Pediatric Dentistry

Early Dental Care

Teething
Normally the first tooth erupts between ages 6 to 12 months. Gums are sore, tender and sometimes irritable until the age of 3. Rubbing sore gums gently with a clean finger, the back of a cold spoon or a cold, wet cloth helps soothe the gums. Teething rings work well, but avoid teething biscuits—they contain sugar that is not good for baby teeth.

While your baby is teething, it is important to monitor the teeth for signs of baby bottle decay. Examine the teeth, especially on the inside or the tongue side, every two weeks for dull spots (whiter than the tooth surface) or lines. A bottle containing anything other than water and left in an infant’s mouth while sleeping can cause decay. This happens because sugar in the liquid mixes with bacteria in dental plaque, forming acids that attack the tooth enamel. Each time a child drinks liquids containing sugar, acids attack the teeth for about 20 minutes. When awake, saliva carries away the liquid. During sleep, the saliva flow significantly decreases and liquids pool around the child’s teeth for long periods, covering the teeth in acids.

Infant’s New Teeth
The primary, or “baby,” teeth play a crucial role in dental development. Without them, a child cannot chew food properly and has difficulty speaking clearly. Primary teeth are vital to development of the jaws and for guiding the permanent (secondary) teeth into place when they replace the primary teeth around age 6.

Since primary teeth guide the permanent teeth into place, infants with missing primary teeth or infants who prematurely lose primary teeth may require a space maintainer, a device used to hold the natural space open. Without a maintainer, the teeth can tilt toward the empty space and cause permanent teeth to come in crooked. Missing teeth should always be mentioned to your family dentist. The way your child cares for his/her primary teeth plays a critical role in how he/she treats the permanent teeth. Children and adults are equally susceptible to plaque and gum problems—hence, the need for regular care and dental checkups.

A Child’s First Dental Visit
A child’s first dental visit should be scheduled around his/her first birthday. The most important part of the visit is getting to know and becoming comfortable with a doctor and his staff. A pleasant, comfortable first visit builds trust and helps put the child at ease during future dental visits. If possible, allow the child to sit in a parent’s lap in the exam room. Children should be encouraged to discuss any fears or anxiety they feel.

Why Primary Teeth Are Important
Primary teeth are important for several reasons. Foremost, good teeth allow a child to eat and maintain good nutrition. Healthy teeth allow for clear pronunciation and speech habits. The self-image that healthy teeth give a child is immeasurable. Primary teeth also guide eruption of the permanent teeth.

Good Diet and Healthy Teeth
The teeth, bones and soft tissue of the mouth require a healthy, well-balanced diet. A variety of foods from the five food groups helps minimize (and avoid) cavities and other dental problems. Most snacks that children eat cause cavities, so children should only receive healthy foods like vegetables, low-fat yogurt and cheeses, which promote strong teeth.

Infant Tooth Eruption
A child’s teeth actually start forming before birth. As early as 4 months of age, the primary or “baby” teeth push through the gums—the lower central incisors are first, then the upper central incisors. The remainder of the 20 primary teeth typically erupt by age 3, but the place and order varies.

Permanent teeth begin eruption around age 6, starting with the first molars and lower central incisors. This process continues until around age 21. Adults have 28 secondary (permanent) teeth—32 including the third molars (wisdom teeth).

Preventing Baby Bottle Tooth Decay
Tooth decay in infants can be minimized or totally prevented by not allowing sleeping infants to breast or bottle-feed. Infants that need a bottle to comfortably fall asleep should be given a water-filled bottle or a pacifier. Our office is dedicated to fighting baby bottle tooth decay. Let us know if you notice any signs of decay or anything unusual in your child’s mouth.

General Treatment

Our practice can provide a wide range of dental services for your children. Our flexibility in our services saves you time and keeps your total dental care within one practice. Our emphasis is on total preventive care for our patients. Total care begins with regular hygiene visits, regular check-ups and continued home oral health routines.

We provide many preventative measures to keep your child’s teeth clean and healthy, including sealants and fluoride treatments. We also educate the parents in early detection of some common problems children may face, including thumb sucking, bruxism and baby bottle tooth decay.
Our primary goal for your children’s dental development is to achieve and maintain optimum oral health through advances in techniques, technologies and by maintaining their scheduled dental exams.

Sedation Dentistry

Sedation dentistry refers to the use of sedation during dental treatment. Sedation is most commonly used during extensive procedures, for patients with dental phobia or for patients who find it difficult to sit still. There are different types of sedation, including nitrous oxide ("laughing gas"), IV sedation, oral sedatives and general anesthetic.

