Frequently Asked Questions
How often should I bring my child for a check up?
The ADA and AAPD recommends that you and your child see a dentist every 6 months. Studies have shown that professional Fluoride treatments every 6 months reduce cavities by 30%. That means that by just showing up your child will get a third less cavities! Studies have also shown that children who receive regular check ups have better oral hygiene at home and are more likely to follow dietary recommendations.
Children are dynamic individuals. They are constantly changing and growing. That means that their teeth and jaws are changing as well and should be monitored and evaluated at regular intervals. Children’s diet and food preferences are also constantly changing and a child who previously was not susceptible to cavities may begin to develop cavities. It is always better to treat cavities when they are small instead of risk losing teeth.
What dental problems could my child have?
Some dental problems begin early in life. Early childhood caries also called Baby bottle tooth decay, is a serious problem due to being put to sleep with the bottle or breast and ad lib feeding. Oral habits such as thumbsucking and pacifier use should be checked, as it can affect the growth of the jaws.
Why are baby teeth so important?
Primary teeth are important because they help with proper chewing and eating, help in speech development, and add to an attractive appearance. Healthy baby teeth allow normal development of the jaws and muscles, and save space for the permanent adult teeth and guide them into place. If a baby tooth is lost too soon the teeth can shift and the adult teeth will become impacted in the jaws necessitating surgery and costly orthodontics. Decayed baby teeth can cause pain, abscesses and infections that can spread to and damage the adult permanent teeth. Also your child’s general health can be affected, if diseased baby teeth are not treated. Remember some baby teeth are not replaced until age 10-14, so they must last for years.
When should I begin brushing?
When your child is first born you can begin wiping the mouth with a warm wet washcloth after each feeding. Once your child gets their first tooth you can begin brushing after each feeding with a soft bristled brush and warm water, or use a non-fluoridated toothpaste. It is important to begin healthy habits from the start. Brush your child’s teeth at least twice a day. Before bedtime is the most important time, since most cavities are made at night.
To help make tooth brushing less of a battle it is a good idea to create a “toothbrushing routine” and stick to it each day. One can’t expect a teenager to miraculously begin brushing their teeth regularly if they have never had the habit instilled in them from an early age.
What about Fluoride?
Children should not use fluoridated toothpaste before about age 2. You should make an appointment to discuss switching over to fluoridated toothpaste with your dentist at this time. Young children swallow toothpaste, so we recommend using no more than a pea size amount.
Some dentists and physicians recommend fluoride supplementation either in vitamins or topically in the form of rinses or gels if you live in a non-fluoridated community. It is important to discuss fluoride supplementation with your dentist and doctor, to decide what is best for your child. Only give as much as the directions say to use, because too much fluoride can cause fluorosis of the teeth.
What about preventative care?
Tooth decay and children no longer have to go hand in hand. At our office we are most concerned with all aspects of preventative care. Caries is an infective disease caused by a bacteria called strep mutans. If a child has a lot of cavities on baby teeth it will spread to an infect the adult teeth. By taking preventative measures such as placing sealants on molars, instituting a fluoride regimen, getting a check up and professional fluoride application every six months, following healthier dietary recommendations, and instilling a better oral hygiene routine at home, your child can be cavity free.
What about sterilization?
Your health and peace of mind are our primary concern: therefore we use state of the art sterilization procedures. After each patient visit, the treatment area is thoroughly disinfected. We ultrasonically clean and heat sterilize all non-disposable instruments. Our staff wears gloves and masks during procedures. Please feel free to ask us for the information on the measures we take to ensure the safety of you and your children, or a tour of the sterilization area.
Brushing and flossing instructions
Children do not develop the fine motor skills to do a good job brushing and flossing until age 6 or 7. That is why we recommend that the parent brush and floss the teeth for the child until this age. You should let your child brush by themselves first to learn how and then be sure to go over it. Teeth should be brushed twice a day in the morning after breakfast and the last thing right before bedtime. Bedtime is the most important because cavities are made at night. Flossing can be done once a day.
