserves the child’s self-esteem and fosters a more positive self-image.

Prevention – Helping parents and children establish sound eating and oral care habits reduces the chances of later tooth decay. In addition to providing check ups and dental cleanings, pediatric dentists are also able to apply dental sealants and topical fluoride to young teeth, advise parents on thumb- sucking/pacifier/smoking cessation, and provide good demonstrations of brushing and flossing.

Intervention – In some cases, pediatric dentists may discuss the possibility of early oral treatments with parents. In the case of oral injury, malocclusion (bad bite), or bruxism (grinding), space maintainers may be fitted, a nighttime mouth guard may be recommended, or reconstructive surgery may be scheduled.

If you have questions or concerns about pediatric dentistry, please contact our office.
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Baby Bottle Tooth Decay

Maintaining the health of primary (baby) teeth is exceptionally important. Although baby teeth will eventually be replaced, they fulfill several crucial functions in the meantime.

Baby teeth aid enunciation and speech production, help a child chew food correctly, maintain space for adult teeth, and prevent the tongue from posturing abnormally in the mouth. When baby teeth are lost prematurely, adjacent teeth shift to fill the gap, causing impacted adult teeth and the potential need for orthodontic treatment. This phenomenon can lead to impacted adult teeth, years of orthodontic treatment, and a poor aesthetic result.

Babies are at risk for tooth decay as soon as the first primary tooth emerges – usually around the age of six months. For this reason, the American Academy of Pediatric Dentistry (AAPD) recommends a “well-baby check up” with a pediatric dentist around the age of twelve months.

What is baby bottle tooth decay?

The term “baby bottle tooth decay” refers to early childhood caries (cavities), which occur in infants and toddlers. Baby bottle tooth decay may affect any or all of the teeth, but is most prevalent in the front teeth on the upper jaw.

If baby bottle tooth decay becomes too severe, the pediatric dentist may be unable to save the affected tooth. In such cases, the damaged tooth is removed, and a space maintainer is provided to prevent misalignment of the remaining teeth.

Scheduling regular checkups with a pediatric dentist and implementing a good homecare routine can completely prevent baby bottle tooth decay.

How does baby bottle tooth decay start?

Acid-producing bacteria in the oral cavity cause tooth decay. Initially, these bacteria may be transmitted from mother or father to baby through saliva. Every time parents share a spoon with the baby or attempt to clean a pacifier with their mouths, the parental bacteria invade the baby’s mouth.

The most prominent cause of baby bottle tooth decay however, is frequent exposure to sweetened liquids. These liquids include breast milk, baby formula, juice, and sweetened water – almost any fluid a parent might fill a baby bottle with.

When sweetened liquids are used as a naptime or bedtime drink, they are a heightened risk because they remain in the mouth for an extended period of time. Oral bacteria feed on the sugar around teeth and emit harmful acids. These acids wear away tooth enamel, resulting in painful cavities and pediatric tooth decay.

Infants who are not receiving an appropriate amount of fluoride are at increased risk for tooth decay. Fluoride works to protect tooth enamel, simultaneously reducing mineral loss and promoting mineral reuptake. Through a series of questionnaires and examinations, the pediatric dentist can determine whether a particular infant needs fluoride supplements or is at high-risk for baby bottle tooth decay.

What can I do at home to prevent baby bottle tooth decay?

Baby bottle tooth decay can be completely prevented by a committed parent. Making regular dental appointments and following the guidelines below will keep each child’s smile bright, beautiful, and free of decay:

  • Try not to transmit bacteria to your child via saliva exchange. Rinse pacifiers and toys in clean water, and use a clean spoon for each person eating.

  • Clean gums after every feeding with a clean washcloth.

  • Use an appropriate toothbrush along with an ADA-approved toothpaste to brush when teeth begin to emerge. Fluoride-free toothpaste is recommended for children under the age of two.

  • Use a pea-sized amount of ADA-approved fluoridated toothpaste when the child has mastered the art of “spitting out” excess toothpaste. Though fluoride is important for the teeth, too much consumption can result in a condition called fluorosis.

  • Do not place sugary drinks in baby bottles or sippy cups. Only fill these containers with water, breast milk, or formula. Encourage the child to use a regular cup (rather than a sippy cup) when the child reaches twelve months old.

  • Do not dip pacifiers in sweet liquids (honey, etc.).

  • Review your child’s eating habits. Eliminate sugar-filled snacks and encourage a healthy, nutritious diet.

  • Do not allow the child to take a liquid-filled bottle to bed. If the child insists, fill the bottle with water as opposed to a sugary alternative.

Care for Your Child’s Teeth

Pediatric oral care has two main components: preventative care at the pediatric dentist’s office and preventative care at home. Though infant and toddler caries (cavities) and tooth decay have become increasingly prevalent in recent years, a good dental strategy will eradicate the risk of both.

The goal of preventative oral care is to evaluate and preserve the health of the child’s teeth. Beginning at the age of twelve months, the American Dental Association (ADA) recommends that children begin to visit the pediatric dentist for “well baby” checkups. In general, most children should continue to visit the dentist every six months, unless instructed otherwise.

How can a pediatric dentist care for my child’s teeth?

The pediatric dentist examines the teeth for signs of early decay, monitors orthodontic concerns, tracks jaw and tooth development, and provides a good resource for parents. In addition, the pediatric dentist has several tools at hand to further reduce the child’s risk for dental problems, such as topical fluoride and dental sealants.

During a routine visit to the dentist: the child’smouth will be fully examined; the teeth will be professionally cleaned; topical fluoride might be coated onto the teeth to protect tooth enamel, and any parental concerns can be addressed. The pediatric dentist can demonstrate good brushing and flossing techniques, advise parents on dietary issues, provide strategies for thumb sucking and pacifier cessation, and communicate with the child on his or her level.

When molars emerge (usually between the agesof two and three), the pediatric dentist may coat them with dental sealant. This sealant covers the hard-to-reach fissures on the molars, sealing out bacteria, food particles, and acid. Dental sealant may last for many months or many years, depending on the oral habits of the child. Dental sealant is an important tool in the fight against tooth decay.

How can I help at home?

Though most parents primarily think of brushing and flossing when they hear

the words “oral care,” good preventative care includes many more factors, such as:

  • Diet – Parents should provide children with a nourishing, well-balanced diet. Very sugary diets should be modified and continuous snacking should be discouraged. Oral bacteria ingest leftover sugar particles in the child’s mouth after each helping of food, emitting harmful acids that erode tooth enamel, gum tissue, and bone. Space out snacks when possible, and provide the child with non-sugary alternatives like celery sticks, carrot sticks, and low-fat yogurt.

  • Oral habits – Though pacifier use and thumb sucking generally cease over time, bothcan cause the teeth to misalign. If the child must use a pacifier, choose an “orthodontically” correct model. This will minimize the risk of developmental problems like narrow roof arches and crowding. The pediatric dentist can suggest a strategy (or provide a dental appliance) for thumb sucking cessation.

  • General oral hygiene – Sometimes, parents clean pacifiers and teething toys by sucking on them. Parents may also share eating utensils with the child. By performing these acts, parents transfer harmful oral bacteria to their child, increasing the risk of early cavities and tooth decay. Instead, rinse toys and pacifiers with warm water, and avoid spoon-sharing whenever possible.

  • Sippy cup use – Sippy cups arean excellent transitional aid when transferring from a baby bottle to an adult drinking glass. However, sippy cups filled with milk, breast milk, soda, juice, and sweetened water cause small amounts of sugary fluid to continually swill around young teeth – meaning acid continually attacks tooth enamel. Sippy cup use should be terminated between the ages of twelve and fourteen months or as soon as the child has the motor skills to hold a drinking glass.

  • Brushing – Children’s teeth shouldbe brushed a minimum of two times per day using a soft bristled brush and a pea-sized amount of toothpaste. Parents should help with the brushing process until the child reaches the age of seven and is capable of reaching all areas of the mouth. Parents should always opt for ADA approved toothpaste (non-fluoridated before the age of two, and fluoridated thereafter). For babies, parents should rub the gum area with a clean cloth after each feeding.

  • Flossing – Cavities and tooth decay form more easily between teeth. Therefore, the child is at risk for between-teeth cavities wherever two teeth grow adjacent to each other. The pediatric dentist can help demonstrate correct head positioning during the flossing process and suggest tips for making flossing more fun!

  • Fluoride – Fluoride helps prevent mineral loss and simultaneously promotes the remineralization of tooth enamel. Too much fluoride can result in fluorosis, a condition where white specks appear on the permanent teeth, and too little can result in tooth decay. It is important to get the fluoride balance correct. The pediatric dentist can evaluate how much the child is currently receiving and prescribe supplements if necessary.

  • If you have questions or concerns about how to care for your child’s teeth, please ask your pediatric dentist.

Dental Emergencies

Although dental injuries and dental emergencies are often distressing for both children and parents, they are also extremely common. Approximately one third of children have experienced some type of dental trauma, and more have experienced a dental emergency.

