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. 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.
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 4 teeth last until 6-7 years of age, the back
teeth (cuspids and molars) aren’t replaced until age 10-13.
Radiographs (X-Ray Films) 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.
In our office we recommend the first radiographs (3) at about 4 1/2 years of
age, depending on what we discover in our initial examination of your child. Follow-up radiographs
are recommended at 6-month to 2-year intervals depending on decay or growth issues that we are
monitoring, presence of fluoride in the child's water supply, and home brushing and flossing. The
American Academy of Pediatric Dentistry recommends radiographs and examinations every six months for
children with a high risk of tooth decay.
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. Our X-ray machine is digital which
allow a minimum amount of exposure. Proper shielding assure that your child receives a minimal
amount of radiation exposure. Our panoramic machine is also digital, which decreases, the amount of
exposure to radiation.
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 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. Permanent teeth are darker (more yellow) in color than
primary teeth. They are denser and made to last a lifetime.
Adults have 28 permanent
teeth, or up to 32 including the third molars (or wisdom teeth).
Tooth Development
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. If the pain still
exists, contact your child's dentist. DO NOT place aspirin on the gum or on the aching
tooth. If the face is swollen apply cold compresses and contact your dentist immediately.
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 the child to hospital emergency room.
Knocked Out Permanent Tooth - Find the tooth. Handle the tooth by the crown, not the root
portion. DO NOT rinse the tooth with regular water and DO NOT clean or handle the tooth
unnecessarily. If the tooth is dirty, you may rinse the tooth with saliva, milk, or saline
water (rarely available). If the tooth is sound, try to reinsert it in the socket. Have
the patient hold the tooth in place by biting on gauze. If you cannot reinsert the tooth,
transport the tooth in a cup containing the patient’s saliva or milk. If the patient is old
enough, 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.
Tooth Hit and Still in Mouth -
If the tooth is fractured (broken), call and go to dental office immediately. If found,
save the piece that's broken off, keep wet and bring to the office. If the tooth is not
fractured (broken), call and go to dental office immediately. (The root of the tooth or
surrounding bone may be broken).
It is important that your child remains calm and still during dental treatment to prevent
injury to your child and dental staff and to receive a high quality of professional dental
care. For the child who is afraid, uncooperative, too young to understand dental treatment
or requires very long, complicated, treatment visits, nitrous oxide/oxygen for analgesia may
be beneficial in helping the child relax.
The following information will help parents
understand sedation with the use of a combination of nitrous oxide and oxygen gases for safe
analgesia.
- It is safe because the child remains awake, responsive, and breathes on his/her own without assistance.
- Much more oxygen is given than what we breathe in normal room air. This provides a wide margin for safety.
- Nitrous oxide/oxygen is breathed through a small pleasantly scented mask placed over the nose.
- Dental treatment is more comfortable and time seems to pass faster for a relaxed child.
- Sometimes nitrous oxide is known as “laughing gas” because some patients
become so comfortable and relaxed that they laugh.
- On the day of the visit, no dairy products should be given prior to the
visit. No food or drink should be given to your child three (3) hours before
treatment.
- A local anesthetic is given, if needed, to numb the areas that are to be
treated so that there is very little discomfort.
- Oxygen is usually given at the end of treatment to remove the effects of
nitrous oxide gas and end the treatment.
- The child is awake and sometimes remains relaxed after dental treatment but
will continue to feel the numbness in the treated area.
Please feel comfortable in discussing with us any other questions you may have about the procedures.
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 chalky white to yellow-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-year olds and three-year olds may not be able to expectorate (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 pediatrician or pediatric dentist.
Certain foods contain high levels of fluoride, especially powdered concentrate infant's
formula, soy-based infant's formula, infant's dry cereals, creamed spinach, and infant's
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. Another source of fluoride can be found in
soft drinks at fast food restaurants, when blending the syrup and carbonation with the city
water supply.
Fluoride in the water supply decreases by 30% the chance of your child getting cavities.
