Pediatric Dentistry is one of the nine recognized dental
specialties of the American Dental Association (ADA).Pediatric dentists complete two to three years of additional
specialized training (after four years of dental school), which includes
study in child psychology, growth and development. Pediatric dentists are
trained to provide comprehensive, preventative and therapeutic oral health
care for infants and children through adolescence, including those with
special health care needs. Our
specialization allows us to perform the most up-to-date and thorough
treatment for a wide variety of children’s dental problems, including tooth
decay, pre-orthodontics and traumatic injuries.
Your Child’s First Dental Visit
An early start in
regular dental care is an important step in your child’s road to total
health. The American Academies of
Pediatrics and Pediatric Dentistry recommend that children visit a dentist
by age one. Our practice is currently piloting an infant oral health
program. At the infant dental visit, our pediatric oral health educators
will consult with the parents, examine the infant and apply topical fluoride
if indicated. Follow-up visits with the doctor will be scheduled according
to the individual needs of the child.
To learn more about your child’s first dental visit, please refer to the
“First Visit” page on this website.
Why
Are The Baby Teeth So
Important?
It is very important to maintain the health of the
baby (primary) teeth. Neglected cavities can and frequently do lead to
problems which affect developing permanent teeth. Primary teeth are important for
(1) proper chewing and
eating
(2) providing space for the permanent teeth and guiding them into the
correct position
(3) permitting normal development of the jaw bones and muscles. Primary
teeth also affect the development of speech and add to an attractive
appearance. While the front teeth last until 6-7 years of age, the back teeth (cuspids and molars) aren’t
replaced until age 10-13.
X-Rays (radiographs) are a vital and necessary part of your child’s
dental diagnostic process. Without them, certain dental conditions can and
will be missed.
Radiographs detect much more than cavities. For example, radiographs may be
needed to survey erupting teeth, diagnose bone diseases, evaluate the
results of an injury, or plan orthodontic treatment. Radiographs 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.
Our office recommends bitewing radiographs once a year for
most children. Children who have an aggressive decay pattern often need
radiographs every six months. We also recommend the first
panoramic radiograph at age six and then every four years afterward.
Pediatric dentists are careful to minimize the exposure of
our patients to radiation. Our office has upgraded to digital radiographs
(as opposed to traditional film). This allows us to obtain a clearer image
while using much less radiation to do so. All patients wear a lead apron
during x-ray exposure to prevent radiation to other areas of their body.
With contemporary safeguards, the amount of radiation
received in a dental x-ray examination is extremely small, and the risk is
negligible. In fact, the dental radiographs represent a far smaller risk
than an undetected and untreated dental problem.
Care of Your Child’s Teeth
Begin daily brushing as soon as the child’s first tooth erupts.
A pea size amount of fluoride toothpaste can be used at the age of 2.
Please try to limit the swallowing of toothpaste. By age eight,
children should be able to brush their own teeth twice a day with
supervision.
Proper brushing removes plaque from the inner, outer and chewing
surfaces. When teaching children to brush, place toothbrush at a 45 degree angle;
start along 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.
Flossing removes plaque between the teeth where a toothbrush
can’t reach. Flossing should begin when any two teeth touch. You should
floss
the child’s teeth until he or she can do it alone. Use about 18 inches of floss,
winding most of it around the middle fingers of both hands. Hold the floss lightly between
the thumbs and forefingers. (Commercial pediatric flossers can also be used
and are somewhat easier to work with.) Use a gentle, back-and-forth motion to guide the floss between
the teeth. Curve the floss into a C-shape and slide it into the space between the gum and
tooth until you feel resistance. Gently scrape the floss against the side of the tooth.
Repeat this procedure on each tooth. Don’t forget the backs of the last four teeth.
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Good Diet = Healthy Teeth
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.
The length of
time that food remains in the mouth also plays a role. For example, hard
candy and breath mints stay in the mouth a long time, creating a longer acid
attack on tooth enamel. If your child must snack, choose nutritious foods
such as vegetables, low-fat yogurt, and low-fat cheese.
How
Do I Prevent Cavities?
Good oral hygiene removes bacteria and the left over food particles that
combine to create cavities. For infants, use a wet gauze or clean washcloth
to wipe the plaque from teeth and gums. Avoid putting your child to bed with
a bottle filled with anything other than water. See "Baby
Bottle Tooth Decay" for more information.
For older children, brush their teeth at least twice a day. Also,
watch the number of snacks containing sugar that you give your children.
The American Academy of Pediatric Dentistry recommends 6 month visits
to the pediatric dentist beginning at your child’s first birthday. Our
office begins seeing children at 2, or sooner if a problem
exists. Routine
visits will start your child on a lifetime of good dental health.