There are two peak risk periods for dental trauma - the first being toddlerhood (18-40 months) when environmental exploration begins, and the second being the preadolescent/adolescent period, when sporting injuries become commonplace.

Detailed below are some of the most common childhood dental emergencies, in addition to helpful advice on how to deal with them.

Toothache

A toothache is common in children of all ages and rarely occurs without cause. Impacted food can cause discomfort in young children, and can be dislodged using a toothbrush, a clean finger, or dental floss. If pain persists, contact the pediatric dentist. Some common causes of toothache include: tooth fractures, tooth decay, tooth trauma, and wisdom teeth eruption (adolescence).

How you can help:

  • Cleanse the area using warm water. Do not medicate or warm the affected tooth or adjacent gum area.

  • Check for impacted food and remove it as necessary.

  • Apply a cold compress to the affected area to reduce swelling.

  • Contact the pediatric dentist to seek advice.

Dental avulsion (knocked-out tooth)

If a tooth has been knocked out of the child’s mouth completely, it is important to contact the pediatric dentist immediately. In general, pediatric dentists do not attempt to reimplant avulsed primary (baby) teeth, because the reimplantation procedure itself can cause damage to the tooth bud, and thereby damage the emerging permanent tooth.

Pediatric dentists always attempt to reimplant avulsed permanent teeth, unless the trauma has caused irreparable damage. The reimplantation procedure is almost always more successful if it is performed within one hour of the avulsion, so time is of the essence!

How you can help:

  • Recover the tooth. Do not touch the tooth roots! Handle the crown only.

  • Rinse off dirt and debris with water without scrubbing or scraping the tooth.

  • For older children, insert the tooth into its original socket using gentle pressure, or encourage the child to place the tooth in the cheek pouch. For younger children, submerge the tooth in a glass of milk or saliva (do not attempt to reinsert the tooth in case the child swallows it).

  • Do not allow the tooth to dry during transportation. Moisture is critically important for reimplantation success.

  • Visit the pediatric dentist (where possible) or take the child to the Emergency Room immediately –time is critical in saving the tooth.

Dental intrusion (tooth pushed into jawbone)

Sometimes, dental trauma forces a tooth (or several teeth) upwards into the jawbone. The prognosis is better for teeth that have been pushed up to a lesser extent (less than 3mm), but every situation is unique. Oftentimes, the force of the trauma is great enough to injure the tooth’s ligament and fracture its socket.
If dental intrusion of either the primary or permanent teeth is suspected, it is important to contact the pediatric dentist immediately. Depending on the nature and depth of the intrusion, the pediatric dentist will either wait for the tooth to descend naturally, or perform root canal therapy to preserve the structure of the tooth.

How you can help:

  • Rinse the child’s mouth with cold water.

  • Place ice packs around affected areas to reduce swelling.

  • Offer Tylenol for pain relief.

  • Contact the pediatric dentist where possible, or proceed to the Emergency Room.

Tooth luxation/extrusion/lateral displacement (tooth displacement)

Tooth displacement is generally classified as “luxation,” “extrusion,” or “lateral displacement,” depending on the orientation of the tooth following trauma. A luxated tooth remains in the socket – with the pulp intact about half of the time. However, the tooth protrudes at an unnatural angle and the underlying jawbone is oftentimes fractured.

The term “extrusion” refers to a tooth that has become partly removed from its socket. In young children, primary tooth extrusions tend to heal themselves without medical treatment. However, dental treatment should be sought for permanent teeth that have been displaced in any manner in order to save the tooth and prevent infection. It is important to contact the pediatric dentist if displacement is suspected.

How you can help:

  • Place a cold, moist compress on the affected area.

  • Offer pain relief (for example, Children’s Tylenol).

  • Contact the pediatric dentist immediately.

Crown fracture

The crown is the largest, most visible part of the tooth. In most cases, the crown is the part of the tooth that sustains trauma. There are several classifications of crown fracture, ranging from minor enamel cracks (not an emergency) to pulp exposure (requiring immediate treatment).

The pediatric dentist can readily assess the severity of the fracture using dental X-rays, but any change in tooth color (for example, pinkish or yellowish tinges inside the tooth) is an emergency warning sign. Minor crown fractures often warrant the application of dental sealant, whereas more severe crown fractures sometimes require pulp treatments. In the case of crown fracture, the pediatric dentist should be contacted. Jagged enamel can irritate and inflame soft oral tissues, causing infection.

How you can help:

  • Rinse the child’s mouth with warm water.

  • Place a cold, moist compress on the affected area.

  • Offer strong pain relief (for example, Children’s Tylenol).

  • Pack the tooth with a biocompatible material.

  • Visit the pediatric dentist or Emergency Room depending on availability and the severity of the injury.

Root fracture

A root fracture is caused by direct trauma and isn’t noticeable to the naked eye. If a root fracture is suspected, dental x-rays need to be taken. Depending on the exact positioning of the fracture and the child’s level of discomfort, the tooth can be monitored, treated, or extracted as a worse case scenario.

How you can help:

  • Place a cold, moist compress on the affected area.

  • Offer pain relief (for example, Children’s Tylenol).

  • Contact the pediatric dentist.

Dental concussion

A tooth that has not been dislodged from its socket or fractured, but has received a bang or knock, can be described as “concussed.” Typically occurring in toddlers, dental concussion can cause the tooth to discolor permanently or temporarily. Unless the tooth turns black or dark (indicating that the tooth is dying and may require root canal therapy), a dental concussion does not require emergency treatment.

Injured cheek, lip or tongue

If the child’s cheek, lip or tongue is bleeding due to an accidental cut or bite, apply firm direct pressure to the area using a clean cloth or gauze. To reduce swelling, apply ice to the affected areas. If the bleeding becomes uncontrollable, proceed to the Emergency Room or call a medical professional immediately.

Fractured jaw

If a broken or fractured jaw is suspected, proceed immediately to the Emergency Room. In the meantime, encourage the child not to move the jaw. In the case of a very young child, gently tie a scarf lengthways around the head and jaw to prevent movement.

Head injury/head trauma

If the child has received trauma to the head, proceed immediately to the Emergency Room. Even if consciousness has not been lost, it is important for pediatric doctors to rule out delayed concussion and internal bleeding.

If you have questions about dental emergencies, please ask your pediatric dentist. 

Dental Radiographs (X-Rays)

 Dental radiographs, also known as dental X-rays, are important diagnostic tools in pediatric dentistry. Dental radiographs allow the dentist to see and treat problems like childhood cavities, tooth decay, orthodontic misalignment, bone injuries, and bone diseases before they worsen. These issues would be difficult (in some cases impossible) to see with the naked eye during a clinical examination.

The American Academy of Pediatric Dentistry (AAPD) approves the use of dental radiographs for diagnostic purposes in children and teenagers. Although radiographs only emit tiny amounts of radiation and are safe to use on an occasional basis, the AAPD guidelines aim to protect young people from unnecessary X-ray exposure.

What are dental X-rays used for?

Dental x-rays are extremely versatile diagnostic tools. Some of their main uses in pediatric dentistry include:

  • Assessing the amount of space available for incoming teeth.

  • Checking whether primary teeth are beingshed in good time for adult teeth to emerge.

  • Evaluating the progression of bone disease.

  • Monitoring and diagnosing tooth decay.

  • Planning treatment (especially orthodontic treatment).

  • Revealing bone injuries, abscesses, and tumors.

  • Revealing impacted wisdom teeth.

When will my child need dental X-rays?

Individual circumstances dictate how often a child needs to have dental radiographs taken. Children at higher-than-average risk of childhood tooth decay (as determined by the pediatric dentist) may need biannual radiographs to monitor changes in the condition of the teeth. Likewise, children who are at high risk for orthodontic problems, for example, malocclusion, may also need sets of radiographs taken more frequently for monitoring purposes.

Children at average or below average risk for tooth decay and orthodontic problems should have a set of dental X-rays taken every one to two years. Even in cases where the pediatric dentist suspects no decay at all, it is still important to periodically monitor tooth and jaw growth – primarily to ensure there is sufficient space available for incoming permanent teeth.

If the oral region has been subject to trauma or injury, the pediatric dentist may want to X-ray the mouth immediately. Developments in X-ray technology mean that specific areas of the mouth can be targeted and X-rayed separately, reducing the amount of unnecessary X-ray exposure.

What precautions will be taken to ensure my child’s safety?

Though dental radiographs are perfectly safe for use on children, the pediatric dentist will take several precautions to ensure the X-ray process does not unduly damage the child’s cells and bodily tissues.

First, the child will be covered in a lead apron to protect the body from unnecessary exposure. Second, the dentist will use shields to protect the parts of the face that are not being X-rayed. Finally, the pediatric dentist will use high-speed film to reduce radiation exposure as much as possible.

If you have questions or concerns about dental radiographs or X-rays, please contact your pediatric dentist.

Does Your Child Grind His or Her Teeth at Night?

