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?
EARLY
INFANT ORAL CARE:
Your Child's First Dental Visit
When will my Baby Start Getting Teeth?
Baby
Bottle Tooth Decay (Early Childhood Caries)
PREVENTION:
Care
of your Child's Teeth
Good Diet = Healthy Teeth
How Do I Prevent Cavities
Seal Out
Decay
Fluoride
Mouth Guards
Xylitol - Reducing Cavities
ADOLESCENT
DENTISTRY:
Tongue Piercing - Is it Really Cool?
Tobacco - Bad News in Any Form
POST OP INSTRUCTIONS
Care of the Mouth After Local Anesthetic
Do's and Don'ts After a Tooth Extraction
For more information on oral health care needs, 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.
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Why
Are The Primary Teeth So Important?
It is very
important to maintain the health of the primary teeth. Neglected
cavities can and frequently do lead to problems which affect
developing permanent teeth. Primary teeth, or baby teeth are
important for (1) proper chewing and eating, (2) providing space
for the permanent teeth and guiding them into the correct
position, and (3) permitting normal development of the jaw bones
and muscles. Primary teeth also affect the development of speech
and add to an attractive appearance. While the front 4 teeth
last until 6-7 years of age, the back teeth (cuspids and molars)
aren’t replaced until age 10-13.
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Eruption Of Your Child’s Teeth
Children’s teeth begin forming before birth. As early as 4
months, the first primary (or baby) teeth to erupt through the
gums are the lower central incisors, followed closely by the
upper central incisors. Although all 20 primary teeth usually
appear by age 3, the pace and order of their eruption varies.
Permanent teeth begin
appearing around age 6, starting with the first molars and lower
central incisors. This process continues until approximately age
21.
Adults have 28
permanent teeth, or up to 32 including the third molars (or
wisdom teeth).
TOOTH DEVELOPMENT
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Dental Emergencies
Toothache: Clean the area of the affected tooth. Rinse
the mouth thoroughly with warm water or use dental floss to
dislodge any food that may be impacted. If the pain still
exists, contact your child's dentist. Do not place aspirin or
heat on the gum or on the aching tooth. If the face is swollen,
apply cold compresses and contact your dentist immediately.
Cut or Bitten Tongue, Lip or Cheek:
Apply ice to injured areas to help control swelling. If there is
bleeding, apply firm but gentle pressure with a gauze or cloth.
If bleeding cannot be controlled by simple pressure, call a
doctor or visit the hospital emergency room.
Knocked Out Permanent Tooth:
If possible, find the tooth. Handle it by the crown, not by the
root. You may rinse the tooth with water only. DO NOT clean with
soap, scrub or handle the tooth unnecessarily. Inspect the tooth
for fractures. If it is sound, try to reinsert it in the socket.
Have the patient hold the tooth in place by biting on a gauze.
If you cannot reinsert the tooth, transport the tooth in a cup
containing the patient’s saliva or milk. If the patient is old
enough, the tooth may also be carried in the patient’s mouth
(beside the cheek). The patient must see a dentist IMMEDIATELY!
Time is a critical factor in saving the tooth.
Knocked
Out Baby Tooth: Contact your pediatric dentist during
business hours. This is not usually an emergency, and in most
cases, no treatment is necessary.
Chipped or Fractured Permanent Tooth: Contact your
pediatric dentist immediately. Quick action can save the tooth,
prevent infection and reduce the need for extensive dental
treatment. Rinse the mouth with water and apply cold compresses
to reduce swelling. If possible, locate and save any broken
tooth fragments and bring them with you to the dentist.
Chipped
or Fractured Baby Tooth: Contact your pediatric dentist.
Severe Blow to the
Head: Take your child to the nearest hospital emergency room
immediately.
Possible Broken or
Fractured Jaw: Keep the jaw from
moving and take your child to the nearest hospital emergency
room.
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Dental Radiographs (X-Rays)
Radiographs (X-Rays)
are a vital and necessary part of your child’s dental diagnostic
process. Without them, certain dental conditions can and will be
missed.