Fluoride is safe. If it is not in your water supply, our office will be able to prescribe
it. The dosage changes at 3 and again at 6 years of age and should be taken daily until 16
years of age. There are other options which may be discussed at the office. Bottled water
is available with fluoride.
Parents can take the following steps to decrease the risk of fluorosis in their children’s
teeth -
- 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 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).
Stains can be just on the surface of the tooth (extrinsic) or incorporated into the
developing tooth (intrinsic). The latter is more rare. Tetracycline antibiotics will stain
teeth that are forming at the time of the drug's use. As a result, tetracyclines are no
longer given to pregnant women or children under twelve (except in life-threatening cases).
The forming teeth may be stained gray to yellow to orange. Some stains can be bleached out;
others need to be covered by bonded plastic resins.
More common are stains on the surfaces of the teeth (extrinsic). These accumulate after
eruption of a tooth into the mouth. Newly erupted primary teeth may have a yellow membrane
on them that will wear of in a few days. Newly erupted permanent teeth appear more yellow
than their milky-white primary neighbors. This is their normal, permanent color. The
permanent teeth are darker because they are denser so that they can last a lifetime.
White color is not always good. Chalky white spots on permanent teeth can be the result of
trauma to a primary tooth while the permanent tooth was developing in the jaw. Or, chalky
white lines at the gum line or around orthodontic braces can be a warning sign. Decay starts
by removing minerals, especially calcium from the outer surface of the tooth. This softens
and allows the acid from the bacteria in plaque to work more quickly. If oral hygiene
(brushing and flossing) is started at this point, using a concentrated fluoride paste, and
the teeth are kept meticulously clean, these areas can harden again by remineralizing. But,
the chalky white lines will remain. If the white turns to brown, the enamel has been broken
by the acid attack and the tooth may now need a filling.
If one or two teeth are dark, gray, pink or yellow, this may be the result of that tooth
having been hit accidentally. Your child should be seen soon thereafter for an X-ray picture
of the tooth and a discussion about possible things that may happen to that tooth.
The rest of the stains mentioned below are all easily removed by a simple polishing done in
the dental office with a rotating rubber cup and pumice.
- Green or orange stain - usually on the front teeth at the gum line. It is
caused by color-producing (chromogenic) bacteria. Colonies of these orange or green
bacteria usually mean that somebody is falling down on the job of cleaning the
child's teeth. It could also mean that the child is a mouth-breather.
- Brown or yellow stain - very likely from antibiotics. The most common
antibiotic to stain the surface of the teeth is Amoxicillin. A single dose may cause
a yellow to brown film to form on the teeth in some children. The stain may
disappear partially or altogether once the prescription of antibiotics is finished.
If it bothers you, the parent, the stain can be readily removed, even for children
under two years of age.
- Black stain - very often this stain is caused by chewable or liquid-iron
supplements, or even multiple vitamins with added iron. This stain polishes off
easily. Some populations naturally form a black line on the teeth at the gums lines
of all the teeth. It tends to reform rather quickly after removal by the dentist.
Where it comes from we do not know. But, we do find that these patients seem to
develop few dental cavities.
Teeth occasionally experience a disturbance during development that results in the enamel
developing atypically. It is usually observed as a discoloration: white, yellow or brown. We
most commonly see it on the first permanent molars and central incisors (two front teeth),
although it can happen to any of the teeth.
- When this anomaly occurs on the front teeth, there may be some cosmetic concerns
to address. In its mildest form it shows as white marks on the teeth, typically near
the chewing edge, though it may be anywhere on the tooth. They are often hydration
dependent meaning if the tooth dries out the white spots become prominent, and when
the tooth remains wet the spots diminish or disappear. These are a cosmetic concern
only and because an adult’s facial posture keeps lips closed more than children,
these blemishes typically remain wet and diminish in appearance. We do not recommend
any treatment procedures until at least the mid-teen years when a more adult facial
posture has developed.
- White blemishes that are larger and more opaque will likely need removal of the
blemish and filling with a cosmetic filling material.
