Pediatric Dentistry
It is the branch of dentistry which deals with the teeth of children.
A child's first visit to the dentist should be enjoyable. Children are not born with a natural fear of the dentist, but they can fear the unknown. Our office makes a special effort to use pleasant, non-frightening, simple words to describe each treatment. We want you and your child to feel at ease from the moment your family arrives at our office. The more you and your child know about the first visit, the better you will feel.
Children should visit the dentist by their first birthday. It is important that your child's newly-erupted teeth (erupting at six to 12 months of age) receive proper dental care and benefit from proper oral hygiene habits right from the beginning.
Getting to know your teeth is fun!
When New Teeth Arrive
Caring for Gums
Even before your baby's first tooth appears, her gums can benefit from your careful attention. After breast- or bottle-feeding, wrap one finger with a clean, damp washcloth or piece of gauze and gently rub it across your baby's gum tissue. This practice both clears your little one's mouth of any fragments of food and begins the process of building a good habit of daily oral care.
Baby's First Tooth
When that first tooth makes an entrance, it's time to upgrade to a baby toothbrush. There are usually two options: a long-handled toothbrush that you and your baby can hold at the same time, and a finger-puppet-like brush that fits over the tip of your pointer finger. In each case, the bristles are soft and few.
At this stage, toothpaste isn't necessary; just dip the brush in water before brushing. If your little one doesn't react well to the introduction of a toothbrush, don't give up. Switch back to a damp washcloth for a few months, then try the toothbrush again. During the teething process, your child will want to chew on just about anything, and a baby toothbrush with a teether can become a favorite toy during this period.
Your child's first primary, or “baby” teeth will begin to erupt between the ages of six to 12 months, and will continue to erupt until about age three. During this time, your child's gums may feel tender and sore. To help alleviate this discomfort, we recommend you soothe the gums by rubbing a clean finger or a cool, wet cloth across them. You may also choose to make use of a teething ring. When your child has finished teething, you can expect a total of 20 primary teeth!
Your child's primary teeth are shed at various times throughout childhood, and his or her permanent teeth begin erupting at age six, and continue until age 21. Adults have 28 permanent teeth, 32 teeth including 4 wisdom teeth.
Adopting Healthy Oral Hygiene Habits
As your child's teeth erupt, be sure to examine them every two weeks, looking for lines and discoloration that may be caused by decay. Remember that sugary foods and liquids can attack a new tooth, so take care that your child brushes his or her teeth after feeding or eating. We recommend brushing four times a day for optimal oral hygiene: after breakfast, after lunch, after dinner, and at bedtime.
Brushing can be fun, and your child should brush as soon as the first tooth arrives. When a baby's tooth erupts, parents should brush the tooth with a soft-bristled toothbrush and a pea-sized amount of toothpaste. For children younger than two, do not use fluoride toothpaste unless advised to do so by your dentist or other healthcare professional. We suggest reviewing proper tooth brushing procedures with your child.
Flossing is also a part of good oral hygiene habits, and your doctor will discuss with you the right time to start flossing. If you notice signs of decay, contact your dentist immediately.
Preventing Tooth Decay with Regular Checkups
Tooth decay is caused by sugars left in your mouth that turn into an acid which can break down your teeth. Children are at high risk for tooth decay for a simple reason — many children and adolescents do not practice regular, good oral hygiene habits. Proper brushing and flossing routines combined with regular dental visits help keep tooth decay away.
Your child should visit the dentist every six months for regular dental cleanings and checkups. We recommend fluoride treatments twice a year along with cleanings to keep teeth their strongest. Tooth sealants are also recommended because they "seal" the deep grooves in your child's teeth, preventing decay from forming in these hard-to-reach areas. Sealants last for several years, but will be monitored at your regular checkups.
Setting a Good Example
As part of the natural learning process, little ones are expert mimics, and you can take advantage of this talent. Brush and floss daily while your child is watching, and she'll intuit at an early age the importance of your good habits. As soon as she shows interest, give her a toothbrush of her own and encourage her to "brush" with you. (You'll find toothbrushes with chunky, short handles are easier for her to grip.) Most children don't have the dexterity necessary to thoroughly clean their own teeth until they're about six or seven, so you'll have to do that part of the job for her. Try different tactics to make brushing fun: flavored toothpaste, a toothbrush with a favorite character on it, or singing songs about brushing. The primary goal is to instill healthy oral habits at an early age to set your child up for a lifetime of healthy, cavity-free teeth!
Thumb-sucking
Along with favorite blankets, teddy bears, and nap time, thumb-sucking can be one of the most comforting aspects of childhood. According to a recent report, between 75% and 95% of infants suck their thumbs, so chances are there's a thumb-sucker (or a former thumb-sucker) in your family. Is this cause for worry?
