What is a Pediatric Dentist?
Why are the Primary Teeth
Eruption of your Child's Teeth
Dental Radiographs (X-rays)
What's the Best Toothpaste for
Does your Child Grind his Teeth at Night? (Bruxism)
What is Pulp Therapy?
What is the Best
Time for Orthodontic Treatment?
EARLY INFANT ORAL CARE:
Your Child's First Dental Visit
When will my Baby Start Getting Teeth?
Baby Bottle Tooth Decay (Early Childhood
Tongue Piercing - Is
it Really Cool?
Tobacco - Bad News in Any Form
For more information on oral health
care needs, please visit the website for the
American Academy of Pediatric Dentistry.
GENERAL TOPICS & FAQ
What Is A
The pediatric dentist has an extra two
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.
Why Are The Primary Teeth So
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) arent
replaced until age 10-13.
Eruption Of Your Childs
Children’s teeth begin forming before
birth. Around 6
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
Adults have 28 permanent teeth, or up to 32 including the third
molars (or wisdom teeth).
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 patients
saliva or milk. If the patient is old enough, the tooth may also be carried in the patients 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
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
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
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
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 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
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
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
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
A few suggestions to help your child get through thumb
Instead of scolding children for thumb sucking, praise them when they
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 dont 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.
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
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
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.
EARLY INFANT ORAL CARE
Your Childs First Dental Visit
- Establishing a "Dental Home"
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.
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,
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.
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
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
Baby Bottle Tooth Decay (Early
One serious form of decay among young children is baby bottle tooth
decay, also referred to by dentists as early childhood caries. This condition is caused by frequent and long exposures of an infants 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 childs
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
After each feeding, wipe the babys 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 childs 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 childs mouth easily.
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
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.
– 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
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
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.