The pediatric dentist has an extra two to three years
of specialized training after dental school, and is
dedicated to the oral health of children from infancy
through the teenage years. The very young, pre-teens,
and teenagers all need different approaches in dealing
with their behavior, guiding their dental growth and
development, and helping them avoid future dental
problems. The pediatric dentist is best qualified to
meet these needs.
Why Are The Primary Teeth Important?
It is very important to maintain the health of the
primary teeth. Neglected cavities can and frequently do
lead to problems which affect developing permanent
teeth. Primary teeth, or baby teeth are important for
(1) proper chewing and eating, (2) providing space for
the permanent teeth and guiding them into the correct
position, and (3) permitting normal development of the
jaw bones and muscles. Primary teeth also affect the
development of speech and add to an attractive
appearance. While the front 4 teeth last until 6-7 years
of age, the back teeth (cuspids and molars) aren’t
replaced until age 10-13.
Eruption Of Your Child's Teeth
Children’s teeth begin forming before birth. As early as 4 months, the first primary (or baby) teeth to erupt through the gums are the lower central incisors, followed closely by the upper central incisors. Although all 20 primary teeth usually appear by age 3, the pace and order of their eruption varies.
Permanent teeth begin appearing around age 6, starting with the first molars and lower central incisors. At the age of 8, you can generally expect the bottom 4 primary teeth (lower central and lateral incisors) and the top 4 primary teeth (upper central and lateral incisors) to be gone and permanent teeth to have taken their place. There is about a one to two year break from ages 8-10 and then the rest of the permanent teeth will start to come in. This process continues until approximately age 21.
Adults have 28 permanent teeth, or up to 32 including the third molars (or wisdom teeth).
Dental Emergencies
Toothache:
Clean the area of the affected tooth. Rinse the mouth thoroughly
with warm water or use dental floss to dislodge any food that
may be impacted. If the pain still exists, contact your child's
dentist. Do not place aspirin or heat on the gum or on the
aching tooth. If the face is swollen, apply cold compresses and
contact your dentist immediately.
Cut or Bitten Tongue, Lip or Cheek: Apply ice to injured
areas to help control swelling. If there is bleeding, apply firm
but gentle pressure with a gauze or cloth. If bleeding cannot be
controlled by simple pressure, call a doctor or visit the
hospital emergency room.
Knocked Out Permanent Tooth: If possible, find the tooth.
Handle it by the crown, not by the root. You may rinse the tooth
with water only. DO NOT clean with soap, scrub or handle the
tooth unnecessarily. Inspect the tooth for fractures. If it is
sound, try to reinsert it in the socket. Have the patient hold
the tooth in place by biting on a gauze or clean cloth. If you
cannot reinsert the tooth, transport the tooth in a cup
containing the patient’s saliva or milk, NOT water. 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.
Unlike with a permanent tooth, the baby tooth should not be
replanted due to possible damage to the developing permanent
tooth. 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.
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.
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.
Does Your Child Grind His Teeth At Night? (Bruxism)
Parents are often concerned about the nocturnal
grinding of teeth (bruxism). Often, the first indication
is the noise created by the child grinding on their
teeth during sleep. Or, the parent may notice wear
(teeth getting shorter) to the dentition. One theory as
to the cause involves a psychological component. Stress
due to a new environment, divorce, changes at school;
etc. can influence a child to grind their teeth. Another
theory relates to pressure in the inner ear at night. If
there are pressure changes (like in an airplane during
take-off and landing, when people are chewing gum, etc.
to equalize pressure) the child will grind by moving his
jaw to relieve this pressure.
The majority of cases of pediatric bruxism do not
require any treatment. If excessive wear of the teeth
(attrition) is present, then a mouth guard (night guard)
may be indicated. The negatives to a mouth guard are the
possibility of choking if the appliance becomes
dislodged during sleep and it may interfere with growth
of the jaws. The positive is obvious by preventing wear
to the primary dentition.
The good news is most children outgrow bruxism. The
grinding decreases between the ages 6-9 and children
tend to stop grinding between ages 9-12. If you suspect
bruxism, discuss this with your pediatrician or
pediatric dentist.
