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 Click on a topic of interest for more
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GENERAL
TOPICS:
What is a Pediatric Dentist?
Why are the Primary Teeth
so Important?
Dental Radiographs (X-rays)
Eruption of your Child's Teeth
Dental Emergencies
Sedation for the Anxious Child
Fluoride
Why are there Stains on
my Child's Teeth?
Gastroesophageal Reflux
- Affect on Teeth
Hypocalcified Teeth
What is Pulp Therapy?
What
Is the Best Toothpaste for
my Child?
Why Does My Child Grind His/Her Teeth?
Thumb Sucking
What is the Best
Time for Orthodontic Treatment?
EARLY INFANT ORAL CARE:
Parental Guidelines for Preparing
your Child for Their First Dental Visit
When will my Baby Start
Getting Teeth?
Baby Bottle Tooth Decay (Early Childhood
Caries)
PREVENTION:
San Rafael Pediatric Dentist
Good Diet = Healthy Teeth
How Do I Prevent Cavities?
Plaque
Chlorhexidine Gluconate
Xylitol Frequently Asked Questions
Xylitol RX
Resin Fillings Used to
Prevent Cavities
Alternative Restorative
Technique for Early Childhood Caries
Demineralization vs Remineralization
Mouth Guards
ADOLESCENT DENTISTRY:
Tongue Piercing - Is
it Really Cool?
Tobacco - Bad News in Any Form
POST OPERATIVE CARE
INSTRUCTIONS:
For more
information on oral health care needs, please visit the website for the
American Academy of Pediatric Dentistry.
If you are
still searching for information not included in our web site you might try the
following links:
American Academy of Pediatric Dentistry
California Society of Pediatric Dentistry
My Pyramid - Nutrition
|
A great book
for your child to read about visiting a dentist:
Dr. De Soto - by Wm. Steig - available in English & Spanish and on
video |
 |
GENERAL TOPICS
What Is A
Pediatric Dentist?
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.
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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.
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Dental
Radiographs (X-Ray Films)
Radiographs (X-Ray Films) are a vital and necessary part of your child’s
dental diagnostic process. Without them, certain dental conditions can and
will be missed.
Radiographs detect much more than cavities. For example, radiographs may be
needed to survey erupting teeth, diagnose bone diseases, evaluate the
results of an injury, or plan orthodontic treatment. Radiographs 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.
In our office we recommend the first radiographs (4) at about 4 1/2
years of age, depending on what we discover in our initial examination of
your child. Follow-up radiographs are recommended at 6-month to 2-year
intervals depending on decay or growth issues that we are monitoring,
presence of fluoride in the child's water supply, and home brushing and
flossing. The American Academy of Pediatric Dentistry recommends
radiographs and examinations every six months for children with a high risk
of tooth decay.
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 radiographs 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. Our panoramic machine is digital, which decreases,
even more, the amount of exposure to radiation.
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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. Permanent teeth are darker (more
yellow) in color than primary teeth. They are denser and made to last a
lifetime
Adults have 28 permanent teeth, or up to 32 including the third
molars (or wisdom teeth).
TOOTH DEVELOPMENT
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Dental Emergencies
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.
Tooth Hit and Still in Mouth: If
the tooth is fractured (broken), call and go to dental office immediately.
If found, save the piece that's broken off, keep wet and bring to the
office. If the tooth is not fractured (broken), call and go to dental
office immediately. (The root of the tooth or surrounding bone may be
broken).
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Top Tips for Preventing Mouth Injuries
click here to read more
Sedation For The Anxious Child
~ Nitrous Oxide/Oxygen Analgesia
It is important that your child remains calm
and still during dental treatment to prevent injury to your child and dental
staff and to receive a high quality of professional dental care. For the
child who is afraid, uncooperative, too young to understand dental treatment
or requires very long, complicated, treatment visits, nitrous oxide/oxygen
for analgesia may be beneficial in helping the child relax.
The following information will help parents
understand sedation with the use of a combination of nitrous oxide and
oxygen gases for safe analgesia.
