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The American Academy of Pediatric Dentistry (AAPD) suggests that parents should make an initial “well-baby” appointment with a pediatric dentist approximately six months after the emergence of the first tooth, or no later than the child’s first birthday.
Although this may seem surprisingly early, the incidence of infant and toddler tooth decay has been rising in recent years. Tooth decay and early cavities can be exceptionally painful if they are not attended to immediately, and can also set the scene for poor oral health in later childhood.
The pediatric dentist is a specialist in child psychology and child behavior, and should be viewed as an important source of information, help, and guidance. Oftentimes, the pediatric dentist can provide strategies for eliminating unwanted oral habits (for example, pacifier use and thumb sucking) and can also help parents in establishing a sound daily oral routine for the child.
What potential dental problems can babies experience?
A baby is at risk for tooth decay as soon as the first tooth emerges. During the first visit, the pediatric dentist will help parents implement a preventative strategy to protect the teeth from harm, and also demonstrate how infant teeth should be brushed and flossed.
In particular, infants who drink breast milk, juice, baby formula, soda, or sweetened water from a baby bottle or sippy cup are at high-risk for early childhood caries (cavities). To counteract this threat, the pediatric dentist discourages parents from filling cups with sugary fluids, dipping pacifiers in honey, and transmitting oral bacteria to the child via shared spoons and/or cleaning pacifiers in their own mouths.
Importantly, the pediatric dentist can also assess and balance the infant’s fluoride intake. Too much fluoride ingestion between the ages of one and four years old may lead to a condition known as fluorosis in later childhood. Conversely, too little fluoride may render young tooth enamel susceptible to tooth decay.
What happens during the first visit?
Pediatric dentists have fun-filled, stimulating dental offices. All dental personnel are fully trained to communicate with infants and young children.
During the initial visit, the pediatric dentist will advise parents to implement a good oral care routine, ask questions about the child’s oral habits, and examine the child’s emerging teeth. The pediatric dentist and parent sit knee-to-knee for this examination to enable the child to view the parent at all times. If the infant’s teeth appear stained, the dentist may clean them. Oftentimes, a topical fluoride treatment will be applied to the teeth after this cleaning.
What questions may the pediatric dentist ask during the first visit?
The pediatric dentist will ask questions about current oral care, diet, the general health of the child, the child’s oral habits, and the child’s current fluoride intake.
Once answers to these questions have been established, the pediatric dentist can advise parents on the following issues:
- Accident prevention.
- Adding xylitol and fluoride to the infant’s diet.
- Choosing an ADA approved, non-fluoridated brand of toothpaste for the infant.
- Choosing an appropriate toothbrush.
- Choosing an orthodontically correct pacifier.
- Correct positioning of the head during tooth brushing.
- Easing the transition from sippy cup to adult-sized drinking glasses (12-14 months).
- Eliminating fussing during the oral care routine.
- Establishing a drink-free bedtime routine.
- Maintaining good dietary habits.
- Minimizing the risk of tooth decay.
- Reducing sugar and carbohydrate intake.
- Teething and developmental milestones.
If you have further questions or concerns about the timing or nature of your child’s first oral checkup, please ask your pediatric dentist.
Though there are some individual differences in the timing of tooth eruption, primary teeth usually begin to emerge when the infant is between six and eight months old. Altogether, a set of twenty primary teeth will emerge by the age of three.
The American Academy of Pediatric Dentistry (AAPD) recommends a first “well-baby” dental visit around the age of twelve months (or six months after the first tooth emerges). This visit acquaints the infant with the dental office, allows the pediatric dentist to monitor development, and provides a great opportunity for parents to ask questions.
Which teeth emerge first?
In general, teeth emerge in pairs, starting at the front of the infant’s mouth. Between the ages of six and ten months, the two lower central incisors break through. Remember that cavities may develop between two adjacent teeth, so flossing should begin at this point.