In most cases, the answer is no. However, it's important to pay attention to your child's habits, in case his behavior has the potential to affect his oral health.
What Is Normal Thumb-Sucking Behavior?
Most children begin sucking their thumb or finger from a very young age; many even start inside the womb. Sucking is a natural reflex for an infant, and it serves an important purpose. Sucking often provides a sense of security and contentment for a young one. It can also be relaxing, which is why many children suck their thumbs as they fall asleep.
Most children stop thumb-sucking on their own between the ages of two and four. They simply grow out of a habit that is no longer useful to them. However, some children continue sucking beyond the preschool years (although studies show that the older a child gets, the lower his chances of continuing to suck his thumb). If your child is still sucking when his permanent teeth start to erupt, it may be time to take action to break the habit.
What Signs Should I Watch For?
First, take note of how your child sucks his thumb. If he sucks passively, with his thumb gently resting inside his mouth, he is less likely to cause damage. If, on the other hand, he is an aggressive thumb-sucker, placing pressure on his mouth or teeth, the habit may cause problems with tooth alignment and proper mouth growth. Extended sucking affects both the teeth and the shape of the face and may lead to a need for orthodontic treatment in the future.
If at any time you suspect your child's thumb-sucking may be affecting his oral health, please give us a call or bring him in for a visit. We can help you assess the situation.
How Can I Help My Child Quit Thumb-Sucking?
Should you need to help your child end his habit, follow these guidelines:
- Always be supportive and positive. Instead of punishing your child for thumb-sucking, give praise when he doesn't suck.
- Put a band-aid on his thumb or a sock over his hand at night. Let him know that this is not a punishment, just a way to help him remember to avoid sucking.
- Start a progress chart, and let him put a sticker up every day that he doesn't suck his thumb. If he makes it through a week without sucking, he gets to choose a prize (trip to the zoo, new set of blocks, etc.). When he has filled up a whole month reward him with something great (a ball glove or new video game); by then the habit should be over. Making your child an active participant in his treatment will increase his willingness to break the habit.
- If you notice your child sucking when he's anxious, work on alleviating his anxiety rather than focusing on the thumb-sucking.
- Take note of the times your child tends to suck (long car rides, while watching movies) and create diversions during these occasions.
- Explain clearly what might happen to his teeth if he keeps sucking his thumb.
At what age is it appropriate to use toothpaste to clean my child's teeth?
Once your child has a few teeth, you can start using toothpaste on the brush. Use only a tiny amount for each cleaning, and be sure to choose toothpaste without fluoride for children under two, as too much fluoride can be dangerous for very young children. Always have your child rinse and spit out toothpaste after brushing, to begin a lifelong habit he'll need when he graduates to fluoride toothpaste. Children naturally want to swallow toothpaste after brushing, and swallowing too much fluoride toothpaste can cause teeth to stain. You should brush your child's teeth for him until he is ready to take on that responsibility himself, which usually happens by age six or seven.
What causes cavities?
Certain types of bacteria live in our mouths. When these bacteria come into contact with sugary foods left behind on our teeth after eating, acids are produced. These acids attack the enamel on the exterior of the teeth, eventually eating through the enamel and creating holes in the teeth, which we call cavities.
How can I help my child avoid cavities?
Be sure your child brushes his teeth at least twice a day with fluoride toothpaste. Flossing daily is also important, as flossing can reach spots between the teeth that brushing can't. Check with your pediatric dentist about a fluoride supplement which helps tooth enamel be harder and more resistant to decay. Avoid sugary foods and drinks, limit snacking, and maintain a healthy diet. And finally, make regular appointments so we can check the health of your child's teeth and provide professional cleanings.
Baby teeth aren't permanent. Why do they need special care?
Although they don't last as long as permanent teeth, your child's first teeth play an important role in his development. While they're in place, these primary teeth help your little one speak, smile and chew properly. They also hold space in the jaw for permanent teeth. If a child loses a tooth too early (due to damage or decay) nearby teeth may encroach on that space, which can result in crooked or misplaced permanent teeth. Also, your child's general health is affected by the oral health of the teeth and gums.
Space Maintainers
Baby teeth aren't just for chewing. Each one also acts as a guide for the eruption of the permanent tooth that replaces it. If a baby tooth is lost too early, the permanent tooth loses its guide. It can drift or erupt into the wrong position in the mouth. Neighboring teeth also can move or tilt into the space. This means that there may not be enough space for the permanent tooth to come in.
Dentists call baby teeth primary or deciduous teeth. Primary teeth can be lost too early for several reasons:
- They can be knocked out in a fall or other accident.
- They may need to be extracted because of severe decay that causes infection.
- They may be missing at birth.
