Pediatric dentists are the pediatricians of dentistry. A pediatric dentist has two to three years specialty training following dental school and limits his/her practice to treating children only. Pediatric dentists are primary and specialty oral care providers for infants and children through adolescence, including those with special health needs.
Primary teeth serve three important functions: they allow children to chew their food, aiding in proper digestion; they serve in proper pronunciation of sounds and formation of speech; and they establish and preserve the space and create the architecture for the developing adult teeth, which form as buds off of primary teeth.
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).
Toothache or inflamed gums
First, rinse the irritated area with warm salt water and place a cold compress on the face if it is swollen. Give the child acetaminophen for any pain, rather than placing aspirin on the teeth or gums. Finally, see a dentist as soon as possible.
Knocked out primary (baby) tooth
Contact your pediatric dentist as soon as possible.
Chipped or broken primary (baby) or 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 you can find the broken tooth fragment, bring it with you to the dentist.
Knocked out permanent tooth
Find the tooth and rinse it gently in cool water. (Do not scrub it or clean it with soap — use just water!) If possible, replace the tooth in the socket and hold it there with clean gauze or a wash cloth. If you can’t put the tooth back in the socket, place the tooth in a clean container with milk, saliva, or water. Get to the pediatric dental office immediately. (Call the emergency number if it’s after hours.) The faster you act, the better your chances of saving the tooth.
Suspected fractured or broken jaw
Keep the jaw from moving and go immediately to the emergency room of your local hospital.
Pediatric dentists are particularly careful to minimize the exposure of child 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, dental X-rays represent a far smaller risk than an undetected and untreated dental problem.
Since every child is unique, the need for dental X-ray films varies from child to child. Films are taken only after a complete review of your child’s health, and only when they are likely to yield information that a visual exam cannot. In general, children need X-rays more often than adults. Their mouths grow and change rapidly. They are more susceptible to tooth decay than adults. The American Academy of Pediatric Dentistry recommends X-ray examinations every six months for children with a high risk of tooth decay. Children with a low risk of tooth decay require X-rays less frequently.
Fluoridated toothpaste should be introduced when a child is 2-3 years of age. Prior to that, parents should clean the child’s teeth with water and a soft-bristled toothbrush. When toothpaste is used after age 2-3, parents should supervise brushing and make sure the child uses no more than a pea-sized amount on the brush. Children should spit out and not swallow excess toothpaste after brushing.
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 use.
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.
Thumb and pacifier sucking habits will generally only become a problem if they go on for a very long period of time. Most children stop these habits on their own, but if they are still sucking their thumbs or fingers when the permanent teeth arrive, a mouth appliance may be recommended by your pediatric dentist.
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 – 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 – 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.
Early Childhood Dental Care
“First visit by first birthday” According to the American Academy of Pediatric Dentistry children should first visit the dentist when they receive their first tooth or by the child’s first birthday. Early dental care is important for dental prevention in the future. However, dental problems can begin early. A major dental concern for young children is Early Childhood Caries, also known as baby bottle tooth decay or nursing caries.
To prevent tooth decay in young children, the American Academy of Pediatric Dentistry recommends that children be encouraged to begin drinking from a cup as they approach their first birthday. At nap times or at night, children should not fall asleep with a bottle. It is recommended that nighttime breast-feeding be avoided after the first primary (baby) teeth begin to erupt. Drinking juice or other sugary drinks from a bottle should always be avoided. When such drinks are offered, they should be served in a cup.
Adolescent Dental Care
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 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.
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 pre-cancerous 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 the lips, and on or under the tongue.
- Pain, tenderness or numbness anywhere in the mouth or lips.
- 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 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.
Prevention and Good Habits
“The sooner, the better!” The American Academy of Pediatric Dentistry states that parents should begin dental cleaning at birth, by cleaning their child’s gums with a soft infant toothbrush and water. Unless it is advised by your child’s pediatric dentist, fluoridated toothpaste is not recommended until 2-3 years of age.
Be sure they have a balanced diet. Then, check how frequently they eat foods with sugar or starch in them. Foods with starch include breads, crackers, pasta and such snacks as pretzels and potato chips. When checking for sugar, look beyond the sugar bowl and candy dish. A variety of foods contain one or more types of sugar, and all types of sugars can promote dental decay. Fruits, a few vegetables and most milk products have at least one type of sugar.
Sugar can be found in many processed foods, even some that do not taste sweet. For example, a peanut butter and jelly sandwich not only has sugar in the jelly, but may have sugar added to the peanut butter. Sugar is also added to such condiments as ketchup and salad dressings.
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.
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.
The American Academy of Pediatric Dentistry recommends visits every six months 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.
Sealants work by filling in the crevasses on the chewing surfaces of the teeth. This shuts out food particles that could get caught in the teeth, causing cavities. The application is fast and comfortable and can effectively protect teeth for many years.
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 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.
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 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 children’s teeth:
- Use baby tooth cleanser on the toothbrush of the very young child.
- Place only a pea sized 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.
