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 (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.
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.
Adults have 28
permanent teeth, or up to 32 including the
third molars (or wisdom teeth).
Look! My Tooth is Loose!
(with 16"x22" poster and stickers)
By Patricia Brennan Dermuth
Illustrated by Mike Cressy
Toothache:
Clean the area of the affected tooth. Rinse
the mouth thoroughly with warm water or use
dental floss to dislodge any food that may
be impacted. If the pain still exists,
contact your child's dentist. Do not place
aspirin or heat 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
injured areas to help control swelling. If
there is bleeding, apply firm but gentle
pressure with a gauze or cloth. If bleeding
cannot be controlled by simple pressure,
call a doctor or visit the hospital
emergency room.
Knocked Out
Permanent Tooth: If possible, find the
tooth. Handle it by the crown, not by the
root. You may rinse the tooth with water
only. DO NOT clean with soap, scrub or
handle the tooth unnecessarily. Inspect the
tooth for fractures. If it is sound, try to
reinsert it in the socket. Have the patient
hold the tooth in place by biting on a
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 (beside the cheek). The
patient must see a dentist IMMEDIATELY! Time
is a critical factor in saving the tooth.
Knocked Out Baby
Tooth: Contact your pediatric dentist
during business hours. This is not usually
an emergency, and in most cases, no
treatment is necessary.
Chipped or Fractured
Permanent Tooth: Contact 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 possible,
locate and save any broken tooth fragments
and bring them with you to the dentist.
Chipped or Fractured
Baby Tooth: Contact your pediatric
dentist.
Severe Blow to the
Head: Take your child to the nearest
hospital emergency room immediately.
Possible Broken or
Fractured Jaw: Keep the jaw from moving
and take your child to the nearest hospital
emergency room.
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.
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.
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.
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. High-speed
film and proper shielding assure that your
child receives a minimal amount of radiation
exposure.
Tooth
brushing is one of the most important tasks
for good oral health. Many toothpastes,
and/or tooth polishes, however, can damage
young smiles. They contain harsh abrasives,
which can wear away young tooth enamel. When
looking for a toothpaste for your child,
make sure to pick one that 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.
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,
consider providing them with a fluoride free
toothpaste, using no toothpaste, or using
only a "pea size" amount of toothpaste.
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, the parent
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, discuss this with your
pediatrician or pediatric dentist.
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 have concerns about thumb sucking or
use of a pacifier, consult your pediatric
dentist.
A few suggestions to
help your child get through thumb sucking:
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.
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).
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.
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 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.
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 the bacteria which 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.
The American Academy of
Pediatrics (AAP), the American Dental
Association (ADA), and the American Academy
of Pediatric Dentistry (AAPD) all recommend
establishing a "Dental Home" for your child
by one year of age. Children who have a
dental home are more likely to receive
appropriate preventive and routine oral
health care.
The Dental Home is
intended to provide a place other than the
Emergency Room for parents.
You can make the first
visit to the dentist enjoyable and positive.
If old enough, 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 to-do
concerning the visit, the better.
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.
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
"Eruption of Your Child’s Teeth" for
more details.
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
(including breast milk), formula, fruit
juice and other sweetened drinks.
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
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.
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. 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.
A sealant is a clear or
shaded plastic material that is applied to
the chewing surfaces (grooves) of the back
teeth (premolars and molars), where 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 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 a chalky white to even
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 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 formula, soy-based infant
formula, infant dry cereals, creamed
spinach, and infant 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.
Parents can take the
following steps to decrease the risk of
fluorosis in their children’s teeth:
Use baby tooth cleanser on the
toothbrush of the very young child.
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).
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.
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.
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 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.
Pediatric Dentistry of Redlands, CA 92373 Dr.
Cameron Fuller, Pediatric Dentist, Drs. Evan Lemley and Brian Novy,
General Dentists.
Serving patients in the surrounding cities
and areas of Redlands, Loma Linda, Yucaipa, San Bernardino, Moreno
Valley, California.
Toothache:
Clean the area of the affected tooth. Rinse
the mouth thoroughly with warm water or use
dental floss to dislodge any food that may
be impacted. If the pain still exists,
contact your child's dentist. Do not place
aspirin or heat on the gum or on the aching
tooth. If the face is swollen, apply cold
compresses and contact your dentist
immediately.
Tooth
brushing is one of the most important tasks
for good oral health. Many toothpastes,
and/or tooth polishes, however, can damage
young smiles. They contain harsh abrasives,
which can wear away young tooth enamel. When
looking for a toothpaste for your child,
make sure to pick one that 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.
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.
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.
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.
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
(including breast milk), formula, fruit
juice and other sweetened drinks.
Sippy
Cups
