Other General Topics
The Pediatric Dentist
Pediatric dentistry is the specialty of dentistry that focuses on the oral health of young people. After completing a dental school curriculum, two to three additional years of training are required to become a pediatric dentist. This specialized program of study and hands-on experience prepares pediatric dentists to meet the needs of infants, children and adolescents, including those with special health care needs. Establishing us as your child’s Dental Home provides us the opportunity to implement preventive dental health habits that keep a child free from dental/oral disease. We will also work with your child’s pediatrician and other physicians as our commitment to total general health.
We focus on prevention, early detection and treatment of dental diseases, and keep current on the latest advances in dentistry for children. Pleasant visits to the dental office promote the establishment of trust and confidence in your child that will last a lifetime. Our goal, along with our staff, is to help all children feel good about visiting the dentist and teach them how to care for their teeth. From our special office design to our communication style, our main concern is what is best for your child.
Four things are necessary for cavities to form: 1) a tooth; 2) bacteria; 3) sugars or other carbohydrates; and 4) time. We can share with you how to make teeth strong, keep bacteria from organizing into harmful colonies, develop healthy eating habits, and understand the role that time plays. Remember dental decay is an infection of the tooth. Visiting us early can help avoid unnecessary treatment. The pediatric dental community is continually doing research to develop new techniques for preventing dental decay and other forms of oral disease.
Studies show that children with poor oral health have decreased school performance, poor social relationships and less success later in life. Children experiencing pain from decayed teeth are distracted and unable to concentrate on schoolwork.
Dental Care for your baby – first dental visit, nursing, teething, perinatal oral health care
Dental care for your baby should start as soon as possible at home (the sooner the better). Starting at birth, clean your child’s gums with an infant toothbrush or cloth and water. Once the teeth start to erupt a soft-bristled toothbrush can be used with fluoridated toothpaste (a “smear” for children under 2 years of age and “pea-sized” amount for age 2-5). The parent, or caregiver, should be involved in cleaning the child’s teeth and start training your child on how to spit out excess toothpaste rather than swallow it. Dental problems can appear very early, especially as the diet starts to include anything besides breast-milk.
Your child should visit a pediatric dentist when the first tooth erupts and no later than his/her first birthday to help prevent cavities and assess any early risk factors.
Breast-feeding: breast-feeding alone does not contribute to cavities but can when other carbohydrates are introduced into the diet. For this reason, it is important not to participate in at-will breast-feeding when other carbohydrates are introduced.
Your child should not fall asleep with a bottle containing anything other than water. Drinking juice or flavored milk from a bottle should be avoided as these can contribute to Early Childhood Caries (formerly called baby bottle tooth decay). Fruit juices should be minimized to 4-6 ounces per day in an open-rimmed cup during meal-times only. Children should be weaned from a bottle around 12-14 months of age.
Teething: From approximately 6 months to 3 years of age your child may experience tender gums due to teething. A cold teething ring, cool spoon or cold wet washcloth can provide comfort to your teething baby. Avoiding rubbing medications on the gums without speaking to a health care professional first because excessive use can be toxic to your child.
Parents/caregivers teeth: perinatal oral health care (around the time of birth) plays a very important role in overall health of pregnant women. It is also essential for the health of newborn children. Many studies show connections between periodontal disease and adverse outcomes in pregnancy including preterm deliveries, low birth weight babies, and preeclampsia (high blood pressure during pregnancy). Also, mothers with poor oral health and high levels of oral bacteria are at a greater risk for infecting their children’s and increasing risk at an early age. Mothers should pay special attention to their own oral care during and after pregnancy with regular dental visits, proper diet, use of fluoride, and proper oral hygiene.
Diet and snacking
A healthy well-balanced diet is essential for proper growth and development of your child. A balanced diet should include the following major food groups: fruits, vegetables, grains, meat and beans, milk. In addition to overall health, a balanced diet contributes to proper development of the teeth. A diet high in carbohydrates, such as sugar and starches, can contribute to tooth decay. When considering which foods are harmful, it is important to look beyond the obvious culprits in candy and soda. Many foods contain at least one type of sugar, either naturally or added to processed foods. Keep in mind that completely avoiding any foods with sugars and starches is not the answer since many of these foods provide essential nutrients. Choosing them wisely is the key. Foods with sugars or starches are better in conjuction with a meal rather than as a snack (such examples of starchy food snacks include crackers, pretzels, potato chips). Sticky foods (i.e – caramels, dried fruit) are more harmful since they cannot be easily washed off the teeth with saliva or water. Fruit juices (even 100% juice) should be minimized to 4-6 ounces per day limited to meal times and had in an open-rimmed cup (not a bottle or sippy cup). Talk to us further about specific foods that are a part of your child’s teeth and we can develop a balanced diet.
