Why should my child see a pediatric dentist instead of a family dentist?

The pediatric dental office is one for children and is less intimidating. All dentists are taught the basics of pediatric dentistry during dental school but a pediatric dentist spends an additional two or three years of training, becoming a specialist in the different needs children and teenagers may have. Baby teeth are not like permanent teeth and need different types of fillings. Early diagnosis of growth issues and orthodontic needs are also part of this training.

When should my child first see the dentist?

The American Academy of Pediatric Dentistry recommends that the first visit be around the time the first tooth erupts into the mouth. It is important at this particular time to discuss diet, hygiene, tooth decay and prevention and fluoride. A full examination and cleaning should be around 2 ½ years of age.

When should I start brushing my child’s teeth?

Whenever your baby feeds, you should wipe the gums and cheeks with a clean damp cloth or gauze pad whether breast feeding or bottle feeding. This removes plaque, the sticky film that contains the decay producing bacteria.

Begin to introduce the toothbrush when the first teeth erupt, brushing at least twice a day. Until your child is able to spit, use a fluoride free toothpaste, such as a teething paste. Once your child is able to spit, use no more than a pea sized amount of fluoride toothpaste. Some children are able to brush on their own as early as 4 or 5, but supervision is needed until your child is able to remove all plaque on their own.

How can I prevent cavities for my child?

Cavities are caused by the bacteria in the plaque feeding on the sugars in our diet. There is a genetic component to getting cavities, and we know that the bacteria that cause cavities can be spread from the parent or care giver to a child. Keep your and your child’s bacteria counts down with the removal of plaque through brushing properly. Keep the quantity of sugar accessible to the bacteria down by feeding your child less sugary foods. Some of the worst foods for cavities are the “healthy” foods such a sugary dried fruits, fruits juices and sports drinks. Never put a baby to sleep with a bottle of sugary liquids such as milk or juice. The sugars in these liquids pool around the teeth and it may allow for the development of “Baby bottle decay”.

Make certain that as soon as your child is able to spit, they are using a fluoride toothpaste. A daily exposure to fluoride may help prevent cavities from developing. If you are using bottled water or your water flows through a filtration system, you need to discuss the issue of fluoride supplements with with Dr. Dana or your child’s pediatrician. This is important in the prevention of decay for the developing permanent teeth.

What do you actually do during a dental examination?

Although we usually tell the children we are “counting their teeth”, the examination is the mort important part of the visit. We actually are counting the teeth, to see if there are too many or if there are missing teeth. We are also looking for any growths on the gums, cheeks, palate and tonsils. Checking for cavities involves looking and feeling, using the “counter” to feel if there are any cavities. If there is likely decay, we may ask for x-rays to confirm the diagnosis. Although we use digital x-rays, which use relatively little radiation, we do not take x-rays unless there is a specific diagnostic need.

My child has a cavity. Why fill it?

Depending on the age of your child when we find a cavity, we may or may not recommend a filling. The baby teeth perform a number of functions. Sure, they may look beautiful, but the most important role of the baby teeth is to hold the space needed for the developing permanent teeth, which are developing in the bone underneath the baby teeth. In many cases, if your child loses the baby teeth too early, that may create a crowding situation that may or may not be able to be corrected with braces at a later time. There are different stages of dental eruption that may require fillings in certain teeth. Knowing when teeth generally fall out enables me to make a better recommendation as to whether you would have me fill the cavities or not. Sometimes we fill the teeth to prevent the cavities from spreading to the next tooth. If your child gets a cavity, we will discuss all treatment options with you.

How do you fill the cavity?

One of the advantages of using a pediatric dentist is that we are specialty trained in different techniques for pain management and behavior management. We are trained in the use of Nitrous Oxide, for both pain management and anxiety management. Local anesthesia is used but we are very careful to make “getting a shot” as painless as possible. We always use child friendly phrases, such as” using sleepy juice to put the tooth to sleep”, “using a whistle to wash the cavity bugs out”, “wiggling to tooth out so you can have a visit from the tooth fairy”. We always go through “tell-show-do” a technique where your child is told exactly what we are going to do in child friendly terms. We ask that when you prepare your child for a filling, do not suggest that we will give them a shot or that it will hurt. Sometimes the best preparation is to say you don’t know but that the doctors will explain everything.

And what will you fix the cavities with?

There has been a movement towards white fillings so if the cavity is relatively small, it can be fixed with a tooth colored filling. If the cavity is so large that the nerve is involved, a pulpotomy (the removal of the top portion of the nerve) is performed and a stainless steel crown will be placed on top of the tooth. A white colored crown is available but is not as likely to last the lifetime of the baby tooth and usually costs more.

What about sealants?

Sealants have been around for about 30 years as an effective way to prevent chewing surface cavities. On the chewing surfaces of the molars, in particular the permanent molars, there are deep grooves that are too narrow for the toothbrush bristles to keep clean. Application of a plastic type material to the grooves acts as a barrier to food and plaque, thus protecting the decay prone chewing surfaces. Let’s discuss whether sealants are a good option for your child.

What about fluoride?

Fluoride is an element that has been proven to prevent cavities. When teeth are developing, having fluoride in the diet allows the teeth to develop stronger enamel. The fluoride in the toothpaste strengthens the outer layer of enamel of the teeth in the mouth but do not help with the developing teeth. Too little fluoride won’t help; too much will cause fluorosis (a chalky white or brown discoloration to the permanent teeth). Fluorosis is commonly a result of a toddler eating too much toothpaste or inappropriate use of fluoride supplements. Please discuss your exposure to fluoride with your child’s pediatrician or us.

Should I take my child to an orthodontist?

Our training involved a heavy emphasis on growth and development. During the examination, your child’s bite will be evaluated and you will be referred to an orthodontist if and when it is appropriate for your child. If there are skeletal issues (the upper and lower jaws don’t fit together properly), these are generally corrected during growth spurts so your child will be referred earlier. Sometimes crowding issues need to be addressed early but not always. Our philosophy has always been to refer to at least two if not three orthodontists and we will help you decide what is the best recommendation for your child. If you have questions, please feel free to ask during the examination.