Click on a topic of interest for more information.

What is a Pediatric Dentist?
Your Child's First Dental Visit
Why are the Primary Teeth so Important?
Dental X-rays
Care of your Child's Teeth
Good Diet = Healthy Teeth
How Do I Prevent Cavities
Seal Out Decay
Baby Bottle Tooth Decay (Early Childhood Caries)
When will my Baby Start Getting Teeth?
Eruption of your Child's Teeth
Dental Emergencies
Fluoride
What's the Best Toothpaste for my Child?
Does your Child Grind his Teeth at Night? (Bruxism)
Thumb Sucking
Tongue Piercing - Is it Really Cool?
Tobacco - Bad News in Any Form
What is the Best Time for Orthodontic Treatment?
Mouth Guards

For more information on oral health care needs, please visit the website for the American Academy of Pediatric Dentistry.

 Your Child’s First Dental Visit

Your child should visit the dentist by his/her 1^st birthday. You can make the first visit to the dentist enjoyable and positive. Your child should be informed of the visit and told that the dentist and her staff will explain all procedures and answer any questions. The less to-do concerning the visit, the better.

 Why Are The Primary Teeth So Important?

Radiographs (X-rays) are a vital and necessary part of your child’s dental diagnostic process. Without them, certain dental conditions can and will be missed.

X-rays detect much more than cavities. For example, X-rays may be needed to survey erupting teeth, diagnose bone diseases, evaluate the results of an injury, or plan orthodontic treatment. X-rays allow dentists to diagnose and treat health conditions that cannot be detected during a clinical examination. If dental problems are found and treated early, dental care is more comfortable for your child and more affordable for you.

The American Academy of Pediatric Dentistry recommends X-rays approximately once a year for most children, and every 6 months for children with a high risk for tooth decay.  The Academy also recommends a panoramic X-ray (of the entire mouth) around age 8, and again around age 15, to assess growth and development.

Pediatric dentists are careful to minimize the exposure of their patients to radiation. We use a digital X-ray system, which provides up to 90% less radiation than conventional X-rays. With contemporary safeguards, the amount of radiation received in a dental X-ray examination is extremely small. The risk is negligible. In fact, the dental X-rays represent a far smaller risk than an undetected and untreated dental problem. Lead body aprons will protect your child. Today’s equipment filters out unnecessary X-rays and restricts the X-ray beam to the area of interest. Digital X-rays and proper shielding assure that your child receives a minimal amount of radiation exposure.
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Begin daily brushing as soon as your child’s first tooth erupts. Use just water, or a non-fluoride toothpaste. A pea-size amount of fluoride toothpaste can be used once your child is old enough not to swallow it. By age 5 or 6, children should be able to brush their own teeth twice a day, but often require parental help.  We recommend parental supervision until about age seven to make sure they are doing a thorough job. However, each child is different. Your dentist can help you determine whether your child has the skill level to brush properly.

Proper brushing removes plaque from the inner, outer and chewing surfaces. When teaching children to brush, place the toothbrush at a 45 degree angle; start along the gum line with a soft bristle brush in a gentle circular motion. Brush the outer surfaces of each tooth, upper and lower. Repeat the same method on the inside surfaces and chewing surfaces of all the teeth. Finish by brushing the tongue to help freshen breath and remove bacteria.

For children who have trouble removing all the plaque, or who are cavity prone, an electric toothbrush may help to keep their teeth cleaner.

Healthy eating habits lead to healthy teeth. Like the rest of the body, the teeth, bones and the soft tissues of the mouth need a well-balanced diet. Children should eat a variety of foods from the five major food groups. Most snacks that children eat can lead to cavity formation. The more frequently a child snacks, the greater the chance for tooth decay. How long food remains in the mouth also plays a role. For example, candy and sticky snacks, such as fruit roll-ups, raisins, and dried fruit stay in the mouth a long time, which cause longer acid attacks on tooth enamel. When your child snacks, choose nutritious foods such as fruits, vegetables, low-fat yogurt, and low-fat cheese which are healthier and better for children’s teeth.  Hard cheese has been shown to kill the bacteria that causes cavities.

