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GENERAL TOPICS:
What is a
Pediatric Dentist?
Why are the
Primary Teeth so Important?
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:
Your Child's First Dental Visit
When will my Baby Start Getting
Teeth?
Baby Bottle Tooth Decay (Early
Childhood Caries)
PREVENTION:
Care of your Child's Teeth
Good Diet = Healthy Teeth
How Do I Prevent Cavities
Seal Out Decay
Fluoride
Mouth Guards
Xylitol - Reducing Cavities
ADOLESCENT DENTISTRY:
Tongue Piercing - Is it Really Cool?
Tobacco - Bad News in Any Form
For
more information on oral health care needs, please visit
the website for the
American Academy of Pediatric
Dentistry.
GENERAL TOPICS & FAQ
What Is A Pediatric
Dentist?
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.
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Why Are
The Primary Teeth So 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.
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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. This process continues
until approximately age 21.
Adults have 28
permanent teeth, or up to 32 including the third molars
(or wisdom teeth).
TOOTH
DEVELOPMENT
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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. 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)
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.
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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:
-
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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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.
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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.
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EARLY INFANT ORAL CARE
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.
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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.
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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.
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PREVENTION
Care of Your Child’s
Teeth
Begin daily brushing as soon as the child’s first tooth
erupts. A pea size amount of fluoride toothpaste can be
used after the child is old enough not to swallow it. By
age 4 or 5, children should be able to brush their own
teeth twice a day with supervision until about age seven
to make sure they are doing a thorough job. However, each
child is different. Your 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.
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
 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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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.
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Seal Out Decay
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 |
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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).
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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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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.
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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.
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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.
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