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What is a Pediatric Dentist?
The pediatric dentist has an extra two years of specialized training 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.
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.
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.
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.
X-Ray’s detect much more than cavities. For example, X-Rays may be needed to survey erupting teeth, diagnose bone diseases, evaluate the results of an injury, or plan orthodontic treatment. X-Rays 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 X-rays 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 X-rays 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.
Care of your Child's Teeth
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 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.
Snacks —- We love them, they taste great, they are usually a good source of quick energy.
Problem —- They can increase the acid that damages teeth. Some snack foods will cling between the teeth for hours. Most foods, including main meals and snacks can be contributing factors in producing cavities. It is not just the presence of sugar, but a combination of factors. Any food that contains sugar or starch is capable of causing decay. Everyone immediately places the blame on sweets, but the truth is that sugars can be found in fruits, vegetables and even milk. Starches or fermentable carbohydrates such as potato chips, croissants, bread sticks, fresh doughy bread, pretzels, soda crackers and many types of cereal can stick to the teeth for some time after a meal. These starches mix with saliva in the mouth which contains an enzyme called amylase. The enzyme rapidly turns the starches into sugar. Therefore, starchy foods, as well as sugary ones, should be limited as between-meal snacks unless you are willing to brush your teeth right after you eat them. Bacteria cannot read labels, and as far as the teeth are concerned sugar is sugar, where it comes from doesn’t matter.
There is no perfect way to eliminate sugar from you diet and you obviously can’t protect your children’s teeth by stopping them from eating! Therefore, the next best step is to eat sensibly and confine sugary sweets to mealtime as much as possible, for research shows that their powers to damage teeth are reduced when ingested along with meals.
The texture of a food, its lack of crispness, its moistness, and its capacity to stick on the teeth without stimulating the flow of saliva all need to be considered. Sticky snacks such as raisins, fruit roll-ups, caramels, dried fruits, and honey cling to the chewing surface of teeth as well as collecting at the gum line and can be more detrimental to dental health than other forms of sugar.
It must be remembered that the frequency of eating sugar and starches and the length of time exposed to the teeth is much more damaging than the amount of sugar consumed. For example, sucking on a cough drop, a life saver or a tootsie-pop can be much more harmful than eating several pieces of candy. In fact, there is a substance in chocolate that blocks a bacterial enzyme that leads to plaque build-up and cavities. This protective tannin-like substance is also found in cocoa, tea, coffee and unsweetened fruit juices.
To prevent your child from getting cavities, pediatric dentists recommend these simple steps:
Make sure your child’s teeth are cleaned every day. While a good approach is to brush following every meal, this is not a requirement. However, it’s a good idea to brush the teeth especially well before the child goes to bed.
Make sure your child’s teeth are protected by fluoride. Fluoride acts as a shield on the teeth and will help retard the actions of the bacteria in the mouth.
Practice healthy snacking by reading labels for sugar content, keeping healthy ready-to-eat snacks on hand, seeing that your child snacks less often and avoiding sweet snacks at bedtime (this includes sweetened drinks) as the saliva flow is lowest at night.
The realistic approach to preventing cavities and keeping healthy teeth for a lifetime is a sensible and nutritious diet; regular oral care, including daily brushing and flossing; and dental check-ups every six months.
Examples of snacks that have a low cavity risk are:
Raw vegetables such as broccoli, carrots, cauliflower, celery, cucumbers and green peppers
Cheeses such as Swiss, Monterey Jack, cheddar, cream and cottage
Peanuts or natural peanut butter (no sugar)
Nuts and seeds
Hard boiled eggs
Plain un-sugared yogurt
Fresh fruits and natural fruit juices (no added sugar)
Examples of snacks that have a high cavity risk are:
Starches such as potato chips, soda crackers, doughnuts, breads, cakes, cookies, sugared breakfast cereals, pancakes, waffles, croissants and pretzels
Bananas, dates, raisins
Fruit Jellies and Jams, fruit pies, dried fruits, fruit bars, fruit roll-ups, and fruit juices
Caramels, and sugared gums
Cooked starches such as carrots
How Do I Prevent Cavities
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.
Seal Out Decay
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.
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.
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.
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).
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.
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. Another source of fluoride can be found in soft drinks at fast food restaurants, when blending the syrup and carbonation with the city water supply.
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).
What’s the Best Toothpaste for my Child?
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. 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.
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 and Other Oral Habits
The position of the permanent teeth is influenced by many environmental factors. Some of these are linked to oral habits present in early infancy. These habits might be thumb sucking, finger sucking, tongue-thrusting, or grinding and clenching the teeth. Dr. Young can usually read signs of these habits by looking at a child’s teeth and can make the parent aware of accompanying changes. He can also suggest the methods that are available to correct the habit, and can advise when the corrective treatment should be instituted.