Radiographs detect much
more than cavities. For example, radiographs may be needed to
survey erupting teeth, diagnose bone diseases, evaluate the
results of an injury, or plan orthodontic treatment. Radiographs
allow dentists to diagnose and treat health conditions that
cannot be detected during a clinical examination. If dental
problems are found and treated early, dental care is more
comfortable for your child and more affordable for you.
The American Academy of
Pediatric Dentistry recommends radiographs every six months for
children with a high risk of tooth decay. In our office, the
norm for healthy kids, is more like every 12-18 months.
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 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?
Tooth brushing is one
of the most important tasks for good oral health. Many
toothpastes, an d/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)
Are you concerned about
your child grinding his teeth at night? You are not alone. The
vast majority of young children grind (brux) their teeth while
sleeping. The noise might be outrageous, but, happily, only a
few kids do significant damage to their teeth. Plus, most kids
grow out of the habit by age 10 without doing any permanent
harm.
There have been many
theories as to why kids grind-stress, bite interferences,
clearing the Eustachian tubes, or just plain high energy (day
and night). But, the main thing to remember is, bruxism is not
unusual, most kids grow out of it without doing any harm, and
older kids with real symptomatic bruxing issues can get relief
with a plastic night guard.
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Thumb
Sucking
 Sucking
is a natural reflex and infants and young children may use
thumbs, fingers, pacifiers and other objects on which to suck.
It may make them feel secure and happy, or provide a sense of
security at difficult periods. Since thumb sucking is relaxing,
it may induce sleep.
Thumb
sucking that persists beyond the eruption of the permanent teeth
can cause problems with the proper growth of the mouth and tooth
alignment. How intensely a child sucks on fingers or thumbs will
determine whether or not dental problems may result. Children
who rest their thumbs passively in their mouths are less likely
to have difficulty than those who vigorously suck their thumbs.
Children
should cease thumb sucking by the time their permanent front
teeth are ready to erupt. Usually, children stop between the
ages of two and four. Peer pressure causes many school-aged
children to stop.
Pacifiers
are no substitute for thumb sucking. They can affect the teeth
essentially the same way as sucking fingers and thumbs. However,
use of the pacifier can be controlled and modified more easily
than the thumb or finger habit. If you have concerns about thumb
sucking or use of a pacifier, consult your pediatric dentist.
A
few suggestions to help your child get through thumb sucking:
-
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.
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What
is the Best Time for Orthodontic Treatment?
Developing
malocclusions, or bad bites, can be recognized as early as 2-3
years of age. Often, early steps can be taken to reduce the need
for major orthodontic treatment at a later age.
Stage I
– Early Treatment: This period of treatment encompasses ages
2 to 6 years. At this young age, we are concerned with
underdeveloped dental arches, the premature loss of primary
teeth, and harmful habits such as finger or thumb sucking.
Treatment initiated in this stage of development is often very
successful and many times, though not always, can eliminate the
need for future orthodontic/orthopedic treatment.
Stage
II – Mixed Dentition: This period covers the ages of 6 to 12
years, with the eruption of the permanent incisor (front) teeth
and 6 year molars. Treatment concerns deal with jaw
malrelationships and dental realignment problems. This is an
excellent stage to start treatment, when indicated, as your
child’s hard and soft tissues are usually very responsive to
orthodontic or orthopedic forces.
Stage III – Adolescent Dentition: This stage deals with the
permanent teeth and the development of the final bite
relationship.
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EARLY INFANT ORAL CARE
Your
Child’s First Dental Visit
 We
recommend that your child have their first dental visit by age
3. You can help prepare your little one by reading a book to
them like Dr. DeSoto by William Steig and by role
playing. Lie your child on the sofa and sit down beside them,
count their teeth, and dry brush their teeth with a toothbrush.
Be confident. Do not use scary words. And do not get into too
much detail. Look at our office pictures in the photo gallery
with your child. Then rely on us to take it form there.
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When Will My Baby
Start Getting Teeth?
Teething, the process
of baby (primary) teeth coming through the gums into the mouth,
is variable among individual babies. Some babies get their teeth
early and some get them late. In general, the first baby teeth
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)
One
serious form of decay among young children is baby bottle tooth
decay. This condition is caused by frequent and long exposures
of an infant’s teeth to liquids that contain sugar. Among these
liquids are milk (including breast milk), formula, fruit juice
and other sweetened drinks.
