Tooth tips

Tooth decay

How a pediatric dentist treats tooth decay depends on what he or she finds. Fillings may be needed to repair mild decay. Severe decay may require a crown, root canal or removal of the tooth.

A filling is a substance that replaces a decayed or broken part of a tooth. Commonly used materials include metal, alloy, plastic, porcelain or composite (a combination of materials). Because they’re usually tooth-colored, composites are often used on front teeth.

Crowns are used to repair teeth that are broken or show so much decay, a filling isn’t enough. They may be made of gold, porcelain or a combination of man-made materials.

In a root canal procedure, the infected core (or pulp) of a tooth is removed to relieve a toothache, stop the infection and promote healing.

Tooth decay and cavities can be avoided if children receive regular dental checkups beginning at age 1, a healthy diet and daily brushing and flossing.

Fluoride helps teeth stay healthy

Pediatric dentists have a good reason for asking about your family’s water supply. They want to determine if your children are getting enough fluoride, which helps develop healthy teeth and prevents early tooth decay, one of the most common childhood diseases.

More than 25 percent of 2- to 5-year-olds are found to have one or more cavities, says the Centers for Disease Control and Prevention.

Fluoride stops the acid produced by bacteria (plaque) from eating away tooth enamel (the hard, shiny substance that protects teeth). It can reverse low levels of tooth decay and keep new cavities from forming.

Generally, most children receive the right amount of fluoride through a combination of fluoridated toothpaste and fluoridated water and children under 6 months don’t need supplements. If you give your child bottled water, check the label to be sure it’s fluoridated. Bring your questions about fluoride to your child’s next dental visit.

What’s so special about pediatric dentists?

Why choose a pediatric dentist? Dentists who specialize in children’s oral health have advanced dental education and experience in child behavior. They dedicate their practice to the diagnosis and treatment of children, including those with special needs. These dental experts and their assistants know how to treat your child! Their first priority is to put their young patients at ease. Guided by body language, facial expressions and words (if the child can verbally communicate), the dental team assesses who needs extra time to adjust to the surroundings.

Children receive lots of praise and explanations. Using the “Tell-Show-Do” technique, the dentist or dental assistant introduces a tool to the child and demonstrates how it’ll be used before the work begins. Answering questions honestly, but with special terms, also helps. For example, the dental team gives “sleepy juice,” not shots, which makes a part of the mouth “feel like your arm or foot is falling asleep.” The saliva suction tool is called Thirsty Charlie. A high-speed drill is Mr. Whistler. The dentist “wiggles the tooth out,” instead of pulling it. Cotton rolls are tooth pillows and fluoride is tooth vitamins. Starting regular dental checkups from age 1 will make your child a confident, happy dental patient for life.

Ease the teething blues

Baby’s first tooth means it’s time to schedule his or her first dental visit and deal with teething. Tender gums can interrupt sleep and make children irritable, drool and constantly chew on things. Cold-like symptoms may also develop. (If a high fever occurs, call your pediatrician.)

To ease the pain, have clean chilled teething rings and washcloths on hand. Swap them out as needed. Massaging baby gums with your clean finger may also help relieve pressure from the incoming tooth. Contact your child’s pediatrician before using over-the-counter pain medication.

Teeth generally emerge between the ages of 6 months and 3 years, but the time line depends on the child. Typically, the two bottom-front teeth push through first. Even before teeth come in, pediatric dentists advise parents to wipe children’s gums after feedings so that they get used to having their mouth cleaned.

Gingivitis

Gingivitis, or gum disease, affects children and adults. If caught early enough, this infection is treatable. Parents and caregivers should check for the following warning signs:

  • Bleeding gums at any time (including during brushing and flossing)
  • Bright red, swollen gums
  • Gums that pull away from the teeth (sometimes exposing the roots)
  • Constant bad breath that doesn’t go away, even with brushing and flossing
  • Children who suffer from Type 1 diabetes may be more susceptible to this disease

A gum exam should be part of every dental checkup your child receives. Gingivitis is 100 percent preventable if parents take children for regular dental visits starting at age 1 – or when the first tooth appears – and brush and floss their teeth twice a day. Use just a smear of toothpaste for youngsters under age 2. A pea-sized amount is right for children ages 2 to 5. Begin flossing when the gaps between the teeth close.

Sand timers

Getting children to brush

“Two” is the magic number when it comes to healthy teeth. Dentists recommend brushing a minimum of twice a day – after breakfast and just before bedtime – for at least two minutes. Since that can be a very long time for children, The Center’s Dr. Amy Kim suggests these fun ways to keep them going:

  • Pick a song that’s about two minutes long and sing it during toothbrush time. Or, play two minutes of a tune from the radio or a child’s favorite CD. Use the first 60 seconds for the top teeth and the other 60 seconds for the bottom teeth.
  • Place a timer in the bathroom, one that indicates minutes and seconds, or even an old-fashioned egg timer that uses sand.
  •  Get a brush that lights up. The Firefly toothbrush, for example, flashes a light for 60 seconds at a time.

Mr. Molar makes a new friend.

Wiggly teeth

To pull or not to pull loose baby teeth? That’s a question all parents and caregivers face.

“Baby teeth should be left alone to fall out naturally,” says Dr. Ana Lucia Seminario, The Center’s interim chair. “If these teeth are bothersome, encouraging children to do the pulling themselves would be the first option, as they can better control how much discomfort they can tolerate.”

Eating apples is an easy and stress-free tool to help the wiggly tooth fall. There are some circumstances when consulting with your pediatric dentist is recommended: If the child is experiencing considerable pain or has special care needs (to avoid risk of aspiration) or has permanent teeth coming out in an undesirable position.