If your child is not yet on solid food it is important not to put him/her to bed with a bottle of milk, formula, juice or other sweetened liquid. When a child sleep, this liquid can remain in the mouth longer feeding bacteria that produce acid, causing tooth decay.
Frequency of snacking is also an important factor. If your child enjoys frequent snacking, it is important to chose healthy snacks (i.e – fruits, carrot sticks or other vegetables) rather than starchy snacks.
Chewing gum: if your child enjoys chewing gum ensure 1) that he/she is age-appropriate and is not swallowing the gum and 2) that it is sugar-free.
Emergency care and Trauma
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- As your child grows and becomes active, it is very important to understand that trauma to the face, head and teeth that can occur as a result. The greatest incidence of trauma to the baby teeth tends to happen around the age of 2-3 when children are very active and motor coordination is developing.
- Emergency care and trauma can be a very scary and frustrating situation for both you and your child. First thing to remember is to stay calm and to remember that your pediatric dentist is there to help. If your child has had a severe blow to the head or a jaw fracture, he/she needs immediate medical attention and should visit your nearest emergency department.
- If your child has a toothache – rinse the irritated area with warm salt water and place a cold compress on the face if it is swollen. Give your child acetaminophen for any pain, rather than placing aspirin on the teeth or gums. Aspirin should not be given to your child in any form. Finally, see a dentist as soon as possible. If your child should have swelling visible outside the face, it is very important to see a dentist right away or, during off hours, visit your nearest emergency room as this could develop into a serious condition.
- If your child has knocked a tooth out: Find the tooth, trying to avoid touching the root of the tooth. If it is a baby tooth, DO NOT place it back in the mouth, but visit the dentist to ensure no other trauma has occurred (placing a baby tooth back can cause long-term damage to the permanent tooth). If a permanent tooth is knocked out, rinse with cool water only (not scrubing) and gently try to reinsert it into the socket where the tooth was. If that is not possible for whatever reason, place the tooth in a glass of cold milk and visit the pediatric dentist immediately (the faster you act the better chances of saving the tooth). If your child’s tooth was not knocked out, it is still important to visit the pediatric dentist to fully assess all injuries/fractures, including providing antibiotics where necessary. Any fractured pieces of teeth should also be saved and brought to the office.
- How to prevent: Your child’s risk for dental injuries can be reduced greatly by following a few simple suggestions. Baby walkers, although popular in the past, have been increasingly discouraged by many health professionals as they can lead to harmful accidents. Child-proofing your house is very important, things to look out for include: sharp objects, potentials for slips such as rugs, electrical outlets that your child can place fingers in, loose wires that your child can place in his/her mouth, slippery bathtubs. Always use a car seat for younger children and seatbelts for older children. For children involved in sports, talk to your dentist about protective mouthguards.
- Please visit http://www.iadt-dentaltrauma.org/for-patients.html from the International Association of Dental Traumotology for more information
- Fluoride is a compound containing fluorine, a natural element, and can help prevent tooth decay by preventing loss of essential mineral from tooth enamel and strengthening areas that are already weakened. Fluoride also decreases acid attacks from cavity-causing bacteria. Fluoride can be found in many dental products such as toothpaste, rinses, gels, and varnish.
- Adding fluoride to drinking water has been considered one of the Ten Greatest Public Health Achievements in the US. It is a safe and inexpensive way to the benefit to children and adults of preventing tooth decay. Research shows that adding fluoride to water has reduced cavity rates by approximately 50%. For more information about fluoride please visit the CDC’s website at: http://www.cdc.gov/fluoridation/
- Using fluoride for prevention of tooth decay has been proven to be safe and effective. However, products containing fluoride should not be within easy reach of children as ingestion of large amounts can cause a condition known as fluorosis or, in severe cases, be toxic.
- Children who are at high risk of developing cavities can benefit the most from fluoride. Speak to your dentist about options such as topical fluoride treatments during dental visits to help prevent cavities. Certain risk factors include a history of previous cavities, a diet high is sugars or carbohydrates, orthodontic appliances, and certain medical conditions such as dry mouth.
- Sedation is a technique used to guide a child’s behavior to help increase cooperation, and reduce anxiety and discomfort during dental procedures. Medications are used that allow the child to become relaxed and drowsy, but is not intended to make a patient unconscious like in the case with general anesthesia.
- Sedation can be used for children who have a high level of anxiety, young children who do not yet understand appropriate cooperating in a dental setting, those requiring extensive dental treatment, or those with special health care needs. Specific medications to be used can be further discussed at your child’s dental visit.
