The pediatric dentist has an extra two to three years of
specialized training after dental school, and is dedicated to the
oral health of children from infancy through the teenage years.
The very young, pre-teens, and teenagers all need different
approaches in dealing with their behavior, guiding their dental
growth and development, and helping them avoid future dental
problems. The pediatric dentist is best qualified to meet these
needs.
Why Are The Primary Teeth Important?
It is very important to maintain the health of the primary
teeth. Neglected cavities can and frequently do lead to problems
which affect developing permanent teeth. Primary teeth, or baby
teeth are important for (1) proper chewing and eating, (2)
providing space for the permanent teeth and guiding them into the
correct position, and (3) permitting normal development of the
jaw bones and muscles. Primary teeth also affect the development
of speech and add to an attractive appearance. While the front 4
teeth last until 6-7 years of age, the back teeth (cuspids and
molars) aren’t replaced until age 10-13.
Eruption Of Your Child's Teeth
Children’s teeth begin forming before birth. As early as 4
months, the first primary (or baby) teeth to erupt through the
gums are the lower central incisors, followed closely by the
upper central incisors. Although all 20 primary teeth usually
appear by age 3, the pace and order of their eruption varies.
Permanent teeth begin appearing around age 6, starting with
the first molars and lower central incisors. This process
continues until approximately age 21.
Adults have 28 permanent teeth, or up to 32 including the
third molars (or wisdom teeth).
Look!
My Tooth is Loose!
(with 16"x22" poster and stickers)
By Patricia Brennan Dermuth
Illustrated by Mike Cressy
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.
Dental
Radiographs (X-Rays)
Radiographs (X-Rays) are a vital and necessary part of your
child’s dental diagnostic process. Without them, certain dental
conditions can and will be missed.
Radiographs detect much more than cavities. For example,
radiographs may be needed to survey erupting teeth, diagnose bone
diseases, evaluate the results of an injury, or plan orthodontic
treatment. Radiographs allow dentists to diagnose and treat
health conditions that cannot be detected during a clinical
examination. If dental problems are found and treated early,
dental care is more comfortable for your child and more
affordable for you.
The American Academy of Pediatric Dentistry recommends
radiographs and examinations every six months for children with a
high risk of tooth decay. On average, most pediatric dentists
request radiographs approximately once a year. Approximately
every 3 years, it is a good idea to obtain a complete set of
radiographs, either a panoramic and bitewings or periapicals and
bitewings.
Pediatric dentists are particularly careful to minimize the
exposure of their patients to radiation. With contemporary
safeguards, the amount of radiation received in a dental X-ray
examination is extremely small. The risk is negligible. In fact,
the dental radiographs represent a far smaller risk than an
undetected and untreated dental problem. Lead body aprons and
shields will protect your child. Today’s equipment filters out
unnecessary x-rays and restricts the x-ray beam to the area of
interest. High-speed film and proper shielding assure that your
child receives a minimal amount of radiation exposure.
What's The Best Toothpaste For My Child?
Tooth
brushing is one of the most important tasks for good oral health.
Many toothpastes, and/or tooth polishes, however, can damage
young smiles. They contain harsh abrasives, which can wear away
young tooth enamel. When looking for a toothpaste for your child,
make sure to pick one that is recommended by the American Dental
Association as shown on the box and tube. These toothpastes have
undergone testing to insure they are safe to use.
Remember, children should spit out toothpaste after brushing
to avoid getting too much fluoride. If too much fluoride is
ingested, a condition known as fluorosis can occur. If your child
is too young or unable to spit out toothpaste, consider providing
them with a fluoride free toothpaste, using no toothpaste, or
using only a "pea size" amount of toothpaste.
Does Your Child Grind His Teeth At Night? (Bruxism)
Parents are often concerned about the nocturnal grinding of
teeth (bruxism). Often, the first indication is the noise created
by the child grinding on their teeth during sleep. Or, the parent
may notice wear (teeth getting shorter) to the dentition. One
theory as to the cause involves a psychological component. Stress
due to a new environment, divorce, changes at school; etc. can
influence a child to grind their teeth. Another theory relates to
pressure in the inner ear at night. If there are pressure changes
(like in an airplane during take-off and landing, when people are
chewing gum, etc. to equalize pressure) the child will grind by
moving his jaw to relieve this pressure.