- Some diseases or conditions can lead to early tooth loss.
Space maintainers may be used:
- If a primary tooth is lost before the permanent tooth is ready to come in
- If a permanent tooth is missing
The maintainer keeps the space open until the permanent tooth comes in.
Types of Space Maintainers
A space maintainer is made of stainless steel and/or plastic. It can be removable. Some space maintainers are cemented onto the teeth on either side of the space in the child's mouth. This is called a fixed space maintainer.
A removable space maintainer looks like a retainer. It uses artificial teeth or plastic blocks to fill in the space or spaces that need to stay open. This type of space maintainer often is used when the space is obvious to other people. Removable space maintainers work well in older children who can reliably follow directions about caring for this appliance.
There are several kinds of fixed space maintainers. A band-and-loop maintainer is made of stainless steel wire. It is held in place by a crown on the tooth next to the space or an orthodontic-type band around one of the teeth next to the open space. A wire loop is attached to the band or crown. It sticks out across the space where the tooth is missing and just touches the tooth on the other side of the open space. The wire loop holds the space open. This allows the permanent tooth enough space to come into the mouth without crowding.
A lower wire known as a "lingual arch" is used when back teeth are lost on both sides of the lower jaw. "Lingual" refers to the inside or tongue side of the teeth. This type of space maintainer uses bands wrapped around a tooth on either side of the mouth behind the missing teeth. A wire connected to the bands runs along the inside of the bottom teeth, just touching them. This will maintain the space on both sides.
Another type of fixed space maintainer is called a distal shoe appliance. It is inserted under the gums. It is used when a child loses the baby tooth in front of a 6-year molar that has not yet come into the mouth. The 6-year molar is also called the first permanent molar. Because it has not come in yet, there is no tooth to hold a band-and-loop space maintainer in place. A distal shoe appliance has a metal wire that is inserted slightly under the gum. This keeps the space from closing.
Distal shoe appliances must be checked often because the incoming tooth can easily become blocked by the wire. The appliance may require adjustment to allow the tooth to come in properly. As a result, most dentists will try to avoid using a distal shoe appliance. Instead, they will try to keep the primary tooth in the mouth until the permanent tooth underneath is ready to come in.
For children missing several teeth, a partial denture may be used instead of a space maintainer. For example, children with a congenital disease called ectodermal dysplasia often are missing multiple primary teeth. There are no permanent teeth to replace them. A child with this condition will use a removable denture into adulthood. After that, the child can receive dental implants or a bridge or continue to use a partial denture to replace the missing teeth.
Are Space Maintainers Always Necessary?
Not every tooth that is lost too early requires a space maintainer. If one of the four upper front teeth is lost early, the space will stay open on its own until the permanent tooth comes in.
If you do not take your child to the dentist regularly — at least every six months — a space maintainer can cause problems. This especially can occur if your child does notbrush well. The gum tissue in the space can grow over the wire arm, increasing the risk of infection. If that happens, your child's dentist may have to remove the gum tissue by surgery.
If the permanent tooth is about to erupt, the dentist may decide not to use a space maintainer unless your child needs braces and space is a critical issue.
Some children may not be able to cooperate during the process of making the space maintainer. Others may be at risk of injury if the space maintainer comes loose or breaks. These include children with diseases that affect how they breathe or swallow, and children who are very young. The ability to cooperate with the dentist is more important than a child's age. Most young children can have space maintainers placed, if needed. Most of them are able to cooperate during the process.
Making the Space Maintainer
Each space maintainer is custom-made by a dentist or orthodontist.
For a fixed space maintainer, a metal band is placed around one of the teeth next to the space, and impressions are made. Impressions are made with a soft material that tastes like toothpaste. It sets into a gel around the teeth and is easily removed from the mouth. This allows the laboratory to make a copy of the teeth to use in making the space maintainer. The band is also removed and sent to the dental laboratory with the impressions. The lab creates the space maintainer and sends it back to your child's dentist. He or she cements it into place at a second office visit. Sometimes, a space maintainer can be made in the office in a single visit without impressions.
To make a removable space maintainer, the dentist first makes impressions. They are sent to a lab, which makes the appliance.
Caring for Your Space Maintainer
The space maintainer may feel unusual at first. But after a few days, your child probably will forget about it. A removable space maintainer with replacement teeth can affect speech until your child gets used to it.
It's important for your child to brush regularly to keep the gum tissue healthy. A child with a fixed space maintainer needs to avoid hard or sticky foods and chewy candy and gum. They can loosen the band or get caught in the wire arm. If the space maintainer comes loose, there is a risk of swallowing or inhaling it into the lung.
Finally, your child shouldn't push on the space maintainer with his or her tongue or fingers. That could bend or loosen it.