Bruxism, or the grinding of teeth, is remarkably common in children and adults. For some children, this tooth grinding is limited to daytime hours, but nighttime grinding (during sleep) is most prevalent. Bruxism can lead to a wide range of dental problems, depending on the frequency of the behavior, the intensity of the grinding, and the underlying causes of the grinding.

A wide range of psychological, usually hear physiological, and physical factors may lead children to brux. In particular, jaw misalignment (bad bite), stress, and traumatic brain injury are all thought to contribute to bruxism, although grinding can also occur as a side effect of certain medications.

What are some symptoms of bruxism?

In general usually, hear intense grinding – especially when it occurs at nighttime. Subtle daytime jaw clenching and grinding, however, can be difficult to pinpoint. Oftentimes, general symptoms provide clues as to whether or not the child is bruxing, including:

  • Frequent complaints of a headache.

  • Injured teeth and gums.

  • Loud grinding or clicking sounds.

  • Rhythmic tightening or clenching of the jaw muscles.

  • Unusual complaints about painful jaw muscles – especially in the morning.

  • Unusual tooth sensitivity to hot and cold foods.

Bruxism is characterized by the grinding of the upper jaw against the lower jaw. Especially in cases where there is vigorous grinding, the child may experience moderate to severe jaw discomfort, headaches, and ear pain. Even if the child is completely unaware of nighttime bruxing (and parents are unable to hear it), the condition of the teeth provides your pediatric dentist with important clues.

First, chronic grinders usually show an excessive wearpattern on the teeth. If jaw misalignment is the cause, tooth enamel may be worn down in specific areas. In addition, children who brux are more susceptible to chipped teeth, facial pain, gum injury, and temperature sensitivity. In extreme cases, frequent, harsh grinding can lead to the early onset of temporomandibular joint disorder (TMJ).

What causes bruxism?

Bruxism can be caused by several different factors. Most commonly, “bad bite” or jaw misalignment promotes grinding. Pediatric dentists also notice that children tend to brux more frequently in response to life stressors. If the child is going through a particularly stressful exam period or is relocating to a new school for example, nighttime bruxing may either begin or intensify.

Children with certain developmental disorders and brain injuries may be at particular risk for grinding. In such cases, your pediatric dentist may suggest botulism injections to calm the facial muscles, or provide a protective nighttime mouthpiece. If the onset of bruxing is sudden, current medications need to be evaluated. Though bruxing is a rare side effect of specific medications, the medication itself may need to be switched for an alternate brand.

How is bruxism treated?

Bruxing spontaneously ceases by the age of thirteen in the majority of children. In the meantime however, your pediatric dentist will continually monitor its effect on the child’s teeth and may provide an interventional strategy.

In general, the cause of the grinding dictates the treatment approach. If the child’s teeth are badly misaligned, your pediatric dentist may take steps to correct this. Some of the available options include: altering the biting surface of teeth with crowns, and beginning occlusal treatment.

If bruxing seems to be exacerbatedby stress, your pediatric dentist may recommend relaxation classes, professional therapy, or special exercises. The child’s pediatrician may also provide muscle relaxants to alleviate jaw clenching and reduce jaw spasms.

In cases where young teeth are sustaining significant damage, your pediatric dentist may suggest a specialized nighttime dental appliance such as a nighttime mouth guard. Mouth guards stop tooth surfaces from grinding against each other, and look similar to a mouthpiece a person might wear during sports. Bite splints or bite plates fulfill the same function and are almost universally successful in preventing grinding damage.

If you have questions or concerns about bruxism or grinding teeth, please contact our office.

Eruption of Your Child’s Teeth

The eruptionof primary teeth (also known as deciduous or baby teeth) follows a similar developmental timeline for most children. A full set of primary teeth begins to grow beneath the gums during the fourth month of pregnancy. For this reason, a nourishing prenatal diet is of paramount importance to the infant’s teeth, gums, and bones.

Generally, thefirst primary tooth breaks through the gums between the ages of six months and one year. By the age of three years old most children have a “full” set of twenty primary teeth. The American Dental Association (ADA) encourages parents to make a “well-baby” appointment with a pediatric dentist approximately six months after the first tooth emerges. Pediatric dentists communicate with parents and children about prevention strategies, emphasizing the importance of a sound, “no tears” daily home care plan.

Although primary teeth are deciduous, they facilitate speech production, proper jaw development, good chewing habits, and the proper spacing and alignment of adult teeth. Caring properly for primary teeth helps defend against painful tooth decay, premature tooth loss, malnutrition, and childhood periodontal disease.

In what order do primary teeth emerge?

As a general rule-of-thumb, the first teeth to emerge are the central incisors (very front teeth) on the lower and upper jaws (6-12 months). These (and any other primary teeth) can be cleaned gently with a soft, clean cloth to reduce the risk of bacterial infection. The central incisors are the first teeth to be lost, usually between 6 and 7 years of age.

Next, the lateral incisors (immediately adjacent to the central incisors) emerge on the upper and lower jaws (9-16 months). These teeth are lost next, usually between 7 and 8 years of age. First molars, the large flat teeth towards the rear of the mouth, then emerge on the upper and lower jaws (13-19 months). The eruption of molars can be painful. Clean fingers, cool gauzes, and teething rings are all useful in soothing discomfort and soreness. First molars are generally lost between 9 and 11 years of age.

Canine (cuspid) teeth then tend to emerge on the upper and lower jaws (16-23 months). Canine teeth can be found next to the lateral incisors and are lost during preadolescence (10-12 years old). Finally, second molars complete the primary set on the lower and upper jaw (23-33 months). Second molars can be found at the very back of the mouth and are lost between the ages of 10 and 12 years old.

What else is known about primaryteeth?

Though each child is unique, baby girls generally have a head start on baby boys when it comes to primary tooth eruption. Lower teeth usually erupt before opposing upper teeth in both sexes.

Teeth usually erupt in pairs – meaningthat there may be months with no new activity and months where two or more teeth emerge at once. Due to smaller jaw size, primary teeth are smaller than permanent teeth, and appear to have a whiter tone. Finally, an interesting mixture of primary and permanent teeth is the norm for most school-age children.

If you have questions or concerns about primary teeth, please contact our office.

First Visit

According to AAPD (American Academy of Pediatric Dentistry) guidelines, infants should initially visit the pediatric dentist around the time of their first birthday. First visits can be stressful for parents, especially for parents who have dental phobias themselves.

It is imperative for parents to continually communicate positive messages about dental visits (especially the first one), and to help the child feel as happy as possible about visiting the dentist.

How can I prepare for my child’s first dental visit?

Pediatric dentists are required to undergo extensive training in child psychology. Their dental offices are generally colorful, child-friendly, and boast a selection of games, toys, and educational tools. Pediatric dentists (and all dental staff) aim to make the child feel as welcome as possible during all visits.

There are several things parents can do to make the first visit enjoyable. Some helpful tips are listed below:

Take another adult along for the visit – Sometimes infants become fussy when having their mouths examined. Having another adult along to soothe the infant allows the parent to ask questions and to attend to any advice the dentist may have.

Leave other children at home – Other children can distract the parent and cause the infant to fuss. Leaving other children at home (when possible) makes the first visit less stressful for all concerned.

Avoid threatening language – Pediatric dentists and staff are trained to avoid the use of threatening language like “drills,” “needles,” “injections,” and “bleeding.” It is imperative for parents to use positive language when speaking about dental treatment with their child.

Provide positive explanations – It is important to explain the purposes of the dental visit in a positive way. Explaining that the dentist “helps keep teeth healthy” is far better than explaining that the dentist “is checking for tooth decay and might have to drill the tooth if decay is found.”

Explain what will happen – Anxiety canbe vastly reduced if the child knows what to expect. Age-appropriate books about visiting the dentist can be very helpful in making the visit seem fun. Here is a list of parent and dentist-approved books:

The Berenstain Bears Visit the Dentist– by Stan and Jan Berenstain.

Show Me Your Smile: A Visit to the Dentist – Part of the “Dora the Explorer” Series.

Going to the Dentist – by Anne Civardi.

Elmo Visits the Dentist – Part of the“Sesame Street” Series.

What will happen during the first visit?

There are several goals for the first dental visit. First, the pediatric dentist and the child need to get properly acquainted. Second, the dentist needs to monitor tooth and jaw development to get an idea of the child’s overall health history. Third, the dentist needs to evaluate the health of the existing teeth and gums. Finally, the dentist aims to answer questions and advise parents on how to implement a good oral care regimen.

The following sequence of events is typical of an initial “well baby checkup”:

  • Dental staff will greet the child and parents.

  • The infant/family health history will be reviewed (this may include questionnaires).

  • The pediatric dentist will address parental questions and concerns.

  • More questions will be asked, generally pertaining to the child’s oral habits, pacifier use, general development, tooth alignment, tooth development, and diet.

  • The dentist will provide advice on good oral care, how to prevent oral injury, fluoride intake, and sippy cup use.

  • The infant’s teeth will be examined. Generally, the dentist and parent sit facing each other. The infant is positioned so that his or her head is cradled in the dentist’s lap. This position allows the infant to look at the parent during the examination.

