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GENERAL TOPICS:
What is a Pediatric Dentist?
Why are the Primary
Teeth so Important?
Eruption of your Child's Teeth
Dental Emergencies
Dental Radiographs
(X-rays)
What's the Best Toothpaste for my Child?
Does your Child Grind his Teeth at Night? (Bruxism)
Thumb Sucking
What is Pulp
Therapy?
Advantages of
Early Orthodontics
EARLY INFANT ORAL CARE:
Your Child's First Dental
Visit
When will my Baby Start
Getting Teeth?
Baby
Bottle Tooth Decay (Early Childhood Caries)
PREVENTION:
Care of your Child's Teeth
Good Diet = Healthy Teeth
How Do I Prevent Cavities
Seal Out Decay
Fluoride
Mouth Guards
Xylitol - Reducing
Cavities
ADOLESCENT DENTISTRY:
Tongue Piercing - Is it
Really Cool?
Tobacco - Bad News in Any Form
For information on special oral
health care needs, we've provided links to the following sites:
National Institute of
Dental & Craniofacial Research
Resource & Information on Cleft Lip
& Palate
National Foundation for Ectodermal
Dysplasias
GENERAL TOPICS & FAQ
What Is A Pediatric Dentist?
The pediatric dentist has an extra two to three years
of specialized training after dental school, and is dedicated to the
oral health of children from infancy through the teenage years. The very
young, pre-teens, and teenagers all need different approaches in dealing
with their behavior, guiding their dental growth and development, and
helping them avoid future dental problems. The pediatric dentist is best
qualified to meet these needs.
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Why
Are The Primary Teeth So Important?
It is very important to maintain the health of the
primary teeth. Neglected cavities can and frequently do lead to problems
which affect developing permanent teeth. Primary teeth, or baby teeth
are important for (1) proper chewing and eating, (2) providing space for
the permanent teeth and guiding them into the correct position, and (3)
permitting normal development of the jaw bones and muscles. Primary
teeth also affect the development of speech and add to an attractive
appearance. While the front 4 teeth last until 6-7 years of age, the
back teeth (cuspids and molars) aren’t replaced until age 10-13.
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Eruption Of Your
Child’s Teeth
Children’s teeth begin forming before birth. As early
as 4 months, the first primary (or baby) teeth to erupt through the gums
are the lower central incisors, followed closely by the upper central
incisors. Although all 20 primary teeth usually appear by age 3, the
pace and order of their eruption varies.
Permanent
teeth begin appearing around age 6, starting with the first molars and
lower central incisors. This process continues until approximately age
21.
Adults have
28 permanent teeth, or up to 32 including the third molars (or wisdom
teeth).
TOOTH
DEVELOPMENT
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Dental Emergencies
Toothache: Clean the area of the
affected tooth. Rinse the mouth thoroughly with warm water or use dental
floss to dislodge any food that may be impacted. If the pain still
exists, contact your child's dentist. Do not place aspirin or heat on
the gum or on the aching tooth. If the face is swollen, apply cold
compresses and contact your dentist immediately.
Cut or Bitten Tongue, Lip or Cheek:
Apply ice to injured areas to help control swelling. If there is
bleeding, apply firm but gentle pressure with a gauze or cloth. If
bleeding cannot be controlled by simple pressure, call a doctor or visit
the hospital emergency room.
Knocked Out Permanent Tooth:
If possible, find the tooth. Handle it by the crown, not by the root.
You may rinse the tooth with water only. DO NOT clean with soap, scrub
or handle the tooth unnecessarily. Inspect the tooth for fractures. If
it is sound, try to reinsert it in the socket. Have the patient hold the
tooth in place by biting on a gauze. If you cannot reinsert the tooth,
transport the tooth in a cup containing the patient’s saliva or milk. If
the patient is old enough, the tooth may also be carried in the
patient’s mouth (beside the cheek). The patient must see a dentist
IMMEDIATELY! Time is a critical factor in saving the tooth.