The scrubbing technique:
- Brush the teeth at the junction of the teeth and gum line- this is where all the food collects
- Hold the bristles towards the teeth and gums
- Move the brush back and forth vigorously with short strokes- just like when you clean anything else
- Make sure you brush all the front, top, and inside surfaces of the teeth
- Brush your tongue at the end- it has a lot of bacteria on it
Thumbsucking and pacifier Use
Thumb, finger sucking and pacifier use is a normal sucking reflex that infants use to help calm themselves. Children usually give up sucking habits by the age of three or four. If a child continues past the age when their adult teeth erupt, they may develop a malformed jaw condition called an anterior open bite, and it can affect speech. A child may need a habit breaker appliance and orthodontics to correct this.
Breaking the habit:
- Wait till the time is right (low stress)- a child must be ready to give it up or therapy will fail
- Motivate your child- show examples of what can happen to their teeth
- Use a reward system- positive reinforcement and small incentives (punishment techniques usually backfire)
The baby teeth first to come into the mouth are the two bottom front teeth. You will notice this when your infant is about 6-8 months old. Next will follow the four upper front teeth and the rest will appear periodically in pairs along the sides of the jaw until your child is about 2 ½ years old. By 2 ½ years old your child will have all 20 baby teeth. Usually at around age 6 your child will start to get their permanent adult teeth. The 6 year adult molars, lower and upper front teeth will appear first. But some children will start to get their adult teeth as early as 5 years and as late as 8 years. It is important to bring your child in for regular dental check ups so that we can evaluate the eruption and catch any problems when they are easily corrected.
Some problems that can occur with tooth eruption that can be prevented are over-retained baby teeth causing the adult teeth to come in crooked. Over-retained baby teeth causing the adult teeth underneath to be impacted. Prematurely loosing baby teeth due to over-crowding. Adult teeth coming in crooked due to over-crowding, and congenitally missing teeth.
Baby bottle tooth decay
Early childhood caries is usually due to diet and poor oral hygiene. It became known as baby bottle decay because putting your child to sleep with a bottle or breast is a prime cause of it. It is usually seen in infants and children as young as 18 months old, and usually the four upper front teeth are affected and so broken down they need to be extracted. This is why we recommend brushing your child’s teeth at least twice a day, once in the morning after breakfast and once in the evening, before bedtime. When your child goes to sleep we do not recommend anything but water in the bottle or sippy cup.
What causes cavities and how can I prevent them?
Most of the time cavities are due to a diet high in sugary foods and a lack of brushing. Limiting sugar such as soda intake and brushing regularly can help.
Cavities are an infectious disease caused by a bacteria called strep mutans. Every time someone eats the bacteria eats too and secrets acid which breaks down the enamel tooth structure. The more sugar you eat the happier the bacteria is, because the more food it has. By brushing and flossing you actually remove the bacteria living in the plaque.
Genetics also comes into play with cavities as well. Some children’s teeth are just more susceptible to cavities, or they have more destructive strains of the bacteria which causes cavities. These children especially need to follow the formula below.
The formula for no cavities:
More brushing + less sugar = less plaque + bacteria = less cavities
Dietary recommendations to prevent cavities
- Limit sugar intake, candy, chips, cakes, cookies, should be treats not something children eat everyday.
- Children should not drink soda, it has no nutritional value and is loaded not only with sugar but caffeine as well.
- Eat lots of healthy fruits and vegetables
- Eat good sources of protein
- Juice intake should be limited to not more than 2- 6oz cups a day. Juice should be cut with water ½ juice, ½ water.
- Children need calcium for healthy teeth and bone development- milk, cheese, yogurt, ice cream
- Drink lots of water
- Don’t let your child run around with a sippy cup of juice all day
- Don’t put your child to sleep with a bottle, breast or sippy cup with anything but water.
- After brushing teeth for bed, only give your child water
What are sealants?
