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GENERAL TOPICS:
EARLY INFANT ORAL CARE:
PREVENTION:
ADOLESCENT DENTISTRY:
For information
on special oral health care needs, we've provided links to the
following sites:
American Academy of Pediatric Dentistry
American Academy of Pediatrics
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) 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 thoroughly.
Rinse the mouth vigorously with warm water or use dental floss to
dislodge impacted food or debris. If the pain still exists, contact
your child's dentist. DO NOT place aspirin 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 bruised areas. If there is bleeding apply firm but
gentle pressure with a gauze or cloth. If bleeding does not stop
after 15 minutes or it cannot be controlled by simple pressure, take
the child to hospital emergency room.
Knocked
Out Permanent Tooth:
Find the tooth. Handle the tooth by the crown, not the root portion.
You may rinse the tooth but DO NOT clean 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. The patient must see a dentist IMMEDIATELY!
Time is a critical factor in saving the tooth.
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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.
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 gets less between the
ages 6-9 and children tend to stop grinding between ages 9-12. If
you suspect bruxism, discuss this with your pediatrician or
pediatric dentist.
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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:
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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.
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Reward
children when they refrain from sucking during difficult periods,
such as when being separated from their parents.
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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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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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EARLY INFANT ORAL CARE
Your Child’s 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 are usually the lower
front (anterior) teeth and usually begin erupting between the age of
6-8 months. See "Eruption
of Your Child’s Teeth" for more
details.
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Early Childhood Caries
One serious form
of decay among young children is Early Childhood Caries. 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 "Early Childhood Caries" 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 six month visits 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:
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Too much
fluoridated toothpaste at an early age.
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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:
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Use baby
tooth cleanser on the toothbrush of the very young child.
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Place
only a pea sized drop of children’s toothpaste on the brush when
brushing.
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Account
for all of the sources of ingested fluoride before requesting
fluoride supplements from your child’s physician or pediatric
dentist.
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Avoid
giving any fluoride-containing supplements to infants until they
are at least 6 months old.
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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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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, or blood poisoning. Your mouth contains millions
of bacteria, and infection is a common complication of oral
piercing. Your tongue could swell large enough to close off your
airway!
Common symptoms
after piercing include pain, swelling, infection, an increased flow
of saliva and injuries to gum tissue. Difficult-to-control bleeding
or nerve damage can result if a blood vessel or nerve bundle is in
the path of the needle.
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:
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A sore
that won’t heal.
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White or
red leathery patches on the lips, and on or under the tongue.
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Pain,
tenderness or numbness anywhere in the mouth or lips.
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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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