Good oral hygiene removes bacteria and the left over food particles that combine to create cavities. For infants without teeth, use a wet gauze or clean washcloth to wipe the plaque from the gums. Avoid putting your child to bed with a bottle filled with anything other than water. See "Baby Bottle Tooth Decay" for more information.

A sealant is a white plastic material that is applied to the chewing surfaces (grooves) of the back teeth (premolars and molars), where four out of five cavities in children are found. This sealant acts as a barrier to food, plaque and acid, thus protecting the decay-prone areas of the teeth. Sealants are checked during each examination and are often touched up.
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One serious form of decay among young children is baby bottle tooth decay. This condition is caused by frequent and long exposure of an infant’s teeth to liquids that contain sugar. Among these liquids are milk (including breast milk), formula, fruit juice and other sweetened drinks.

Putting a baby to bed for a nap or at night with a bottle containing anything other than water can cause serious and rapid tooth decay. Sweet liquid pools around the child’s teeth giving plaque bacteria an opportunity to produce acids that attack tooth enamel. If you must give your baby a bottle as a comforter at bedtime, it should contain only water.  If your child won't fall asleep without the bottle and its usual beverage, gradually dilute the bottle's contents with water over a period of two to three weeks, until it contains only water.

After each feeding, wipe your baby’s gums and teeth with a damp washcloth or gauze pad to remove plaque. The easiest way to do this is to sit down and place the child’s head in your lap. Whatever position you use, be sure you can see into the child’s mouth easily.
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Teething, the process of baby (primary) teeth coming through the gums into the mouth, is variable among individual babies. Some babies get their teeth early and some get them late. In general the first baby teeth are usually the lower front (anterior) teeth and usually begin erupting between the age of 6-10 months. See "Eruption of Your Child’s Teeth" for more details.
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Children’s teeth begin forming before birth. As early as 4 months, the first primary (or baby) teeth to erupt through the gums are the lower central incisors, followed closely by the upper central incisors. Although all 20 primary teeth usually appear by age 3, the pace and order of their eruption varies.

Fluoride is an element, which has been shown to be beneficial to teeth. However, too little or too much fluoride can be detrimental to the teeth. Little or no fluoride will not strengthen the teeth to help them resist cavities. Excessive fluoride ingestion by preschool-aged children can lead to dental fluorosis, which is a chalky white to brown discoloration of the permanent teeth. Many children often get more fluoride than their parents realize. Being aware of a child’s potential sources of fluoride can help parents prevent the possibility of dental fluorosis.

Some of these sources of excess fluoride are:

• Swallowing too much fluoridated toothpaste at an early age (before being able to spit).

• The inappropriate use of fluoride supplements.

• Hidden sources of fluoride in the child’s diet.

Two and three-year olds may not be able to expectorate (spit out) fluoride-containing toothpaste when brushing. As a result, these youngsters may ingest an excessive amount of fluoride during tooth brushing. Toothpaste ingestion during this critical period of permanent tooth development is the greatest risk factor in the development of fluorosis. We recommend brushing with water, or non-fluoridated toothpaste, until your child can spit. 

Excessive and inappropriate intake of fluoride supplements may also contribute to fluorosis. Fluoride drops and tablets, as well as fluoride fortified vitamins, should not be given to infants younger than six months of age. After that time, fluoride supplements should only be given to children after all of the sources of ingested fluoride have been accounted for and upon the recommendation of your pediatrician or pediatric dentist.

Certain foods contain high levels of fluoride, especially: powdered concentrate infant formula, soy-based infant formula, infant dry cereals, creamed spinach, and infant chicken products. Please read the label or contact the manufacturer. Some beverages also contain high levels of fluoride, especially: decaffeinated teas, white grape juices, and juice drinks manufactured in fluoridated cities.  Soft drinks at fast food restaurants are often made using the city water supply.  This water may be fluoridated.

Parents can take the following steps to decrease the risk of fluorosis in their children’s teeth:

• Use a non-fluoride baby tooth cleanser on the toothbrush for the young child.

• Place only a pea-sized drop of children’s toothpaste on the brush when brushing.

• Account for all of the sources of ingested fluoride before requesting fluoride supplements from your child’s physician or pediatric dentist.

• Avoid giving any fluoride-containing supplements to infants until they are 6 months old.

• Obtain fluoride level test results for your drinking water before giving fluoride supplements to your child (check with local water utilities).