Thumb
Sucking
Sucking is a natural reflex and infants and young
children may use thumbs, fingers, pacifiers and other
objects on which to suck. It may make them feel secure
and happy, or provide a sense of security at difficult
periods. Since thumb sucking is relaxing, it may induce
sleep.
Thumb sucking that persists beyond the eruption of
the permanent teeth can cause problems with the proper
growth of the mouth and tooth alignment. How intensely a
child sucks on fingers or thumbs will determine whether
or not dental problems may result. Children who rest
their thumbs passively in their mouths are less likely
to have difficulty than those who vigorously suck their
thumbs.
Children should cease thumb sucking by the time their
permanent front teeth are ready to erupt. Usually,
children stop between the ages of two and four. Peer
pressure causes many school-aged children to stop.
Pacifiers are no substitute for thumb sucking. They
can affect the teeth essentially the same way as sucking
fingers and thumbs. However, use of the pacifier can be
controlled and modified more easily than the thumb or
finger habit. If you have concerns about thumb sucking
or use of a pacifier, consult your pediatric dentist.
A few suggestions to help your child get through
thumb sucking:
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.
What Is Pulp
Therapy?
The pulp of a tooth is the inner, central core of the
tooth. The pulp contains nerves, blood vessels,
connective tissue and reparative cells. The purpose of
pulp therapy in Pediatric Dentistry is to maintain the
vitality of the affected tooth (so the tooth is not
lost).
Dental caries (cavities) and traumatic injury are the
main reasons for a tooth to require pulp therapy. Pulp
therapy is often referred to as a "nerve treatment",
"children's root canal", "pulpectomy" or "pulpotomy".
The two common forms of pulp therapy in children's teeth
are the pulpotomy and pulpectomy.
A pulpotomy removes the diseased pulp tissue within
the crown portion of the tooth. Next, an agent is placed
to prevent bacterial growth and to calm the remaining
nerve tissue. This is followed by a final restoration
(usually a stainless steel crown).
A pulpectomy is required when the entire pulp is
involved (into the root canal(s) of the tooth). During
this treatment, the diseased pulp tissue is completely
removed from both the crown and root. The canals are
cleansed, disinfected and, in the case of primary teeth,
filled with a resorbable material. Then, a final
restoration is placed. A permanent tooth would be filled
with a non-resorbing material.
What Is The Best Time For Orthodontic Treatment?
Developing malocclusions, or bad bites, can be
recognized as early as 2-3 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.
Adult Teeth Coming
in Behind Baby Teeth
This is a very common occurrence with children,
usually the result of a lower, primary (baby) tooth not
falling out when the permanent tooth is coming in. In
most cases if the child starts wiggling the baby tooth,
it will usually fall out on its own within two months.
If it doesn't, then contact your pediatric dentist,
where they can easily remove the tooth. The permanent
tooth should then slide into the proper place.
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 during pregnancy. Research has
shown evidence that periodontal disease can increase the
risk of preterm birth and low birth weight. Talk to your
doctor or dentist about ways you can prevent periodontal
disease during pregnancy.
Additionally, mothers with poor oral health may be at
a greater risk of passing the bacteria which causes
cavities to their young children. Mother's should follow
these simple steps to decrease the risk of spreading
cavity-causing bacteria:
Visit your dentist regularly.
Brush and floss on a daily basis to reduce
bacterial plaque.
Proper diet, with the reduction of beverages and
foods high in sugar & starch.
Use a fluoridated toothpaste recommended by the
ADA and rinse every night with an alocohol-free,
over-the-counter mouth rinse with .05 % sodium
fluoride in order to reduce plaque levels.
Don't share utensils, cups or food which can
cause the transmission of cavity-causing bacteria to
your children.
Use of xylitol chewing gum (4 pieces per day by
the mother) can decrease a child’s caries rate.
Your Child's First Dental Visit-Establishing A "Dental
Home"
The American Academy of Pediatrics (AAP), the
American Dental Association (ADA), and the American
Academy of Pediatric Dentistry (AAPD) all recommend
establishing a "Dental Home" for your child by one year
of age. Children who have a dental home are more likely
to receive appropriate preventive and routine oral
health care.
