The Pediatric Dentist
Why Primary Teeth are Important
Eruption of your Child's Teeth
Dental Radiographs (X-rays)
The Best Toothpaste for my Child
Grinding Teeth at Night (Bruxism)
Thumb Sucking
Pulp Therapy
The Best Time for Orthodontic Treatment

EARLY INFANT ORAL CARE:

Perinatal & Infant Oral Health
Your Child's First Dental Visit
When Your Baby will Start Getting Teeth
Baby Bottle Tooth Decay (Early Childhood Caries)

PREVENTION:

Care of your Child's Teeth & Gums
Good Diet = Healthy Teeth
How to Prevent Cavities
Seal Out Decay
Fluoride
Mouth Guards
Xylitol - Reducing Cavities

ADOLESCENT DENTISTRY:

Tongue Piercing - Not Really Cool
Tobacco - Bad News in Any Form

The pediatric dentist has an extra two to three years of specialized training after dental school and is dedicated to the oral health of infants, children, teens, young adults and special needs patients. 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.
 

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 teeth (incisors) last until 6 to 7 years of age, the back teeth (cuspids and molars) aren’t replaced until age 10 to 13.
 

Children’s teeth begin forming before birth. Around 6 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).

Please click on the timeline below to see the teeth erupt and to learn more.

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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 three 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.
 

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-sized" amount of toothpaste.
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The majority of cases of pediatric bruxism do not require any treatment since most children outgrow bruxism. The grinding decreases between the ages 6 and 9 and children tend to stop grinding between ages 9-12. If you suspect bruxism, discuss this with your pediatrician or pediatric dentist.
 

• 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. 

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" or "children's root canal". 

Pulp therapy removes the diseased pulp tissue.  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). 
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Developing malocclusions, or bad bites, can be recognized as early as 2 to 3 years of age. Often, early steps can be taken to reduce the need for major orthodontic treatment at a later age.

Stage I – Early Treatment: This period of treatment encompasses ages 2 to 6 years. At this young age, we are concerned with underdeveloped dental arches, the premature loss of primary teeth, and harmful habits such as finger or thumb sucking. Treatment initiated in this stage of development is often very successful and many times, though not always, can eliminate the need for future orthodontic/orthopedic treatment.

Stage II – Mixed Dentition: This period covers the ages of 6 to 12 years, with the eruption of the permanent incisor (front) teeth and 6-year molars. Treatment concerns deal with jaw malrelationships and dental realignment problems. This is an excellent stage to start treatment, when indicated, as your child’s hard and soft tissues are usually very responsive to orthodontic or orthopedic forces.

Stage III – Adolescent Dentition: This stage deals with the permanent teeth and the development of the final bite relationship.
 

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.

When the child is seen at one year, the first visit can be pleasant and uneventful, introducing the child and parents to the dental office. Emphasis is on the developmental assessment of the child’s oral health. Caries (tooth decay) or developmental disturbances can be managed early. Fluoride varnish may be applied to counteract beginning decay on newly erupted teeth.

Five Steps for Baby's First Dental Visit

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.

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 and 8 months. See "Eruption of Your Child’s Teeth" for more details.
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One serious form of decay among young children is baby bottle tooth decay, also referred to by dentists as early childhood caries. 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. 

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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Good oral hygiene removes bacteria and the leftover 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.

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

Fluoride 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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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 one 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 our pediatric dentists about custom and store-bought mouth protectors.
 

One of the biggest risks for a baby or child to have early tooth decay is the presence of a dental cavity in the mother’s mouth. That is because tooth decay is a bacterial infection that can be transmitted from mother to child. Everyone in the family should keep their teeth clean (brush and floss). Chewing gum that contains xylitol has been shown to reduce bacteria that cause cavities.  A mother who takes care of her teeth and gums during pregnancy decreases the chance of a premature or underweight baby and the bad bacteria in her mouth are also reduced. Once her baby is born, there will be fewer bacteria to transmit from mother’s mouth to baby’s mouth. A mother’s oral health is very important to her baby.

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 is 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 to 20 grams per day, divided into three to seven consumption periods. Higher results did not result in greater reduction and may lead to diminishing results.  Similarly, consumption frequency of less than three 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. 
 

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.

Follow the advice of the American Dental Association and give your mouth a break – skip the mouth jewelry.
 

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, he or she will avoid bringing cancer-causing chemicals in direct contact with his or her tongue, gums and cheek.
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