For more information on oral health
care needs, please visit the website for the
American Academy of Pediatric Dentistry
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) arenít replaced until age 10-13.
Childrenís 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).
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 patientís
saliva or milk. If the patient is old enough, the tooth may also
be carried in the patientís 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
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
childís 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. Todayís 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.
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
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.
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.
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
A few suggestions to help your child get through thumb
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
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.
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 Ė 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 Ė 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
childís hard and soft tissues are usually very responsive to
orthodontic or orthopedic forces.
Stage III Ė Adolescent Dentition: This stage deals with the
permanent teeth and the development of the final bite
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.
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.
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
Childís Teeth" for more details.
One serious form of decay among young children is baby bottle
tooth decay. This condition is caused by frequent and long
exposures of an infantís 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 childís 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 babyís 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 childís 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 childís mouth
Begin daily brushing as soon as the childís 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
Flossing removes plaque between the teeth, where a toothbrush
canít reach. Flossing should begin when any two teeth touch. You
should floss the childís 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. Donít
forget the backs of the last four teeth.
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 childrenís teeth.
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
The American Academy of Pediatric Dentistry recommends visits
every six months to the pediatric dentist, beginning at your
childís 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 childís molars to prevent decay on hard to clean
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
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 childís potential
sources of fluoride can help parents prevent the possibility of
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 childís 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
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 childrenís teeth:
- Use baby tooth cleanser on the toothbrush of the very
- Place only a pea sized drop of childrenís toothpaste on
the brush when brushing.
- Account for all of the sources of ingested fluoride before
requesting fluoride supplements from your childís physician or
- 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).
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 childís 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
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.
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
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 Ė skip the mouth jewelry.
Tobacco in any form can jeopardize your childís health and
cause incurable damage. Teach your child about the dangers of
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
If your child is a tobacco user you should watch for the
following that could be early signs of oral cancer:
- A sore that wonít heal.
- White or red leathery patches on the lips, and on or under
- Pain, tenderness or numbness anywhere in the mouth or
- 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 itís 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.
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