Click on a topic of interest for more information.

What is a Pediatric Dentist?
Your Child's First Dental Visit
Why are the Primary Teeth so Important?
Nitrous Oxide
Dental Radiographs (X-rays)
Care of your Child's Teeth
Good Diet = Healthy Teeth
How Do I Prevent Cavities
Preventive Resins
Baby Bottle Tooth Decay (Early Childhood Caries)
When will my Baby Start Getting Teeth?
Eruption of your Child's Teeth
Dental Emergencies
Fluoride
What is Pulp Therapy?

What's the Best Toothpaste for my Child?
Does your Child Grind his Teeth at Night? (Bruxism)
Thumb Sucking
Tongue Piercing - Is it Really Cool?
Tobacco - Bad News in Any Form
What is the Best Time for Orthodontic Treatment?
Mouth Guards

Other Conditions

For more information on oral health care needs, please visit the website for the American Academy of Pediatric Dentistry.


What Is A Pediatric Dentist?

The pediatric dentist is a dental professional who has an additional two to three years of specialized training after dental school and is dedicated to the oral health of children ranging in age 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 trained in the psychology of children and is best qualified to meet children’s needs. Pediatric dentists are taught to recognize diseases that are typically diagnosed in childhood years. Additionally, pediatric dentists are further trained in sedation techniques, and if need be, can practice advanced procedures in an operating room setting. Pediatric dentistry is a recognized specialty of the American Dental Association (ADA).
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 Your Child’s First Dental Visit

According to the American Academy of Pediatric Dentistry (AAPD), your child should visit the dentist by his/her 1st birthday. You can make the first visit to the dentist enjoyable and positive.  It is helpful to let the child interact with the pediatric dentist and staff.  The pediatric dentist and staff will try to engage the child in conversation.  The parent’s role should be one of a silent observer and allow the child to build a rapport with the dental specialist.  Empowering the child to have a dominant role in his/her own dental health will foster good oral hygiene practices into adulthood. 

Many parents may be fearful or apprehensive of their own dental visits, however, it is imperative that the parent’s feelings are NOT passed on or communicated to your child regarding their visit.  We are fully aware that a child’s tears are a natural response to the unknown.  We are trained and experienced in comforting a nervous or fearful child, and in many cases, can turn their anxiety around and continue to have a positive experience.  Through use of positive reinforcement, even the most tentative of children can successfully complete an exam or treatment and in doing so, feel a strong sense of accomplishment.

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,” “shot,” “pull,” “drill,” or “hurt,”.  Pediatric dental offices make a practice of using words that convey the same message, but are pleasant and non-frightening for the child.
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 Why Are The Primary Teeth So Important?

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.

NITROUS OXIDE

“The American Academy of Pediatric Dentistry (AAPD) recognizes nitrous oxide/oxide inhalation as a safe and effective technique to reduce anxiety, produce analgesia, and enhance effective communication between a patient and health care provider. The need to diagnose and treat, as well as the safety of the patient and practitioner, should be considered before using nitrous oxide.” Pediatric Dentistry, Vol. 27, No. 7, Reference Manual 2005-2006, p 107-109. Also see American Dental Association: http://ada.org/prof/resources/positions/statements/useof.asp.

Nitrous oxide (N2O) is a quick acting and safe analgesic agent when administered by a trained, knowledgeable professional. N2O is also referred to as “laughing gas,” “sweet air,” or, “the gas.” The nitrous oxide system in our office has safeguards installed whereby the amount of nitrous oxide is regulated and is always accompanied by a continuous flow of oxygen. The use of nitrous oxide is not mandatory in every dental procedure, but is considered “standard of care” for certain procedures and/or for certain children. The disadvantages of nitrous oxide use are few, however cost could be the biggest as some insurance companies do not reimburse for its use during some dental procedures. The risks of nitrous oxide are minimal but sometimes patients experience lightheadedness or feelings of nausea. The effects of nitrous oxide are short-lived as nitrous oxide leaves the body within two minutes of cessation. The alternative measure to nitrous oxide, is to simply decline its use during treatment. Remember the use of nitrous oxide is not mandatory, however, is recommended for your child’s comfort during treatment.

