Children's Dentistry

About Children's Teeth

The first set of teeth is known by several names such as baby, deciduous, primary or succedaneous teeth. Not only do these teeth function to help children get nutrition and to look cute, but they also hold the space needed for some of the permanent teeth to later erupt. These deciduous teeth are capable of getting cavities and bacterial abscesses so it is important to keep them clean from the very beginning and important to fix them when they have cavities.

Sometimes babies are born with teeth, or teeth can erupt very early on and these teeth are called neonatal teeth. These can be the primary teeth or they can be little enamel pearls that will later fall out.

Home care should begin as early as possible. Good oral cleaning habits are difficult to instill in older children so I recommend beginning early in life. I recommend cleaning infant teeth with a cotton ball or something similar. The most important area to clean on teeth for patients of all ages is the gum line. As children grow from infants to toddlers and older, there are a variety of dental hygiene products available such as cotton finger coverings, modified teething rings with brushes and baby toothbrushes. Even very basic, inexpensive electric toothbrushes can be great for children. There is no precise product that is best for everyone, so use your own judgment in selecting what you use. Early habits are extremely important to build and you do not want to instill objection to these habits. Try not to force tooth brushing or flossing on children when they may be more cooperative at another time. Brush your children’s teeth for them until you are sure that they are capable of doing an adequate job on their own and even then, inspect their work from time to time. I recommend having the child lie on their back either on your lap or on a bed so that their mouth is up (like in a dental chair) and you have better access to see and for better lighting. You might even consider those camping headlights that strap to your head. Here is an idea that I had: When my daughter was still an infant, I wanted her to get used to the idea that flossing was normal. I found berry flavored floss and I would introduce her to the flavored floss even before she had teeth. I couldn’t say for sure if this helped my daughter build a better flossing habit but I don’t think that it hurt.

Diet plays an important role in tooth health from infancy on. “Baby bottle caries” is the term used for small children who sleep with a bottle full of milk or acidic juices, and develop a lot of decay early in life. It is best to not send children to bed with a bottle and if you do use a bottle at night, water would be preferred. In general, children of all ages should avoid over exposure to acidic, sticky and or sweet foods. Surprisingly, raisins can be bad for teeth even though we think of them as a healthy snack because they stick to the teeth and provide a sustained supply of sugar to any bacteria that may be lurking. Other bad products are the increasing number of sour candies available on the market today. The sour component is acid and can even be citric acid which is vitamin C. While vitamin C is good and we need it, a frequent prolonged exposure to teeth with vitamin C could be catastrophic. Chewable vitamins can actually be bad for teeth because of their high vitamin C content. Limit other sources of acid like sodas, juices, etc. What do you think about fruit wraps; healthy or potentially harmful for teeth?

Floss should be used to clean any teeth that are touching other teeth. If the primary teeth come in with big gaps, all surfaces can be adequately cleaned with a brush. Sometimes children as young as 2 can present with a lot of cavities. That situation is more complicated than with older children because managing fillings will be more difficult with younger children. Floss holders are often a good option to use because they are smaller than two adult fingers.

Water flossers like the WaterPik brand can clean areas not cleansable with other implements. It would be a great option for all kids with braces. I am not sure which age is good to begin using a water pik. 10 to 12 is probably a good age range to begin assessing your child’s potential to use a water pik.

Fluoride is found naturally in the environment in vegetables and in water supplies. It is a vital component of teeth and is incorporated in teeth as they develop under the gums. With studies comparing fluoride intake and cavity rates, we know that too little fluoride results in weaker teeth and too much fluoride can cause discolored teeth. So, there is an ideal range of fluoride for teeth formation and wouldn’t you want that for your child? Today, many municipal water sources fluoridate water supplies but many children drink filtered or bottled fluids. Bottled water containing fluoride is now available as are fluoride supplements. Most fluoride supplements are given by pediatricians as they see children earlier than dentists do. As a result, dentists that I know rarely will prescribe fluoride but we are all able to. Be careful, some fluoride supplements have Vitamin C as an added component. This seems counterintuitive to me because of the acidity of vitamin C. Once formed and in the mouth, the surface of teeth can lose fluoride when exposed to acid and can reabsorb fluoride when fluoride is available to the teeth. Fluoridated water is not concentrated enough for this function of re-mineralizing the tooth surface but rather fluoridated water is ideal for helping teeth reach optimal hardness while still forming under the gums. Fluoridated toothpastes help remineralize teeth as do fluoride treatments which are common at dental cleanings for children to age 14 and now also for seniors with high cavity rates.

