Why Should I take my Child to a Pediatric Dentist?
Nitrous Oxide Sedation
Heart Murmurs, should I Inform my Dentist?
White Fillings or Silver Fillings?
Are Teeth Effected during Pregnancy?
Under Bites
Juvenile Diabetes
Why Are The Primary Teeth So Important
Teething, What to Expect
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?
What is the Best Time for Orthodontic Treatment?
 

EARLY INFANT ORAL CARE:

National Institute of Dental & Craniofacial Research
Resource & Information on Cleft Lip & Palate
National Foundation for Ectodermal Dysplasias
American Academy Pediatric Dentistry
American Dental Association
American Orthodontic Society
Massachusetts Dental Society
American Academy of Pediatrics
  

GENERAL TOPICS & FAQ

Why Should I take my Child to a Pediatric Dentist?

The pediatric dentist has an extra two to three years of specialized training after dental school and is a specialist in the care of the oral health, growth and development, and behavior of children from infancy throughout teenager years.  They are trained and best qualified to treat special patients who may have emotional, physical, or mental handicaps and therefore helping them avoid future dental problems. The environment at the pediatric dental office is dedicated to ease the anxiety and fear of the child of the dental care.

When should my child first see a dentist?

The first dental visit should be six months after the first tooth erupts or at age one, unless there is a problem in the teeth or the mouth. Early examination and early preventive care will protect your child’s health for now and the future. At this age the pediatric dentist can asses the dental health of your child, and discuss the best way to maintain your child’s teeth. Early prevention saves your child’s teeth, and reduces potential cost of treating early childhood caries and other dental problems.

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Nitrous-Oxide Sedation

My child is afraid of going to the dentist. My family dentist referred my child to a pediatric dentist to have the dental work done with nitrous-oxide sedation. What is nitrous-oxide sedation?

Many children feel more calm and comfortable at the pediatric dental office. The environment, the dentist and the staff are geared to handle children with care and gentle approach. However, sometimes a child may need more than that to coop with the anxiety that caused by dental procedures. In that case, Nitrous-Oxide (laughing gas) – Oxygen sedation may be considered. When inhaled, Nitrous Oxide-Oxygen (N2O-O2) gases are absorbed by the body and calm the child. N2O-O2 helps the child to be less sensitive to the sights, sounds or sensation of the dental procedure. It is easily removed from the body by normal breathing. It is not general anesthesia. Your child remains awake but sedated. N2O-O2 is not for every one. It may not be effective if the child has nasal congestion, or sever anxiety, or discomfort wearing, or breathing a nose mask. Your pediatric dentist should be able to evaluate the need of your child.
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Heart Murmurs, should I inform my Dentist?

Yes you should.  The dentist should be made aware of the general health condition of your child before treating him. There are some heart conditions require prophylactic antibiotic coverage before the dental treatment to protect the heart from possible infection. Not all heart murmurs require antibiotics coverage before the dental appointment, though.  You should ask your physician specifically whether your child needs any precautions before the dental appointment or not.
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White Fillings or Silver Fillings?

White fillings are made of plastic resins that are similar to the tooth color and structure. The silver traditional fillings are made of an alloy of metals including Silver, Mercury, and other metals. They are known to be durable. White fillings are compatible with dental sealants. A tooth can be filled and sealed at the same time to prevent further decay.  They work best in small cavities and low stress bearing tooth surfaces.  They are more technique sensitive than the silver fillings.  The white fillings are usually more expensive than the silver fillings.  Discuss the choice of fillings with your pediatric dentist.  You may find more information at www.aapd.org and www.ada.org
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Are Teeth Affected during Pregnancy?

Yes they are..  A good health and proper diet of the pregnant woman is critical for the health and proper development of the baby.  Primary teeth begin to develop during the second month of pregnancy. A diet that is well balanced and contain vitamins A, C, and D, protein, calcium and phosphorous is helpful to develop healthy teeth.  A mother’s caries-causing bacteria can be transmitted to her child. It is important that the pregnant woman maintain her teeth and gum in good health before the birth of the child.  For more information visit www.ada.org
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Under Bites
 
Normally, the upper teeth overlap slightly over the lower teeth. That is called an over-bite. A bit or a slight over-bite is not harmful or abnormal. If the lower teeth overlap over the upper teeth, that is called a cross-bite or under-bite. The under-bite may be caused by maligned teeth (crowded or crocked teeth). Some under-bites are caused by maligned or mismatched jaws. If the under-bite is causing your child to shift the jaw when bite or chews, it should be addressed as soon as possible to prevent any possible damage to the jaw joint. It is best to have your child checked by a pediatric dentist or an orthodontist.

