What is a Pediatric Dentist?
A pediatric dentist is a dentist who has undergone 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. In each stage of development, different approaches are needed to deal with behavior, guide dental growth and development, and help avoid future dental problems. The pediatric dentist is best qualified to meet these needs.
Why Are The Primary Teeth Important?
Eruption Of Your Child's Teeth
Permanent teeth begin appearing around age 6, starting with the first molars and lower central incisors. At the age of 8, you can generally expect 4 primary teeth on the bottom (lower central and lateral incisors) and 4 primary teeth on the top (upper central and lateral incisors) to be replaced by permanent teeth. Around ages 10-12, another wave of permanent teeth begin to make their appearance. This process continues until approximately age 21. By the time children reach adulthood, they typically have 28 permanent teeth, or up to 32 including the third molars (or wisdom teeth).
During the transition from primary to permanent teeth, many parents have concerns about the possibility of adult teeth coming in behind the primary teeth, failing to push these first teeth out in the process. This is a very common occurrence and, in most cases, the primary tooth will fall out within two months if the child starts wiggling it. If not, your pediatric dentist can easily remove the tooth, allowing the permanent tooth to slide into the proper place.
Dental Radiographs (X-Rays)
While x-rays are used to detect cavities, they are also serve many other important functions. For example, radiographs may be needed to survey erupting teeth, diagnose bone diseases, evaluate the results of an injury, or plan orthodontic treatment. They allow dentists to diagnose and treat health conditions that cannot be detected during a clinical examination. If these issues are found and treated early, more extensive dental issues can be avoided and dental care will be more comfortable for your child and more affordable for you.
On average, most pediatric dentists request basic radiographs once a year and a complete set every 3 years. For children with a high risk of tooth decay, the American Academy of Pediatric Dentistry recommends x-rays and examinations every six months.
Pediatric dentists are particularly careful to minimize their patients’ exposure to radiation. With modern safeguards, including protective body shields, precision x-ray machines and high-speed filming, the amount of radiation received in a dental x-ray is extremely small and the risk negligible. In fact, these x-rays present a far smaller risk to children’s health than undetected and untreated dental problems. It is of upmost importance to us to protect your children as if they were our own!
Choosing The Right Toothpaste
We recommend your child(ren) to use fluoride toothpaste at every brushing starting at the age of three. You can begin introducing fluoride toothpaste at the age of 2 ½ once a day. Prior to this, a training, non-fluoride toothpaste is safe to use.
Parents are often concerned about children grinding their teeth (bruxism) while asleep. This condition is usually discovered by the noise it creates or by noticeable signs of wear on the teeth.
There are varying theories about the cause of bruxism in children. One theory attributes the condition to stress (divorce, changes at school, etc.). While another theory asserts that children may grind their teeth at night to relieve pressure in the inner ear.
If excessive wear of the teeth (attrition) is present, then a mouth guard may be used. While this prevents damage to the teeth, it may interfere with jaw growth and increases the risk of choking. The good news is that most children outgrow pediatric bruxism by 9-12 years of age without intervention. If you suspect this condition, discuss your concerns with your pediatrician or pediatric dentist.
The pulp of a tooth is the inner, central core. It contains nerves, blood vessels, connective tissue and reparative cells. The purpose of pulp therapy in pediatric dentistry is to maintain the vitality of a tooth affected by decay or injury in attempts to save it from being lost. Pulp therapy is often referred to as a “nerve treatment” or “children’s root canal” and the two most common forms of this pediatric treatment 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 all of the pulp is affected, extending into the root canal(s) of the tooth. The diseased pulp tissue is completely removed from both the crown and root and the canals are cleansed and disinfected. If the area affected is a primary tooth, it will then be filled with a resorbable material. If the tooth is permanent, a non-resorbable material will be used. Lastly, a final restoration is placed.
What Is The Best Time For Orthodontic Treatment?
Stage I – Early Treatment: This period refers to the treatment of children aged 2 to 6 years. At this young age, we are concerned with underdeveloped dental arches, the premature loss of primary teeth, and harmful habits such as finger or thumb sucking. Treatment initiated in this stage of development is often very successful and many times, though not always, can eliminate the need for future orthodontic/orthopedic treatment.
