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PEDIATRIC DENTISTRY TOPICS

Primary Tooth Eruption Chart

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 6-8 months.

Permanent Tooth Eruption Chart

Permanent teeth begin erupting around age 6, starting with the first molars and lower front teeth (central incisors). This process continues until approximately age 21.

Baby bottle tooth decay

A serious form of dental decay among young children is baby bottle tooth decay. This condition is caused by frequent, long exposure of an infant’s teeth to liquids that contain sugar. Among these liquids are milk, breastmilk, formula and juice.

 

Putting a baby to bed with a bottle, or nursing a baby to sleep, can cause serious and rapid tooth decay. The 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 at night time, it should contain water only. This condition is also known was Early Childhood Caries (ECC). For further information on ECC, please visit the American Academy of Pediatric Dentistry website.

Thumb/pacifier habits

Sucking is a natural reflex and infants and young children may use thumbs, fingers or pacifiers on which to suck. It may make them feel secure and happy or provide a sense of security.  Thumb sucking that persists beyond the eruption of the permanent teeth can cause problems with the proper growth of the mouth and alignment of the teeth. How intensely a child sucks on fingers or thumb 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. Most children quit on their own before they start school. If you have questions about thumb sucking, or the use of a pacifier, Dr. Dail will go over some techniques that would work best for your child.

 

The importance of primary teeth

It is very important to maintain the health of primary teeth. Neglected cavities can lead to problems which affect the developing permanent teeth. Primary teeth are important for proper chewing and eating, providing space for the developing permanent teeth and guiding them into the correct position. Primary teeth also affect the development of speech and add to an attractive appearance. While the front teeth last until age 6-7 years, the back teeth (molars and cuspids) aren’t lost until age 10-13.

 

Preventing cavities

  • Good oral hygiene beginning as soon as the first tooth erupts. Parents should help children brush their teeth every day. Floss your child’s teeth if there are no spaces between the teeth.

  • Parents should not put children to sleep with a bottle containing any liquid other than water. Parents should encourage their infants to begin drinking from a cup around their first birthday.

  • Parents should provide healthy, balanced meals for children. They should limit the amount of sugar-laden foods and snacks in their diet. Plenty of healthy snacks should be available for children. Cheese products actually fight dental caries.

  • Limit your child’s exposure to sweetened drinks. Milk and juice should be limited to meal times and children should be given water in between meals.

  • You can make your child’s teeth more decay resistant by using an ADA approved children’s toothpaste. Place only a pea sized amount of toothpaste on the toothbrush if your child is able to spit. Prior to age 4 or 5 most children will swallow the toothpaste, for this reason a baby tooth cleanser should be used in children under 3. Your pediatric dentist can help you determine which kind of toothpaste is right for your child based on their development and caries risk.

  • Children taking oral medications should have their teeth cleansed after each dose of medication. A vast majority of children’s medications contain sucrose, which can increase the risk of developing dental caries.

 

Taking care of your child’s teeth

Begin cleaning your child’s teeth as soon as the first tooth erupts. For small infants, a clean washcloth or “finger” brush will keep the new teeth clean. As the molars erupt, around 12 months of age, begin introducing a small soft bristled toothbrush. Parents should use a tiny ‘smear’ or ‘rice sized’ amount of fluoride toothpaste to brush baby teeth twice daily as soon as they erupt. Once children are 3 to 6 years old, then the amount should be increased to a ‘pea-size’ dollop.  It is important that an adult help children brush their teeth every day. Parents should also floss their children’s teeth daily if there are no spaces between the teeth.

 

Dental X-Rays

Radiographs or X-Rays are a vital and necessary part of your child’s dental exam. Without them, certain dental conditions can and will be missed. X-Rays detect much more than cavities. Radiographs 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.  The American Academy of Pediatric Dentistry recommends radiographs and examinations every six months for children with a high risk of tooth decay.  Pediatric dentists are particularly careful to minimize the exposure of their patients to radiation. With contemporary safeguards, the amount of radiation received in a dental X-Ray is extremely small. We utilize digital radiography further reducing the radiation exposure. Dental X-Rays represent a far smaller risk than an undetected and untreated dental problem.

