Dental Topics
Click on a topic of interest for more
information.
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 information on special oral health care needs,
we've provided links to the following sites:
National Institute of Dental & Craniofacial
Research
Resource & Information on Cleft Lip &
Palate
National Foundation for Ectodermal Dysplasias
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) arent replaced until age
10-13.
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Eruption Of
Your Childs Teeth
Childrens 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
patients saliva or milk. If the patient is old enough, the tooth may also
be carried in the patients 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 childs 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. Todays 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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Whats the Best Toothpaste for my
Child?
Tooth
brushing is one of the most important tasks for good oral health.
Many toothpastes, an d/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 dont 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 childs 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 Childs
First Dental Visit
According to the American Academy of Pediatric
Dentistry (AAPD), your child should visit the dentist by his/her 1st
birthday. You can make the first visit to the dentist enjoyable and
positive. 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 Childs
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 infants 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 childs 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 babys 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 childs 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 childs mouth easily.
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PREVENTION
Care of Your Childs
Teeth
Begin daily brushing as soon as the childs 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 cant reach.
Flossing should begin when any two teeth touch. You should floss
the childs 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. Dont 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 childrens 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 childs
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 childs 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
childs 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 childs
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 childrens teeth:
- Use baby tooth cleanser on the toothbrush of the
very young child.
- Place only a pea sized drop of childrens toothpaste
on the brush when brushing.
- Account for all of the sources of ingested fluoride
before requesting fluoride supplements from your childs 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 childs 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 childs 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 its 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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Top]
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