Click on a topic of interest for more
What is a Pediatric Dentist?
Why are the Primary Teeth so Important?
Eruption of your Child's Teeth
Dental Radiographs (X-rays)
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:
When will my Baby Start
Baby Bottle Tooth Decay (Early Childhood Caries)
Care of your Child's Teeth
Good Diet = Healthy Teeth
How Do I Prevent Cavities
Seal Out Decay
For more information on oral health care needs,
please visit the website for the
American Academy of Pediatric Dentistry.
GENERAL TOPICS & FAQ
The pediatric dentist has an extra two to three
years of specialized training after dental school, and is dedicated to the oral health of children from infancy
through the teenage years. The very young, pre-teens, and teenagers all need different
approaches in dealing with their behavior, guiding their dental growth and development,
and helping them avoid future dental problems. The pediatric dentist is best qualified to
meet these needs.
It is very important to maintain the health of the primary teeth.
Neglected cavities can and frequently do lead to problems which affect developing
permanent teeth. Primary teeth, or baby teeth are important for (1) proper chewing and
eating, (2) providing space for the permanent teeth and guiding them into the correct
position, and (3) permitting normal development of the jaw bones and muscles. Primary
teeth also affect the development of speech and add to an attractive appearance. While the
front 4 teeth last until 6-7 years of age, the back teeth (cuspids and molars) arent
replaced until age 10-13.
Childrens 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
Adults have 28 permanent teeth, or up to 32 including the third
molars (or wisdom teeth).
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 a 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 Permanent Tooth: Find the tooth. Handle the tooth
by the crown, not the root portion. You may rinse the tooth 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 patients
saliva or milk. If the patient is old enough, the tooth may also be carried in the patients mouth. The patient
must see a dentist IMMEDIATELY! Time is a critical factor in saving the tooth.
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
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.
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
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.
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
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.
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
Ask your pediatric dentist about custom and
store-bought mouth protectors.
EARLY INFANT ORAL CARE
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
One serious form of decay among young children is baby bottle tooth
decay. 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.
Begin daily brushing as soon as the childs first tooth erupts.
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 until about age seven to make sure they are doing a thorough job.
However, each child is different. Your dentist 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.
Flossing removes plaque between the teeth where a toothbrush
cant reach. Flossing should begin when any two teeth touch. You should
floss the childs teeth until he or she can do it alone. 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. Dont forget the backs of the last four 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 can lead to cavity formation. The more frequently a child snacks, the greater
the chance for tooth decay. How long food remains in the mouth also plays a role. For
example, hard candy and breath mints stay in the mouth a long time, which cause longer
acid attacks on tooth enamel. If your child must snack, choose nutritious foods such as
vegetables, low-fat yogurt, and low-fat cheese which are healthier and better for
Good oral hygiene removes bacteria and the left over food particles that
combine to create cavities. For infants, use a wet gauze or clean washcloth
to wipe the plaque from teeth and gums. Avoid putting your child to bed with
a bottle filled with anything other than water. See "Baby
Bottle Tooth Decay" for more information.
For older children, brush their teeth at least twice a day. Also,
watch the number of snacks containing sugar that you give your children.
The American Academy of Pediatric Dentistry recommends 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 protective sealants or home
fluoride treatments for your child. Sealants can be applied to your child’s
molars to prevent decay on hard to clean surfaces.
A sealant is a clear or shaded plastic material that is applied to
the chewing surfaces (grooves) of the back teeth (premolars and molars), where four out of
five cavities in children are found. This sealant acts as a barrier to food, plaque and
acid, thus protecting the decay-prone areas of the teeth.
Before Sealant Applied
After Sealant Applied
Fluoride is an element, which has been shown to be beneficial to
teeth. However, too little or too much fluoride can be detrimental to the teeth. Little or
no fluoride will not strengthen the teeth to help them resist cavities. Excessive fluoride
ingestion by preschool-aged children can lead to dental fluorosis, which is a chalky white
to even brown discoloration of the permanent teeth. Many children often get more fluoride
than their parents realize. Being aware of a childs potential sources of fluoride
can help parents prevent the possibility of dental fluorosis.
Some of these sources are:
- Too much fluoridated toothpaste at an early age.
- The inappropriate use of fluoride supplements.
- Hidden sources of fluoride in the childs 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
Certain foods contain high levels of fluoride, especially powdered
concentrate infant formula, soy-based infant formula, infant dry cereals, creamed spinach,
and infant chicken products. Please read the label or contact the manufacturer. Some
beverages also contain high levels of fluoride, especially decaffeinated teas, white
grape juices, and juice drinks manufactured in fluoridated cities.
Parents can take the following steps to decrease the risk of
fluorosis in their childrens teeth:
- Use baby tooth cleanser on the toothbrush of the very young child.
- Place only a pea sized drop of childrens toothpaste on the
brush when brushing.
- Account for all of the sources of ingested fluoride before requesting
fluoride supplements from your childs 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).