Tooth brushing is one of the most important tasks for good oral health. Many toothpastes, and/or tooth polishes, however, can damage young smiles. They contain harsh abrasives which can wear away young tooth enamel. When looking for a toothpaste for your child make sure to pick one that is recommended by the American Dental Association. These toothpastes have undergone testing to insure they are safe to use.

Parents are often concerned about the nocturnal grinding of teeth (bruxism). Often, the first indication is the noise created by the child grinding on their teeth during sleep. The parent may notice wear (teeth getting shorter) to the dentition. In adults, bruxism is often related to stress, however in children this has not been proven.  Bruxism is very common among children.

The majority of cases of pediatric bruxism do not require any treatment. If wear of the permanent teeth (attrition) is present, then a mouth guard (night guard) may be indicated. 

Sucking is a natural reflex, and infants and young children may use thumbs, fingers, pacifiers and other objects on which to suck. It may make them feel secure and happy or provide a sense of security at difficult periods. Since thumb sucking is relaxing, it may induce sleep.

Thumb sucking can cause problems with the proper growth of the mouth and tooth alignment. How intensely a child sucks on fingers or thumbs will determine whether or not dental problems may result. Children who rest their thumbs passively in their mouths are less likely to have difficulty than those who vigorously suck their thumbs.

Children should cease thumb sucking by the time their permanent front teeth are ready to erupt. Usually, children stop between the ages of two and four. Peer pressure causes many school-aged children to stop.

Pacifiers are no substitute for thumb sucking. They can affect the teeth essentially the same way as sucking fingers and thumbs. However, use of the pacifier can be controlled and modified more easily than the thumb or finger habit. If you have concerns about thumb sucking or use of a pacifier, consult your pediatric dentist.

A few suggestions to help your child get through thumb sucking:

There are many risks involved with oral piercings, including chipped or cracked teeth, blood clots, or blood poisoning. Your mouth contains millions of bacteria, and infection is a common complication of oral piercing. Your tongue could swell large enough to close off your airway!

Possible sequelae of piercing include pain, swelling, infection, an increased flow of saliva, and injuries to gum tissue. Difficult-to-control bleeding or nerve damage can result if a blood vessel or nerve bundle is in the path of the needle.

Tobacco in any form can jeopardize your child’s health and cause incurable damage. Teach your child about the dangers of tobacco.

Smokeless tobacco, also called spit, chew or snuff, is often used by teens who believe that it is a safe alternative to smoking cigarettes. This is an unfortunate misconception. Studies show that spit tobacco may be more addictive than smoking cigarettes and may be more difficult to quit. Teens who use it may be interested to know that one can of snuff per day delivers as much nicotine as 60 cigarettes. In as little as three to four months, smokeless tobacco use can cause periodontal disease and produce pre-cancerous lesions called leukoplakias.

If your child is a tobacco user you should watch for the following that could be early signs of oral cancer:

• A sore that won’t heal

• White or red leathery patches on the lips, and on or under the tongue

• Pain, tenderness or numbness anywhere in the mouth or lips

• Difficulty chewing, swallowing, speaking or moving the jaw or tongue; or a change in the way the teeth fit together

Because the early signs of oral cancer usually are not painful, people often ignore them. If it’s not caught in the early stages, oral cancer can require extensive, sometimes disfiguring, surgery. Even worse, it can kill.

Developing malocclusions, or bad bites, can be recognized as early as 2-3 years of age, although treatment does not usually begin until at least age 7 or 8. 

Treatment in the Mixed Dentition: This period covers the ages of 6 to 12 years, with the eruption of the permanent incisor (front) teeth and 6 year molars. Treatment concerns deal with jaw malrelationships and dental realignment problems. This is an excellent stage to start treatment, when indicated, as your child’s hard and soft tissues are usually very responsive to orthodontic or orthopedic forces.

When a child begins to participate in recreational activities and organized sports, injuries can occur. A properly fitted mouth guard, or mouth protector, is an important piece of athletic gear that can help protect your child’s smile, and should be used during any activity that could result in a blow to the face or mouth.

Mouth guards help prevent broken teeth, and injuries to the lips, tongue, face or jaw. A properly fitted mouth guard will stay in place while your child is wearing it, making it easy for them to talk and breathe.