Pediatric Dentistry FAQs

The pediatric dentist has an extra two years of specialized training and is dedicated to the oral health of children from infancy through adolscence. The very young, preteens, teens and young adults 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.

Your child should visit the dentist by his/her 1st birthday. You can make the first visit to the dentist enjoyable and positive. Your child should be informed of the visit and told that the dentist and staff will explain all procedures and answer any questions. The less to-do concerning the visit, the better.

You should have your teeth checked and cleaned at least twice a year, though your dentist or dental hygienist may recommend more frequent visits.

Regular dental exams and cleaning visits are essential in preventing dental problems and maintaining the health of your teeth and gums. At these visits, your teeth are cleaned and checked for cavities. Additionally, there are many other things that are checked and monitored to help detect, prevent, and maintain your dental health. These include:

• Medical history review: Knowing the status of any current medical conditions, new medications, and illnesses, gives us insight to your overall health and also your dental health.
• Examination of diagnostic X-rays (radiographs): Essential for detection of decay, tumors, cysts, and bone loss. X-rays also help determine tooth and root positions.
• Oral cancer screening: Check the face, neck, lips, tongue, throat, tissues, and gums for any signs of oral cancer.
• Gum disease evaluation: Check the gums and bone around the teeth for any signs of periodontal disease.
• Examination of tooth decay: All tooth surfaces will be checked for decay with special dental instruments.
• Examination of existing restorations: Check current fillings, crowns, etc.
• Removal of calculus (tartar): Calculus is hardened plaque that has been left on the tooth for sometime and is now firmly attached to the tooth surface. Calculus forms above and below the gum line, and can only be removed with special dental instruments.
• Removal of plaque: Plaque is a sticky, almost invisible film that forms on the teeth. It is a growing colony of living bacteria, food debris, and saliva. The bacteria produce toxins (poisons) that inflame the gums. This inflammation is the start of periodontal disease!
• Teeth polishing: Removes stain and plaque that is not otherwise removed during toothbrushing and scaling.
• Oral hygiene recommendations: Review and recommend oral hygiene aids as needed (electric dental toothbrushes, special cleaning aids, fluorides, rinses, etc.).
• Review dietary habits: Your eating habits play a very important role in your dental health.

As you can see, a good dental exam and cleaning involves much more than simply checking for cavities and polishing your teeth. We are committed to providing you with the best possible care, and to do so, will require regular check-ups and cleanings.

It is very important to maintain the health of the primary teeth. We are often asked "why put fillings in baby teeth when they will fall out anyway?" Neglected cavities can and frequently do lead to problems which affect developing permanent teeth. 

Primary teeth are important for:

1. Nutrition. The primary teeth allow your child to chew properly, thus enabling proper nutrition. It is found that children with significant cavities are often underweight. It's not fun to eat when it hurts! Children may not be able to verbalize their dental pain, but will find themselves limiting food choices due to chewing discomfort. 

2. Speech. Your child will learn to talk using the primary dentition. By the age of seven, when the upper front teeth begin to come out, most speechskills are already formed. In some cases, children that lose their primary front teeth too early have been shown to require speech therapy.

3. Proper Dental Development. Primary teeth provide space for the permanent teeth and guide them into the correct position. A healthy primary dentition helps to permit normal development of the jaw bones and muscles. The front four baby teeth (incisors) last until 6-7 years of age, the back teeth (canines and molars) are not replaced until 10-13 years of age. Early loss of a baby tooth due to caries, infection, or trauma may lead to space loss that may need correction by orthodontic therapy.

4. Positive Self-Image. Certainly the development of a positive self-image is enhanced by a nice smile unmarred by brown or missing teeth.

5. Oral Health and Overall General Health of a Child. Once a cavity is detected in a primary tooth, it can worsen quickly. If neglected, cavities can progress to the core of the tooth where the nerve lies. When this happens, the tooth becomes painful, the nerve becomes inflaimed and dies, an abscess forms and the tooth is usually lost. The infection can cause serious damage to the permanent tooth developing underneath. In some instances, a severely affected tooth can require emergency hospitalization to treat.

