Toddlers, pre-teens, and teenagers have different needs when it comes to dental health, growth, and development. As a result, some dentists undergo an extra two to three years of specialized training after dental school. This added expertise uniquely equips “pediatric dentists” to help children from infancy through the teenage years correct oral problems and avoid future dental issues.
Primary teeth are often referred to as baby teeth. The front four usually last until age six or seven; the back ones (i.e., cuspids and molars) are usually replaced between the ages of 10 and 13. It’s tempting to think, “Why worry? They’re just baby teeth! They’re going to fall out anyway!”
Here’s why caring for baby teeth is crucial. Primary teeth are extremely important for:
What’s more, neglected cavities in primary teeth can (and frequently do) lead to problems with developing permanent teeth.
Children’s teeth begin forming before birth. As early as four months, the first primary (or baby) teeth begin to erupt through the gums. The lower central incisors usually appear first, followed closely by the upper central incisors. Although all 20 primary teeth usually appear by age three, the pace and order of their eruption can vary widely.
Permanent teeth begin showing up around age six, starting with the first molars and lower central incisors. By the age of eight, you can generally expect the bottom four primary teeth (lower central and lateral incisors) and the top four primary teeth (upper central and lateral incisors) to be gone and permanent teeth in their place. There is often a one to two-year break from ages eight to ten, and then the rest of the permanent teeth will start to come in. This process continues until approximately age 21.
Adults have 28 permanent teeth, or up to 32 if you count the third molars (AKA the wisdom teeth).
Dental x-rays (AKA radiographs) are a vital and necessary part of your child’s dental diagnostic process. Without them, certain dental conditions can and will be missed.
For children with a high risk of tooth decay, the American Academy of Pediatric Dentistry recommends x-rays and examinations every six months. Most pediatric dentists request x-rays approximately once a year. Approximately every three years, it’s a good idea to obtain a complete set of x-rays.
Like all pediatric dentists, we at PDAO are extremely careful to minimize the exposure of our patients to radiation. Lead body aprons and shields will protect your child. Our advanced equipment filters out unnecessary X-rays and restricts the X-ray beam to the targeted area. In short, your child will not be exposed to an unsafe amount of radiation. The risk is negligible. The greater risk is not detecting and treating a dental problem early.
X-rays reveal much more than cavities. They help us survey erupting teeth, diagnose bone diseases, evaluate the results of an injury, and plan orthodontic treatment. They reveal issues that cannot be detected during a visual, clinical examination. By finding and treating problems early, dental care becomes more comfortable for your child and more affordable for you.
Many kinds of toothpaste contain harsh abrasives that can wear away tooth enamel and damage young smiles. It’s important, therefore, when looking for a toothpaste for your child, to make sure you pick one that has been recommended by the American Dental Association (as shown on the box and tube) and has proven under testing to be safe to use.
Use only a smear of toothpaste (the size of a grain of rice) to brush the teeth of a child less than three years of age. For children three to six years old, use a “pea-size” amount of toothpaste and perform or assist your child’s toothbrushing. Remember that young children do not have the ability to brush their teeth effectively on their own. Children should spit out and not swallow excess toothpaste after brushing
What’s that noise you hear while your child sleeps? Why do some of his/her teeth seem worn or shorter? It could be the common problem of nocturnal grinding (AKA bruxism).
This behavior may be caused by psychological factors–perhaps stress due to a new environment, a divorce, changes at school, etc. Another theory suggests that pressure in the inner ear at night can prompt children to move their jaws unconsciously in an attempt to relieve this pressure (much like chewing gum during an airplane’s take-off or landing causes one’s ears to “pop” open.)
The majority of cases of pediatric bruxism do not require treatment. Most children outgrow it. The grinding often decreases between the ages of six to nine and children tend to stop grinding between ages nine and 12. If you suspect your child is grinding his or her teeth, discuss this with your pediatrician or pediatric dentist.