Stage II – Mixed Dentition: This period refers to the treatment of children aged 6 to 12 years, with the eruption of the permanent incisor (front) teeth and 6 year molars. Treatment concerns deal with jaw malrelationships and dental realignment problems. Because the hard and soft tissues are usually very responsive to orthodontic and orthopedic forces during this time, when treatments are needed, they are very effective.
Stage III – Adolescent Dentition: This stage deals with the permanent teeth and the development of the final bite relationship.
It is our hope that you never need to put the following information into practice, but should a dental emergency occur, it is important to know what to do. The list below covers the most common dental emergencies occurring in children.
- Toothache: Clean the affected tooth and surrounding area. Rinse the mouth thoroughly with warm water and, if needed, use dental floss to dislodge any food that may be impacted. If the pain continues, contact your child’s dentist. Do not use aspirin or heat on the gum or tooth. If the face is swollen, apply cold compresses and call 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 gauze or a cloth. If this does not control the bleeding, call a doctor or visit the hospital emergency room.
- Knocked out permanent tooth: Handle the tooth as little as possible and avoid contact with the root. While holding the tooth by the crown, rinse only with water. DO NOT scrub or use soap. Inspect the tooth for fractures. If it is sound, try to reinsert it in the socket and hold it in place by biting down on gauze or a clean cloth. If this is not possible, transport the tooth in a cup containing the patient’s saliva or milk, NOT water. If old enough, the patient can keep it in their 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. Unlike with a permanent tooth, the baby tooth should not be reinserted due to possible damage to the developing permanent tooth. In most cases, no treatment is necessary.
- Chipped/fractured permanent tooth: Time is a critical factor. Contact your pediatric dentist immediately to reduce the chance of infection or the need for extensive dental treatment. Rinse the mouth with water and apply a cold compress to reduce swelling. If you can find the broken piece of tooth, bring it with you to the dentist.
- Chipped/fractured baby tooth: Contact your pediatric dentist.
- Possible broken or fractured jaw: Keep the jaw from moving and take your child to the nearest hospital emergency room.
If a dental emergency occurs in conjunction with a severe blow to the head, call 911 immediately or take your child to the nearest hospital emergency room.
Read more about how to prevent dental emergencies during recreational activities and sports with mouth guards.
Early Infant Oral Care
Perinatal & Infant Oral Health
The American Academy of Pediatric Dentistry (AAPD) recommends that all pregnant women receive oral healthcare and counseling. Talk to your doctor or dentist about ways you can prevent periodontal disease during pregnancy, as research has shown evidence that this condition can increase the risk of preterm birth and low birth weight. Additionally, mothers with poor oral health may be at greater risk of passing the bacteria which causes cavities to their young children. These simple steps should be followed to decrease this risk:
- Visit your dentist regularly.
- Brush and floss on a daily basis to reduce bacterial plaque.
- Maintain proper diet, limiting beverages and foods high in sugar and starch.
- Use a fluoridated toothpaste recommended by the ADA and rinse every night with an alcohol-free, over-the-counter mouth rinse containing .05 % sodium fluoride.
- Don’t share utensils, cups or food, since this can result in the transmission of cavity-causing bacteria to your children.
- Use xylitol chewing gum (4 pieces per day by the mother), as it can decrease a child’s decay rate.
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. Those who have this relationship are more likely to receive appropriate preventive and routine oral health care.
Making the first visit to the dentist an enjoyable experience can go a long way in establishing a positive association for years to come. Try to put your child’s mind at ease by explaining what the appointment will be like, while refraining from the use of words that might cause unnecessary fear. Another great reason to choose a pediatric dentist is that they are highly skilled at explaining concepts to children in pleasant, non-threatening terms and help young patients feel comfortable right away.
When Will My Baby Start Getting Teeth?