It is safe because the child remains awake,
responsive, and breathes on his/her own without assistance.
Much more oxygen is given than what we breathe
in normal room air. This provides a wide margin for safety.
Nitrous oxide/oxygen is breathed through a
small pleasantly scented mask placed over the nose.
Dental treatment is more comfortable and time
seems to pass faster for a relaxed child.
Sometimes nitrous oxide is known as “laughing
gas” because some patients become so comfortable and relaxed that they
laugh.
On the day of the visit, no dairy products
should be given prior to the visit. No food or drink should be given to
your child three (3) hours before treatment.
A local anesthetic is given, if needed, to
numb the areas that are to be treated so that there is very little
discomfort.
Oxygen is usually given at the end of
treatment to remove the effects of nitrous oxide gas and end the
treatment.
The child is awake and sometimes remains
relaxed after dental treatment but will continue to feel the numbness in
the treated area.
Please feel comfortable in discussing with us any
other questions you may have about the procedures.
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Fluoride
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 chalky white
to yellow-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-year olds 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's formula, soy-based infant's formula, infant's dry cereals, creamed spinach,
and infant's 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.
Fluoride in the water supply decreases by 30% the
chance of your child getting cavities. Fluoride is safe. If it
is not in your water supply (Marin Municipal Water District is fluoridated;
North Bay Water District is not), our office will be able to prescribe it.
The dosage changes at 3 and again at 6 and should be taken daily until 16
years of age. If you are in the MMWD and have a water filtration
system or use a lot of bottled water, your child may not be receiving an
adequate amount of fluoride and will be more prone to getting cavities!
Bottled water is available with fluoride.
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 children until 2 years of age, in a
fluoridated community.
-
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).
[Back to Top]
Fast Facts About Fluoride
click here to read more
Why Are There Stains On My
Child's Teeth?
Stains can be just on the surface of the
tooth (extrinsic) or incorporated into the developing tooth (intrinsic). The
latter is more rare. Tetracycline antibiotics will stain teeth that are
forming at the time of the drug's use. As a result, tetracyclines are no
longer given to pregnant women or children under twelve (except in
life-threatening cases). The forming teeth may be stained gray to yellow to
orange. Some stains can be bleached out; others need to be covered by bonded
plastic resins.
More common are stains on the surfaces of the
teeth (extrinsic). These accumulate after eruption of a tooth into the
mouth. Newly erupted primary teeth may have a yellow membrane on them that
will wear of in a few days. Newly erupted permanent teeth appear more yellow
than their milky-white primary neighbors. This is their normal, permanent
color. The permanent teeth are darker because they are denser so that they
can last a lifetime.
White color is not always good. Chalky white
spots on permanent teeth can be the result of trauma to a primary tooth
while the permanent tooth was developing in the jaw. Or, chalky white lines
at the gum line or around orthodontic braces can be a warning sign. Decay
starts by removing minerals, especially calcium from the outer surface of
the tooth. This softens and allows the acid from the bacteria in plaque to
work more quickly. If oral hygiene (brushing and flossing) is started at this
point, using a concentrated fluoride paste, and the teeth are kept
meticulously clean, these areas can harden again by remineralizing. But, the
chalky white lines will remain. If the white turns to brown, the enamel has
been broken by the acid attack and the tooth may now need a filling.
If one or two teeth are dark, gray, pink or
yellow, this may be the result of that tooth having been hit accidentally.
Your child should be seen soon thereafter for an X-ray picture of the tooth and
a discussion about possible things that may happen to that tooth.
The rest of the stains mentioned below are
all easily removed by a simple polishing done in the dental office with a
rotating rubber cup and pumice.
-
Green or orange stain---usually on the front teeth at the gum line. It
is caused by color-producing (chromogenic) bacteria. Colonies of these
orange or green bacteria usually mean that somebody is falling down on the
job of cleaning the child's teeth. It could also mean that the child is a
mouth-breather.