Knocked Out Baby Tooth: Contact your
pediatric dentist during business hours. This is not usually an
emergency, and in most cases, no treatment is necessary.
Chipped or Fractured Permanent Tooth: Contact
your pediatric dentist immediately. Quick action can save the tooth,
prevent infection and reduce the need for extensive dental treatment.
Rinse the mouth with water and apply cold compresses to reduce swelling.
If possible, locate and save any broken tooth fragments and bring them
with you to the dentist.
Chipped or Fractured Baby Tooth: Contact your
pediatric dentist.
Severe Blow to the Head: Take your child to
the nearest hospital emergency room immediately.
Possible Broken or Fractured Jaw:
Keep the jaw from moving and take your child to the nearest hospital
emergency room.
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Dental Radiographs (X-Rays)
Radiographs
(X-Rays) are a vital and necessary part of your child’s dental
diagnostic process. Without them, certain dental conditions can and will
be missed.
Radiographs
detect much more than cavities. For example, radiographs may be needed
to survey erupting teeth, diagnose bone diseases, evaluate the results
of an injury, or plan orthodontic treatment. Radiographs allow dentists
to diagnose and treat health conditions that cannot be detected during a
clinical examination. If dental problems are found and treated early,
dental care is more comfortable for your child and more affordable for
you.
The
American Academy of Pediatric Dentistry recommends radiographs and
examinations every six months for children with a high risk of tooth
decay. On average, most pediatric dentists request radiographs
approximately once a year. Approximately every 3 years, it is a good
idea to obtain a complete set of radiographs, either a panoramic and
bitewings or periapicals and bitewings.
Pediatric
dentists are particularly careful to minimize the exposure of their
patients to radiation. With contemporary safeguards, the amount of
radiation received in a dental X-ray examination is extremely small. The
risk is negligible. In fact, the dental radiographs represent a far
smaller risk than an undetected and untreated dental problem. Lead body
aprons and shields will protect your child. Today’s equipment filters
out unnecessary x-rays and restricts the x-ray beam to the area of
interest. High-speed film and proper shielding assure that your child
receives a minimal amount of radiation exposure.
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What’s the Best Toothpaste
for my Child?
 Tooth brushing
is one of the most important tasks for good oral health. Many
toothpastes, and/or tooth polishes, however, can damage young smiles.
They contain harsh abrasives, which can wear away young tooth enamel.
When looking for a toothpaste for your child, make sure to pick one that
is recommended by the American Dental Association as shown on the box
and tube. These toothpastes have undergone testing to insure they are
safe to use.
Remember,
children should spit out toothpaste after brushing to avoid getting too
much fluoride. If too much fluoride is ingested, a condition known as
fluorosis can occur. If your child is too young or unable to spit out
toothpaste, consider providing them with a fluoride free toothpaste,
using no toothpaste, or using only a "pea size" amount of toothpaste.
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Does Your Child Grind His
Teeth At Night? (Bruxism)
Parents are often concerned about the nocturnal
grinding of teeth (bruxism). Often, the first indication is the noise
created by the child grinding on their teeth during sleep. Or, the
parent may notice wear (teeth getting shorter) to the dentition. One
theory as to the cause involves a psychological component. Stress due to
a new environment, divorce, changes at school; etc. can influence a
child to grind their teeth. Another theory relates to pressure in the
inner ear at night. If there are pressure changes (like in an airplane
during take-off and landing, when people are chewing gum, etc. to
equalize pressure) the child will grind by moving his jaw to relieve
this pressure.
The majority of cases of pediatric bruxism do not
require any treatment. If excessive wear of the teeth (attrition) is
present, then a mouth guard (night guard) may be indicated. The
negatives to a mouth guard are the possibility of choking if the
appliance becomes dislodged during sleep and it may interfere with
growth of the jaws. The positive is obvious by preventing wear to the
primary dentition.
The good news is most children outgrow bruxism. The
grinding decreases between the ages 6-9 and children tend to stop
grinding between ages 9-12. If you suspect bruxism, discuss this with
your pediatrician or pediatric dentist.
