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?
Bleaching
Reducing Fear
Nitrous Oxide (Laughing Gas)
Local Anesthesia (Sleepy water)

EARLY INFANT ORAL CARE:

Perinatal and Infant Oral Health

Your Child's First Dental Visit
When will my Baby Start Getting Teeth?
Baby Bottle Tooth Decay (Early Childhood Caries)
Is there something I should do before my baby gets teeth?
How can I make teething easier for my baby?
When should I start cleaning my baby’s teeth?
What if my toddler won’t let me brush?
How does the Pediatric Dentist work with infant and toddlers?
How do I keep my child from getting decay?
Sugar and Acid Control
Avoid Sugar and Acid Between Meals
What about breastfeeding and decay?
Sippy Cup Tips To reduce the risk of cavities
How do I know if my child has decay?
What do I do about thumb sucking and pacifiers?
When my child has an accident involving teeth what do I do?

PREVENTION:

Care of your Child's Teeth & Gums
Good Diet = Healthy Teeth
What is a cavity
How Do I Prevent Cavities
Seal Out Decay

Dental Fillings
Silver Amalgam
White Fillings (Composites)
Fluoride
Mouth Guards
Xylitol - Reducing Cavities

ADOLESCENT DENTISTRY:

Tongue Piercing - Is it Really Cool?
Tobacco - Bad News in Any Form

For more information concerning pediatric dentistry, please visit the website for the
American Academy of Pediatric Dentistry.


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.
 

 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.
 

Eruption Of Your Child’s Teeth

Children’s teeth begin forming before birth. Around 6 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).

Please click on the timeline below to see the teeth erupt and to learn more.

 

Look! My Tooth is Loose!
(with 16"x22" poster and stickers)

By Patricia Brennan Demuth
Illustrated by Mike Cressy

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Dental Emergencies

Pediatric Dentist - Dental EmergenciesToothache: 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.

Pediatric Dentist - X-ray

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?

Pediatric Dentist - Brushing TeethTooth 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.
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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.
 

 Thumb Sucking

Pediatric Dentist - Thumb SuckingSucking 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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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.

What is the Best Time for Orthodontic Treatment?

Pediatric Dentist - Orthodontic TreatmentDeveloping 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.

Bleaching

Our tooth whitening service is targeted at our young adult patients. We know how important it is to develop positive self-esteem and find that some of our patients can benefit from this service. Individual teeth can be whitened in the office or an impression can be taken for home bleaching trays to lighten all the teeth. You will be given a prescription-strength bleaching gel to use in these trays. Dramatic results can be seen in a matter of 4-6 weeks. Tooth whitening is not for everyone. Some may develop tooth or gum sensitivity. These symptoms usually subside within a few days after stopping. Tooth whitening may not be effective with certain types of discoloration.

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Reducing Fear

Dr. Smith understands parents’ concerns about the fears their children possess in regard to receiving dental care. Many tell him they fear going to the dentist themselves and want things to be different for their children. Dr. Smith and staff employ a variety of methods to ensure that goal is realized.

The office environment a child enters into plays a big part in either contributing to or reducing anxiety. When children are at ease with their surroundings they tend to adopt a more relaxed attitude. Dr. Smith’s office has been designed especially for children. They will feel right at home with the fun atmosphere and cheerful colors. Communicating with children on their level is one of the most important ways to reduce fears. Dr. Smith and staff are excellent communicators with children. They have a great deal of experience at it because it’s what they do all day long. We constantly apply a technique known as “Tell – Show – Do”. We tell the child what we are going to do in terms they can easily understand. Then we demonstrate it to them on their finger. Then we do the procedure. The technique is as effective as it is simple but it is frequently ignored because it takes a little extra time. Children can’t be rushed and should be given the time they deserve.

While these methods usually reduce fear and anxiety, some children may still exhibit apprehension regardless of the efforts made to put them at ease. When that is the case there is no substitute for the patience you constantly see exhibited by Dr. Smith and staff. When other options are ineffective, demonstrating patience to a child eventually wins out. Nothing brings more joy to Dr. Smith and the staff than seeing frightened children replace their fears with confidence and their frowns with smiles.
 

