GENERAL
TOPICS:
What
is a Pediatric Dentist? Your
Child's First Dental Visit Care
of your Child's Teeth For information on special oral health care needs, we've provided links to the following sites: National Institute of
Dental & Craniofacial Research 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. 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.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
Toothache: 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. If the pain still exists, contact your child's dentist. DO NOT place aspirin 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 bruised areas. If there is bleeding apply firm but gentle pressure with a gauze or cloth. If bleeding does not stop after 15 minutes or it cannot be controlled by simple pressure, take the child to hospital emergency room. Knocked Out Permanent Tooth: Find the tooth. Handle the tooth by the crown, not the root portion. You may rinse the tooth but DO NOT clean 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. The patient must see a dentist IMMEDIATELY! Time is a critical factor in saving the tooth.
What is best toothpaste for my child? Tooth brushing is one of the most important tasks for good oral
health. Many toothpastes, an 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. Does Your Child Grind His Teeth At Night? (Bruxism) 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 gets less 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.
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:
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. 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. 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. Your Child’s First Dental Visit According to the American Academy of Pediatric Dentistry (AAPD), 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 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. 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 are usually the lower front (anterior) teeth and
usually begin erupting between the age of 6-8 months. See "Eruption
of Your Child’s Teeth" for more
details. 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. Begin daily brushing as soon as the child’s first tooth erupts. A pea size amount of fluoride toothpaste can be used after the child is old enough not to swallow it. By age 4 or 5, children should be able to brush their own teeth twice a day with supervision until about age seven to make sure they are doing a thorough job. However, each child is different. Your dentist can help you determine whether the child has the skill level to brush properly. 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 the child’s teeth until he or she can do it
alone. Use about 18 inches of floss, winding most of it around the
middle fingers of both hands. Hold the floss lightly between the
thumbs and forefingers. Use a gentle, back-and-forth motion to guide
the floss between the teeth. Curve the floss into a C-shape and
slide it into the space between the gum and tooth until you feel
resistance. Gently scrape the floss against the side of the tooth.
Repeat this procedure on each tooth. Don’t forget the backs of the
last four teeth.
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 six month visits 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:
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:
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, or blood poisoning. 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 – 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:
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. |
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. 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.
