Pediatric Dentistry

There are a number of issues that parents and pediatric dentists encounter with children’s oral health. Here are some of the more common problems and explanations as to how they occur and how to prevent them whenever possible.

Tooth Decay

Caries, or tooth decay, is a preventable disease. While the presence of dental caries might not endanger your life, it may negatively impact your quality of life.

When your teeth and gums are consistently exposed to large amounts of starches and sugars, acids may form that begin to eat away at tooth enamel. Carbohydrate-rich foods such as candy, cookies, soft drinks and even fruit juices leave deposits on your teeth. Those deposits bond with the bacteria that normally survive in your mouth and form plaque. The combination of deposits and plaque forms acids that can damage the mineral structure of teeth, with tooth decay resulting.

Sensitive Teeth

Your teeth expand and contract in reaction to changes in temperature. Hot and cold food and beverages can cause pain or irritation to people with sensitive teeth. Over time, tooth enamel can be worn down, gums may recede or teeth may develop microscopic cracks, exposing the interior of the tooth and irritating nerve endings. Just breathing cold air can be painful for those with extremely sensitive teeth.

Gum Disease

Gum, or periodontal, disease can cause inflammation, tooth loss and bone damage. Gum disease begins with a sticky film of bacteria called plaque. Gums in the early stage of disease, or gingivitis, can bleed easily and become red and swollen. As the disease progresses to periodontitis, teeth may fall out or need to be removed by a dentist. Gum disease is highly preventable and can usually be avoided by daily brushing and flossing. One indicator of gum disease is consistent bad breath or a bad taste in the mouth.

Bad Breath (Halitosis)

Daily brushing and flossing helps to prevent the buildup of food particles, plaque and bacteria in your mouth. Food particles left in the mouth deteriorate and cause bad breath. While certain foods may create temporary bad breath, consistent bad breath may be a sign of gum disease or another health problem.

Canker Sores

Canker sores (aphthous ulcers) are small sores inside the mouth that often recur. Generally lasting one or two weeks, the duration of canker sores can be reduced by the use of antimicrobial mouthwashes or topical agents. The canker sore has a white or gray base surrounded by a red border.

Orthodontic Problems

A bite that does not meet properly (a malocclusion) can be inherited, or some types may be acquired. Some causes of malocclusion include missing or extra teeth, crowded teeth or misaligned jaws. Accidents or developmental issues, such as finger or thumb sucking over an extended period of time, may cause malocclusions.

Parents have a lot of questions about early dental care, especially when it comes to teething, first teeth, and a child’s first visit to the dentist. See the information below for details on how you can provide the best care for your child through these early stages.

Teething

Normally the first tooth erupts between ages 6 to 12 months. Gums are sore, tender and sometimes irritable until the age of 3. Rubbing sore gums gently with a clean finger, the back of a cold spoon or a cold, wet cloth helps soothe the gums. Teething rings work well, but avoid teething biscuits—they contain sugar that is not good for baby teeth.

While your baby is teething, it is important to monitor the teeth for signs of baby bottle decay. Examine the teeth, especially on the inside or the tongue side, every two weeks for dull spots (whiter than the tooth surface) or lines. A bottle containing anything other than water and left in an infant’s mouth while sleeping can cause decay. This happens because sugar in the liquid mixes with bacteria in dental plaque, forming acids that attack the tooth enamel. Each time a child drinks liquids containing sugar, acids attack the teeth for about 20 minutes. When awake, saliva carries away the liquid. During sleep, the saliva flow significantly decreases and liquids pool around the child’s teeth for long periods, covering the teeth in acids.

Infant’s New Teeth

The primary, or “baby,” teeth play a crucial role in dental development. Without them, a child cannot chew food properly and has difficulty speaking clearly. Primary teeth are vital to development of the jaws and for guiding the permanent (secondary) teeth into place when they replace the primary teeth around age 6.

Since primary teeth guide the permanent teeth into place, infants with missing primary teeth or infants who prematurely lose primary teeth may require a space maintainer, a device used to hold the natural space open. Without a maintainer, the teeth can tilt toward the empty space and cause permanent teeth to come in crooked. Missing teeth should always be mentioned to your family dentist. The way your child cares for his/her primary teeth plays a critical role in how he/she treats the permanent teeth. Children and adults are equally susceptible to plaque and gum problems—hence, the need for regular care and dental checkups.

