It's never too early to keep an
eye on your child's oral development. Your pediatric dentist can
identify malocclusion - crowded or crooked teeth or bite problems - and
intervene early to guide the teeth as they emerge in the mouth.
Malocclusion is often inherited but can be caused by dental injuries,
the early loss of primary teeth, or dental habits such as thumb sucking,
fingernail biting, or lip biting. Early orthodontic treatment can
prevent more extensive treatment later.
Early orthodontics can indeed
improve your child's smile, but the benefits are more than just for
appearance. Pediatric orthodontics can straighten teeth, guide erupting
teeth into position, correct bite problems, and prevent the need for
tooth extractions. Straight teeth are easier to keep clean and less
susceptible to tooth decay and gum disease.
It is imperative that your child
maintains good oral hygiene during early orthodontic care. The child
must regularly brush and floss to keep the appliance and your child's
health in top shape. Removable appliances should be brushed each time
the teeth are brushed. Regular dental check-ups will continue to
protect your child from tooth decay and gum disease. Also, contact your
pediatric dentist if the appliance breaks to keep orthodontic treatment
on-time and on-track.
Your child can eat a normal diet
except sticky foods (gum, hard candy, caramels, taffy) and hard foods
(peanuts, ice, popcorn). Some orthodontic appliances can alter speech,
but most children adapt quickly and speak clearly within a day or two.
Generally, children can safely run, jump, swim, and play with an
orthodontic appliance. Check with your pediatric dentist for specific
advice on your child's activities.
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Fluoride encourages
remineralization (a strengthening of weak areas on the tooth). These
areas are the beginning spots of cavity formation. Fluoride is
sometimes added in water and in dental products such s toothpaste, mouth
rinses, varnish, and supplements. Fluoride is documented to be safe and
highly effective if used in the recommended quantities. You only need
to use small amounts of fluoride to get the maximum benefit. It is
important to keep toothpaste, gel, rinses and other supplements out of
reach for your children and only allow them to use those products with
your supervision.
If the water where you live does
not have enough fluoride, your pediatric dentist may prescribe fluoride
supplements in the form of drops or pills. These will be given to your
child starting at about 6 months of age until they are 12 to 16 years
old. Only use these as directed because too much fluoride can stain
spots on your child’s teeth. You can also call your local water company
to see if your water is being fluoridated. If you are unsure that your
water is fluoridated, you may bring a sample of the drinking water to
our office for water analysis. Please call our office or speak to our
staff at your child’s next appointment for fluoride testing
instructions.
At each dental follow up
appointment, we may provide your child with fluoride treatments,
depending on the child’s age and overall risk for tooth decay.
Treatments are in the form of topical fluoride that comes in many
forms. Gels and foams can be placed in fluoride trays and applied after
your child’s teeth have been thoroughly cleaned. We may also use
fluoride varnish. The advantages of varnish are that it is easy and
quick to apply, decreases the amount of fluoride digested, and continues
to “soak” into the enamel for about 24 hours after its application.
Using varnish is useful for young patients and those children with
special needs.
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A lot of parents may think that
gingivitis and periodontal (gum) disease is only an adult problem.
However, gingivitis (the first stage of periodontal disease) is a common
problem in children and adolescents. The bacteria in plaque can release
toxins around the gum and cause infection. This makes the gum tissue
swell, turn red and bleed easily. Gingivitis is a serious health
problem…it can even contribute to heart disease and stroke.
We understand that maintaining a
healthy mouth can be a challenge for kids, especially with an individual
with a disability. Or if an orthodontic appliance is worn, cleaning the
teeth can be even more of a challenge. Other conditions that make
children more susceptible to periodontal disease include Type I
Diabetes, Down syndrome, and Papillon-Lefevre syndrome.
SIGNS AND
SYMPTOMS
Children and teens with
gingivitis notice that their gums bleed during brushing and flossing.
You may also notice that their gums are receding and may have loose
teeth. In time, if left untreated, the bone supporting the teeth can be
destroyed by gingivitis.