Nitrous Oxide (Laughing Gas)

Some children are given nitrous oxide/oxygen, or what you may know as laughing gas, to relax them for some dental treatment. Nitrous oxide/oxygen is a blend of two gases, oxygen and nitrous oxide. Nitrous oxide/oxygen is given through a small breathing mask which is placed over the child’s nose, allowing them to relax, but without putting them to sleep. The American Academy of Pediatric Dentistry recognizes this technique as a very safe, effective technique to use for treating children’s dental needs. The gas is mild, easily taken, and then with normal breathing, it is quickly eliminated from the body. It is non-addictive. While inhaling nitrous oxide/oxygen, your child remains fully conscious and keeps all natural reflexes.
 

Local Anesthesia (Sleepy water)

Children should have a comfortable experience when going to the dentist. Local anesthetics are an important tool for the control of pain and discomfort during dental treatment. Local anesthesia is safe for children. Children remain conscious when local anesthetic is given.

Local anesthetics are the commonly used drugs in dentistry. Local anesthetics create a chemical roadblock between the source of the pain or stimulation – and the brain.. Anesthetics prevent the production and propagation of nerve signals.

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EARLY INFANT ORAL CARE

Perinatal & Infant Oral Health

Pediatric Dentist - Perinatal & Infant Oral HealthThe 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.
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 Baby Bottle Tooth Decay (Early Childhood Caries)

Pediatric Dentist - Baby Bottle Tooth DecayOne serious form of decay among young children is baby bottle tooth decay, also referred to by dentists as 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.
 

 Is there something I should do before my baby gets teeth?

Establishing a pattern of separating eating and sleeping while your baby is small is very important. Feed the baby, then wipe off the gums with gauze or wash cloth. This separates eating from sleeping and gets the baby accustomed to mouth cleaning routines. Keeping the bottle out of the crib allows the baby to learn to sleep through the night at a younger age, and avoids a later struggle over taking away the bedtime bottle.
 

 How can I make teething easier for my baby?

Teething rings are important to help the teeth work through the gums. As soon as the teeth penetrate the gum tissue, the discomfort begins to go away. Try cooling the teething ring in the refrigerator. Give the baby Tylenol Drops when needed, but be sure to follow the guidelines on the bottle. There is no perfect solution to teething. If the baby has a fever or actually seems sick, be sure to check with your pediatrician. An illness may be present along with the teething.
 

 When should I start cleaning my baby’s teeth?

As soon as the teeth erupt through the gums, you can wipe the teeth clean. Then change to a baby size soft toothbrush as soon as possible because it cleans better between the teeth and at the gum line. Just use a dry brush with no toothpaste. Place the brush squarely against the tooth at the gum line and jiggle side to side. Don’t use toothpaste until 2. After 2, brush with a half a pea size of toothpaste without Fluoride. Follow the same path around the mouth each time to cover all the outside, inside and chewing surfaces. It should take 1 to 1 ½ minutes to brush a toddler’s teeth. You can put your child’s head in your lap for comfort, security, and good vision. Don’t let your toddler carry a toothbrush around because of the danger of falling with it.

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 What if my toddler won’t let me brush?

We would rather insist on brushing than insist on fillings. Many toddlers resist. That’s part of the joy of parenting. Sit down on the floor, put the toddler’s head in your lap, and brush. For particularly athletic offspring this may be a two parent activity for a while, but don’t give up.
 

 How does the Pediatric Dentist work with infant and toddlers?

We keep the child secure by leaving them in the parent’s lap. After a period of getting acquainted, we move into a knee-to-knee position with the parent who slowly leans the child’s head back onto Dr. Smith’s knees. Many children accept this procedure happily, but even if there is a little fussing, the exam only takes about a minute. It is not usually necessary to do a teeth cleaning.
 

 How do I keep my child from getting decay?

Dental caries is a disease of the teeth caused by bacteria. Certain types of bacteria will produce acid if the bacteria are feeding on sugars or fermentable carbohydrates. This acid will break down the mineral structure of the teeth, and the result is a cavity. If you give your child a bottle, be sure it contains only water at naps and bedtime. Do not drink juice, pop, or milk in between meals; limit to meal time only. These drinks and sugar snacks between meals will attack the baby’s teeth and cause decay. This type of tooth decay advances very rapidly and can cause abscessed teeth in as young as a year old child.
 

 Sugar and Acid Control

Decay bacteria produce acid for 30 minutes every time sugar enters the mouth, and the “GOOD” bacteria have difficulty reproducing in that acid environment, so the percentage of “BAD” bacteria increases. Also, some drinks and treats are so high in acid that they dissolve enamel and advance decay without any help from decay bacteria.
 

