- Why are Baby Teeth Important?
- Growth and Development of your Child's Teeth
- Dental Radiographs (X-rays)
- What's the Best Toothpaste for my Child?
- Does Your Child Grind His Teeth at Night? (Bruxism)
- What is Pulp Therapy?
- What is the Best Time for Orthodontic Treatment?
- Adult Teeth Coming in Behind Baby Teeth
- Care of Your Child's Teeth
- Good Diet = Healthy Teeth
- How Do I Prevent Cavities?
- Seal Out Decay
- Mouth Guards
- Xylitol - Reducing Cavities
- Beware of Sports Drinks
For more information concerning pediatric dentistry, please visit the website for the American Academy of Pediatric Dentistry.
Why Are Baby Teeth Important?
Though they are commonly called “baby teeth,” many people are surprised to learn that this first set of teeth (also called primary teeth, deciduous teeth, or milk teeth) does not typically finish falling out until around 12 years old. The 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. Cavities on these teeth, if left unfixed, will continue to grow and eventually lead to infection (abscess) and/or pain. On occasion, they can also cause problems which affect developing permanent teeth.
Growth and Development 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 3, the pace and order of their eruption varies.
Permanent teeth begin appearing around age 6, starting with the first molars (which come in all the way in the back of the mouth and do not push out any baby teeth) and lower central incisors up front (which should push out the baby teeth). At the age of 8, you can generally expect the bottom 4 primary teeth (lower central and lateral incisors) and the top 4 primary teeth (upper central and lateral incisors) to be gone and permanent teeth to have taken their place. There is about a one to two year break from ages 8-10 and then the rest of the permanent teeth will start to come in. If you include the wisdom teeth, which are very unpredictable in their size, shape, and timing for growing in (if ever), this process continues until approximately age 18, although by age 12 all the baby teeth have usually been replaced by adult teeth.
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. For example, cavities forming between the teeth often show no visible changes just by looking in the mouth until they are so large that they have grown very close to or into the nerve of the tooth.
Even still, radiographs detect much more than cavities. For example, radiographs show the development and position of erupting teeth, diagnose bone diseases, evaluate the results of an injury, and plan orthodontic treatment. If dental problems are found and treated early, dental care is more comfortable for your child and more affordable for you.
The American Academy of Pediatric Dentistry recommends radiographs and examinations every six months for children with a high risk of tooth decay. On average, most pediatric dentists request radiographs approximately once a year. Approximately every 3 years, it is a good idea to obtain a complete set of radiographs, either a panoramic and bitewings or periapicals and bitewings.
We are particularly careful to minimize the exposure of our patients to radiation. Lead body aprons and thyroid collars will protect your child from unnecessary exposure. In addition, our digital electronic x-ray equipment significantly reduces the number of x-rays and the amount of radiation needed per x-ray to create an image of diagnostic quality.
What's The Best Toothpaste For My Child?
Tooth brushing is a major determinant of oral health. Proper technique (brushing all teeth on all sides to remove food and plaque) and proper timing (after breakfast, right before bed) is most important. It’s a great idea to let your child practice brushing, but it is important that an adult helps the child brush (whether they like it or not!) until they are skilled enough to tie their own shoes, usually around age 7-8, obviously with decreasing supervision and assistance during the last few years prior to full independence.
We follow the American Academy of Pediatric Dentistry’s recommendation of using fluoride toothpaste for children of all ages. However, the amount of toothpaste used is a critical variable. Children under age 3-years should use a “grain of rice” (smear) amount of fluoride toothpaste, and children age 3-6 years should use a “pea size” amount. All fluoride toothpaste in the U.S. contains an equivalent concentration of fluoride, whether it is marketed for children or adults – it is only the flavor (children’s is usually bubblegum) that changes! When choosing a toothpaste for your child, pick one they are most likely to enjoy using, and make sure it is recommended by the American Dental Association as shown on the box and tube. These toothpastes have undergone testing to insure they are safe to use.
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, you 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. If excessive wear of the teeth (attrition) is present, then a mouth guard (night guard) may be indicated. The negatives to a mouth guard are the possibility of choking if the appliance becomes dislodged during sleep and it may interfere with growth of the jaws. The positive is obvious by preventing wear to the primary dentition.
