Dental Topics

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. See Fig.1 below.

Fig.1: Eruption of Your Child's Teeth

 

Permanent teeth begin erupting around age 6, starting with the first molars and lower front teeth (central incisors). This process continues until approximately age 21.

Fig.1: Eruption of Your Child's Teeth

 

A serious form of dental decay among young children is baby bottle tooth decay. This condition is caused by frequent, long exposure of an infant’s teeth to liquids that contain sugar. Among these liquids are milk, breastmilk, formula and juice.

Putting a baby to bed with a bottle, or nursing a baby to sleep, can cause serious and rapid tooth decay. The liquid pools around the child’s teeth giving plaque bacteria an opportunity to produce acids that attack tooth enamel. If you must give your baby a bottle as at comforter at night time, it should contain water only. This condition is also known was Early Childhood Caries (ECC). For further information on ECC, please visit the American Academy of Pediatric Dentistry website.

 

Sucking is a natural reflex and infants and young children may use thumbs, fingers or pacifiers on which to suck. It may make them feel secure and happy or provide a sense of security.

Thumb sucking that persists beyond the eruption of the permanent teeth can cause problems with the proper growth of the mouth and alignment of the teeth. How intensely a child sucks on fingers or thumb 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. Most children quit on their own before they start school. If you have questions about thumb sucking, or the use of a pacifier, consult your pediatric dentist.

 

It is very important to maintain the health of primary teeth. Neglected cavities can lead to problems which affect the developing permanent teeth. Primary teeth are important for proper chewing and eating, providing space for the developing permanent teeth and guiding them into the correct position. Primary teeth also affect the development of speech and add to an attractive appearance. While the front teeth last until age 6-7 years, the back teeth (molars and cuspids) aren’t lost until age 10-13.

 

Begin cleaning your child's teeth as soon as the first tooth erupts. For small infants, a clean washcloth or "finger" brush will keep the new teeth clean. As the molars erupt, around 12 months of age, begin introducing a small soft bristled toothbrush. It is recommended that children under the age of 3 use a non-fluoridated "training" toothpaste.

It is important that an adult help children brush their teeth every day. Parents should also floss their children's teeth daily if there are no spaces between the teeth.

 

1. Good oral hygiene beginning as soon as the first tooth erupts. Parents should help children brush their teeth every day. Floss your child’s teeth if there are no spaces between the teeth.
2. Parents should not put children to sleep with a bottle containing any liquid other than water. Parents should encourage their infants to begin drinking from a cup around their first birthday.
3. Parents should provide healthy, balanced meals for children. They should limit the amount of sugar-laden foods and snacks in their diet. Plenty of healthy snacks should be available for children. Cheese products actually fight dental caries.
4. Limit your child's exposure to sweetened drinks. Milk and juice should be limited to meal times and children should be given water in between meals.
5. You can make your child's teeth more decay resistant by using an ADA approved children's toothpaste. Place only a pea sized amount of toothpaste on the toothbrush if your child is able to spit. Prior to age 4 or 5 most children will swallow the toothpaste, for this reason a baby tooth cleanser should be used in children under 3. Your pediatric dentist can help you determine which kind of toothpaste is right for your child based on their development and caries risk.
6. Children taking oral medications should have their teeth cleansed after each dose of medication. Nearly 100% of children's medications contain sucrose, which can increase the risk of developing dental caries.

Fig.1: How Can I Prevent Cavities?

 

Radiographs or X-Rays are a vital and necessary part of your child’s dental exam. Without them, certain dental conditions can and will be missed. X-Rays detect much more than cavities. Radiographs may be needed to survey erupting teeth, diagnose bone diseases, evaluate the results of an injury, or plan orthodontic treatment. X-Rays allow dentists to diagnose and treat health conditions that cannot be detected during a clinical examination.

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 is extremely small. Dental X-Rays represent a far smaller risk than an undetected and untreated dental problem.