Juvenile Diabetes

It is unfortunate that your child has juvenile diabetes. Do not despair. With good team work together we can make your child's life easier. First, maintain your child's blood sugar by having it checked regularly per your physician recommendations. Second, consult regularly with your pediatric dentist, or a nutritionist as for the type of diet that help maintain the blood sugar level at normal level. Because of the frequent snacking and in presence of your child's condition, your child's gums may be at a higher risk of inflammation. Choose her snacks wisely. As for your child's teeth, as long as he/she maintains regular brushing and flossing after each major meal your child should be fine. Your pediatric dentist may recommend seeing your child more frequently to monitor your child's oral health.
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Teeth Whitening

In some cases the need for teeth bleaching is purely subjective. But in some cases it is with a merit and more objective. If your child's teeth are stained due to medications, or excessive Fluoride, or other conditions, then you should discuss your options with your pediatric dentist. In some cases, the child may need a procedure called microabrasion to address the stained or damaged enamel. In other cases, a veneer or bonding is needed. Bleaching is the process of whiting the teeth with certain chemicals. Some of these materials come in low concentration safe enough to be used at home. Some should be used only under professional supervision. All of whiting materials may cause sensitivity to the teeth, and may irritate the gum, and may damage some fillings. The safety of teeth-bleaching in children is not well established yet. I do not recommend teeth-bleaching at mixed dentition stage (presence of baby and permanent teeth). It is wise to consult with your pediatric dentist before you allow your child to bleach the teeth.

Why Are The Primary Teeth So Important?

Primary (baby) teeth serve a number of important functions:

• They help your child maintain good nutrition by chewing food properly.

• They allow proper speech and pronunciation.

• They help children feel good about their looks to others.

• “Baby” teeth help guide the “adult” teeth to proper place. When the “baby” tooth is lost too early, the  child should have a space maintainer to keep the space open for the “adult” tooth to come in.

• “Baby” molars usually last until age 10 years or later.

Useful tips:

• Birth to 6 months: Clean mouth with gauze after feedings and bedtime.

• 6 to 12 months: First tooth appear; time to see the pediatric dentist for an exam and prevention tips in baby diet and oral hygiene to prevent painful dental problems for the child, and save the parent costly dental repairs.
 
• Brush teeth after each feeding and bedtime.

• Limit the use of “sippy cup” as it has similar effect as the baby bottle on front teeth.

• Maintain regular dental visits to your pediatric dentist as recommended.

• If your child likes to have snacks throughout the day, increase the frequency of the brushing and flossing of the teeth to prevent the harmful plaque from staying on the teeth for too long and damaging the teeth.

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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Teething, What to Expect

Usually, the lower front teeth start to erupt first at age six months. Then, the top front teeth follow and so on toward the back throughout the first three years of age. The baby my experience pain during this time. Some mild analgesics may help. Slight elevation of temperature may be expected. If your baby’s temperature approaches 100 degrees, you should contact your physician to rule out any medical problems. The baby may become irritable, and may not sleep regularly as usual. Your baby may not take the bottle or breast feeds as usual. These are signs of irritated gum. You may rub or massage the gum with cool cloth, or other over the counter teething balms or teething gels. This will ease the baby’s discomfort. You may notice some rash like irritation in the diaper area. Apply a little bit of lotion on the area. The stool may become slightly softer than usual. If your baby has diarrhea, contact your physician. Remember to start wiping the teeth and clean them after each meal. Have your baby seen by your pediatric dentist by your baby’s first birthday.

Eruption Of Your Child’s Teeth

Look! My Tooth is Loose! (with 16"x22" poster and stickers) By Patricia Brennan Demuth Illustrated by Mike Cressy

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Dental Emergencies

My child fell on his face about a month ago. One of the top front teeth has turned black. What should I do?