A Child’s First Dental Visit

A child’s first dental visit should be scheduled around his/her first birthday. The most important part of the visit is getting to know and becoming comfortable with a doctor and his staff. A pleasant, comfortable first visit builds trust and helps put the child at ease during future dental visits. If possible, allow the child to sit in a parent’s lap in the exam room. Children should be encouraged to discuss any fears or anxiety they feel.

Why Primary Teeth Are Important

Primary teeth are important for several reasons. Foremost, good teeth allow a child to eat and maintain good nutrition. Healthy teeth allow for clear pronunciation and speech habits. The self-image that healthy teeth give a child is immeasurable. Primary teeth also guide eruption of the permanent teeth.

Good Diet and Healthy Teeth

The teeth, bones and soft tissue of the mouth require a healthy, well-balanced diet. A variety of foods from the five food groups helps minimize (and avoid) cavities and other dental problems. Most snacks that children eat cause cavities, so children should only receive healthy foods like vegetables, low-fat yogurt and cheeses, which promote strong teeth.

Infant Tooth Eruption

A child’s teeth actually start forming before birth. As early as 4 months of age, the primary or “baby” teeth push through the gums—the lower central incisors are first, then the upper central incisors. The remainder of the 20 primary teeth typically erupt by age 3, but the place and order varies.

Permanent teeth begin eruption around age 6, starting with the first molars and lower central incisors. This process continues until around age 21. Adults have 28 secondary (permanent) teeth—32 including the third molars (wisdom teeth).

If you encounter an emergency situation with your child’s teeth or mouth, please contact us during business hours (See: Our Locations for contact info for the NC office closest to you).

Tooth Ache

Begin by cleaning around the sore tooth meticulously. Using warm salt water, rinse the mouth to displace any food trapped between teeth. UNDER NO CIRCUMSTANCES should you use aspirin on the aching tooth or on the gum. In the event of facial swelling, apply a cold compress to the area. For temporary pain relief, acetaminophen is recommended. Contact our pediatric dentists as soon as possible.

Cut or Bitten Tongue, Lip or Cheek

Ice can be applied to any bruised areas. For bleeding, apply firm (but gentle) pressure with sterile gauze or a clean cloth. If the bleeding does not stop with pressure or continues after 15 minutes, go to an emergency room.

Broken Braces and Wires

Remove a broken appliance only if it comes out easily. If it is lodged or painful to remove, cover any protruding edges with wax, cotton balls, gauze or chewing gum. DO NOT REMOVE any wire caught in the gums, cheek or tongue; call your orthodontist immediately. Emergency attention is usually not required for loose or broken appliances that cause no discomfort.

Broken Tooth

Rinse the area with warm water. Put a cold compress over the facial area of the injury. Recover any broken tooth fragments. Call our office immediately.

Knocked Out Permanent Tooth

Recover the tooth, making sure to hold it by the crown (top) and not the root end. Rinse, but do not clean or handle the tooth more than necessary. Reinsert the tooth in the socket and hold it in place using a clean piece of gauze or cloth. If the tooth cannot be reinserted, carry it in a cup containing milk or water. Because time is essential, call our office immediately.

Possible Broken Jaw

In the event of jaw injury, go immediately to an emergency room.

Bleeding After a Baby Tooth Falls Out

Fold a piece of gauze and place it (tightly) over the bleeding area. Bite down on the gauze for 15 minutes. If bleeding continues, call our office.

Cold or Canker Sores

Over-the-counter medications will usually provide temporary relief. If sores persist, call our office for additional advice or suggestions.

Please refer to our FAQs and answers below to help you understand the needs and importance of Pediatric Dentistry and children’s oral health care.

How should I clean my baby’s teeth?

A toothbrush with soft bristles and a small head, especially one designed for infants, is the best choice for infants. Brushing at least once a day, at bedtime, will remove plaque bacteria that can lead to decay.

At what age should my child see a pediatric dentist instead of our regular family dentist?

“First visit by first birthday” is the general rule. To prevent dental problems, your child should see a pediatric dentist when the first tooth appears, usually between 6 and 12 months of age, certainly no later than his/her first birthday.

Why should my child see a Pediatric Dentist instead of our regular family dentist?