Next (and sometimes simultaneously), the two upper central incisors emerge – usually between the ages of eight and twelve months. Teething can be quite an uncomfortable process for the infant. Clean teething rings and cold damp cloths can help ease the irritation and discomfort.
Between the ages of nine and sixteen months the upper lateral incisors emerge – one on either side of the central incisors. Around the same time, the lower lateral incisors emerge, meaning that the infant has four adjacent teeth on the lower and upper arches. Pediatric dentists suggest that sippy cup usage should end when the toddler reaches the age of fourteen months. This minimizes the risk of “baby bottle tooth decay.”
Eight more teeth break through between the ages of thirteen and twenty three months. On each arch, a cuspid or canine tooth will appear immediately adjacent to each lateral incisor. Immediately behind (looking towards the back of the child’s mouth), first molars will emerge on either side of the canine teeth on both jaws.
Finally, a second set of molars emerges on each arch – usually beginning on the lower arch. Most children have a complete set of twenty primary teeth before the age of thirty-three months. The pediatric dentist generally applies dental sealant to the molars, to lock out food particles, bacteria, and enamel-attacking acids.
How can I reduce the risk of early caries (cavities)?
Primary teeth preserve space for permanent teeth and guide their later alignment. In addition, primary teeth help with speech production, prevent the tongue from posturing abnormally, and play an important role in the chewing of food. For these reasons, it is critically important to learn how to care for the child’s emerging teeth.
Here are some helpful tips:
- Brush twice each day – The AAPD recommends a pea-sized amount of ADA approved (non-fluoridated) toothpaste for children under two years old, and the same amount of an ADA approved (fluoridated) toothpaste for children over this age. The toothbrush should be soft-bristled and appropriate for infants.
- Start flossing – Flossing an infant’s teeth can be difficult but the process should begin when two adjacent teeth emerge. The pediatric dentist will happily demonstrate good flossing techniques.
- Provide a balanced diet – Sugars and starches feed oral bacteria, which produce harmful acids and attack tooth enamel. Ensure that the child is eating a balanced diet and work to reduce sugary and starchy snacks.
- Set a good example – Children who see parents brushing and flossing are often more likely to follow suit. Explain the importance of good oral care to the child; age-appropriate books often help with this.
- Visit the dentist – The pediatric dentist monitors oral development, provides professional cleanings, applies topical fluoride to the teeth, and coats molars with sealants. Biannual trips to the dental office can help to prevent a wide range of painful conditions later.
If you have questions or concerns about the emergence of your child’s teeth, please contact your pediatric dentist.
Primary teeth, also known as “baby teeth” or “deciduous teeth,” begin to develop beneath the gums during the second trimester of pregnancy. Teeth begin to emerge above the gums approximately six months to one year after birth. Typically, preschool children have a complete set of 20 baby teeth – including four molars on each arch.
One of the most common misconceptions about primary teeth is that they are irrelevant to the child’s future oral health. However, their importance is emphasized by the American Dental Association (ADA), which urges parents to schedule a “baby checkup” with a pediatric dentist within six months of the first tooth emerges.
What are the functions of primary teeth?
Primary teeth can be painful to acquire. To soothe tender gums, biting on chewing rings, wet gauze pads, and clean fingers can be helpful. Though most three-year-old children have a complete set of primary teeth, eruption happens gradually – usually starting at the front of the mouth.
The major functions of primary teeth are described below:
Speech production and development – Learning to speak clearly is crucial for cognitive, social, and emotional development. The proper positioning of primary teeth facilitates correct syllable pronunciation and prevents the tongue from straying during speech formation.
Eating and nutrition – Children with malformed or severely decayed primary teeth are more likely to experience dietary deficiencies, malnourishment, and to be underweight. Proper chewing motions are acquired over time and with extensive practice. Healthy primary teeth promote good chewing habits and facilitate nutritious eating.
