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) aren’t
replaced until age 10-13.
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).
Look! My Tooth is Loose!
(with 16"x22" poster and
stickers)
By Patricia Brennan Dermuth
Illustrated by Mike Cressy
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 patient’s
saliva or milk. If the patient is old
enough, the tooth may also be carried in
the patient’s 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 dentist.
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 child’s 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 bitewings.
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. Today’s
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.
Tooth
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 use.
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.
Sucking
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 pediatric
dentist.
A few suggestions
to help your child get through thumb
sucking:
Children often suck their thumbs
when feeling insecure. Focus on
correcting the cause of anxiety,
instead of the thumb sucking.
Children who are sucking for
comfort will feel less of a need
when their parents provide comfort.
Reward children when they
refrain from sucking during
difficult periods, 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 approaches don’t work,
remind the children of their habit
by bandaging the thumb or putting a
sock on the hand at night. Your
pediatric dentist may recommend the
use of a mouth appliance.
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 pulpectomy.
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
crown).
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 -
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.
The
American Academy of Pediatric Dentistry
(AAPD) recommends that all pregnant
women receive oral healthcare and
counseling during pregnancy. Research
has shown evidence that periodontal
disease can increase the risk of preterm
birth and low birth weight. Talk to your
doctor or dentist about ways you can
prevent periodontal disease during
pregnancy.
Additionally,
mothers with poor oral health may be at
a greater risk of passing the bacteria
which causes cavities to their young
children. Mother's should follow these
simple steps to decrease the risk of
spreading cavity-causing bacteria:
Visit your dentist regularly.
Brush and floss on a daily basis
to reduce bacterial plaque.
Proper diet, with the reduction
of beverages and foods high in sugar
& starch.
Use a fluoridated toothpaste
recommended by the ADA and rinse
every night with an alocohol-free,
over-the-counter mouth rinse with
.05 % sodium fluoride in order to
reduce plaque levels.
Don't share utensils, cups or
food which can cause the
transmission of cavity-causing
bacteria to your children.
Use of xylitol chewing gum (4
pieces per day by the mother) can
decrease a child’s caries rate.
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.
The 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.
See
"Eruption of Your Child’s 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 infant’s 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 child’s 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 baby’s 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 child’s 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 child’s
mouth easily.
Sippy cups should
be used as a training tool from the
bottle to a cup and should be
discontinued by the first birthday. If
your child uses a sippy cup throughout
the day, fill the sippy cup with water
only (except at mealtimes). By filling
the sippy cup with liquids that contain
sugar (including milk, fruit juice,
sports drinks, etc.) and allowing a
child to drink from it throughout the
day, it soaks the child’s teeth in
cavity causing bacteria.
Healthy 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 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. 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 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.
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 teeth.
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 (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 child’s 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
mouth protectors.
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 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.
So follow the
advice of the American Dental
Association and give your mouth a break
- skip the mouth jewelry.
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.
Pediatric Dentist, Denver, CO 80238 - Dr. Jesse Witkoff
Serving patients in the surrounding cities and areas of Stapleton,
Aurora, Commerce City, and Denver Colorado.
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.
Tooth
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 use.
Sucking
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.
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.
The
American Academy of Pediatric Dentistry
(AAPD) recommends that all pregnant
women receive oral healthcare and
counseling during pregnancy. Research
has shown evidence that periodontal
disease can increase the risk of preterm
birth and low birth weight. Talk to your
doctor or dentist about ways you can
prevent periodontal disease during
pregnancy.
One
serious form of decay among young
children is baby bottle tooth decay.
This condition is caused by frequent and
long exposures of an infant’s teeth to
liquids that contain sugar. Among these
liquids are milk (including breast
milk), formula, fruit juice and other
sweetened drinks.
Sippy
Cups
