Dental Topics
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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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