Sedation can range from the use of nitrous oxide to calm a patient to general anesthetics used to put patients to sleep. Patients with dental phobia, low pain tolerance, major dental treatment, physical handicaps or strong gag reflexes may require sedation. Procedures like fillings, crowns, bridges, root canals, extractions, cosmetic procedures and periodontal treatments often require sedation.

Sedation is endorsed by the American Dental Association and is an effective way to make many patients comfortable during their dental visit. Before using a sedative or anesthetic, it is important to tell your pediatric dentist about any medications or medical treatments your child is receiving. Before administering any sedative or anesthetic, your pediatric dentist will talk to you about the process of sedation and pre- and post-sedation instructions.

"Laughing Gas"

Nitrous oxide, more commonly known as laughing gas, is often used as a conscious sedative during a dental visit. The gas is administered with a mixture of oxygen and has a calming effect that helps phobic or anxious patients relax during their dental treatment. Because it is a mild sedative, patients are still conscious and can talk to their pediatric dentist during their visit. After treatment, the nitrous is turned off and oxygen is administered for five to 10 minutes to help flush any remaining gas. The effects wear off almost immediately. Nitrous oxide rarely has side effects, although some patients may experience minor nausea and constipation. Your pediatric dentist will provide you with pre- and post-sedation instructions.

Prevention

Tooth Decay Prevention
Tooth decay is a progressive disease resulting in the interaction of bacteria that naturally occur on the teeth and sugars in the everyday diet. Sugar causes a reaction in the bacteria, causing it to produce acids that break down the mineral in teeth, forming a cavity. Dentists remove the decay and fill the tooth using a variety of fillings, restoring the tooth to a healthy state. Nerve damage can result from severe decay and may require a crown (a crown is like a large filling that can cap a tooth, making it stronger or covering it). Avoiding unnecessary decay simply requires strict adherence to a dental hygiene regimen: brushing and flossing twice a day, regular dental checkups, diet control and fluoride treatment. Practicing good hygiene avoids unhealthy teeth and costly treatment.

Sealants
The grooves and depressions that form the chewing surfaces of the back teeth are extremely difficult (if not impossible) to clean of bacteria and food. As the bacteria reacts with the food, acids form and break down the tooth enamel, causing cavities. Recent studies indicate that 88 percent of total cavities in American school children are caused this way.

Tooth sealants protect these susceptible areas by sealing the grooves and depressions, preventing bacteria and food particles from residing in these areas. Sealant material is a resin typically applied to the back teeth, molars and premolars and areas prone to cavities. It lasts for several years but needs to be checked during regular appointments.

Fluoride
Fluoride is a substance that helps teeth become stronger and resistant to decay. Regularly drinking water treated with fluoride and brushing and flossing regularly ensures significantly lower cavities. Dentists can evaluate the level of fluoride in a primary drinking water source and recommend fluoride supplements (usually in tablets or drops), if necessary.

Thumb Sucking

Sucking is a natural reflex that relaxes and comforts babies and toddlers. Children usually cease thumb sucking when the permanent front teeth are ready to erupt. Typically, children stop between the ages of 2 and 4 years. Thumb sucking that persists beyond the eruption of primary teeth can cause improper growth of the mouth and misalignment of the teeth. If you notice prolonged and/or vigorous thumb sucking behavior in your child, talk to your dentist.

Here are some ways to help your child outgrow thumb sucking:

  • Don’t scold a child when they exhibit thumb sucking behavior; instead, praise them when they don’t thumb suck.
  • Focus on eliminating the cause of anxiety—thumb sucking is a comfort device that helps children cope with stress or discomfort.
  • Praise them when they refrain from the habit during difficult periods.
  • Place a bandage on the thumb or a sock on their hand at night.

Fillings

Fillings

The concept of a “filling” is replacing and restoring your tooth structure that is damaged due to decay or fracture with a material. We will replace old, broken-down amalgam/metal fillings that contain traces of mercury with white fillings (composites) to restore your smile and teeth to a more natural look and feel.

With today’s advancements, no longer will you have to suffer the embarrassment of unsightly and unhealthy silver/mercury fillings or metal margins of the past. Eliminate the dark, black appearance in your teeth with new-age, state-of-the-art, tooth-colored resin or porcelain materials.