Mouth guards hold top priority as sports equipment. They protect not just the teeth, but the lips, cheeks, and tongue. They help protect children from such head and neck injuries as concussions and jaw fractures. Increasingly, organized sports are requiring mouth guards to prevent injury to their athletes. Research shows that most oral injuries occur when athletes are not wearing mouth protection.
Whenever he or she is in an activity with a risk of falls or of head contact with other players or equipment. This includes football, baseball, basketball, soccer, hockey, skateboarding, even gymnastics. We usually think of football and hockey as the most dangerous to the teeth, but nearly half of sports-related mouth injuries occur in basketball and baseball.
Any mouth guard works better than no mouth guard. So, choose a mouth guard that your child can wear comfortably. If a mouth guard feels bulky or interferes with speech, it will be left in the locker room. You can select from several options in mouth guards. First, preformed or “boil-to-fit” mouth guards are found in sports stores. Different types and brands vary in terms of comfort, protection, and cost. Second, customized mouth guards are provided through your pediatric dentist. They cost a bit more, but are more comfortable and more effective in preventing injuries. Your pediatric dentist can advise you on what type of mouth guard is best for your child.
What Is Tooth Decay?
Plaque is a soft, sticky film of bacteria that grows on the tooth’s surface. This plaque produces acids that can contribute to tooth decay and irritate gums. If left on the surface of your teeth it can seep into the pores of the enamel of your teeth and cause demineralization. This creates a weak spot on the surface or enamel of the tooth that if left untreated may become a cavity.
Decay often begins between the teeth, on the gum line and around existing fillings. Plaque that isn’t removed from the tooth surface can harden into a substance called tartar and can cause bad breath.
Untreated decay can destroy the tooth surface enter the tooth and infect the pulp. If this happens it can only be taken care of by pulp therapy.
What Is Pulp Therapy?
Pulp is the inner part of the tooth that contains nerves, blood vessels and connective tissue. Dental caries(cavities) left untreated is one of the main reasons for pulp therapy which is used in order to save the tooth. This therapy is sometimes referred to as a “mini root canal”. The correct name is a pulpotomy or a pulpectomy.
A pulpotomy removes the diseased portion within the crown of the tooth and a material is placed to prevent bacterial growth and to calm the nerve tissue. When this is completed a stainless steel crown or a restoration is placed.
A pulpectomy is required when the roots of the tooth are also infected. At this time the diseased pulp tissue is removed from both the crown and the root. The root canals are cleansed and disinfected then filled with a resorbable material. The final restoration is then placed.
Limit the amount of sugar that your children have. This not only includes candy, but carbohydrates as well. Fruits and juices are also high in natural sugars that can cause tooth decay.
Make sure your child gets enough fluoride. Some areas of the country have fluoridated water, but most of Northern New Jersey does not have fluoridated water. In this case, there are supplements that your child’s pediatrician or dentist can prescribe. Also, your child should receive regular fluoride treatments at the dentist.
Teach your children how to brush and floss correctly. This means helping your smaller children brush their teeth and as they get older, continue to supervise their brushing and flossing.
Bring your children to the dentist regularly. The American Dental Association now recommends children start visiting the dentist as soon as their first teeth erupt. By the age of two, most of your babies teeth will have erupted. Early visits to the dentist also means early intervention in your baby’s dental health.
Even before your child is born the teeth begin forming. The first teeth begin erupting when your child is as young as four months old. These first teeth are called primary teeth or “baby teeth”. Your child will have 20 primary teeth total with the last ones appearing at the age of three.
Your child’s permanent teeth usually begin appearing around the age of six, although this can vary widely based upon a number of factors. The last teeth to erupt are your third molars, or “wisdom teeth”. These teeth usually begin to appear around the ages of 17-21. As well, the wisdom teeth are the most common teeth to be missing.
Before calling the dentist swish your mouth thoroughly with warm water especially where the pain exists. Brush your teeth and use dental floss to dislodge any food that is impacted between the teeth. If your child’s face is swollen or there is a bump on the gum contact your pediatric dentist immediately. Cold compresses can be used while you are waiting to see the dentist.
Trauma To Teeth
If your tooth is knocked out try to find the tooth. Try not to touch the root portion of the tooth. You may rinse the tooth to see if it is sound with no fractures but do not handle it unnecessarily. If the tooth does not have any fractures try to reinsert it in the socket and hold it in place by biting on a gauze and proceed immediately to the dentist. When you cannot reinsert the tooth, bring it to the dentist in a cup containing milk or the patient’s saliva. With an older child the tooth can be transported in the mouth under the tongue. Time is very critical during a trauma to the teeth even if the tooth has not fallen out. If the tooth has become loose or fractured and it is still in the gum time is of the essence also. Do not touch the tooth to see if it is loose but go immediately to the dentist where an x-ray can be taken to see if there was any damage to the roots.
Permanent Tooth Coming In and Primary Tooth Still In Place
The primary or “baby teeth” should start to fall out between the ages of 6 or 7. Sometimes the permanent tooth will errupt before the primary tooth has fallen out. The reason the primary teeth fall out is because the roots are absorbed and there is nothing to hold the tooth in the gums. If the primary tooth does not fall out after the permanent tooth has appeared and a month goes by call your pediatric dentist and they will advise you of what the next steps will be.