1. What is the difference between a pediatric dentist and a general (family) dentist?

Pediatric dentists are the pediatricians of dentistry. Pediatric dentists have two or three more years of specialty training following dental school during which they learn children’s growth and development as well as unique restorative and emotional treatment for children. Pediatric dentists limit their practice to treating children only.

2. When should I take my child to the dentist for the first time?

According to the American Academy of Pediatric Dentistry (AAPD), in order to prevent dental problems, your child should see a pediatric dentist within six months of appearance of the first tooth, but no later than his/her first birthday.

3. How often does my child need to see the pediatric dentist? 

A check-up every six months is recommended by the AAPD in order to prevent cavities and diagnose any dental problems. However, your pediatric dentist can tell you when and how often your child should visit based on his or her personal oral health as well as growth and development.

4. Are baby teeth really that important?

Primary, or “baby,” teeth are important for many reasons. Not only do they help children speak clearly and chew naturally, but they also aid in forming a path for permanent teeth to follow when they are ready to grow in (erupt). Most importantly if “baby” teeth are not taken care of, they can develop painful infections that can lead to aggressive antibiotic treatments, extractions, and even hospitalizations.

5. When will my child have teeth come in and fall out?

Baby (primary) teeth:
The average age for the first tooth to erupt in infants is 6 months. This tooth is the bottom central incisor. Your child should have 20 primary (baby) teeth by 2 ½ to 3 years of age. 
Permanent (adult) teeth:
The first permanent molars, or 6 year molars, come in around the age of 6 and they erupt (come in) behind all of the primary. Your child should lose his or her first tooth (lower central incisor) around the age of 6-7. The average age for a child to lose his or her last baby tooth is 12 years of age. 

6. What should I use to clean my baby’s teeth?

A toothbrush is the best tool to remove plaque bacteria that can lead to decay. Any soft-bristled toothbrush with a small head, preferably one designed specifically for infants, should be used at least once a day at bedtime.

7. How can I prevent decay caused by nursing?

Once your child has teeth, avoid nursing children to sleep or on-demand feedings throughout the night. Do not put your child to bed with a bottle of milk, juice, formula, or sweetened liquid. Any un-swallowed liquid remaining in the mouth will bathe his or her teeth in sugar and feed the bacteria which cause cavities. Learn the proper way to brush and floss your child’s teeth. Your child’s dentist will teach you proper technique at your first appointment by 1 year of age. Take your child to a dentist regularly to have his/her teeth and gums checked.

8. Are thumb sucking and pacifier habits harmful for a child’s teeth?

Thumb and pacifier sucking habits will generally only become a problem if they go on for a long period of time. Development of the teeth and bones may be affected by persistent sucking habits. Changes that may occur include bite problems, interference of normal tooth position and eruption, and alteration in bone growth. Professional evaluation of a habit by your pediatric dentist is recommended for children beyond 3 years of age. If he or she is still sucking thumbs or fingers when the permanent teeth arrive, a dental habit appliance may be recommended by your pediatric dentist to aid your child in halting the habit.

9. Toothpaste: when should we start using it and how much should we use?

Fluoridated toothpaste should be introduced when a child is 2-3 years of age, once the child is able to spit (AAPD recommends a rice grain size of fluoridated toothpaste as soon as the first teeth are growing in). Prior to that, parents should clean the child’s mouth with water and a soft-bristled toothbrush. Non-fluoridated toddler toothpaste may also be used for younger children who cannot spit. When fluoridated toothpaste is used after the age of 2 or 3, parents should supervise brushing and make sure the child uses no more a pea-sized amount on the brush. Children should spit out and not swallow excess toothpaste after brushing. If not monitored, children may easily swallow over four times the recommended daily amount of fluoride in toothpaste. 

10. How does fluoride work and how safe is it?

Fluoride encourages remineralization (a strengthening of weak areas on the tooth). These areas are the beginning spots of cavity formation. Fluoride is present naturally in water and in many foods, as well as in dental products such as toothpaste, mouth rinses, gels, varnish, and supplements. Fluoride is documented to be safe and highly effective if used in recommended quantities. Only small amounts of fluoride are needed for the maximum benefit. It is important to keep toothpaste, gels, rinses, and supplements out of reach for young children.

11. How do I know if my child is getting enough fluoride?

Have your pediatric dentist evaluate the fluoride level of your child’s primary source of drinking water. If your child drinks from multiple sources, then provide samples to your dentist (in plastic containers). A balanced diet does not guarantee proper amount of fluoride for the development of your child’s teeth. 

