Dental Topics

For more information concerning pediatric dentistry, please visit the website for the American Academy of Pediatric Dentistry.

General Topics

What Is A Pediatric Dentist?

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.

Why Are The Primary Teeth 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.

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).

Dental Emergencies

Toothache: Causes of toothaches can range from being mild to severe. If your child has a toothache, Brush, floss and rinse (with warm water) the area of pain to try to get any debris out of the area. If your child is still in pain after the cleaning, call us to make an appointment. If your child’s face is swollen, IMMEDIATELY call us to make an appointment as this can be life threatening.

Cut or Bitten Tongue, Lip or Cheek:  Apply ice to injured areas. If there is bleeding, apply pressure with a gauze or cloth. If bleeding cannot be controlled, visit the hospital emergency room.

Knocked Out Permanent Tooth: Try to find the tooth if possible, holding it by the crown of the tooth and not the root. Do not try to scrub the tooth or clean with soap and water, instead only rinse the tooth with water. Place the tooth in a cup of your child’s saliva or milk. For older patients, we suggest placing the tooth in their own mouth, holding it against the cheek. The most important factor in saving the tooth is time– please contact us IMMEDIATELY so we can attempt to save the tooth.

Knocked Out Baby Tooth: Call us during regular business honors. This is typically not an emergency. We cannot reimplant the tooth like a permanent tooth, but we would like to take some routine x-rays to make sure there are no tooth fragments inside the mouth or lip.

Chipped or Fractured Tooth: Call us immediately! It is important to act quickly because your child’s nerve could be exposed depending on the severity of the fracture.

Dental Radiographs (X-Rays)

Radiographs (X-Rays) are a necessary part of your child’s exam. Without x-rays, we cannot give you a complete diagnosis.

Panoramic x-rays help us see things other than just the teeth

Radiographs detect much more than cavities. For example, radiographs may be needed to evaluate erupting teeth, growth patterns, diagnose bone diseases, evaluate the results of an injury, or plan orthodontic treatment. Radiographs allow dentists to diagnose conditions that cannot be detected during a typical clinical examination. Without radiographs, we cannot see “small” problems and must wait for them to get very big before we can see with just the naked eye– this means larger and more expensive treatment will be required.

The American Academy of Pediatric Dentistry recommends radiographs and examinations every six months for children who have a high risk of tooth decay and a panoramic x-ray every 3 years, unless it is required to diagnose or rule out other problems.

We are particularly careful to minimize radiation exposure to our patents. By using digital X-rays and modern shielding techniques, the amount of radiation received in a dental X-ray examination is extremely small with negligible risk. Dental radiographs represent a MUCH smaller risk than undetected and untreated dental issues..

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

A common worry of our parents is centered around their child grinding his or her teeth while they sleep (aka nocturnal bruxism). You may hear your child at night or possibly notice some wear on their teeth. There are several different reasons why children grind at night– some could be related to stress, anatomy, and airway issues. The best way to determine the cause and best solution is to visit us for an examination.

Thumb Sucking and Pacifiers

Digit sucking is a natural reflex for infants and young children. It may make them feel secure and happy and helps to induce sleep.

If your child’s thumb sucking habit persists beyond the eruption of the permanent teeth can cause problems with proper tooth alignment, spacing and growth. How intensely a child sucks on fingers or thumbs will determine whether or not dental problems may result. Children who
passively rest their thumbs in their mouths are less likely to experience skeletal transformations compared to those who suck vigorously with a lot of pressure.

According to most studies, children usually stop between the ages of two and four, however sometimes peer pressure causes many school-aged children to stop.

Pacifiers can affect the teeth essentially the same way as sucking fingers and thumb but pacifiers 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, set up an appointment with us, but realize it is a very difficult habit to break and it will require a lot of patience from the parents and a willingness to quit by the child.

What Is Pulp Therapy?

The “pulp” contains all the nerves, arteries, and veins of the tooth

The inner portion of tooth that contains the blood vessels and nerves is called the pulp. The purpose of pulp therapy (aka therapeutic pulpotomies) is to maintain the vitality of the tooth, or to put it more simply: to keep the tooth “alive.” If a pulpotomy is not performed when indicated, the tooth is at risk for creating an infection (abscess) of the jaws, which means the infected tooth must be extracted.

A pulpotomy is the removal of infected pulp tissue within the crown portion of the tooth and replacing it with a medicated filling material, which is then covered by a stainless steel crown.

Early Infant Oral Care

Perinatal and Infant Oral Health

The AAPD recommends that all pregnant women receive oral hygiene instructions, counseling and oral health care during pregnancy. Studies have shown that gum disease can increase the risk of low birth weight and preterm birth.

Mothers with poor oral health may be at a greater risk of passing the bad bacteria which causes cavities to their young children. This is called “vertical transmission” and is the number one way children receive cavity causing bacteria in their mouths.

Here are some simple steps to decrease the risk of spreading cavity-causing bacteria:

  • Have routine dental check ups
  • Brush and floss daily.
  • Maintain a proper diet–reduce sugary or starchy food and beverage
  • Brush using a toothpaste with fluoride.
  • Don’t share cups, utensils, straws or foo. This 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
    • Once your child is old enough to chew gum without swallowing it, the gum makes a great treat!