 

Fluoride

There are many myths and misconceptions regarding fluoride, however, fluoride is an essential component in fighting gum disease and tooth decay. Fluoride is routinely used in our offices on each patient, applied at each regularly scheduled cleaning. Here are some points about fluoride:

  • Fluoride is safe and necessary at appropriate levels.  Fluoride works two ways: internally, strengthening the teeth under the gums in the jawbone, and externally, fluoride strengthens tooth enamel on the surface of the teeth. Children between 6 months and age 16 should take in fluoride every day.

  • Fluoride occurs naturally in some water, but in most major municipalities it is added to the water to help prevent tooth decay.  However, Monterey County water is not fluoridated.

  • As more parents turn to bottled water for drinking and food preparation, pediatric dentists are concerned about whether children will get enough fluoride. Most bottled water brands do not contain the level of fluoride recommended by the AAPD, American Dental Association, American Academy of Pediatrics, American Medical Association, US Public Health Service, and the World Health Organization.

  • Dr. Dail recommends that children who regularly drink bottled water, well water, or unfluoridated tap water get fluoride in some other way. Studies show it's the low dose and high frequency application of Fluoride that is most effective at preventing caries, therefore using fluoridated toothpaste is ideal.

  • Most bottled water brands process water by distilled- or reverse-osmosis systems that remove fluoride along with contaminants. Some types of bottled water add fluoride to the final product and are safe for children of all ages.

  • As important as fluoride is, it only works when used at the appropriate levels. Too much fluoride can cause a harmless discoloration of the teeth known as enamel fluorosis.

  • Parents, be more cautious using toothpaste with children under age 2. They are not able to spit the toothpaste out after brushing and tend to swallow it. Too much fluoride taken internally between age 2-4 can lead to enamel fluorosis, or discoloration of the teeth.

 

Sealants

A sealant is a clear plastic material that is applied to the chewing surfaces of the back teeth (premolars and molars). This sealant acts as a barrier to food, plaque and acid, thus protecting the most decay prone areas of the teeth.

Composites or “tooth colored fillings”

Tooth colored fillings, called composites, are made from durable plastics called composite resins. They look more natural and are less noticeable than other filling materials because they are similar in color and texture to the natural teeth. Tooth colored fillings are compatible with sealants and therefore Dr. Dail will also be able to seal the portion of the tooth that is not replaced with a composite filling. Because they work best for small fillings they may not always the best treatment for every tooth. During your child’s regular check-up appointment if a cavity is found, together you and your pediatric dentist can discuss what type of filling is best for your child.

 
Crowns

Sometimes cavities in children’s teeth become so large that restoring the tooth with a filling is no longer an option. In these cases, stainless steel crowns are used to restore baby teeth to their original shape and size. Stainless steel is a long-lasting material in the mouth that will serve quite well for the life of the baby (primary) tooth. This will help keep the tooth and root intact until normal tooth loss occurs.

 
Composite Resin Crowns

For the front teeth composite resin (white filling material) can be used to restore moderate to large sized cavities. These fillings bond to all of the available remaining enamel to help hold the filling on. These fillings are used after a lot of tooth structure has been lost due to decay or an accident. These fillings quite successfully restore the look of the teeth and are versatile enough to hold up under moderate stress. These fillings can only be places when there is enough tooth structure left to bond the filling on. When there is a lot of tooth structure missing an extraction may be the only option for the baby tooth.

Pulp Therapy

A deep cavity in a child’s baby (primary) tooth may go into the nerve (pulp) of the tooth. In such cases a nerve treatment called a pulpotomy is recommended to save the tooth. A pulpotomy removes part of the pulp of a tooth to prevent or treat the formation of an abscess. A medicated filling material is placed in the nerve space and a crown is then used to restore your child’s tooth. A pulpotomy is similar to, but not as complex as a root canal treatment of an adult tooth. Both procedures prevent unnecessary loss of the tooth. Primary teeth are important in guiding the permanent teeth into position and should therefore remain in your child’s mouth until they are lost naturally. Proper brushing and flossing, a healthy diet, and regular check-ups with your pediatric dentist will go a long way in helping to prevent large cavities.

