Pediatric Dentistry

Pediatric Dentistry promotes the dental health of children as well as serves as educational resources for parents. It is important to establish a comprehensive and accessible ongoing relationship between the dentist and patient. This is because early oral examination aids in the detection of the early stages of tooth decay. Early detection is essential to maintain oral health, modify aberrant habits, and treat as needed and as simply as possible.

One of the most important components of pediatric dentistry is child psychology. Pediatric dentists are trained to create a friendly, fun, social atmosphere for visiting children, and always avoid threatening words like “drill,” “needle,” and “injection.” Dental phobias beginning in childhood often continue into adulthood, so it is of paramount importance that children have positive experiences and find their “dental home” as early as possible.

Pediatric dentists fulfill many important functions pertaining to the child’s overall oral health and hygiene. They place particular emphasis on the proper maintenance and care of deciduous (baby) teeth, which are instrumental in facilitating good chewing habits, proper speech production, and also hold space for permanent teeth.
Other important functions include:

Education – Pediatric dentists educate the child using models, computer technology, and child-friendly terminology; thus emphasizing the importance of keeping teeth strong and healthy. In addition, they advise parents on disease prevention, trauma prevention, good eating habits, and other aspects of the home hygiene routine.

Monitoring growth – By continuously tracking growth and development, pediatric dentists are able to anticipate dental issues and quickly intervene before they worsen. Also, working towards earlier corrective treatment preserves the child’s self-esteem and fosters a more positive self-image.

Prevention – Helping parents and children establish sound eating and oral care habits reduces the chances of later tooth decay. In addition to providing check ups and dental cleanings, pediatric dentists are also able to apply dental sealants and topical fluoride to young teeth, advise parents on thumb-sucking/pacifier/smoking cessation, and provide good demonstrations of brushing and flossing.

Intervention – In some cases, pediatric dentists may discuss the possibility of early oral treatments with parents. In the case of oral injury, malocclusion (bad bite), or bruxism (grinding), space maintainers may be fitted, a nighttime mouth guard may be recommended, or reconstructive surgery may be scheduled.

If you have questions or concerns about pediatric dentistry, please contact our office.

Pediatric oral care has two main components: preventative care at the pediatric dentist’s office and preventative care at home. Though infant and toddler caries (cavities) and tooth decay have become increasingly prevalent in recent years, a good dental strategy will eradicate the risk of both.

The goal of preventative oral care is to evaluate and preserve the health of the child’s teeth. Beginning at the age of twelve months, the American Dental Association (ADA) recommends that children begin to visit the pediatric dentist for “well baby” checkups. In general, most children should continue to visit the dentist every six months, unless instructed otherwise.

Though most parents primarily think of brushing and flossing when they hear the words “oral care,” good preventative care includes many more factors, such as:

Diet – Parents should provide children with a nourishing, well-balanced diet. Very sugary diets should be modified and continuous snacking should be discouraged. Oral bacteria ingest leftover sugar particles in the child’s mouth after each helping of food – emitting harmful acids that erode tooth enamel, gum tissue, and bone if left unchecked. Space out snacks where possible, and provide the child with non-sugary alternatives like celery sticks, carrot sticks, and low-fat yogurt.

Oral habits – Though pacifier use and thumb sucking generally cease over time, both can cause the teeth to misalign. If the child must use a pacifier, choose an “orthodontically” correct model. This will minimize the risk of developmental problems like narrow roof arches and crowding. The pediatric dentist can suggest a strategy (or provide a dental appliance) for thumb sucking cessation.

General oral hygiene – Sometimes, parents cleanse pacifiers and teething toys by sucking them. Parents may also share eating utensils with the child. Harmful oral bacteria are transmitted from parent-to-child in these ways, increasing the risk of early cavities and tooth decay. Instead, rinse toys and pacifiers with warm water and avoid spoon-sharing wherever possible.

Sippy cup use – Sippy cups are an excellent transitional aid for the baby bottle-to-adult drinking glass period. However, sippy cups filled with milk, breast milk, soda, juice, and sweetened water cause small amounts of sugary fluid to continually swill around young teeth – meaning continuous acid attacks on tooth enamel. Sippy cup use should be terminated between the ages of twelve and fourteen months – or whenever the child has the motor capabilities to hold a drinking glass.

Brushing – Children’s teeth should be brushed a minimum of two times per day using a soft bristled brush and a pea-sized amount of toothpaste. Parents should help with the brushing process until the child reaches the age of seven and is capable of reaching all areas of the mouth. Parents should always opt for ADA approved toothpaste (non-fluoridated before the age of two, and fluoridated thereafter). For babies, parents should rub the gum area with a clean cloth after each feeding.

Flossing – Cavities and tooth decay form more easily between teeth. Therefore, the child is at risk for between-teeth cavities wherever two teeth grow adjacent to each other. The pediatric dentist can help demonstrate correct head positioning during the flossing process, and suggest tips for making flossing more fun!

Fluoride – Fluoride helps prevent mineral loss and simultaneously promotes the remineralization of tooth enamel. Too much fluoride can result in fluorosis, a condition where white specks appear on the permanent teeth, and too little can result in tooth decay. It is important to get the fluoride balance correct. The pediatric dentist can evaluate how much the child is currently receiving and prescribe supplements if necessary.

If you have questions or concerns about how to care for your child’s teeth, please ask your pediatric dentist.

The pediatric dentist examines the teeth for signs of early decay, monitors orthodontic concerns, tracks jaw and tooth development, and provides a good resource for parents. In addition, the pediatric dentist has several tools at hand to further reduce the child’s risk for dental problems, such as topical fluoride and dental sealants.