 AVOID SUGAR AND ACID BETWEEN MEALS:

Sugar-Containing Beverages: Fruit juice (even if diluted), sport drinks such as Gatorade, and soft drinks. The nutritional guidelines of the American Academy of Pediatrics recommend limiting juice to 4-6 ounces per day for children ages one to six years. Also, do not allow your child to drink milk before falling asleep.
 

Sugar-Containing Food: Candy, cookies, sugar chewing gum, peanut butter, jelly, and dried fruits (raisins and fruit snacks).
 

Decay-Safe Snacks: Carrot sticks, celery filled with cream cheese or sugar-free peanut butter, cheese, apples, jicama, and nuts.
 

 What about breastfeeding and decay?

Breast milk contains lactose so it can cause decay when children nurse during the night. Children who have erupted teeth early and who nurse for many short periods or stay attached to the mother while they sleep are particularly at risk. If you are still nursing after your baby’s teeth erupt, try to reduce the amount of night nursing, and keep your child’s teeth very clean.
 

 Sippy Cup Tips To reduce the risk of cavities

  • It should not be used for a long period of time… it is only designed to help your child transition from a bottle to a cup…it is not a pacifier
  • Unless being used at mealtime, the sippy cup should only be filled with water
Sippy cups should not be used at naptime or bedtime unless they only have water in them. Always remember to clean your child’s teeth before placing him or her in bed.

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 How do I know if my child has decay?

If you see changes in the coloring of the teeth such as white spots, lines, or brown discoloration this could signal decay. If your child cries when they eat or drink hot or cold foods, they may have decay. Consult with a dentist as soon as possible.
 

 What do I do about thumb sucking and pacifiers?

There is not much we can do about thumb sucking before three years of age that is both effective and kind. So we suggest a low key effort to minimize the time spent sucking. If they are stilling sucking their thumb at age three the first step is to evaluate whether the habit is causing a significant problem. If the change in bite or tooth position is small, there may not be a need to do anything at that time. But if there is a cross bite, anterior open “bite”, or protruding incisors, we should consider a strategy to end the habit. The most effective strategies are individually designed by Dr. Smith –parent team. Since the pacifier is not attached to the child, we can exert a little more control. After infancy, use the pacifier only for sleep and real distress. Don’t automatically bring it everywhere with you. The ideal time for a child to be weaned from the pacifier is 8 to 15 months of age. A pacifier can also be a medical hazard, once the child has upper and lower front teeth they are capable of chewing through the pacifier with those sharp teeth and choking.
 

 When my child has an accident involving teeth what do I do?

If your child bumps a tooth and loosens it, it is out of its usual position, or is broken or lost you should call Dr. Smith as soon as possible (even after office hours). If your child cuts or bites their lip or cheek: Apply ice to injured areas to help control swelling. If there is bleeding, apply firm but gentle pressure with a cloth or gauze. When a child has had an injury to the inside of their month, it could look like a lot of blood, but remember that the blood is mixing with saliva and it is not as much as you may think. In some instances Dr. Smith will advise you what to do or ask you to come in. Since most children don’t get their permanent upper and lower teeth until they are about seven years of age, serious accidents before that are rare.

If the child knocked out a permanent tooth, try to find the tooth. Handle by the crown, not the root. You may rinse the tooth in water only. DO NOT clean with soap, scrub or handle the tooth unnecessarily. If the patient is old enough have them hold the tooth between their check and the lower teeth, if this is not possible place the tooth in a cup with milk. The patient needs to see Dr. Smith or another Dentist immediately. If your child chipped or fractured a permanent tooth the root could be fractured or the nerve of the tooth exposed. Please call Dr. Smith immediately on his emergency number.

Hospital emergency rooms do not know how to handle teeth issues, but if your child hit their head, needs stitches, or broke any bones go to the emergency room first.
 


PREVENTION

Care of Your Child’s Teeth & Gums

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Good Diet = Healthy Teeth

Pediatric Dentist - Nutritious FoodsHealthy 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.

What is a Cavity?

That’s the word no one wants to hear at the dentist’s office. A cavity develops when a tooth decays or breaks down. A cavity is a hole that can grow bigger and deeper over time. Cavities are also called dental caries and if you have a cavity, it is important to get it repaired.

Why would your tooth develop a hole? Blame plaque. That’s a sticky, slimy substance made up mostly of germs that cause tooth decay. The bacteria in your mouth makes acids and when plaque clings to your teeth the acids can eat away at the outermost layer of the tooth, called enamel.

