Pediatric Dental FAQs

A pediatric dentist has two extra years of specialized training and is dedicated to the oral health of children from infancy through teenage years. Infants, children, preteens and teenagers all need different approaches in dealing with their behavior, dental growth and development, and helping them avoid future dental problems. The pediatric dentist is best qualified to meet all of these needs.

The primary teeth, or baby teeth, are important for:

• Proper chewing and eating
• Providing space for the permanent teeth and guiding them into the correct position
• Permitting normal development of the jaw bones and muscles

They also affect speech development and the appearance of the mouth and teeth. While the front teeth last until around age six or seven, the back teeth (cuspids and molars) aren’t replaced until age 10-13. Therefore, it is very important to maintain the health of primary teeth. Neglected cavities in baby teeth can and do lead to problems that can affect the developing permanent teeth.

Like the rest of the body, the teeth and mouth need a well-balanced diet from a variety of foods from the five major food groups. Many snacks children eat can lead to cavity formation. The more frequently a child snacks, the greater the chance for tooth decay. In addition, when food stays in the mouth for a long time, this causes longer acid attacks on tooth enamel. When your child snacks, choose nutritious foods such as vegetables, low-fat yogurt and low-fat cheeses, which are healthier and better for children’s teeth.

Baby bottle tooth decay is a form of decay caused by frequent and long exposure of infant teeth to liquid containing sugar, such as 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 with liquid other than water can cause serious and rapid tooth decay, as sweet liquid pools around the child’s teeth. This gives plaque bacteria a chance to produce acids that attach to tooth enamel. If your baby won’t fall asleep without the bottle containing a sweet liquid, gradually dilute the liquid 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 to remove plaque.

Children’s teeth begin forming before birth. As early as four months, the first primary (or baby) teeth to erupt are the lower central incisors, closely followed by the upper central incisors. All 20 primary teeth usually appear by age three, but the pace and order of their eruption widely varies. Permanent teeth usually begin to appear around age six, starting with the first molars and lower central incisors. This process continues until around age 21. Adults have 28 permanent teeth, or up to 32 including the third molars (wisdom teeth).

Many toothpastes can actually damage a child’s smile. They contain harsh abrasives that can wear away at young tooth enamel. When picking a toothpaste, be sure to pick one recommended by the American Dental Association, because these have undergone testing to make sure they are safe. If a child is too young or unable to spit out their toothpaste, consider picking a fluoride-free toothpaste to prevent fluorosis, or use just a pea-size amount or no toothpaste.

Sucking is a natural reflex and infants and young children may use thumbs, fingers, pacifiers and other objects on which to suck. It can provide a sense of security and happiness at difficult periods and can induce sleep. However, thumb-sucking after the permanent teeth have erupted can cause problems with mouth and tooth alignment. The intensity with which a child sucks on fingers or thumbs will determine whether or not dental problems occur. Usually, children stop thumb-sucking between ages of two and four. Pacifiers are not a substitute for thumb sucking, as they can affect the teeth in the same way. However, pacifier-usage is easier to control and modify. Consult your pediatric dentist if you have concerns about these habits. To get your child through thumb-sucking:

• Rather than scolding children when they are thumb-sucking, praise them when they are not.
• Since children suck their thumbs when feeling insecure, focus on correcting the cause of the anxiety.
• Reward children when they refrain from sucking during a challenging period, 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 don’t work, remind children of the habit by bandaging the thumb or putting a sock on the hand of sucking finger at night. Your pediatric dentist may recommend the use of a mouth appliance.

Your child should visit the dentist by his or her first birthday. You can help make your child’s first visit a positive, pleasant experience. Your child should be told of the visit and that the dentist and staff will explain all procedures and answer any questions. It is best if you avoid using words around your child that could cause unnecessary fear, such as “needle,” “pull,” “drill,” or “hurt.” Pediatric dental offices make an effort to use words that convey the same message but are pleasant and not frightening to the child.