During a routine visit to the dentist, the child’s mouth will be fully examined, the teeth will be professionally cleaned, topical fluoride may be coated onto the teeth to protect tooth enamel, and any parental concerns can be addressed. The pediatric dentist can demonstrate good brushing and flossing techniques, advise parents on dietary issues, provide strategies for thumb sucking and pacifier cessation, and communicate with the child on his or her level.

When molars emerge (usually between the ages of two and three), the pediatric dentist may coat them with dental sealant. This sealant covers the hard-to-reach fissures on the molars, sealing out bacteria, food particles and acid. Dental sealant may last for many months or many years, depending on the oral habits of the child. Dental sealant provides an important tool in the fight against tooth decay.

The eruption of primary teeth (also known as deciduous or baby teeth) follows a similar developmental timeline for most children. A full set of primary teeth begins to grow beneath the gums during the fourth month of pregnancy. For this reason, a nourishing prenatal diet is of paramount importance to the infant’s teeth, gums, and bones.

Generally, the first primary tooth breaks through the gums between the ages of six months and one year. By the age of three years old most children have a “full” set of twenty primary teeth. The American Dental Association (ADA) encourages parents to make a “well-baby” appointment with a pediatric dentist approximately six months after the first tooth emerges. Pediatric dentists communicate with parents and children about prevention strategies, emphasizing the importance of a sound, “no tears” daily home care plan.

Although primary teeth are deciduous, they facilitate speech production, proper jaw development, good chewing habits – and the proper spacing and alignment of adult teeth. Caring properly for primary teeth helps defend against painful tooth decay, premature tooth loss, malnutrition, and childhood periodontal disease.


IN WHAT ORDER DO PRIMARY TEETH EMERGE?
As a general rule-of-thumb, the first teeth to emerge are the central incisors (very front teeth) on the lower and upper jaws (6-12 months). These (and any other primary teeth) can be cleaned gently with a soft, clean cloth to reduce the risk of bacterial infection. The central incisors are the first teeth to be lost, usually between 6 and 7 years of age.

Next, the lateral incisors (immediately adjacent to the central incisors) emerge on the upper and lower jaws (9-16 months). These teeth are lost next, usually between 7 and 8 years of age. First molars, the large flat teeth towards the rear of the mouth then emerge on the upper and lower jaws (13-19 months). The eruption of molars can be painful. Clean fingers, cool gauzes, and teething rings are all useful in soothing discomfort and soreness. First molars are generally lost between 9 and 11 years of age.

Canine (cuspid) teeth then tend to emerge on the upper and lower jaws (16-23 months). Canine teeth can be found next to the lateral incisors, and are lost during preadolescence (10-12 years old). Finally, second molars complete the primary set on the lower and upper jaw (23-33 months). Second molars can be found at the very back of the mouth, and are lost between the ages of 10 and 12 years old.


WHAT ELSE IS KNOWN ABOUT PRIMARY TEETH?
Though each child is unique, baby girls generally have a head start on baby boys when it comes to primary tooth eruption. Lower teeth usually erupt before opposing upper teeth in both sexes.

Teeth usually erupt in pairs – meaning that there may be months with no new activity and months where two or more teeth emerge at once. Due to smaller jaw size, primary teeth are smaller than permanent teeth, and appear to have a whiter tone. Finally, an interesting mixture of primary and permanent teeth is the norm for most school-age children.

If you have questions or concerns about primary teeth, please contact your pediatric dentist.

According to AAPD (American Academy of Pediatric Dentistry) guidelines, infants should initially visit the pediatric dentist around the time of their first birthday. First visits can be stressful for parents, especially for parents who have dental phobias themselves.

It is imperative for parents to continually communicate positive messages about dental visits (especially the first one), and to help the child feel as happy as possible about visiting the dentist.

HOW CAN I PREPARE FOR MY CHILD’S FIRST DENTAL VISIT?
Pediatric dentists are required to undergo extensive training in child psychology. Their dental offices are generally colorful, child-friendly, and boast a selection of games, toys, and educational tools. Pediatric dentists (and all dental staff) aim to make the child feel as welcome as possible during all visits.

There are several things parents can do to make the first visit enjoyable. Some helpful tips are listed below:

Take another adult along for the visit – Sometimes infants become fussy when having their mouths examined. Having another adult along to soothe the infant allows the parent to ask questions and to attend to any advice the dentist may have.

Leave other children at home – Other children can distract the parent and cause the infant to fuss. Leaving other children at home (when possible) makes the first visit less stressful for all concerned.

Avoid threatening language – Pediatric dentists and staff are trained to avoid the use of threatening language, like drills, needles, injections, and bleeding. It is imperative for parents to use positive language when speaking about dental treatment with their child.

Provide positive explanations – It is important to explain the purposes of the dental visit in a positive way. Explaining that the dentist “helps to keep teeth healthy” is far better than explaining that the dentist “is checking for tooth decay, and may have to drill the tooth if decay is found.”

Explain what will happen – Anxiety can be vastly reduced if the child knows what to expect. Age-appropriate books about visiting the dentist can be very helpful in making the visit seem fun. Here is a list of parent and dentist-approved books:

  • The Berenstain Bears Visit the Dentist – by Stan and Jan Berenstain.
  • Show Me Your Smile: A Visit to the Dentist – Part of the “Dora the Explorer” Series.
  • Going to the Dentist – by Anne Civardi.
  • Elmo Visits the Dentist – Part of the “Sesame Street” Series.

WHAT WILL HAPPEN DURING THE FIRST VISIT?
There are several goals for the first dental visit. First, the pediatric dentist and the child need to get properly acquainted. Second, the dentist needs to monitor tooth and jaw development to get an idea of the child’s overall health history. Third, the dentist needs to evaluate the health of the existing teeth and gums. Finally, the dentist aims to answer questions and advise parents on how to implement a good oral care regimen.

