Pediatric Dentists complete extra two to three years of specialized training after dental school and are best qualified to care for children of all ages, from infancy to adolescence, as all ages need different approaches. Pediatric Dentists help you and your child develop and maintain healthy habits and smiles until they are ready to move on to a general dentist.
Yes!! Research has shown that mothers with poor oral health may be at a greater risk of passing cavity-causing bacteria to their children. Periodontal (gum) disease can increase the risk of preterm birth and low birth weight. The American Academy of Pediatric Dentistry (AAPD) recommends that all pregnant women continue to visit the dentist for checkups during pregnancy and maintain good oral care at home.
To decrease the risk of spreading the bacteria, mothers should visit their dentist regularly, floss and brush two times daily, maintain a healthy diet full of natural fiber, and reduce sugary foods. Additionally, increasing water intake and using fluoridated toothpaste helps prevent cavities and improves oral health.
Our office, as well as The American Academy of Pediatric Dentistry (AAPD) and The American Academy of Pediatrics (AAP) recommends taking your child to their first dental appointment and establishing a dental home by the age of one or shortly after the first tooth erupts.
Children’s teeth begin forming before birth. Your child’s first tooth will typically erupt between 4-6 months, although it is completely normal to see teeth earlier or later . Usually, the two bottom front teeth – the central incisors – erupt first, followed by the upper front teeth – called the central and lateral incisors. Your child should have their first full set of teeth by their third birthday.
Most children have 20 primary, or baby teeth. Typically, there are 10 upper teeth and 10 lower teeth. These 20 primary teeth are eventually replaced by 32 permanent teeth, 16 in the upper jaw and 16 in the lower jaw.
The eruption of the permanent molars usually happens between ages 6 and 7. Therefore these teeth are often referred to as the “six-year molars”. These molars erupt behind the baby molars. Many children will have 28 of their permanent teeth by age 13. These teeth include eight incisors, eight premolars, eight molars, and four canines.
The last teeth to develop are the third molars, better known as “wisdom teeth”. These teeth generally begin to erupt between the ages of 17 and 21 however often become impacted and fail to erupt properly due to lack of space. Due to these teeth being located so far back in the mouth, they can be difficult to clean. These teeth often require removal to prevent any issues or damage to adjacent teeth.
Please see the “Tooth Eruption Charts” below for reference.
Baby, or primary, teeth are important for (1) proper chewing and nutrition (2) holding space for the permanent teeth and guiding them into the correct position (3) facilitating normal development of the jaws and (4) affecting development of speech and appearance. Often the last baby tooth will not fall out until early teenage years. If a baby tooth is lost too early or has neglected cavities this will lead to problems in these areas.
One of the most common forms of early childhood caries is “baby bottle tooth decay,” which is caused by the frequent or continuous exposure of a baby’s teeth to liquids containing sugar: milk (including breast milk), formula, fruit juice etc. Baby bottle tooth decay primarily affects the upper front teeth, but other teeth may also be affected.
Early symptoms of baby bottle tooth decay are white spots on the surface of teeth or at the gum line which can progress to brown or black spots on teeth, bleeding or swollen gums, infection, fever, and bad breath. If your child shows any of these symptoms, you need to see your pediatric dentist immediately to prevent further, more complicated problems from occurring.
1 – Don’t send your child to bed with a bottle of anything EXCEPT water. Liquids containing sugar (even milk or breastmilk) can pool around the teeth and cause cavities.
2 – If you child must nurse or use a bottle at night gently brush teeth after to avoid sugars staying on teeth while they sleep.
3 – Gently brush your child’s first teeth 2 times per day with the proper amount of fluoride toothpaste.
4 – Limit sugary drinks and food.
If your child has a toothache, gently brush and floss to keep the area clean and have them have them rinse their mouth with warm water to ease the pain. If the pain persists for more than 24 hours, contact your pediatric dentist. Persistent toothaches can indicate more serious problems that need to be observed by a dental professional.
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 as this can damage vital tissue on it. If the tooth looks whole, 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 (ideal) or milk. The patient must see a dentist IMMEDIATELY! Time is a critical factor in saving the tooth. Ideally the tooth should be reimplanted in less than 60 minutes, the quicker the tooth is placed back into the socket the better the prognosis.
DO NOT reimplant the tooth, this can damage the permanent tooth. Contact your pediatric dentist during business hours. This is not usually an emergency, and in most cases no treatment is necessary however it should still be evaluated to rule out any other issues.
If the fracture is large enough that the tooth itself is bleeding or your child is experiencing significant pain, contact your pediatric dentist immediately. Rinse the mouth with water and apply cold compresses to reduce swelling. If it is a permanent tooth save any broken tooth fragments, store them in a cup of the child’s own spit and bring them with you to the dentist as sometimes it can be reattached.. If the fracture is very small and your child is not in any discomfort you can call the office during business hours.
