Pediatric dentistry is a branch of dentistry dedicated to the treatment of children, from infancy through the teenage years. The very young, pre-teens and teenagers require unique approaches in managing their dental needs, behavior, growth and development, guiding them to a lifetime of dental health.

Your Child’s First Dental Visit Your child should visit the dentist by his or her first 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 his staff will explain all procedures and answer any questions. It is best if you refrain from using words around your child that might cause unnecessary fear, such as needle, pull, drill or hurt. Dentists make a practice of using words that convey the same message, but are pleasant and non-frightening to the child.

Why Are the Primary Teeth/Baby 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: proper chewing and eating, providing space for the permanent teeth and guiding them into the correct position, and 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 four teeth last until 6 or 7 years of age, the back teeth (cuspids and molars) aren’t replaced until age 10 to 13. Care of Your Child’s Teeth Begin daily brushing as soon as the child’s first tooth erupts. A pea-size amount of fluoride toothpaste can be used after the child is old enough not to swallow it. By age 4 or 5, children should be able to brush their own teeth twice a day with supervision until about age 7 to make sure they are doing a thorough job. However, each child is different. Your dentist can help you determine whether the child has the skill level to brush properly. Proper brushing removes plaque from the inner, outer and chewing surfaces. When teaching children to brush, place the toothbrush at a 45 degree angle and start along the gum line with a soft bristle brush in a gentle circular motion. Brush the outer surfaces of each tooth, upper and lower. Repeat the same method on the inside surfaces and chewing surfaces of all the teeth. Finish by brushing the tongue to help freshen breath and remove bacteria. Flossing removes plaque between the teeth where a toothbrush can’t reach. Flossing should begin when any two teeth touch. You may wish to floss the child’s teeth until he or she can do it alone. Use about 18 inches of floss, winding most of it around the middle fingers of both hands. Hold the floss lightly between the thumbs and forefingers. Use a gentle, back-and-forth motion to guide the floss between the teeth. Curve the floss into a c-shape and slide it into the space between the gum and tooth until you feel resistance. Gently scrape the floss against the side of the tooth. Repeat this procedure on each tooth. Don’t forget the backs of the last four teeth. Good Diet Equals Healthy Teeth Healthy eating habits lead to healthy teeth. Like the rest of the body, the teeth, bones and 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.

Seal Out Decay A sealant is a clear or shaded plastic material that is applied to the chewing surfaces (grooves) of the back teeth (premolars and molars), where four out of five cavities in children are found. This sealant acts as a barrier to food, plaque and acid, thus protecting the decay-prone areas of the teeth. The sealant protects the chewing surface of the teeth from the formation of cavities.

They do not protect in between the teeth. The research done on pit and fissure sealants are showing they last 7-15 years, with some research finding they last a lifetime with the proper maintenance.

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, 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.

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. Tooth decay can result when baby teeth are not cared for. Tooth decay will cause discomfort for your baby or child. Some cases of tooth decay, depending on the severity, can cause an infection. One sign of an infection is the mouth is in discomfort or swelling around the tooth or gums. The baby will also not eat or drink his or her favorites. Another sign may be a pimple-like mark on the gums above the tooth. If this should happen, consult your dentist as soon as possible.

Eruption of Your Child’s Teeth Children’s teeth begin forming before birth. As early as 4 months, the first primary teeth to erupt through the gums are the lower central incisors, followed closely by the upper central incisors. Although all 20 primary teeth usually appear by age 3, the pace and order of their eruption varies. Permanent teeth begin appearing around age 6, starting with the first molars and lower central incisors. This process continues until approximately age 21. Adults have 28 permanent teeth, or up to 32 including the third molars, or wisdom teeth.

As your child’s teeth start to appear in the mouth, your child may have some discomfort. The baby’s gums may become sore and irritated, and he or she may become cranky or fussy. To help reduce the irritation rub your baby’s gums with a clean finger. Gently massaging the area will help the discomfort of your baby’s mouth. Letting your child chew on something cold (like a chewing ring) will help a lot. The teething process will not make your child ill. It often seems that your child has a cold or mild fever along with the drooling and chewing. If your child is or becomes ill call your physician.

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. Do not place aspirin on the gum or on the aching tooth. If face is swollen, apply a cold compress. Take the child to a dentist.

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 child to a hospital emergency room.

– A 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 its 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. The tooth may also be carried in the patient’s mouth. The patient must see a dentist immediately. Time is a critical factor in saving the tooth.

Fluoride

Fluoride is an element which has been shown to be beneficial to teeth. However, too little or too much fluoride can be detrimental to the teeth. Little or no fluoride will not strengthen the teeth to help them resist cavities. Excessive fluoride ingestion by preschool-aged children can lead to dental fluorosis, which is a chalky white to even brown discoloration of the permanent teeth. Many children often get more fluoride than their parents realize. Being aware of a child’s potential sources of fluoride can help parents prevent the possibility of dental fluorosis. Some of these sources are:

– Too much fluoridated toothpaste at an early age.

– The inappropriate use of fluoride supplements.