The following sequence of events is typical of an initial “well baby checkup”:

  1. Dental staff will greet the child and parents.
  2. The infant/family health history will be reviewed (this may include questionnaires).
  3. The pediatric dentist will address parental questions and concerns.
  4. More questions will be asked, generally pertaining to the child’s oral habits, pacifier use, general development, tooth alignment, tooth development, and diet.
  5. The dentist will provide advice on good oral care, how to prevent oral injury, fluoride intake, and sippy cup use.
  6. The infant’s teeth will be examined. Generally, the dentist and parent sit facing each other. The infant is positioned so that his or her head is cradled in the dentist’s lap. This position allows the infant to look at the parent during the examination.
  7. Good brushing and flossing demonstrations will be provided.
  8. The state of the child’s oral health will be described in detail, and specific recommendations will be made. Recommendations usually relate to oral habits, appropriate toothpastes and toothbrushes for the child, orthodontically correct pacifiers, and diet.
  9. The dentist will detail which teeth may appear in the following months.
  10. The dentist will outline an appointment schedule and describe what will happen during the next appointment.

If you have questions or concerns about your child’s first dental visit, please contact the pediatric dentist.

Fluorine, a natural element in the fluoride compound, has proven to be effective in minimizing childhood cavities and tooth decay. Fluoride is a key ingredient in many popular brands of toothpaste, oral gel, and mouthwash, and can also be found in most community water supplies. Though fluoride is an important part of any good oral care routine, overconsumption can result in a condition known as fluorosis. The pediatric dentist is able to monitor fluoride levels, and check that children are receiving the appropriate amount.


HOW CAN FLUORIDE PREVENT TOOTH DECAY?
Fluoride fulfills two important dental functions. First, it helps to staunch mineral loss from tooth enamel, and second, it promotes the remineralization of tooth enamel.

When carbohydrates (sugars) are consumed, oral bacteria feed on them and produce harmful acids. These acids attack tooth enamel – especially in children who take medications or produce less saliva. Repeated acid attacks result in cavities, tooth decay, and childhood periodontal disease. Fluoride protects tooth enamel from acid attacks and reduces the risk of childhood tooth decay.

Fluoride is especially effective when used as part of a good oral hygiene regimen. Reducing the consumption of sugary foods, brushing and flossing regularly, and visiting the pediatric dentist biannually, all supplement the work of fluoride and keep young teeth healthy.


HOW MUCH FLUORIDE IS ENOUGH?
Since community water supplies and toothpastes usually contain fluoride, it is essential that children do not ingest too much. For this reason, children under the age of two should use an ADA-approved, non-fluoridated brand of toothpaste. Children between the ages of two and five years old should use a pea-sized amount of ADA-approved fluoridated toothpaste on a clean toothbrush twice each day. They should be encouraged to spit out any extra fluid after brushing. This part might take time, encouragement, and practice.

The amount of fluoride children ingest between the ages of one and four years old determines whether or not fluorosis occurs later. The most common symptom of fluorosis is white specks on the permanent teeth. Children over the age of eight years old are not considered to be at-risk for fluorosis, but should still use an ADA-approved brand of toothpaste.

DOES MY CHILD NEED FLUORIDE SUPPLEMENTS?
The pediatric dentist is the best person to decide whether a child needs fluoride supplements. First, the dentist will ask questions in order to determine how much fluoride the child is currently receiving, gain a general health history, and evaluate the sugar content in the child’s diet. If a child is not receiving enough fluoride and is determined to be at high-risk for tooth decay, an at-home fluoride supplement may be recommended.

Topical fluoride can also be applied to the tooth enamel quickly and painlessly during a regular office visit. There are many convenient forms of topical fluoride, including foam, liquids, varnishes, and gels. Depending on the age of the child and their willingness to cooperate, topical fluoride can either be held on the teeth for several minutes in specialized trays or painted on with a brush.

If you have questions or concerns about fluoride or fluorosis, please contact your pediatric dentist.

A child’s general level of health often dictates his or her oral health, and vice versa. Therefore, supplying children with a well-balanced diet is more likely to lead to healthier teeth and gums. A good diet provides the child with the many different nutrients he or she needs to grow. These nutrients are necessary for gum tissue development, strong bones, and to protect the child against certain illnesses.

According to the food pyramid, children need vegetables, fruits, meat, grains, beans, and dairy products to grow properly. These different food groups should be eaten in balance for optimal results.


HOW DOES MY CHILD’S DIET AFFECT HIS OR HER TEETH?
Almost every snack contains at least one type of sugar. Most often, parents are tempted to throw away candy and chocolate snacks – without realizing that many fruit snacks contain one (if not several) types of sugar or carbohydrate. When sugar-rich snacks are eaten, the sugar content attracts oral bacteria. The bacteria feast on food remnants left on or around the teeth. Eventually, feasting bacteria produce enamel-attacking acids.

When tooth enamel is constantly exposed to acid, it begins to erode – the result is childhood tooth decay. If tooth decay is left untreated for prolonged periods, acids begin to attack the soft tissue (gums) and even the underlying jawbone. Eventually, the teeth become prematurely loose or fall out, causing problems for emerging adult teeth – a condition known as childhood periodontal disease.

Regular checkups and cleanings at the pediatric dentist’s office are an important line of defense against tooth decay. However, implementing good dietary habits and minimizing sugary food and drink intake as part of the “home care routine” are equally important.


HOW CAN I ALTER MY CHILD’S DIET?
The pediatric dentist is able to offer advice and dietary counseling for children and parents. Most often, parents are advised to opt for healthier snacks, for example, carrot sticks, reduced fat yoghurt, and cottage cheese. In addition, pediatric dentists may recommend a fluoride supplement to protect tooth enamel – especially if the child lives in an area where fluoride is not routinely added to community water.