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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.  In our office, we use digital X-Rays which expose children to 90% less radiation than traditional X-Ray modalities.  Digital X-Rays are instantaneous, so children and parents can see images immediately upon taking them.  Digital X-Rays also have the ability to be enlarged, so areas of interest can be closely examined by the doctor.  Finally, digital X-Rays can be sent electronically (emailed) to other specialists such as orthodontists, oral surgeons, endodontists, or to another dentist for a second opinion.

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.

A panoramic radiograph is a growth and development X-Ray and is taken every 3 to 4 years.  It shows the development of the permanent teeth, their position in relation to the primary (baby) teeth, missing teeth, or any extra teeth that may be present.  The X-Ray will also show any anomalies in the bone such as a cyst or a tumor.

     Panorex X-Ray
 

 Bitewing X-Rays are taken to detect decay between the teeth.  When teeth touch, it is impossible to see between them.  Bitewing X-Rays let us visualize between these teeth and are essential in the diagnosis of early decay between the teeth.
 

                               Bitewing X-Ray
 

Periapical X-Rays allow the dentist to visualize the entire tooth, including the root structure.  These X-Rays are used to visualize the structures/bone that hold the teeth in place.  These types of films are especially important in cases, such as trauma, where roots or bone may be damaged.  Periapical X-Rays can also help visualize the development of permanent teeth and can help diagnose extra or missing teeth.
 

Periapical X-Ray
 

Pediatric dentists are particularly careful to minimize the exposure of their young patients to radiation. With contemporary safeguards, the amount of radiation received in a dental X-Ray examination is extremely small and the risk is negligible. In fact, the dental radiographs represent a far smaller risk than an undetected and untreated dental problem. Lead body aprons with thyroid collars when appropriate, will protect your child. Today’s equipment filters out unnecessary X-Rays and restricts the X-Rays beam to the area of interest. High-speed film and proper shielding assure that your child receives a minimal amount of radiation exposure.
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Care of Your Child’s Teeth

Begin daily brushing as soon as the child’s first tooth erupts. Initially, just a wet toothbrush or a toothbrush with non-fluoridated toothpaste can be used until the child learns to spit. A pea-size amount of fluoride toothpaste can be used after the child is old enough not to swallow it. By age 4 or 5, children should be able to brush their own teeth twice a day with supervision.  At about age seven, children do not need to be directly supervised while they brush, however parents should still make sure they are doing a thorough job.  Each child is different; your dentist or hygienist can help you determine whether 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 toothbrush at a 45 degree angle; start along gum line with a soft bristle brush in a gentle circular motion. Brush the outer surfaces of each tooth, upper and lower. Repeat the same method on the inside surfaces and chewing surfaces of all the teeth. Finish by brushing the tongue to help freshen breath and remove bacteria.  Be sure to thoroughly rinse the toothbrush to remove all bacteria and avoid reintroducing bacteria into the mouth during the next brushing.  A tongue scraper can be used instead of a toothbrush to remove bacteria from the tongue.

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, approximately at 9 or 10 years old depending upon your child’s dexterity. For children, flossers with handles are a great, and fun, way to floss, especially for small children with developing dexterity.  For traditional string flossing, 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.

Generally speaking, wax floss is typically easier to use, especially when the teeth are close together. When flossing a child, it is sometimes easier to lay them down.  This will make it easier to visualize what you are doing and the child will be unable to back away.
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 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 contain carbohydrates and can lead to cavity formation. Carbohydrates break down into simple sugars in the mouth and start the cavity process.  These simple sugars feed the bacteria in the mouth thereby creating acids that lower the pH.  The acids attack the dental enamel and weaken it, allowing for the formation of cavities.  The more frequently a child snacks, the more acidic their mouth will  become and the greater the risk for tooth decay. The time between meals or snacks allows for the mouth to reach a neutral pH level where the risk of tooth decay drastically decreases.  The length of time food remains in the mouth also plays a role in tooth health. 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.  Remember, even if your child is snacking on healthy foods, the more frequently a child eats, or continually grazes during the day, the greater the risk for tooth decay.  It is best to have planned snacks between meals and consume nothing but water after toothbrushing before bed.
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How Do I Prevent Cavities?