Pediatric dentistry is a dental specialty that focuses on the oral health of young people. Following dental school, a pediatric dentist has two to three years additional specialty training in the unique needs of infants, children and adolescents, including those with special health needs.

What is baby bottle tooth decay and how can I prevent it?

Baby bottle tooth decay is a pattern of rapid decay associated with prolonged nursing. It happens when a child goes to sleep while breast-feeding and/or bottle-feeding. During sleep, the flow of saliva is reduced and the natural self-cleansing action of the mouth is diminished. Avoid nursing children to sleep or putting anything other than water in their bedtime bottle. Encourage your child to drink from a cup as they approach their first birthday. He/she should be weaned from the bottle at 12-14 months of age.

Can thumbsucking be harmful for my child’s teeth?

Thumb and pacifier sucking habits that go on for a long period of time can create crowded, crooked teeth or bite problems. If they are still sucking their thumbs or fingers when the permanent teeth arrive, a mouth appliance may be recommended by your pediatric dentist. Most children stop these habits on their own.

What are dental sealants and how do they work?

Sealants are clear or shaded plastic applied to the teeth to help keep them cavity-free. Sealants fill in the grooved and pitted surfaces of the teeth, which are hard to clean, and shut out food particles that could get caught, causing cavities. Fast and comfortable to apply, sealants can effectively protect teeth for many years.

When should my child start using toothpaste?

Do not use fluoridated toothpaste until age 3. Earlier than that, clean your child’s teeth with water and a soft-bristled toothbrush. After age 3, parents should supervise brushing. Use no more than a pea-sized amount of toothpaste and make sure children do not swallow excess toothpaste.

If my child gets a toothache, what should I do?

To comfort your child, rinse his/her mouth with warm salt water and apply a cold compress or ice wrapped in a cloth on your child’s face if it is swollen. Do not put heat or aspirin on the sore area, but you may give the child acetaminophen for pain. See us as soon as possible.

Is my child getting enough fluoride?

Fluoride has been shown to dramatically decrease a person’s chances of getting cavities by making teeth stronger. Fluoride in the drinking water is the best and easiest way to get it, but to make sure your child is getting enough fluoride, have your pediatric dentist evaluate the fluoride level of your child’s primary source of water. If your child is not getting enough fluoride internally through water (especially in communities where the water district does not fluoridate the water or if your child drinks bottled water without fluoride), your pediatric dentist may prescribe fluoride supplements.

How safe are dental X-rays?

With contemporary safeguards, such as lead aprons and high-speed film, the amount of radiation received in a dental X-ray examination is extremely small. Even though there is very little risk, pediatric dentists are particularly careful to minimize the exposure of child patients to radiation. In fact, dental X-rays represent a far smaller risk than an undetected and untreated dental problem.

My child plays sports. How should I protect my child’s teeth?

A mouth guard should be a top priority on your child’s list of sports equipment. Athletic mouth protectors, or mouth guards, are made of soft plastic and fit comfortably to the shape of the upper teeth. They protect a child’s teeth, lips, cheeks and gums from sports-related injuries. Any mouth guard works better than no mouth guard, but a custom-fitted mouth guard fitted by our doctor is your child’s best protection against sports-related injuries.

When do the first teeth start to erupt?

At about 6 months, the two lower front teeth (central incisors) will erupt, followed shortly by the two upper central incisors. The remainder of the baby teeth appear during the next 18 to 24 months but not necessarily in an orderly sequence from front to back. At 2 to 3 years, all of these 20 primary teeth should be present

What should I do if my child knocks out a permanent tooth?

First of all, remain calm. If possible, find the tooth and hold it by the crown rather than the root. Replace the tooth in the socket and hold it there with clean gauze or a washcloth. If you can’t put the tooth back in the socket, place the tooth in a clean container with milk and take your child and the glass immediately to the pediatric dentist. The faster you act, the better your chances of saving the tooth.

How can I help my child through the teething stages?

Sore gums when teeth erupt are part of the normal eruption process. The discomfort is eased for some children by use of a teething biscuit, a piece of toast or a frozen teething ring. Your pharmacy should also have medications that can be rubbed on the gums to reduce the discomfort.

I noticed a space between my child’s two upper front teeth. Is this cause for concern?

