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).
Look!
My Tooth is Loose!
(with 16"x22" poster and stickers)
By Patricia Brennan Dermuth
Illustrated by Mike Cressy
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 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.
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 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 radiation exposure.
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. 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.
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.
Thumb Sucking
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.
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 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.
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.
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. Mother's 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 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.
Your
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.
When 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 appear are 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 more details.
Baby Bottle
Tooth Decay (Early Childhood Caries)
One
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 mouth easily.
Sippy
Cups
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 causing bacteria.
Prevention
Care Of Your Child's Teeth
Good Diet =
Healthy 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 children’s
teeth.
How Do I
Prevent Cavities?
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
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 when brushing.
Account for all of the sources of ingested fluoride
before requesting fluoride supplements from your child’s 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).
Mouth Guards
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
breathe.
Ask your pediatric dentist about
custom and store-bought mouth protectors.
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.
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, 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 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. By doing so,
they will avoid bringing cancer-causing chemicals in direct contact with
their tongue, gums and cheek.
Pediatric Dentist Houston, TX. - Houston
Dentistry For Children
Dr. Douglas Escue and Dr. Bret Ibarra serving patients in the
surrounding cities and areas of Houston, TX.
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.