12. How can parents help prevent cavities?

Parents should take their children to the pediatric dentist every six months for check-ups, beginning with the eruption of the first tooth (around 1 year of age). Then, the dentist can recommend a specific program of brushing, flossing, and other treatments for parents to supervise and teach to their children. Of course a balanced healthy diet limiting sugary snacks and drinks will help give your child a lifetime of healthy habits.

If your child is not on solid foods yet and they have teeth, then do not nurse them to sleep or in the middle of the night. Also, do not put them to bed with a bottle of milk, juice, formula, or sweetened liquid. While they sleep, any un-swallowed liquid bathes their teeth and feeds bacteria which produces acid and causes cavities. 

13. What are recommendations for a healthy diet that is safe for my child’s teeth?

Make sure your child has a balanced diet, including one serving each of: fruits and vegetables, breads and cereals, milk and dairy products, and meat, fish, and eggs. Limiting the servings of sugars (candy, cookies, and soft drinks) and starches will also aid in protecting your child’s teeth from decay. Suggested snack foods include: peanuts, popcorn, cheese, low-fat yogurt, bananas, oranges, apples, carrots, celery, and hard-boiled eggs. Having your child drink water in between meals is also desired for good oral health. 

14. How do I choose a good training cup (also known as sippy cup)?

As you shift from having your child on the bottle or nursing to a training cup, be aware of: what kind of training cup you choose, what goes into the cup, how frequently your child sips on it, and not allowing your child to carry it around. The best training cup for your child is one without a valve. The ‘no-spill’ cups include a valve beneath the spout which do not allow your child to sip (they make your child suck the liquid, just like a baby bottle). A useful training cup will have a snap-on or screw-on lid with a spout. A useful cup may also have two handles. 

Do not let your child constantly sip liquids containing sugar (milk, juices, soda, etc) because they encourage development of decay or cavities. Offer these liquids only at mealtimes. Saliva production increases during a meal and helps neutralize acid production and rinse food particles from the mouth. If your child is thirsty between meals then offer water.

Do not let your child carry the training cup around, or get into the habit of keeping it in the car or stroller. At-will, frequent sips of sugary liquids encourages tooth decay. Your child also runs the risk of trauma if they are allowed to walk around with the training cup since most toddlers are still wobbly on their feet at times. 

Once your child has learned how to sip, they are ready for a regular cup. 

15. How do sealants work?

According to national estimates, 78% of children in the United States have experienced dental decay by the age of 17 years. As much as 90% of decay occurs in pits and fissures on top of the teeth in school-age children. The teeth at highest risk are the permanent first and second molars as they are hard to reach with a toothbrush, and often come in slowly and for a long time can be partially covered by soft tissue.

Sealants work by filling in the pits and fissures on the chewing surfaces of back teeth (molars and premolars). This prevents food particles and plaque from getting caught in the deep grooves of the teeth. The covering is only over the biting surface of the tooth, so areas on the side and between teeth cannot be coated with the sealant. For this reason, good oral hygiene, flossing and a good diet are still very important in preventing decay next to these sealants or in areas unable to be covered.

The American Dental Association (ADA) recognizes that sealants can play an important role in the prevention of tooth decay. When properly applied and maintained, they can successfully protect the chewing surfaces of your child's teeth. A total prevention program includes regular visits to the dentist, the use of fluoride, daily brushing and flossing, and limiting the number of times sugar-rich foods are eaten or drank. If these measures are followed and sealants are used on the child's teeth, the risk of decay can be reduced or may even be eliminated!

The procedure for applying sealants is fast and non-invasive.  We compare it to applying nail polish on nails. Following the placement of sealants, your child should refrain from eating ice or hard candy. This tends to fracture the sealant. Normal retention of a properly applied and maintained sealant is four years or longer. 

16. How should my child brush and floss his/her teeth?

Children do not have the hand coordination to properly and completely brush their teeth until the age of 7 to 8 years when they can easily tie their shoes. Even then, they still need supervision up to the age of 10 to 11.  Teeth need to be brushed at least twice a day: in the morning after breakfast, and most importantly at night before bed. After the nighttime brushing, your child should not have anything to eat or drink except for water. The proper technique for brushing includes: 1)angling the toothbrush at a 45-degree angle to the gums; 2)doing 3 circles on every side of every tooth; 3)brushing the chewing surfaces of the teeth; and 4)brushing the tongue after the teeth. This should take approximately 2 to 3 minutes (a timer may be used).

