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.
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.
Children’s teeth begin forming before birth. Around 6
months, the first primary (or baby) teeth to erupt through the gums are
the lower central incisors, followed closely by the upper central
incisors. Although all 20 primary teeth usually appear by age 3, the pace
and order of their eruption varies.
Permanent teeth begin appearing around age 6, starting
with the first molars and lower central incisors. This process continues
until approximately age 21.
Adults have 28 permanent teeth, or up to 32 including
the third molars (or wisdom teeth).
Please click on the timeline below to see the teeth
erupt and to learn more.
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 PermanentTooth: 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.
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 and examinations every six months for children with a high
risk of tooth decay. On average, most pediatric dentists request
radiographs approximately once a year. Approximately every 3 years, it is
a good idea to obtain a complete set of radiographs, either a panoramic
and bitewings or periapicals and bitewings.
Pediatric dentists are particularly careful to minimize
the exposure of their patients to radiation. With contemporary safeguards,
the amount of radiation received in a dental X-ray examination is
extremely small. The risk is negligible. In fact, the dental radiographs
represent a far smaller risk than an undetected and untreated dental
problem. Lead body aprons and shields will protect your child. Today’s
equipment filters out unnecessary x-rays and restricts the x-ray beam to
the area of interest. High-speed film and proper shielding assure that
your child receives a minimal amount of radiation exposure.
Tooth
brushing is one of the most important tasks for good oral health. Many
toothpastes, and/or tooth polishes, however, can damage young smiles. They
contain harsh abrasives, which can wear away young tooth enamel. When
looking for a toothpaste for your child, make sure to pick one that is
recommended by the American Dental Association 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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Parents are often concerned about
the nocturnal grinding of teeth (bruxism). Often, the first indication is
the noise created by the child grinding on their teeth during sleep. Or,
the parent may notice wear (teeth getting shorter) to the dentition. One
theory as to the cause involves a psychological component. Stress due to a
new environment, divorce, changes at school; etc. can influence a child to
grind their teeth. Another theory relates to pressure in the inner ear at
night. If there are pressure changes (like in an airplane during take-off
and landing, when people are chewing gum, etc. to equalize pressure) the
child will grind by moving his jaw to relieve this pressure.
The majority of cases of pediatric
bruxism do not require any treatment. If excessive wear of the teeth
(attrition) is present, then a mouth guard (night guard) may be indicated.
The negatives to a mouth guard are the possibility of choking if the
appliance becomes dislodged during sleep and it may interfere with growth
of the jaws. The positive is obvious by preventing wear to the primary
dentition.
The good news is most children
outgrow bruxism. The grinding decreases between the ages 6-9 and children
tend to stop grinding between ages 9-12. If you suspect bruxism, discuss
this with your pediatrician or pediatric dentist.
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.
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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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.
The American Academy of Pediatrics (AAP),
the American Dental Association (ADA), and the American Academy of
Pediatric Dentistry (AAPD) all recommend establishing a "Dental
Home" for your child by one year of age. Children who have a
dental home are more likely to receive appropriate preventive and routine
oral health care.
The
Dental Home is intended to provide a place other than the
Emergency Room for parents.
You can make the first visit to the
dentist enjoyable and positive. If old enough, your child should be
informed of the visit and told that the dentist and their staff will
explain all procedures and answer any questions. The less to-do concerning
the visit, the better.
It is best if you refrain from using
words around your child that might cause unnecessary fear, such as needle,
pull, drill or hurt. Pediatric dental offices make a practice of using
words that convey the same message, but are pleasant and non-frightening
to the child.
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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One serious form of decay among
young children is baby bottle tooth decay, also referred to by dentists as
early childhood caries. This condition is caused by frequent and long
exposures of an infant’s teeth to liquids that contain sugar. Among these
liquids are milk (including breast milk), formula, fruit juice and other
sweetened drinks.
Putting a baby to bed for a nap or
at night with a bottle other than water can cause serious and rapid tooth
decay. Sweet liquid pools around the child’s teeth giving plaque bacteria
an opportunity to produce acids that attack tooth enamel. If you must give
the baby a bottle as a comforter at bedtime, it should contain only
water. If your child won't fall asleep without the bottle and its usual
beverage, gradually dilute the bottle's contents with water over a period
of two to three weeks.
After each feeding, wipe the baby’s
gums and teeth with a damp washcloth or gauze pad to remove plaque. The
easiest way to do this is to sit down, place the child’s head in your lap
or lay the child on a dressing table or the floor. Whatever position you
use, be sure you can see into the child’s mouth easily.
Healthy
eating habits lead to healthy teeth. Like the rest of the body, the teeth,
bones and the soft tissues of the mouth need a well-balanced diet.
Children should eat a variety of foods from the five major food groups.
Most snacks that children eat can lead to cavity formation. The more
frequently a child snacks, the greater the chance for tooth decay. How
long food remains in the mouth also plays a role. For example, hard candy
and breath mints stay in the mouth a long time, which cause longer acid
attacks on tooth enamel. If your child must snack, choose nutritious foods
such as vegetables, low-fat yogurt, and low-fat cheese, which are
healthier and better for children’s teeth.
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Good oral hygiene removes bacteria and the left over
food particles that combine to create cavities. For infants, use a wet
gauze or clean washcloth to wipe the plaque from teeth and gums. Avoid
putting your child to bed with a bottle filled with anything other than
water. See "Baby Bottle Tooth Decay"
for more information.
For older children, brush their teeth at least
twice a day. Also, watch the number of snacks containing sugar that you
give your children.
The American Academy of Pediatric Dentistry recommends
visits every six months to the pediatric dentist, beginning at your
child’s first birthday. Routine visits will start your child on a lifetime
of good dental health.
Your pediatric dentist may also recommend protective
sealants or home fluoride treatments for your child. Sealants can be
applied to your child’s molars to prevent decay on hard to clean surfaces.
A sealant is a clear or shaded
plastic material that is applied to the chewing surfaces (grooves) of the
back teeth (premolars and molars), where four out of five cavities in
children are found. This sealant acts as a barrier to food, plaque and
acid, thus protecting the decay-prone areas of the teeth.
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).
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.
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.
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.
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.
Tooth
brushing is one of the most important tasks for good oral health. Many
toothpastes, and/or tooth polishes, however, can damage young smiles. They
contain harsh abrasives, which can wear away young tooth enamel. When
looking for a toothpaste for your child, make sure to pick one that is
recommended by the American Dental Association as shown on the box and
tube. These toothpastes have undergone testing to insure they are safe to
use.
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.
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.