 

There are many myths and misconceptions regarding fluoride, however, fluoride is an essential component in fighting gum disease and tooth decay. Fluoride is routinely used in our offices on each patient, applied at each regularly scheduled cleaning. Here are some points about fluoride:

• Fluoride is safe and necessary at appropriate levels.
  Fluoride works two ways: internally, strengthening the teeth under the gums in the jawbone, and externally, fluoride strengthens tooth enamel on the surface of the teeth. Children between 6 months and age 16 should take in fluoride every day.
• Water fluoridation is the safest and most cost-effective way to prevent tooth decay.
• Two of the most common sources of fluoride are tap water and fluoridated toothpaste. Fluoride occurs naturally in some water, but in most major municipalities it is added to the water to help prevent tooth decay.
• As more parents turn to bottled water for drinking and food preparation, pediatric dentists are concerned about whether children will get enough fluoride. Most bottled water brands do not contain the level of fluoride recommended by the AAPD, American Dental Association, American Academy of Pediatrics, American Medical Association, US Public Health Service, and the World Health Organization.
• Pediatric dentists recommend that children who regularly drink bottled water, well water, or unfluoridated tap water get fluoride in some other way. Fluoride vitamins, drops, and tablets are good examples of fluoride supplements.
• Most bottled water brands process water by distilled- or reverse-osmosis systems that remove fluoride along with contaminants. Some types of bottled water add fluoride to the final product and are safe for children of all ages.
• If you want to keep fluoride in your tap water, try using a charcoal- or carbon-activated filtration pitcher (such as Brita) that offers better-tasting water without removing fluoride.
• As important as fluoride is, it only works when used at the appropriate levels. Too much fluoride can cause a harmless discoloration of the teeth known as enamel fluorosis.
• Regardless of whether or not their water is fluoridated, children need to brush with a pea-sized amount of fluoridated toothpaste two times a day: after breakfast and before bed. Parents need to supervise children's toothbrushing until age 8, when most children have the manual dexterity to accomplish this ask independently.
• Parents, be more cautious using toothpaste with children under age 2. They are not able to spit the toothpaste out after brushing and tend to swallow it. Too much fluoride taken internally between age 2-4 can lead to enamel fluorosis, or discoloration of the teeth.

A sealant is a clear plastic material that is applied to the chewing surfaces of the back teeth (premolars and molars). This sealant acts as a barrier to food, plaque and acid, thus protecting the most decay prone areas of the teeth.

Tooth colored fillings, called composites, are made from durable plastics called composite resins. They look more natural and are less noticeable than other filling materials because they are similar in color and texture to the natural teeth. Tooth colored fillings are compatible with sealants and therefore your pediatric dentist will also be able to seal the portion of the tooth that is not replaced with a composite filling. Because they work best for small fillings they may not always the best treatment for every tooth. During your child’s regular check-up appointment if a cavity is found, together you and your pediatric dentist can discuss what type of filling is best for your child.

 

Sometimes cavities in children’s teeth become so large that restoring the tooth with a filling is no longer an option. In these cases, stainless steel crowns are used to restore baby teeth to their original shape and size. Stainless steel is a long-lasting material in the mouth that will serve quite well for the life of the baby (primary) tooth. This will help keep the tooth and root intact until normal tooth loss occurs.

 

A deep cavity in a child’s baby (primary) tooth may go into the nerve (pulp) of the tooth. In such cases a nerve treatment called a pulpotomy is recommended to save the tooth. A pulpotomy removes part of the pulp of a tooth to prevent or treat the formation of an abscess. A medicated filling material is placed in the nerve space and a crown is then used to restore your child’s tooth. A pulpotomy is similar to, but not as complex as a root canal treatment of an adult tooth. Both procedures prevent unnecessary loss of the tooth. Primary teeth are important in guiding the permanent teeth into position and should therefore remain in your child’s mouth until they are lost naturally. Proper brushing and flossing, a healthy diet, and regular check-ups with your pediatric dentist will go a long way in helping to prevent large cavities.

 

Baby teeth usually stay in place until "pushed out" by a permanent tooth that takes it's place. Unfortunately, some children lose baby teeth too early. A tooth may be lost early due to trauma or significant dental disease. If your child loses a baby tooth too early, the remaining baby teeth may tilt, drift, or move up or down to fill the gap. When this happens, they fill the space intended for the permanent tooth, and the permanent tooth can come in crowded or crooked. This condition, if left untreated, may require extensive (and expensive) orthodontic treatment (braces or even surgery).