If excessive wear of the teeth (attrition) is present, then a mouth guard (or night guard) may be needed. The drawbacks to a mouth guard are the possibility of choking if the appliance becomes dislodged during sleep. Also, it can sometimes interfere with the growth of the child’s jaws. The primary benefit of a mouth guard is preventing excessive wear to the teeth.
Sucking is a natural reflex for infants and young children. It makes them feel secure and happy, especially when they’re feeling stressed. Since thumb-sucking is relaxing, it may induce sleep. For these reasons, kids don’t only suck when a pacifier is available. They also turn to fingers, thumbs, and other objects.
Typically, children stop this practice between the ages of two and four. Thumb-sucking that persists beyond the appearance 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 issues than those who vigorously suck their thumbs.
Ideally, children should cease thumb-sucking by the time their permanent front teeth are ready to erupt. Oftentimes, school-aged children stop because of peer pressure.
A word of warning: Pacifiers should not be used as a substitute for thumb-sucking. They can affect the teeth in the same way that thumb-sucking does. However, the 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 the use of a pacifier, consult your pediatric dentist.
A few suggestions to help your child get through thumb-sucking:
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.
Sometimes a cavity or traumatic injury can injure the pulp of a tooth. (The pulp is the inner, central core of the tooth. It’s where the nerves, blood vessels, connective tissue, and reparative cells live.) When this happens, pulp therapy is required to maintain the vitality of the affected tooth. We never want to lose a tooth if we can help it.
Pulp therapy is often referred to as a “nerve treatment” or a “root canal.” The two common forms of pulp therapy in children’s teeth are pulpotomy and pulpectomy.
A pulpotomy removes the diseased pulp tissue within the crown portion of the tooth. Next, an agent is inserted to prevent bacterial growth and calm the aggravated nerve tissue. This is followed by a final restoration (usually a stainless steel crown).
A pulpectomy is required when the entire pulp is involved (down into the root 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.
We can see bad bites (AKA malocclusions) developing in children as early as two to three 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 occurs between ages two and six. At this young age, we’re 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. Many times, though not always, it can eliminate the need for future orthodontic/orthopedic treatment!
Stage II – Mixed Dentition: This period covers the ages of six to 12 years, with the eruption of the permanent incisor (front) teeth and six-year molars. Treatment concerns often focus on the jaws and dental alignment 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.
This is a common occurrence in children. Usually, a lower, primary (baby) tooth hasn’t fallen out, but the permanent tooth is coming in. In most cases, if the child starts wiggling the baby tooth, it will usually fall out on its own within two months. If it doesn’t, contact your pediatric dentist. He or she can easily remove the tooth. The permanent tooth should then slide into its proper place.
Research has shown that pregnant women with periodontal disease have an increased risk for preterm births and infants with low birth weights. For this reason, the American Academy of Pediatric Dentistry (AAPD) recommends that all pregnant women receive oral healthcare and counseling during pregnancy.
Additionally, mothers with poor oral health may be at a greater risk of passing cavity-causing bacteria to their young children. To reduce this risk, mothers should:
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 with 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 (and we can help). 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 “fanfare” and “drama” surrounding the visit, the better.
It’s best to refrain from using words that might cause unnecessary fear. Talk of needles, pulling teeth, drilling, or pain only heightens anxiety. Your pediatric dental professional is trained to explain procedures to children in a non-frightening way.
Teething, the process of baby (AKA 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. They usually begin erupting between the age of 6-8 months.
One common form of tooth decay (AKA caries) among young children is baby bottle tooth decay. This condition, which can be both rapid and serious, is caused by frequent and extended exposures of an infant’s teeth to liquids containing sugar. Liquids include milk (even breast milk), formula, fruit juice, and other sweetened drinks.
This is why babies should never be put down for a nap or put to bed at night with a bottle containing anything other than water. Sweet liquid pools around the child’s teeth giving plaque bacteria an opportunity to produce acids that attack tooth enamel. If your child won’t fall asleep without a bottle of milk, 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 and place the child’s head in your lap. Or you can 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.
