FAQ

It is very important to maintain the health of the primary teeth. Neglected cavities can and frequently do cause pain and/or infection.  When left untreated, these cavities can negatively 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.
Radiographs (X-Rays) are a necessary part of your child's dental diagnostic process. Without them, certain dental conditions can and will  be missed. X-Rays detect much more than cavities. For example, X-Rays  may be needed to survey erupting teeth, diagnose bone diseases, evaluate the  results of an injury, or plan orthodontic treatment. X-Rays 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  X-rays 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. It is recommended that your child obtain a complete set of  radiographs approximately every three years, either a panoramic and bite wings  or periapicals and bite wings.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 X-rays 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.
Begin daily brushing as soon as the child’s first tooth erupts. A tiny 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. 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 brushing along the 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. Establishing a specific routine (brushing the teeth in a certain order) will help ensure that the child does not miss any areas.Flossing removes plaque between the teeth where a toothbrush can’t reach. Flossing should begin when any two teeth touch. You should floss the child’s 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. Don’t forget the backs of the last four teeth. Floss picks can be substituted if you wish.
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.Don't forget that water is a very important dietary ingredient. Review your water supply with the dentist to determine if it is fluoridated. If you use bottled water for your child, make sure it is fluoridated. If you need to discuss this issue, please let us know. Water should not be replaced by soda or juice in the diet. Soda should be eliminated if possible. Limit your child's consumption of juice to 4-6 ounces a day. Juice should be diluted with water for younger children to limit the amount of sugar intake. It is best to have children drink the juice at a sitting instead of consuming it freely throughout the day.
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.For older children, brush their teeth at least twice a day. Also, watch the number of snacks containing sugar that you give your children. Remember that dried fruit treats are mostly sugar!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.
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. Be sure to lift the lip to check along the gum line. 
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. 
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).
Fluorides are a natural occurring trace element in most sources of water. Too little fluoride in your child's water will lead to a lifetime of unnecessary decay. Too much can lead to dental fluorosis. Fluorosis is a chalky white, yellow, or 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. A very tiny pea-size amount of toothpaste should be used with this age group.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 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 tiny, pea-size 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).

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. 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 "tiny pea-sized" amount of toothpaste.{slide=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 his or her 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. Children who are very active, often "burn off energy at night" by grinding their teeth. Growing jaws can also sometimes result in grinding if one jaw grows more rapidly than the other. Disproportionate growth in jaws can be detected by your pediatric dentist.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 mouth guard can help to prevent 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.
When a child begins to participate in recreational activities and organized sports, injuries can occur. A properly fitted mouth guard is an important piece of athletic gear that can help protect your child’s smile. It 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 fitting 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.
 Thumb sucking is a natural reflex and a normal activity. Fingers, thumbs, or pacifiers may be preferred by some infants. When the habit is intense or vigorous and persists longer than normal, severe un-correctable orthodontic problems can result. Individual counseling is recommended to determine if your child is prone to these problems.
You might not be surprised anymore to see people with pierced tongues, lips or cheeks. You may, however, 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, the risk of choking, or blood poisoning. 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 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 precancerous 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 your lips, and on or under your tongue.
  • Pain, tenderness, or numbness anywhere in the mouth or lips.
  • Difficulty chewing, swallowing, speaking, or moving your jaw or tongue.
  • 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.

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. Your child may benefit from one or more of the following treatments: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 brief 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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