You should replace your child’s toothbrush every 3 months. If the bristles are worn, then replace it more often. Make sure your child is not applying too much pressure while brushing because too much pressure may injure the gums.

Flossing removes plaque and food from between the teeth, where a toothbrush cannot reach. You need to floss your child’s teeth until age 10 and possibly longer. Flossing should be done every day for prevention of decay development between the teeth as well as gingivitis. When you are flossing make sure you ‘hug’ the tooth, like drying off your back with a towel, with the floss to prevent injuring the gum tissue in between the teeth. Do not force the floss straight down between the teeth. Instead use gentle pressure and work the floss in a ‘sawing motion’ until it passes through where the teeth touch each other. Always use a clean piece of floss. You may also use a floss-holder to help you get in the back of your child’s mouth.

17. What can I do to protect my child’s teeth from sporting events?

A properly fitted soft mouth guard can protect your child’s teeth, cheeks, lips, gums, and smile. Many experts recommend that a mouth guard be worn for any recreational activity that poses a risk of injury to the mouth. Sports in which a mouth guard should be worn include (but not limited to): basketball, football, baseball, soccer, softball, wrestling, martial arts, hockey, volleyball, skateboarding, lacrosse, boxing, and extreme sports. 

There are 3 types of mouth guards: 1) ready-made, or stock, mouth guard you can purchase at a sports store 2) mouth-formed ‘boil-and-bite’ mouth guard also purchased from a sports store 3) custom-made mouth guard made by the dentist. If your child doesn’t have all of their permanent teeth then a ‘boil-and-bite’ mouth guard should be sufficient. However, the most effective mouth guard should be resilient, tear-resistant, and comfortable. It should fit properly, be easy to clean, and not restrict speech or breathing. These mouth guards must be made by your dentist!

18. What should I do if my child falls and knocks out a permanent tooth?

The most important thing to do is to remain calm so you can find the tooth. Once you find it, do not hold the root. Rinse it gently in water only without scrubbing or soaping it. Hold the tooth by the crown (the part you see in the mouth) and try to re-insert it into the socket. If it does not go into the socket easily, do not force it, instead place it into a glass filled with saliva, saline solution, or milk (NOT WATER), and call your pediatric dentist immediately. In order for the tooth to have a good prognosis, your child needs to be seen as soon as possible.  After 60 minutes of the tooth being out of the mouth chances of healing are slim. 

The reimplanted tooth will then be splinted by the dentist (an and orthodontic wire will be attached to several teeth around the tooth in question to stabilize it and allow the tooth to attach to the bone again).  Your child will need to see an endodontist (root canal specialist) soon to initiate root canal treatment in order to prevent resorption of the root.

19. What should I do if my child has a toothache?

Rinse their mouth (or irritated area) with warm salt water, floss in between their teeth, and place a cold compress on the face if it is swollen. Give your child either Tylenol or Ibuprofen for pain if it is needed (following the manufacturer’s directions). Do not place aspirin on their gums because this will cause a chemical burn. Call your dentist to see him or her as soon as possible. He or she might first prescribe an antibiotic to start immediately.

20. How safe are dental X-rays?

There is very little risk in dental X-rays. Pediatric dentists are especially careful to limit the amount of radiation to which children are exposed.  See one of our “Clinical Updates” for more detailed information on prescribing x-rays, frequency, and precautions. We use top of the line digital x-ray technology as well as conservative technique and lead aprons to minimize radiation.

21. What is this second row of teeth (permanent teeth coming in behind baby teeth) and what do I do about it?

Frequently, especially in the lower front jaw, permanent teeth will erupt without dissolving the baby tooth root. It results in a double row of teeth which we sometimes call "shark" teeth. On occasion, it is just a matter of time for the baby tooth to come out on its own. However, in many cases the baby teeth will need assistance from a dentist to exfoliate. In our practice we give children two weeks from the time that the permanent tooth breaks the gums to work on "wiggling" the tooth out. After that it is important for the dentist to remove the retained baby tooth and make room for the adult tooth to move forward. The good news is that the tongue will usually push the permanent tooth into its correct position after the baby tooth is removed. Often teeth come in pairs, so if one tooth is not coming in correctly, it's partner on the other side might not either. We might recommend the removal of both "partners" to save patients from visiting our office twice for the same procedure. "Wiggling" of these over-retained teeth is an easy procedure that takes just a few minutes and most children leave excited to have a gift for the tooth fairy.