Usually, the space will close in the next few years as the other front teeth erupt. We can determine whether there is cause for concern.

If my child gets a cavity in a baby tooth, should it still be filled?

Primary, or “baby,” teeth are important for many reasons. Not only do they help children speak clearly and chew naturally, they also aid in forming a path that permanent teeth can follow when they are ready to erupt. Some of them are necessary until a child is 12 years old or longer. Pain, infection of the gums and jaws, impairment of general health and premature loss of teeth are just a few of the problems that can happen when baby teeth are neglected. Also, because tooth decay is really an infection and will spread, decay on baby teeth can cause decay on permanent teeth. Proper care of baby teeth is instrumental in enhancing the health of your child.

What causes tooth decay?

Four things are necessary for cavities to form — a tooth, bacteria, sugars or other carbohydrates and time. Dental plaque is a thin, sticky, colorless deposit of bacteria that constantly forms on everyone’s teeth. When you eat, the sugars in your food cause the bacteria in plaque to produce acids that attack the tooth enamel. With time and repeated acid attacks, the enamel breaks down and a cavity forms.

When should my child have their first visit?

The American Academy of Pediatric Dentistry recommends that children be seen at 12 months of age. This first appointment will introduce you and your child to the office and we will provide additional information on diet, oral hygiene and allow us to answer any questions you may have.

When you arrive for your child’s first visit, please be prepared to complete all insurance and health information forms that will allow us to begin your child’s dental treatment. We will ask you to fill out several forms that will get you acquainted with our office. It may be more convenient for you to download the New Patient Forms from this website and bring them with you to the appointment. It is also important for you to bring your insurance information with you so we can properly submit your claim for you.

The initial appointment will last approximately one hour. Oral hygiene instructions will be provided along with suggestions to help you care for your child’s teeth. In most cases, a cleaning, fluoride treatment and possibly X-rays will be provided, along with an evaluation that will outline any existing dental problems and proposed treatment.

Our practice can provide a wide range of dental services for your children. Our flexibility in our services saves you time and keeps your total dental care within one practice. Our emphasis is on total preventive care for our patients. Total care begins with regular hygiene visits, regular check-ups and continued home oral health routines.

We provide many preventative measures to keep your child’s teeth clean and healthy, including sealants and fluoride treatments. We also educate the parents in early detection of some common problems children may face, including thumb sucking, bruxism and baby bottle tooth decay.

Our primary goal for your children’s dental development is to achieve and maintain optimum oral health through advances in techniques, technologies and by maintaining their scheduled dental exams.

Teeth Cleanings

Schedule an annual routine dental cleaning for your child. During this visit, one of our dental hygienists will remove plaque from their teeth, especially from places where a toothbrush can’t reach, such as underneath the gum line and in-between teeth. We will then clean your child’s teeth and apply fluoride to help protect their teeth once they leave the office.

Fluoride is a relatively recent but important advancement in dental and oral health. Studies consistently show that a moderate but consistent exposure of teeth to fluoride helps strengthen and rebuild tooth structure, and helps prevent future decay.

If your child is due for their annual dental cleaning, please contact us to schedule an appointment.

Teeth Cleanings

Schedule an annual routine dental cleaning for your child. During this visit, one of our dental hygienists will remove plaque from their teeth, especially from places where a toothbrush can’t reach, such as underneath the gum line and in-between teeth. We will then clean your child’s teeth and apply fluoride to help protect their teeth once they leave the office.

Fluoride is a relatively recent but important advancement in dental and oral health. Studies consistently show that a moderate but consistent exposure of teeth to fluoride helps strengthen and rebuild tooth structure, and helps prevent future decay.

If your child is due for their annual dental cleaning, please contact us to schedule an appointment.

Fillings

A “filling” is a material designed to replace and restore tooth structure that is damaged due to decay or fracture. Several types of filling restorations are available. Our doctors will decide which one will work best for your child.

Understanding Fillings

A common question we get is about patients trying to understand the difference between white fillings and silver Amalgam fillings. Here is what we tell them:

• White fillings bond to the tooth; they strengthen the tooth by restoring most of its original shape. Silver amalgams, on the other hand, weaken the teeth and make them more susceptible to breaking. Broken teeth can be very expensive to replace; white amalgam can actually save time and money in the long run.
• White filling composites are preferred by most patients. This is due to the natural color, strength and overall appearance and feel. Composites are naturally more comfortable.
• Hot and cold sensitivity is greatly reduced with composite material compared to the silver/mercury amalgams.
• Restorations with composites require less removal of tooth, less structure to place than those with amalgams and especially with new cavities. Dramatically smaller holes are needed with a composite.

