Dental topics | Henderson Pediatric Dentistry

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, including those with special health needs. The very young, pre-teens, and teenagers all need different approaches in dealing with their behavior, guiding their dental growth and development, and helping them avoid future dental problems. The pediatric dentist is best qualified to meet these needs.

Why are “baby teeth” important?

Although primary teeth are often called baby teeth, the first tooth is usually lost around age 6, while some primary molars remain in place until 10 to 13 years of age. Primary teeth are necessary for proper chewing, speech, development of the jaws, and esthetics. Taking care of primary teeth is also important as they aid in forming a path that permanent teeth can follow when they are ready to erupt.

Do special children have special dental needs?

Most do. Some special children are very susceptible to tooth decay, gum disease or oral trauma. Others require medication or diet detrimental to dental health. Still other children have physical difficulty with effective dental habits at home. The good news is, dental disease is preventable. If dental care is started early and followed conscientiously, every child can enjoy a healthy smile.

At what age should my child have his/her first dental visit?

“First visit by first birthday” is the general rule

The American Academy of Pediatric Dentistry recommends that a child’s first visit to the dentist should occur by 12 months of age. This visit will enable the dentist to evaluate your child and introduce you to proper oral hygiene. Diet, fluoride, finger and pacifier habits and tooth eruption will be discussed to insure optimal dental health.

What if my child cries?

Please do not be upset if your child cries. This is a normal reaction to the unknown. In fact, with infants, crying actually helps us to see everything in the mouth that we need to see. As your child matures, it is part of our goal to encourage their independence and promote self-esteem.

When should I start cleaning my baby’s teeth?

The sooner the better! The goal is to remove plaque bacteria that can lead to decay. Starting at birth, clean your child’s gums with a soft infant toothbrush or cloth and water. As soon as the teeth begin to appear, start brushing twice daily using fluoridated toothpaste and a soft, age-appropriate sized toothbrush. Use a “smear” of toothpaste to brush the teeth of a child less than 2 years of age. For the 2-5 year old, dispense a “pea-size” amount of toothpaste and perform or assist your child’s toothbrushing. Remember that young children do not have the ability to brush their teeth effectively.

When do the first teeth start to erupt?

At about 6 months, the two lower front teeth (central incisors) will erupt, followed shortly by the two upper central incisors. The remainder of the baby teeth appear during the next 18 to 24 months but not necessarily in an orderly sequence from front to back. At 2 to 3 years, all of these 20 primary teeth should be present.

What is baby bottle tooth decay (Early Childhood Caries) and how can I prevent it?

One serious form of decay among young children is baby bottle tooth decay (Early Childhood Caries). 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. Early childhood caries also occurs when a child goes to sleep while breast-feeding. During sleep, the flow of saliva is reduced and the natural self-cleansing action of the mouth is diminished. Sweet liquid pools around the child’s teeth giving plaque bacteria an opportunity to produce acids that attack tooth enamel. If you must give your baby a bottle as a comforter at bedtime, it should contain only tap water.

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.

Encourage your child to drink from a cup as they approach their first birthday. He/she should be weaned from the bottle at 12-14 months of age. He/she should be weaned from the sippy cup by 2 years of age and juice exposure should be limited to mealtimes only with water in between meals.

Dental Home

Starting at Age 1
The American Academy of Pediatrics (AAP), the American Dental Association (ADA), and the American Academy of Pediatric Dentistry (AAPD) all recommend establishing a “Dental Home” for your child by one year of age.

Five Steps for Baby’s
First Dental Visit

Step 1 Clinical Examination by age 12 months	• Complete medical history • Knee-to-knee exam with guardian • Note clinical dental caries • Soft tissue irregularities • Dietary & oral hygiene instruction • Identify enamel decalcification, hypoplasia areas • Growth and Development Evaluation
Step 2 Caries Risk Assessment	• Bottle or breast fed at night on demand • Non-water in bedtime bottle • Decalcification/caries present • Oral home care • Sugary foods, snacks
Step 3 Diet Counseling for Infants	• No juice or milk at bedtime • Sippy cups can encourage decay • Avoid sugar drinks, sodas • Encourage variety and a balanced diet • Low-sugar snacks • Fluorides – topical and systemic
Step 4 Oral Home Care for Infants	• Brush/massage teeth and gums at least 2x daily • Small, soft toothbrush • Tiny amount of toothpaste, with Fluoride • Guidance on thumb sucking, pacifier • Response/ Prevention for home accidents, trauma
Step 5 Future visits	• Based on Risk Assessment • Oral evaluations and cleanings 2x yearly • Emphasis on caries prevention

Are thumb, finger and pacifier habits bad for the teeth and jaws?

The majority of children stop sucking on thumbs, fingers, pacifiers or other objects on their own between two and three years of age without any harm being done to their teeth or jaws. However, children that repeatedly suck on a finger, pacifier or other object over long periods of time may cause the upper front teeth to tip toward the lip or not come in properly. We will carefully monitor the direction of tooth eruption into the mouth. Often times, problems that arise related to oral habits will correct themselves if stopped in a timely manner. However, the longer the habit persists, the more likely it will cause a permanent malformation of the jaw and related skeleton.

The majority of children stop sucking habits on their own. Some children may need the help of their parents. When your child is old enough to understand the possible results of an oral habit, we will encourage your child to stop. We will explain to them what happens to the teeth if he/she doesn’t stop. It is very important to get children to want to stop and to realize that it is a part of growing up. This will greatly increase their chances of terminating the habit.

