Dental FAQs

What happens during the exam?

At every exam we will review your child’s health history; take any necessary x-rays; clean your child’s teeth (if any are present); conduct a thorough clinical examination of your child’s mouth, palate, gums, tongue and teeth; and teach them about good food choices and how to brush and floss their teeth. Prevention in dentistry is the best treatment we can offer!

After every examination, we provide parents with essential information about your child’s dental health:

• An assessment of your child's risk for decay;
• An evaluation of your child's soft tissues and gums;
• An evaluation of your child's bite and dental growth; and
• An assessment of your child's oral health as it pertains to his or her overall health including suggestions about nutrition.

Tell me about dental x-rays (Radiographs).

Radiographs (X-Rays) are a vital and necessary part of your child’s dental diagnostic process. Without x-rays, certain dental conditions can and will be missed because they can’t be seen solely by visual examination.

Radiographs allow us to diagnose and treat health conditions, to evaluate the results of an injury or to plan an orthodontic treatment. If dental problems are found and treated early, dental care is more comfortable for your child. 

We recommend obtaining radiographs when necessary. This will be different for each child. For most children this works out to approximately every two years, although that may be more frequent for children with a high risk of tooth decay.

Are dental x-rays safe?

With contemporary safeguards, the amount of radiation received in a dental X-ray examination is extremely small and the risk is negligible.  We use digital x-rays, which further lowers radiation, as well as lead body aprons and shields to protect your child. Today’s equipment filters out unnecessary x-rays.  Shielding assures that your child receives a minimal amount of radiation exposure.

Dental radiographs represent a far smaller risk than an undetected and untreated dental problem!

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Why do you want to know about my child’s diet?

Healthy eating habits lead to healthy teeth.   Children need to eat a variety of foods from the five major food groups (protein, dairy, vegetables and fruit, grains, fats). Like the rest of the body, the teeth, bones and the soft tissues of the mouth need a well-balanced diet.

The more frequently a child snacks, the greater the chances are for tooth decay. When your child eats between meals, choose nutritious and yummy foods such as vegetables, low-fat yogurt, and low-fat cheese.  Avoid sticky candy and other foods high in processed sugar or corn syrup.  Read the nutritional labels on packaged foods so you can make good choices for your children.

My child won’t go to sleep without nursing or taking a bottle.

One serious form of decay among young children is baby bottle tooth decay, sometimes referred to as ‘bottle rot.’ The official, proper name of this condition is called Early Childhood Caries (ECC). This condition is caused by frequent and long exposures of an infant’s teeth to liquids that contain sugars. Among these liquids are milk (including breast milk), formula, fruit juice and other sweetened drinks.

If you give your child a bottle filled with juice or milk, or breastfeed them before putting them to sleep, it could cause serious and rapid tooth decay. The reason? Sweet liquid pools around the child’s teeth and gives plaque bacteria an opportunity to produce acids that attack tooth enamel.  During the day, saliva produced in your child’s mouth protects teeth from these acids, but at night saliva production decreases and the teeth are left more vulnerable.

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 your child becomes used to only water at bedtime. After the final nighttime feeding (including breastfeeding), brush or 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.

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Why are baby teeth so important?  They’ll be replaced anyway.

It is important to maintain the health of the primary or baby teeth to establish a good foundation of oral health for your child. Neglected primary teeth frequently lead to problems that can affect developing permanent (adult) teeth and create a lifetime of dental problems.

Primary baby teeth are essential for proper chewing and eating: they are the first steps in the digestive system.  Primary teeth affect speech development, provide space for the permanent teeth and encourage normal development of the jaw and surrounding muscles. They also contribute to an attractive appearance.  Unhealthy teeth can lead to poor self-esteem and other issues that affect one’s confidence, and can prevent a child from reaching his or her full potential.

When will my child begin losing his/her baby teeth?

We do everything possible to keep your child’s primary teeth healthy and to be ready for permanent teeth.  Your child may have some of those primary teeth until he or she is a teenager! 

The following charts show the approximate timing for tooth eruption and replacement.

Teeth Eruption Primary Chart

Teeth Eruption Permanent Chart

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Why are you so concerned about decay?