Sealants

Sealants serve as a barrier against tooth decay which often occurs in the grooves on the chewing surfaces of the back teeth where plaque tends to accumulate.

A sealant is a plastic material (resin) applied to the chewing surfaces of the back teeth-the premolars and molars. The resin bonds to the depressions and grooves (called pits and fissures) in the back teeth.

Sealants are necessary because the back teeth have uneven pits and fissures that are difficult to keep clean. The pits and fissures hold plaque and food debris that toothbrush bristles cannot reach. Most tooth decay occurs in these hard-to-clean grooves. Sealants form a thin covering to keep out plaque and debris and decrease the risk of decay.

Children and teenagers are primary candidates for sealants because of the likelihood of developing decay begins as soon as the back teeth appear. Sealants are usually placed on the surface of the teeth that have not been previously filled and show no signs of decay.

Fluoride

Fluoride is a substance that helps teeth become stronger and resistant to decay. Regularly drinking water treated with fluoride and brushing and flossing regularly ensures significantly lower cavities. Dentists can evaluate the level of fluoride in a primary drinking water source and recommend fluoride supplements (usually in tablets or drops), if necessary.

Tooth Extractions

General Extractions

An extraction is the complete removal of a tooth. Extractions are sometimes necessary if a primary tooth is preventing the normal eruption of a permanent tooth, if the tooth has suffered extensive tooth decay or trauma that cannot be repaired, if the patient has gum disease, or if the tooth is impacted (usually the wisdom teeth). Depending on the complexity of the case, an extraction can be performed surgically or non-surgically. A mild anesthesia is used to ensure your child is as comfortable as possible throughout the procedure.

Wisdom Teeth

The third molars are more commonly called “wisdom teeth.” Usually appearing in the late teens or early twenties, third molars often lack the proper space in the jaw to erupt fully or even at all. This common condition is called impaction. When any tooth lacks the space to come through or simply develops in the wrong place of the jaw and becomes impacted, problems can arise. Primarily, damage to adjacent teeth and crowding occur.

In certain cases, the wisdom tooth that cannot come through becomes inflamed under the gums and in the jawbone, causing a sac to develop around the root of the tooth that then fills with liquid. This can cause a cyst or an abscess if it becomes infected. If either of these situations goes untreated, serious damage to the underlying bone and surrounding teeth and tissues can result. To potentially stave off this result, an extraction of one, several or all of the wisdom teeth may be advised. If that is the case, we have the equipment and training needed to perform such extractions, with an absolute minimum of discomfort.

Ask our staff for more information regarding tooth extractions if you feel your child may need one.

Bonding

Bonding is a common solution for

• Fixing or repairing chipped or cracked teeth
• Reducing unsightly gaps or spaces between teeth
• Reducing unsightly gaps or spaces between teeth

Bonding is often used to improve the appearance of your teeth and enhance your smile. As the name indicates, composite material, either a plastic or resin, is bonded to an existing tooth. Unlike veneers or crowns, composite bonding removes little, if any, of the original tooth.

Composite bonding has many advantages:

• It is a quick process, which typically lasts less than one hour.
• It does not reduce the tooth’s original structure and is relatively inexpensive.
• Composite resins come in many different shades and provide better matching of shades to the natural color of the teeth.
• Composite bonds, however, are not as durable and long-lasting as veneers and crowns and may need to be re-touched or replaced in the future.
• Composite bonds stain more easily and therefore require proper care and regular cleaning. In order to ensure the longest possible duration of the bonding, composites should be brushed and flossed daily. Common staining elements include coffee, tea, tobacco, foods and candy.

Proper oral hygiene is critically important for our children. Establishing healthy habits in terms of dental care and keeping excellent care of primary and new teeth is an important job for parents. Below are our tips for best practices for pediatric oral hygiene. Please contact our office with any questions or to schedule an appointment for your child.

