GENERAL TOPICS:

What is a Pediatric Dentist?
Why are the Primary Teeth so Important?
Eruption Schedule
Dental Emergency Questions
What is the Reason for Dental Radiographs?
What's the Best Toothpaste for my Child?
Does your Child Grind his Teeth at Night? (Bruxism)
What About Thumb, Finger and Pacifier Habits?
What is Pulp Therapy?
What is the Best Time for Orthodontic Treatment?
Mouth Guards

EARLY INFANT ORAL CARE:

When Should My Child First See A Dentist?
When will my Baby Start Getting Teeth?
What is Baby Bottle Decay (Early Childhood Caries)?

PREVENTION:

How Do I Take Care of My Child's Teeth?
How Does a Child's Diet Affect Their Dental Health?
How Do I Prevent Cavities?
What are Sealants?
What is Enamel Fluorosis? How is it Prevented?

ADOLESCENT ISSUES:

Tongue Piercing - Is it Really Cool?
What Effects Can Tobacco have on my Mouth?

POST-OP INSTRUCTIONS:

Care of the Mouth after Local Anesthetic
Care of the Mouth after Trauma
Care of the Mouth after Extractions
Care of Sealants
Oral Discomfort after a Cleaning

For information on special oral health care needs, we've provided links to the following sites:

Pediatric dentistry is the specialty of dentistry that focuses on the oral health and unique needs of young people. After completing a four-year dental school curriculum, two to three additional years of rigorous training is required to become a pediatric dentist. This specialized program of study and hands-on experience prepares pediatric dentists to meet the unique needs of your infants, children and adolescents, including persons with special health care needs.

Why Are The Primary Teeth So Important?

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.

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Dental Emergency Questions

When your child needs urgent dental treatment, your pediatric dentist stands ready to help. Please keep our emergency number available and convenient.

Q: What if my child has a toothache?
A: Clean the area of the affected tooth thoroughly. Rinse the mouth vigorously with water or use dental floss to dislodge impacted food or debris. To comfort your child, apply a cold compress or ice wrapped in a
cloth. Do not put heat or aspirin on the sore area. Contact our office to schedule an appointment.

Q: What should I do if my child's baby tooth is knocked out?
A: Contact our office as soon as possible.

Q: What should I do if my child's permanent tooth is knocked out?
A: Find the tooth and rinse it gently in cool water. (Do not scrub it or clean it with soap - use only water!) If possible, replace the tooth in the socket and hold it there with clean guaze or a wash cloth. If you cannot put the tooth back in the socket, place the tooth in a clean container with milk, saliva or water. Contact our office immediately (telephone the emergency number if it is after hours.) The faster that you act, the better the chances of saving the tooth.

Q: What if a tooth is chipped or fractured?
A: Contact our office 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 you can find the broken tooth fragment, bring it with you to our office.

Q: Can dental injuries be prevented?
A: Absolutely! First reduce oral injury in sports by wearing a mouth guard. Second, always use a car seat for young children. Require seatbelts for everyone else in the car. Third, child-proof your home to prevent
falls, electrical injuries, and choking on small objects. Fourth, protect your child from unnecessary toothaches with regular dental visits and preventative care.

Parents are welcome to contact our office during or after hours for telephonic consultation.

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What is the Reason for Dental Radiographs?

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.
Fluoridated toothpaste should be introduced when a child is 2-3 years of
age.  However, many toothpastes and polishes can damage young smiles. They
contain harsh abrasives which can wear away young tooth enamel.  When
looking for a toothpaste for your child, be certain to choose one that is
recommended by the American Dental Association.  These toothpastes have
undergone testing to insure they are safe to use.  Prior to 2-3 years of age, parents should clean their child's teeth with water and a soft-bristled
toothbrush.  When toothpaste is used after 2-3 years of age, parents should
supervise brushing and make certain that the child uses no more than a pea-sized amount on the brush.  Children should spit out and not swallow excess toothpaste after brushing.
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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 gets less 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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What About Thumb, Finger and Pacifier Habits?

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

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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What is the Best Time for Orthodontic Treatment?

Although only a few orthodontic problems need to be corrected in the primary or early mixed dentition, an early exam will allow the pediatric dentist to offer advice and guidance as to when the appropriate age to begin orthodontic treatment will be. Allow your pediatric dentist to guide you as to when to refer your child to the orthodontist.

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.
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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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When should My Child First See a Dentist?

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 are usually the lower front (anterior) teeth and usually begin erupting between the age of 6-8 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. 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.

Encourage your child to drink from a cup as they approach their first birthday. Children should not fall asleep with a bottle. At-will nighttime breast-feeding should be avoided after the primary (baby) teeth begin to erupt. Drinking juice from a bottle should be avoided. When juice is offered, it should be in a cup. Children should be weaned from the bottle by 12-14 months of age.

Good oral hygiene removes bacteria and the left over food particles that combine to create cavities. Starting at birth, use a wet gauze or clean washcloth to wipe the plaque from the teeth and gums. Avoid putting your child to bed with a bottle filled with anything other than water. See "Baby Bottle Decay" for more information.