- Sedation can provide a better environment for providing dental care and prevent injury to the child from uncontrolled or undesired movements
- Safety: sedation is safe when a proper medical history is taken and when administered via proper guidelines. However, speak to your pediatric dentist about the risks and benefits of sedating your child. It is always in everybody’s best interest when all questions are answered and you are fully informed about sedating your child.
- If choosing sedation as an option for your child, your pediatric dentist will review with you detailed instructions before and after your visit.
- Parents should inform the pediatric dentist of any illness that occurs prior to the sedation appointment; it may be necessary to reschedule the appointment for the safety of your child. It is very important to follow instructions regarding fasting from fluids and foods prior to the appointment.
- Although many pediatric dental offices are geared towards children with a specially trained staff, some children may still exhibit a level of anxiety that can deter proper dental care. Nitrous Oxide/oxygen is a safe, effective sedative agent use to reduce anxiety and allow for better communication and treatment. Some added benefits include providing relief to those children who have a heightened gag reflex as well as increasing the pain threshold.
- Nitrous oxide/oxygen is a blend of two gases: nitrous oxide and oxygen. It is administered by placing a mask over the child’s nose and as he/she breathes normally, uptake will occur into the lungs. The child will receive at least 50% pure oxygen during the dental procedure. At the end of treatment, the sedative gas is eliminated by administering pure oxygen and has no lingering effects.
- Your child will smell a faint sweetness from the gas and have a feeling of relaxation and sometimes giddiness/euphoria, giving it the alternate name of “laughing gas”. He/she may also feel a tingling sensation throughout the body.
- Safety: nitrous oxide/oxygen is perhaps the safest sedative agent in dentistry. It is very well tolerated, has a fast onset, is quickly reversible with no lingering effects and is non-allergenic. Your child will be fully conscious, with all natural reflexes, and capable of responding to questions. It is important to inform your pediatric dentist about any respiratory conditions that may make it hard for your child to breathe through his/her nose, which can limit the effectiveness of nitrous oxide/oxygen.
- Although your child can eat prior to receiving nitrous oxide/oxygen sedation, it is better to provide either a light meal or no food prior to the visit. Sometimes, nausea or vomiting can occur when the child presents with a full stomach.
- General anesthesia is a controlled state of unconsciousness that eliminates awareness, movement and discomfort during dental treatment. A physician or dentist with specialized training can use various medications to provide general anesthesia for patients receiving dental care.
- General anesthesia may be indicated for children with extensive dental needs who are extremely uncooperative, fearful/anxious or for the very young child. General anesthesia also can be helpful for children requiring significant surgical procedures or patients having special health care needs.
- Although there is some risk associated with general anesthesia, it can be used safely and effectively when administered by an appropriately trained individual in an appropriately equipped facility. Precautions are taken to protect your child during general anesthesia; personnel who are trained to manage complications will monitor your child closely. Your pediatric dentist will discuss the benefits and risks of general anesthesia and why it may be recommended for your child.
- A physical evaluation is required prior to general anesthesia for dental care. This physical assessment provides information to ensure the safety of your child during the general anesthesia procedure. Your pediatric dentist or general anesthesia provider will advise you which evaluation appointments are required. Parents should inform the pediatric dentist of any illness that occurs prior to the general anesthesia appointment; it may be necessary to reschedule the appointment for the safety of your child. It is very important to follow instructions regarding fasting from fluids and foods prior to the appointment. Your child will be discharged from the facility when stable, alert, and ready to depart. Patients often are tired following general anesthesia. You will be instructed to let the child rest at home with minimal activity until the next day. Post-operative dietary recommendations also will be given.
- Brushing, dental development, flossing, fluoride, oral habits, orthodontics, parent involvement, proper diet, sealants, sports safety, regular dental visits
- Preventative dentistry means a healthier smile for your child. Children with healthy mouths chew more easily and gain more nutrients from the foods they eat. They learn to speak more quickly and clearly. They have a better chance of general health, because disease in the mouth can endanger the rest of the body. A healthy mouth is more attractive, giving children confidence in their appearance. Finally, preventive dentistry means less extensive and less expensive treatment for your child.
- After evaluating your child’s dental health at his/her first dental visit, your pediatric dentist will design a personalized program of home care for your child. This program will include brushing and flossing instructions, diet counseling, and if necessary, fluoride recommendations. By following these directions, you can help give your child a lifetime of healthy habits.
- Examination, tooth cleaning and fluoride treatments are all part of your child’s prevention program. However, there is much more. For example, your pediatric dentist can apply sealants to protect your child from tooth decay, help you select a mouth guard to prevent sports injuries to the face and teeth, and provide early diagnosis and care of orthodontic problems. Your pediatric dentist is uniquely trained to develop a combination of office and home preventive care to insure your child a happy smile.