- Blemishes of a more yellow or brown nature are often improved with bleaching
techniques that can be done at any age. If the blemish does not respond to
bleaching, we can offer other cosmetic procedures to remove discolorations and
refill the blemishes with cosmetic filling materials.
- If the aberration is severe enough it will result in soft enamel that chips
and/or decays easily. It may also result in an atypical shape for the tooth. This is
sometimes referred to as enamel hypoplasia. We usually observe this on the molar
teeth. When this occurs, it is important to remove the very soft enamel and place a
filling in the area. We do this in a conservative fashion by bonding on a filling
material to replace the lost or decayed portion of the tooth. This usually needs
“touching up” as the tooth grows and exposes more of the compromised enamel. The
soft enamel may also chip around the bonded filling necessitating occasional
repairs. Occasionally the aberration in the enamel is extensive enough that we
recommend a stainless steel crown as a temporary crown during the growing years. A
large percentage of these molar teeth will be best served with a cast onlay or a
full crown restoration after all permanent teeth have emerged, growth is finished,
and the occlusion has stabilized (age 18 or older). In the meantime, we will
maintain the integrity of the teeth with conservative repairs.
- These teeth can also be very sensitive for reasons we do not know.
Restoring or covering the hypocalcified enamel will occasionally help this.
Toothpastes for sensitive teeth (i.e., Sensodyne™, Thermodent™) can also be helpful.
Avoiding highly acidic snack patterns (carbonated beverages, fruit juices, sour
candies) will likely be very helpful as well.
The pulp of a tooth is the inner central core of the tooth. The pulp contains nerves, blood
vessels, connective tissue and reparative cells. The purpose of pulp therapy in pediatric
dentistry is to maintain the vitality of the affected tooth (so the tooth is not lost) until
the permanent tooth is ready to erupt.
Dental caries (cavities) and traumatic injury are the main reasons for a tooth to require
pulp therapy. Pulp therapy is often referred to as a "nerve treatment," "children's root
canal," "pulpectomy" or "pulpotomy." The two common forms of pulp therapy in children's
teeth are the pulpotomy and pulpectomy.
A pulpotomy removes the diseased pulp tissue within the crown portion of the tooth. Next,
an agent is placed to prevent bacterial growth and to calm the remaining nerve tissue. This
is followed by a final restoration (usually a stainless steel crown).
A pulpectomy is required when the entire pulp is involved [into the root canal(s) of the
tooth]. During this treatment, the diseased pulp tissue is completely removed from both
the crown and root. The canals are cleansed, disinfected and in the case of primary teeth,
filled with a resorbable material. Then a final restoration is placed. A permanent tooth
would be filled with a non-resorbing material.
Tooth brushing with fluoridated toothpaste is one of the most important tasks for good oral
health. Some children dislike the flavor of toothpaste. I recommend that you obtain 2 or 3
small tubes of toothpaste. Tell the child that they need to use one of the samples.
Initially start with a very small amount, i.e. smear. Some 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 American Dental Association. These toothpastes have undergone testing
to insure they are safe to use and that the ingredients work as advertised.
In the past some people have recommended to not use fluoride toothpaste until age 2 years.
Since fluoride can be so beneficial, I recommend that a very small amount be used when teeth
erupt (small “pea size” or jut a smear).
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, use only a very small amount of
toothpaste, i.e. a small “pea size” or smear.
As many as 80-90% of young children grind (brux) their teeth at night. Many children also
brux during the day. The only directly related cause known for bruxing is that children with
a combination of allergies and severely restricted airways will brux. The jaw movement opens
the eustachion tube and gives relief. This would be similar to yawning while driving to Lake
Tahoe in order to alleviate the pressure in one’s ears. We know that animals grind their
teeth to keep them sharp and that females are more likely to brux than males. Interestingly,
there is a hereditary component to bruxing. In children, the anatomy of the
temperomandibular joint (TMJ) allows easy movement of the bottom jaw (mandible). These
movements become harder to make as the TMJ matures with age. All the other explanations for
bruxing are conjecture.