The good news is most children outgrow bruxism. The grinding decreases between the ages 6-9 and children tend to stop grinding between ages 9-12. If you suspect bruxism, mention it to us and we will happy to evaluate and discuss it further.
What Is Pulp Therapy?
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 does not die and need to be removed prematurely).
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", "baby root canal", "pulpectomy" or "pulpotomy". The last two are slightly different from each other.
A pulpotomy removes the diseased pulp tissue within the crown portion of the tooth. Next, a medicinal material 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.
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.
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 such as eliminating habits and space maintainers 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, when the permanent teeth start to grow in and replace baby teeth. Treatment during this stage typically addresses discrepancies in jaw growth and size such as crossbites and spacing issues. 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: At 12+ years, this stage deals with the permanent teeth and the development of the final bite relationship. This is the traditional age at which most children who need braces will get them.
Adult Teeth Coming in Behind Baby Teeth
This is a very common occurrence with children, and can be due to factors such as crowding (the adult tooth could not fit in the space where the baby tooth did) or the adult teeth compensating for improper position of the baby teeth. It is nothing to be extremely concerned over. However, if the baby tooth is not loose and does not become loose within a few weeks after you see the permanent tooth poke through the gums, there is a good chance the baby tooth will need to be professionally removed. In the meantime, encourage your child to wiggle the baby tooth. Either way, once the baby tooth is out, the permanent tooth should then slide into the proper place.
Early Infant Oral Care
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. Talk to your doctor or dentist about ways you can prevent periodontal disease during pregnancy.
Additionally, mothers with poor oral health may be at a greater risk of passing bacteria that 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 plaque.
- Proper diet, with the reduction of beverages and foods high in sugar & starch.
- Use a fluoridated toothpaste recommended by the ADA and rinse every night with an alocohol-free, over-the-counter mouth rinse with .05 % sodium fluoride in order to reduce plaque levels.
- Don't share utensils, cups or food which can cause the transmission of cavity-causing bacteria to your children.
- Use of xylitol chewing gum (4 pieces per day by the mother) can decrease a child’s caries rate.
When Will My Baby Start Getting Teeth?
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 to appear are usually the lower front (anterior) teeth and they usually begin erupting between the age of 6-8 months.
See "Growth and Development of your Child’s Teeth" for more details.
Baby Bottle Tooth Decay (Early Childhood Caries)
The most serious form of cavities 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 (including breast milk), formula, fruit juice and other sweetened drinks.
When the baby is feeding on breast milk only, the amount and frequency is not a concern. However, once other foods are introduced to the diet, putting a baby to bed for a nap or at night with a bottle containing anything 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 until it is only water.
After each feeding, wipe the baby’s gums and teeth with a damp washcloth or gauze pad to remove plaque. The easiest way to do this is to sit down, place the child’s head in your lap or lay the child on a dressing table or the floor. Whatever position you use, be sure you can see into the child’s mouth easily.
Sippy cups should be used as a training tool from the bottle to a cup and should be discontinued by the first birthday. If your child uses a sippy cup throughout the day, fill the sippy cup with water only (except at mealtimes). By filling the sippy cup with liquids that contain sugar (including milk, fruit juice, sports drinks, etc.) and allowing a child to drink from it throughout the day, it soaks the child’s teeth in cavity causing bacteria.
Thumb Sucking and Pacifier Habits
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.
Sucking habits that last more than a few years will cause problems with the proper growth of the mouth and tooth alignment. How intensely a child sucks will determine how quickly and severely these problems develop.
To best prevent permanent changes to the shape of the jaws and position of the teeth, the sucking habit should ideally be eliminated by 36 months of age. The further past this age that the habit continues, the more likely it will be that some or all of the growth changes become permanent. At that point, orthodontics will be needed to reposition the teeth. However, a sucking habit is even more powerful than braces, and if the habit continues during orthodontic treatment, it will be a never-ending tug of war!