  • Good brushing and flossing demonstrations will be provided.

  • The state of the child’s oral health will be described in detail, and specific recommendations will be made. Recommendations usually relate to oral habits, appropriate toothpaste and toothbrushes for the child, orthodontically correct pacifiers, and diet.

  • The dentist will detail which teeth may appear in the following months.

  • The dentist will outline an appointment schedule and describe what will happen during the next appointment.

If you have questions or concerns about your child’s first dental visit, please contact our office.

Fluoride

Fluoride, a natural element in the fluoride compound, has proven to be effective in minimizing childhood cavities and tooth decay. Fluoride is a key ingredient in many popular brands of toothpaste, oral gel, and mouthwash, and can also be found in most community water supplies. Though fluoride is an important part of any good oral care routine, overconsumption can result in a condition known as fluorosis. The pediatric dentist is able to monitor fluoride levels, and check that children are receiving the appropriate amount.

How can fluoride prevent tooth decay?

Fluoride fulfills two important dental functions. First, it helps staunch mineral loss from tooth enamel, and second, it promotes the remineralization of tooth enamel.

When carbohydrates (sugars) are consumed, oral bacteria feed on them and produce harmful acids. These acids attack tooth enamel - especially in children who take medications or produce less saliva. Repeated acid attacks result in cavities, tooth decay, and childhood periodontal disease. Fluoride protects tooth enamel from acid attacks and reduces the risk of childhood tooth decay.

Fluoride is especially effective when used as part of a good oral hygiene regimen. Reducing the consumption of sugary foods, brushing and flossing regularly, and visiting the pediatric dentist biannually, all supplement the work of fluoride and keep young teeth healthy.

How much fluoride is enough?

Since community water supplies and toothpaste usually contain fluoride, it is essential that children do not ingest too much. For this reason, children under the age of two should use an ADA-approved, non-fluoridated brand of toothpaste. Children between the ages of two and five years old should use a pea-sized amount of ADA-approved fluoridated toothpaste, on a clean toothbrush, twice each day. They should be encouraged to spit out any extra fluid after brushing. This part might take time, encouragement, and practice.

A number of fluoride children ingest between the ages of one and four years old determines whether or not fluorosis occurs later. The most common symptom of fluorosis is white specks on the permanent teeth. Children over the age of eight years old are not considered to be at-risk for fluorosis, but should still use an ADA-approved brand of toothpaste.

Does my child need fluoride supplements?

The pediatric dentist is the best person to decide whether a child needs fluoride supplements. First, the dentist will ask questions in order to determine how much fluoride the child is currently receiving, gain a general health history, and evaluate the sugar content in the child’s diet. If a child is not receiving enough fluoride and is determined to be at high-risk for tooth decay, an at-home fluoride supplement might be recommended.

Topical fluoride can also be applied to the tooth enamel quickly and painlessly during a regular office visit. There are many convenient forms of topical fluoride, including foam, liquids, varnishes, and gels. Depending on the age of the child and their willingness to cooperate, topical fluoride can either be held on the teeth for several minutes in specialized trays or painted on with a brush.

If you have questions or concerns about fluoride or fluorosis, please contact our office.

Good Diet

A child’s general level of health often dictates his or her oral health, and vice versa. Therefore, supplying children with a well-balanced diet is more likely to produce healthier teeth and gums. A good diet provides the child with the many different nutrients he or she needs to grow. These nutrients are necessary for gum tissue development, strong bones, and protection against certain illnesses.

According to the food pyramid, children need vegetables, fruits, meat, grains, beans, and dairy products to grow properly. These different food groups should be eaten in balance for optimal results.

How does mychild’s diet affect his or her teeth?

Almost every snack contains at least one type of sugar. Most often, parents are tempted to throw away candy and chocolate snacks – without realizing that many fruit snacks contain one (if not several) types of sugar or carbohydrate. When sugar-rich snacks are eaten, the sugar content attracts oral bacteria. The bacteria feast on food remnants left on or around the teeth. Eventually, feasting bacteria produce enamel-attacking acids.

When tooth enamel is constantly exposed to acid, it begins to erode – the result is childhood tooth decay. If tooth decay is left untreated for prolonged periods, acids begin to attack the soft tissue (gums) and even the underlying jawbone. Eventually, the teeth become prematurely loose or fall out, causing problems for emerging adult teeth – a condition known as childhood periodontal disease.

Regular checkups and cleanings at the pediatric dentist’s office are an important line of defense against tooth decay. However, implementing good dietary habits and minimizing sugary food and drink intake as part of the “home care routine” are equally important.

How can I alter my child’s diet?

The pediatric dentist is able to offer advice and dietary counseling for children and parents. Most often, parents are advised to opt for healthier snacks, for example, carrot sticks, reduced fat yoghurt, and cottage cheese. In addition, pediatric dentists may recommend a fluoride supplement to protect tooth enamel – especially if the child lives in an area where fluoride is not routinely added to community water.

Parents should also ensure that children are not continuously snacking – even in a healthy manner. Lots of snacking means that sugars are constantly attaching themselves to teeth, and tooth enamel is constantly under attack. It is also impractical to try to clean the teeth after every snack, if “every snack” means every ten minutes!

Finally, parents are advised to opt for faster snacks. Mints and hard candies remain in the mouth for a long period of time - meaning that sugar is coating the teeth for longer. If candy is necessary, opt for a sugar-free variety or a variety that can be eaten expediently.

Should my child eat starch-rich foods?

It is important for the child to eata balanced diet, so some carbohydrates and starches are necessary. Starch-rich foods generally include pretzels, chips, and peanut butter and jelly sandwiches. Since starches and carbohydrates break down to form sugar, it is best that they are eaten as part of a meal (when saliva production is higher), than as a standalone snack. Provide plenty of water at mealtimes (rather than soda) to help the child rinse sugary food particles off the teeth.

As a final dietary note, avoid feeding your childsticky foods if possible. It is incredibly difficult to remove stickiness from the teeth - especially in younger children who tend not to be as patient during brushing.

If you have questions or concerns about your child’s general or oral health, please contact our office.

How Often Should Children Have Dental Checkups?

The American Academy of Pediatric Dentists (AAPD) advises parents to make biannual dental appointments for children, beginning approximately six months after the first tooth emerges.

These two important yearly visits allow the pediatric dentist to monitor new developments in the child’s mouth, evaluate changes in the condition of teeth and gums, and continue to advise parents on good oral care strategies.

The pediatric dentist may schedule additional visits for children who are particularly susceptible to tooth decay or who show early signs of orthodontic problems.

What is the purpose of dental checkups?

First, the pediatric dentist aims to provide a “good dental home” for the child. If a dental emergency does arise, parents can take the child for treatment at a familiar, comfortable location.

Second, the pediatric dentist keeps meticulous records of the child’s ongoing dental health and jaw development. In general, painful dental conditions do not arise overnight. If the pediatric dentist understands the child’s dental health history, it becomes easier to anticipate future issues and intervene before they arise.

Third, the pediatric dentist is able to educate parents and children during the visit. Sometimes the pediatric dentist wants to introduce one or several factors to enhance tooth health - for example, sealants, fluoride supplements, or xylitol. Other times, the pediatric dentist asks parents to change the child’s dietary or oral behavior - for example, reducing sugar in the child’s diet, removing an intraoral piercing, or even transitioning the child from sippy cups to adult-sized drinking glasses.

Finally, dental X-rays are often the only way to identify tinycavities in primary (baby) teeth. Though the child may not be feeling any pain, left unchecked, these tiny cavities can rapidly turn into large cavities, tooth decay, and eventually, childhood periodontal disease. Dental X-rays are only used when the pediatric dentist suspects cavities or orthodontic irregularities.

Are checkups necessary if my child has healthyteeth?

The condition of a child’s teeth can change fairly rapidly. Even if the child’s teeth were evaluated as healthy just six months prior, changes in diet or oral habits (for example, thumb sucking) can quickly render them vulnerable to decay or misalignment.

In addition to visual examinations, the pediatric dentist provides thorough dental cleanings during each visit. These cleanings eradicate the plaque and debris that can build up between teeth and in other hard to reach places. Though a good homecare routine is especially important, these professional cleanings provide an additional tool to keep smiles healthy.

The pediatric dentist is also able to monitor the child’sfluoride levels during routine visits. Oftentimes, a topical fluoride gel or varnish is applied to teeth after the cleaning. Topical fluoride remineralizes the teeth and staunches mineral loss, protecting tooth enamel from oral acid attacks. Some children are also given take-home fluoride supplements (especially those residing in areas where fluoride is not routinely added to the community water supply).

Finally, the pediatric dentist may apply dental sealants to thechild’s back teeth (molars). This impenetrable liquid plastic substance is brushed onto the molars to seal out harmful debris, bacteria, and acid.

If you have questions or concerns about when to schedule your child’s dental checkups please contact your pediatric dentist.

How to Prevent Cavities

Childhood Cavities, also known as childhood tooth decay and childhood caries, are common in children all over the world. There are two main causes of cavities: poor dental hygiene and sugary diets.