The majority of cases of pediatric bruxism do not require any
treatment. If excessive wear of the teeth (attrition) is present,
then a mouth guard (night guard) may be indicated. The negatives
to a mouth guard are the possibility of choking if the appliance
becomes dislodged during sleep and it may interfere with growth
of the jaws. The positive is obvious by preventing wear to the
primary dentition.
The good news is most children outgrow bruxism. The grinding
decreases between the ages 6-9 and children tend to stop grinding
between ages 9-12. If you suspect bruxism, discuss this with your
pediatrician or pediatric dentist.
Thumb Sucking
Sucking
is a natural reflex and infants and young children may use
thumbs, fingers, pacifiers and other objects on which to suck. It
may make them feel secure and happy, or provide a sense of
security at difficult periods. Since thumb sucking is relaxing,
it may induce sleep.
Thumb sucking that persists beyond the eruption of the
permanent teeth can cause problems with the proper growth of the
mouth and tooth alignment. How intensely a child sucks on fingers
or thumbs will determine whether or not dental problems may
result. Children who rest their thumbs passively in their mouths
are less likely to have difficulty than those who vigorously suck
their thumbs.
Children should cease thumb sucking by the time their
permanent front teeth are ready to erupt. Usually, children stop
between the ages of two and four. Peer pressure causes many
school-aged children to stop.
Pacifiers are no substitute for thumb sucking. They can affect
the teeth essentially the same way as sucking fingers and thumbs.
However, use of the pacifier can be controlled and modified more
easily than the thumb or finger habit. If you have concerns about
thumb sucking or use of a pacifier, consult your pediatric
dentist.
A few suggestions to help your child get through thumb
sucking:
Children often suck their thumbs when feeling insecure.
Focus on correcting the cause of anxiety, instead of the
thumb sucking.
Children who are sucking for comfort will feel less of a
need when their parents provide comfort.
Reward children when they refrain from sucking during
difficult periods, such as when being separated from their
parents.
Your pediatric dentist can encourage children to stop
sucking and explain what could happen if they continue.
If these approaches don’t work, remind the children of
their habit by bandaging the thumb or putting a sock on the
hand at night. Your pediatric dentist may recommend the use
of a mouth appliance.
The pulp of a tooth is the inner, central core of the tooth.
The pulp contains nerves, blood vessels, connective tissue and
reparative cells. The purpose of pulp therapy in Pediatric
Dentistry is to maintain the vitality of the affected tooth (so
the tooth is not lost).
Dental caries (cavities) and traumatic injury are the main
reasons for a tooth to require pulp therapy. Pulp therapy is
often referred to as a "nerve treatment", "children's root
canal", "pulpectomy" or "pulpotomy". The two common forms of pulp
therapy in children's teeth are the pulpotomy and pulpectomy.
A pulpotomy removes the diseased pulp tissue within the crown
portion of the tooth. Next, an agent is placed to prevent
bacterial growth and to calm the remaining nerve tissue. This is
followed by a final restoration (usually a stainless steel
crown).
A pulpectomy is required when the entire pulp is involved
(into the root canal(s) of the tooth). During this treatment, the
diseased pulp tissue is completely removed from both the crown
and root. The canals are cleansed, disinfected and, in the case
of primary teeth, filled with a resorbable material. Then, a
final restoration is placed. A permanent tooth would be filled
with a non-resorbing material.
What Is The Best Time For Orthodontic Treatment?
Developing
malocclusions, or bad bites, can be recognized as early as 2-3
years of age. Often, early steps can be taken to reduce the need
for major orthodontic treatment at a later age.
Stage I – Early Treatment: This period of treatment
encompasses ages 2 to 6 years. At this young age, we are
concerned with underdeveloped dental arches, the premature loss
of primary teeth, and harmful habits such as finger or thumb
sucking. Treatment initiated in this stage of development is
often very successful and many times, though not always, can
eliminate the need for future orthodontic/orthopedic treatment.
Stage II – Mixed Dentition: This period covers the ages
of 6 to 12 years, with the eruption of the permanent incisor
(front) teeth and 6 year molars. Treatment concerns deal with jaw
malrelationships and dental realignment problems. This is an
excellent stage to start treatment, when indicated, as your
child’s hard and soft tissues are usually very responsive to
orthodontic or orthopedic forces.