The Dental Home is intended to provide a place other
than the Emergency Room for parents.
You can make the first visit to the dentist enjoyable
and positive. If old enough, your child should be
informed of the visit and told that the dentist and
their staff will explain all procedures and answer any
questions. The less to-do concerning the visit, the
better.
It is best if you refrain from using words around
your child that might cause unnecessary fear, such as
needle, pull, drill or hurt. Pediatric dental offices
make a practice of using words that convey the same
message, but are pleasant and non-frightening to the
child.
When Will My Baby Start Getting Teeth?
Teething, the process of baby (primary) teeth coming
through the gums into the mouth, is variable among
individual babies. Some babies get their teeth early and
some get them late. In general, the first baby teeth to
appear are usually the lower front (anterior) teeth and
they usually begin erupting between the age of 6-8
months. See
"Eruption of Your Child’s Teeth" for more details.
Baby Bottle Tooth Decay (Early Childhood Caries)
One serious form of decay among young children is
baby bottle tooth decay. This condition is caused by
frequent and long exposures of an infant’s teeth to
liquids that contain sugar. Among these liquids are milk
(including breast milk), formula, fruit juice and other
sweetened drinks.
Putting a baby to bed for a nap or at night with a
bottle other than water can cause serious and rapid
tooth decay. Sweet liquid pools around the child’s teeth
giving plaque bacteria an opportunity to produce acids
that attack tooth enamel. If you must give the baby a
bottle as a comforter at bedtime, it should contain only
water. If your child won't fall asleep without the
bottle and its usual beverage, gradually dilute the
bottle's contents with water over a period of two to
three weeks.
After each feeding, wipe the baby’s gums and teeth
with a damp washcloth or gauze pad to remove plaque. The
easiest way to do this is to sit down, place the child’s
head in your lap or lay the child on a dressing table or
the floor. Whatever position you use, be sure you can
see into the child’s mouth easily.
Sippy Cups
Sippy cups should be used as a training tool from the
bottle to a cup and should be discontinued by the first
birthday. If your child uses a sippy cup throughout the
day, fill the sippy cup with water only (except at
mealtimes). By filling the sippy cup with liquids that
contain sugar (including milk, fruit juice, sports
drinks, etc.) and allowing a child to drink from it
throughout the day, it soaks the child’s teeth in cavity
causing bacteria.
Prevention
Care Of Your Child's Teeth
Brushing Tips:
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.
If they are under the age of 2, use a small "smear" of toothpaste.
If they're 2-5 years old, use a "pea-size" amount of toothpaste.
Be sure and use an ADA-accepted fluoride toothpaste and make sure your child does not swallow it.
When brushing, the parent should brush the child's teeth until they are old enough to do a good job on their own.
Flossing Tips:
Flossing removes plaque between teeth and under the gumline where a toothbrush can't reach.
Flossing should begin when any two teeth touch.
Be sure and floss your child's teeth daily until he or she can do it alone.
Good Diet = Healthy Teeth
Healthy eating habits lead to healthy teeth. Like the
rest of the body, the teeth, bones and the soft tissues
of the mouth need a well-balanced diet. Children should
eat a variety of foods from the five major food groups.
Most snacks that children eat can lead to cavity
formation. The more frequently a child snacks, the
greater the chance for tooth decay. How long food
remains in the mouth also plays a role. For example,
hard candy and breath mints stay in the mouth a long
time, which cause longer acid attacks on tooth enamel.
If your child must snack, choose nutritious foods such
as vegetables, low-fat yogurt, and low-fat cheese, which
are healthier and better for children’s teeth.
How Do I Prevent Cavities?
Good oral hygiene removes bacteria and the left over
food particles that combine to create cavities. For
infants, use a wet gauze or clean washcloth to wipe the
plaque from teeth and gums. Avoid putting your child to
bed with a bottle filled with anything other than water.
See "Baby
Bottle Tooth Decay" for more information.
For older children, brush their teeth at least
twice a day. Also, watch the number of snacks containing
sugar that you give your children.
The American Academy of Pediatric Dentistry
recommends visits every six months to the pediatric
dentist, beginning at your child’s first birthday.