-
Brown/yellow stain---very likely from antibiotics. The most common
antibiotic to stain the surface of the teeth is Amoxicillin. A single dose
may cause a yellow to brown film to form on the teeth in some children. The
stain may disappear partially or altogether once the prescription of
antibiotics is finished. If it bothers you, the parent, the stain can be
readily removed, even for children under two years of age.
-
Black stain---very often this stain is caused by chewable- or liquid-iron
supplements, or even multiple vitamins with added iron. This stain polishes
off easily. Some populations naturally form a black line on the teeth at the
gums lines of all the teeth. It tends to reform rather quickly after removal
by the dentist. Where it comes from we do not know. But, we do find that
these patients seem to develop few dental cavities.
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Gastroesophageal Reflux
- Affect On Teeth
Guide
for Parents Whose Children Have Dental Signs of GER
(Gastroesophageal Reflux)
The effect of GER on the teeth:
When stomach acid rises into the mouth, the teeth
can be affected. We have observed areas of dental corrosion in your child’s
teeth. This takes on the form of “reverse architecture” in that what were once
cusp tips are now areas of moon cratering where parts of the teeth may appear
scalloped out and be sensitive to cold foods and touch. These erosion areas can
become quite deep and in some instances will cause fillings to be washed out or
will erode into teeth exposing the nerve or make untreated cavities worse.
Some Symptoms known
to result from GER:
-Child
reports frequent “hot burps” or “baby vomit”
-Child has frequent
belching after eating
-Child reports
having burning in the area of the heart or stomach ache
-Child is irritable
after meals
-Child reports bad
taste (acidy, like vomit) taste in mouth upon
awakening
in the morning, and breath has an acid odor
-Child has
chronic hoarseness/ laryngitis/ pharyngitis/coughing
-Parent hears
continuous coughing during sleep (usually GERD not asthma)
-Associated with
Asthma / Premature birth / ADHD / Cerebral Palsey / Obesity
What to do now:
1. Suggested dietary changes
to help reduce reflux:
-Avoid juices
(especially o.j. with pulp), carbonated, sports drinks and water with acid added
like Vitamin water.
Read the label.
Look for acetic, phosphoric or other acids.
-Chew gum flavored mainly with xylitol, a naturally occurring sugar
substitute, e.g.:
Spry® which is 100% xylitol
-Use hard cheese as a
snack or snack chaser, the calcium neutralizes acid
-Avoid
fried & spicy foods & pickles & vinegar
-Avoid overeating (supersizing)
-Don’t lie down
immediately after eating
-NO MINTS,
PEPPERMINT or SOUR
CANDIES (Skittles, War Heads, Altoids…)
KEEP IN MIND:
normal saliva pH greater than 6.3 or just about neutral like plain water
after eating acidity in
the mouth drops to about pH 3.5 because the bacteria create acid from the food
saliva usually neutralizes that acid very quickly unless the food supply, for
instance lots of sports drink is constantly being replenished emineralization
(dissolving) of enamel begins at about pH 5.5!
2. Elevate
head of bed with a 2 x 4.
3. Swish
water and rinse after a bad taste, or acid food and drink. DO NOT BRUSH as that
will remove recently dissolved enamel!
4. Review
resources for an in-depth understanding of GER:
-Articles on the
internet (type GER or GERD into the search engine)
The National Digestive
Diseases Information Clearinghouse website has three sites with excellent
information related to GERD in general; in children and adolescents; and
infants:
http://digestive.niddk.nih.gov/ddiseases/pubs/gerd/index.htm
http://digestive.niddk.nih.gov/ddiseases/pubs/gerinchildren/index.htm
http://digestive.niddk.nih.gov/ddiseases/pubs/gerdinfant/index.htm
5. Work
with your child to assist him/her to be able to accurately describe:
-What it feels like when
reflux occurs
-How often reflux occurs
-What time of day it
occurs (bedtime, after meals, upon awakening, etc.)
