- Why are the Primary Teeth so Important?
- Dental Radiographs (X-rays)
- Eruption of your Child’s Teeth
- Dental Emergencies
- Sedation for the Anxious Child
- Why are there Stains on my Child’s Teeth?
- Hypocalcified Teeth
- What is Pulp Therapy?
- What Is the Best Toothpaste for my Child?
- Why Does My Child Grind Her/His Teeth?
- Thumb Sucking
- What is the Best Time for Orthodontic Treatment?
Early Infant Oral Care
- Parental Guidelines for Preparing your Child for Their First Dental Visit
- When will my Baby Start Getting Teeth?
- Baby Bottle Tooth Decay (Early Childhood Caries)
- Care of your Child’s Teeth
- Good Diet = Healthy Teeth
- How Do I Prevent Cavities?
- Chlorhexidine Gluconate
- Xylitol Frequently Asked Questions
- Resin Fillings Used to Prevent Cavities
- Alternative Restorative Technique (ART) for Early Childhood Caries
- Athletic Mouth Guards
- Tongue Piercing – Is it Really Cool?
- Tobacco = Bad News in Any Form
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,
- 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.
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).
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.
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.
Early Infant Oral Care
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.
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.
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.
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.