Why are Dental Radiographs (X-Rays) Important?
Looks great right?…Well look again…there are cavities between the teeth that you could not see by looking in the mouth!
Radiographs are valuable and necessary aids to diagnose and treat conditions that cannot be seen by looking in the mouth. Radiographs can detect much more than cavities. Radiographs can show erupting teeth, diagnose bone diseases, assess an injury and help with the planning of orthodontic treatment. If dental problems are found and treated early, dental care is more comfortable and less invasive for your child and more affordable for you.
With current safeguards and equipment the amount of radiation from a dental radiograph is extremely small. The routine cavity checking radiographs produce less radiation that you would receive while flying on an airplane. Today’s equipment filters out unnecessary exposure and restricts the x-ray beam to the area of interest to limit the body’s exposure. Dental radiographs represent a far smaller risk than an undetected and untreated dental disease and problems.
Developing malocclusion, or bad bites, can be recognized as early as 2-3 years of age. Often, preventative steps can be taken to help reduce the need for major orthodontic treatment later on.
All baby teeth: the main concern would be habits, such as finger or thumb sucking and early loss of primary teeth due to cavities or trauma.
During mixed dentition (both baby and permanent teeth- targeted treatment for jaw and dental alignment problems to create a better foundation for the remainder of the permanent teeth to erupt and prevent damage to any permanent teeth due to a bad bite. This is a great time to start treatment, as your child’s growing hard and soft tissues are usually very responsive to orthodontic or orthopedic forces.
All permanent teeth: This would be the time for full braces and final alignment off all the permanent teeth.
When adult teeth come in behind the baby teeth it is often called “Shark Teeth”. It is common and occurs as the result of a lower baby tooth not falling out when the permanent tooth is arriving. In most cases, the baby tooth will fall out on its own within a couple of months. If it does not fall out contact your pediatric dentist.
If your child shows signs of disturbed sleep including long pauses in breathing, tossing and turning in the bed, chronic mouth breathing during sleep, night sweats (owing to increased effort to breathe) this may be an indication of sleep apnea. This is far more common than parents realize and is mostly seen in children between 2 and 8 years old, although it can present itself at any age.
If your child is suffering from these symptoms, we can help determine underlying causes and may refer your child to an Ear, Nose, and Throat (ENT) doctor for further evaluation. While there is a possibility that affected children will “grow out of” their sleep disorders, the evidence is steadily growing that untreated pediatric sleep apnea can affect attention-deficit hyperactivity disorder, bed-wetting, sleep-walking, and even failure to thrive.
While it can be common for children to breathe through their mouths on occasion (when they are congested, have a cold, or are involved in strenuous activities) breathing through the mouth all the time, including when you’re sleeping, can lead to problems.
If your child is suffering from these symptoms, we can help determine underlying causes and may refer your child to an Ear, Nose, and Throat (ENT) doctor for further evaluation. Mouth breathing in children can cause bad breath, crooked teeth, jaw alignment issues, and other orthodontic problems.
Nitrous Oxide
Many children can benefit from the use of nitrous oxide/oxygen, or what you may know as laughing gas, for their dental treatment. Nitrous oxide/oxygen inhalation is a very safe, mild form of conscious sedation used to calm and relax anxious patients without putting them to sleep. It also helps with pain control and relieves gagging. Nitrous oxide and oxygen are both colorless, odorless gases that are given through a small breathing mask which is placed over the child’s nose. The gas is mild and easily taken and with normal breathing it is quickly eliminated from the body. It is also non-addictive. While inhaling nitrous oxide/oxygen, your child remains fully conscious and maintains their natural reflexes. The American Academy of Pediatric Dentistry recognizes this technique as a very safe, effective technique to use when treating children’s dental needs.
Prior to your appointment:
Please inform us of any change to your child’s health and/or medical condition.
Tell us about any respiratory condition that makes breathing through the nose difficult for your child. It may limit the effectiveness of the nitrous oxide/oxygen.
Let us know if your child is taking any medication on the day of the appointment.
In-office Sedation
Most dental procedures for children are completed in-office with nitrous oxide (laughing gas) and local (numbing) anesthesia however very young, fearful, uncooperative children or children with special health care needs may require sedation. Intravenous (IV) sedation is a deep sleep that insulates your child from the stress and possible discomfort associated with dental procedures.
If sedation is recommended for your child, the benefits of treatment this way have been deemed to outweigh the risks. The risks of anesthesia are less than the risk of even driving or riding in a car daily. Pediatric anesthesiologists who have extensive training in anesthesia for children will administer and monitor your child while your pediatric dentist provides his/her medically necessary dental care. We work with Pediatric Dental Anesthesia Associates (PDAA) to provide this type of sedation for your children. Their expert teams of Board Certified Pediatric Anesthesiologists and nurses work with our dental team to provide your child’s necessary dental care right here in our office. You can learn more about this by visiting PDAA’s website at: https://pediatricsedation.com/
Outpatient General Anesthesia
Your child’s safety is our top priority! Our doctors will carefully review your child’s medical history and will inform you if your child is not a good candidate for sedation in the office. If that is the case, we will refer you to a hospital or surgery center for General Anesthesia.