If you don’t go to the dentist the acids can continue to make their way through the enamel, and create decay. If you’ve ever had a toothache or heard an adult complain about one, it may have been because there was a cavity that reached all the way inside a tooth where the nerve endings are. Ouch!

Dr. Smith will carefully examine your teeth and may take X-rays. If he discovers a cavity he can repair it for you (at another appointment), by first removing the damaged part of your tooth with a special instrument. Dr. Smith will then fill the hole in your tooth with a filling material.

Does it hurt? Sometimes it does, but Dr. Smith can give you an anesthetic. That’s a kind of medicine that will numb the area around the problem tooth while you’re getting the filling.
 

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

Even if your child brushes and flosses carefully, it is sometimes difficult and impossible-to clean the tiny grooves and pits in certain teeth. Food and bacteria build up in these crevices placing your child in danger of tooth decay. The teeth most at risk of decay are the six-year and twelve-year molars. Many times the permanent premolars and primary molars will also benefit from sealant coverage.

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. The sealant acts as a barrier to food, plaque, and acid, thus protecting the decay-prone areas of the teeth.

Sealants may last for many years if properly cared for. If your child has good oral hygiene and avoids biting hard objects (ice, hard candy, pencils and pens, etc.), sealants will last longer. Dr. Smith will check the sealants during your child’s routine dental visits every six months and will recommend re-application or repair when necessary.

Pediatric Dentist - Tooth  Before Sealant Application
Before Sealant Applied
Pediatric Dentist - Tooth After Sealant Application
After Sealant Applied

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Dental Fillings

Dental fillings are dental materials that have been used to repair a decayed tooth. The tooth is first prepared using dental instruments to remove the decay and create space for the dental material of choice – then the material is placed.

The restored tooth’s final appearance, longevity, cost, and preparation method, are all predetermined by what dental material is chosen.

Dental materials are grouped into three main categories: silver amalgam, composite resin and crowns. Each has its advantages and disadvantages, and where and when it can be used. Ask Dr. Smith if your situation provides you with any choices-the location and the size of the decay often limits your options.
 

Silver Amalgam

Amalgam is the dental material commonly seen in “silver fillings”. It is possibly the oldest and most thoroughly researched dental material.

Its advantages are abundant. It is strong, durable, and withstands biting forces amazingly well. It is easy to place, self-setting (does not require ultraviolet light), barely shrinks on setting, and has little leakage (bacteria cannot get through the filling-tooth interface to cause decay). It can be placed while the region is still wet (important in small children), and is the least expensive of all the dental materials.

While amalgam is clearly great, it does have significant limitations. Amalgam does contain traces of mercury, a toxic substance. Agencies like the FDA, and CDC, have not found evidence of harm from dental amalgam fillings. Ultimately though, the greatest drawback to amalgam is its appearance. Being silver, Dr. Smith will only use amalgam for back teeth, such as molars.
 

White Fillings (Composites)

A composite filling is a tooth colored quartz-like material. After tooth decay is removed and cleaned, this tooth colored material is placed and hardened or cured with a highly intense ultraviolet light, and the final surface is shaped and polished to match the tooth. The final restoration is virtually invisible.

Composite fillings are more than just attractive. They require minimal tooth preparation, in other words less healthy tooth structure is removed to restore the tooth. Also, a sealant is placed over the remaining exposed grooves of the tooth to minimize the risk of decay on another area of the tooth.

The investment in a composite filling is higher than that for a silver filling. This is due to the fact that the composite material is more expensive and the restoration is more difficult and time consuming to place. Also, on baby teeth, with cavities occurring between the teeth they are more likely to have recurrent decay, thus resulting in the need for replacement more often.
 

Fluoride

Fluoride is a natural element that can be found in many things, such as water, food, and toothpaste. Fluorides primary benefit is to remineralize tooth structure and make the teeth stronger and more resistant to an acid attack and decay (cavity).

Fluoride that is absorbed by the body is used by the cells that build your teeth to make enamel stronger. When placed topically it makes the crystals that form enamel more durable and more resistant to decay.

Dr. Smith recommends that topical fluoride (varnish) be placed every 6 months at your cleaning to be most effective.

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Pediatric Dentist - Mouth GuardsMouth 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. 
 


ADOLESCENT DENTISTRY

Pediatric Dentist - Teens

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 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.
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