Why should my child see a pediatric dentist?

Pediatric dentists limit their practice exclusively to the treatment of infants, children and adolescents, including those with special health care needs. The pediatric dentist is required to complete an extra two to three-year residency program after completing four years of dental school. Major emphasis is placed on the total development of the child, including his psychological and dental well-being. This extended training also includes growth and development of the teeth and mouth, child psychology, behavior management, facial injuries, restorative, orthodontic, and preventive care, hospital dentistry and treatment of the chronically ill and handicapped children. Many parents select a children's dentist just as they would a pediatrician, to assure that their child has the benefit of this additional experience.

At what age should I bring my child in for the first appointment?

The first visit should be by the first birthday. This will primarily be a question and answer session, and it will allow the pediatric dentist to screen your child for a variety of developmental problems. This is so that an assessment and record can be made of your child's dental development and risk of getting cavities. This also gives us the opportunity to discuss good oral hygiene practices at home, diet, injury prevention and possible need for fluoride supplements. If we find cavities or other problems, these things can be taken care of early before they become a bigger problem. This appointment will also serve to inform the parent of how to care for the baby’s teeth and gums. The first regular “check-up” should be between 2 and 3 years of age.

When should we start brushing our baby’s teeth?

As soon as teeth begin to appear in your baby’s mouth, you should start to clean them. Wiping the teeth with a soft cloth after feeding is adequate until the molars come in. Molars require a toothbrush to properly clean them since they contain many crevices that cannot be easily wiped clean. Any soft-bristled toothbrush with a small head, preferably one designed specifically for infants, should be used at least once a day at bedtime.

Toothpaste: when should we begin using it and how much should we use?

Fluoridated toothpaste should be introduced when a child is 2-3 years of age. Prior to that, parents should clean the child's teeth with water or a non-fluoridated infant toothpaste and a soft-bristled toothbrush. When toothpaste is used after age 2-3, parents should supervise brushing and make sure the child uses no more than a pea-sized amount on the brush. Children should spit out and not swallow excess toothpaste after brushing.

How many times should I brush my preschooler’s teeth?

Brushing twice a day is adequate to remove plaque and debris from teeth.

At what age should I expect my children to brush independently?

Children can begin to brush independently once they demonstrate the ability to do an adequate job by themselves. This varies from child to child. Most children require “hands on” assistance until age 5 or 6 years of age and need close supervision until age 8 or 9. By age 10, most children can do a good job but require the occasional “spot check” just to make sure. Most parents let their kids brush independently too soon.

How worried should I be about cavities in the baby teeth?

The primary teeth play an important role in the growth and development of the jaw, face and whole child. Tooth decay is much more common in the primary dentition, and untreated tooth decay can lead to serious, painful and even life-threatening infections. Untreated tooth decay in the primary teeth will increase the probability of problems in the permanent dentition. These problems include inadequate space for permanent teeth, speech problems, chewing and nutritional problems.

How do I prepare my child so that he is not frightened at his first dental appointment?

Bringing your child to the dentist from infancy helps him or her become accustomed to the sights, smells and sounds of the dental office from an early age. Many parents project their personal fears onto their children, and children are very good at noticing this. We recommend reading some children’s books about going to the dentist so that you can introduce your child to the idea of their first dental visit as a positive experience. Explain to your child that the dentist will clean and count the teeth and that it will be easy and fun. Do not spend too much time preparing your child, however, since dwelling on the subject may cause the child to wonder why you are making such a big deal out of it. It should be as matter-of-fact as going to the grocery store.

My child is afraid of losing his baby teeth when he turns five, what can I do to prepare him?

Concerns about body integrity loom large in the minds of most 4 and 5-year-olds. Worries about losing teeth are common. It is interesting to note that most cultures have a tooth fairy or some similar tradition. This legend may help children deal with this loss of a body part. Focus on the positive. If your child has older siblings or similar-aged friends who have “been there,” you can point out how they survived the experience and now have new “grown-up” teeth growing to replace the “baby” ones. Tell him that it is an important part of growing up. There are also many children’s books on the topic that help describe the experience in a positive light.

My child grinds her teeth often at night. The sound is horrible! Should anything be done and can it be dangerous to her teeth?

Grinding of the teeth, especially at night during sleep, is a very common habit. At least 80% of children do it at some point. Some children even do it while they are awake. The sound can be very disturbing, but in most cases, there is little cause for concern and most children grow out of it. If the grinding continues into the full permanent dentition, a night guard can be fabricated to protect the teeth from extensive wear. However because a night guard functions much like a retainer, inhibiting a development of the jaws and occlusion, they are not usually used prior to the establishment of the mature adult occlusion. This typically is at around 14 or 15 years of age.

Are thumb-sucking and pacifier habits harmful for a child's teeth?

Non-nutritive sucking habits are very common. It is normal for a 2-year-old to feel a need for a pacifier. They find comfort in the sucking activity; this is also true for thumb and finger sucking. Very few children will take a pacifier to kindergarten. When a child reaches age 3 to 3 1/2 years old, you can try to explain that big kids do not need pacifiers and suggest trading it in for something else very special. All adults in the house should be in agreement when you do the trade, and you must stick to your decision. If a child seems reluctant to give up the pacifier or the thumb, do not push it. They may not be emotionally ready for the change, and pushing the issue may make things worse. Usually, once the child uses the pacifier or thumb only to fall asleep, this means they are nearly ready to give it up altogether. Keep in mind that thumb and pacifier sucking habits will generally only become a problem if they go on for a very long period of time. Most children stop these habits on their own, but if they are still sucking their thumbs or fingers when the permanent teeth arrive, a mouth appliance may be recommended to help them stop.

Our kids get very little sugar at home, but at their grandmother’s house, they get candy and sweet snacks all the time. What can I do?