Toothpaste comes in many varieties. The function of toothpaste is to provide fluoride and to help foam bacteria away. Some toothpastes contain antibacterial agents and lately there has been controversy about that. Sodium Lauryl/Laureth Sulfate (SLS) is a detergent additive found in many toothpastes. Some people are allergic to SLS and they may notice a string like accumulation of their surface cells as the cells slough off of their cheeks and gums. I am not aware of any meaningful, long term consequences of this SLS sensitivity but there are SLS free alternatives if this is a concern. The most important aspect of cleaning teeth is to mechanically remove plaque with a toothbrush, water flosser and floss. Therefore, I sometimes recommend brushing children’s teeth without toothpaste if they do not tolerate the toothpaste. Unless there are specific goals of a toothpaste (cavity prone patients, patients with sensitive teeth, etc.), I go for the most pleasant taste.

Timing for first visits varies from individual to individual. Certainly if you see a dark spot or other perceived problem, give your dentist a call. Commonly, people will bring their children to a dentist between 2.5– 4 years of age for a first visit. Our philosophy is to introduce children to the office at their own pace. We try to make every visit a positive one. For example, if a child is having a bad day and doesn’t want to cooperate, we might just speak briefly in a friendly voice, give them a “prize” and invite them to visit us again for more fun. Some first visits progress to a full exam and cleaning.

Sealants are special fillings that are painted onto the biting surface of molars to make rough uncleanable surfaces smooth and easily cleanable. We prepare and clean the surface, double check for the absence of decay and then apply and harden the sealant. This is commonly done on the first permanent molars and can only be done well when the teeth are fully erupted into the mouth. Some dentists disagree with performing sealings stating that it is also possible to “seal in” undetected decay. There is a separate topic devoted to sealants on this website.

Braces are best done during the growth phases. Orthodontists and some general dentists will evaluate and treat patients who may need and/or desire braces. Often we wait until the age of 8 or 9 for the referral to the orthodontists but the orthodontists may not begin immediately. Instead, they may follow the growth and development of your child until just the right time. More and more, adult orthodontia is increasing in popularity.

Frequently Asked Questions about Pediatric Dentistry

When should my child first visit the dentist?

Recent American Dental Association recommendations are that children begin appointments at age 1. As a parent myself, I can tell you that this is too early for most children to actually do any exam or cleaning. The ADA probably wants dentists to do nutritional counseling and to do quick visual exams. I recommend that parents occasionally inspect their child’s teeth. Using a flashlight, lay your child on a bed face up and look for anything unusual. I am happy to see children as early as 1 and I think that 2.5-3 is also a good range to see kids for a first visit. Know that my goal is always for a non threatening visit. If your child is tired and not having a good day, the visit might be a trip to the toy box for a good memory of the office and we’ll try again at a later date. Some kids allow exams and cleaning but again, this is unpredictable. As for nutritional counseling, here are some basics:

Don’t let children fall asleep with juice in a sippy cup or bottle. The acid from the juice can easily cause cavities if left on the teeth for a prolonged period.
Know that fruit and juice is acidic and it is a good idea to brush or at least rinse afterward if practical.
Use caution with fruit roll ups and raisins as these foods are sticky and will keep sugar and acids on the teeth where they remain.
Sugar is not bad for teeth but sugar is converted into acid when there is plaque (bacteria) around. Therefore it is necessary to begin cleaning a child’s teeth as soon as the teeth are in.

How important are baby teeth?