Begin daily brushing as soon as the child's first tooth erupts. Remember that most children do not have the dexterity to brush their teeth effectively and therefore you must do it for them. Unless it is advised by your child's pediatric dentist, do not use fluoridated toothpaste until age 2-3. A pea size amount of fluoride toothpaste can be used after the child is old enough not to swallow it. By age 6 or 7, children should be able to brush their own teeth twice a day with supervision until age nine to make sure they are doing a thorough job. However, each child is different, Your pediatric 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.

Children must have a balanced diet for their teeth to develop properly. They also need a balanced diet for healthy gum tissue around the teeth. Equally important, a diet high in certain kinds of carbohydrates, such as sugar and starches, may place your child at a extra risk of tooth decay.

Check how often your child eat foods with sugar or starch in them. Foods with starch include breads, crackers, pasta and snacks such as pretzels and potato chips. When looking for sugar in your child's diet, look beyond the sugar bowl and candy dish. A variety of foods contain one or more types of sugar, and all types of sugars can promote dental decay. Fruits, a few vegetables and most milk products have at least one type of sugar. Sugar can be found in many processed foods, even some that do not taste sweet. For example, a peanut butter and jelly sandwich not only has sugar in the jelly, but may have sugar added to the peanut butter. Sugar is also added to such condiments as catsup and salad dressings.

We do not expect a child to give up all foods with sugar or starch. Many of these foods provide nutrients that your child needs. You simply need to select and serve them wisely. A food with sugar or starch is safer for teeth if it's eaten with a meal, not as a snack. Sticky foods, such as dried fruit or toffee, are not easily washed away from the teeth by saliva, water or milk. So, they have more cavity-causing potential than foods more rapidly cleared from the teeth. We would be happy to prove further information about selecting and serving foods that protect your child's dental health.

If your child is not yet on solid foods, avoid nursing your child to sleep or putting them to bed with a bottle of milk, formula, juise, or sweetened liquid. While your child sleeps, any unswallowed liquid in the mouth supports bacteria that produce acids and attack the teeth. Protect your child from severe tooth decay by putting them to bed with nothing more than a pacifier or bottle of water.

In summary, here are tips for your child's diet and dental health:

• Ask your pediatric dentist to help you access your child's diet and dental health.
• Shop smart! Do not routinely stock your pantry with sugary or starchy snacks. Buy "fun foods" for special occasions only.
• Limit the number of snack times and choose nutritious snacks.
• Provide a balanced diet, and save food with sugar or starch for mealtimes.
• Don't put your young child to bed with a bottle of milk, formula or juice.
• If your child chews gum or sips soda, choose those items that are sugar-free.

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Sealants protect the grooved and pitted surfaces of the teeth, especially the chewing surfaces of back teeth where most cavities in children are found. Made of clear or shaded plastic, sealants are applied to the teeth to help keep them cavity-free.

Even if your child brushes and flosses carefully, it is difficult, and sometimes impossible, to clean the tiny grooves and pits on certain teeth. The natural flow of saliva usually keeps the smooth surfaces of teeth clean but does not wash out the grooves and fissures. So, the teeth most at-risk of decay are the six-year and twelve-year molars. Many times, the permanent premolars and primary molars will also benefit from sealant coverage. Food and bacteria build up in the crevices of these teeth, placing your child in danger of tooth decay. Sealants "seal out" food and plaque, thus reducing the risk of decay.

The application of a sealant is quick and comfortable. The tooth is first cleaned. It is then conditioned and dried. The sealant is then flowed onto the grooves of the tooth and then hardened with a special light. Your child will be able to eat and drink immediately following the appointment.

Research shows that sealants can last for many years if properly cared for. Sealants will assist in protecting your child's teeth throughout the most cavity-prone years. If your child has good oral hygiene and avoids biting hard objects, sealants will last longer. Our office will check your child's sealants during routine dental visits and will recommend reapplication or repair when necessary.

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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).

There are many risks involved with oral piercings including chipped or cracked teeth, blood clots, or blood poisoning. 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.

Tobacco in any form can jeopardize your child’s health and cause incurable damage. Teach your child about the dangers of tobacco.

Smoking can have the following effects on your child's oral health:

• Oral Cancer
• Periodontal (gum) disease-a leading cause of tooth loss and sensitivity
• Delayed healing after a tooth extraction or other oral surgery
• Fewer options for some kinds of dental care (smokers are often poor candidates for implants)
• Bad breath
• Stained teeth and gums
• Diminished senses of taste and smell

Like cigarettes, smokeless tobacco products contain a variety of toxins associates with cancer. At least 28 cancer-causing chemicals have been identified in smokeless tobacco products. Smokeless tobacco is known to cause cancers of the mouth, lip, tongue, and pancreas. Users also may be at risk for cancer of the voice box, esophagus, colon and bladder, because they swallow some of the toxins in the juice created by using smokeless tobacco. Smokeless tobacco can irritate your gum tissue, causing periodontal disease. Sugar is often added to smokeless tobacco to enhance the flavor, increasing the risk for tooth decay. Smokeless tobacco also typically contains sand and grit, which often wears down the user's teeth.

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.