Space maintainers hold open the empty space left by a lost tooth by preventing movement in the remaining teeth until the permanent tooth takes it's natural position in the child's mouth. This treatment is much more affordable and much easier on your child than to move them back later with orthodontic procedures. Typically, the space maintainer is well tolerated by children and is left in place until the permanent teeth begin to erupt.

 

Some children are given nitrous oxide, or what you may know as laughing gas, to relax them for their dental treatment. Nitrous oxide is given through a small breathing nose, allowing them to relax, but without putting them to sleep. The American Academy of Pediatric Dentistry recognizes this technique as a very safe, effective technique to use for treating children’s dental needs. Nitrous oxide is not effective in children who are too young or too anxious to sit in the chair and have the nosepiece placed on their nose.

 

Oral sedation is administered by our doctors in office and is used for patients who due to age and/or high anxiety (dental phobia) cannot cope with traditional dental treatment. Their fear and anxiety causes them a tremendous amount of stress. Oral conscious sedation is a way of using medication to relax a child without the loss of consciousness. Conscious sedation aids in calming a child so that he or she can accept dental treatment in a more relaxed state. This can help prevent injury to the patient and provide a better environment for providing dental care. Pediatric dentists are trained to administer, monitor and manage sedated patients.

• What special instructions should I follow before the sedation appointment?
  To alleviate potential anxiety your pediatric dentist may recommend minimal discussion of the dental appointment with the child. Should your child become ill, contact our offices. It may be necessary to choose to arrange another appointment. It is important not to have a meal before a sedation appointment. Your doctor will inform you about specific food and fluid intake guidelines prior to the sedation appointment.
• What special instructions should I follow after the sedation appointment?
  Children who have been sedated are requested to return home for the remainder of the day with appropriate supervision. Your doctor will discuss specific post-sedation instructions with you, including appropriate diet, physical activity and requested supervision.

 

Intravenous sedation allows patients to sleep throughout their appointment, eliminating physical movement, emotional anxiety and pain. This allows your pediatric dentist to complete all necessary treatment in one comfortable appointment. IV sedation is used for patients that have extensive dental needs, patients with mental or physical special needs, the very young, children with moderate to severe dental phobia, or when oral conscious sedation has been ineffective.

At PDS, this in-office procedure is preformed by Dr. Todd Christensen. Dr. Christensen is a dental anesthesiologist that specializes in the treatment of pediatric patients. Dr. Christensen is a Diplomate of the National Board of Anesthesiology and is a Fellow within the American Dental Society of Anesthesiology.

• What special instructions should I follow before the IV appointment?
  To alleviate potential anxiety your pediatric dentist may recommend minimal discussion of the dental appointment with the child. Should your child become ill, contact our offices. It may be necessary to choose to arrange another appointment. It is important not to have a meal before a sedation appointment. Your doctor will inform you about specific food and fluid intake guidelines prior to the sedation appointment.
• What special instructions should I follow after the sedation appointment?
  Children who have been sedated are requested to return home for the remainder of the day with appropriate supervision. Your doctor will discuss specific post-sedation instructions with you, including appropriate diet, physical activity and requested supervision.

Some patients require that their dental treatment be completed in a hospital setting. General anesthesia allows your pediatric dentist to complete all treatment in one comfortable appointment. This is most commonly used on patients that have extensive dental needs, the very young patient and those with mental or physical challenges, as well as, the medically compromised. Our doctors complete their GA cases at The Gilbert Surgery Center or Phoenix Children’s Hospital.

 

We treat ALL children! We have had extensive experience treating children of all abilities and serious dental conditions and have helped many families with their dental challenges. We understand the difficulties you may be facing, and can share our knowledge and experience to help you. We are committed to providing the best dental care for all children, regardless of their developmental, dental, or health care needs.

 

There is always a doctor on call. If your child has a dental emergency after regular office hours, and you need to talk to the doctor please call our office. The answering service will instruct you on how to page the doctor.

Unfortunately, our children have accidents. Many times these accidents can injure teeth or involving facial or head areas. Toddlers, children playing sports or just engaging in regular play, can suddenly and unexpectedly incur a mouth, facial, or head injury. Below are some suggestions for handling these injuries and tips for immediate treatment that can be instrumental in saving your children's teeth in the event an injury occurs. We would suggest that you print this page, and keep it handy, just in case an accident occurs.

