For more information concerning pediatric dentistry, please visit the
website for the American
Academy of Pediatric Dentistry.
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
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.
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
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).
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 patient's
saliva or milk. If the patient is old enough, the tooth may also be carried
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 and bring them with you to the dentist.
Chipped or Fractured Baby Tooth: Contact 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.
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
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
What's The Best Toothpaste For My Child?
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 toothpaste.
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
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.
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
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 material.
The Best Time For Orthodontic Treatment?
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.
Adult Teeth Coming in Behind Baby
is a very common occurrence with children, usually the result of a lower,
primary (baby) tooth not falling out when the permanent tooth is coming in.
In most cases if the child starts wiggling the baby tooth, it will usually
fall out on its own within two months. If it doesn't, then contact your
pediatric dentist, where they can easily remove the tooth. The
permanent tooth should then slide into the proper place.
Perinatal & Infant Oral Health
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. Mother's
should follow these simple steps to decrease the risk of spreading
- 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
- Use a fluoridated toothpaste recommended by the ADA and rinse every
night with an alocohol-free, over-the-counter mouth rinse with .05 %
sodium fluoride in order to reduce plaque levels.
- Don't share utensils, cups or food which 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.
Child's 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.
The 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, the better.
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.
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
appear are usually the lower front (anterior) teeth and they usually begin
erupting between the age of 6-8 months.
"Eruption of Your Child's Teeth" for more details.
Tooth Decay (Early Childhood Caries)
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 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
Sippy cups should be used as a training tool from the bottle to a cup and
should be discontinued by the first birthday. If your child uses a sippy cup
throughout the day, fill the sippy cup with water only (except at
mealtimes). By filling the sippy cup with liquids that contain sugar
(including milk, fruit juice, sports drinks, etc.) and allowing a child to
drink from it throughout the day, it soaks the child's teeth in cavity
Your Child's Teeth
Good Diet =
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 children's
How Do I
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 visits every six
months 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.
Seal Out Decay
A sealant is a protective coating 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 child's 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 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 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 only a pea sized drop of children's toothpaste on the brush
- Account for all of the sources of ingested fluoride before
requesting fluoride supplements from your child's physician or pediatric
- 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
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
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%
Beware of Sports Drinks
to the high sugar content and acids in sports drinks, they have erosive
potential and the ability to dissolve even fluoride-rich enamel, which can
lead to cavities.
To minimize dental problems, children should avoid sports drinks and
hydrate with water before, during and after sports. Be sure to talk to
your pediatric dentist before using sports drinks.
If sports drinks are consumed:
- reduce the frequency and contact time
- swallow immediately and do not swish them around the mouth
- neutralize the effect of sports drinks by alternating sips of water
with the drink
- rinse mouthguards only in water
- seek out dentally friendly sports drinks
Tongue Piercing - Is It
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 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.
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
- 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