Cavities can be incredibly painful and often lead to tooth decay and childhood periodontitis if left untreated. Ensuring that children eat a balanced diet, embarking on a sound home oral care routine, and visiting the pediatric dentist biannually are all crucial factors for both cavity prevention and excellent oral health.

What causes cavities?

Cavities form when children's teeth are exposed to sugary foods on a regular basis. Sugars and carbohydrates (like the ones found in white bread) collect on and around the teeth after eating. A sticky film (plaque) then forms on the tooth enamel. The oral bacteria within the plaque continually ingest sugar particles and emit acid. Initially, the acid attacks the tooth enamel, weakening it and leaving it vulnerable to tooth decay. If conditions are allowed to worsen, the acid begins to penetrate the tooth enamel and erodes the inner workings of the tooth.

Although primary (baby) teeth are eventually lost, they fulfill several important functions and should be protected. It is essential that children brush and floss twice per day (ideally more), and visit the dentist for bi-annual cleanings. Sometimes the pediatric dentist coats teeth with a sealant and provides fluoride supplements to further bolster the mouth’s defenses.

How will I know if my child has a cavity?

Large cavities can be excruciatingly painful, whereas tiny cavities may not be felt at all. Making matters even trickier, cavities sometimes form between the teeth, making them invisible to the naked eye. Dental X-rays and the dentist’s trained eyes help pinpoint even the tiniest of cavities so they can be treated before they worsen.

Some of the major symptoms of cavities include:

  • Heightened sensitivity to cool or warm foods

  • Nighttime waking and crying

  • Pain

  • Sensitivity to spicy foods

  • Toothache

  • If a child is experiencing any of these symptoms, it is important to visit the pediatric dentist. Failure to do so will make the problem worse, leave the child in pain, and possibly jeopardize a tooth that could have been treated.

How can I prevent cavities at home?

Biannual visits with the pediatric dentist are only part of the battle against cavities. Here are some helpful guidelines for cavity prevention:

  • Analyze the diet – Too many sugary or starchy snacks can expedite cavity formation. Replace sugary snacks like candy with natural foods where possible, and similarly, replace soda with water.

  • Cut the snacks – Snacking too frequently can unnecessarily expose teeth to sugars. Save the sugar and starch for mealtimes, when the child is producing more saliva, and drinking water. Make sure they consume enough water to cleanse the teeth.

  • Lose the sippy cup – Sippy cups are thought to cause “baby bottle tooth decay” when they are used beyond the intended age (approximately twelve months). The small amount of liquid emitted with each sip causes sugary liquid to continually swirl around the teeth.

  • Avoid stickiness – Sticky foods (like coffee) form plaque quickly and are extremely difficult to pry off the teeth. Avoid them when possible.

  • Rinse the pacifier – Oral bacteria can be transmitted from mother or father to baby. Rinse a dirty pacifier with running water as opposed to sucking on it to avoid contaminating the baby’s mouth.

  • Drinks at bedtime – Sending a child to bed with a bottle or sippy cup is bad news. The milk, formula, juice, or sweetened water basically sits on the teeth all night – attacking enamel and maximizing the risk of cavities. Ensure the child has a last drink before bedtime, and then brush the teeth.

  • Don’t sweeten the pacifier – Parents sometimes dip pacifiers in honey to calm a cranky child. Do not be tempted to do this. Use a blanket, toy, or hug to calm the child instead.

  • Brush and floss – Parents should brush and floss their child’s teeth twice each day until the child reaches the age of seven years old. Before this time, children struggle to brush every area of the mouth effectively.

  • Check on fluoride –When used correctly, fluoride can strengthen tooth enamel and help stave off cavities. Too much or too little fluoride can actually harm the teeth, so ask the pediatric dentist for a fluoride assessment.

  • Keep to appointments – The child’s first dental visit should be scheduled around his or her first birthday, as per the American Academy of Pediatric Dentistry (AAPD) guidelines. Keep to a regular appointment schedule to create healthy smiles!

If you have questions or concerns about cavity prevention, please contact our office.

Mouth Guards

Mouth guards, also known as sports guards athletic mouth protectors, are crucial pieces of equipment for any child participating in potentially injurious recreational or sporting activities. Fitting snugly over the upper teeth, mouth guards protect the entire oral region from traumatic injury, preserving both the esthetic appearance and the health of the smile. In addition, mouth guards are sometimes used to prevent tooth damage in children who grind (brux) their teeth at night.

The American Academy of Pediatric Dentistry (AAPD) in particular, advocates for the use of dental mouth guards during any sporting or recreational activity. Most store-bought mouth guards cost fewer than ten dollars, making them a perfect investment for every parent.

How can mouth guards protect my child?

The majority of sporting organizations now require participants to routinely wear mouth guards. Though mouth guards are primarily designed to protect the teeth, they can also vastly reduce the degree of force transmitted from a trauma impact point (jaw) to the central nervous system (base of the brain). In this way, mouth guards help minimize the risk of traumatic brain injury, which is especially important for younger children.

Mouth guards also reduce the prevalence of the following injuries:

  • Cheek lesions

  • Concussions

  • Gum and soft tissue injuries

  • Jawbone fractures

  • Lip lesions

  • Neck injuries

  • Tongue lesions

  • Tooth fractures

What type of mouth guard should I purchase for my child?

Though there are literally thousands of mouth guard brands, most brands fall into three major categories: stock mouth guards, boil and bite mouth guards, and customized mouth guards.

Some points to consider when choosing a mouth guard to include:

How much money is available to spend?

  • How often does the child play sports?

  • What kind of sport does the child play? (Basketball and baseball tend to cause the most oral injuries).

  • In light of these points, here is an overview of the advantages and disadvantages of each type of mouth guard:

  • Stock mouth guards – These mouth guards can be bought directly off the shelf and immediately fitted into the child’s mouth. The fit is universal (one-size-fits-all), meaning that the mouth guard doesn’t adjust. Stock mouth guards are very cheap, easy to fit, and quick to locate at sporting goods stores. Pediatric dentists favor this type of mouth guard least, as it provides minimal protection, obstructs proper breathing and speaking, and tends to be uncomfortable.

  • Boil and bite mouth guards – These mouth guards are usually made from thermoplastic and are easily located at most sporting goods stores. First, the thermoplastic must be immersed in hot water to make it pliable, and then it must be pressed on the child’s teeth to create a custom mold. Boil and bite mouth guards are slightly more expensive than stock mouthguards but tend to offer more protection, feel more comfortable in the mouth, and allow for easy speech production and breathing.

  • Customized mouth guards – These mouth guards offer the greatest degree of protection and are custom-made by the dentist. First, the dentist makes an impression of the child’s teeth using the special material, and then the mouth guard is constructed over the mold. Customized mouth guards are more expensive and take longer to fit, but are more comfortable, orthodontically correct, and fully approved by the dentist.

If you have questions or concerns about choosing a mouth guard for your child, please contact our office.

Pacifiers and Thumb-Sucking

For most infants, the sucking of thumbs and pacifiers is a happy, everyday part of life. Since sucking is a natural, instinctual baby habit, infants derive a sense of comfort, relaxation, and security from using a thumb or pacifier as a sucking aid.

According to research from the American Academy of Pediatric Dentistry (AAPD), the vast majority of children will cease using a pacifier before the age of four years old. Thumb sucking can be a harder habit to break and tends to persist for longer without intervention. Children who continue to suck thumbs or pacifiers after the age of five (and particularly those who continue after permanent teeth begin to emerge) are at high-risk for developing dental complications.

How can thumb sucking and pacifier use damage children’s teeth?

Pacifier and thumb sucking damage can be quite insidious. Both can be difficult to assess with the naked eye, and both tend to occur over a prolonged period of time. Below is an overview of some of the risks associated with prolonged thumb sucking and pacifier use:

Jaw misalignment – Pacifiers come in a wide range of shapes and sizes, most of which are completely unnatural for the mouth to hold. Over time, pacifiers and thumbs can guide the developing jaws out of correct alignment.

Tooth decay – Many parents attempt to soothe infants by dipping pacifiers in honey, or some other sugary substance. Oral bacteria feed on sugar and emit harmful acids. The acids attack tooth enamel and can lead to pediatric tooth decay and childhood caries.
Roof narrowing – The structures in the mouth are extremely pliable during childhood. Prolonged, repeated exposure to thumb and pacifier sucking actually cause the roof of the mouth to narrow (as if molding around the sucking device). This can cause later problems with developing teeth.

Slanting teeth – Growing teeth can be caused to slant or protrude by thumb and pacifier sucking, leading to poor esthetic results. In addition, thumb sucking and pacifier use in later childhood increase the need for extensive orthodontic treatments.

Mouth sores – Passive sucking is much less harmful than aggressive sucking. Aggressive sucking (popping sounds when the child sucks) may cause sores or ulcers to develop.

If you do intend to purchase a pacifier:

  • Buy a one-piece pacifier to reduce the risk of choking.

  • Buy an “orthodontically correct” model.