-Whether certain food
seems to be related to refluxing (make a list)
-How long has he/she been
aware of refluxing
Once you have
gathered all the information you can, keep a diary
of symptoms and
IF symptoms, in addition to dental erosion are present:
6. Contact
your child’s pediatrician for an evaluation of the need for diagnostic tests
and/or medication.
Please keep me informed of the
outcome of any tests and the effect of any medication that is prescribed for
your child.
Long term medical and dental
risks: If untreated, GE Reflux can predispose you to esophageal (throat)
problems in adulthood. There is higher risk for tooth decay as saliva cannot
neutralize the strong acid.
Click
here for a printable version of "Guide for Parents
Whose Children Have Dental Signs of GER (Gastroesophageal Reflux)"
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Hypocalcified Teeth
Teeth occasionally experience a disturbance
during development that results in the enamel developing atypically. It is
usually observed as a discoloration: white, yellow or brown. We most
commonly see it on the first permanent molars and central incisors (two
front teeth), although it can happen to any of the teeth.
-
When
this anomaly occurs on the front teeth, there may be some cosmetic concerns
to address. In its mildest form it shows as white marks on the teeth,
typically near the chewing edge, though it may be anywhere on the tooth.
They are often hydration dependent meaning if the tooth dries out the white
spots become prominent, and when the tooth remains wet the spots diminish or
disappear. These are a cosmetic concern only and because an adult’s facial
posture keeps lips closed more than children, these blemishes typically
remain wet and diminish in appearance. We do not recommend any treatment
procedures until at least the mid-teen years when a more adult facial
posture has developed.
-
White
blemishes that are larger and more opaque will likely need removal of the
blemish and filling with a cosmetic filling material.
-
Blemishes of a more yellow or brown nature are often improved with bleaching
techniques that can be done at any age. If the blemish does not respond to
bleaching, we can offer other cosmetic procedures to remove discolorations
and refill the blemishes with cosmetic filling materials.
-
If
the aberration is severe enough it will result in soft enamel that chips
and/or decays easily. It may also result in an atypical shape for the tooth.
This is sometimes referred to as enamel hypoplasia. We usually observe this
on the molar teeth. When this occurs, it is important to remove the very
soft enamel and place a filling in the area. We do this in a conservative
fashion by bonding on a filling material to replace the lost or decayed
portion of the tooth. This usually needs “touching up” as the tooth grows
and exposes more of the compromised enamel. The soft enamel may also chip
around the bonded filling necessitating occasional repairs. Occasionally the
aberration in the enamel is extensive enough that we recommend a stainless
steel crown as a temporary crown during the growing years. A large
percentage of these molar teeth will be best served with a cast onlay or a
full crown restoration after all permanent teeth have emerged, growth is
finished, and the occlusion has stabilized (age 18 or older). In the
meantime, we will maintain the integrity of the teeth with conservative
repairs.
-
These
teeth can also be very sensitive for reasons we do not know. Restoring
or covering the hypocalcified enamel will occasionally help this.
Toothpastes for sensitive teeth (i.e., Sensodyne™, Thermodent™) can also be
helpful. Avoiding highly acidic snack patterns (carbonated beverages, fruit
juices, sour candies) will likely be very helpful as well.
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What
Is Pulp Therapy?
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) until the permanent tooth is ready to erupt.
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.
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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 and that the ingredients
work as advertised.
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.
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Why Does My Child Grind His/Her
Teeth
As many as 80-90% of young children grind (brux) their
teeth at night. Many children also brux during the day. The only directly
related cause known for bruxing is that Children with a combination of
allergies and severely restricted airways will brux. The jaw movement opens
the eustachion tube and gives relief. This would be similar to yawning while
driving to Lake Tahoe in order to alleviate the pressure in one’s ears. We
know that animals grind their teeth to keep them sharp and that females are
more likely to brux than males. Interestingly, there is a hereditary
component to bruxing. In children, the anatomy of the temperomandibular
joint (TMJ) allows easy movement of the bottom jaw (mandible). These
movements become harder to make as the TMJ matures with age. All the other
explanations for bruxing are conjecture.
