The pediatric
dentist has an extra two years of specialized training 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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Your Child’s First Dental Visit
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 his 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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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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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. X-Ray’s
detect much more than cavities. For example, X-Rays may be needed to survey
erupting teeth, diagnose bone diseases, evaluate the results of an injury,
or plan orthodontic treatment. X-Rays 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 X-rays 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 is extremely
small. The risk is negligible. In fact, the dental X-rays 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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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 may wish to 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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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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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 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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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.
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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. 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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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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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).
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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. DO
NOT place aspirin on the gum or on the aching tooth. If face is swollen apply
cold compresses. Take the child to a dentist. 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 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. 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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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.
Blending the syrup, carbonation with the city water supply often makes soft
drinks at fast food restaurants – so if fluoride is in the water –
this is another source.
Parents can take the following steps to decrease the risk of fluorosis in their children’s teeth:
• Use baby tooth cleanser on the toothbrush in 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 6 months old.
• Obtain fluoride level test results for your drinking water before giving fluoride supplements to your child (check with local water utilities).
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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Sucking is a natural reflex and infants and young children may use thumbs, fingers, pacifiers and other objects on which to suck. It may make them feel secure and happy or provide a sense of security at difficult periods. Since thumb sucking is relaxing, it may induce sleep. Thumb sucking that persists beyond the eruption of the permanent teeth can cause problems with the proper growth of the mouth and tooth alignment. How intensely a child sucks on fingers or thumbs will determine whether or not dental problems may result. Children who rest their thumbs passively in their mouths are less likely to have difficulty than those who vigorously suck their thumbs. Children should cease thumb sucking by the time their permanent front teeth are ready to erupt. Usually, children stop between the ages of two and four. Peer pressure causes many school-aged children to stop. Pacifiers are no substitute for thumb sucking. They can affect the teeth essentially the same way as sucking fingers and thumbs. However, use of the pacifier can be controlled and modified more easily than the thumb or finger habit. If you have concerns about thumb sucking or use of a pacifier, consult your pediatric dentist.
A few suggestions to help your child get through thumb sucking:
• Instead of scolding children for thumb sucking, praise them when they are not.
• Children often suck their thumbs when feeling insecure. Focus on correcting the cause of anxiety, instead of the thumb sucking.
• Children who are sucking for comfort will feel less of a need when their parents provide comfort.
• Reward children when they refrain from sucking during difficult periods, such as when being separated from their parents.
• Your pediatric dentist can encourage children to stop sucking and explain what could happen if they continue.
• If these approaches don’t work, remind the children of their habit by bandaging the thumb or putting a sock on the hand at night. Your pediatric dentist may recommend the use of a mouth appliance.
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"Harold's
Hideaway Thumb"
by Harriet Sonnenschein, Jurg Obnzt (Illustrator), Jurg Obrist (Illustrator)David
Decides
"About
Thumbsucking - A Story for Children, a Guide for Parents"
by Susan Heitler P H.D., Paula Singer (Photographer)
"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:
• A sore that won’t heal
• White or red leathery patches on your lips, and on or under your tongue
• Pain, tenderness or numbness anywhere in the mouth or lips
• Difficulty chewing, swallowing, speaking or moving your jaw or tongue; or a change in the way your 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.
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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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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