Comparing White Fillings Versus Silver Amalgam Fillings:

  • White fillings bond to the tooth; they strengthen the tooth by restoring most of its original shape. Silver amalgams, on the other hand, weaken the teeth and make them more susceptible to breaking. Broken teeth can be very expensive to replace; white amalgam can actually save time and money in the long run.
  • White filling composites are preferred by most patients. This is due to the natural color, strength and overall appearance and feel. Composites are naturally more comfortable.
  • Hot and cold sensitivity is greatly reduced with composite material compared to the silver/mercury amalgams.
  • Restorations with composites require less removal of tooth, less structure to place than those with amalgams and especially with new cavities.  Dramatically smaller holes are needed with a composite.
  • White fillings are healthier because no traces of mercury are used, unlike silver amalgams.

Emergency Info

Tooth Ache
Begin by cleaning around the sore tooth meticulously. Using warm salt water, rinse the mouth to displace any food trapped between teeth. UNDER NO CIRCUMSTANCES should you use aspirin on the aching tooth or on the gum. In the event of facial swelling, apply a cold compress to the area. For temporary pain relief, acetaminophen is recommended. See a dentist as soon as possible.

Cut or Bitten Tongue, Lip or Cheek
Ice can be applied to any bruised areas. For bleeding, apply firm (but gentle) pressure with sterile gauze or a clean cloth. If the bleeding does not stop with pressure or continues after 15 minutes, go to an emergency room.

Broken Tooth
Rinse the area with warm water. Put a cold compress over the facial area of the injury. Recover any broken tooth fragments. Get immediate dental attention.

Knocked Out Permanent Tooth
Recover the tooth, making sure to hold it by the crown (top) and not the root end. Rinse, but do not clean or handle the tooth more than necessary. Reinsert the tooth in the socket and hold it in place using a clean piece of gauze or cloth. If the tooth cannot be reinserted, carry it in a cup containing milk or water. Because time is essential, see a dentist immediately.

Other Emergency Conditions:

Possible Broken Jaw
In the event of jaw injury, tie the mouth closed with a towel, tie or handkerchief. Go immediately to an emergency room.

Bleeding After a Baby Tooth Falls Out
Fold a piece of gauze and place it (tightly) over the bleeding area. Bite down on the gauze for 15 minutes; if bleeding continues, see a dentist.

Cold or Canker Sores
Over-the-counter medications will usually provide temporary relief. If sores persist, visit your dentist.

Common Problems

Tooth Decay
Caries, or tooth decay, is a preventable disease. While caries might not endanger your life, they may negatively impact your quality of life.

When your teeth and gums are consistently exposed to large amounts of starches and sugars, acids may form that begin to eat away at tooth enamel. Carbohydrate-rich foods such as candy, cookies, soft drinks and even fruit juices leave deposits on your teeth. Those deposits bond with the bacteria that normally survive in your mouth and form plaque. The combination of deposits and plaque forms acids that can damage the mineral structure of teeth, with tooth decay resulting.

Sensitive Teeth
Your teeth expand and contract in reaction to changes in temperature. Hot and cold food and beverages can cause pain or irritation to people with sensitive teeth. Over time, tooth enamel can be worn down, gums may recede or teeth may develop microscopic cracks, exposing the interior of the tooth and irritating nerve endings. Just breathing cold air can be painful for those with extremely sensitive teeth.

Gum Disease
Gum, or periodontal, disease can cause inflammation, tooth loss and bone damage. Gum disease begins with a sticky film of bacteria called plaque. Gums in the early stage of disease, or gingivitis, can bleed easily and become red and swollen. As the disease progresses to periodontitis, teeth may fall out or need to be removed by a dentist. Gum disease is highly preventable and can usually be avoided by daily brushing and flossing. One indicator of gum disease is consistent bad breath or a bad taste in the mouth.

Bad Breath (Halitosis)
Daily brushing and flossing helps to prevent the buildup of food particles, plaque and bacteria in your mouth. Food particles left in the mouth deteriorate and cause bad breath. While certain foods, such as garlic or anchovies, may create temporary bad breath, consistent bad breath may be a sign of gum disease or another dental problem.

Canker Sores
Canker sores (aphthous ulcers) are small sores inside the mouth that often recur. Generally lasting one or two weeks, the duration of canker sores can be reduced by the use of antimicrobial mouthwashes or topical agents. The canker sore has a white or gray base surrounded by a red border.

Orthodontic Problems
A bite that does not meet properly (a malocclusion) can be inherited, or some types may be acquired. Some causes of malocclusion include missing or extra teeth, crowded teeth or misaligned jaws. Accidents or developmental issues, such as finger or thumb sucking over an extended period of time, may cause malocclusions.