General Topics

 

EARLY INFANT ORAL CARE

 

PREVENTION

 

ADOLESCENT DENTISTRY

 

GENERAL TOPICS

What Is A Pediatric Dentist?

Pediatric dentists are the pediatricians of dentistry.  A pediatric dentist obtains an extra two to three years of specialty training after dental school and limits her practice to treating children from infancy to early adulthood, including those with special health needs.

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Why Are Primary Teeth Important?

Primary teeth, or baby teeth, are important for (1) proper chewing and eating, (2) maintaining space for the permanent teeth and guiding them into the correct positions, and (3) permitting normal development of the jaw bones and muscles.  Neglected cavities can and often do lead to problems that affect the developing permanent teeth.  While the front four teeth are lost between 4-7 years of age, the back teeth (cuspids and molars) aren’t replaced until age 9-13.

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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 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, stating 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).

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Dental Emergencies

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 plac 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 the tooth, transport the tooth in a cup containing the patient’s saliva or cold milk.  If the patient is old enough, the tooth may also be carries 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 (stored in cold milk) and bring them with you to the dentist.

Chipped or Fractured Baby Tooth:  Contac 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.

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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. 

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 radiograph 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, digital x-rays, and proper shielding assure that your child receives a minimal amount of exposure.

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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 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.  Use a “smear” of fluoridated toothpaste to brush the teeth of a child less than 2 years of age.  For the 2-5 year old, dispense a “pea-size” amount of toothpaste and perform or assist your child’s toothbrushing.  Remember that young children do not have the ability to brush their teeth effectively.

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Does Your Child Grind His Teeth At Night? (Bruxism)

 

Parents are often concerned about the nocturnal grinding of teeth (bruxim).  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 age 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 / Pacifier

 

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. 

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How Do Cavities Form?

Cavities are caused by germs that are passed from adult to child.  Babies are born without the bacteria that cause cavities.  They get it from saliva that is passed from their caregiver’s mouth to their own by sharing spoons, drinks, and kisses.  Once a child acquires the cavity-causing bacteria, a poor diet and oral hygiene contribute to cause decay. 

Tooth decay happens when bacteria in your mouth consume the sugars in your diet.  When foods with sugar and starch are eaten, it gives bacteria on the teeth energy, allowing them to multiply and start making acids that can eat away the enamel on teeth.  This “acid attack” usually lasts for an additional 30 minutes after the end of a meal or snack.  If your child snacks frequently, the acid attack is prolonged and causes a cavity. 

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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”, “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 rot 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. 

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Space Maintainers

Space maintainers are metal or plastic appliances made specifically for your child’s mouth.  They are small and unobtrusive and most children easily adjust to them after the first few days.

Space maintainers may be important for your child if a baby tooth is lost prematurely from trauma or tooth decay.

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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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Early Infant Oral Care

Perinatal & Infant Oral Health

The American Academy of Pediatric Dentistry (AAPD) recommends that all pregnant women receive oral healthcare and counseling during pregnancy.  Research has shown evidence that periodontal disease can increase the risk of preterm birth and low birth weight.  Talk to your doctor or dentist about ways you can prevent periodontal disease during pregnancy.

Additionally, mothers with poor oral health may be at a greater risk of passing the bacteria, which causes cavities to their young children.  Mothers 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 fluoridated toothpaste recommended by the ADA and rinse every night with an alcohol-free, over-the-counter mouth rinse with .05% sodium fluoride in order to reduce plaque levels. 
  • Don’t share utensils, cups or food that 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.
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When Should My Child First See a Dentist?

“First visit by first birthday” sums it up.  Your child should visit a pediatric dentist when the first tooth comes in, usually between 6 and 12 months of age.  This visit will establish a dental home for your child.  Early examination and preventive care will protect your child’s smile now and in the future. 

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Why So Early?  What Dental Problems Could a Baby Have?

The most important reason is to begin a thorough prevention program.  Dental problems can begin early.  A big concern is Early Childhood Caries (formerly known as baby bottle tooth decay or nursing caries).  Once a child’s diet includes anything besides breast milk, erupted teeth are at risk for decay.  The earlier the dental visit, the better the chance of preventing dental problems.  Children with healthy teeth chew food easily and smile with confidence.

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Early Childhood Caries (Baby Bottle Tooth Decay)

One serious form of decay among young children is early childhood caries.  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.

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Sippy Cups

Sippy cups should only be used as a training tool to transition from the bottle to a cup and should be discontinued as soon as the child can drink from a regular cup.  Unless being used at mealtime, the sippy cup should only be filled with water.  Frequent and prolonged drinking of any other liquid, even if diluted or labeled “no added sugar”, can lead to cavities. 