Outpatient General Anesthesia for dental treatment is provided within a hospital or outpatient surgery center. General anesthesia is a controlled state of unconsciousness that eliminates awareness, movement, and discomfort during dental treatment. General anesthesia renders your child completely asleep, the same as would be provided for patients having their tonsils removed or ear tubes placed.
The benefits of sedation and general anesthesia are pain-free delivery of dental care, dental treatment can be performed under optimal conditions thus providing optimal results, treatment can be completed in one visit versus multiple office visits and the child avoids a stressful appointment which maintains a positive outlook on dental care thus minimizing fear at future dental visits. The inherent risks attempting treatment on a non-cooperative child in clinic are: treatment may be compromised, multiple appointments needed to complete treatment, possible emotional trauma, physical injury due to child struggling, and/or moving unexpectedly during treatment. The risks of NO treatment include pain, infection, swelling, the spread of new decay, damage to their developing adult teeth, and possible life-threatening hospitalization from a dental infection. Dental treatment is medically necessary care and our office will help you schedule these types of appointments with our team and Anesthesia providers as well as provide you with all the necessary information.
Silver diamine fluoride (SDF) is an antibacterial liquid containing silver and fluoride and is used to treat tooth sensitivity and to help slow the cavity process or stop tooth decay. SDF can help buy time for those patients who are very young, fearful, or have special needs that may otherwise require sedation for traditional dental treatment. Treatment with SDF does not always eliminate the need for dental fillings or crowns to repair function or esthetics. SDF may require repeated application and is most effective when applied to teeth with cavities twice early.
Risks related to SDF include, but are not limited to:
•The affected area will stain black permanently. Healthy tooth structure will not stain. Stained tooth structure can be replaced with a filling or crown in the future.
•If accidentally applied to the skin or gums, a brown or white stain may appear that causes no harm and will disappear in one to three weeks. It can stain clothing if it touches it during application.
•There may be a metallic taste that will go away rapidly.
•There is a risk that the procedure will not stop the decay and no guarantee of success is granted or implied.
•If tooth decay is not arrested, the decay will progress. In that case the tooth will require further treatment, such as repeat SDF, a filling or crown, root canal/pulp treatment or extraction.
Parents are often concerned about the nighttime grinding of teeth (bruxism). Often the first indication is the noise created by the child grinding on their teeth during sleep or you may notice wear (teeth getting shorter). There are several theories why children grind their teeth: psychological, stress due to a new environment, divorce, changes at school; etc., pressure in the inner ear at night and most common is the eruption of new teeth. As the larger adult teeth erupt into the mouth opposite the smaller baby teeth they may not always fit together perfectly and may cause a child to grind for a period of time.
The majority of cases of pediatric bruxism do not require any treatment and the good news is most kids grow out of it! If excessive wear of the teeth (attrition) is present, then a mouth guard (night guard) may be indicated but not often. 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.
Thumb sucking, finger sucking, and pacifier use are habits common in many children.
It may make them relax, fall asleep, feel happy or provide a sense of security at difficult periods.
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.
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.
Often children naturally stop their habits by the age of 3. We also recommend this as continuation past this age can cause negative effects on the permanent teeth and jaws. If you have concerns about thumb sucking or use of a pacifier consult your pediatric dentist.
1-Good oral hygiene if the most important factor! It removes bacteria and left over food particles that combine to create cavities.
2-Eat a healthy diet with fruits and vegetables.
3-Use a fluoride toothpaste (one grain of rice for kids under 3 years of age and a pea sized amount for kids 3 and older.
4-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 and habits. Your pediatric dentist may also recommend protective sealants or both in office and home fluoride treatments for your child. Sealants can be applied to your child’s adult molars to prevent decay on hard to clean surfaces.
It’s never too early to begin a healthy oral care routine. You should begin caring for your infant’s gums long before their first tooth emerges. Before you baby’s teeth erupt use a soft washcloth or small baby toothbrush to gently brush their gums two times daily. This will clean their gums and get them used to an oral hygiene routine so they will fuss less for brushing once teeth begin to erupt.
Once your child has a few baby teeth – usually between 6 and 12 months – then you can graduate from a washcloth to a toothbrush designed for toddlers which have much softer bristles and a smaller head than those meant for older children. As soon as teeth erupt plaque bacteria will begin to accumulate so it is very important to keep these teeth clean. Brushing two times daily will remove any plaque or sugar that’s left by their food and help prevent early cavities.