Since grinding is so common in children, it may be part of normal eruption and promote teeth
to come together is a normal position.
Children usually grow out of this problem by age ten without causing any permanent damage.
If the problem persists into the early teens and the dentist recognizes signs of unusual
wear to the permanent teeth, preventive measures can be taken to prevent future damage.
Treatment may involve a plastic nightguard for nighttime wear and/or bio-feedback therapy.
Remember, bruxism in young children does not always mean that damage is occurring or that
dental problems will occur later in life.
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 take the pacifier from the child
and the child starts thumb sucking, immediately return the pacifier and slowly remove the
pacifier at a late date. If you have concerns about thumb sucking or use of a pacifier,
consult your pediatric dentist.
A few suggestions to help your child stop 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 pediatric 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 pediatric dentist
may recommend the use of a mouth appliance.
Developing malocclusions, or bad bites, can be recognized as early as 2 to 3 years of age.
Often, early steps can be taken to reduce the need for major orthodontic treatment at a
later age.
Stage I, Early Treatment - This period of treatment encompasses ages 2 to 6 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/orthopedic treatment.
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
malrelationships 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 or orthopedic forces.
Stage III, Adolescent Dentition - This stage deals with the permanent teeth and the
development of the final bite relationship.
We recommend that you and your child visit our office well before your child's second
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 their staff will explain all
procedures and answer any questions. The less fuss and anxiety concerning the visit, the
better. We examine most children, under 3 1/2, in their parent's lap. We will discuss
findings and how to keep your child's teeth clean and healthy. A follow-up visit may be
anywhere from a few months to over one year depending on the findings of the exam.
It is best if you refrain from using words around your child that might cause unnecessary
fear, such as needle, pull, drill or hurt. Pediatric dental offices make a practice of using
words that convey the same message, but are pleasant and non-frightening to the child. See
A Note to Parents (scroll down the page).
Teething, the process of baby (primary) teeth coming through the gums into the mouth, is
variable among individual babies. Some babies get their teeth early and some get them late.
In general the first baby teeth are usually the lower front (anterior) teeth and usually
begin erupting between the age of 6-8 months.
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, formula, fruit juice and other sweetened drinks. It has not
been well documented that breast milk will cause decay, and breast milk alone may not cause
cavities at all.
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. If your child won't fall asleep
without the bottle and its usual beverage, gradually dilute the bottle's contents with water
over a period of two to three weeks.
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 easily see into the child’s mouth.
Plaque is a sticky film in which bacteria breed; it grows on teeth. The bacteria take about
24 hours to mature to the point where they can make acid. The acid causes cavities and
makes the gums bleed. Children's teeth should be cleaned as soon as they erupt into the
mouth. Use a wet wash cloth or a small child-size toothbrush. Use a small pea-size amount
of fluoride toothpaste starting about age 2. Use a wet washcloth or the Infa Dent™, at bath
time, to clean your infant's gum pads and/or newly emerging teeth.
Children should be encouraged to brush their teeth, by themselves, in the morning after
breakfast. At night, an adult should brush and as necessary, floss the child's teeth. The
child will have the ability to brush, on their own, at between 7 to 10 years of age. Each
child is different. Your pediatric dentist and staff can help you determine when 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; start along the gum line with
a soft bristle brush in a gentle circular motion. Brush the inner surfaces of the bottom
molar teeth first. Finish the inner surfaces of the bottom teeth, then the outer and
chewing surfaces. Repeat the same method on the top teeth. Finish by brushing the tongue
to help freshen the 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 should 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. You may find it easier to use the flossing tool
that we will dispense and demonstrate how to comfortably use this on your child.
Disclosing the plaque enables older children to brush until all the plaque is removed. A
disclosing solution is recommended.
Always look at your child's teeth. Color change could indicate a problem. Watch as new teeth
erupt. Keep them clean. Some medications, such as Amoxicillin® and iron supplements may
temporarily stain the surface of the teeth. The stain is easily removed by a light polishing
in our office.