Cavities are caused by four factors-

·         acid levels of the mouth (see "Good Diet = Healthy Teeth" for more information),

·         anatomy of the teeth,

·         genetics, and

·         oral hygiene. 

Anatomy of teeth can affect the formation of cavities.  If the chewing surfaces of molars and premolars have numerous and/or deep grooves, bacteria and plaque lodge in these grooves increasing the risk of decay. 

Genetics play a role in not only how the teeth are shaped but how much bacteria a person inherently has in their mouth.  The more bacteria a person harbors in their mouth, the more acidic their mouth will become after carbohydrates are ingested. Additionally, the more bacteria a person has, the longer it will take for the acid to clear from the mouth and for the pH to neutralize. 

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.

Cavities are preventable through good oral hygiene, regular dental check-ups, and proper nutrition.  For older children, parents should brush their teeth at least twice a day. Also, watch the number of snacks containing carbohydrates and sugar that you give your children.  Drinking water, or for older children, chewing sugar-free gum that contains xylitol (like Trident) following a meal can help in washing away acid causing bacteria. 

The American Academy of Pediatric Dentistry recommends six month visits to the pediatric dentist beginning at your child’s first birthday. Routine visits will start your child on a lifetime of good dental health.

Your pediatric dentist may also recommend preventive resins or home fluoride treatments for your child. Preventive resins can be applied to your child’s molars and premolars to prevent decay on hard to clean surfaces.
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Preventive Resins

At our office, we use preventive resins to prevent decay on the chewing surfaces (grooves) of molars and premolars (back teeth). Preventive resins are different than traditional sealants in that preventive resins are made of a more durable material that adhere better to the enamel of the tooth. These resins have been found to last longer than traditional sealants. Once applied, it is rare that a preventive resin would have to be replaced or repaired, unlike traditional sealants. Therefore, by using preventive resins, children are awarded the long term benefit of less overall treatment time and parents benefit too from the cost effectiveness of a single procedure. A preventive resin is a white 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 resin acts as a barrier to food, plaque and acid, thus protecting the decay-prone areas of the teeth.

Before Resin Applied After Resin Applied


Before Resin Applied


After Resin Applied

Most cavities form on the chewing surfaces of teeth; therefore preventive resins greatly decrease the chances of cavity formation in a child’s mouth. However, since preventive resins are applied only to the chewing surfaces of back teeth, it is important to floss between these teeth where the enamel is not protected and cavities have the potential to form.
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 Baby Bottle Tooth Decay (Early Childhood Caries)

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 liquids pool 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 easily into the child’s mouth.
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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 are usually the lower front (anterior) teeth and usually begin erupting between the age of 6-8 months. See "Eruption of Your Child’s Teeth" for more details.
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Eruption 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 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).

TOOTH DEVELOPMENT


Look! My Tooth is Loose!
(with 16"x22" poster and stickers)

By Patricia Brennan Demuth
Illustrated by Mike Cressy

 

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Dental Emergencies

Toothache: Clean the area of the affected tooth thoroughly. Rinse the mouth vigorously with warm water or use dental floss to dislodge impacted food or debris. If the pain still exists, contact your child's dentist.  DO NOT place aspirin on the gum or on the aching tooth. If the face is swollen, apply cold compresses and contact your dentist immediately.

Cut or Bitten Tongue, Lip or Cheek: Apply ice to bruised areas. If there is bleeding, apply firm but gentle pressure with sterile gauze or cloth. If bleeding does not stop after 15 minutes or it cannot be controlled by simple pressure, take the child to hospital emergency room.

Knocked Out Primary (Baby)Tooth: Find the tooth. Inspect the tooth for fractures. Call your pediatric dentist.  Under NO circumstances should you try to reinsert the tooth, as this could damage the tooth bud of the permanent adult tooth that will eventually develop.  The pediatric dentist may want to see the child and the tooth, if it could be found, to see if there may be a tooth fragment still left inside the bone socket. 

 

If there is any question whether the tooth is a baby or adult tooth, place the tooth in a cup containing the patient’s saliva or milk and call a pediatric dentist IMMEDIATELY!  Time is a critical factor in saving an adult tooth.  DO NOT attempt to reinsert the tooth.