Putting a
baby to bed for a nap or at night with a bottle other than water
can cause serious and rapid tooth decay. Sweet liquid pools
around the child’s teeth giving plaque bacteria an opportunity
to produce acids that attack tooth enamel. If you must give the
baby a bottle as a comforter at bedtime, it should contain only
water. If your child won't fall asleep without the bottle and
its usual beverage, gradually dilute the bottle's contents with
water over a period of two to three weeks.
After each
feeding, wipe the baby’s gums and teeth with a damp washcloth or
gauze pad to remove plaque. The easiest way to do this is to sit
down, place the child’s head in your lap or lay the child on a
dressing table or the floor. Whatever position you use, be sure
you can see into the child’s mouth easily.
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PREVENTION
Care of Your Child’s
Teeth
Begin
daily brushing as soon as the child’s first tooth erupts.
Non-fluoride, training toothpastes are valuable, but not
essential. In fact, we recommend dry brushing on the changing
table as a good way to get access early on.
Two times
per day is the rule for brushing. A grown-up should be in charge
until at least seven years old. Flossing with miniature flossing
aids works well, too. Don't use fluoride toothpaste until your
child is a champion spitter.
Proper
brushing removes plaque from the inner, outer and chewing
surfaces. When teaching children to brush, place toothbrush at a
45 degree angle; start along gum line with a soft bristle brush
in a gentle circular motion. Brush the outer surfaces of each
tooth, upper and lower. Repeat the same method on the inside
surfaces and chewing surfaces of all the teeth. Finish by
brushing the tongue to help freshen breath and remove bacteria .
Flossing
removes plaque between the teeth, where a toothbrush can't
reach. Flossing should begin when any two teeth touch. You
should floss a child's teeth until he or she can do it alone. We
recommend the use of flossing aids to make this process easy and
fun.
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Good Diet = Healthy
Teeth
 Healthy
eating habits lead to healthy teeth. Like the rest of the body,
the teeth, bones and the soft tissues of the mouth need a
well-balanced diet. Children should eat a variety of foods from
the five major food groups. Most snacks that children eat can
lead to cavity formation. The more frequently a child snacks,
the greater the chance for tooth decay. How long food remains in
the mouth also plays a role. For example, hard candy and breath
mints stay in the mouth a long time, which cause longer acid
attacks on tooth enamel. If your child must snack, choose
nutritious foods such as vegetables, low-fat yogurt, and low-fat
cheese, which are healthier and better for children’s teeth.
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How Do I Prevent
Cavities?
Plaque is the villain. If you want your kids to be cavity-free,
you have got to help them learn to "circle brush" that sticky,
bacterial plaque off their teeth. The "cavity creep" germs that
breed in the plaque metabolize the sugars from our diets to make
cavity causing acid. Besides good bruising, a diet that
minimizes retentive sugars is crucial.
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Seal Out Decay
Your
pediatric dentist may recommend protective sealants for your
child. A sealant is a white, opaque resin that is bonded into
the groves on the chewing surfaces of the back teeth. Because
four our of five cavities in children are found in these
grooves, it is often a good idea to consider some extra
protection there.
|
Before Sealant Applied |
After Sealant Applied |
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Fluoride
Fluoride
is an element, which has been shown to be beneficial to teeth.
However, too little or too much fluoride can be detrimental to
the teeth. Little or no fluoride will not strengthen the teeth
to help them resist cavities. Excessive fluoride ingestion by
preschool-aged children can lead to dental fluorosis, which is a
chalky white to even brown discoloration of the permanent teeth.
Many children often get more fluoride than their parents
realize. Being aware of a child’s potential sources of fluoride
can help parents prevent the possibility of dental fluorosis.
Some
of these sources are:
-
Too much fluoridated toothpaste at an early age.
-
The inappropriate use of fluoride supplements.
-
Hidden sources of fluoride in the child’s diet.