• Early Childhood Caries (formerly termed Baby Bottle Tooth Decay or Nursing Caries) is a transmissible infectious process that affects children younger than age 5 and results in tooth destruction. It is caused by tooth-adherent bacteria, primarily mutans streptococci (MS), that metabolizes sugars to produce acids, which over time, demineralize and destroy tooth structure. 
• Early Childhood Caries is caused by frequent exposure to sugary liquids for long periods. This can happen when a baby is put to bed with a bottle (containing milk, juice, pop, etc), babies nursing on demand through the night or toddlers grazing with a sippy cup. This condition can destroy the primary teeth requiring major dental treatment for infants and toddlers. If gone untreated, the permanent teeth could also be affected. Many times treatment takes place in the hospital OR under general anesthesia.
• Early Childhood Caries are also caused by vertical transmission of mutans streptococci, primarily from the child's primary caregiver. MS may be vertically transmitted from caregiver to child through salivary contact, affected by the frequency and amount of exposure. It is therefore important to minimize saliva-sharing activities (such as sharing utensils) to decrease the transmission of bacteria, especially if the primary caregiver has a history of dental caries. 
  
  
  
  
  
  To help reduce the risk of developing Early Childhood Caries, follow a few simple guidelines:
• Establish a Dental Home by a child's first birthday for a caries risk assessment and oral health education for prevention of caries.
• Avoid saliva-sharing activities.
• Avoid high frequency consumption of liquids and/or solid foods containing sugar. According to the American Academy of Pediatrics, it is important to limit intake of fruit juice for children ages 1-6 years to only 4-6 ounces of juice per day in a cup, at snack or meal time. Some healthy tips: 1. Never allow your baby or toddler to fall asleep with a bottle containing
  milk, formula, fruit juices or any sweetened liquids (including breast milk).
  2. Never give your baby a pacifier dipped in sugar or honey.
  3. Use water only in grazing bottles and sippy cups.
  4. Encourage children to drink from a cup as they approach their first birthday.
• Wipe the baby's gums with a clean gauze pad after each feeding. Begin brushing your child's teeth with a little water as soon as the first tooth appears. Any soft bristled toothbrush with a small head, designed specifically for infants, should be used at bedtime. A toothbrush will remove plaque bacteria that can lead to tooth decay.

Brushing and flossing help control the plaque and bacteria that cause dental disease.

Plaque is a film of food debris, bacteria, and saliva that sticks to the teeth and gums. The bacteria in plaque convert certain food particles into acids that cause tooth decay. Also, if plaque is not removed, it turns into calculus (tartar). If plaque and calculus are not removed, they begin to destroy the gums and bone, causing periodontal (gum) disease.

Plaque formation and growth is continuous and can only be controlled by regular brushing, flossing, and the use of other dental aids.

Toothbrushing – Brush your teeth at least twice a day (especially before going to bed at night) with an ADA approved soft bristle brush and toothpaste.

• Brush at a 45 degree angle to the gums, gently using a small, circular motion, ensuring that you always feel the bristles on the gums.
• Brush the outer, inner, and biting surfaces of each tooth.
• Use the tip of the brush head to clean the inside front teeth.
• Brush your tongue to remove bacteria and to freshen your breath.

Electric toothbrushes are also recommended. They are easy to use and can remove plaque efficiently. Simply place the bristles of the electric brush on your gums and teeth and allow the brush to do its job, several teeth at a time.

Flossing – Daily flossing

Daily flossing is the best way to clean between the teeth and under the gumline. Flossing not only helps clean these spaces, it disrupts plaque colonies from building up, preventing damage to the gums, teeth, and bone.

Plaque is a sticky, almost invisible film that forms on the teeth. It is a growing colony of living bacteria, food debris, and saliva. The bacteria produce toxins (acids) that cause cavities and irritate and inflame the gums. Also, when plaque is not removed above and below the gumline, it hardens and turns into calculus (tartar). This will further irritate and inflame the gums and also slowly destroy the bone. This is the beginning of periodontal disease.

How to floss properly:

• Take 12-16 inches (30-40cm) of dental floss and wrap it around your middle fingers, leaving about 2 inches (5cm) of floss between the hands.
• Using your thumbs and forefingers to guide the floss, gently insert the floss between teeth using a sawing motion.
• Curve the floss into a “C” shape around each tooth and under the gumline. Gently move the floss up and down, cleaning the side of each tooth.

Floss holders are recommended if you have difficulty using conventional floss.

Rinsing – It is important to rinse your mouth with water after brushing, and also after meals if you are unable to brush. If you are using an over-the-counter product for rinsing, it’s a good idea to consult with your dentist or dental hygienist on its appropriateness for you.

Although thorough brushing and flossing removes most food particles and bacteria from easy to reach tooth surfaces, they do not reach the deep grooves on chewing surfaces of teeth. More than 75 percent of dental decay begins in these deep grooves (called pits and fissures). Toothbrush bristles are often too large to clean most of these areas, thus sealants play an important role.