Permanent teeth are darker (more yellow) in color than primary teeth. They are denser and
made to last a lifetime.
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.
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.
As soon as the child can hold the toothbrush, they should brush their own teeth in the
morning, after the parent places toothpaste on the brush. A parent should brush the
child's teeth at night.. Also, watch the number of snacks containing sugar that you give
your children.
The American Academy of Pediatric Dentistry recommends six month visits to the pediatric
dentist beginning at your child’s first birthday. Routine visits will start your child on a
lifetime of good dental health.
Your pediatric dentist may also recommend other measures such as home fluoride treatments.
Chlorhexidine gluconate 0.12% (CHX) rinse has been prescribed because the oral health
assessment data placed your child in a level 3- or 4- risk category. Levels 3 and 4 are
high-risk categories for gum problems and tooth decay. CHX is effective in reducing bacteria
harmful to the teeth and gums. In combination with chewing gum or lozenges sweetened with
100% xylitol, studies have shown a tremendous reduction in these harmful bacteria over time.
What can your child expect when using CHX?
- CHX may taste bitter to some patients and may affect how foods taste. Use CHX
after meals. Avoid drinking water for 30 minutes after rinsing with CHX to lesson
the aftertaste.
- CHX may cause brown staining of plaque or tarter that is missed while brushing
and flossing. This can be easily removed by your dentist. White filling materials
have been known to stain but your dentist can also correct this.
- To minimize staining, recommended brushing and flossing techniques need to be
followed. Brush with a tarter prevention toothpaste while using CHX.
- Rare hypersensitivity and generalized allergic reactions have been reported.
How is CHX used?
- Thoroughly brush and floss thoroughly and wait at least 60 minutes
after brushing before rinsing with CHX because the fluoride in the toothpaste
will decrease the effectiveness of CHX. Note: Your child could use CHX before
brushing as long as he/she waits 60 minutes before brushing.
- Use ½ ounce, 1 time daily, for 1 week per month (for example, the first
week of every month). Continue for 6 months at which time the need for continued
use of CHX will be reassessed by the dentist.
- Swish vigorously for 30 seconds being sure to cover all areas of the teeth.
After 30 seconds, spit it out.
- Do not rinse with water immediately after CHX treatment.
- Why is xylitol special? It is an FDA- approved sugar substitute that is both
anticavity and antiplaque.
- What is xylitol? Xylitol, a 5 carbon sugar alcohol, 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.
- Why are xylitol containing gum and lozenges so special? Xylitol, when used
by bacteria (strepmutans) as a food, decreases their ability to stick to the
surfaces of the teeth and then reduces their ability to form dental plaque. It also
reduces the acid-producing potential of the bacteria (strepmutans), which is the
leading cause of tooth decay according to the Acid Theory of Dental Decay.
- Does xylitol reduce dental plaque? Yes. You can tell this after a few days by
the smooth glassy feeling that your teeth will have when you touch them with your
tongue. The feeling of the smoothness is similar to that of an ice cube melting in
your mouth.
- Does xylitol reduce the risk of cavities? Yes. Studies have shown that there
has been as much as an 80% reduction in tooth decay over an extended period of
usage compared to the groups not chewing xylitol-containing gum. Using xylitol as a
sugar substitute or a small dietary addition has demonstrated a dramatic reduction
in new tooth decay along with the reversal of existing dental caries. Xylitol
provides additional protection that enhances all existing prevention methods. This
effect is long lasting and possibly permanent. Low decay rates persist, even years
after the trials had been completed.
- Who should use 100% xylitol chewing gum? Xylitol can be used by anyone who is
concerned about fighting dental decay and dental plaque. Children should begin
using the gum as soon as they are old enough to responsibly chew gum. Expectant
mothers (and any relatives that will have contact with the newborn) should begin
chewing the gum during the pregnancy thus reducing the chance that they will pass
on the bad bacteria to the newborn child by sharing food or kissing. Significantly
fewer cavities occurred in the children when their mothers chewed 100%
xylitol-sweetened gum during and after pregnancy.