Knocked Out Permanent (Adult)Tooth: Find the tooth. Handle the tooth by the crown, not the root portion. You may rinse the tooth gently but DO NOT clean 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 under the tongue. The patient must see a dentist IMMEDIATELY!  Time is a critical factor in saving the tooth.

 

Intruded Tooth Following a Fall:  In some instances, a child may fall in such a way that the tooth gets forced up into the bone and will appear as a missing or partially erupted tooth.  It is important that the pediatric dentist is contacted immediately to evaluate the trauma to the tooth.  In many cases, a primary tooth will be left alone to re-erupt.  An adult tooth can be pulled back down into normal position and splinted to aid in healing.  X-Rays will need to be taken to evaluate the teeth, bony anatomy, and to exclude the possibility of any additional trauma that may have occurred.

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Fluoride

Fluoride is a naturally occurring element, which has been shown to be beneficial to teeth by maintaining the strength of dental enamel.  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 (see fluorosis). 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.
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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 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", or "pulpotomy". 

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). 


 

What’s the Best Toothpaste for my Child?

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. 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.
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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, 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 gets less 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.
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 Thumb Sucking

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:

  • 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.
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David Decides About Thumbsucking - A Story for Children, a Guide for Parents
by Susan Heitler P H.D., Paula Singer (Photographer)

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, or blood poisoning. 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.
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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.
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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 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.
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Mouth Guards

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.
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Other Conditions

·         Over retained baby teeth- Sometimes an adult tooth can erupt, but the primary, or baby tooth, has not yet fallen out.  In these instances, the baby tooth needs to be extracted in order to allow for the adult tooth to completely erupt and be in proper alignment.  In many cases, an emerging crooked adult tooth will fall into proper alignment once the baby tooth is extracted.

·         Abscess- An abscess is a small, localized infection that begins when a tooth’s nerve is damaged by decay or trauma. This infection usually becomes visible on the cheek-side of the gum tissue, near the affected tooth.  It appears as a small pimple or boil, or the gums can appear deep-red and swollen.  If gone untreated, the abscess can result in a more systemic infection that may result in hospitalization.

·         Dental dysplasia- A malformation of enamel during tooth development caused by unknown origins.  A tooth with dysplasia may appear with white or brown spots depending on the severity, or may even appear with frank holes in the tooth.  A dysplastic tooth can be sensitive, specifically to cold.  A parent who believes that their child has a dysplastic tooth should contact a pediatric dentist, for this condition can be confused with dental caries, (cavities).  Treatment can range from small, traditional white fillings to stainless steel crowns, in severe cases.

·         Decalcification- Loss of naturally present calcium in the tooth as a result of demineralization.  Demineralization occurs when plaque is allowed to sit on the teeth and leach calcium from the tooth. It appears as white bands, or halos, where plaque has accumulated.  A decalcified area is a weakened area and is more prone to developing into a cavity.  A parent who believes that their child has decalcification of a tooth should contact a pediatric dentist, for this condition can develop into dental caries, (cavities).

·         Fluorosis- is the chalky white to even brown discoloration of the permanent teeth due to the ingestion of too much fluoride.

Some of the sources of ingested fluoride are:

·         Ingestion of 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 soda or 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 less than 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).

·         call your town’s water department and inquire if the water supply is fluoridated.

  • Children’s Medications- Many children’s medications contain flavoring and/or sweeteners that could potentially increase the risk of cavities.  Upon administering medications to your child, it is important to brush their teeth or wipe out any of the residue so staining or the risk of cavities will be minimized.
     
Discoloration Following Trauma- In some cases, an injured tooth may change color following a fall or blow to the mouth. An injured tooth may appear off-white, to grey, or even brown following trauma. This color change is a natural response to injury, but could be indicative of varying types of injury.  Color changes can occur in days, weeks, or even months following the trauma.  It is best to contact a pediatric dentist as soon as discolorization is discovered to allow for the widest possibility of treatment options for the child.
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Annandale, New Jersey Pediatric Dentist ~ Dr. Mary Jo McGuire
Pediatric Dental Associates of Clinton

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