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Thumb
Sucking
 Sucking is a
natural reflex and infants and young children may use thumbs, fingers,
pacifiers and other objects on which to suck. It may make them feel
secure and happy, or provide a sense of security at difficult periods.
Since thumb sucking is relaxing, it may induce sleep.
Thumb sucking that persists beyond the eruption of
the permanent teeth can cause problems with the proper growth of the
mouth and tooth alignment. How intensely a child sucks on fingers or
thumbs will determine whether or not dental problems may result.
Children who rest their thumbs passively in their mouths are less likely
to have difficulty than those who vigorously suck their thumbs.
Children should cease thumb sucking by the time their
permanent front teeth are ready to erupt. Usually, children stop between
the ages of two and four. Peer pressure causes many school-aged children
to stop.
Pacifiers are no substitute for thumb sucking. They
can affect the teeth essentially the same way as sucking fingers and
thumbs. However, use of the pacifier can be controlled and modified more
easily than the thumb or finger habit. If you have concerns about thumb
sucking or use of a pacifier, consult your pediatric dentist.
A few suggestions to help your child get through
thumb sucking:
-
Instead of scolding children for thumb sucking,
praise them when they are not.
-
Children often suck their thumbs when feeling
insecure. Focus on correcting the cause of anxiety, instead of the
thumb sucking.
-
Children who are sucking for comfort will feel less
of a need when their parents provide comfort.
-
Reward children when they refrain from sucking
during difficult periods, such as when being separated from their
parents.
-
Your pediatric dentist can encourage children to
stop sucking and explain what could happen if they continue.
-
If these approaches don’t work, remind the children
of their habit by bandaging the thumb or putting a sock on the hand at
night. Your pediatric dentist may recommend the use of a mouth
appliance.
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What
is Pulp Therapy?
The pulp of a tooth is the inner, central
core of the tooth. The pulp contains nerves, blood vessels, connective
tissue and reparative cells. The purpose of pulp therapy in Pediatric
Dentistry is to maintain the vitality of the affected tooth (so the
tooth is not lost).
Dental caries (cavities) and traumatic
injury are the main reasons for a tooth to require pulp therapy. Pulp
therapy is often referred to as a "nerve treatment", "children's root
canal", "pulpectomy" or "pulpotomy". The two common forms of pulp
therapy in children's teeth are the pulpotomy and pulpectomy.
A pulpotomy removes the diseased pulp tissue
within the crown portion of the tooth. Next, an agent is placed to
prevent bacterial growth and to calm the remaining nerve tissue. This
is followed by a final restoration (usually a stainless steel crown).
A pulpectomy is required when the entire
pulp is involved (into the root canal(s) of the tooth). During this
treatment, the diseased pulp tissue is completely removed from both the
crown and root. The canals are cleansed, disinfected and, in the case
of primary teeth, filled with a resorbable material. Then, a final
restoration is placed. A permanent tooth would be filled with a non-resorbing
material.
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Advantages of Early Orthodontics
The American
Association for Orthodontists recommends that every child have an orthodontic
evaluation by the age of 7. Early detection and treatment gives your child the
edge: a much better chance for natural and normal development. By working with
the natural growth instead of against it, we can prevent problems from
becoming worse, and give your child a lifetime of healthy smiles!
Early treatment
should be initiated for:
-
Habits such
as tongue thrusting and thumb sucking
-
A
constricted airway due to swollen adenoids or tonsils
-
Mouth
breathing or snoring problems
-
A bad bite
-
Bone
problems (i.e. narrow or underdeveloped jaws)
-
Space
maintenance (for missing teeth)
Phase One -
Functional (Growth) Appliances and/or Limited Braces - Ages 5 to 12
In the first
phase, the doctor is interested in the position and symmetry of the jaws,
future growth, spacing of the teeth, breathing and other oral habits which
may, over a period of time, result in abnormal dentofacial development.