“Localized aggressive
periodontitis” can affect healthy young children. It’s found in teens
and young adults also. This mainly affects the first molars and
incisors. It is characterized by the severe loss of alveolar bone and
oddly, patients generally form very little plaque or calculus.
“Generalized aggressive
periodontitis” usually begins around puberty and involves the entire
mouth. It is marked by inflammation of the gums and heavy accumulation
of plaque and calculus. Eventually, it will cause the teeth to become
loose.
CAN ANYTHING BE
DONE TO CORRECT GINGIVITIS?
Yes! The good news is that with
improved home oral care and help from your pediatric dentist, gingivitis
can be a reversible disease. If your child or teen already has
gingivitis, we will help both of you stop the disease process and
maintain good oral health for the future.
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After local anesthesia is used,
your child may accidentally chew on his or her lip, cheek or tongue to
the point of injury. Once the initial bleeding stops, the area will
likely turn whitish in color. Do not be alarmed – this is normal and
not a sign of infection. Luckily, these areas of the mouth heal very
quickly.
- If the
area doesn’t stop bleeding in 30 minutes and/or the area of injury
is significant, take your child to the local emergency room.
- Apply
an ice pack over the area during the first 3 days if there is
swelling. Place the ice pack on the area for 15 minutes and remove
it for 15 minutes. Repeat this process for 1 hour, 3 times a day.
- Give
your child Tylenol or Motrin over the counter as directed per the
manufacturer’s label for pain.
- Call
us if the wound is not healing in 5-7 days or if it seems infected.
- Signs
of infection include continued swelling, drainage, and/or redness.
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Certain trauma from
falling or being hit in the mouth from flying objects while
playing sports, can cause a permanent tooth to be knocked out or
“avulsed”. If this happens, sometimes the tooth can be saved by
quick, careful action. If the tooth is replaced in the first 30
minutes, it has a good chance of survival.
First, if your child has
any broken bones or other injuries, you should seek immediate
medical attention at a hospital emergency room. If the nature
of the injury is only dental in nature, the most important thing
to remember is to remain calm so you can find the tooth.
Once you find it, do not
hold the root and do not rinse off the tooth. Hold the tooth by
the crown (the big white part you normally see in the mouth) and
try to re-insert it into the socket. Try as best you can to
position it like the neighboring tooth and hold the tooth in
position with your finger or by your child biting on gauze.
If it doesn’t go into the
socket, do not try to force it. Just place the tooth in a glass
of milk or in a container with your child’s saliva covering the
tooth and call our office. An adult parent (NOT the child) can
keep the tooth under the tongue until taken to the dentist. You
may use a “Save a Tooth” kit from your local pharmacy that has
solutions and instructions to prolong the life of an avulsed
tooth. This kit should be bought ahead of time in case this
type of emergency occurs with your child.
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Babies who go to bed with
a bottle of milk, formula, or juice are more likely to develop
tooth decay because the sugar in those liquids stays in contact
with the teeth during the night. Follow these simple steps to
avoid this significant problem for your child:
- Avoid nursing children
to sleep, nighttime feedings, or putting anything other than
water in their bedtime bottle after his or her first tooth
erupts.
- Do not put your child to
bed with a bottle of milk, juice, formula or sweetened
liquid.
- Stop nursing when your
child falls asleep or stops sucking on the bottle.
- Try not to let your
child walk around using a bottle of milk, formula or juice
as a pacifier.
- Start teaching your
child how to drink out of a cup at about 6 months of age.
Your goal is to stop letting your child use a bottle by 12
to 14 months at the very latest.
- Do not dip your child’s
pacifier into honey, sugar, sugar-filled drinks, or in your
own saliva. It is true that the same cavity-causing
bacteria in your own mouth can easily be spread to your
child’s mouth.
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- After the
extraction, replace the gauze as it becomes soggy and apply pressure
by biting on it for 30 minutes. Slight oozing and staining of
saliva is normal for up to 2-3 days.