Trauma to teeth may result in the tooth nerve death or degeneration. Changing of the tooth color suggests that changes have occurred due to the trauma. If the damaged primary tooth is not addressed properly, it may lead to further damage to the permanent tooth. Whenever the primary tooth receives trauma, there is a possibility of trauma transferred to the permanent tooth. There are other signs to watch for when a tooth receives trauma. Tooth mobility, pain or discomfort, changing in eating or chewing habits, swelling, or pus discharge from the gum are all signs of pathological changes. It is wise to have your pediatric dentist exam your child when there is trauma to the face or mouth to address the case properly.
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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)

Try to help your child to stop grinding or clinching their teeth if they do it while awake. Sometimes children grind their teeth during sleep for a short while during childhood, and they stop on there own.  If the child continues to grind their teeth during sleep, they need to have a night-guard to protect the teeth from attrition.  Teeth grinding may be related to bite problems, emotional stress, or change in the child’s environment.  It is wise to consult with your pediatric dentist, and your physician to rule out any bite related problems, or medical problems.
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Thumb Sucking

My child sucks his thumb. Should I worry?

Thumb or finger sucking is common among infants. It usually stop by age two. If your child does not stop, try to discourage the habit after age four. Peer pressure causes many school-aged children to stop.  Prolonged thumb or finger sucking, or prolonged use of a pacifier can create crowded teeth and distorted bite. You should consult with a pediatric dentist to best deal with the problem. 

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.

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.

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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David Decides About Thumbsucking - A Story for Children, a Guide for Parents by Susan Heitler PHD Paula Singer (Photographer)

What is Pulp Therapy?

EARLY INFANT ORAL CARE

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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Baby Bottle Tooth Decay (Early Childhood Caries)

What is Baby Bottle Decay, and how can I prevent it in my child?

One of the risk factors of early childhood caries (Baby Bottle Decay) is prolonged exposure of baby’s teeth to liquids containing sugar, including milk, formula and fruit juice. You can prevent Baby Bottle Decay by never put your baby to bed with a bottle, or use the bottle or the “sippy” cup with milk, or juice as a pacifier for a fussy baby. Always wipe your infant’s gum and teeth with a washcloth after feeding. For your older baby, brush the teeth after each main meal. For further evaluation of your baby’s diet and dental care consult your pediatric dentist.

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PREVENTION

Care of Your Child’s Teeth

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

How should I choose better snacks for my child?

Healthy eating habits lead to healthy teeth. Your child needs a balanced diet that includes all major food groups. To reduce the risk of tooth decay, avoid frequent consumption of foods and drinks high in sugar and starches such as: pastry, crackers, pretzels, potato chips, candy, soda, juices, etc. Every time we eat food, or drink beverages that contain sugar or starch, the bacteria produce acids that attack tooth enamel. That will weaken the teeth over time and contribute to tooth-decay. A food with sugar or starch is safer for teeth if it is eaten with a meal, not as a snack. Sticky foods, such as pastry, dried fruit, or toffee, are not easily washed away from the teeth by saliva, water, or milk. Therefore, they have more cavity-causing potential than foods more rapidly cleared from the teeth. Limit the number of snack times; choose nutritious snacks such as: fresh fruits, vegetables, yogurt, cheese, nuts, etc. Final advice: ask your pediatric dentist to help you assess your child’s diet. 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.

My child frequently drinks soda. Should I encourage them to drink diet soda instead of regular?

Soft drinks including soda do not offer much of nutritional value.  Encourage your child to drink water, milk, or fruit juices in moderation instead of sodas.  Regular soda contain high amount of sugar.  Diet soda does not contain sugar but they contain phosphoric acid and citric acid (as the regular soda).  Heavy consumption of regular or diet soda exposes the teeth frequently to these acids.  That contributes to enamel erosion, and tooth decay. For further information ask your pediatric dentist, or visit www.ada.org or www.aapd.org
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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.

Seal Out Decay

Fluoride

My family lives in a town that it does not have Fluoride in the water. We drink well water. Should I give my children Fluoride supplements?

Fluoride reduces dental caries significantly at an optimal level. It helps making teeth more resistant to tooth decay. Because Fluoride occurs naturally in ground water, you should first test your well water for Fluoride level, and then consult with your pediatric dentist or pediatrician. Fluoride level of 1 ppm (parts per million) is considered optimal. The dose of the Fluoride supplement is related to the age of the child and the level of Fluoride in the water.

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.

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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 perchilds 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?

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

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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