  • Do not dip it in honey or any other sugary liquid.

  • Rinse with water (as opposed to cleansing with your mouth) to prevent bacterial transmissions.

How can I encourage my child to stop thumb or pacifier sucking?

In most cases, children naturally relinquish the pacifier or thumb over time. As children grow, they develop new ways to self-soothe, relax, and entertain themselves. When thumb sucking or pacifier use persists past the age of five, a gentle intervention may be required.

Here are some helpful suggestions to help encourage the child to cease thumb sucking or pacifier use:

  • Ask the pediatric dentist to speak with the child about stopping. Often, the message is heard more clearly when delivered by a health professional.

  • Buy an ADA-recommended specialized dental appliance to make it difficult for the child to engage in sucking behaviors.

  • Implement a reward system (not a punishment), whereby the child can earn tokens or points towards a desirable reward for not thumb-sucking or using a pacifier.

  • Wrap thumbs in soft cloths or mittens at nighttime.

If the above suggestions do not seem to be working, your pediatric dentist can provide more guidance. Remember: the breaking of a habit takes time, patience, and plenty of encouragement!

Sealing Out Tooth Decay

Tooth decay has become increasingly prevalent in preschoolers. Not only is tooth decay unpleasant and painful, it can also lead to more serious problems like premature tooth loss and childhood periodontal disease.

Dental sealants are an important tool in preventing childhood caries (cavities) and tooth decay. Especially when used in combination with other preventative measures, like biannual checkups and an excellent daily home care routine, sealants can bolster the mouth’s natural defenses, and keep smiles healthy.

How do sealants protect children’s teeth?

In general, dental sealants are used to protect molars from oral bacteria and harmful oral acids. These larger, flatter teeth reside toward the back of the mouth and can be difficult to clean. Molars mark the site of four out of five instances of tooth decay. Decay-causing bacteria often inhabit the nooks and crannies (pits and fissures) found on the chewing surfaces of the molars. These areas are extremely difficult to access with a regular toothbrush.

If the pediatric dentist evaluates a child to be an at high risk for tooth decay, he or she may choose to coat additional teeth (for example, bicuspid teeth). The sealant acts as a barrier, ensuring that food particles and oral bacteria cannot access vulnerable tooth enamel.

Dental sealants do not enhance the health of the teeth directly, and should not be used as a substitute for fluoride supplements (if the dentist has recommended them) or general oral care. In general, however, sealants are less costly, less uncomfortable, and more aesthetically pleasing than dental fillings.

How are sealants applied?

Though there are many different types of dental sealant, most are comprised of liquid plastic. Initially, the pediatric dentist must thoroughly clean and prepare the molars, before painting sealant on the targeted teeth. Some sealants are bright pink when wet and clear when dry. This bright pink coloring enables the dentist to see that all pits and fissures have been thoroughly coated.

When every targeted tooth is coated to the dentist’s satisfaction, the sealant is either left to self-harden or exposed to blue spectrum natural light for several seconds (depending on the chemical composition of the specific brand). This specialized light works to harden the sealant and cure the plastic. The final result is a clear (or whitish) layer of thin, hard, durable sealant.

It should be noted that the “sealing” procedure is easily completed in one office visit, and is entirely painless.

When should sealants be applied?

  • Sealants are usually applied when the primary (baby) molars first emerge. Depending on the oral habits of the child, the sealants may last for the life of the primary tooth or need replacing several times. Essentially, sealant durability depends on the oral habits of the individual child.

  • Pediatric dentists recommend that permanent molars be sealed as soon as they emerge. In some cases, the sealant can be applied before the permanent molar is full grown.

  • The health of the sealant must be monitored at biannual appointments. If the seal begins to lift off, food particles may become trapped against the tooth enamel, actually causing tooth decay.

If you have questions or concerns about dental sealants, please contact your pediatric dentist.

Sippy Cups

Many pediatric dentists believe that frequent, prolonged sippy cup use contributes to toddler tooth decay. Sippy cups are an excellent tool to help ease the transition between baby bottles and regular adult drinking glasses. However, sippy cups have become so effective in preventing spills and leaks, that the majority of parents continue to use them -often well into late toddlerhood. As a consequence, pediatric cavities (often called “baby bottle cavities”) are becoming increasingly prevalent in children between the ages of two and five.

The American Academy of Pediatric Dentistry (AAPD) advises parents to make a “well-baby” checkup with a pediatric dentist approximately six months after the first tooth has emerged. At this visit, the pediatric dentist is able to educate parents about sippy cup use and general oral care routines, as well as provide strategies for eliminating unwanted oral habits.

When should my child use a sippy cup?

A sippy cup should be introduced when the child is first physically able to grasp it. Its use should be discontinued as soon as the child has enough motor control to use an adult-sized cup – usually around one year of age. Children are at risk for tooth decay as soon as the first teeth emerge from the gums, making it crucial to implement a good oral care routine as early as possible.

During the sippy cup period, pediatric dentists provide the following guidelines for parents:

  • Don’t fill sippy cups with sugary liquids (opt for water whenever possible).

  • Don’t let children sip continuously from a sippy cup (remove the cup when the child has finished drinking).

  • Don’t let the child take a sippy cup to bed (unless it contains water).

  • Don’t use sippy cups to comfort a distressed child (especially one containing sugary liquids).

  • Frequently rinse the sippy cup with water to eliminate germs.

  • If the child must drink sugary liquids, let them do it at mealtime (when saliva production is at its highest levels).

How do sippy cups cause tooth decay?

Sippy cups alone do not cause tooth decay. Oftentimes, the real problem is that parents tend to fill them with sugary, decay-promoting liquids. Examples of such liquids are breast milk, baby formula, fruit juice, soda, and sweetened water.
Since sippy cups only emit a tiny amount of fluid at a time, the sugars in the fluids are continuously being washed in and around the child’s teeth. Oral bacteria feed on these sugars and produce harmful oral acids. Acids attack the tooth enamel, weakening it and rendering it susceptible to decay. Sometimes cavities (caries) from between the teeth, which are hard to see. Biannual appointments with the pediatric dentist are the best way to monitor the condition of the teeth, and to ensure that cavities are not developing.

Which sippy cup should I choose for my child?

All sippy cups are not created equal. The American Dental Association (ADA) provides the following guidelines for choosing a good sippy cup:

  • Avoid “no-spill” valves – In essence, sippy cups with no-spill valves do not advance the child’s sipping. They only release a tiny amount of liquid, meaning that sugars are swelling around the mouth more often.

  • Choose a spot – Cups with a snap-on or screwing lid with a spout are preferable to the alternatives. These cups promote good drinking habits, as opposed to being “glorified baby bottles.”

  • Two handles are better than one – The goal of the transition is to make the child feel comfortable enough to grasp an adult-sized cup. Since larger cups require the use of two hands, it is better for the child to get into this habit early.

If you have questions or concerns about tooth decay or the use of sippy cups, please contact our office.

Tongue Piercing

There has been an upsurge in the amount of teenagers getting tongue piercings. Teenagers often view these piercings as a harmless expression of their growing individuality. Oftentimes, parents allow teens to pierce their tongues because the metal bar is impermanent. In addition, tongue bars are not as visually apparent as a tattoo or eyebrow piercing might be.

Unfortunately, tongue piercings can have a serious (even deadly) impact on health. Pediatric dentists routinely advise adolescents to avoid intraoral or perioral piercings for a number of good reasons.

Why is tongue piercing harmful?

First, there are a growing number of unlicensed piercing parlors in throughout the country. Such parlors have been recognized as potential transmission vectors for tetanus, tuberculosis, and most commonly - hepatitis. Second, a great number of painful conditions can result from getting a tongue piercing (even in a licensed parlor). These conditions include:

  • Bacterial infections

  • Blood clots

  • Blood poisoning

  • Brain abscess

  • Chronic pain

  • Damaged nerves (trigeminal neuralgia) 

  • Fractured/cracked teeth

  • Heart infections

  • Hypersensitivity reactions (to the metal bar)

  • Periodontal disease/gum recession

  • Problems enunciating

  • Scarring

What is the most common tongue piercing problems?

To pierce a tongue, the body piercer must first hold it steady with a clamp. Next, a hollowed, pointed metal needle is driven through the tongue. Finally, the piercer attaches the tongue bar to the bottom end of the needle, and then drags it upwards through the tongue. Two metal screw-on balls are then used to secure the tongue bar.

Most commonly, severe pain and swelling are experienced for several days after the piercing episode. Moreover, the new holes in the tongue are especially infection-prone, because the oral cavity is home to many bacteria colonies. In the medium term, saliva production may increase as the body responds to a completely unnatural entity in the mouth.

Are there long-term problems associated with a tongue piercing?

Long-term problems with tongue piercings are very common. The screw-on balls constantly scrape against tooth enamel, making teeth susceptible to decay and gums susceptible to periodontal disease. Soft tissue can also become infected in specific areas, as the tongue bar continues to rub against it.