A sealant is a thin plastic coating that covers and protects the chewing surfaces of molars, premolars, and any deep grooves or pits on teeth. Sealant material forms a protective, smooth barrier covering natural depressions and grooves in the teeth, making it much easier to clean and help keep these areas free of decay.

Who may need sealants?

Children and teenagers - As soon as the six-year molars (the first permanent back teeth) appear or any time throughout the cavity prone years of 6-16.

Infants - Baby teeth are occasionally sealed if the teeth have deep grooves and the child is cavity prone.

Adults - Tooth surfaces without decay that have deep grooves or depressions that are difficult to clean.

Sealants are easily applied by your dentist or dental hygienist and the process only takes minutes per tooth. After the chewing surfaces are roughened with an acid solution that helps the sealant adhere to the tooth, the sealant material is “painted” onto the tooth surface, where it hardens and bonds to the teeth. Sometimes a special light will be used to help the sealant material harden.

After sealant treatment, it’s important to avoid chewing on ice cubes, hard candy, popcorn kernels, or any hard or sticky foods. Your sealants will be checked for wear and chipping at your regular dental check-up.

Combined with good home care, a proper diet, and regular dental check-ups, sealants are very effective in helping prevent tooth decay.

Xylitol – Reducing Cavities

Tooth decay is a common, yet preventable childhood problem. Left untreated, cavities in primary (baby) and permanent (adult) teeth become painful and negatively impact the esthetics and functionality of the teeth.

Some children are particularly susceptible to tooth decay, even after receiving regular dental examinations and oral care at home. The American Academy of Pediatric Dentistry (AAPD) has recently recognized the benefits of a substance called Xylitol for reducing childhood tooth decay.

What is Xylitol?

Xylitol is a natural substance that can be found in a variety of fruits and vegetables. Some of the most common Xylitol- rich foods include: berries, mushrooms, corns, and lettuces. Study results indicate that 4-20 grams of Xylitol each day, divided into three or more helpings, can reduce tooth decay and cavities by as much as 70%. As a point of reference, a single cup of berries contains a little less than one gram of Xylitol.

It can be difficult to encourage children (especially toddlers) to consistently eat four or more cups of fruit or vegetables each day. For this reason, Xylitol is also available as a sugar substitute, a gum, and as a concentrate in numerous health foods. No other sugar substitute has been shown to benefit young teeth in the same way.

It should be noted that excessive Xylitol consumption does not provide “more” tooth protection. Sticking to the recommended daily amount is enough to enhance other cavity-reduction efforts, and the effects will last well into the future.

How does Xylitol work?

The combination of many factors increases susceptibility to childhood tooth decay and cavities. These factors include: oral care habits, diet, carbohydrate consumption, sucrose consumption, salivary flow rate, and tooth resistance to plaque.

More specifically, harmful oral bacteria feed on sugars and carbohydrates, producing acids. When sugary foods are consumed, these acids attack and destroy vulnerable tooth enamel. Xylitol works to neutralize the acids, reducing enamel destruction, and minimizing the threat of cavities in the process. Xylitol also stimulates saliva production, meaning that food particles, plaque and bacteria are continually removed from the teeth. When used in combination with fluoride, Xylitol works to remineralize teeth, protecting tooth enamel and minimizing new cavity formation.

When should my child start using Xylitol?

Although Xylitol gum is not suitable for very young children, infants actually benefit from maternal chewing! Mothers of children between three months and two years old who used Xylitol gum several times each day, protected their child from tooth decay until the age of five years old. In this case, Xylitol reduced the amount of microorganisms transmitted from mother to child.

Once the child reaches toddlerhood, Xylitol can be consumed as a sugar substitute, or as a natural byproduct of eating fruit and vegetables. Older children can reduce the threat of new cavities by chewing Xylitol gum.

Clean the area of the affected tooth thoroughly. Rinse the mouth vigorously with warm water or use dental floss to dislodge impacted food or debris. DO NOT place aspirin on the gum or on the aching tooth. If face is swollen apply cold compresses. Call your pediatric dentist to schedule an appointment as soon as possible for an examination.

Tongue Piercing

There has been an upsurge in the amount of teenagers getting tongue piercings. Teenagers often view these piercings as a harmless expression of their growing individuality. Oftentimes, parents allow teens to pierce their tongues because the metal bar is impermanent. In addition, tongue bars are not as visually apparent as a tattoo or eyebrow piercing might be.