Treatment
initiated in this phase of development is often very successful and some
times, though not always, can eliminate the need for future orthodontic
treatment.
Phase
Two - Braces - Ages 12 to 14
In the second
phase, the doctor will be looking at how your child’s teeth and jaws fit,
and more specifically work, together. Your child’s teeth will be
straightened and their occlusion (bite) is properly aligned. Attention will be
given to the jaw joint, (TMJ), the facial profile and periodontal (gum)
tissues. By undergoing the first phase, we can usually reduce the amount of
time needed for braces.
Facts: Early Treatment is Important to Consider!
Facial
Development
- Seventy-five
percent of 12-year-olds need orthodontic treatment. Yet 90% of a child's face
has already developed! By guiding facial development earlier, through the use
of functional appliances, 80% of the treatment can be corrected before the
adult teeth are present!
Cooperation
- Younger children between the ages of 8 and 11 are often much more
cooperative than children of ages 12 to 14.
Shorter
Treatment Time - Another advantage of
early Phase One treatment is that children will need to wear fixed braces on
their adult teeth for less time.
To
Correct Underdeveloped or Overdeveloped Jaws
- Almost 55% of children who need orthodontic treatment due to a bad bite have
underdeveloped or overdeveloped upper or lower jaws. Functional appliances
and/or limited braces can reposition the jaws, improving the child's profile
and correcting the bite problem - within 7 to 9 months!
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EARLY INFANT ORAL CARE
Your Child’s First Dental
Visit - Establishing a "Dental Home"
The American Academy of Pediatrics (AAP), the
American Dental Association (ADA), and the American Academy of Pediatric
Dentistry (AAPD) all recommend establishing a "Dental
Home" for your child by one year of age. Children who have a
dental home are more likely to receive appropriate preventive and
routine oral health care.
The Dental Home is intended
to provide a place other than the
Emergency Room for parents.
You can make the first visit to the dentist enjoyable
and positive. If old enough, your child should be informed of the visit
and told that the dentist and their staff will explain all procedures
and answer any questions. The less to-do concerning the visit, the
better.
It is best if you refrain from using words around
your child that might cause unnecessary fear, such as needle, pull,
drill or hurt. Pediatric dental offices make a practice of using words
that convey the same message, but are pleasant and non-frightening to
the child.
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When Will My Baby Start
Getting Teeth?
Teething,
the process of baby (primary) teeth coming through the gums into the
mouth, is variable among individual babies. Some babies get their teeth
early and some get them late. In general, the first baby teeth to appear
are usually the lower front (anterior) teeth and they usually begin
erupting between the age of 6-8 months. See "Eruption
of Your Child’s Teeth" for more details.
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Baby Bottle Tooth Decay
(Early Childhood Caries)
One serious form of decay among young children is
baby bottle tooth decay. This condition is caused by frequent and long
exposures of an infant’s teeth to liquids that contain sugar. Among
these liquids are milk (including breast milk), formula, fruit juice and
other sweetened drinks.
Putting a baby to bed for a nap or at night with a
bottle other than water can cause serious and rapid tooth decay. Sweet
liquid pools around the child’s teeth giving plaque bacteria an
opportunity to produce acids that attack tooth enamel. If you must give
the baby a bottle as a comforter at bedtime, it should contain only
water. If your child won't fall asleep without the bottle and its usual
beverage, gradually dilute the bottle's contents with water over a
period of two to three weeks.
After each feeding, wipe the baby’s gums and teeth
with a damp washcloth or gauze pad to remove plaque. The easiest way to
do this is to sit down, place the child’s head in your lap or lay the
child on a dressing table or the floor. Whatever position you use, be
sure you can see into the child’s mouth easily.
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PREVENTION
Care of Your Child’s Teeth
Begin daily brushing as soon as the child’s first
tooth erupts. A pea size amount of fluoride toothpaste can be used after
the child is old enough not to swallow it. By age 4 or 5, children
should be able to brush their own teeth twice a day with supervision
until about age seven to make sure they are doing a thorough job.