- Moderate bleeding can be controlled by biting on a tea bag wrapped
in gauze and moistened slightly with water. If HEAVY bleeding
continues, call our office.
- Make
sure your child does not bite, scratch or pick at his or her lip,
cheek and tongue while it is numb or “asleep”. This numbness can
last for about 2-3 hours.
- After 24
hours, gently rinse the area with warm salt water after meals (1/2
teaspoon of salt per 1 cup of water).
- Brushing and flossing can be resumed within 24 hours.
- Restrict diet to liquids for the first 3 hours, but avoid drinking
out of a straw. Then eat soft foods for the rest of the day.
Examples of soft foods are soup, Jello, yogurt, and eggs. Your
child should chew on the opposite side of the extracted tooth for
the first 24 hours.
- You
can give your child Tylenol or Motrin every 4 hours as directed on
the label for pain.
- Apply
ice packs to the face to reduce post-operative swelling for the
first 3 days. You can apply the pack for 15 minutes, alternately
removing it for 15 minutes up to 1 hour, 3 times a day.
- Call
us if any questions or problems arise. Notify us immediately if any
of the following occur:
- Vomiting occurs beyond 4 hours after the appointment
- Temperature remains elevated beyond 24 hours or goes above 101°F
- Any difficulty breathing
- Excessive pain, not relieved by the prescribed medication
- Excessive bleeding
- Any other matter causing you concern
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The “pulp” of the tooth is the
inner central core of the tooth. It consists of blood vessels, nerves
and connective tissue. Cavities and injury are the main causes for a
tooth to require “pulp therapy”. Pulp therapy is used to maintain the
vitality of the affected tooth so the tooth is not lost. The two most
common examples of pulp therapy are often referred to as “pulpectomy” or
“pulpotomy”.
A pulpectomy
is required when the entire pulp is involved into the root canal of the
tooth. The diseased pulp tissue is completely removed from both the
crown and the root. The canals are then cleansed, disinfected and if in
a primary tooth, filled with a material that resorbs. Then a final
restoration is placed. A permanent tooth would be filled with a
material that does not resorb.
A pulpotomy removes the diseased
pulp tissue in the crown portion of the tooth. Then an agent is placed
to prevent bacterial growth and to calm the remaining nerve tissue.
This is followed with a final restoration such as a stainless steel
crown.
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According to national data, 78%
of children in the United States have experienced tooth decay by the age
of 17. Believe it or not, as much as 90% of decay occurs in school age
children! The teeth that are at the highest risk are the permanent
first and second molars where fluoride has its least protective effect
on the pits and fissures of those teeth. The American Dental
Association and American Academy of Pediatric Dentistry recognize that
sealants can play an important role in the prevention of tooth decay.
ARE YOUR
CHILD’S TEETH PROTECTED? – NOT WITHOUT SEALANTS!
A dental sealant is a thin
coating that is applied to the biting surfaces of the back teeth.
Sealants fill in the pits and fissures of those molars and premolars.
This helps keep food particles and plaque off of the deep grooves of the
teeth. Sealants form a smooth surface that is easy to clean. However,
the covering is only for the biting surface of the tooth – areas on the
sides and between the teeth cannot be coated with sealants. Therefore,
good oral hygiene, flossing, and a good diet are still very important in
preventing decay next to these sealants or areas unable to be covered.
HOW ARE
SEALANTS APPLIED?
The application of sealants is
very fast, easy and painless! First, a solution is applied to the
chewing surface of the tooth to prepare the enamel and help it to bond
with the sealant material. Next, the tooth is washed and dried. Then,
the sealant is applied using a tiny brush and then hardened with a
visible blue light. The sealants can last many years. During every
dental visit, our doctors and hygienists will check the condition of the
sealant(s) and advise you if additional sealants are needed.
HOW CAN I
PROTECT MY CHILD’S SEALANTS?
Your child should avoid chewing
foods and candy that can fracture the sealant. Do not allow your child
to chew on ice or eat hard candy or very sticky foods. Examples of
foods to avoid are taffy, Now and Laters, and Jolly Ranchers.