Unfortunately, tongue piercings can have a serious (even deadly) impact on health. Pediatric dentists routinely advise adolescents to avoid intraoral or perioral piercings for a number of good reasons.

Why is tongue piercing harmful?

First, there are a growing number of unlicensed piercing parlors in throughout the country. Such parlors have been recognized as potential transmission vectors for tetanus, tuberculosis, and most commonly - hepatitis. Second, a great number of painful conditions can result from getting a tongue piercing (even in a licensed parlor). These conditions include:

• Bacterial infections
• Blood clots
• Blood poisoning
• Brain abscess
• Chronic pain
• Damaged nerves (trigeminal neuralgia)
• Fractured/cracked teeth
• Heart infections
• Hypersensitivity reactions (to the metal bar)
• Periodontal disease/gum recession
• Problems enunciating
• Scarring

What are the most common tongue piercing problems?

To pierce a tongue, the body piercer must first hold it steady with a clamp. Next, a hollowed, pointed metal needle is driven through the tongue. Finally, the piercer attaches the tongue bar to the bottom end of the needle, and then drags it upwards through the tongue. Two metal screw-on balls are then used to secure the tongue bar.

Most commonly, severe pain and swelling are experienced for several days after the piercing episode. Moreover, the new holes in the tongue are especially infection-prone, because the oral cavity is home to many bacteria colonies. In the medium term, saliva production may increase as the body responds to a completely unnatural entity in the mouth.

Are there long-term problems associated with tongue piercing?

Long-term problems with tongue piercings are very common. The screw-on balls constantly scrape against tooth enamel, making teeth susceptible to decay and gums susceptible to periodontal disease. Soft tissue can also become infected in specific areas, as the tongue bar continues to rub against it.

If the tongue bar is inappropriately long, it can get tangled around the tongue or teeth. In a similar way to an earring getting ripped out of the ear, a tongue bar can be ripped out of the tongue. This is extremely painful, as well as difficult to repair.

In sum, the American Dental Association (ADA) advises against any type of oral piercing, and so does the pediatric dentist.

If you are a concerned parent, or would like the pediatric dentist to speak with your teen about tongue piercing, please contact our office.

Tobacco Use

Tobacco use is one of the leading causes of death in society. Fortunately, it is also among the most preventable. Aside from being a sociably undesirable habit, smoking can result in oral cancer, reduce smelling and tasting abilities, compromise recovery after oral surgery, stain the teeth, and increase the risk of contracting periodontal disease. The American Dental Association (ADA) and all pediatric dentists encourage children, adolescents, and adults to abstain from all forms of tobacco use.

Almost all adult smokers have tried smoking before the age of nineteen. In all likelihood, an individual who abstains from smoking throughout the teenage years will never pick up the habit. Therefore, it is essential that parents strongly discourage preadolescent and adolescent tobacco use.

Is smokeless tobacco less dangerous for teens?

Tobacco use in any form brings the oral region into direct contact with carcinogens (cancer causing agents). These carcinogens and other harmful chemicals cause irreparable damage to the child’s oral health.

Parents and teens often mistakenly evaluate smokeless tobacco as the “safer” option. In fact, smokeless tobacco has been proven to deliver a greater concentration of harmful agents into the body, and to be far more addictive. One snuff of tobacco has approximately the same nicotine content as sixty regular cigarettes. In addition, smokeless tobacco causes leukoplakias in the mouth, which are dangerous pre-cancerous lesions.

What are the signs of oral cancer?

Oral cancer can be difficult to detect without the aid of the dentist. In some cases, oral cancer is not noticeable or even painful until its later stages. Parents of tobacco users must be aware of the following symptoms:

• Changes in the way the teeth fit together.
• Difficulty moving the jaw.
• Mouth sores that don’t heal.
• Numbness or tenderness.
• Red or white spots on the cheek, lip, or tongue.

Oral cancer is treatable if caught early. Disfiguring surgery can be avoided by having the child abstain from tobacco use and getting regular preventative dental checkups.

How can I stop my child from using tobacco?

There are several ways to discourage children and adolescents from using tobacco products. First, talking to the child personally about the dangers of tobacco use (or asking the dentist to talk to the child) has proven an effective preventative strategy. Second, parents should lead by example. According to research studies, children of non-smokers are less likely to pick up this dangerous habit. Third, monitor the child closely. If the child will not cooperate, screenings for tobacco can be requested at the dental office.

If you have questions or concerns about your childhood tobacco use, please contact your pediatric dentist.