Your Child’s First Dental Visit and The Establishment of 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. Kids with a “dental home” are more likely to receive regular preventive treatment and routine oral health care– which means fewer cavities!

You can make the first visit to the dentist an enjoyable and positive experience, which creates happy and confident regular patients. If old enough, your child should be informed of what the appointment will consist of to ease their concern.

Please don’t use words or phrases around your child that might cause unnecessary fear (needle, pull, drill or hurt). Also don’t treat the trip to the dentist as a punishment or make us seem like a “villain.” We got into this field because we love kids and want to kept their mouths, bodies, and psyches healthy!

When Will My Baby Start Getting Teeth?

Tooth eruption (aka “teething”) is extremely variable and depends based on your unique child. Some kids get their teeth earlier and some get them later but generally, the first baby teeth to appear are usually the lower front (anterior) teeth and they around the age of 6-8 months. 

Baby Bottle Tooth Decay (Early Childhood Caries)

On demand feeding with milk in a bottle may cause dental problems

A serious form of decay among young children is Early Childhood Caries (formerly called Baby Bottle Tooth Decay). This disease is caused by frequent long exposures of an infant’s teeth to liquids that contain sugar –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. Sugary liquids pool on the teeth giving plaque bacteria an opportunity to produce acids that attack tooth enamel. Not to mention these sweet drinks are acidic as is!

If you must give your infant a bottle at bedtime for comfort, it should contain only water. If your child resists, gradually dilute the milk with water more and more until it is 100% water.After bottle feeding, wipe the baby’s gums and teeth with a washcloth or gauze to remove plaque.

Sippy Cups

Sippy cups are a training tool to transition from the bottle to a cup and should be discontinued by the first birthday. If your child uses a sippy cup throughout the day, only put milk or juice during meals. Water can be used throughout the day. By filling the sippy cup with liquids that contain sugar (including milk, fruit juice, etc.) throughout the day, it greatly increases your child’s risk of getting cavities.


A Healthy Diet Means Healthy Teeth

Healthy eating habits lead to healthy bodies including healthy teeth. Children should eat a variety of foods, especially fresh fruits and vegetables. Most snacks that are marketed to children can lead to cavities and the more frequently a child eats snacks, the greater the chance for tooth decay. When giving your child a snack, choose healthy and nutrient dense foods such as vegetables, low-fat yogurt, and low-fat cheese. Refer to our snack guide for other tips on healthy snacking.

How Do I Prevent Cavities?

Good oral hygiene, a healthy diet and regular dental checkups are the best way to prevent cavities. That means brushing their teeth at least twice a day, and limiting the sugary or starchy snacks you give your children. Other than diet, hygiene, and check-ups there are a few other preventive measures we can take.

Seal Out Decay

A sealant is a coasting of a white plastic material that is applied to the grooves of the back teeth (premolars and molars), where 80% of cavities in children are found. Sealants act to protect the teeth from food, plaque and acid. Most insurances cover this procedure and we are usually more than happy to place sealants the same day as your child’s six month visit.

before and after sealants


Fluoride is a naturally occurring element, which has been shown to be beneficial to teeth. While, excessive fluoride ingestion by younger (preschool-aged) children can lead to a condition called “dental fluorosis”, the amount of fluoride given at our offices is not nearly enough to cause fluorosis. On the contrary, the amount of fluoride we give our patients each visit is enough to decrease the risk of cavities by over 17%! .

Young children and toddlers often times are unable to spit after brushing and swallow toothpaste. Toothpaste ingestion during this critical period of permanent tooth development is the greatest risk factor in the development of fluorosis. Using a small smear of toothpaste (about the size of a grain of rice) between the age of first tooth and 3 years will help prevent excessive fluoride ingestion. For ages 3-6, a small pea sized amount will be sufficient. If you have any other fluoride concerns, please bring it up at your next appointment– we would love to discuss fluoride with you.

Mouth Guards

When your child begins to participate in organized sports, they greatly increase their risk of injury, especially to the teeth and mouth. If your child is participating in a sport such as football or basketball, we highly recommend wearing a properly fitted mouth guard each and every time they play.

Athletic mouth guards help prevent broken teeth, as well as other injuries to the lips, tongue, face and even jaw. We recommend at least getting a “boil and bite” mouth guard before playing sports, but getting a customized guard from our office is ideal.

Xylitol – Reducing Cavities

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.

Beware of Sports Drinks

Because sports drinks have extremely high sugar and acid content , they have the potential to dissolve even fluoride-rich enamel, leading to tooth discoloration, decalcification and even cavities.

Because of the high risk for dental problems, we recommend that children should avoid sports drinks and hydrate with water before, during and after sports. 

If your child drinks sports drinks take these precautions to help reduce the risk of cavities

  • reduce the how often they drink sports drinks
  • swallow immediately and do not swish sports drinks– this only spreads the acid
  • neutralize the acid in sports drinks by drinking and swishing with water immediately after consuming sports drinks
  • Make sure they rinse their mouth guards only in water
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