Interestingly, bruxism, bed wetting, sleep
talking, nocturnal muscle cramping, drooling while sleeping, and starting to
sleep though the night at a later age are all associated.
Children usually grow out of this problem by age ten without causing any
permanent damage. If the problem persists into the early teens and the
dentist recognizes signs of unusual wear to the permanent teeth, preventive
measures can be taken to prevent future damage. Treatment may involve a
plastic nightguard for nighttime wear and/or bio-feedback therapy.
Remember, bruxism in young children does not always mean that damage is
occurring or that dental problems will occur later in life.
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Thumb
Sucking
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.
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 stop 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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What
Is The Best Time For Orthodontic Treatment?
Developing malocclusions, or bad bites, can be
recognized as early as 2 to 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.
[Back to Top]
EARLY INFANT
ORAL CARE
Parental
Guidelines for Preparing Your Child for Their First Dental Visit
We recommend that you and your child visit our office
well before your child's second 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 fuss and anxiety concerning the visit, the better.
We examine most children, under 3 1/2, in their parent's lap. We will
discuss findings and how to keep your child's teeth clean and healthy.
A follow-up visit may be anywhere from a few months to over one year
depending on the findings of the exam.
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. See Parent
Guidelines.
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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.
[Back to Top]
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 easily see into the child’s mouth.
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PREVENTION
5 Things You Didn't Know About Teeth
click here to read more
7 Steps to Protect Your Child's Teeth
click here to read more
Care
Of Your Child’s Teeth
Plaque is a sticky film in which bacteria breed; it
grows on teeth. The bacteria take about 24 hours to mature to the
point where they can make acid. The acid causes cavities and makes the
gums bleed. Children's teeth should be cleaned as soon as they erupt
into the mouth. Use a wet wash cloth or a small child-size toothbrush.
Use a small pea-size amount of fluoride toothpaste starting about age 2.
Use a wet washcloth or the Infa Dent™, at bath time, to clean your infant's
gum pads and/or newly emerging teeth.
Children should be encouraged to brush their teeth, by
themselves, in the morning after breakfast. At night, an adult should
brush and as necessary, floss the child's teeth. The child will have the
ability to brush, on their own, at between 7 to 10 years of age. Each
child is different. Your pediatric dentist and staff can help you
determine when 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 the toothbrush at
a 45 degree angle; start along the gum line with a soft bristle brush in a
gentle circular motion. Brush the inner surfaces of the bottom molar teeth
first. Finish the inner surfaces of the bottom teeth, then the outer and
chewing surfaces. Repeat the same method on the top teeth. Finish by
brushing the tongue to help freshen the 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.
You may find it easier to use the flossing tool that we will dispense and
demonstrate how to comfortably use this on your child. We highly recommend
Wild Flossers® by Johnson and Johnson.
Disclosing the plaque enables older children to brush
until all the plaque is removed. A disclosing solution is recommended.
Always look at your child's teeth. Color
change could indicate a problem. Watch as new teeth erupt. Keep them clean.
Some medications, such as Amoxicillin® and iron
supplements may temporarily stain the surface of the teeth. The stain
is easily removed by a light polishing in our office. See
Why are there Stains on
my Child's Teeth?
Permanent teeth are darker (more yellow) in color than
primary teeth. They are denser and made to last a lifetime
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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. 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.
Hard candies and chewing gum in which xylitol is the
main sweetening ingredient are highly recommended. Xylitol is a naturally
occurring sugar substitute that encourages remineralization and prevents
decay. See
Demineralization vs Remineralization.
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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.
As soon as the child can hold the toothbrush, they should brush their own
teeth in the morning, after the parent places toothpaste on the brush.
A parent should brush the child's teeth at night.. 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 other measures such as home
fluoride treatments.
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Plaque
Plaque is a sticky film in which bacteria
breed, it grows on teeth. The bacteria take about 24 hours to mature to the
point where they can make acid. The acid causes cavities and makes the gums
bleed.
Disclosing the plaque enables older children
to brush until all the plaque is removed. A disclosing solution is
recommended.