However, each child is different. Your dentist can help you determine
whether the child has the skill level to brush properly.
Proper brushing removes plaque from the inner, outer
and chewing surfaces. When teaching children to brush, place toothbrush
at a 45 degree angle; start along gum line with a soft bristle brush in
a gentle circular motion. Brush the outer surfaces of each tooth, upper
and lower. Repeat the same method on the inside surfaces and chewing
surfaces of all the teeth. Finish by brushing the tongue to help freshen
breath and remove bacteria.
Flossing removes plaque between the teeth, where a
toothbrush can’t reach. Flossing should begin when any two teeth touch.
You should floss the child’s teeth until he or she can do it alone. Use
about 18 inches of floss, winding most of it around the middle fingers
of both hands. Hold the floss lightly between the thumbs and
forefingers. Use a gentle, back-and-forth motion to guide the floss
between the teeth. Curve the floss into a C-shape and slide it into the
space between the gum and tooth until you feel resistance. Gently scrape
the floss against the side of the tooth. Repeat this procedure on each
tooth. Don’t forget the backs of the last four teeth.
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Good Diet = Healthy Teeth
 Healthy eating
habits lead to healthy teeth. Like the rest of the body, the teeth,
bones and the soft tissues of the mouth need a well-balanced diet.
Children should eat a variety of foods from the five major food groups.
Most snacks that children eat can lead to cavity formation. The more
frequently a child snacks, the greater the chance for tooth decay. How
long food remains in the mouth also plays a role. For example, hard
candy and breath mints stay in the mouth a long time, which cause longer
acid attacks on tooth enamel. If your child must snack, choose
nutritious foods such as vegetables, low-fat yogurt, and low-fat cheese,
which are healthier and better for children’s teeth.
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How Do I Prevent Cavities?
Good oral
hygiene removes bacteria and the left over food particles that combine
to create cavities. For infants, use a wet gauze or clean washcloth to
wipe the plaque from teeth and gums. Avoid putting your child to bed
with a bottle filled with anything other than water. See "Baby
Bottle Tooth Decay" for more information.
For older
children, brush their teeth at least twice a day. Also, watch the
number of snacks containing sugar that you give your children.
The
American Academy of Pediatric Dentistry recommends visits every six
months to the pediatric dentist, beginning at your child’s first
birthday. Routine visits will start your child on a lifetime of good
dental health.
Your
pediatric dentist may also recommend protective sealants or home
fluoride treatments for your child. Sealants can be applied to your
child’s molars to prevent decay on hard to clean surfaces.
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Seal Out Decay
A sealant is a clear or shaded plastic material that
is applied to the chewing surfaces (grooves) of the back teeth
(premolars and molars), where four out of five cavities in children are
found. This sealant acts as a barrier to food, plaque and acid, thus
protecting the decay-prone areas of the teeth.
|
Before Sealant Applied |
After Sealant Applied |
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Fluoride
Fluoride is an element, which has been shown to be
beneficial to teeth. However, too little or too much fluoride can be
detrimental to the teeth. Little or no fluoride will not strengthen the
teeth to help them resist cavities. Excessive fluoride ingestion by
preschool-aged children can lead to dental fluorosis, which is a chalky
white to even brown discoloration of the permanent teeth. Many children
often get more fluoride than their parents realize. Being aware of a
child’s potential sources of fluoride can help parents prevent the
possibility of dental fluorosis.
Some of these sources are:
-
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 baby tooth cleanser on the toothbrush of the
very young child.
-
Place only a pea sized drop of children’s
toothpaste on the brush when brushing.
-
Account for all of the sources of ingested fluoride
before requesting fluoride supplements from your child’s physician or
pediatric dentist.
-
Avoid giving any fluoride-containing supplements to
infants until they are at least 6 months old.
-
Obtain fluoride level test results for your
drinking water before giving fluoride supplements to your child (check
with local water utilities).