What should I do if my child's baby tooth is knocked out?
Contact our offices, or your pediatric dentist, as soon as possible. Baby teeth are usually not put back into the mouth but the child should be seen by the dentist to determine if any roots remain or other teeth have been injured.

What should I do if my child's permanent tooth is knocked out?
Find the tooth and rinse it gently in cool water. Do NOT scrub it or clean it with soap-just rinse with water! If possible, replace the tooth in the socket and hold it there with clean gauze or a wash cloth. If you can't put the tooth back into the socket, place the tooth in a clean container with milk, saliva, or water. Get to the pediatric dental office immediately, or, if it is after hours, call our office where we will be immediately contacted to call you back. The faster you act, the better your chances of saving the tooth.

What if a tooth is chipped or fractured?
Contact our offices, or your pediatric dentist immediately. Quick action can save the tooth, prevent infection and reduce the need for extensive dental treatment. Rinse the mouth with water and apply cold compresses to reduce swelling. If you can find the broken tooth fragment, bring it with you to the dentist.

What about a severe blow to the head or a jaw fracture?
Go immediately to the emergency room of your local hospital. A blow to the head can be life threatening!

What if my child has a toothache?
Call your pediatric dentist and visit the office promptly. To comfort your child, rinse the mouth with water. Apply a cold compress or ice wrapped in a cloth. Do not put heat or aspirin on the sore area.

How can dental injuries be prevented?
The first thing to do is child proof your home. This entails making sure infants an toddlers cannot find sharp objects such as pencils and pens to put in their mouth and ensuring that electrical outlets and cords are out of their reach.

As children are learning to walk, make sure their are not sharp corners on furniture they may fall against and suffer injury. Pad those sharp coffee table corners or remove them completely until the child has learned to walk with complete balance. Use common sense, if it looks like it could injure a falling child, it can!

Make sure your child is belted safely in his stroller and car seat at all times!

Reduce oral injury in sports by wearing mouthguards. This includes not just school or league sports, but the backyard variety also. Most children lose teeth on the playground, not just in organized school sports!

Developing malocclusions can be recognized as early at 2-3 years of age. Often, early steps can be taken to reduce the need for major orthodontic treatment at a later age.

Phase I - Early Treatment: Phase I treatment, if necessary, is usually initiated on children between the ages of 7 and 10 years. The primary objective for Phase I is to address significant problems to prevent them from becoming more severe.

Phase II - Orthodontics: This is generally done when all or nearly all of the permanent teeth have erupted. The goal is to coordinate and align the teeth and jaws.

 

Parents are often concerned about nocturnal grinding of teeth. Often, the first indication is the noise created when the child grinds during their sleep. The majority of cases of pediatric bruxism do not require any treatment. The good news is that most children outgrow bruxism. The majority of children stop grinding as the permanent first molars erupt.

Dentistry for adolescents and teens is a fundamental part of the advanced training of a pediatric dentist. In addition to providing preventive dentistry for your teen like cleanings, fluoride treatments, and brushing and flossing tips and techniques, a pediatric dentist can address concerns with your teen about the way their teeth look. You or your teen may have esthetic concerns about chips, broken teeth, tooth color, spacing, or orthodontic concerns that your pediatric dentist will discuss with you. In addition during the teen years wisdom teeth will be developing and your pediatric dentist will make sure the proper treatment is prescribed for them. Regular dental care for your teen provided by your pediatric dentist will ensure a healthy smile to last a lifetime.

 

When a child begins to participate in recreational activities and organized sports, injuries can occur. A properly fitted mouth guard is an important piece of athletic gear that can help protect your child’s smile. It 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.

 

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.

Piercing has become very popular as of late and you have probably seen someone with a pierced tongue or lip. You may not know that these decorations can cause permanent damage to your mouth.

The risks of oral piercing include pain, nerve damage, extensive bleeding, chipped or cracked teeth and damaged gums. Because your mouth is full of bacteria, a major risk of piercing your tongue is infection and swelling.
We join the American Dental Association and recommend avoiding mouth jewelry.