Self-confidence – Even very young children can be quick to point out ugly teeth and crooked smiles. Taking good care of primary teeth can make social interactions more pleasant, reduce the risk of bad breath, and promote confident smiles and positive social interactions.
Straighter smiles – One of the major functions of primary teeth is to hold an appropriate amount of space for developing adult teeth. In addition, these spacers facilitate the proper alignment of adult teeth and also promote jaw development. Left untreated, missing primary teeth cause the remaining teeth to “shift” and fill spaces improperly. For this reason, pediatric dentists often recommend space-maintaining devices.
Excellent oral health – Badly decayed primary teeth can promote the onset of childhood periodontal disease. As a result of this condition, oral bacteria invade and erode gums, ligaments, and eventually bone. If left untreated, primary teeth can drop out completely – causing health and spacing problems for emerging permanent teeth. To avoid periodontal disease, children should practice an adult-guided oral care routine each day, and infant gums should be rubbed gently with a clean, damp cloth after meals.
If you have questions or concerns about primary teeth, please contact your pediatric dentist.
Dental Exams and Checkups
You should have your teeth checked and cleaned at least twice a year, though your dentist or dental hygienist may recommend more frequent visits.
Regular dental exams and cleaning visits are essential in preventing dental problems and maintaining the health of your teeth and gums. At these visits, your teeth are cleaned and checked for cavities. Additionally, there are many other things that are checked and monitored to help detect, prevent, and maintain your dental health. These include:
- Medical history review: Knowing the status of any current medical conditions, new medications, and illnesses, gives us insight to your overall health and also your dental health.
- Examination of diagnostic X-rays (radiographs): Essential for detection of decay, tumors, cysts, and bone loss. X-rays also help determine tooth and root positions.
- Oral cancer screening: Check the face, neck, lips, tongue, throat, tissues, and gums for any signs of oral cancer.
- Gum disease evaluation: Check the gums and bone around the teeth for any signs of periodontal disease.
- Examination of tooth decay: All tooth surfaces will be checked for decay with special dental instruments.
- Examination of existing restorations: Check current fillings, crowns, etc.
- Removal of calculus (tartar): Calculus is hardened plaque that has been left on the tooth for sometime and is now firmly attached to the tooth surface. Calculus forms above and below the gum line, and can only be removed with special dental instruments.
- Removal of plaque: Plaque is a sticky, almost invisible film that forms on the teeth. It is a growing colony of living bacteria, food debris, and saliva. The bacteria produce toxins (poisons) that inflame the gums. This inflammation is the start of periodontal disease!
- Teeth polishing: Removes stain and plaque that is not otherwise removed during toothbrushing and scaling.
- Oral hygiene recommendations: Review and recommend oral hygiene aids as needed (electric dental toothbrushes, special cleaning aids, fluorides, rinses, etc.).
- Review dietary habits: Your eating habits play a very important role in your dental health.
As you can see, a good dental exam and cleaning involves much more than simply checking for cavities and polishing your teeth. We are committed to providing you with the best possible care, and to do so, will require regular check-ups and cleanings.
Pediatric dentists (or pedodontists) are qualified to meet the dental needs of infants, toddlers, school-age children, and adolescents. Pediatric dentists are required to undertake an additional two or three years of child-specific training after fulfilling dental school requirements.
In addition to dental training, pediatric dentists specifically study child psychology. This enables them to communicate with children in an effective, gentle, and non-threatening manner.
The American Academy of Pediatric Dentistry (AAPD) recommends that children see a pediatric dentist before the age of one (or approximately six months after the emergence of the first primary tooth). Though this might seem early, biannual preventative dental appointments are imperative for excellent oral health.
Parents should take children to see a pediatric dentist for the following reasons:
- To ask questions about new or ongoing issues.
- To discover how to begin a “no tears” oral care program in the home.
- To find out how to implement oral injury prevention strategies in the home.
- To find out whether the child is at risk for developing caries (cavities).