Stage III – Adolescent Dentition: This stage deals with
the permanent teeth and the development of the final bite
relationship.
Adult Teeth Coming in Behind Baby Teeth
This is a very common occurrence with children, usually the result of a lower,
primary (baby) tooth not falling out when the permanent tooth is coming in. In most
cases if the child starts wiggling the baby tooth, it will usually fall out on its own
within two months. If it doesn't, then contact your pediatric dentist, where they can
easily remove the tooth. The permanent tooth should then slide into the proper place.
Early Infant Oral Care
Perinatal & Infant Oral Health
The
American Academy of Pediatric Dentistry (AAPD) recommends that
all pregnant women receive oral healthcare and counseling during
pregnancy. Research has shown evidence that periodontal disease
can increase the risk of preterm birth and low birth weight. Talk
to your doctor or dentist about ways you can prevent periodontal
disease during pregnancy.
Additionally, mothers with poor oral health may be at a
greater risk of passing the bacteria which causes cavities to
their young children. Mother's should follow these simple steps
to decrease the risk of spreading cavity-causing bacteria:
Visit your dentist regularly.
Brush and floss on a daily basis to reduce bacterial
plaque.
Proper diet, with the reduction of beverages and foods
high in sugar & starch.
Use a fluoridated toothpaste recommended by the ADA and
rinse every night with an alocohol-free, over-the-counter
mouth rinse with .05 % sodium fluoride in order to reduce
plaque levels.
Don't share utensils, cups or food which can cause the
transmission of cavity-causing bacteria to your children.
Use of xylitol chewing gum (4 pieces per day by the
mother) can decrease a child’s caries rate.
Your Child's First Dental Visit-Establishing A "Dental Home"
The American Academy of Pediatrics (AAP), the American Dental
Association (ADA), and the American Academy of Pediatric
Dentistry (AAPD) all recommend establishing a "Dental Home" for
your child by one year of age. Children who have a dental home
are more likely to receive appropriate preventive and routine
oral health care.
The Dental Home is intended to provide a place
other than the Emergency Room for parents.
You can make the first visit to the dentist enjoyable and
positive. If old enough, your child should be informed of the
visit and told that the dentist and their staff will explain all
procedures and answer any questions. The less to-do concerning
the visit, the better.
It is best if you refrain from using words around your child
that might cause unnecessary fear, such as needle, pull, drill or
hurt. Pediatric dental offices make a practice of using words
that convey the same message, but are pleasant and
non-frightening to the child.
When Will My Baby Start Getting Teeth?
Teething, the process of baby (primary) teeth coming through
the gums into the mouth, is variable among individual babies.
Some babies get their teeth early and some get them late. In
general, the first baby teeth to appear are usually the lower
front (anterior) teeth and they usually begin erupting between
the age of 6-8 months.
See "Eruption of Your Child’s
Teeth" for more details.
Baby Bottle Tooth Decay (Early Childhood Caries)
One
serious form of decay among young children is baby bottle tooth
decay. This condition is caused by frequent and long exposures of
an infant’s teeth to liquids that contain sugar. Among these
liquids are milk (including breast milk), formula, fruit juice
and other sweetened drinks.
Putting a baby to bed for a nap or at night with a bottle
other than water can cause serious and rapid tooth decay. Sweet
liquid pools around the child’s teeth giving plaque bacteria an
opportunity to produce acids that attack tooth enamel. If you
must give the baby a bottle as a comforter at bedtime, it should
contain only water. If your child won't fall asleep without the
bottle and its usual beverage, gradually dilute the bottle's
contents with water over a period of two to three weeks.
After each feeding, wipe the baby’s gums and teeth with a damp
washcloth or gauze pad to remove plaque. The easiest way to do
this is to sit down, place the child’s head in your lap or lay
the child on a dressing table or the floor. Whatever position you
use, be sure you can see into the child’s mouth easily.
Sippy
Cups
Sippy cups should be used as a training tool from the bottle
to a cup and should be discontinued by the first birthday. If
your child uses a sippy cup throughout the day, fill the sippy
cup with water only (except at mealtimes). By filling the sippy
cup with liquids that contain sugar (including milk, fruit juice,
sports drinks, etc.) and allowing a child to drink from it
throughout the day, it soaks the child’s teeth in cavity causing
bacteria.