Routine visits will start your child on a lifetime of
good dental health.
Your pediatric dentist may also recommend protective
sealants or home fluoride treatments for your child.
Sealants can be applied to your child’s molars to
prevent decay on hard to clean surfaces.
Seal Out
Decay
A sealant is a protective coating 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
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).
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.
Xylitol - Reducing
Cavities
The American Academy of Pediatric Dentistry (AAPD)
recognizes the benefits of xylitol on the oral health of
infants, children, adolescents, and persons with special
health care needs.
The use of XYLITOL GUM by mothers (2-3 times per day)
starting 3 months after delivery and until the child was
2 years old, has proven to reduce cavities up to 70% by
the time the child was 5 years old.
Studies using xylitol as either a sugar substitute or
a small dietary addition have demonstrated a dramatic
reduction in new tooth decay, along with some reversal
of existing dental caries. Xylitol provides additional
protection that enhances all existing prevention
methods. This xylitol effect is long-lasting and
possibly permanent. Low decay rates persist even years
after the trials have been completed.
Xylitol is widely distributed throughout nature in
small amounts. Some of the best sources are fruits,
berries, mushrooms, lettuce, hardwoods, and corn cobs.
One cup of raspberries contains less than one gram of
xylitol.
Studies suggest xylitol intake that consistently
produces positive results ranged from 4-20 grams per
day, divided into 3-7 consumption periods. Higher
results did not result in greater reduction and may lead
to diminishing results. Similarly, consumption frequency
of less than 3 times per day showed no effect.
To find gum or other products containing xylitol, try
visiting your local health food store or search the
Internet to find products containing 100% xylitol.
Beware of
Sports Drinks
Due to the high sugar content and acids in sports
drinks, they have erosive potential and the ability to
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 sports. Be sure to talk to your pediatric dentist
before using 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 with the drink
rinse mouthguards only in water
seek out dentally friendly sports drinks
Adolescent Dentistry
Tongue
Piercing - Is It Really Cool?
You might not be surprised anymore to see people with
pierced tongues, lips or cheeks, but you might be
surprised to know just how dangerous these piercings can
be.
There are many risks involved with oral piercings,
including chipped or cracked teeth, blood clots, blood
poisoning, heart infections, brain abscess, nerve
disorders (trigeminal neuralgia), receding gums or scar
tissue. Your mouth contains millions of bacteria, and
infection is a common complication of oral piercing.
Your tongue could swell large enough to close off your
airway!
Common symptoms after piercing include pain,
swelling, infection, an increased flow of saliva and
injuries to gum tissue. Difficult-to-control bleeding or
nerve damage can result if a blood vessel or nerve
bundle is in the path of the needle.
So follow the advice of the American Dental
Association and give your mouth a break – skip the mouth
jewelry.
Tobacco - Bad News In
Any Form
Tobacco in any form can jeopardize your child’s
health and cause incurable damage. Teach your child
about the dangers of tobacco.
Smokeless tobacco, also called spit, chew or snuff,
is often used by teens who believe that it is a safe
alternative to smoking cigarettes. This is an
unfortunate misconception. Studies show that spit
tobacco may be more addictive than smoking cigarettes
and may be more difficult to quit. Teens who use it may
be interested to know that one can of snuff per day
delivers as much nicotine as 60 cigarettes. In as little
as three to four months, smokeless tobacco use can cause
periodontal disease and produce pre-cancerous lesions
called leukoplakias.
If your child is a tobacco user you should watch for
the following that could be early signs of oral cancer:
A sore that won’t heal.
White or red leathery patches on the lips, and
on or under the tongue.
Pain, tenderness or numbness anywhere in the
mouth or lips.
Difficulty chewing, swallowing, speaking or
moving the jaw or tongue; or a change in the way the
teeth fit together.
Because the early signs of oral cancer usually are
not painful, people often ignore them. If it’s not
caught in the early stages, oral cancer can require
extensive, sometimes disfiguring, surgery. Even worse,
it can kill.
Help your child avoid tobacco in any form. By doing
so, they will avoid bringing cancer-causing chemicals in
direct contact with their tongue, gums and cheek.