As soon as your child’s first tooth erupts, you should begin daily brushing. After the child is old enough to not swallow it, you can use a pea-size amount of fluoride toothpaste. By the age of four or five, children should be able to brush their own teeth twice a day with supervision until around age seven. But your dentist can help you determine when your child is skilled enough to brush properly on their own. When teaching children to brush, place the toothbrush at a 45-degree angle. Start along the gum line with a soft bristle in a gentle circular motion. Brush the outer surfaces of each tooth. Repeat the same method on the inside surfaces and chewing surfaces of all teeth. Finish by brushing the tongue to freshen breath and remove bacteria. Flossing removes plaque and food between the teeth where a toothbrush can’t reach. You should begin flossing when two teeth touch in your child’s mouth. You should floss for your child 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 forefinger. Use a gentle, back-and-forth motion to guide the floss between the teeth. 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, and don’t forget the backs of the last four teeth!

• Good oral hygiene. This removes bacteria and leftover food that can create cavities. For infants, use a wet gauze or clean washcloth to wipe plaque from teeth and gums.
• For older children, brush their teeth at least twice a day and watch the number of sugary snacks you give them.
• The American Academy of Pediatric Dentistry recommends six-month visits to the pediatric dentist starting at age one. Routine visits will create good oral health habits.
• Your pediatric dentist may recommend protective sealants or home fluoride treatments for your child.

Teething is variable among babies. Generally the first baby teeth are the lower front (anterior) and usually begin erupting between the ages of 6-8 months. See “Eruption of Your Child’s Teeth” for more details.

Too much fluoride ingestion by preschool-aged children leads to dental fluorosis, which is a chalky white to brown discoloration of the permanent teeth. Being aware of a child’s potential sources of fluoride can help parents prevent dental fluorosis. Some of these sources are:

• Too much fluoridated toothpaste at an early age. Two and three year olds may not be able to spit out toothpaste when brushing, and therefore they ingest an excessive amount of fluoride. Because this is a critical period of permanent tooth development, this is the greatest risk factor in the development of fluorosis.
• Inappropriate use of fluoride supplements. Fluoride drops and tablets, as well as fluoride-fortified vitamins, should not be given to infants younger than six months. After that, they should only be given to children after all sources of ingested fluoride have been accounted for and on the recommendation of your pediatrician or pediatric dentist.
• Certain foods contain high levels of fluoride, especially powdered concentrated 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 fluoride levels, including decaffeinated teas, white grape juice and juice or soft drinks manufactured in fluoridated cities.

Parents can take the following steps to decrease their child’s risk of fluorosis:

• Use baby tooth cleaner on toothbrush of children who might swallow the toothpaste
• Use only a pea-sized amount of toothpaste when brushing children’s teeth
• Account for all sources of fluoride in a child’s diet before requesting fluoride supplements from your child’s physician or pediatric dentist
• Don’t give fluoride-containing supplements to infants until the are six months old
• Obtain fluoride level test results for your drinking water from your local water utilities before giving fluoride supplements to your child

Parents often first notice the noise created by the child grinding their teeth during sleep, or they may notice wear to the teeth. One theory is that stress due to a new environment, divorce, changes at school, etc. can cause a child to grind their teeth. Another theory says it may be caused by inner ear pressure at night. Usually bruxism doesn’t require treatment. But if excessive wear of the teeth occurs, a mouth guard may be recommended. However, mouthguards to present a choking risk. Good news: most children outgrow bruxism by ages 9 through 12. You can discuss this issue with your pediatrician or pediatric dentist.

Given how common pierced tongues, lips or cheeks are nowadays, you may be surprised to know just how dangerous piercing can be. Risks with oral piercing include chipped or cracked teeth, blood clots and 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 airways! Common symptoms after piercing include pain, swelling, infection and increased flow of saliva and injuries to gum tissue. Difficulty 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!