Sealants have revolutionized preventative care in dentistry. It used to be that we had to wait for a cavity to form and then drill and fill it. Now we can prevent the cavities from ever starting with sealants.
Sealants are a white material that fill in and cover the grooves of the back teeth. Because they are bonded in you don’t need to drill the teeth. However, because they are only bonded in and chewing forces are so strong, they must be periodically replaced and maintained. Well-maintained sealants have been shown to reduce cavities in the grooves (the most common site for cavities) by 83%.
Athletic mouth protectors are a must for any child participating in such sports as hockey, soccer, karate, football, basketball, baseball and skateboarding, as well as many other sports. They protect the teeth, lips, cheeks, tongue and jaw bones. Most injuries occur to the mouth and head area when a child is not wearing a mouth guard. Choose a mouth guard that feels comfortable to your child. There are many options of mouth guards. Most guards are found in athletic stores. These vary in comfort, protection as well as cost. The least expensive tend to be the least effective in preventing injuries. Customized mouth guards can be provided through our practice. They tend to be more expensive but are much more comfortable and shock absorbent. Remember your child’s jaws are still growing so mouth guards should be replaced each season so that they fit well and offer the most protection.
Most Children with poor oral home care suffer from gingivitis. This is an infection of the gum tissues caused by poor brushing. It can cause the gums to be red, inflamed and to bleed easily. It is an infection which left alone can spread to the bone surrounding the teeth, causing tooth loss called periodontitis.
Most children who have gums which bleed when brushing stop brushing. Children who’s gums bleed when brushing should actually be brushing more often and doing a better job. By brushing you are removing the bacteria which causes gingivitis, massaging and strengthening the gums, to toughen them up and keeping them healthy.
Some medical conditions in children can cause an exacerbation of gingivitis and periodontal disease such as puberty, poorly controlled diabetes, and Down’s syndrome.
Adolescent oral care
There is evidence to suggest that gingivitis and periodontitis increases in the teenage years. This is due to a lack of motivation in brushing and flossing on the part of the teen. Children who have instilled in them a good oral home care routine from a very early age are more likely to have good oral hygiene during the teen years.
Be a good role model for your child during these years by brushing and flossing regularly yourself. Emphasize the importance of good oral hygiene by scheduling regular dental visits for your child. At these appointments we will review oral hygiene with your child. Studies have shown that children who receive regular dental visits are more motivated to practice good oral hygiene at home.
As pediatric dentists we monitor the growth and development of your child’s teeth and jaws, at every visit. We are trained to correct minor orthodontic problems which can prevent major orthodontic treatment in the future. When appropriate we recommend a referral to an orthodontist to address problems. Some problems a child might have are tooth crowding, jaw growth discrepancies, impacted adult teeth.
The results of orthodontic treatment can be dramatic- a beautiful smile, improved dental health, and self-esteem.
Mild sedation– Nitrous Oxide(laughing gas) is an anti-anxiety medication, which you inhale through a nasal hood. It is best for an older child who wants to co-operate but is anxious and having a hard time. The child must be able to keep it on their nose and breathe through their nose. It does not put a child to sleep, but simply relaxes them. It also has pain relief (analgesic) properties, and helps to reduce the gag reflex for children with strong gag reflexes. Best of all it is one of the safest drugs, as soon as you turn it off it leaves your body in a few minutes.
Conscious sedation is also for children who are anxious. There are many different types of medicines that you can give orally 1 hour or so prior to the procedure. Sometimes it is used in conjunction with Nitrous Oxide. It works best on older children who want to cooperate but are finding it difficult, and need a little bit more sedation than Nitrous Oxide can offer. It does not put a child to sleep.
Deep sedation is done in a hospital setting with a licensed anesthesiologist, or in a licensed Oral Surgeon’s office for ambulatory surgery (such as for extractions). The child is given general anesthesia either through an IV or inhalational. This is usually done for an anxious child who needs multiple extractions, an extensive amount of treatment, or has medical issues that prevent them from being treated in a traditional dental clinic setting.