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When a baby tooth is lost too
soon, the teeth beside it may tilt or drift into that empty space. Teeth
in the other jaw may move up or down to fill the gap. As teeth beside
the gap shift into the empty space, they create a lack of space in the
jaw for the permanent teeth. When that happens, permanent teeth are
crowded and can come in crooked. If left untreated, the condition may
require extensive orthodontic treatment.
Space maintainers are used to
prevent any drifting of teeth and loss of space in your child’s teeth.
They keep the remaining teeth in place until a permanent tooth is in
that natural position. Space maintainers are appliances made out of
metal or plastic and are custom fit to your child’s mouth. They are
small and unobtrusive in appearance. Using space maintainers is more
affordable and easier on your child than having to move those teeth back
in place with orthodontic treatment. The appliance often feels
different and may cause minor discomfort while biting for a few days
following insertion, but this will improve over time.
If your child has had a space
maintainer placed, here are some helpful instructions to follow:
- Avoid
sticky foods and sweets or chewing gum.
- Maintain good oral hygiene, keeping the appliance clean by brushing
twice daily. Don’t forget to brush around the bands of the space
maintainer.
- Avoid
“playing” with the space maintainer with the tongue or fingers.
This may loosen or even break the appliance.
- Continue regular dental visits where the doctors and hygienists will
check the space maintainer often.
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Tobacco in ANY form, including
cigarettes and chewing tobacco, can seriously harm your child’s health
and cause irreversible and incurable damage. Smokeless tobacco, known
as chew or snuff, is sometimes used by teens who think that it is safer
than cigarettes. But studies show that chewing tobacco may be more
addictive than cigarettes and also more difficult to quit.
ATTENTION TEENS! – Did you know
that ONE can of snuff per day delivers as much nicotine as 60
CIGARETTES?? In as little as 3-4 months, smokeless tobacco can cause
periodontal disease and cause pre-cancerous lesions called “leukoplakia”.
Tobacco also destroys your
smile! If you want a healthy, attractive smile, smoking cigarettes or
chewing tobacco is definitely NOT an option –
If your child is a tobacco user,
you should watch for the following signs of oral cancer:
- A sore
that will not heal
- White
or red leather-like patches on the lips and/or 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.
Some early signs of oral cancer
are usually not painful, so it’s easy to ignore them. If it’s not
caught early, oral cancer can require extensive, sometimes disfiguring,
surgery and can even kill.
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You may not be surprised anymore
to see people with pierced tongues, lips, or cheeks. But you may be
surprised to know just how dangerous these piercings can be! They can
cause cracked or chipped teeth, blood clots, or even blood poisoning.
Remember that your mouth contains millions of bacteria and can cause
infection in a piercing site. Your tongue can even swell large enough
to close off your airway!
Common symptoms after piercing
are altered eating habits, pain, swelling, infection, injured gum
tissue, severe bleeding, or nerve damage.
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For infants, parents can wipe the
baby’s new teeth with a moist, soft cloth or gauze. As babies grow, you
can use a child’s toothbrush. Children’s hands and mouths are different
than adults. They need to use toothbrushes designed for children with a
small, rounded head and soft bristles. Only use a pea-sized amount of
fluoride toothpaste at the age of 2-3 when your child is able to spit it
out. They will need supervision and help brushing for several years
because they don’t have the coordination to properly and completely
brush their teeth until the age of 7 to 8.
Their teeth need to be brushed at
least twice a day, in the morning after breakfast and every night at
bedtime. After the nighttime brushing, do not allow your child to eat
or drink anything except water.
- Angle
the toothbrush at a 45-degree angle to the gums.
- Brush
with 3 circles on every surface of every tooth – top and bottom.
- Hold
the brush flat on top of the teeth and brush the chewing surfaces
with short strokes – about a half tooth wide.
- Gently
brush the tongue after the teeth.
- Replace your child’s toothbrush every 3 months and after any
contagious illness, such as strep throat.