Parents should also ensure that children are not continuously snacking – even in a healthy manner. Lots of snacking means that sugars are constantly attaching themselves to teeth, and tooth enamel is constantly under attack. It is also impractical to try to clean the teeth after every snack, if “every snack” means every ten minutes!

Finally, parents are advised to opt for faster snacks. Mints and hard candies remain in the mouth for a long period of time – meaning that sugar is coating the teeth for longer. If candy is necessary, opt for a sugar-free variety, or a variety that can be eaten expediently.


SHOULD MY CHILD EAT STARCH-RICH FOODS?
It is important for the child to eat a balanced diet, so some carbohydrates and starches are necessary. Starch-rich foods generally include pretzels, chips, and peanut butter and jelly sandwiches. Since starches and carbohydrates break down to form sugar, it is best that they are eaten as part of a meal (when saliva production is higher), than as a standalone snack. Provide plenty of water at mealtimes (rather than soda) to help the child rinse sugary food particles off the teeth.

As a final dietary note, avoid feeding your child sticky foods if possible. It is incredibly difficult to remove stickiness from the teeth – especially in younger children who tend not to be as patient during brushing.
If you have questions or concerns about your child’s general or oral health, please contact your pediatric dentist.

The American Academy of Pediatric Dentists (AAPD) advises parents to make biannual dental appointments for children, beginning approximately six months after the first tooth emerges.

These two important yearly visits allow the pediatric dentist to monitor new developments in the child’s mouth, evaluate changes in the condition of teeth and gums, and continue to advise parents on good oral care strategies.

The pediatric dentist may schedule additional visits for children who are particularly susceptible to tooth decay or who show early signs of orthodontic problems.


WHAT IS THE PURPOSE OF DENTAL CHECKUPS?
First, the pediatric dentist aims to provide a “good dental home” for the child. If a dental emergency does arise, parents can take the child for treatment at a familiar, comfortable location.

Second, the pediatric dentist keeps meticulous records of the child’s ongoing dental health and jaw development. In general, painful dental conditions do not arise overnight. If the pediatric dentist understands the child’s dental health history, it becomes easier to anticipate future issues and intervene before they arise.

Third, the pediatric dentist is able to educate parents and children during the visit. Sometimes the pediatric dentist wants to introduce one or several factors to enhance tooth health – for example, sealants, fluoride supplements, or xylitol. Other times, the pediatric dentist asks parents to change the child’s dietary or oral behavior – for example, reducing sugar in the child’s diet, removing an intraoral piercing, or even transitioning the child from sippy cups to adult-sized drinking glasses.

Finally, dental X-rays are often the only way to identify tiny cavities in primary (baby) teeth. Though the child may not be feeling any pain, left unchecked, these tiny cavities can rapidly turn into large cavities, tooth decay, and eventually, childhood periodontal disease. Dental X-rays are only used when the pediatric dentist suspects cavities or orthodontic irregularities.


ARE CHECKUPS NECESSARY IF MY CHILD HAS HEALTHY TEETH?
The condition of a child’s teeth can change fairly rapidly. Even if the child’s teeth were evaluated as healthy just six months prior, changes in diet or oral habits (for example, thumb sucking) can quickly render them vulnerable to decay or misalignment.

In addition to visual examinations, the pediatric dentist provides thorough dental cleanings during each visit. These cleanings eradicate the plaque and debris that can build up between teeth and in other hard to reach places. Though a good homecare routine is especially important, these professional cleanings provide an additional tool to keep smiles healthy.
The pediatric dentist is also able to monitor the child’s fluoride levels during routine visits. Oftentimes, a topical fluoride gel or varnish is applied to teeth after the cleaning. Topical fluoride remineralizes the teeth and staunches mineral loss, protecting tooth enamel from oral acid attacks. Some children are also given take-home fluoride supplements (especially those residing in areas where fluoride is not routinely added to the community water supply).

Finally, the pediatric dentist may apply dental sealants to the child’s back teeth (molars). This impenetrable liquid plastic substance is brushed onto the molars to seal out harmful debris, bacteria, and acid.
If you have questions or concerns about when to schedule your child’s dental checkups please contact your pediatric dentist.


HOW MUCH FLUORIDE IS ENOUGH?
Since community water supplies and toothpastes usually contain fluoride, it is essential that children do not ingest too much. For this reason, children under the age of two should use an ADA-approved, non-fluoridated brand of toothpaste. Children between the ages of two and five years old should use a pea-sized amount of ADA-approved fluoridated toothpaste on a clean toothbrush twice each day. They should be encouraged to spit out any extra fluid after brushing. This part might take time, encouragement, and practice.

The amount of fluoride children ingest between the ages of one and four years old determines whether or not fluorosis occurs later. The most common symptom of fluorosis is white specks on the permanent teeth. Children over the age of eight years old are not considered to be at-risk for fluorosis, but should still use an ADA-approved brand of toothpaste.

Childhood cavities, also known as childhood tooth decay and childhood caries, are common in children all over the world. There are two main causes of cavities: poor dental hygiene and sugary diets.

Cavities can be incredibly painful, often leading to tooth decay and childhood periodontitis if left untreated. Ensuring that children eat a balanced diet, embarking on a sound home oral care routine, and visiting the pediatric dentist biannually, are all crucial factors for both cavity prevention and excellent oral health.

WHAT CAUSES CAVITIES?
Cavities form when children’s teeth are exposed to sugary foods on a regular basis. Sugars and carbohydrates (like the ones found in white bread) collect on and around the teeth after eating. A sticky film (plaque) then forms on the tooth enamel. The oral bacteria within the plaque continually ingest sugar particles and emit acid. Initially, the acid attacks the tooth enamel, weakening it and leaving it vulnerable to tooth decay. If conditions are allowed to worsen, the acid begins to penetrate the tooth enamel and erodes the inner workings of the tooth.
Although primary (baby) teeth are eventually lost, they fulfill several important functions and should be protected. It is essential that children brush and floss twice per day (ideally more), and visit the dentist for biannual cleanings. Sometimes the pediatric dentist coats teeth with a sealant and provides fluoride supplements to further bolster the mouth’s defenses.