“Swallowing a tooth will not cause harm to the child,” says Dr. Seminario. “However, it may be a tooth fairy disappointment.”

Teeth grinding

Teeth grinding (or “bruxism”) may sound scary coming from young mouths, but it usually isn’t harmful. Grinding is common in children under age 7 and typically stops when their six-year permanent molars come through.

Pain from an earache or teething, an abnormal bite (the top and bottom teeth don’t meet) or a change in routine – such as a new sibling or school – can cause children to grind their teeth while sleeping. Middle- and high-school-age students may suffer stress-related grinding when they’re facing a major test.

In some cases, a child is angry or unable to verbally express frustration about something. Children who are hyperactive or have certain medical conditions, such as cerebral palsy, may also grind.

Tell your pediatric dentist about any grinding or jaw clenching that you or family members have noticed. (People often don’t know that they’re doing this.) Also mention if your child complains of a sore jaw or face in the morning or pain when chewing.

Grinding can wear down tooth enamel, chip teeth or increase sensitivity. If the child has baby teeth, the dentist may say nothing needs to be done.

Older children might need a plan that protects their permanent teeth, but doesn’t affect normal growth. The dentist may prescribe a special night guard that takes some getting used to, but provides quick results.

Most children outgrow bruxism, but until they do, parental observation and dental visits are needed to keep the situation in check.

Sealants

Sealants are thin plastic coatings that protect teeth from decay. They’re applied to the grooves on the back teeth to keep out germs and food particles. It’s best to apply sealants soon after the first permanent molars come up and before decay starts to occur – at about age 5 or 6. Second permanent molars emerge at about age 12 and these teeth should receive sealants, too.

The process is easy. A special gel sits on the chewing surface for a few seconds, the tooth is washed and dried and the sealant is painted on. A protective shield forms in about a minute. Sealants are hardly visible and can last for several years, then are reapplied.

Primary teeth

Children are born with 20 primary teeth. Each one is important for helping them speak normally and chew naturally. “Baby” teeth also control the growth pattern of the face and hold space for permanent teeth to come in properly. After feedings, gently wipe your baby’s gums with a clean soft cloth or a two-inch square of gauze wrapped around your finger. This removes plaque and bacteria. When the first tooth appears, schedule a pediatric dental visit and begin using a soft-bristle, age-appropriate toothbrush twice a day. Add a “smear” of fluoride toothpaste at age 2.

Halloween

During Halloween week, children can have their candy and clean teeth, too. Try to serve them a healthy, hearty meal before trick-or-treating, so they’ll be less tempted to gorge on sweets. When they come home, hand out glasses of water to wash away some of the sugars and neutralize acids. No matter how tired they are, children should brush well and floss before bedtime. Afterward, let children make withdrawals from a “candy bank” so you can control how much they eat and when.

Dental appointments

The earlier children begin going to the dentist, the more comfortable they’ll be with exams throughout their life. Schedule their first appointment when they turn 1. Children can zero in on a parent’s fears, so if you’re afraid, the less you say the better. If you fuss or tell children how brave they are, they may think something scary will happen. Instead, share a book about going to the dentist. Mention that dentists and dental assistants like children and help them keep their teeth healthy.

Tooth injuries

Two injuries require an immediate trip to a pediatric dentist. If a tooth is knocked out, rinse it under warm water, gently push it back in the socket and hold it there or place it in a cup of milk or cool water. Remember to bring the tooth with you! Don’t scrub the tooth or remove attached tissue. For a broken tooth, gently clean the injured area with warm water. Place cold compresses on the face to decrease swelling.

Dental visits

To get the most out of your child’s dental visits, don’t be shy. Tell the dental assistant or dentist how your child is feeling. Describe the medications he or she takes and include drug allergies. If you don’t understand the dentist’s explanations, ask questions. If treatment is required, make sure you know why and what it involves. Ask if there are other options, how they differ in cost and which the dentist thinks will best fix the problem.

Healthy snacks

If the whole family enjoys healthy snacks, children will want them, too. A healthy snack is low in sugar and high in nutrients – just what young teeth and mouths need. Keep low-fat string cheese and yogurt, milk and cut fruit and veggies on hand. Let children choose healthy options at the store and mix-and-match them with hummus, low-fat dips or whole-grain crackers. Limit the number of snack times and save “fun foods” for special occasions.

Flossing helps teeth and gums

By age 2, daily flossing is preferred. It removes food and plaque from between the teeth. Plaque is the sticky yellow substance that forms on teeth after eating things like bread, raisins, cookies and cake and drinking milk or soda. Bacteria grows on the plaque and forms an acid that leads to tooth decay. It can get past the gums, damage the bone and destroy the root.

To floss your child’s teeth, wrap the floss around your fingers and glide it between the teeth in a C-shaped motion. Be gentle! Forcing the floss between teeth can make the gums bleed, which can scare children into thinking that flossing hurts (it shouldn’t). To prevent bacteria from spreading in the mouth, use a new section of floss each time you move between two teeth.

Thumb sucking

Most children outgrow thumb sucking by age 5. If it continues when permanent teeth start coming in, dental or speech problems may occur. Children can develop teeth that stick out or don’t close properly or a lisp. Older children often get teased for thumb sucking, which makes them secretive and ashamed. Stress, anxiety or other emotional issues should be addressed first. Ask your pediatric dentist for advice. Breaking this habit requires patience, love and encouragement from parents and caregivers.

Sippy cups and bottles

Children and parents love sippy cups and bottles because they are familiar and because there are no spills! We recommend that children are weaned from the sippy cup and bottle by age 1. If your child uses either after that age, be sure that it doesn’t contain juice, soda or other sweet liquids. A cup or bottle filled with sugary beverages encourages their use and greatly increases the risk for cavities.

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