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Healthy Diet = Healthy Teeth

To ensure your child is eating a diet that is healthy for the body and safe for teeth, be sure to 1) provide a well-balanced diet and 2) monitor how frequently they eat foods with sugar or starch in them.  Foods with starch include breads, crackers, pasta, pretzels, and potato chips.  When checking for sugar, look beyond candy.  A variety of foods, even healthy ones like fruits and some vegetables, contain one or more types of sugar, and all types of sugar can cause decay. 

This does not mean your child should be restricted from foods with sugar and starch.  It simply means you need to select and serve them wisely. Choose foods that are more rapidly cleared from teeth like apples or yogurt.  Sticky foods, such as dried fruit or toffee, are not easily washed away from the teeth by saliva or water and have more cavity-causing potential.  Limit snacking frequency by offering foods with high sugar or starch content during a meal, rather than as a snack alone.  The more frequently the teeth are exposed to sugars and starches, the more likely cavities can form. 

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How Do I Prevent Cavities?

Good oral hygiene removes bacteria and the leftover 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 “Early Childhood Caries” for more information.

For older children, brush their teeth at least twice a day.  Also, limit the frequency of snacks containing sugar and starch.  See “Healthy Diet = Healthy Teeth” for more information.

(I’d like to be able to click on “Early Childhood Caries” and “Healthy Diet = Healthy Teeth” as a link to bring them directly to that topic.)

The American Academy of Pediatric Dentistry recommends visits to the dentist every six months, beginning with the 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. 

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Seal Out Decay

Sealants are 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.  Sealants act as a barrier to food, plaque and acid to reduce the risk of tooth decay. 

Sealants can last for many years if properly cared for.  If your child has good oral hygiene and avoids biting hard objects, they will last longer.  Your pediatric dentist will check the sealants during routine dental visits and recommend reapplication or repair when necessary. 

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Fluoride

Fluoride is a compound that contains fluorine, a natural element.  Proper use of fluoride on a routine basis can help prevent tooth decay.  Fluoride may be added to community water supplies if it is not already naturally present.  Research shows that community water fluoridation has lowered decay rates by over 50 percent, which means that fewer children grow up with cavities.  Fluoride can be found as an active ingredient in many dental products such as toothpaste, mouth rinses, gels and varnish. 

Fluoride prevents cavities by inhibiting the loss of minerals from tooth enamel and encouraging remineralization (strengthening areas that are weakened and beginning to develop cavities).  Fluoride also affects bacteria that cause cavities; discouraging acid attacks that break down the tooth.   

Using fluoride for prevention and cavity control is proven to be safe and effective.  Nevertheless, products containing fluoride should be stored out of the reach of young children.  Too much fluoride can cause fluorosis of developing permanent teeth.  The appearance of fluorosis may vary from tiny white specks or streaks to pitted enamel with brown discoloration.  The severity depends on the amount, duration and timing of excessive fluoride intake.  The appearance of teeth affected by fluorosis can be greatly improved by a variety of treatments in esthetic dentistry. 

Your pediatric dentist considers many factors before recommending a fluoride supplement.  Your child’s age, risk of developing dental decay, and dietary sources are important considerations.  Infant formulas contain different amounts of fluoride.  Bottled, filtered and well waters also vary in the amount of fluoride they contain.  Some Westchester towns contain community water fluoridation, while others do not.  It is best to check your most recent community water report for fluoride levels.  For those with well water, you can have the water tested by independent companies. 

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Xylitol – Reducing Cavities

Xylitol is a natural sugar that is extracted from fibrous parts of plants.  It differs from other sugars because cavity-causing bacteria in the mouth cannot break it down to create an “acid attack” on teeth enamel.  Since no acid is produced, the pH level in the mouth remains unchanged, which also helps to prevent plaque from forming and bacteria from sticking to the teeth.  See “How Do Cavities Form” for more information. 

The benefits of xylitol on the oral health of infants, children, adolescents, and persons with special heath care needs is recognized by the American Academy of Pediatric Dentistry (AAPD). Research shows that the use of xylitol containing products can reduce the risk of tooth decay in children and adults who are prone to cavities.  Xylitol currently is available in many forms (gums, mints, chewable tablets, lozenges, toothpastes, mouthwashes, and sweetener).   To find products containing xylitol, visit your local health food store for products listing xylitol as the first ingredient. 

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Mouthguards

When a child begins to participate in recreational activities and organized sports, injuries can occur.  A properly fitted mouthguard 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.  

Mouthguards help decrease the risk of injuries to the teeth, lips, tongue, face or jaw.  Research shows it also reduces the risk of concussion.  A properly fitted mouthguard will stay in place while your child is wearing it, making talking and breathing comfortable. 

Ask Dr. Mao about the different types of mouthguards. 

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ADOLESCENT DENTISTRY

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, speech impediment, blood clot, blood poisoning, heart infection, brain abscess, nerve disorder (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.

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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 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 call 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.  Be a good role model! 

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