- Sealants protect the hard to clean grooves and pitted surfaces of teeth, especially the chewing surfaces of back teeth where most cavities are found.
- Sealants can last for several years if properly maintained and cared for. If your child has good oral hygiene and avoids hard and sticky foods, the sealants will last longer. Additionally, regular dental visits are still important to monitor stability of the sealants and to provide the necessary re-application or repair
- Sealants can be quickly and easily placed in one visit without the need for local anesthesia.
- Space maintainers are appliances made of metal or plastic that are custom fit to your child’s mouth to prevent loss of space as your child’s teeth are developing. They are small and unobtrusive in appearance. Most children easily adjust to them after the first few days.
- A baby tooth usually stays in place until a permanent tooth underneath pushes it out and takes its place. Unfortunately, some children lose a baby tooth too soon because it was knocked out accidentally or removed because of dental disease. When a tooth is lost early, your pediatric dentist may recommend a space maintainer to prevent future space loss and dental problems. When a baby tooth is lost too soon, the teeth beside it may tilt or drift into the empty space. Teeth in the other jaw may move up or down to fill the gap. When this happens, they create a lack of space for the permanent teeth. Therefore, permanent teeth can come in crooked. If left untreated, the condition may require extensive orthodontic treatment.
- Space maintainers hold open this empty space open. They steady the remaining teeth, preventing movement until the permanent tooth takes its natural position. It is more affordable – and easier on your child – to keep teeth in normal positions with a space maintainer than to move them back in place with orthodontic treatment.
- There are some special instructions for children with space maintainers. Avoid sticky sweets or chewing gum; do not tug or push on the space maintainer with your fingers, tongue or other foreign object (like a spoon/fork); keep it clean with brushing and flossing; and continue regular dental visits.
Thumb, Finger, Grinding/Bruxism, and Pacifier Habits
- Children suck on fingers, pacifiers or other objects to provide a sense of security. It is a normal occurrence in young age and, in fact, some babies begin to suck on their fingers even before they are born.
- Most children stop sucking on fingers, pacifiers or other objects on their own between 2 and 4 years of age. However, some children continue these habits over long periods of time. In these children, the upper front teeth may tip or not come in properly, creating on open bite. Frequent or intense habits over a prolonged period of time can affect the way the child’s teeth bite together, as well as the growth of the jaws and bones that support the teeth. Research has shown that long-term changes tend to occur when these habits are continues past the age of 3.
- When your child is old enough to understand, you and your pediatric dentist can encourage your child to stop, as well as talk about what happens to the teeth and jaws if your child does not stop. This advice, coupled with support from parents, helps most children quit. If this approach does not work, your pediatric dentist may recommend ways to change the behavior, including a mouth appliance that interferes with sucking habits.
- Bruxism (aka grinding) – the regular forceful contact between the chewing surfaces of teeth, can occur while awake or asleep. The cause is multifactorial. Reported complications include dental attrition, headaches, temporomandibular joint (TMJ) problems, and soreness of the muscles used for chewing. Research suggests that grinding of the teeth at a younger age is self-limiting and does not progress to adult bruxism.
X-ray use and safety
- Since every child is unique, the need for dental X-rays will vary from child to child. X-rays are taken only after reviewing your child’s medical and dental histories and performing a clinical examination, and only when they are likely to yield information that a visual examination cannot.
- For children with a high risk of tooth decay, the American Academy of Pediatric Dentistry recommends X-ray examinations every six months to detect cavities developing between the teeth. Children with a low risk of tooth decay require X-rays less frequently
- X-ray films detect much more than cavities. For example, X-rays may be needed to survey erupting teeth, diagnose bone diseases and other pathologies, evaluate the results of an injury, or plan orthodontic treatment. X-rays allow dentists to diagnose and treat conditions that cannot be detected during a clinical exam.
- There is very little risk with dental x-rays. Pediatric dentists are especially careful with children to limit the amount of radiation exposure by only taking x-rays when they’re necessary. Additionally, a lead apron, high-speed and digital x-rays are used to minimize radiation. Today’s equipment filters out unnecessary x-rays and restricts the x-ray beam to the area of interest. In cases of pregnancy, patient or accompanying caregiver, it is important to inform the office so that we may take additional precautions for safety.
Although we encourage parents to read through the material presented on our website, please keep in mind that it is presented for educational purposes only and does not imply diagnoses for your child. Treatment options and diagnoses can only be given after a visit to the dentist and a thorough medical history and clinical/radiographic examination.