When parents fill a sippy cup with liquid that contains sugar (e.g., milk, fruit juice, sports drinks, etc.) and allow their child to drink from it all day, the child’s teeth are exposed to cavity-causing bacteria.
This is why sippy cups should be used only as a training tool–to transition children from a bottle to a cup. The use of these cups should be discontinued by the first birthday. If your child uses a sippy cup throughout the day, fill it with water only (except at mealtimes).
Healthy eating habits are an important part of having healthy teeth. Like the rest of the body, the teeth, bones, and soft tissues of the mouth need a well-balanced diet.
Here are some crucial reminders:
Good oral hygiene. Period. This removes the bacteria and leftover food particles that combine to create cavities. What does this look like for parents?
A sealant is a protective coating that is applied to the chewing surfaces (grooves) of the back teeth (premolars and molars), where 80% of cavities in children are found. Sealants act as a barrier to food, plaque, and acid, thus protecting the decay-prone areas of the teeth
Fluoride is a naturally occurring element, shown to prevent tooth decay by as much as 50-70%. But the amount has to be correct.
With little or no fluoride, the teeth aren’t able to resist cavities. With too much fluoride, children can develop dental fluorosis, which is typically a chalky white discoloration (brown in advanced cases) of the permanent teeth. Be sure to follow your pediatric dentist’s instructions on suggested fluoride use and possible supplements, if needed.
You can help by using fluoride toothpaste and only a smear of toothpaste (the size of a grain of rice) to brush the teeth of a child less than three years of age. For children three to six years old, use a “pea-size” amount of toothpaste and perform or assist your child’s toothbrushing. Remember that young children do not have the ability to brush their teeth effectively on their own. Children should spit out and not swallow excess toothpaste after brushing, in order to avoid fluorosis.
When kids begin to participate in recreational activities and organized sports, injuries to the mouth and teeth are always possible. A properly fitted mouthguard can help protect your child’s smile. Mouth protectors are strongly recommended for any activity that could result in a blow to the face or mouth.
Mouthguards can help prevent broken teeth, as well as injuries to the lips, tongue, face or jaw. A properly fitted mouthguard 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 use of xylitol gum by mothers (two to three times per day) starting three months after birth and until the child was two years old, has proven to reduce cavities up to 70% by the time the child was five years old.
No wonder the American Academy of Pediatric Dentistry (AAPD) recognizes and recommends its benefits!
Xylitol is found in 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 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 decay. 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.
Studies suggest xylitol intake of four to 20 grams per day consistently produces positive results. Higher amounts did not result in greater tooth decay reduction–and may actually lead to diminishing results. Similarly, consuming xylitol less than three times per day resulted in no benefit.
To find gum or other products containing xylitol, visit your local health food store or search the Internet to find products containing 100% xylitol.
Due to the acids and high sugar content in sports drinks, they have erosive potential and the ability to dissolve even fluoride-rich enamel, which can lead to cavities.
To minimize dental problems, children should avoid sports drinks and hydrate with water before, during, and after sports. Be sure to talk to your pediatric dentist before using sports drinks.
If sports drinks are consumed:
More and more people have pierced tongues, lips, or cheeks.
Very few people are aware of how dangerous these oral piercings can be. This is because your mouth contains millions of bacteria, and infection is a common complication.
Besides infection (at the site of the piercing and infection of the heart), the risks of oral piercings include:
None of these risks are worth it. 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 unpeakable damage.
Teens often turn to smokeless tobacco–sometimes called spit, chew, or snuff–thinking it’s a safe alternative to smoking cigarettes. This is an unfortunate misconception. Studies show that spit tobacco may be more addictive than smoking cigarettes–and, consequently, more difficult to quit. Few people know that one can of snuff has as much nicotine as three packs of 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:
Because the early signs of oral cancer are not always 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.