Teething, the process of primary (baby) teeth coming through the gums, varies among babies. In general, the first baby teeth to appear are the lower front (anterior) teeth and usually begin erupting between 6 and 8 months of age.
See Eruption of Your Child’s Teeth for more details.
Baby Bottle Tooth Decay
After each feeding, wipe the baby’s gums and teeth with a damp washcloth or gauze pad to remove plaque.
Sucking is a natural reflex for infants and young children and it is common for them to use thumbs, fingers, pacifiers or other objects. This provides a sense of security and relaxation and, for many, induces sleep. Proper tooth alignment and growth of the mouth can be influenced by this practice. How intensely children suck their thumbs, coupled with how old they are when they stop, can determine whether dental problems may result. While most children stop sucking their thumbs between the ages of two and four, it is important that the habit is broken by the time their permanent teeth are ready to erupt.
Pacifiers can affect teeth in essentially the same way as sucking fingers and thumbs. However, use of a pacifier can be controlled and modified more easily. If you have concerns about thumb sucking or use of a pacifier, consult your pediatric dentist.
Here are a few suggestions to help your child stop thumb sucking:
- If insecurity is the catalyst for sucking, focus on correcting the cause of anxiety instead of the thumb sucking behavior itself.
- Those who suck for comfort will feel less of a need when comfort is provided by their parents.
- Reward children when they refrain from sucking during difficult periods, such as when being separated from parents.
- Your pediatric dentist can encourage children to stop sucking and explain the possible outcomes of continuing the behavior.
- Bandaging the thumb or putting a sock on the hand at night can help to remind the child of the habit.
- If these strategies do not help, your pediatric dentist may recommend the use of a mouth appliance.
The key to maintaining oral health for a lifetime is prevention! Establishing a lifestyle of health and a strong oral hygiene routine can save your child from major dental problems down the road and save you from unnecessary expenses.
- Starting at birth, clean your child’s gums with a soft cloth and water.
- As soon as your child’s teeth erupt, brush them with a soft-bristled toothbrush.
- Be sure to use an ADA-recommended fluoride toothpaste and carefully follow the instructions listed on the product.
- Flossing should be instituted as soon as any two teeth touch, as it removes plaque that a toothbrush can’t reach.
- Parents should brush and floss children’s teeth until they are old enough to achieve a thorough cleaning on their own.
Good Diet = Healthy Teeth
Healthy eating habits lead to healthy teeth. Like the rest of the body, the teeth, bones and soft tissues of the mouth need a well-balanced diet. Children should eat a variety of foods from the five major food groups. Many popular snacks can lead to cavity formation. In addition, the more frequently a child snacks can play a role in tooth decay. Foods that stay in the mouth for long periods of time, such as hard candy and mints, cause longer acid attacks on tooth enamel and can increase the risk of cavities. If your child must snack, choose nutritious foods such as vegetables, low-fat yogurt, and low-fat cheese, which are healthier and better for the teeth. It is important to avoid any vitamins, fruits, fruit snacks, and candy that are sold in a “gummy, sticky, or dried form”. These types of foods allow the sugar to remain on your child’s teeth for hours and even days, significantly increasing their risk of cavities.
Brushing and flossing remove bacteria and leftover food particles that combine to create cavities. For infants, use wet gauze or a clean washcloth to wipe plaque from teeth and gums. Avoid putting your child to bed with a bottle of anything other than water. See Baby Bottle Tooth Decay for more information. For older children, brush their teeth at least twice a day. Also, limit the number of sugar-containing snacks you provide.
The American Academy of Pediatric Dentistry recommends visiting the pediatric dentist for thorough exams and cleanings every six months, beginning at your child’s first birthday. Your pediatric dentist may recommend protective sealants to prevent decay to molars or home fluoride treatments. Routine visits will prepare your child for a lifetime of good dental health.
Seal Out Decay
A sealant is a protective coating that is applied to the chewing surfaces (grooves) of the premolars and molars. Four out of five cavities in children are found in these hard to clean areas. Sealants act as barriers to food, plaque and acid, thus protecting the decay-prone areas of the teeth.