For children under the age of 3 use only a very smear of fluoridated toothpaste – about the size of a grain of rice. For kids 3 and older, use a pea-sized amount of toothpaste. Always be sure to rinse their mouth out with cool water after you’re done brushing, and try to keep them from swallowing any toothpaste. Use if these small amounts still gives them the anticavity benefit of fluoride however without the risk of swallowing it if they are unable to spit it out.
Flossing is also important for baby teeth to remove the plaque and food that become lodged between teeth that touch. If you cannot see between the teeth then your toothbrush will not be able to fit between the teeth to clean so flossing is critical to help prevent cavities in those hard to reach areas. Be sure to floss your child’s teeth daily.
Absolutely! Health eating habits help children form and maintain healthy teeth. Children should eat a variety of healthy foods including fruits and vegetables. In between meals choose healthy snacks. Starchy carbs like potato chips and crackers can feed the cavity causing bacteria and sticky sugars like fruit snacks can stick to teeth long after you are done chewing and can lead to cavities. Fibrous vegetables like broccoli, celery and apples can clean your teeth as you eat them!
Adult molar often have deep grooves on the biting surface that can collect bacteria and food debs that can be difficult to clean out. Dental sealants work to prevent cavities by sealing these difficult to clean pits and fissures that naturally occur in molars.
Fluoride is an element which has been shown to be beneficial to teeth. However, too little or too much fluoride can be detrimental to the teeth. Little or no fluoride will not strengthen the teeth and harden the enamel to help them resist cavities. Excessive fluoride ingestion by children can lead to dental fluorosis in forming teeth, which is a chalky white to even brown discoloration of the permanent teeth. Many children often get more fluoride than their parents realize. Being aware of a child’s potential sources of fluoride can help parents prevent the possibility of dental fluorosis.
Some of these sources are:
*Fluoridated water
*The inappropriate use of fluoride supplements. Excessive and inappropriate intake of fluoride supplements may contribute to fluorosis. Fluoride drops and tablets, as well as fluoride fortified vitamins should not be given to children until all of the sources of ingested fluoride have been accounted for and upon the recommendation of your pediatrician or pediatric dentist. Obtain fluoride level test results for your drinking water before giving fluoride supplements to your child (check with local water utilities).
*Swallowing Too much fluoridated toothpaste at an early age.
Children may not be able to spit out fluoride-containing toothpaste when brushing and may ingest an excessive amount of fluoride during tooth brushing. Toothpaste ingestion during this critical period of permanent tooth development is the greatest risk factor in the development of fluorosis. For children 3 years and older, use only a pea size amount of fluoride toothpaste and for those younger, a small smear equivalent to a grain or two of rice.
* Be careful with formula, or nursery water to mix with formulas, that have been supplemented with fluoride.
Xylitol has the sweet benefits of traditional sugar, but it does not have negative effects on teeth like sugar. The natural sugar alcohol, Xylitol, helps prevent cavities by inhibiting the growth of bacteria that causes cavities. You can find natural xylitol in some fruits, berries and veggies. Xylitol can most often be found in gums and mints.
The American Academy of Pediatric Dentistry (AAPD) recognizes the benefits of xylitol for the oral health of infants, children, adolescents, and persons with special health care needs.
Sports drinks can contain high levels of sugar and acid. These sugars give bad oral bacteria the fuel it needs to create cavities. The added acid increases the acidity in your mouth which favor cavity causing bacteria.
Mouthguards work to prevent tooth loss and other facial injuries. Mouthguards work by helping cushion a blow to the face and jaw to minimize the risk of broken teeth and injuries to the lips, tongue face or jaw. Did you know that the CDC estimates that more than 3 million teeth are knocked out at youth sporting events? Mouthguards come in a variety of shapes, sizes, and are designed for multiple sports. A properly fitting mouth guard will stay in place while you child is wearing it and make it easier for them to talk and breath. Ask your pediatric dentist about store bought or custom fitting mouthguards.
A frenectomy is the removal of connective tissue (called the frenum) from under the tongue (Lingual Frenectomy) or the upper gums (Maxillary Frenectomy). New technologies have made frenectomies a safe and convenient option for even very young children.
Babies who have difficulty achieving or maintaining proper latching may have a condition called Ankyloglossia, sometimes referred to as tongue-tie. Tongue-tie is usually related to a short, thick frenum, which limits the tongue’s capacity to move. Apart from breastfeeding difficulty, tongue ties can also impact speech and eating in children and adults. Patients often try to compensate for the lack of tongue mobility by changing their jaw position – resulting in other orthodontic issues.
Frenectomies can be an important part of orthodontic treatment when a long or short frenum is causing issues such as: limiting tongue movement, tension on the gums, tooth displacement or a persistent gap between the front teeth after all the permanent teeth have erupted