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Resin Fillings Used To
Prevent Cavities
“My child has a
cavity?!”
or
“I thought a sealant was to prevent a cavity, then why a resin filling?”
 A cavity is by definition a hollow place-- a hole.
Often, molar, premolar teeth and the backsides of top front teeth are formed
with deep grooves, pits, and fissures. Despite one’s best efforts, the
toothbrush bristles cannot reach down to clean out these crevices (see
photo). It is warm, dark, and moist at the bottom of these pits, and the
acid from bacteria easily begins to soften the tooth enamel as decay begins.
You may have heard about “sealants.” Sealants are
supposed to be a protective coating to prevent decay. Some dentists advocate
doing the procedure on all permanent molar teeth and many primary molar
teeth soon after these teeth erupt into the mouth. However, it seems that
not all people need this procedure. In fact, about 80% of children need it
in at least one permanent molar and about 10% of children need it in a
primary molar.
In this office, we advocate the procedure only when
signs indicate that decay is starting or extremely possible to start in a
tooth. Then, the tooth receives a mini-resin, “invisible” filling. The
“water whistle” (also known to many of you as the “drill”) is used to
explore the deep pits, fissures and grooves of the affected tooth and remove
any decay that is lurking there. Only the most minimal amount of tooth
structure is removed to eliminate any possible decay. This is usually a
painless procedure for the child, and no numbing is routinely required. Some
children may feel a quick tinge of “cold” when the bottom of the pit is
reached and the last bit of decay is removed. Children are always warned of
this potential feeling at the appropriate time. The feeling is usually not
enough to warrant an injection and the subsequent experience of numbness for
hours afterwards.
Approached in this way, the resin will more likely
remain for years without recurring decay under the small, conservative,
“invisible” mini-filling. These are not the fillings with which most of us
are familiar.
We tell the children that these do not “count” as
cavities because they could not be prevented. And, when we refer to them as
“fillings”, they are not the fillings that most of us are familiar with.
They are small, conservative, “invisible” mini, resin fillings.
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Alternative Restorative
Technique (ART) For Early Childhood Caries (ECC)
Explanation for Parents
Early Childhood Caries (ECC) is a very
aggressive fast-moving type of decay! ECC is a particular challenge to treat
due to the child’s limited capacity to understand at this age (age 1 or 2).
We are also very limited in the length of time a child will sit still and
allow us to work. If the work is significant, our only alternative to treat
these cavities and avoid infections, abscesses and extractions used to be
general anesthesia in the hospital or sedation in the dental office.
ART is a variety of new techniques designed
to slow down or stop the decay and to place temporary fillings as the child
is developing so more conventional fillings can be placed. We are buying
time and attempting to avoid the hospital treatment or sedation. This
technique relies on daily support at home. If we do not have excellent help
at home, failure is more likely and we may be faced with the general
anesthesia choice and the extensive dental work. These techniques include:
-
Identification and cessation of the cause of the early caries. Without
excellent cooperation at this step in the home all the rest of our efforts
will be in vain. We will lose time, increase the costs, and need to do
immediate conventional treatment on a worsened condition.
-
Remineralizing with topical fluoride applications at the office and at home.
All the fluoride research conducted during the last 20 years demonstrates
that the beneficial effect of fluoride is topical, i.e., we don’t need to
ingest it to receive any benefit. And, the fluoride can remineralize areas
where the cavity has started. It is healing the cavity.
-
Removing bulk decay from the cavities with quiet instruments and opening the
areas to permit easier cleaning with tooth brushes, floss and toothpicks.
Injections of local anesthetic are not required and treatment can be done
with the child in the parent’s lap.
-
Placing temporary fillings where feasible or necessary. We use materials
that will inhibit the potential for new, active caries to start.
-
Monitoring carefully! We recommend follow-up visits at 3-month intervals and
placement of fluoride varnish.
a) If caries is progressing we
want to identify that quickly while as many conservative options for
treatment as possible are still available.
b) If we need to modify the
program, we want to identify the need and the reasons at the earliest
interval possible.