Prevention
Care Of Your Child's Teeth
Good Diet = Healthy Teeth
Healthy
eating habits lead to healthy teeth. Like the rest of the body,
the teeth, bones and the soft tissues of the mouth need a
well-balanced diet. Children should eat a variety of foods from
the five major food groups. Most snacks that children eat can
lead to cavity formation. The more frequently a child snacks, the
greater the chance for tooth decay. How long food remains in the
mouth also plays a role. For example, hard candy and breath mints
stay in the mouth a long time, which cause longer acid attacks on
tooth enamel. If your child must snack, choose nutritious foods
such as vegetables, low-fat yogurt, and low-fat cheese, which are
healthier and better for children’s teeth.
How Do I Prevent Cavities?
Good oral hygiene removes bacteria and the left over food
particles that combine to create cavities. For infants, use a wet
gauze or clean washcloth to wipe the plaque from teeth and gums.
Avoid putting your child to bed with a bottle filled with
anything other than water. See "Baby
Bottle Tooth Decay" for more information.
For older children, brush their teeth at least twice a
day. Also, watch the number of snacks containing sugar that you
give your children.
The American Academy of Pediatric Dentistry recommends visits
every six months to the pediatric dentist, beginning at your
child’s first birthday. Routine visits will start your child on a
lifetime of good dental health.
Your pediatric dentist may also recommend protective sealants
or home fluoride treatments for your child. Sealants can be
applied to your child’s molars to prevent decay on hard to clean
surfaces.
Seal Out Decay
A sealant is a protective coating that is applied to the
chewing surfaces (grooves) of the back teeth (premolars and
molars), where four out of five cavities in children are found.
This sealant acts as a barrier to food, plaque and acid, thus
protecting the decay-prone areas of the teeth.
Before Sealant Applied
After Sealant Applied
Fluoride
Fluoride is an element, which has been shown to be beneficial
to teeth. However, too little or too much fluoride can be
detrimental to the teeth. Little or no fluoride will not
strengthen the teeth to help them resist cavities. Excessive
fluoride ingestion by preschool-aged children can lead to dental
fluorosis, which is a chalky white to even brown discoloration of
the permanent teeth. Many children often get more fluoride than
their parents realize. Being aware of a child’s potential sources
of fluoride can help parents prevent the possibility of dental
fluorosis.
Some of these sources are:
Too much fluoridated toothpaste at an early age.
The inappropriate use of fluoride supplements.
Hidden sources of fluoride in the child’s diet.
Two and three year olds may not be able to expectorate (spit
out) fluoride-containing toothpaste when brushing. As a result,
these youngsters may ingest an excessive amount of fluoride
during tooth brushing. Toothpaste ingestion during this critical
period of permanent tooth development is the greatest risk factor
in the development of fluorosis.
Excessive and inappropriate intake of fluoride supplements may
also contribute to fluorosis. Fluoride drops and tablets, as well
as fluoride fortified vitamins should not be given to infants
younger than six months of age. After that time, fluoride
supplements should only be given to children after all of the
sources of ingested fluoride have been accounted for and upon the
recommendation of your pediatrician or pediatric dentist.
Certain foods contain high levels of fluoride, especially
powdered concentrate infant formula, soy-based infant formula,
infant dry cereals, creamed spinach, and infant chicken products.
Please read the label or contact the manufacturer. Some beverages
also contain high levels of fluoride, especially decaffeinated
teas, white grape juices, and juice drinks manufactured in
fluoridated cities.
Parents can take the following steps to decrease the risk of
fluorosis in their children’s teeth:
Use baby tooth cleanser on the toothbrush of the very
young child.
Place only a pea sized drop of children’s toothpaste on
the brush when brushing.
Account for all of the sources of ingested fluoride
before requesting fluoride supplements from your child’s
physician or pediatric dentist.
Avoid giving any fluoride-containing supplements to
infants until they are at least 6 months old.
Obtain fluoride level test results for your drinking
water before giving fluoride supplements to your child (check
with local water utilities).
Mouth Guards
When
a child begins to participate in recreational activities and
organized sports, injuries can occur. A properly fitted mouth
guard, or mouth protector, is an important piece of athletic gear
that can help protect your child’s smile, and should be used
during any activity that could result in a blow to the face or
mouth.