Baby teeth are very important to your child’s health. They certainly can develop cavities which if left unchecked, could lead to infections, swelling and pain. If there is early tooth loss, the neighboring teeth can drift into the space of the lost tooth and this can block a permanent tooth from erupting. Baby teeth also allow your child to learn how to properly chew and get nutrition. And, don’t forget about the role of teeth in those family photos!

Is it normal to have a child’s permanent lower front teeth come in way behind the baby teeth?

Several times a year I get a frantic call from a parent stating that they are concerned that it looks very wrong when permanent teeth are erupting way behind the lower front baby teeth. In fact, this is common and normal. Once the adult tooth erupts higher, the tongue can exert force on it to move it forward and the baby tooth will then become loose and fall out.

What methods of sedation or management are used for children that are unable to cooperate?

Many children’s specialists and some general dentists are comfortable using some form of sedation for children that have dental needs but are unable to cooperate. Because of safety concerns, there are now more regulations concerning sedation. Any dentist wishing to use sedation for any patient must have had special training and must maintain extra continuing education specific to sedation. Here are some very basic categories of what can be used:

Oral sedation. With children, this is usually in the form of a mixture of liquid medications.
I.V. sedation: This type of sedation might be started with an injection prior to beginning the I.V. line.
General Anesthesia: This type of anesthesia is probably more common in a hospital setting.
Lastly, some dental offices might employ a dental anesthesiologist to come to their office to provide the sedation.

When parents are faced with decisions on how to manage their loved ones dental needs, ask your dentist as many questions as you need to in order to be comfortable. There are risks associated with even the local anesthetic that many patients call “novocaine”. As techniques and medications continue to evolve, dental anesthesia will become safer but I still stress to anyone reading this to seek out current information.

How to prepare for your child’s trip to the dentist:

Before your visit – It is important not to influence your child in a negative way by using the dentist as a threat or punishment or by complaining or venting about your dislike of dental visits where your child can overhear. I have heard numerous times where a parent might be frustrated and tell a child something like “you had better behave or I will take you to the dentist and he/she will pull out your teeth”. Another type of communication may be well meaning but can have the opposite effect. For example, when you take a child to the zoo, if you say “don’t worry, the Lion won’t eat you”, the child might ponder the fact that Lions could eat people. So I would recommend that you not tell your child “don’t worry, the dentist won’t hurt you”. Instead, you could consider telling your children about fun or interesting things that might take place during the dental visit like “The dentist is going to count your teeth and make them shiny”. If your child is fearful, you can emphasize that the dentist is gentle and that they will probably have fun but be careful not to say something that isn’t true because you do not want your child to lose trust in what you say. One parent recommended role playing with your children to educate them in a comfortable environment. You can also tell them about a wonderful toy box which has a variety of fun toys for the kids to choose from after visits. Of course nobody knows your child like you do so ultimately, use your own judgment. If you have questions or concerns about a visit I would suggest that you call your dental office prior to the appointment. It is always better for the dentist to know your concerns and for you to be familiar with treatment philosophies before the appointment to minimize confusion and to create a more harmonious atmosphere for your child.

During your visit – (Pre - Covid) Some but not all dentists might invite parents to join them in the treatment area and to observe the treatment. Many parents may prefer to browse magazines in the reception area. If you get the option to join in the treatment area, I would suggest the following in order to help your child receive treatment in the safest possible manner.

1) I recommend that you do not speak to your child during the appointment. Your child is tuned to your voice and you could channel your child’s attention away from the dental team.

2) Please do not touch your child. Your loving attempt to hold your child’s hand or leg will again take their attention away from the dentist and this could be a safety issue.

If the appointment is an easy one, the dentist may invite you into conversation and to come close to view the procedure but please initially follow the dentist’s requests. During COVID and possibly beyond, it is not common for parents to be invited into the treatment area.

After your visit – Reinforce positive experiences like the toy box or the nice dentist or assistant. Talk about how good their teeth feel and how healthy their mouth is after visiting the dentist. If anesthetic is used, observe your child until the numbness is gone to be sure your child does not chew his/her lip or tongue. For nutrition during numbness, try blended foods or soups but avoid hot foods or foods that need to be chewed. Call your dentist if you have any questions or concerns.