HOW WILL I KNOW IF MY CHILD HAS A CAVITY?
Large cavities can be excruciatingly painful, whereas tiny cavities may not be felt at all. Making matters even trickier, cavities sometimes form between the teeth, making them invisible to the naked eye. Dental X-rays and the dentist’s trained eyes help pinpoint even the tiniest of cavities so they can be treated before they worsen.
Some of the major symptoms of cavities include:
Heightened sensitivity to cool or warm foods
Nighttime waking and crying
Pain
Sensitivity to spicy foods
Toothache
If a child is experiencing any of these symptoms, it is important to visit the pediatric dentist. Failure to do so will make the problem worse, leave the child in pain, and could possibly jeopardize a tooth that could have been treated.

HOW CAN I PREVENT CAVITIES AT HOME?
Biannual visits with the pediatric dentist are only part of the battle against cavities. Here are some helpful guidelines for cavity prevention:

  1. Analyze the diet – Too many sugary or starchy snacks can expedite cavity formation. Replace sugary snacks like candy with natural foods where possible, and similarly replace soda with water.
  2. Cut the snacks – Snacking too frequently can unnecessarily expose teeth to sugars. Save the sugar and starch for mealtimes, when the child is producing more saliva, and drinking water. Make sure they consume enough water to cleanse the teeth.
  3. Lose the sippy cup – Sippy cups are thought to cause “baby bottle tooth decay” when they are used beyond the intended age (approximately twelve months). The small amount of liquid emitted with each sip causes sugary liquid to continually swill around the teeth.
  4. Avoid stickiness – Sticky foods (like toffee) form plaque quickly, and are extremely difficult to pry off the teeth. Avoid them where possible.
  5. Rinse the pacifier – Oral bacteria can be transmitted from mother or father to baby. Rinse a dirty pacifier with running water as opposed to sucking on it, to avoid contaminating the baby’s mouth.
  6. Drinks at bedtime – Sending a child to bed with a bottle or sippy cup is bad news. The milk, formula, juice, or sweetened water basically sits on the teeth all night – attacking enamel and maximizing the risk of cavities. Ensure the child has a last drink before bedtime, and then brush the teeth.
  7. Don’t sweeten the pacifier – Parents sometimes dip pacifiers in honey to calm a cranky child. Do not be tempted to do this. Use a blanket, toy, or hug to calm the child instead.
  8. Brush and floss – Parents should brush and floss their child’s teeth twice each day until the child reaches the age of seven years old. Before this time, children struggle to brush every area of the mouth effectively.
  9. Check on fluoride –When used correctly, fluoride can strengthen tooth enamel and help stave off cavities. Too much or too little fluoride can actually harm the teeth, so ask the pediatric dentist for a fluoride assessment.
  10. Keep to appointments – The child’s first dental visit should be scheduled around his or her first birthday, as per the American Academy of Pediatric Dentistry (AAPD) guidelines. Keep to a regular appointment schedule to create healthy smiles!

If you have questions or concerns about cavity prevention, please contact your pediatric dentist.

Though many parents think of “teenagers” when presented with the term “dental appliances,” the use of such appliances in young children is very common. Some dental appliances may be recommended for preventative purposes, while others may be recommended for treatment purposes.
It can be extremely difficult to encourage young children to wear removable dental appliances regularly, but there is some good news. Pediatric dental appliances can prevent injury to the teeth and may also reduce (or even eliminate) the need for extensive treatment later.


WHAT TYPES OF PEDIATRIC DENTAL APPLIANCE ARE MOST COMMON?
There are many types of pediatric dental appliances – each one fulfilling a different dental function. The major categories of pediatric dental appliance are described below:

Mouth Guards – The American Academy of Pediatric Dentistry (AAPD) and American Dental Association (ADA) recommend that children wear mouth guards when engaging in any potentially injurious activity, including sporting and recreational endeavors.

The pediatric dentist can craft a customized mouth guard for the child, or a thermoplastic “boil-and-bite” mouth guard can be purchased at a sporting goods store. Similar mouth guards are used for children who “brux” or grind their teeth at night.

Space Maintainers – Sometimes, primary (baby) teeth are lost prematurely due to trauma or decay. Adjacent teeth tend to shift to fill the space, causing spacing and alignment problems for permanent (adult) teeth. Space maintainers or “spacers” are inserted as placeholders until the permanent teeth are ready to erupt. There are two main types of space maintainer:

Fixed Space Maintainers – Depending on the position of the missing tooth and the condition of the surrounding teeth, the pediatric dentist may adhere a “band and loop,” a “crown and loop,” or a “distal shoe” type of spacer to fill the empty gap. All spacers fulfill the same function; just the nature of the attachment to the adjacent teeth differs. Fixed spacers are usually made of metal and are highly durable. If a highly visible tooth is missing, an acrylic button may be added to reduce the esthetic impact.

Removable space maintainers – Removable spacers are rarely used with young children. Working a little like orthodontic retainers, special plastic parts fit into the empty slot to prevent the “drifting” of adjacent teeth.

Thumb Sucking Appliances – The majority of children naturally outgrow their thumb-sucking habit. However, children who continue to thumb suck after the age of five or six (especially vigorously) risk oral complications. These complications include: narrowed arches, impacted teeth, and misaligned teeth.