Grandmothers everywhere love to spoil their grandchildren. It’s very hard to stop this! If it is only on occasion, this should not be a problem. However, if they spend a significant amount of time—especially overnight stays—with their grandmother or another caretaker who gives them lots of sugar, make sure that 1) they have a toothbrush available at that house and it is being used and 2) they brush their teeth when they come home. Also make sure the grandparent or caretaker knows that tooth decay is associated with excessive sugar intake and frequent snacking. If the children have had cavities in the past, this is especially important.

How do I know if my child has gingivitis?

Gingivitis is inflammation of the gums due to chronic build-up of plaque. It is easy to recognize: the gums will be puffy and red and will bleed when you brush and floss your child’s teeth. It is usually painless and should not cause fever. For a variety of reasons, children are more resistant to gingival problems than adults, including gingivitis. If you notice blood on your child’s toothbrush after brushing, don’t be alarmed. The more thoroughly you brush your child’s gums and teeth, the more quickly the gingivitis will resolve. If the bleeding continues for a couple of weeks, in spite of consistent better hygiene, bring your child to see a dentist. A few problems that are more serious can mimic the symptoms of gingivitis.

My dentist’s office is far away. If my child’s tooth is knocked out, should we go to the emergency room?

If you are reasonably confident that your child has no serious, life-threatening injuries (such as to the head and spine), you will probably receive more prompt attention at your dentist’s office. If it is a permanent tooth, the best thing to do is to put the tooth back in the socket (where it came from). If that is not possible, place the tooth in a cup of milk and contact your dentist ASAP. If you cannot reach your dentist, go to the emergency room. Minutes matter when a permanent tooth is knocked out. The longer a tooth is out of the mouth, the poorer the prognosis for its long-term survival. Avoid touching the roots of the tooth when handling it, as there are many important cells on the root surface that can be killed or brushed off if you touch the root surface. If you need to rinse off the tooth, rinse it in saliva, NOT TAP WATER, as tap water can kill the cells on the root surface. If you are certain that the tooth is a baby tooth, you should still see the dentist if your child has had trauma to the face and mouth. However, baby teeth are NEVER re-implanted because 1) re-implanting them may cause damage to the developing permanent tooth and 2) the long-term prognosis for re-implanted baby teeth is very poor.

Is it okay to breast feed my infant at night after her teeth have started coming in?

On-demand breast feeding at night can be a problem if the child falls asleep without having her teeth cleaned. When carbohydrates and sugars found in milk are introduced to the mouth, the bacteria naturally inhabiting the mouth will convert these sugars into sticky plaque and acid waste, which eats away at the enamel on the teeth, causing decalcification of the enamel and eventual decay. Breast milk is very sweet, and even these “natural” sugars are utilized by bacteria just as any other sugar. Usually, the problem only occurs if the child is feeding frequently during the night. If your baby wakes up in the middle of the night and feeds for a few minutes, then falls asleep again, it will probably not be a problem if the mouth is generally cleaned 1-2 times a day. However, if the child nurses all night long—either on the breast or with a bottle of milk or other sugar-containing drink—or feeds 4-5 times a night, this can cause problems leading to tooth decay. Remember, most children do not have teeth until 6-7 months of age, and tooth decay only is a problem if there are teeth present in the mouth. A healthy 2-3 year old child should not be feeding several times at night. If your toddler uses a bottle at night for comfort, the drink inside should not contain sugar. If only water is in the bottle at night, there will be no risk for tooth decay.

We have well water. Does this mean my child needs a fluoride supplement?

Fluoride has been shown to dramatically decrease a person's chances of getting cavities by making teeth stronger. Fluoride in the drinking water is the best and easiest way to get it. The first thing you need to do is have your well water tested by your city for the fluoride content. It is possible that the well water you use contains enough natural fluoride that you do not need any supplementation. If there is not enough fluoride in the water, you have several choices. Many people choose to drink bottled water that has fluoride added. If you use this water for drinking, mixing it with concentrates of juice, cooking, etc., you do not need any additional fluoride. If you do not want to do that, fluoride supplements can be prescribed by your dentist or pediatrician. Fluoride supplements should be given to your child until their 12-year molars are fully erupted (approximately age 12 years) and are prescribed based on the fluoride content in the water and the age of the child. For example, a 3-year-old who is not drinking any fluoridated water should receive 1/2 mg per day, and a school-aged child should receive 1 mg per day. Most major cities have fluoride in the drinking water system. Your pediatric dentist or pediatrician can help determine if your child needs fluoride supplements or not.

Is it normal for a child’s gums to look bruised when their teeth are coming in?

It is not uncommon for the gums to appear bruised and swollen just prior to the tooth breaking through the gums. This bubble-shaped lesion is called an eruption cyst, and it usually requires no treatment. Often, the eruption cyst will last anywhere from a few weeks to a month. If it does not resolve in over a month, a dentist should evaluate it. Sometimes the lesion needs to be lanced, or cut open slightly, in order for the tooth to be able to erupt properly.

What should I do if my child has a toothache?

First, rinse the irritated area with warm salt water and place a cold compress on the face if it is swollen. Give the child Tylenol or Motrin for any pain. NEVER place aspirin on the teeth or gums, as it can be very harmful to the oral tissues. Finally, see a dentist as soon as possible.

How often does my child need to see the pediatric dentist?

A checkup every six months is recommended in order to prevent cavities and other dental problems. However, your pediatric dentist can tell you when and how often your child should visit based on their personal oral health.

How safe are dental X-rays?

There is very little risk in dental X-rays. Pediatric dentists are especially careful to limit the amount of radiation to which children are exposed. Lead aprons and high-speed film are used to ensure safety and minimize the amount of radiation.