 

Space maintainers

Baby teeth usually stay in place until “pushed out” by a permanent tooth that takes it’s place. Unfortunately, some children lose baby teeth too early. A tooth may be lost early due to trauma or significant dental disease. If your child loses a baby tooth too early, the remaining baby teeth may tilt, drift, or move up or down to fill the gap. When this happens, they fill the space intended for the permanent tooth, and the permanent tooth can come in crowded or crooked. This condition, if left untreated, may require extensive (and expensive) orthodontic treatment (braces or even surgery).

Space maintainers hold open the empty space left by a lost tooth by preventing movement in the remaining teeth until the permanent tooth takes it’s natural position in the child’s mouth. This treatment is much more affordable and much easier on your child than to move them back later with orthodontic procedures. Typically, the space maintainer is well tolerated by children and is left in place until the permanent teeth begin to erupt.

Silver Diamine Fluoride

While the ideal way to treat teeth with decay (caries) is by removing the decay and placing a restoration (filling or crown), there is an alternative, non-invasive treatment that recently received FDA approval, Silver Diamine Fluoride (SDF) is a clinically applied treatment that controls active dental caries and aids in preventing further progression of the disease. SDF has a dual mechanism of action resulting from the combination of its ingredients. The silver component acts as an anti-microbial agent killing bacteria and preventing the formation of new biofilm, while the fluoride acts to prevent further demineralization of tooth structure. Application of SDF is simple and noninvasive. The carious teeth are isolated, kept dry, and all excess debris is removed. A small brush is dipped in a drop of SDF and placed on the lesion(s) for two minutes. Then, excess SDF is removed and patients are instructed to not eat or drink for one hour.  The only reported side effect is black staining of the tooth at the site of SDF application which is a common occurrence.  

 

This treatment will be applied to all of the affected teeth 1 to 5 times in separate visits.. The number of visits needed will be decided by Dr. Dail depending upon the treatment response. Once the decay is arrested (stopped), the tooth/teeth can be restored in the future if needed/desired.

 

The following are potential candidates for this treatment:

  • Young children who have difficulty cooperating for treatment

  • Children with excessive decay who are not candidates for oral or IV sedation

  • Special needs patients

  • For those patients who need a low cost alternative to traditional restorative procedures

 

Sample pictures of teeth treated by Silver Diamine Fluoride:

Grinding teeth/Bruxism

Parents are often concerned about nocturnal grinding of teeth. Often, the first indication is the noise created when the child grinds during their sleep. The majority of cases of pediatric bruxism do not require any treatment. The good news is that most children outgrow bruxism. The majority of children stop grinding as the permanent first molars erupt.

 

Teens: How your Pediatric Dentist can help

Dentistry for adolescents and teens is a fundamental part of the advanced training of a pediatric dentist. In addition to providing preventive dentistry for your teen like cleanings, fluoride treatments, and brushing and flossing tips and techniques, a pediatric dentist can address concerns with your teen about the way their teeth look. You or your teen may have esthetic concerns about chips, broken teeth, tooth color, spacing, or orthodontic concerns that Dr. Dail will discuss with you. In addition during the teen years wisdom teeth will be developing and your pediatric dentist will make sure the proper treatment is prescribed for them. Regular dental care for your teen provided by your pediatric dentist will ensure a healthy smile to last a lifetime.

 

Mouthguards

When a child begins to participate in recreational activities and organized sports, injuries can occur. A properly fitted mouth guard is an important piece of athletic gear that can help protect your child’s smile. It 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.

 

Tobacco use

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.

Help your child avoid tobacco in any form. By doing so, they will avoid bringing cancer-causing chemicals in direct contact with their tongue, gums and cheek.

 

Tongue piercing

You have probably seen someone with a pierced tongue or lip. You may not know that these decorations can cause permanent damage to your mouth.  The risks of oral piercing include pain, nerve damage, extensive bleeding, chipped or cracked teeth and damaged gums.  Because your mouth is full of bacteria, a major risk of piercing your tongue is infection and swelling. We join the American Dental Association and recommend avoiding mouth jewelry.

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