- To receive information about extinguishing unwanted oral habits (e.g., finger-sucking, etc.).
- To receive preventative treatments (fluorides and sealants).
- To receive reports about how the child’s teeth and jaws are growing and developing.
What does a pediatric dentist do?
Pediatric dentistry offices are colorful, fun, and child-friendly. Dental phobias are often rooted in childhood, so it is essential that the child feel comfortable, safe, and trusting of the dentist from the outset.
The pediatric dentist focuses on several different forms of oral care:
Prevention – Tooth decay is the most prevalent childhood ailment. Fortunately, it is almost completely preventable. Aside from providing advice and guidance relating to home care, the pediatric dentist can apply sealants and fluoride treatments to protect tooth enamel and minimize the risk of cavities.
Early detection – Examinations, X-rays, and computer modeling allow the pediatric dentist to predict future oral problems. Examples include malocclusion (bad bite), attrition due to grinding (bruxism), and jaw irregularities. In some cases, optimal outcomes are best achieved by starting treatment early.
Treatment – Pediatric dentists offer a wide range of treatments. Aside from preventative treatments (fluoride and sealant applications), the pediatric dentist also performs pulp therapy and treats oral trauma. If primary teeth are lost too soon, space maintainers may be provided to ensure the teeth do not become misaligned.
Education – Education is a major part of any pediatric practice. Not only can the pediatric dentist help the child understand the importance of daily oral care, but parents can also get advice on toothpaste selection, diet, thumb-sucking cessation, and a wide range of related topics.
Updates – Pediatric dentists are well informed about the latest advances in the dentistry field. For example, Xylitol (a naturally occurring sugar substitute) has recently been shown to protect young teeth against cavities, tooth decay, and harmful bacteria. Children who do not see the dentist regularly may miss out on both beneficial information and information about new diagnostic procedures.
If you have questions or concerns about when to see a pediatric dentist, please contact our office.
Although thorough brushing and flossing removes most food particles and bacteria from easy to reach tooth surfaces, they do not reach the deep grooves on chewing surfaces of teeth. More than 75 percent of dental decay begins in these deep grooves (called pits and fissures). Toothbrush bristles are often too large to clean most of these areas, thus sealants play an important role.
A sealant is a thin plastic coating that covers and protects the chewing surfaces of molars, premolars, and any deep grooves or pits on teeth. Sealant material forms a protective, smooth barrier covering natural depressions and grooves in the teeth, making it much easier to clean and help keep these areas free of decay.
Who may need sealants?
Children and teenagers - As soon as the six-year molars (the first permanent back teeth) appear or any time throughout the cavity prone years of 6-16.
Infants - Baby teeth are occasionally sealed if the teeth have deep grooves and the child is cavity prone.
Adults - Tooth surfaces without decay that have deep grooves or depressions that are difficult to clean.
Sealants are easily applied by your dentist or dental hygienist and the process only takes minutes per tooth. After the chewing surfaces are roughened with an acid solution that helps the sealant adhere to the tooth, the sealant material is “painted” onto the tooth surface, where it hardens and bonds to the teeth. Sometimes a special light will be used to help the sealant material harden.
After sealant treatment, it’s important to avoid chewing on ice cubes, hard candy, popcorn kernels, or any hard or sticky foods. Your sealants will be checked for wear and chipping at your regular dental check-up.
Combined with good home care, a proper diet, and regular dental check-ups, sealants are very effective in helping prevent tooth decay.
Evaluating the many brands of oral products claiming to be “best for children” can be an overwhelming task. Selecting an appropriately sized toothbrush and a nourishing, cleansing brand of children’s toothpaste is of paramount importance for maintaining excellent oral health.
Why brush primary teeth?
The importance of maintaining the health of primary (baby) teeth is often understated. Primary teeth are essential for speech production, chewing, jaw development, and they also facilitate the proper alignment and spacing of permanent adult teeth. Brushing primary teeth prevents bad breath and tooth decay, and also removes the plaque bacteria associated with childhood periodontal disease.