- How often does my child need to use xylitol? Best results are achieved when the
gum is chewed 3-5 times per day, after each meal or snack and ½ hour before
bedtime.
- How long does my child need to chew xylitol? Chew it for at least 5 minutes but
chewing it longer will not cause harm. You should chew it for as many months or
years as desired to have the benefits of its cavity- and plaque-fighting
qualities.
- Are there other advantages to chewing 100% xylitol gum? Yes. The gum may reduce
bad breath, and studies have also shown that there can be up to a 40% reduction in
ear infections. If your child suffers from frequent ear infections, you can further
reduce their risk by using a xylitol- containing nasal wash.
- Can my child stop brushing and flossing his/her teeth? No. Maintain a good oral
hygiene routine of regularly brushing and flossing.
- Can my child stop visiting my dentist? No. Maintain regular dental visits for
cleaning and fluoride treatments and other recommended preventive care.
- Does my child need fluoride? Yes, xylitol is just another tool that is
recognized to be effective against tooth decay.
- Can my child eat anything that he/shes want once he/she starts chewing the
xylitol gum? No. You should still carefully watch your child’s intake of
high-density carbohydrates (sugar) and avoid sugar- and acid- containing juice and
waters.
- Is xylitol safe to use? Yes. Our bodies normally produce about 15 grams of
xylitol each day. There have been no reported side effects when used as directed,
i.e., 4-12 grams per day. A person who exceeds 30 grams per day may experience some
lower gastrointestinal discomfort for a few days (osmotic diarrhea) if they are
xylitol-sensitive individuals.
A cavity is by definition a hollow place-- a hole. Often, molar, premolar teeth and the
backsides of top front teeth are formed with deep grooves, pits, and fissures. Despite one’s
best efforts, the toothbrush bristles cannot reach down to clean out these crevices (see
photo). It is warm, dark, and moist at the bottom of these pits, and the acid from bacteria
easily begins to soften the tooth enamel as decay begins.
You may have heard about “sealants.” Sealants are supposed to be a protective coating to
prevent decay. Some dentists advocate doing the procedure on all permanent molar teeth and
many primary molar teeth soon after these teeth erupt into the mouth. However, it seems
that not all people need this procedure. Depending upon other preventive factors, about 50
to 70% of children need it in at least one permanent molar and 5 to 10% of children need it
in a primary molar.
In this office, we advocate the procedure only when signs indicate that decay is starting or
extremely possible to start in a tooth. Then, the tooth receives a mini-resin, “invisible”
filling. The “water whistle” (also known to many of you as the “drill”) is used to explore
the deep pits, fissures and grooves of the affected tooth and remove any decay that is
lurking there. Only the most minimal amount of tooth structure is removed to eliminate any
possible decay. This is usually a painless procedure for the child, and no numbing is
routinely required. Some children may feel a quick tinge of “cold” when the bottom of the
pit is reached and the last bit of decay is removed. Children are always warned of this
potential feeling at the appropriate time. The feeling is usually not enough to warrant an
injection and the subsequent experience of numbness for hours afterwards.
Approached in this way, the resin will more likely remain for years without recurring decay
under the small, conservative, “invisible” mini-filling. These are not the fillings with
which most of us are familiar. If the procedures are done extremely well, the “sealants”
can last a lifetime.
We tell the children that these do not “count” as cavities because they could not be
prevented. And, when we refer to them as “fillings”, they are not the fillings that most of
us are familiar with. They are small, conservative, “invisible” mini, resin fillings.
Early Childhood Caries (ECC) is a very aggressive fast-moving type of decay! ECC is a
particular challenge to treat due to the child’s limited capacity to understand at this age
(age 1 or 2). We are also very limited in the length of time a child will sit still and
allow us to work. If the work is significant, our only alternative to treat these cavities
and avoid infections, abscesses and extractions used to be general anesthesia in the
hospital or sedation in the dental office.