Mouth guards help prevent broken teeth, and injuries to the
lips, tongue, face or jaw. A properly fitted mouth guard will
stay in place while your child is wearing it, making it easy for
them to talk and breathe.
Ask your pediatric dentist about custom and store-bought mouth
protectors.
Xylitol - Reducing Cavities
The American Academy of Pediatric Dentistry (AAPD) recognizes
the benefits of xylitol on the oral health of infants, children,
adolescents, and persons with special health care needs.
The use of XYLITOL GUM by mothers (2-3 times per day) starting
3 months after delivery and until the child was 2 years old, has
proven to reduce cavities up to 70% by the time the child was 5
years old.
Studies using xylitol as either a sugar substitute or a small
dietary addition have demonstrated a dramatic reduction in new
tooth decay, along with some reversal of existing dental caries.
Xylitol provides additional protection that enhances all existing
prevention methods. This xylitol effect is long-lasting and
possibly permanent. Low decay rates persist even years after the
trials have been completed.
Xylitol is widely distributed throughout nature in small
amounts. Some of the best sources are fruits, berries, mushrooms,
lettuce, hardwoods, and corn cobs. One cup of raspberries
contains less than one gram of xylitol.
Studies suggest xylitol intake that consistently produces
positive results ranged from 4-20 grams per day, divided into 3-7
consumption periods. Higher results did not result in greater
reduction and may lead to diminishing results. Similarly,
consumption frequency of less than 3 times per day showed no
effect.
To find gum or other products containing xylitol, try visiting
your local health food store or search the Internet to find
products containing 100% xylitol.
Beware of Sports Drinks
Due
to the high sugar content and acids in sports drinks, they have
erosive potential and the ability to dissolve even fluoride-rich
enamel, which can lead to cavities.
To minimize dental problems, children should avoid sports
drinks and hydrate with water before, during and after sports. Be
sure to talk to your pediatric dentist before using sports
drinks.
If sports drinks are consumed:
reduce the frequency and contact time
swallow immediately and do not swish them around the
mouth
neutralize the effect of sports drinks by alternating
sips of water with the drink
rinse mouthguards only in water
seek out dentally friendly sports drinks
Adolescent Dentistry
Tongue Piercing -
Is It Really Cool?
You might not be surprised anymore to see people with pierced
tongues, lips or cheeks, but you might be surprised to know just
how dangerous these piercings can be.
There are many risks involved with oral piercings, including
chipped or cracked teeth, blood clots, blood poisoning, heart
infections, brain abscess, nerve disorders (trigeminal
neuralgia), receding gums or scar tissue. Your mouth contains
millions of bacteria, and infection is a common complication of
oral piercing. Your tongue could swell large enough to close off
your airway!
Common symptoms after piercing include pain, swelling,
infection, an increased flow of saliva and injuries to gum
tissue. Difficult-to-control bleeding or nerve damage can result
if a blood vessel or nerve bundle is in the path of the needle.
So follow the advice of the American Dental Association and
give your mouth a break – skip the mouth jewelry.
Tobacco - Bad News In Any Form
Tobacco in any form can jeopardize your child’s health and
cause incurable damage. Teach your child about the dangers of
tobacco.
Smokeless tobacco, also called spit, chew or snuff, is often
used by teens who believe that it is a safe alternative to
smoking cigarettes. This is an unfortunate misconception. Studies
show that spit tobacco may be more addictive than smoking
cigarettes and may be more difficult to quit. Teens who use it
may be interested to know that one can of snuff per day delivers
as much nicotine as 60 cigarettes. In as little as three to four
months, smokeless tobacco use can cause periodontal disease and
produce pre-cancerous lesions called leukoplakias.
If your child is a tobacco user you should watch for the
following that could be early signs of oral cancer:
A sore that won’t heal.
White or red leathery patches on the lips, and on or
under the tongue.
Pain, tenderness or numbness anywhere in the mouth or
lips.
Difficulty chewing, swallowing, speaking or moving the
jaw or tongue; or a change in the way the teeth fit together.
Because the early signs of oral cancer usually are not
painful, people often ignore them. If it’s not caught in the
early stages, oral cancer can require extensive, sometimes
disfiguring, surgery. Even worse, it can kill.
Help your child avoid tobacco in any form. By doing so, they
will avoid bringing cancer-causing chemicals in direct contact
with their tongue, gums and cheek.