Two and
three year olds may not be able to expectorate (spit out)
fluoride-containing toothpaste when brushing. As a result, these
youngsters may ingest an excessive amount of fluoride during
tooth brushing. Toothpaste ingestion during this critical period
of permanent tooth development is the greatest risk factor in
the development of fluorosis.
Excessive
and inappropriate intake of fluoride supplements may also
contribute to fluorosis. Fluoride drops and tablets, as well as
fluoride fortified vitamins should not be given to infants
younger than six months of age. After that time, fluoride
supplements should only be given to children after all of the
sources of ingested fluoride have been accounted for and upon
the recommendation of your pediatrician or pediatric dentist.
Certain
foods contain high levels of fluoride, especially powdered
concentrate infant formula, soy-based infant formula, infant dry
cereals, creamed spinach, and infant chicken products. Please
read the label or contact the manufacturer. Some beverages also
contain high levels of fluoride, especially decaffeinated teas,
white grape juices, and juice drinks manufactured in fluoridated
cities.
Parents can take the following steps to decrease the risk of
fluorosis in their children’s teeth:
-
Use baby tooth cleanser on the toothbrush of the very young
child.
-
Place only a pea sized drop of children’s toothpaste on the
brush when brushing.
-
Account for all of the sources of ingested fluoride before
requesting fluoride supplements from your child’s physician or
pediatric dentist.
-
Avoid giving any fluoride-containing supplements to infants
until they are at least 6 months old.
-
Obtain
fluoride level test results for your drinking water before
giving fluoride supplements to your child (check with local
water utilities).
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Mouth Guards
When a
child begins to participate in recreational activities and
organized sports, injuries can occur. A properly fitted mouth
guard, or mouth protector, is an important piece of athletic
gear that can help protect your child’s smile, and should be
used during any activity that could result in a blow to the face
or mouth.
Mouth
guards help prevent broken teeth, and injuries to the lips,
tongue, face or jaw. A properly fitted mouth guard will stay in
place while your child is wearing it, making it easy for them to
talk and breathe.
Ask
your pediatric dentist about custom and store-bought mouth
protectors.
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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.
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ADOLESCENT DENTISTRY
Tongue
Piercing – Is it Really Cool?
You might
not be surprised anymore to see people with pierced tongues,
lips or cheeks, but you might be surprised to know just how
dangerous these piercings can be.
There are
many risks involved with oral piercings, including chipped or
cracked teeth, blood clots, blood poisoning, heart infections,
brain abscess, nerve disorders (trigeminal neuralgia), receding
gums or scar tissue. Your mouth contains millions of bacteria,
and infection is a common complication of oral piercing. Your
tongue could swell large enough to close off your airway!
Common
symptoms after piercing include pain, swelling, infection, an
increased flow of saliva and injuries to gum tissue.
Difficult-to-control bleeding or nerve damage can result if a
blood vessel or nerve bundle is in the path of the needle.
So follow
the advice of the American Dental Association and give your
mouth a break – skip the mouth jewelry.
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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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Post Operative Instructions
Care of the Mouth
after Local Anesthetic
When
small children are numb, particularly the first time, you have
to keep a close eye on them post operatively. Sometimes they
just cannot stop themselves from scratching or biting a numb
cheek or lip. This can result in a minor scratch or a more
severe abrasion or swelling. We recommend a straight liquid diet
and quiet play for the first 2-3 hours after treatment until the
anesthetic has worn off. Keeping a cotton roll "pillow" in their
mouth during this time works wonders, too.
Dos and Don't
After a Tooth Extraction:
Do:
Call our office if you have any concerns (415) 892-9696
Bite
on gauze or a cotton roll for 10-15 minutes after the extraction
Have
an extra gauze available for any oozing later if necessary
Have
only a super-soft diet for the rest of the day of surgery
Brush gently before bed
Take
the appropriate dosage of acetaminophen (Tylenol) or ibuprofen
(Advil or Motrin) if your child is uncomfortable and not
allergic
Don't:
Rinse vigorously
Spit
excessively
Drink through a straw
Put
your fingers in the extraction site
Exercise strenuously
Eat
foods that require chewing
Injure the numb area
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