If the tongue bar is inappropriately long, it can get tangled around the tongue or teeth. In a similar way to an earring getting ripped out of the ear, a tongue bar can be ripped out of the tongue. This is extremely painful, as well as difficult to repair.

In sum, the American Dental Association (ADA) advises against any type of oral piercing and so does the pediatric dentist.

If you are a concerned parent or would like the pediatric dentist to speak with your teen about tongue piercing, please contact our office.

What is Pulp Therapy?

The “pulp” of a tooth cannot be seen with the naked eye. The pulp is found at the center of each tooth and is comprised of nerves, tissue, and many blood vessels, which work to channel vital nutrients and oxygen. There are several ways in which pulp can be damaged. Most commonly in children, tooth decay or traumatic injury lead to painful pulp exposure and inflammation.

Pediatric pulp therapy is known by several other names, including root canal, pulpotomy, pulpectomy, and nerve treatment. The primary goal of pulp therapy is to treat, restore, and save the affected tooth.

Pediatric dentists perform pulp therapy on both primary (baby) teeth and permanent teeth. Though primary teeth are eventually shed, they are needed for speech production, proper chewing, and to guide the proper alignment and spacing of permanent teeth.

What are the signs of pulp injury and infection?

Inflamed or injured pulp is exceptionally painful. Even if the source of the pain isn’t visible, it will quickly become obvious that the child needs to see the pediatric dentist.

Here are some of the other signs to look for:

  • Constant unexplained pain.

  • Nighttime pain.

  • Sensitivity to warm and cool food temperatures.

  • Swelling or redness around the affected tooth.

  • Unexpected looseness or mobility of the affected tooth.

When should a child undergo pulp therapy?

Every situation is unique. The pediatric dentist assesses the age of the child, the positioning of the tooth, and the general health of the child before making a recommendation to extract the tooth or to save it via pulp therapy.

Some of the undesirable consequences of prematurely extracted/missing teeth are listed below:

  • The arch length may shorten.

  • In the case of primary tooth loss, permanent teeth may lack sufficient space to emerge.

  • Opposing teeth may grow in a protruding or undesirable way.

  • Premolars may become painfully impacted.

  • Remaining teeth may “move” to fill the gap.

  • The tongue may posture abnormally.

How is pulp therapy performed?

Initially, the pediatric dentist will perform visual examinations and evaluate X-rays of the affected areas. The amount and location of pulp damage dictate the nature of the treatment. Although there are several other treatments available, the pediatric pulpotomy and pulpectomy procedures are among the most common performed.

Pulpotomy - If the pulp root remains unaffected by injury or decay, meaning that the problem is isolated in the pulp tip, the pediatric dentist may leave the healthy part alone and only remove the affected pulp and surrounding tooth decay. The resulting gap is then filled with a biocompatible, therapeutic material, which prevents infection and soothes the pulp root. Most commonly, a crown is placed on the tooth after treatment. The crown strengthens the tooth structure, minimizing the risk of future fractures.

Pulpotomy Treatment is extremely versatile. It can be performed as a standalone treatment on baby teeth and growing permanent teeth, or as the initial step in a full root canal treatment.

Pulpectomy - In the case of severe tooth decay or trauma, the entire tooth pulp (including the root canals) may be affected. In these circumstances, the pediatric dentist must remove the pulp, cleanse the root canals, and then pack the area with biocompatible material. This usually takes several office visits.

In general, the reabsorbable material is used to fill primary teeth, and the non-absorbable material is used to fill permanent teeth. Either way, the final treatment step is to place a crown on the tooth to add strength and provide structural support. The crown can be disguised with a natural-colored covering, if the child prefers.

If you have questions or concerns about the pediatric pulp therapy procedure, please contact your pediatric dentist.

What’s the Best Toothpaste for My Child?

Evaluating the many brands of oral products claiming to be “best for children” can be an overwhelming task. Selecting an appropriately sized toothbrush and a nourishing, cleansing brand of children’s toothpaste is of paramount importance for maintaining excellent oral health.

Why brush primary teeth?

The importance of maintaining the health of primary (baby) teeth is often understated. Primary teeth are essential for speech production, chewing, jaw development, and they also facilitate the proper alignment and spacing of permanent adult teeth. Brushing primary teeth prevents bad breath and tooth decay, and also removes the plaque bacteria associated with childhood periodontal disease.

What differences are there among toothpaste brands?

Though all toothpaste are not created equal, most brands generally contain abrasive ingredients to remove stains, soapy ingredients to eliminate plaque, fluorides to strengthen tooth enamel, and some type of pleasant-tasting flavoring.

The major differences between brands are the thickness of the paste, the level of fluoride content, and the type of flavoring. Although fluoride strengthens enamel and repels plaque bacteria, too much of it can actually harm young teeth – a condition known as dental fluorosis. Children between the ages of one and four years old are most at risk for this condition, so fluoride levels should be carefully monitored during this time.

Be aware that adult and non-ADA approved brands of toothpaste often contain harsher abrasives, which remove tooth enamel and weaken primary teeth. In addition, some popular toothpaste brands contain sodium lauryl sulfate (shown as “SLS” on the package), which cause painful mouth ulcers in some children.

So which toothpaste brand should I choose?

  • The most important considerations to make before implementing an oral care plan and choosing a toothpaste brand is the age of the child. Home oral care should begin before the emergence of the first tooth. A cool clean cloth should be gently rubbed on the gums after feeding to remove food particles and bacteria.

  • Prior to the age of two, the child will have many teeth and brushing should begin. Initially, select fluoride-free “baby” toothpaste and softly brush the teeth twice per day. Flavoring is largely unimportant, so the child can play an integral role in choosing whatever type of toothpaste tastes most pleasant.

  • Between the middle and the end of the third year, select an American Dental Association (ADA) accepted the brand of toothpaste containing fluoride. The ADA logo is clear and present on toothpaste packaging, so be sure to check for it. Use only a tiny pea or rice-sized amount of fluoride toothpaste, and encourage the child to spit out the excess after brushing. Eliminating the toothpaste takes practice, patience, and motivation – especially if the child finds the flavoring tasty. If the child does ingest tiny amounts of toothpaste, don’t worry; this is perfectly normal and will cease with time and encouragement.

  • Dental fluorosis is not a risk factor for children over the age of eight, but an ADA accepted toothpaste is always the recommended choice for children of any age.

  • If you have questions or concerns about choosing an appropriate brand of toothpaste for your child, your pediatric dentist will be happy to make recommendations.

When Should Children Have Their First Dental Visit?

The American Academy of Pediatric Dentistry (AAPD) suggests that parents should make an initial “well-baby” appointment with a pediatric dentist approximately six months after the emergence of the first tooth, or no later than the child’s first birthday.

Although this may seem surprisingly early, the incidence of infant and toddler tooth decay has been rising in recent years. Tooth decay and early cavities can be exceptionally painful if they are not attended to immediately, and can also set the scene for poor oral health in later childhood.

The pediatric dentist is a specialist in child psychology and child behavior and should be viewed as an important source of information, help, and guidance. Oftentimes, the pediatric dentist can provide strategies for eliminating unwanted oral habits (for example, pacifier use and thumb sucking) and can also help parents in establishing a sound daily oral routine for the child.

What potential dental problems can babies experience?

A baby is at risk for tooth decay as soon as the first tooth emerges. During the first visit, the pediatric dentist will help parents implement a preventative strategy to protect the teeth from harm, and also demonstrate how infant teeth should be brushed and flossed.

In particular, infants who drink breast milk, juice, baby formula, soda, or sweetened water from a baby bottle or sippy cup are at high-risk for early childhood caries (cavities). To counteract this threat, the pediatric dentist discourages parents from filling cups with sugary fluids, dipping pacifiers in honey, and transmitting oral bacteria to the child via shared spoons and/or cleaning pacifiers in their own mouths.

Importantly, the pediatric dentist can also assess and balance the infant’s fluoride intake. Too much fluoride ingestion between the ages of one and four years old may lead to a condition known as fluorosis in later childhood. Conversely, too little fluoride may render young tooth enamel susceptible to tooth decay.

What happens during the first visit?

Pediatric dentists have fun-filled, stimulating dental offices. All dental personnel is fully trained to communicate with infants and young children.

During the initial visit, the pediatric dentist will advise parents to implement a good oral care routine, ask questions about the child’s oral habits, and examine the child’s emerging teeth. The pediatric dentist and parent sit knee-to-knee for this examination to enable the child to view the parent at all times. If the infant’s teeth appear stained, the dentist may clean them. Oftentimes, a topical fluoride treatment will be applied to the teeth after this cleaning.

What questions may the pediatric dentist ask during the first visit?

The pediatric dentist will ask questions about current oral care, diet, the general health of the child, the child’s oral habits, and the child’s current fluoride intake.

Once answers to these questions have been established, the pediatric dentist can advise parents on the following issues:

  • Accident prevention.

  • Adding xylitol and fluoride to the infant’s diet.

  • Choosing an ADA approved non-fluoridated brand of toothpaste for the infant.

  • Choosing an appropriate toothbrush.