Eliminating a sucking habit can be extremely difficult. There are a variety of methods you can try, and every child responds differently to each technique. For some, peer pressure at preschool or kindergarten is enough to cause them to stop. Other proactive techniques include:
- Substitution of comforts, such as giving them a special blanket or stuffed animal to hold instead
- A reward system, where the child gets a star on the calendar for each day they do not repeat the habit, with prizes at certain intervals (week, month)
- If it is a subconscious habit, wearing mittens to sleep or painting “Mavala,” a foul-tasting material on the fingernails, is another effective technique.
- If all else fails, a special type of retainer can be made to block the thumb out of the mouth.
Care Of Your Child's Teeth
- Starting at birth, clean your child's gums with a soft cloth and water.
- As soon as your child's teeth erupt, brush them with a soft-bristled toothbrush.
- If they are under the age of 2, use a small "smear" of toothpaste.
- If they're 2-5 years old, use a "pea-size" amount of toothpaste.
- Be sure and use an ADA-accepted fluoride toothpaste and make sure your child does not swallow it.
- When brushing, the parent should brush the child's teeth until they are old enough to do a good job on their own.
- Flossing removes plaque between teeth and under the gumline where a toothbrush can't reach.
- Flossing should begin when any two teeth touch.
- Be sure and floss your child's teeth daily until he or she can do it alone.
Good Diet = Healthy Teeth
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. It is not necessarily about how much sugar is consumed daily that causes cavities. What is more important is how frequently a sugar or carbohydrate is consumed. Generally, 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 sugared gum 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. These usually have no sugar, and the dairy is “basic,” the opposite of acidic, which is the environment bacteria likes most to grow cavities.
How Do I Prevent Cavities?
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 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 protective sealants or home fluoride treatments for your child. Sealants can be applied to your child’s molars to prevent decay on hard to clean surfaces.
Seal Out Decay
A sealant is a protective coating that is applied to the pits and grooves on the chewing surfaces (grooves) of the back teeth (premolars and molars), where food likes to get caught and four out of five cavities in children are found. This sealant acts as a barrier to food, plaque and acid, thus protecting the decay-prone areas of the teeth.
Fluoride is a naturally occurring element, which has shown to prevent tooth decay by as much as 50-70%, Despite the advantages, too little or too much fluoride can be detrimental to the teeth. With little or no fluoride, the teeth aren’t strengthened to help them resist cavities. Excessive fluoride ingestion by young children can lead to dental fluorosis, which is typically a chalky white discoloration (brown in advanced cases) of the permanent teeth. Be sure to follow our careful recommendations (reiterated below) on suggested fluoride use and possible supplements, if needed.
You can help by using a fluoride toothpaste and only a smear of toothpaste (the size of a grain of rice) to brush the teeth of a child less than 3 years of age. For children 3 to 6 years old, use a "pea-size" amount of toothpaste and perform or assist your child’s toothbrushing. Remember that young children do not have the ability to brush their teeth effectively on their own. Children should spit out and not swallow excess toothpaste after brushing, in order to avoid fluorosis.
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 and store-bought mouth protectors.
Xylitol - Reducing 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.
Beware of Sports Drinks
Due to the high sugar content and acids in sports drinks, they have erosive potential and the ability to dissolve even fluoride-rich enamel, which can lead to cavities.
To minimize dental problems, children should avoid sports drinks and hydrate with water before, during and after sports. Be sure to talk to your pediatric dentist before using sports drinks.
If sports drinks are consumed:
- reduce the frequency and contact time
- swallow immediately and do not swish them around the mouth
- neutralize the effect of sports drinks by alternating sips of water with the drink
- rinse mouthguards only in water
- seek out dentally friendly sports drinks
Tongue Piercing - Is It Really Cool?
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, blood poisoning, heart infections, brain abscess, nerve disorders (trigeminal neuralgia), receding gums or scar tissue. Your mouth contains millions of bacteria, and infection is a common complication of oral piercing. Your tongue could swell large enough to close off your 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 and give your mouth a break – skip the mouth jewelry.
Tobacco - Bad News In Any Form
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 won’t heal.
- 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 kill.
Help your child avoid tobacco in any form. By doing so, they will avoid bringing cancer-causing chemicals in direct contact with their tongue, gums and cheek.