Below are some common questions, answers and recommendations regarding pediatric dentistry.
What Is A Pediatric Dentist?
The pediatric dentist has an extra two 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 and will help mold young patients into excellent adult dental patients that continue their routine dental care throughout life.
Why Are The Primary Teeth 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 9-14.
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 2 ½ to 3, the pace and order of their eruption varies from person to person. 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).
Dental Radiographs (X-Rays)
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 AAPD recommends radiographs and examinations every 6 to 12 months for children with a history or high risk of tooth decay. On average, most pediatric dentists request radiographs approximately once a year to 18 months. Usually by age 9 a Panorex x-ray is indicated to assess for growth & development as well as if an orthodontic consult is indicated.
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. Digital equipment and proper shielding assure that your child receives an even lower amount of radiation exposure. If you still have concerns regarding having x-rays taken, please speak with Dr. Bob & his staff.
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 toothpaste for your child, make sure to pick one that is recommended by the ADA 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 young (1 – 3 yrs old) & unable to spit out toothpaste, consider providing them with fluoride-free toothpaste or using only a ½ “pea size” amount of fluoridated toothpaste.
Does Your Child Grind His Teeth At Night? (Bruxism)
Parents are often concerned about the nocturnal grinding of teeth (bruxism). Often, the first indication is the noise created by the child grinding on their teeth during sleep. Or, the parent may notice wear (teeth getting shorter) to the dentition. One theory as to the cause involves a psychological component. Stress due to a new environment, divorce, changes at school, etc. 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, etc. 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. The good news is most children outgrow bruxism. The grinding decreases between the ages 6-9 and children tend to stop grinding between ages 9-12. If your child is 18+ years old & grinds, a night guard can be easily made to alleviate the undue stress placed on the jaw. If you suspect bruxism, discuss this with Dr. Bob & his staff.
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, speak with Dr. Bob & his staff.
A few suggestions to help your child get through thumb sucking:
Children often suck their thumbs when feeling insecure. Focus on correcting the cause of anxiety, instead of the thumb sucking. Reward children when they refrain from sucking during difficult periods, such as when being separated from their parents. Dr. Bob & staff can encourage children to stop sucking and explain what could happen if they continue. Dr. Bob may recommend the use of a mouth appliance (“habit breaker”) or an ointment that can be applied daily until the habit ceases.
What Is The Best Time For Orthodontic Treatment?
Developing malocclusions, or bad bites, can be recognized as early as 2-3 years of age. Often, early steps can be taken to reduce the need for major orthodontic treatment at a later age, which could last for 3+ years. Dr. Bob works closely with local orthodontists & will assess your child’s situation at each cleaning visit.
Stage I – Early Treatment: This period of treatment encompasses ages 6 to 8 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 treatment (ex: Anterior cross-bite corrections, ectopic molars).
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 mal-relationships 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 forces (ex: posterior cross-bites)
Stage III – Adolescent Dentition: This stage deals with the permanent teeth and the development of the final bite relationship (ex: full braces on both arches).
Perinatal & Infant Oral Health
The American Academy of Pediatric Dentistry (AAPD) recommends that all pregnant women receive oral healthcare and counseling during pregnancy. Research has shown evidence that periodontal disease can increase the risk of preterm birth and low birth weight.
Additionally, mothers with poor oral health may be at a greater risk of passing the bacteria which causes cavities to their young children. Mother’s should follow these simple steps to decrease the risk of spreading cavity-causing bacteria:
Visit your dentist regularly.
Brush and floss on a daily basis to reduce bacterial build-up (plaque).
Proper diet, with the reduction of beverages and foods high in sugar & starch.
Use fluoridated toothpaste and rinse every night with an alcohol-free, over-the-counter mouth rinse with .05 % sodium fluoride in order to further reduce plaque levels.
Don’t share utensils, cups or food which can cause the transmission of cavity-causing bacteria to your children. THIS IS VERY IMPORTANT!
Use of xylitol chewing gum (4 pieces per day by the mother) can decrease a child’s caries rate considerably.
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).
For older children, brush their teeth at least twice a day. Also, watch the number of snacks containing sugar that you give your children.
The American Academy of Pediatric Dentistry recommends visits every six months to the pediatric dentist, beginning around child’s first birthday. Routine visits will start your child on a lifetime of good dental health.
A sealant is a clear or shaded plastic material that is applied to the chewing surfaces (grooves) of the back adult teeth (premolars and molars), where most 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.
Made of clear or white plastic, sealants are applied to the teeth to help keep them cavity-free. Research shows that sealants can last for many years if properly cared for. Therefore, your child will be protected throughout the most cavity-prone years.
The application of a sealant is quick and comfortable. The tooth is first cleaned, then dried. The sealant is then flowed onto the grooves of the tooth and hardened with a special bright light. Your child will be able to eat right after this quick appointment. Staying away from the “sticky-chewy” treats will allow these coatings to stay intact for many years. Our office will assess your child’s sealants at each cleaning visit once they have been applied.
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 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 ingested fluoridated toothpaste at an early age (2 yrs old to 4 yrs old).
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 “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 child’s pediatric dentist following a risk assessment.
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.
Parents can take the following steps to decrease the risk of fluorosis in their children’s teeth:
Use baby/toddler toothpaste (non-Fluoridated) on the toothbrush of till about 2 years old.
Place only a ½ 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. If your water is supplied via a well your town hall can direct you to a local company that will test it for you (often at no charge).
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/your town hall to see what level your town is fluoridated at).
Mouth Guards (trauma)
When a child begins to participate in recreational activities and organized sports, injuries can occur. A properly fitted mouth guard 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 Dr. Bob about custom made and store-bought mouth guards.
Xylitol (Reduces Cavities)
The American Academy of Pediatric Dentistry (AAPD) recognizes the benefits of xylitol on the oral health of infants, children, adolescents, and persons with special health care needs.
The use of XYLITOL GUM by mothers (2-3 times per day) starting 3 months after delivery and until the child was 2 years old, has proven to reduce cavities up to 70% by the time the child was 5 years old.
Studies using xylitol as either a sugar substitute or a small dietary addition have demonstrated a dramatic reduction in new tooth decay, along with some reversal of existing dental caries. Xylitol provides additional protection that enhances all existing prevention methods. This xylitol effect is long-lasting and possibly permanent. Low decay rates persist even years after the trials have been completed!
Xylitol is widely distributed throughout nature in small amounts. Some of the best sources are fruits, berries, mushrooms, lettuce, hardwoods, and corn cobs. One cup of raspberries contains less than one gram of xylitol. Studies suggest xylitol intake that consistently produces positive results ranged from 4-20 grams per day, divided into 3-7 consumption periods. Higher results did not result in greater reduction and may lead to diminishing results. Similarly, consumption frequency of less than 3 times per day showed no effect.
To find gum or other products containing xylitol, try visiting your local health food store or search the Internet to find products containing 100% xylitol.
Please call our office at 508-337-3307 with any questions or concerns about your child’s dental health. We will be happy to assist you!