- Flossing removes plaque and food from between the teeth, where the
toothbrush can’t reach – your child should have their teeth flossed
daily!
- You
need to floss your child’s teeth until the age of 10 when their hand
coordination has adequately developed.
- Floss
in between each tooth by “hugging” each tooth with the floss to
prevent injuring the soft gum tissue.
- Avoid
forcing the floss straight down between the teeth to prevent injury.
- Using
a gentle pressure, work the floss in a “sawing” motion until it
passes through where the teeth touch each other.
- Always
use a clean piece of floss. There are handy floss holders you can
find at area pharmacies that help you get the floss into the back of
your child’s mouth easier.
For most toddlers,
getting them to brush their teeth can be quite a challenge! Here are
some helpful hints that may make this less of a battle:
- Let
your child pick out a toothbrush with his or her favorite cartoon
character on it.
- Read
your child some children’s books about tooth brushing habits.
- Let
the child brush his or her own teeth first and then you will “help
out”.
- Show
your child how you will brush their teeth using a doll or stuffed
animal while you “brush” the toy’s teeth.
- Have a
routine where everyone brushes their teeth together – remember that
YOU are your child’s best role model. Stick to the same routine
every day.
- You
can let your child rinse or chew products that will “stain” their
teeth temporarily to show him or her the importance and fun of
brushing the stain off. Ask your pediatric dentist for these
product suggestions.
- Remain
positive and try to make the experience fun.
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Your child’s first baby teeth to
come in or “erupt” are usually the two bottom front teeth. This occurs
at about 6-8 months of age. Then the 4 upper front teeth erupt, and
then other teeth will erupt periodically. Your child will continue to
“teethe” or have new teeth erupt until about 2 ½ years of age. At that
point, your child should have all 20 teeth. Between ages 5-6, the first
permanent teeth will erupt. Some permanent teeth will replace baby
teeth and some do not – don’t worry if some teeth are a few months early
or late.
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X-Rays or Radiographs
Radiographs (x-rays) are a
necessary part of your child’s dental diagnostic process to diagnose
certain dental conditions. X-rays detect more than just cavities – they
can diagnose bone disease, evaluate injuries, and help in the planning
of orthodontic treatment. Some diseases cannot be discovered simply
with a clinical exam. Children generally need X-rays more often than
adults because their mouths grow and change rapidly. They are also more
susceptible to tooth decay than adults. The American Academy of
Pediatric Dentistry recommends X-rays every six months for children with
a high risk of tooth decay. Children with a low risk of tooth decay
require X-rays less frequently. On average, pediatric dentists
recommend X-rays about once a year, but every 3 years, it’s a good idea
to obtain a complete set of X-rays.
Pediatric dentists are very
careful to minimize the exposure of radiation to the children. The
amount of radiation is actually very small in dental X-rays and the risk
is negligible. We use lead body apron shields to protect your child and
our equipment uses digital radiographs to reduce radiation exposure and
enhance diagnostic imaging. We use small, lightweight, phosphor plates
that are more flexible and comfortable than conventional analogue films.
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A properly fitted soft mouth
guard can protect your child’s teeth, cheeks, lips, and gums. A
mouth guard is recommended for any recreational activity that poses
a risk of injury to your child’s mouth. Sports that definitely
should be considered for use of a mouth guard include (but not
limited to): football, gymnastics, basketball, baseball, soccer,
softball, hockey, skateboarding, boxing, martial arts, wrestling and
extreme sports.
There are 3 types of mouth
guards:
- “Ready-Made” or “stock” guards
- “Boil-and-Bite” mouth formed guards
- Custom made mouth guards made by your dentist
If your child doesn’t have
all of their permanent teeth, then a “boil-and-bite” mouth guard
should work fine. The guard should be resilient, tear resistant,
and comfortable. Make sure it fits properly and is easy to clean,
along with not restricting breathing or speaking. We will be happy
to confirm that your child’s mouth guard is properly fitting at
his/her next dental appointment if you bring it with you.
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