Our office may also recommend protective sealants or home
fluoride treatments for your child. Sealants can be applied to your child’s
molars to prevent decay on hard to clean surfaces.
A sealant is a clear or shaded 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.
One serious form of decay among young children is baby bottle tooth
decay. This condition is caused by frequent and long exposures 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 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 the 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.
After each feeding, wipe the 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, place
the child’s head in your lap or lay the child on a dressing table or the floor.
Whatever position you use, be sure you can see into the child’s mouth easily.
When
Will My Baby Start Getting Teeth?
Teething is variable among individual babies. Some babies get their teeth
early and some get them late. The first baby teeth are typically the lower front (anterior) teeth and usually begin erupting between
the age of 6-8 months. See "Eruption
of Your Child’s Teeth" for
more details.
Children’s teeth begin forming before birth and
erupt as early as four
months of age. The first primary (or baby) teeth to erupt are most
often the lower central incisors, followed closely by the upper central
incisors. Although all twenty primary teeth
usually appear by age three, the pace and order of their eruption varies.
Permanent teeth begin appearing around age six, usually starting with the
first molars and lower central incisors. This process continues until approximately age
21.
Adults have 28 permanent teeth, or up to 32 including the third
molars (or wisdom teeth).
Toothache: Clean the area of the affected tooth thoroughly.
Rinse the mouth vigorously with warm water or use dental floss to dislodge impacted food
or debris. If the pain still exists, contact your child's dentist. DO NOT place aspirin on the gum or on the aching tooth.
If the face is swollen
apply cold compresses and contact your dentist immediately.
Cut or Bitten Tongue, Lip or Cheek: Apply ice to bruised
areas. If there is bleeding apply firm but gentle pressure with a gauze or cloth. If
bleeding does not stop after 15 minutes or it cannot be controlled by simple pressure,
take the child to hospital emergency room.
Knocked Out Permanent Tooth:
Find the tooth. Handle the tooth by the crown, not the root portion. DO NOT
clean or handle the tooth unnecessarily. Inspect the tooth for fractures. If
it is sound, try to reinsert it in the socket. Have the patient hold the
tooth in place by biting on a gauze.
If you cannot
reinsert the tooth, transport the tooth in a cup containing milk. If milk is
unavailable, place the tooth in a cup containing the child’s saliva or in
the child’s cheek. The patient must see a dentist IMMEDIATELY! Time is a
critical factor in saving the tooth.
Fluoride is naturally occurring substance that is
widely used to prevent cavities.
Fluoride is found in toothpaste, rinses, gels and most city water supplies.
The indications for administering the various forms of fluoride primarily
depend on the age of the child, their cavity-history and perceived
susceptibility to develop cavities in the future, and whether they drink
fluoridated water. When used properly, the various forms of fluoride will
enhance the oral health status of infants and children. As is true of many
other substances, improper use of fluoride has the potential to produce
objectionable side effects. Excessive fluoride ingestion by preschool-aged
children can lead to dental fluorosis, which is chalky white and even brown
discoloration of the permanent teeth. Being aware of a child's potential
sources of flouride can help parents prevent the possibility of dental
fluorosis.
Some of these sources are:
Swallowing too much fluoridated toothpaste at an
early age.
The inappropriate use of fluoride supplements.
Hidden sources of fluoride in the child’s diet.
Parents can take the following steps to decrease the risk of
fluorosis in their children’s teeth:
Use baby tooth cleanser on the toothbrush of the very 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 at least 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. When
looking for a toothpaste for your child make sure to pick one that is
recommended for children by the American Dental Association. These toothpastes have
undergone testing to insure they are safe to use. Many adult toothpastes
contain whiteners, and/or tooth polish that can damage young smiles. They
contain harsh abrasives which can wear away young tooth enamel.
Remember, children should
spit out toothpaste after brushing to avoid getting too much fluoride. If
too much fluoride is ingested, a condition known as fluorosis can occur. If
your child is too young or unable to spit out toothpaste, use only a tiny smear.
Does Your Child Grind His Teeth
At Night? (Bruxism)
Parents are often concerned about the
nighttime grinding of teeth
(bruxism). The first indication is the noise created by the grinding. The parent may
also notice wear (teeth getting shorter) to the
dentition. The causes of bruxism are multi factorial and difficult to pinpoint,
however, they are usually self limiting.
The majority of cases of pediatric bruxism do not require any
treatment. If excessive wear of the teeth (attrition) is present, then a mouth guard
(night guard) may be indicated. The good news is most children outgrow bruxism. The grinding
decreases between the ages six and nine and children tend to stop grinding between ages
nine and twelve. If you
suspect bruxism, discuss this with your pediatrician or pediatric dentist.