  • Choosing an orthodontically correct pacifier.

  • Correct positioning of the head during tooth brushing.

  • Easing the transition from sippy cup to adult-sized drinking glasses (12-14 months).

  • Eliminating fussing during the oral care routine.

  • Establishing a drink-free bedtime routine.

  • Maintaining good dietary habits.

  • Minimizing the risk of tooth decay.

  • Reducing sugar and carbohydrate intake.

  • Teething and developmental milestones.

If you have further questions or concerns about the timing or nature of your child’s first oral checkup, please ask your pediatric dentist.

When Will My Baby Start Getting Teeth?

The initial growth period for primary (baby) teeth begins in the second trimester of pregnancy (around 16-20 weeks). During this time, it is especially important for expectant mothers to eat a healthy, nutritious diet, since nutrients are needed for bone and soft tissue development.
Though there are some individual differences in the timing of tooth eruption, primary teeth usually begin to emerge when the infant is between six and eight months old. Altogether, a set of twenty primary teeth will emerge by the age of three.

The American Academy of Pediatric Dentistry (AAPD) recommends a first “well-baby” dental visit around the age of twelve months (or six months after the first tooth emerges). This visit acquaints the infant with the dental office, allows the pediatric dentist to monitor development, and provides a great opportunity for parents to ask questions.

Which teeth emerge first?

In general, teeth emerge in pairs, starting at the front of the infant’s mouth. Between the ages of six and ten months, the two lower central incisors break through. Remember that cavities may develop between two adjacent teeth, so flossing should begin at this point.

Next (and sometimes simultaneously), the two upper central incisors emerge – usually between the ages of eight and twelve months. Teething can be quite an uncomfortable process for the infant. Clean teething rings and cold damp cloths can help ease the irritation and discomfort.

Between the ages of nine and sixteen months, the upper lateral incisors emerge – one on either side of the central incisors. Around the same time, the lower lateral incisors emerge, meaning that the infant has four adjacent teeth on the lower and upper arches. Pediatric dentists suggest that sippy cup usage should end when the toddler reaches the age of fourteen months. This minimizes the risk of “baby bottle tooth decay.”

Eight more teeth break through between the ages of thirteen and twenty-three months. On each arch, a cuspid or canine tooth will appear immediately adjacent to each lateral incisor. Immediately behind (looking towards the back of the child’s mouth), first molars will emerge on either side of the canine teeth on both jaws.

Finally, the second set of molars emerges on each arch – usually beginning on the lower arch. Most children have a complete set of twenty primary teeth before the age of thirty-three months. The pediatric dentist generally applies dental sealant to the molars, to lock out food particles, bacteria, and enamel-attacking acids.

How can I reduce the risk of early caries (cavities)?

Primary teeth preserve space for permanent teeth and guide their later alignment. In addition, primary teeth help with speech production, prevent the tongue from posturing abnormally, and play an important role in the chewing of food. For these reasons, it is critically important to learn how to care for the child’s emerging teeth.

Here are some helpful tips:

  • Brush twice each day – The AAPD recommends a pea-sized amount of ADA approved (non-fluoridated) toothpaste for children under two years old, and the same amount of an ADA approved (fluoridated) toothpaste for children over this age. The toothbrush should be soft-bristled and appropriate for infants.

  • Start flossing – Flossing an infant’s teeth can be difficult but the process should begin when two adjacent teeth emerge. The pediatric dentist will happily demonstrate good flossing techniques.

  • Provide a balanced diet – Sugars and starches feed oral bacteria, which produce harmful acids and attack tooth enamel. Ensure that the child is eating a balanced diet and work to reduce sugary and starchy snacks.

  • Set a good example – Children who see parents brushing and flossing are often more likely to follow suit. Explain the importance of good oral care to the child; age-appropriate books often help with this.

  • Visit the dentist – The pediatric dentist monitors oral development, provides professional cleanings, applies topical fluoride to the teeth, and coats molars with sealants. Biannual trips to the dental office can help to prevent a wide range of painful conditions later.

If you have questions or concerns about the emergence of your child’s teeth, please contact your pediatric dentist.

Why Are Primary Teeth Important?

Primary teeth, also known “baby teeth” or “deciduous teeth,” begin to develop beneath the gums during the second trimester of pregnancy. Teeth begin to emerge above the gums approximately six months to one year after birth. Typically, preschool children have a complete set of 20 baby teeth – including four molars on each arch.

One of the most common misconceptions about primary teeth is that they are irrelevant to the child’s future oral health. However, their importance is emphasized by the American Dental Association (ADA), which urges parents to schedule a “baby checkup” with a pediatric dentist within six months of the first tooth emerges.

What are the functions of primary teeth?

Primary teeth can be painful to acquire. To soothe tender gums, biting on chewing rings, wet gauze pads, and clean fingers can be helpful. Though most three-year-old children have a complete set of primary teeth, eruption happens gradually – usually starting at the front of the mouth.

The major functions of primary teeth are described below:

Speech production and development – Learning to speak clearly is crucial for cognitive, social, and emotional development. The proper positioning of primary teeth facilitates correct syllable pronunciation and prevents the tongue from straying during speech formation.

  • Eating and Nutrition – Children with malformed or severely decayed primary teeth are more likely to experience dietary deficiencies, malnourishment, and to be underweight. Proper chewing motions are acquired over time and with extensive practice. Healthy primary teeth promote good chewing habits and facilitate nutritious eating.

  • Self-confidence– Even very young children can be quick to point out ugly teeth and crooked smiles. Taking good care of primary teeth can make social interactions more pleasant, reduce the risk of bad breath, and promote confident smiles and positive social interactions.

  • Straighter Smiles – One of the major functions of primary teeth is to hold an appropriate amount of space for developing adult teeth. In addition, these spacers facilitate the proper alignment of adult teeth and also promote jaw development. Left untreated, missing primary teeth cause the remaining teeth to “shift” and fill spaces improperly. For this reason, pediatric dentists often recommend space-maintaining devices.

  • Excellent oral health – Badly decayed primary teeth can promote the onset of childhood periodontal disease. As a result of this condition, oral bacteria invade and erode gums, ligaments, and eventually bone. If left untreated, primary teeth can drop out completely – causing health and spacing problems for emerging permanent teeth. To avoid periodontal disease, children should practice an adult-guided oral care routine each day, and infant gums should be rubbed gently with a clean, damp cloth after meals.

If you have questions or concerns about primary teeth, please contact your pediatric dentist.

Xylitol – Reducing Cavities

Tooth decay is a common, yet preventable childhood problem. Left untreated, cavities in primary (baby) and permanent (adult) teeth become painful and negatively impact the esthetics and functionality of the teeth.

Some children are particularly susceptible to tooth decay, even after receiving regular dental examinations and oral care at home. The American Academy of Pediatric Dentistry (AAPD) has recently recognized the benefits of a substance called Xylitol for reducing childhood tooth decay.

What is Xylitol?

Xylitol is a natural substance that can be found in a variety of fruits and vegetables. Some of the most common Xylitol- rich foods include: berries, mushrooms, corns, and lettuces. Study results indicate that 4-20 grams of Xylitol each day, divided into three or more helpings, can reduce tooth decay and cavities by as much as 70%. As a point of reference, a singe cup of berries contains a little less than one gram of Xylitol.

It can be difficult to encourage children (especially toddlers) to consistently eat four or more cups of fruit or vegetables each day. For this reason, Xylitol is also available as a sugar substitute, a gum, and as a concentrate in numerous health foods. No other sugar substitute has been shown to benefit young teeth in the same way.

It should be noted thatexcessive Xylitol consumption does not provide “more” tooth protection. Sticking to the recommended daily amount is enough to enhance other cavity-reduction efforts, and the effects will last well into the future.

How does Xylitol work?

The combination of many factors increases susceptibility to childhood tooth decay and cavities. These factors include: oral care habits, diet, carbohydrate consumption, sucrose consumption, salivary flow rate, and tooth resistance to plaque.

More specifically, harmfuloral bacteria feed on sugars and carbohydrates, producing acids. When sugary foods are consumed, these acids attack and destroy vulnerable tooth enamel. Xylitol works to neutralize the acids, reducing enamel destruction, and minimizing the threat of cavities in the process. Xylitol also stimulates saliva production, meaning that food particles, plaqueand bacteria are continually removed from the teeth. When used in combination with fluoride, Xylitol works to remineralize teeth, protecting tooth enamel and minimizing new cavity formation.

When should my child startusing Xylitol?

Although Xylitol gum is not suitable for very young children, infants actually benefit from maternal chewing! Mothers of children between three months and two years old who used Xylitol gum several times each day, protected their child from tooth decay until the age of five years old. In this case, Xylitol reduced the amount of microorganisms transmitted from mother to child.

Once the child reaches toddlerhood, Xylitol can be consumed as a sugar substitute, or as a natural byproduct of eating fruit and vegetables. Older children can reduce the threat of new cavities by chewing Xylitol gum.
If you have questions or concernsabout Xylitol or tooth decay, please contact our practice.