ART is a variety of new techniques designed to slow down or stop the decay and to place
temporary fillings as the child is developing so more conventional fillings can be placed.
We are buying time and attempting to avoid the hospital treatment or sedation. This
technique relies on daily support at home. If we do not have excellent help at home,
failure is more likely and we may be faced with the general anesthesia choice and the
extensive dental work. These techniques include -
- Identification and cessation of the cause of the early caries. Without
excellent cooperation at this step in the home all the rest of our efforts will be
in vain. We will lose time, increase the costs, and need to do immediate
conventional treatment on a worsened condition.
- Remineralizing with topical fluoride applications at the office and at
home. All the fluoride research conducted during the last 20 years demonstrates
that the beneficial effect of fluoride is topical, i.e., we don’t need to ingest it
to receive any benefit. And, the fluoride can remineralize areas where the cavity
has started. It is healing the cavity.
- Removing bulk decay from the cavities with quiet instruments and opening
the areas to permit easier cleaning with tooth brushes, floss and toothpicks.
Injections of local anesthetic are not required and treatment can be done with the
child in the parent’s lap.
- Placing temporary fillings where feasible or necessary. We use materials
that will inhibit the potential for new, active caries to start.
- Monitoring carefully! We recommend follow-up visits at 3-month intervals and
placement of fluoride varnish.
- If caries is progressing we want to identify that quickly while as
many conservative options for treatment as possible are still available.
- If we need to modify the program, we want to identify the need and the
reasons at the earliest interval possible.
We want to emphasize that if this program if followed correctly, it is highly successful. If
the program is not followed adequately it may not be successful and may lead to a delay in
treatment and a worsening of the problem. If at any time in the process you feel you cannot
fulfill your home care activities that we are requesting, let us know so we can adjust the
program to better suit your needs.
When a child begins to participate in recreational activities and organized sports,
injuries can occur. A properly fitted mouth guard, or mouth protector, 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 your pediatric dentist about custom-made and store-bought mouth protectors.
You might not be surprised anymore to see people with pierced tongues, lips or cheeks,
but you might be surprised to know just how dangerous these piercings can be.
There are many risks involved with oral piercings including chipped or cracked teeth,
blood clots, or blood poisoning. The mouth contains millions of bacteria, and infection
is a common complication of oral piercing. The tongue could swell large enough to close
off the airway!
Common symptoms after piercing include pain, swelling, infection, an increased flow of
saliva and injuries to gum tissue. Difficult-to-control bleeding or nerve damage can
result if a blood vessel or nerve bundle is in the path of the needle.
So follow the advice of the American Dental Association - Skip the mouth jewelry.
Tobacco in any form can jeopardize your child’s health and cause incurable damage. Teach
your child about the dangers of tobacco.
Smokeless tobacco, also called spit, chew or snuff, is often used by teens who believe that
it is a safe alternative to smoking cigarettes. This is an unfortunate misconception.
Studies show that spit tobacco may be more addictive than smoking cigarettes and may be more
difficult to quit. Teens who use it may be interested to know that one can of snuff per day
delivers as much nicotine as 60 cigarettes. In as little as three to four months, smokeless
tobacco use can cause periodontal disease and produce pre-cancerous lesions called
leukoplakias.
If your child is a tobacco user you should watch for the following that could be early signs
of oral cancer -
- A sore that doesn't subside
- White or red leathery patches on the lips, and on or under the tongue
- Pain, tenderness or numbness anywhere in the mouth or lips
- Difficulty chewing, swallowing, speaking or moving the jaw or tongue; or a
change in the way the teeth fit together
Because the early signs of oral cancer usually are not painful, people often ignore them. If
it’s not caught in the early stages, oral cancer can require extensive, sometimes
disfiguring, surgery. Even worse, it can be fatal.
Help your child avoid tobacco in any form. By doing so, your child will avoid bringing
cancer-causing chemicals in direct contact with their tongue, gums and cheek.