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Thumb
Sucking
Sucking is a natural reflex.
Infants and young children may suck
thumbs, fingers, pacifiers and other objects. 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 that persists beyond the eruption of the
permanent teeth can cause problems with the proper growth of the mouth and
tooth alignment. The intensity of the sucking will determine whether or not
dental problems 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:
Instead of scolding children for thumb sucking, praise them when they
are not.
Children often suck their thumbs when feeling insecure. Focus on
correcting the cause of anxiety, instead of the thumb sucking.
Children who are sucking for comfort will feel less of a need when
their parents provide comfort.
Reward children when they refrain from sucking during difficult
periods, such as when being separated from their parents.
Your pediatric dentist can encourage children to stop sucking and
explain what could happen if they continue.
If these approaches don’t work, remind the children of their
habit by bandaging the thumb or putting a sock on the hand at night. Your pediatric
dentist may recommend the use of a mouth appliance.
You might not be surprised anymore to see people with
pierced tongues, lips or cheeks, but you might be surprised to know just how
dangerous these piercings can be.
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!
Common symptoms after 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.
So follow the advice of the American Dental
Association and give your mouth a break – skip the mouth jewelry.
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
A change in the way the teeth fit together.
Because the early signs of oral cancer are
usually not
painful, people often ignore them. If it is 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.
A malocclusion (improper bite) can be
recognized as early as two or three years of age. Early steps can
often be taken to
reduce the need for major orthodontic treatment at a later age.
Phase I
Orthodontic Treatment:
Treatment
between the ages of six and twelve coincides with the eruption of the
permanent incisor (front) teeth and six-year molars. 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.
Patients who have phase I treatment often need a second phase of treatment
after all the permanent teeth have erupted.
Phase II
Orthodontic Treatment:
This
phase of treatment begins after all the permanent teeth are present and aims
to develop the final bite relationship. Many patients require only a single
phase of treatment which is synonymous with phase II treatment.
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. Mouth Guards should be used during all activities
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.
Ask your pediatric dentist about custom and
store-bought mouth protectors.
Pediatric Dentist,
Greensboro, NC Dr. Marc Goldenberg, Dr. Kate Pierce and Dr. Matthew
Applebaum, The Greensboro
Center for Pediatric Dentistry,
Serving patients in the surrounding cities and areas of Greensboro,
North Carolina.
It is very important to maintain the health of the
baby (primary) teeth. Neglected cavities can and frequently do lead to
problems which affect developing permanent teeth. Primary teeth are important for
Begin daily brushing as soon as the child’s first tooth erupts.
A pea size amount of fluoride toothpaste can be used at the age of 2.
Please try to limit the swallowing of toothpaste. By age eight,
children should be able to brush their own teeth twice a day with
supervision.
Good oral hygiene removes bacteria and the left over food particles that
combine to create cavities. For infants, use a wet gauze or clean washcloth
to wipe the plaque from teeth and gums. Avoid putting your child to bed with
a bottle filled with anything other than water. See "
Toothache: Clean the area of the affected tooth thoroughly.
Rinse the mouth vigorously with warm water or use dental floss to dislodge impacted food
or debris. If the pain still exists, contact your child's dentist. DO NOT place aspirin on the gum or on the aching tooth.
If the face is swollen
apply cold compresses and contact your dentist immediately.
Tooth brushing is one of the most important tasks for good oral health. When
looking for a toothpaste for your child make sure to pick one that is
recommended for children by the American Dental Association. These toothpastes have
undergone testing to insure they are safe to use. Many adult toothpastes
contain whiteners, and/or tooth polish that can damage young smiles. They
contain harsh abrasives which can wear away young tooth enamel.
Parents are often concerned about the
nighttime grinding of teeth
(bruxism). The first indication is the noise created by the grinding. The parent may
also notice wear (teeth getting shorter) to the
dentition. The causes of bruxism are multi factorial and difficult to pinpoint,
however, they are usually self limiting.
Sucking is a natural reflex.
Infants and young children may suck
thumbs, fingers, pacifiers and other objects. 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.
You might not be surprised anymore to see people with
pierced tongues, lips or cheeks, but you might be surprised to know just how
dangerous these piercings can be.
Tobacco in any form can jeopardize your child’s
health and cause incurable damage. Teach your child about the dangers of
tobacco.
A malocclusion (improper bite) can be
recognized as early as two or three years of age. Early steps can
often be taken to
reduce the need for major orthodontic treatment at a later age.
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. Mouth Guards should be used during all activities
that could result in a blow to the face or mouth.