The “palatal crib” appliance usually stops thumb sucking immediately. The “crib” is crafted and affixed to the teeth by the pediatric dentist, almost like a barely visible set of dental braces. Preventing the thumb from reaching the roof of the mouth reduces gratification – and breaks the habit very quickly. Removable variations of the “crib” are also available, and can be used depending on the age of the child and his or her willingness to cooperate.

Expansion Appliances – An overbite, where the upper front teeth protrude over the lower front teeth, can be corrected with an expansion appliance, as can a crossbite. The expansion appliance is used to stretch and widen the arch, providing enough space for the teeth to be realigned in a straight manner. Expansion appliances are custom-made, and can be affixed to the inside or the outside of the teeth. Children born with a cleft palate may be required to wear an expansion appliance to prepare the jaw for oral surgery.

Bionator – If the pediatric dentist suspects that the child’s jaws are not growing in proportion to one another, a bionator device may be recommended. In general, the bionator positions the lower jaw forward, helping the teeth to erupt and align properly. This dental appliance is successful in reducing extensive orthodontic treatments later on, and helps to promote natural-looking alignment.

If you have questions or concerns about dental appliances, please contact your pediatric dentist.

Tooth decay has become increasingly prevalent in preschoolers. Not only is tooth decay unpleasant and painful, it can also lead to more serious problems like premature tooth loss and childhood periodontal disease.

Dental sealants are an important tool in preventing childhood caries (cavities) and tooth decay. Especially when used in combination with other preventative measures, like biannual checkups and an excellent daily home care routine, sealants can bolster the mouth’s natural defenses, and keep smiles healthy.


HOW DO SEALANTS PROTECT CHILDREN’S TEETH?
In general, dental sealants are used to protect molars from oral bacteria and harmful oral acids. These larger, flatter teeth reside toward the back of the mouth and can be difficult to clean. Molars mark the site of four out of five instances of tooth decay. Decay-causing bacteria often inhabit the nooks and crannies (pits and fissures) found on the chewing surfaces of the molars. These areas are extremely difficult to access with a regular toothbrush.

If the pediatric dentist evaluates a child to be at high risk for tooth decay, he or she may choose to coat additional teeth (for example, bicuspid teeth). The sealant acts as a barrier, ensuring that food particles and oral bacteria cannot access vulnerable tooth enamel.

Dental sealants do not enhance the health of the teeth directly, and should not be used as a substitute for fluoride supplements (if the dentist has recommended them) or general oral care. In general however, sealants are less costly, less uncomfortable, and more aesthetically pleasing than dental fillings.


HOW ARE SEALANTS APPLIED?
Though there are many different types of dental sealant, most are comprised of liquid plastic. Initially, the pediatric dentist must thoroughly clean and prepare the molars, before painting sealant on the targeted teeth. Some sealants are bright pink when wet and clear when dry. This bright pink coloring enables the dentist to see that all pits and fissures have been thoroughly coated.

When every targeted tooth is coated to the dentist’s satisfaction, the sealant is either left to self-harden or exposed to blue spectrum natural light for several seconds (depending on the chemical composition of the specific brand). This specialized light works to harden the sealant and cure the plastic. The final result is a clear (or whitish) layer of thin, hard, durable sealant.

It should be noted that the “sealing” procedure is easily completed in one office visit, and is entirely painless.


WHEN SHOULD SEALANTS BE APPLIED?
Sealants are usually applied when the primary (baby) molars first emerge. Depending on the oral habits of the child, the sealants may last for the life of the primary tooth, or need replacing several times. Essentially, sealant durability depends on the oral habits of the individual child.

Pediatric dentists recommend that permanent molars be sealed as soon as they emerge. In some cases, sealant can be applied before the permanent molar is full grown.

The health of the sealant must be monitored at biannual appointments. If the seal begins to lift off, food particles may become trapped against the tooth enamel, actually causing tooth decay.

Evaluating the many brands of oral products claiming to be “best for children” can be an overwhelming task. Selecting an appropriately sized toothbrush and a nourishing, cleansing brand of children’s toothpaste is of paramount importance for maintaining excellent oral health.


WHY BRUSH PRIMARY TEETH?
The importance of maintaining the health of primary (baby) teeth is often understated. Primary teeth are essential for speech production, chewing, jaw development, and they also facilitate the proper alignment and spacing of permanent adult teeth. Brushing primary teeth prevents bad breath and tooth decay, and also removes the plaque bacteria associated with childhood periodontal disease.


WHAT DIFFERENCES ARE THERE AMONG TOOTHPASTE BRANDS?
Though all toothpastes are not created equal, most brands generally contain abrasive ingredients to remove stains, soapy ingredients to eliminate plaque, fluorides to strengthen tooth enamel, and some type of pleasant-tasting flavoring.

The major differences between brands are the thickness of the paste, the level of fluoride content, and the type of flavoring. Although fluoride strengthens enamel and repels plaque bacteria, too much of it can actually harm young teeth – a condition known as dental fluorosis. Children between the ages of one and four years old are most at risk for this condition, so fluoride levels should be carefully monitored during this time.

Be aware that adult and non-ADA approved brands of toothpaste often contain harsher abrasives, which remove tooth enamel and weaken primary teeth. In addition, some popular toothpaste brands contain sodium lauryl sulfate (shown as “SLS” on the package), which cause painful mouth ulcers in some children.


SO WHICH TOOTHPASTE BRAND SHOULD I CHOOSE?
The most important considerations to make before implementing an oral care plan and choosing a toothpaste brand is the age of the child. Home oral care should begin before the emergence of the first tooth. A cool clean cloth should be gently rubbed along the gums after feeding to remove food particles and bacteria.

Prior to the age of two, the child will have many teeth and brushing should begin. Initially, select fluoride-free “baby” toothpaste and softly brush the teeth twice per day. Flavoring is largely unimportant, so the child can play an integral role in choosing whatever type of toothpaste tastes most pleasant.