What differences are there among toothpaste brands?
Though all toothpastes are not created equal, most brands generally contain abrasive ingredients to remove stains, soapy ingredients to eliminate plaque, fluorides to strengthen tooth enamel, and some type of pleasant-tasting flavoring.
The major differences between brands are the thickness of the paste, the level of fluoride content, and the type of flavoring. Although fluoride strengthens enamel and repels plaque bacteria, too much of it can actually harm young teeth – a condition known as dental fluorosis. Children between the ages of one and four years old are most at risk for this condition, so fluoride levels should be carefully monitored during this time.
Be aware that adult and non-ADA approved brands of toothpaste often contain harsher abrasives, which remove tooth enamel and weaken primary teeth. In addition, some popular toothpaste brands contain sodium lauryl sulfate (shown as “SLS” on the package), which causes painful mouth ulcers in some children.
So which toothpaste brand should I choose?
The most important considerations to make before implementing an oral care plan and choosing a toothpaste brand is the age of the child. Home oral care should begin before the emergence of the first tooth. A cool clean cloth should be gently rubbed along the gums after feeding to remove food particles and bacteria.
Prior to the age of two, the child will have many teeth and brushing should begin. Initially, select fluoride-free “baby” toothpaste and softly brush the teeth twice per day. Flavoring is largely unimportant, so the child can play an integral role in choosing whatever type of toothpaste tastes most pleasant.
Between the middle and the end of the third year, select an American Dental Association (ADA) accepted brand of toothpaste containing fluoride. The ADA logo is clear and present on toothpaste packaging, so be sure to check for it. Use only a tiny pea or rice-sized amount of fluoride toothpaste, and encourage the child to spit out the excess after brushing.
Eliminating the toothpaste takes practice, patience, and motivation – especially if the child finds the flavoring tasty. If the child does ingest tiny amounts of toothpaste, don’t worry; this is perfectly normal and will cease with time and encouragement.
Dental fluorosis is not a risk factor for children over the age of eight, but an ADA accepted toothpaste is always the recommended choice for children of any age.
If you have questions or concerns about choosing an appropriate brand of toothpaste for your child, your pediatric dentist will be happy to make recommendations.
We’re all at risk for having a tooth knocked out. More than 5 million teeth are knocked out every year! If we know how to handle this emergency situation, we might be able to save the tooth. Teeth that are knocked out can possibly be re-implanted if we act quickly and follow these simple steps:
- Locate the tooth and handle it only by the crown (chewing part of the tooth), NOT by the roots.
- DO NOT scrub or use soap or chemicals to clean the tooth. If it has dirt or debris on it, rinse it gently with your own saliva or whole milk. If that is not possible, rinse it very gently with water.
- Get to a dentist within 30 minutes. The longer you wait, the less chance there is for successful reimplantation.
Ways to transport the tooth
- Try to replace the tooth back in its socket immediately. Gently bite down on gauze, a wet tea bag or on your own teeth to keep the tooth in place. Apply a cold compress to the mouth for pain and swelling as needed.
- If the tooth cannot be placed back into the socket, place the tooth in a container and cover with a small amount of your saliva or whole milk. You can also place the tooth under your tongue or between your lower lip and gums. Keep the tooth moist at all times. Do not transport the tooth in a tissue or cloth.
- Consider buying a “Save-A-Tooth” storage container and keeping it as part of your home first aid kit. The kit is available in many pharmacies and contains a travel case and fluid solution for easy tooth transport.
The sooner the tooth is replaced back into the socket, the greater the likelihood it has to survive. So be prepared, and remember these simple steps for saving a knocked-out tooth.
You can prevent broken or knocked-out teeth by:
- Wearing a mouthguard when playing sports
- Always wearing your seatbelt
- Avoiding fights
- Avoid chewing hard items such as ice, popcorn kernels, hard breads, etc.