It is generally accepted that there is a connection between the development of the dental arches and the action of the surrounding muscles associated with the tongue and lips. Pediatric dentists are concerned with the way the baby is held while nursing, how the child nurses, and the kind of nipple that is used if he or she is bottle fed. The professional is also interested in other signs of oral habits such as chapped lips, clean thumbs from thumb sucking, and bitten fingernails. Pressures exerted by habits such a these can create an imbalance of the muscle system that directs the erupting teeth into place or holds them where they belong.
Thumb sucking is probably the most prevalent oral habit and receives the most attention. It also generates the most questions.
Sucking is one of a baby’s inherent reflexes, and if this reflex were not present the infant would not seek food or nourishment. It is a natural normal infant habit and gives the baby a feeling of security, pleasure and considerable satisfaction during the first year of life. If the infant chooses this habit it should not be discouraged in the early years. The parent or care giver can try gently moving the infant’s hand away from the mouth and attempt to interest him or her in a favorite toy. The parent can also try to encourage the use of a pacifier as an alternative to thumb sucking, or as a replacement for excessive use of a nursing bottle.
After age two, thumb sucking usually decreases, appearing only at bedtime or when the child is under stress or overly tired. Gradually it will stop altogether. Even up to the age of four or five, the parent probably does not have to worry about the child sucking his or her thumb unless heavy vigorous pressure is being applied by the thumb. Any irregularity in the position of the teeth that is directly due to the sucking habit is generally self-correcting as long as the child abandons the habit by the time the permanent teeth begin erupting.
There are two types of thumb suckers, “active” and “passive”. The “passive” thumb sucker places the thumb in the mouth and it just lies there exerting no undue pressure and causing no bone changes. On the other hand, the “active” thumb sucker exerts, heavy, vigorous pressure with the thumb against the dentition, and when this habit is continued for a prolonged period of time it can affect the position of the incoming permanent teeth and the shape of the jaws. This pressure may force the teeth out of position and narrow the dental arches, thus bringing the upper teeth too close together and resulting in the child having an “open bite” (the teeth do not contact all the way around when the mouth is closed). “Active” thumb sucking may also interfere with the child’s speech patterns.
It cannot be stressed strongly enough, however, that if a child has this habit, do not scold, nag, ridicule, scorn, punish or belittle him in an attempt to stop it. Rather than helping stop the habit, these methods may increase the anxiety and resultant sucking, and the attention gained may reinforce the habit. The child may even thumb suck for security or to get attention. With some children thumb sucking can lead to severe dental difficulties which can be corrected by orthodontia; however, with other children, thumb sucking can lead to social difficulties and must be managed in a different manner.
There are many training aids, techniques, and types of therapy available today to help a child overcome the habit. Dr. Young will be glad to discuss this matter with you and explain the many avenues that can be pursued in helping your child correct this habit.
Most professionals feel that pacifiers should be encouraged as an alternative to thumb sucking. If one is used, care must be taken in purchasing it for the protection of the infant. It should be of one-piece construction, thus making it unable to be pulled apart by the child. Also, the pieces cannot be ingested or cause choking. It should have a large, ventilated shield, and should be made of a non-toxic material which is capable of being sterilized. The pacifier should not be tied around the infant’s neck and the parent should avoid putting sweets such as sugar or honey on it to encourage its use! The orthodontic nipple construction of the pacifier is preferable to the thumb shape construction.
An “open bite” can occur when a child sucks a finger or fingers in preference to the thumb. This same result can happen if a child is a “tongue-thruster”, since this individual places his tongue between the upper and lower front teeth each time he swallows and thus puts force on the teeth preventing the erupting teeth from coming down into their normal position.
Some children have the habit of “grinding” their teeth, especially during sleep. This habit is fairly common among children and its causes are many and varied; however, it is not to be considered in the same vein as adult grinding and malocclusion. The baby teeth flatten and wear with the grinding because the tooth enamel is thinner. If it persists after the permanent teeth have erupted the dentist will then discuss the problem with the parent.
Another oral habit that can affect the normal dental development is “clenching” or “locking” the teeth, and the parent should be sure to mention this to the dentist.
If these various habits occurring during childhood are diagnosed and corrected early in the transition between a child’s primary and permanent dental development, the chances of the child having beautiful, straight teeth are greatly improved.
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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Harold’s Hideaway Thumb
by Harriet Sonnenschein, Jurg Obnzt (Illustrator), Jurg Obrist (Illustrator)
David Decides About Thumbsucking – A Story for Children, a Guide for Parents
by Susan Heitler P H.D., Paula Singer (Photographer)
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.
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.
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