Fluoride is a naturally occurring element, which has been shown to prevent tooth decay by as much as 50-70%. It is important to follow your pediatric dentist’s instructions concerning fluoride use, as too much or too little can be detrimental to the teeth. With little or no fluoride, the teeth can be weak in resisting cavities. However, excessive fluoride ingestion by young children can lead to dental fluorosis, which is evidenced by a chalky white discoloration (brown in advanced cases) of the permanent teeth.
You can help maintain this balance by using the correct dosage of fluoride toothpaste at home: a small smear of toothpaste (the size of a grain of rice) for children younger than 3 years of age and a pea-sized amount for children 3 to 6 years of age. Remember that young children do not have the ability to brush their teeth effectively on their own and require assistance. Children should spit out and not swallow excess toothpaste in order to avoid fluorosis.
During recreational activities and organized sports, injuries can occur to the lips, tongue, face or jaw, and can even include broken teeth. A mouth guard or mouth protector is an important piece of athletic gear that can protect your child’s smile when worn during any activity that could result in a blow to the face. When properly fitted, a mouth guard will stay in place, making it easy for your child to talk or breathe, while also keeping them safe. Ask your pediatric dentist about custom and store-bought mouth protectors.
Xylitol & Cavity Reduction
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. A study showed that the use of xylitol gum by mothers (2-3 times per day) starting 3 months after delivery and until their child was 2 years old, has proven to reduce cavities up to 70% by the time the child turned 5.
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. The effects of xylitol are long-lasting and possibly permanent. Low decay rates persist even years after 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. However, one cup of raspberries contains less than one gram of xylitol and studies suggest intake that consistently produces positive results ranged from 4-20 grams per day over 3-7 consumption periods.
Gum and/or other products containing xylitol can be found online or at many local health food stores.
Sports Drinks & Decay
The high sugar content and acids found in sports drinks have the potential to erode and dissolve even fluoride-rich enamel, which can lead to cavities.
To minimize dental problems, children should avoid sports drinks and hydrate with water before, during and after physical exertion. Be sure to talk to your pediatric dentist before your child uses sports drinks.
If sports drinks are consumed:
- reduce the frequency and contact time
- swallow immediately and do not swish them around the mouth
- neutralize the effect of sports drinks by alternating sips of water
- rinse mouthguards only in water
- seek out dental friendly sports drinks
Facial 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. The human mouth contains millions of bacteria, so infection is a common complication. Infections can cause the tongue to swell large enough to close off a person’s airways. Other symptoms include pain, increased flow of saliva, injuries to gum tissue, chipped or cracked teeth, receding gums and scar tissue. If a blood vessel or nerve bundle is in the path of the needle, difficult-to-control bleeding or nerve damage can result. In some cases, more severe problems can arise from what seems like a simple piercing, such as blood clots, blood poisoning, heart infections, brain abscess, and nerve disorders (trigeminal neuralgia).
Encourage your teens to follow the advice of the American Dental Association and skip the mouth jewelry.
Tobacco - Bad News In Any Form
Tobacco in any form can jeopardize your child’s health and cause irreversible damage. Teach your child about the dangers of tobacco use.
Smokeless tobacco, also called spit, chew or snuff, is often used by teens who believe it to be a safe alternative to smoking cigarettes. This is an unfortunate misconception. Studies show that spit tobacco may be more addictive than smoking cigarettes and more difficult to quit. 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 precancerous lesions called leukoplakias.
If your teen is a tobacco user, you should watch for the following early signs of oral cancer:
- A sore that won’t heal.
- White or red leathery patches on the lips or on/under the tongue.
- Pain, tenderness or numbness anywhere in the mouth or lips.
- Difficulty chewing, swallowing, speaking or moving the jaw or tongue.
- A change in the way the teeth fit together.
Because the early signs of oral cancer are not always painful, people often ignore them. If not caught in the early stages, oral cancer can require extensive, sometimes disfiguring, surgery. Even worse, it can kill.
Help children understand the dangers of bringing cancer-causing substances in direct contact with their mouths and encourage them to avoid tobacco use in any form.