Between the middle and the end of the third year, select an American Dental Association (ADA) accepted brand of toothpaste containing fluoride. The ADA logo is clear and present on toothpaste packaging, so be sure to check for it. Use only a tiny pea or rice-sized amount of fluoride toothpaste, and encourage the child to spit out the excess after brushing. Eliminating the toothpaste takes practice, patience, and motivation – especially if the child finds the flavoring tasty. If the child does ingest tiny amounts of toothpaste, don’t worry; this is perfectly normal and will cease with time and encouragement.

Dental fluorosis is not a risk factor for children over the age of eight, but an ADA accepted toothpaste is always the recommended choice for children of any age.

If you have questions or concerns about choosing an appropriate brand of toothpaste for your child, your pediatric dentist will be happy to make recommendations.

The American Academy of Pediatric Dentistry (AAPD) suggests that parents should make an initial “well-baby” appointment with a pediatric dentist approximately six months after the emergence of the first tooth, or no later than the child’s first birthday.

Although this may seem surprisingly early, the incidence of infant and toddler tooth decay has been rising in recent years. Tooth decay and early cavities can be exceptionally painful if they are not attended to immediately, and can also set the scene for poor oral health in later childhood.

The pediatric dentist is a specialist in child psychology and child behavior, and should be viewed as an important source of information, help, and guidance. Oftentimes, the pediatric dentist can provide strategies for eliminating unwanted oral habits (for example, pacifier use and thumb sucking) and can also help parents in establishing a sound daily oral routine for the child.


WHAT POTENTIAL DENTAL PROBLEMS CAN BABIES EXPERIENCE?
A baby is at risk for tooth decay as soon as the first tooth emerges. During the first visit, the pediatric dentist will help parents implement a preventative strategy to protect the teeth from harm, and also demonstrate how infant teeth should be brushed and flossed.

In particular, infants who drink breast milk, juice, baby formula, soda, or sweetened water from a baby bottle or sippy cup are at high-risk for early childhood caries (cavities). To counteract this threat, the pediatric dentist discourages parents from filling cups with sugary fluids, dipping pacifiers in honey, and transmitting oral bacteria to the child via shared spoons and/or cleaning pacifiers in their own mouths.

Importantly, the pediatric dentist can also assess and balance the infant’s fluoride intake. Too much fluoride ingestion between the ages of one and four years old may lead to a condition known as fluorosis in later childhood. Conversely, too little fluoride may render young tooth enamel susceptible to tooth decay.


WHAT HAPPENS DURING THE FIRST VISIT?
Pediatric dentists have fun-filled, stimulating dental offices. All dental personnel are fully trained to communicate with infants and young children.

During the initial visit, the pediatric dentist will advise parents to implement a good oral care routine, ask questions about the child’s oral habits, and examine the child’s emerging teeth. The pediatric dentist and parent sit knee-to-knee for this examination to enable the child to view the parent at all times. If the infant’s teeth appear stained, the dentist may clean them. Oftentimes, a topical fluoride treatment will be applied to the teeth after this cleaning.


WHAT QUESTIONS MAY THE PEDIATRIC DENTIST ASK DURING THE FIRST VISIT?
The pediatric dentist will ask questions about current oral care, diet, the general health of the child, the child’s oral habits, and the child’s current fluoride intake.

Once answers to these questions have been established, the pediatric dentist can advise parents on the following issues:

  • Accident prevention.
  • Adding xylitol and fluoride to the infant’s diet.
  • Choosing an ADA approved, non-fluoridated brand of toothpaste for the infant.
  • Choosing an appropriate toothbrush.
  • Choosing an orthodontically correct pacifier.
  • Correct positioning of the head during tooth brushing.
  • Easing the transition from sippy cup to adult-sized drinking glasses (12-14 months).
  • Eliminating fussing during the oral care routine.
  • Establishing a drink-free bedtime routine.
  • Maintaining good dietary habits.
  • Minimizing the risk of tooth decay.
  • Reducing sugar and carbohydrate intake.
  • Teething and developmental milestones.

The initial growth period for primary (baby) teeth begins in the second trimester of pregnancy (around 16-20 weeks). During this time, it is especially important for expectant mothers to eat a healthy, nutritious diet, since nutrients are needed for bone and soft tissue development.

Though there are some individual differences in the timing of tooth eruption, primary teeth usually begin to emerge when the infant is between six and eight months old. Altogether, a set of twenty primary teeth will emerge by the age of three.

The American Academy of Pediatric Dentistry (AAPD) recommends a first “well-baby” dental visit around the age of twelve months (or six months after the first tooth emerges). This visit acquaints the infant with the dental office, allows the pediatric dentist to monitor development, and provides a great opportunity for parents to ask questions.


WHICH TEETH EMERGE FIRST?
In general, teeth emerge in pairs, starting at the front of the infant’s mouth. Between the ages of six and ten months, the two lower central incisors break through. Remember that cavities may develop between two adjacent teeth, so flossing should begin at this point.

Next (and sometimes simultaneously), the two upper central incisors emerge – usually between the ages of eight and twelve months. Teething can be quite an uncomfortable process for the infant. Clean teething rings and cold damp cloths can help ease the irritation and discomfort.

Between the ages of nine and sixteen months the upper lateral incisors emerge – one on either side of the central incisors. Around the same time, the lower lateral incisors emerge, meaning that the infant has four adjacent teeth on the lower and upper arches. Pediatric dentists suggest that sippy cup usage should end when the toddler reaches the age of fourteen months. This minimizes the risk of “baby bottle tooth decay.”

Eight more teeth break through between the ages of thirteen and twenty three months. On each arch, a cuspid or canine tooth will appear immediately adjacent to each lateral incisor. Immediately behind (looking towards the back of the child’s mouth), first molars will emerge on either side of the canine teeth on both jaws.