We want to emphasize that if this program if
followed correctly, it is highly successful. If the program is not followed
adequately it may not be successful and may lead to a delay in treatment and
a worsening of the problem. If at any time in the process you feel you
cannot fulfill your home care activities that we are requesting, let us know
so we can adjust the program to better suit your needs.
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Athletic Mouth
Guards
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-made and
store-bought mouth protectors.
[Return to Top of Page]
ADOLESCENT DENTISTRY
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. The
mouth contains millions of bacteria, and infection is a common complication
of oral piercing. The tongue could swell large enough to close off the
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: Skip the mouth jewelry.
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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 doesn't subside
- 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 be fatal.
Help your child avoid tobacco in any form. By doing
so, your child will avoid bringing cancer-causing chemicals in direct contact with
their tongue, gums and cheek.
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POST OPERATIVE CARE
INSTRUCTIONS
Tooth Extraction Instructions
Your child's mouth is expected to
heal normally. To assure this, please follow these instructions:
1. Make certain that your child continues to bite on the gauze for 15 to 20
minutes after leaving
our office. This biting pressure stops
the bleeding and
allows better clotting.
2. Use the extra gauze we have provided when the initial gauze becomes
overly wet. Fold the
gauze pad into fourths and place it into the extraction site. Then have your
child bite firmly.
3. Bleeding should stop in about 20 to 45 minutes after extraction. A slight
oozing of blood for
a day is normal. If it is a problem, have the child continue to bite on the
gauze. Call our office if there is excessive bleeding. Sometimes, a little
blood mixed with saliva appears to be excessive bleeding. Have your child’s
head slightly elevated for sleep and use an old pillow
case.
4. The area where the tooth was (extraction site) will turn dark burgundy
red and a gray-yellow
spot may appear in the center. This is normal healing. Within 5 to 10 days
after extraction, the
area will become pink and look normal again.
5. For one hour following the extraction your child should have nothing
to eat or
drink. For the remainder of the day your child should eat soft foods and
avoid hot foods and eating on the side of the extraction. (Examples of soft
foods are soups, pasta, eggs, oatmeal, yogurt, gelatin, puddings, apple
sauce, soft cheeses, mashed potatoes, and creamed spinach). If a front tooth
was extracted, avoid foods that need to be incised like chicken or ribs on
the bone or corn on the cob.
6. On the day of extraction, your child should not rinse his or her mouth or
drink
through a straw because these activities may disturb the clot.
7. Be careful and watch that your child does not accidentally bite or
scratch the numb cheek,
tongue and/or lip. It can happen very quickly! The numbness generally lasts
one to three
hours.
8. Gentle brushing with warm salt water (1 tsp. salt per 8 oz. glass of water) can
begin the morning
following the extraction. A clean mouth will heal more quickly. Continue the
rinsing for
several days and longer if there is a problem keeping the area clean.
9. If your child feels discomfort, he or she can have the appropriate
dosage of acetaminophen
(Tylenol®) or ibuprofen (Advil® or Motrin®) pain killer if your child is not
allergic.
10. Do not hesitate to call our office if you have any concerns or
questions: (415) 459-1444
Care After Local Anesthetic
Anesthetic numbs the tissues of the lips, the
cheeks, and sometimes the tongue of the area involved. Children
usually do not understand the effects of this local anesthetic and have the
tendency to chew or suck the affected area, occasionally causing laceration
and swelling of the tissues. Although this may not be a serious thing,
it can be very uncomfortable. PLEASE watch your child very closely
until the numbness disappears: upper jaw 2 hours or so, lower jaw 3 to 4 hours
if a block is given or about 1 hour if local infiltration is used. If
the child bites the numb area, it usually occurs shortly after leaving the
office.
The following is a recommended book and
excellent preparation prior to a filling appointment where an injection will
be given:
 Going to the
Dentist by Anne Civardi
|
Loose
Tooth Luke
Arthur's
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