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Mouth
Guards
When a child begins to participate in recreational
activities and organized sports, injuries can occur. A properly fitted
mouth guard, or mouth protector, is an important piece of athletic gear
that can help protect your child’s smile, and should be used during any
activity that could result in a blow to the face or mouth.
Mouth guards help prevent broken teeth, and injuries
to the lips, tongue, face or jaw. A properly fitted mouth guard will
stay in place while your child is wearing it, making it easy for them to
talk and breathe.
Ask your pediatric dentist about custom and
store-bought mouth protectors.
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Xylitol - Reducing
Cavities
The
American Academy of Pediatric Dentistry (AAPD) recognizes the benefits
of xylitol on the oral health of infants, children, adolescents, and
persons with special health care needs.
The
use of XYLITOL GUM by mothers (2-3 times per day) starting 3 months
after delivery and until the child was 2 years old, has proven to reduce
cavities up to 70% by the time the child was 5 years old.
Studies using xylitol as either a sugar
substitute or a small dietary addition have demonstrated a dramatic
reduction in new tooth decay, along with some reversal of existing
dental caries. Xylitol provides additional protection that enhances all
existing prevention methods. This xylitol effect is long-lasting and
possibly permanent. Low decay rates persist even years after the trials
have been completed.
Xylitol is widely distributed throughout
nature in small amounts. Some of the best sources are fruits, berries,
mushrooms, lettuce, hardwoods, and corn cobs. One cup of raspberries
contains less than one gram of xylitol.
Studies suggest xylitol intake that consistently produces positive
results ranged from 4-20 grams per day, divided into 3-7 consumption
periods. Higher results did not result in greater reduction and may lead
to diminishing results. Similarly, consumption frequency of less than 3
times per day showed no effect.
To find gum or other products containing
xylitol, try visiting your local health food store or search the
Internet to find products containing 100% xylitol.
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ADOLESCENT DENTISTRY
Tongue Piercing – Is it
Really Cool?
You might not be surprised anymore to see people with
pierced tongues, lips or cheeks, but you might be surprised to know just
how dangerous these piercings can be.
There are many risks involved with oral piercings,
including chipped or cracked teeth, blood clots, blood poisoning, heart
infections, brain abscess, nerve disorders (trigeminal neuralgia),
receding gums or scar tissue. Your mouth contains millions of bacteria,
and infection is a common complication of oral piercing. Your tongue
could swell large enough to close off your airway!
Common symptoms after piercing include pain,
swelling, infection, an increased flow of saliva and injuries to gum
tissue. Difficult-to-control bleeding or nerve damage can result if a
blood vessel or nerve bundle is in the path of the needle.
So follow the advice of the American Dental
Association and give your mouth a break – skip the mouth jewelry.
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Tobacco – Bad News in Any Form
Tobacco in any form can jeopardize your child’s
health and cause incurable damage. Teach your child about the dangers of
tobacco.
Smokeless tobacco, also called spit, chew or snuff,
is often used by teens who believe that it is a safe alternative to
smoking cigarettes. This is an unfortunate misconception. Studies show
that spit tobacco may be more addictive than smoking cigarettes and may
be more difficult to quit. Teens who use it may be interested to know
that one can of snuff per day delivers as much nicotine as 60
cigarettes. In as little as three to four months, smokeless tobacco use
can cause periodontal disease and produce pre-cancerous lesions called
leukoplakias.
If your child is a tobacco user you should watch for
the following that could be early signs of oral cancer:
-
A sore that won’t heal.
-
White or red leathery patches on the lips, and on
or under the tongue.
-
Pain, tenderness or numbness anywhere in the mouth
or lips.
-
Difficulty chewing, swallowing, speaking or moving
the jaw or tongue; or a change in the way the teeth fit together.
Because the early signs of oral cancer usually are
not painful, people often ignore them. If it’s not caught in the early
stages, oral cancer can require extensive, sometimes disfiguring,
surgery. Even worse, it can kill.
Help your child avoid tobacco in any form. By doing
so, they will avoid bringing cancer-causing chemicals in direct contact
with their tongue, gums and cheek.
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