Finally, a second set of molars emerges on each arch – usually beginning on the lower arch. Most children have a complete set of twenty primary teeth before the age of thirty-three months. The pediatric dentist generally applies dental sealant to the molars, to lock out food particles, bacteria, and enamel-attacking acids.


HOW CAN I REDUCE THE RISK OF EARLY CARIES (CAVITIES)?
Primary teeth preserve space for permanent teeth and guide their later alignment. In addition, primary teeth help with speech production, prevent the tongue from posturing abnormally, and play an important role in the chewing of food. For these reasons, it is critically important to learn how to care for the child’s emerging teeth.

Here are some helpful tips:

  1. Brush twice each day – The AAPD recommends a pea-sized amount of ADA approved (non-fluoridated) toothpaste for children under two years old, and the same amount of an ADA approved (fluoridated) toothpaste for children over this age. The toothbrush should be soft-bristled and appropriate for infants.
  2. Start flossing – Flossing an infant’s teeth can be difficult but the process should begin when two adjacent teeth emerge. The pediatric dentist will happily demonstrate good flossing techniques.
  3. Provide a balanced diet – Sugars and starches feed oral bacteria, which produce harmful acids and attack tooth enamel. Ensure that the child is eating a balanced diet and work to reduce sugary and starchy snacks.
  4. Set a good example – Children who see parents brushing and flossing are often more likely to follow suit. Explain the importance of good oral care to the child; age-appropriate books often help with this.
  5. Visit the dentist – The pediatric dentist monitors oral development, provides professional cleanings, applies topical fluoride to the teeth, and coats molars with sealants. Biannual trips to the dental office can help to prevent a wide range of painful conditions later.

If you have questions or concerns about the emergence of your child’s teeth, please contact your pediatric dentist.

Primary teeth, also known as “baby teeth” or “deciduous teeth,” begin to develop beneath the gums during the second trimester of pregnancy. Teeth begin to emerge above the gums approximately six months to one year after birth. Typically, preschool children have a complete set of 20 baby teeth – including four molars on each arch.

One of the most common misconceptions about primary teeth is that they are irrelevant to the child’s future oral health. However, their importance is emphasized by the American Dental Association (ADA), which urges parents to schedule a “baby checkup” with a pediatric dentist within six months of the first tooth emerges.


WHAT ARE THE FUNCTIONS OF PRIMARY TEETH?
Primary teeth can be painful to acquire. To soothe tender gums, biting on chewing rings, wet gauze pads, and clean fingers can be helpful. Though most three-year-old children have a complete set of primary teeth, eruption happens gradually – usually starting at the front of the mouth.

The major functions of primary teeth are described below:
Speech production and development – Learning to speak clearly is crucial for cognitive, social, and emotional development. The proper positioning of primary teeth facilitates correct syllable pronunciation and prevents the tongue from straying during speech formation.

Eating and nutrition – Children with malformed or severely decayed primary teeth are more likely to experience dietary deficiencies, malnourishment, and to be underweight. Proper chewing motions are acquired over time and with extensive practice. Healthy primary teeth promote good chewing habits and facilitate nutritious eating.

Self-confidence – Even very young children can be quick to point out ugly teeth and crooked smiles. Taking good care of primary teeth can make social interactions more pleasant, reduce the risk of bad breath, and promote confident smiles and positive social interactions.

Straighter smiles – One of the major functions of primary teeth is to hold an appropriate amount of space for developing adult teeth. In addition, these spacers facilitate the proper alignment of adult teeth and also promote jaw development. Left untreated, missing primary teeth cause the remaining teeth to “shift” and fill spaces improperly. For this reason, pediatric dentists often recommend space-maintaining devices.

Excellent oral health – Badly decayed primary teeth can promote the onset of childhood periodontal disease. As a result of this condition, oral bacteria invade and erode gums, ligaments, and eventually bone. If left untreated, primary teeth can drop out completely – causing health and spacing problems for emerging permanent teeth. To avoid periodontal disease, children should practice an adult-guided oral care routine each day, and infant gums should be rubbed gently with a clean, damp cloth after meals.

If you have questions or concerns about primary teeth, please contact your pediatric dentist.


WHAT HAPPENS DURING THE FIRST VISIT?
Pediatric dentists have fun-filled, stimulating dental offices. All dental personnel are fully trained to communicate with infants and young children.

During the initial visit, the pediatric dentist will advise parents to implement a good oral care routine, ask questions about the child’s oral habits, and examine the child’s emerging teeth. The pediatric dentist and parent sit knee-to-knee for this examination to enable the child to view the parent at all times. If the infant’s teeth appear stained, the dentist may clean them. Oftentimes, a topical fluoride treatment will be applied to the teeth after this cleaning.


WHAT QUESTIONS MAY THE PEDIATRIC DENTIST ASK DURING THE FIRST VISIT?
The pediatric dentist will ask questions about current oral care, diet, the general health of the child, the child’s oral habits, and the child’s current fluoride intake.

Once answers to these questions have been established, the pediatric dentist can advise parents on the following issues:

  • Accident prevention.
  • Adding xylitol and fluoride to the infant’s diet.
  • Choosing an ADA approved, non-fluoridated brand of toothpaste for the infant.
  • Choosing an appropriate toothbrush.
  • Choosing an orthodontically correct pacifier.
  • Correct positioning of the head during tooth brushing.
  • Easing the transition from sippy cup to adult-sized drinking glasses (12-14 months).
  • Eliminating fussing during the oral care routine.
  • Establishing a drink-free bedtime routine.
  • Maintaining good dietary habits.
  • Minimizing the risk of tooth decay.
  • Reducing sugar and carbohydrate intake.
  • Teething and developmental milestones.