Brushing

Use a toothbrush with soft bristles and a small strip of fluoride toothpaste, unless the child is under the age of 3. If a child is younger than age 3, parents should clean their child’s teeth with water and a soft-bristled toothbrush. After age 3, parents should supervise brushing. Use no more than a pea-sized amount of toothpaste and make sure children do not swallow excess toothpaste.
When you brush your teeth, move the brush in small circular motions to reach food particles that may be under your gum line. Hold the toothbrush at an angle and brush slowly and carefully, covering all areas between teeth and the surface of each tooth. It will take you several minutes to thoroughly brush your teeth. Brush up on the lower teeth, down on the upper teeth and the outside, inside and chewing surface of all of your front and back teeth. Brush your tongue and the roof of your mouth before you rinse.

Brush your teeth two to three times daily to avoid the accumulation of food particles and plaque.

As soon as the bristles start to wear down or fray, replace your toothbrush with a new one. Do not swallow any toothpaste; rinse your mouth thoroughly with water after you finish brushing. It is important to carefully floss and brush daily for optimal oral hygiene.

Flossing

For areas between the teeth that a toothbrush can’t reach, dental floss is used to remove food particles and plaque. Dental floss is a thin thread of waxed nylon that is used to reach below the gum line and clean between teeth. It is very important to floss between your teeth every day.

Pull a small length of floss from the dispenser. Wrap the ends of the floss tightly around your middle fingers. Guide the floss between all teeth to the gum line, pulling out any food particles or plaque. Unwrap clean floss from around your fingers as you go, so that you have used the floss from beginning to end when you finish. Floss behind all of your back teeth.

Floss at night to make sure your teeth are squeaky clean before you go to bed. When you first begin flossing, your gums may bleed a little. If the bleeding does not go away after the first few times, let a staff member know at your next appointment.

Diet Control

The teeth, bones and soft tissues of the mouth require a healthy, well-balanced diet. A variety of foods from the five food groups help minimize and avoid cavities and other dental problems. Consumption of foods that contain sugars and starches should be decreased. These foods can include candies, cookies, chips and crackers. Healthier foods, such as vegetables, low-fat yogurt and cheeses, help promote stronger teeth.

Dental Visits

You should visit your general dentist twice a year (once every six months). In order to maintain a healthy smile, it is vital to have professional cleanings and regular check-ups. Your dentist will examine your teeth and provide an evaluation of existing dental problems and proposed treatment. If you have a dental emergency, you should call us immediately.

We understand that you may have a lot of questions regarding care for your child and his or her teeth post-dental treatments. We will address many of the common post-treatment procedures here for your reference. We invite you to contact us with any additional questions or concerns you may have.

Local Anesthetic (Numbing)

If your child’s treatment requires the use of a local anesthetic (numbing), please be aware that the length of time he or she may be numb may vary. Numbness of the upper teeth can last approximately 2-4 hours. Lower teeth can be numb for approximately 3-5 hours. A very soft diet during this time is required (examples: yogurt, soups or applesauce). A regular diet can be resumed when the child no longer feels numb.

Cheek Biting

It is important to note that when a child (especially younger children) experiences the sensation of numbness, they have a tendency to pinch or chew their lip, tongue or cheek. To prevent this, have your child bite on a cotton roll or wet washcloth until the numbing subsides. If you suspect that cheek or lip biting has occurred, here are some symptoms to look for:

• Mild to severe swelling of lip, tongue or cheek
• White or grayish patch of skin on lip, tongue or cheek
• The affected area feels warm to the touch.
• Fever

What To Do

We recommend giving your child ibuprofen (Advil, Motrin), a soft diet and the use of a cold compress. If your child develops a fever and/or the area feels warm to the touch, or the swelling is severe, call our office for further instructions.

Extractions (Tooth Removal)

If your child’s treatment requires extractions, have them bite on gauze for 30 minutes to help control the bleeding. If bleeding continues, have them bite on a wet tea bag for an additional 30 minutes. If bleeding still persists, contact the office where your child was treated.

Keep the area clean, but do not allow your child to brush or rinse vigorously. Instruct them to keep their tongue out of the area, and do not allow them to drink through a straw for at least 24 hours. Your child may eat and drink after the bleeding is controlled, but should have a soft diet for 24 hours. Motrin may be given for any discomfort. If any problems arise, please contact us.