– Hidden sources of fluoride in the child’s diet.

Two and three-year-olds may not be able to expectorate, or 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 6 months of age. After that time, fluoride supplements should only be given to children after all of the sources of ingested fluoride have been accounted for and upon the recommendation of your pediatrician or pediatric dentist. Certain foods contain high levels of fluoride, especially powdered concentrate infant formula, soy-based infant formula, infant dry cereals, creamed spinach and infant chicken products. Please read the label or contact the manufacturer. Some beverages also contain high levels of fluoride, especially decaffeinated teas, white grape juices and juice drinks manufactured in fluoridated cities. Blending the syrup, carbonation and the city water supply often makes soft drinks at fast food restaurants, so if fluoride is in the water it will contribute as another source.

Parents can take the following steps to decrease the risk of fluorosis in their children’s teeth:

– Use baby tooth cleanser on the toothbrush for the very young child.

– Place only a pea-sized drop of children’s toothpaste on the brush when brushing.

– Account for all of the sources of ingested fluoride before requesting fluoride supplements from your child’s physician or pediatric dentist.

– Avoid giving any fluoride-containing supplements to infants until they are 6 months old.

– Check with local water utilities to obtain fluoride level test results for your drinking water before giving fluoride supplements to your child.

Does Your Child Grind His Teeth at Night? (Bruxism)

Parents are often concerned about the nocturnal grinding of teeth called bruxism. Often, the first indication is the noise created by the child grinding on their teeth during sleep. The parent may also notice wear to the dentition. One theory involves a psychological component: stress due to a new environment, divorce, or changes at school can influence a child to grind their teeth. Another theory relates to pressure in the inner ear at night. If there are pressure changes (like in an airplane during take-off and landing when people are chewing gum, to equalize pressure) the child will grind by moving his jaw to relieve this pressure.

The majority of cases of pediatric bruxism do not require any treatment. If excessive wear of the teeth or attrition is present then a mouthguard, also known as a night guard, may be indicated. The negatives to a mouthguard are the possibility of choking if the appliance becomes dislodged during sleep, and it may interfere with growth of the jaws. The positive is obvious by preventing wear to the primary dentition. The good news is most children outgrow bruxism. The grinding subsides between the ages of 6-9, and the children tend to stop grinding between the ages of 9 and 12. If you suspect bruxism, discuss this with your pediatrician or pediatric dentist.

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, 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 2 and 4. 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 pacifier use, consult your pediatric dentist. A few suggestions to help your child get through thumb sucking: – Instead of scolding children for thumb sucking, praise them when they are not.

– Children often suck their thumbs when feeling insecure. Focus on correcting the cause of anxiety instead of the thumb sucking. – Children who are sucking for comfort will feel less of a need when their parents provide comfort. – Reward children when they refrain from sucking during difficult periods, such as when being separated from their parents. – Your 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 dentist may recommend the use of a mouth appliance.

Space Maintainers When there is a premature loss of a primary baby tooth, it is necessary to place a space maintainer.

Each primary tooth has a permanent tooth that will come in after it falls out. Normally the permanent tooth is right below the primary tooth and comes into mouth soon after the primary tooth exfoliates. If a primary tooth comes out early and nothing is done to keep the teeth in position, the teeth adjacent to the lost tooth will start to tip and drift into the open space. This will cause the available space to get smaller and the new tooth that will erupt later will not have adequate room.

If a primary molar is lost at age 5 or 6, the permanent tooth will not come in until age 11 or 12. A space maintainer is an appliance that is fixed or removable and is made of acrylic or metal. A fixed space maintainer comes in two varieties: unilateral (band and loop) or bilateral (lingual or palatal arch). The band is fit on the tooth behind the missing tooth, and a wire is attached near the gum line connecting to the tooth in front of the space. This prevents any shifting in either direction of the adjacent teeth. The removable space maintainer is similar to an acrylic retainer that is used after braces to hold the teeth position. There are indications for each type.

Why Fix Baby Teeth? The primary (baby) teeth are important for eating, proper chewing and swallowing of food, and good speech. Proper care of the primary teeth also keep your child’s smile beautiful. Decay on primary teeth can progress quickly, as they are small and have a thin layer of the enamel, the harder, more cavity resistant part of the tooth. The front upper and lower primary teeth fall out at about 6 years old. The back teeth, three in each quarter, fall out at about 12 years of age.

If there is decay on primary teeth that will be in the mouth for a reasonable amount of time, they should be restored. Decay can progress into the nerve of a primary tooth in 12 months or less. This can cause pain and may even cause the teeth to become infected. An infected primary tooth needs either a nerve treatment or to be removed. If a tooth is removed, a space maintainer is placed to prevent tooth shifting (see Space Maintainers). Also, decay between the teeth will make the tooth narrower as the tooth breaks down, and will allow the teeth to drift together, losing space for the permanent teeth. A few millimeters of tooth loss can occur and may cause additional crowding of the permanent teeth as they erupt. The proper oral hygiene and preventive care in the dental office and at home will go a long way in keeping your child’s smile intact and beautiful.