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.
Once your child wants to stop, a reward system and earnest reminders will help he/she accomplish the goal.
If all options have been exhausted, we will discuss with you the use of a fixed dental appliance to exhaust the habit.

Is my child getting enough fluoride?

Fluoride has been shown to dramatically decrease a person’s chances of getting cavities by making teeth stronger. Fluoride in the drinking water is the best and easiest way to get it, but to make sure your child is getting enough fluoride, we will evaluate the fluoride level of your child’s primary source of water. If your child is not getting enough fluoride internally through water (especially in communities where the water district does not fluoridate the water or if your child drinks bottled water without fluoride), we may prescribe fluoride supplements.

What’s the Best Toothpaste for my Child?

Toothbrushing 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 as shown on the box and tube. 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 “lateral smear” amount of toothpaste.

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.

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.

The American Academy of Pediatric Dentistry recommends radiographs 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.

Pediatric dentists are particularly careful to minimize the exposure of their patients to radiation. With contemporary safeguards, such as lead aprons and high-speed film, the amount of radiation received in a dental X-ray examination is extremely small. Even though there is very little risk, pediatric dentists are particularly careful to minimize the exposure of child patients to radiation. In fact, dental X-rays represent a far smaller risk than an undetected and untreated dental problem.

What causes tooth decay?

Four things are necessary for cavities to form — a tooth, bacteria, sugars or other carbohydrates and time. Dental plaque is a thin, sticky, colorless deposit of bacteria that constantly forms on everyone’s teeth. When you eat, the sugars in your food cause the bacteria in plaque to produce acids that attack the tooth enamel. With time and repeated acid attacks, the enamel breaks down and a cavity forms.

How can parents help prevent tooth decay?

Parents should take their children to the dentist regularly, beginning with the eruption of the first tooth. Then, the dentist can recommend a specific program of brushing, flossing, and other treatments for parents to supervise and teach to their children. These home treatments, when added to regular dental visits and a balanced diet, will help give your child a lifetime of healthy habits.

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.

What are dental sealants and how do they work?

Sealants are clear or shaded plastic applied to the teeth to help keep them cavity-free. Sealants fill in the grooved surfaces of the teeth, which are hard to clean, and shut out food particles that could get caught, causing cavities. Fast and comfortable to apply, sealants can effectively protect teeth for many years.

Before Sealant Applied

After Sealant Applied

If my child gets a cavity in a baby tooth, should it still be filled?

Primary, or “baby,” teeth are important for many reasons. Not only do they help children speak clearly and chew naturally, they also aid in forming a path that permanent teeth can follow when they are ready to erupt. Some of them are necessary until a child is 12 years old or longer. Pain, infection of the gums and jaws, impairment of general health and premature loss of teeth are just a few of the problems that can happen when baby teeth are neglected. Also, because tooth decay is really an infection and will spread, decay on baby teeth can cause decay on permanent teeth. Proper care of baby teeth is instrumental in enhancing the health of your child.

Dental Emergencies

Toothache: To comfort your child, clean the area of the affected tooth. Rinse the mouth thoroughly with warm water or use dental floss to dislodge any food that may be impacted. If the pain still exists, contact your child’s dentist. Do not place aspirin or heat on the gum or on the aching tooth, but you may give the child acetaminophen for pain. If the face is swollen, apply cold compresses and contact your dentist immediately.

Cut or Bitten Tongue, Lip or Cheek: Apply ice to injured areas to help control swelling. If there is bleeding, apply firm but gentle pressure with a gauze or cloth. If bleeding cannot be controlled by simple pressure, call a doctor or visit the hospital emergency room.

Knocked Out Permanent Tooth: First of all, remain calm. If possible, find the tooth and hold it by the crown rather than the root. Replace the tooth in the socket and hold it there with clean gauze or a washcloth. If you can’t put the tooth back in the socket, place the tooth in a clean container with milk or patient’s saliva and take your child and the container immediately to the pediatric dentist. If the patient is old enough, the tooth may also be carried in the patient’s mouth (beside the cheek). The faster you act, the better your chances of saving the tooth.

Knocked Out Baby Tooth: Contact your pediatric dentist during business hours. This is not usually an emergency, and in most cases, no treatment is necessary.

Chipped or Fractured Permanent Tooth: Contact your pediatric dentist immediately. Quick action can save the tooth, prevent infection and reduce the need for extensive dental treatment. Rinse the mouth with water and apply cold compresses to reduce swelling. If possible, locate and save any broken tooth fragments and bring them with you to the dentist.

Chipped or Fractured Baby Tooth: Contact your pediatric dentist.

Severe Blow to the Head: Take your child to the nearest hospital emergency room immediately.

Possible Broken or Fractured Jaw: Keep the jaw from moving and take your child to the nearest hospital emergency room.

My child plays sports. How should I protect my child’s teeth?

A mouth guard should be a top priority on your child’s list of sports equipment. Athletic mouth protectors, or mouth guards, are made of soft plastic and fit comfortably to the shape of the upper teeth. They protect a child’s teeth, lips, cheeks and gums from sports-related injuries. Any mouth guard works better than no mouth guard, but a custom-fitted mouth guard is your child’s best protection against sports-related injuries.