Dental decay in children is on the rise.  According to a February 2010 report from the Centers for Disease Control and Prevention, dental decay is the most common chronic disease of childhood – five times more common than asthma!

The good news is that we know that decay detected at the beginning stages of enamel demineralization can actually be reversed using fluoride as a trace mineral. Demineralization refers to the damage done to the tooth's enamel caused by acid from the bacteria; when this occurs, important minerals have been depleted from the enamel. Demineralization is also commonly referred to as a ‘white spot’ or ‘white spot lesion.’ However, we can reduce demineralization with careful applications of fluoride in the office. When the tooth enamel begins to harden again, it is called--no surprise!--remineralization. If caught in time, remineralization allows the tooth to avoid the need for a traditional filling.  We monitor and track these areas of concern at every dental visit so these teeth can stay healthy and avoid fillings if at all possible.

How do cavities form?

The good news is cavities don’t form overnight!  Cavities form when traces of food particles (carbohydrates) combine with the natural bacteria of your mouth and produce a thick layer of sticky plaque, especially at the gum line. The chemical combination of food and bacteria creates a lactic acid that is strong enough to weaken and eventually disintegrate the natural enamel on teeth, causing the enamel to break down. Plaque becomes a natural breeding ground for decay (cavities) and periodontal disease, which affects the health of the gums or gingival.

We suggest that parents and children don’t share food, utensils or toothbrushes. The reason? The bacteria that cause cavities are transmitted from the parent or caregiver to the child. Even parents and caregivers need to be mindful of and maintain their own oral health!

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What can I do to prevent cavities in my child?

For infants, we recommend using a wet gauze or clean washcloth and gently to wipe the plaque from your baby’s teeth and gums.  Do this after the morning feeding and before your child goes to sleep for the night. Avoid putting your child to bed with a bottle filled with anything other than water.  

Toddlers and children just starting school need to have an adult help them brush their teeth at least twice a day and floss daily.  Fine motor skills used in brushing don’t develop in children until at least ages 6-7. Your child can be ready to brush their teeth unsupervised if they are able to write in cursive or tie their shoes without assistance. 

Many children respond well to using an electric toothbrush. Ask us about when to start and how to introduce this into your child’s tooth routine.

Be sure your child receives regular dental checkups and cleanings every six months up until age 16.  If your child is at high risk for tooth decay, has had cavities or is in braces, we may recommend more frequent visits.  And of course, always teach and encourage your children to make healthy food choices at meals and for snacks.

What’s the best toothpaste for my child?

Tooth brushing is one of the most important tasks for good oral health.

When selecting toothpaste for your child, make sure to choose one that is recommended by the American Dental Association and include the ADA Seal of Acceptance. These toothpastes have undergone objective scientific evaluation and testing to insure they are safe and effective to use.

 
For very young children, use an amount of toothpaste smaller than a baby pea or just a smear.  It’s important for parents and caregivers to help children get in the habit of spitting out toothpaste after brushing.   Toothpaste is NOT a food.

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What’s the scoop on fluoride and teeth? 

Fluoride has been studied, tested and proven to be beneficial to teeth and helpful in reducing cavities.  Fluoride is a trace mineral found naturally in many water sources; it strengthens the enamel of your teeth at a molecular level.  The U.S. Public Health Service credits fluoride with reducing the cavity rate over the last several generations.

Despite this wonderful benefit, our bodies need just the right amount of fluoride – not too much and not too little. Too little fluoride will eliminate any health benefits and leave the enamel of teeth at risk for decay.   Ask us if you have any concerns about the appropriate amount of fluoride for your child.

What are sealants?

A sealant is a clear or shaded plastic material that is applied to the chewing surfaces (grooves) of the back teeth (premolars and molars). Sealants act as a barrier to food, plaque and acid to protect the decay-prone areas of the teeth—the chewing and eating surfaces. Most cavities in permanent teeth are found in these molars, and sealants have been found to prevent cavities when applied early, usually just after the teeth have erupted (around age six).  Sealants do not protect between teeth, so it’s important to continue to floss if a sealant is applied.

What is pulp therapy?

The pulp of a tooth is the inner central core of the tooth.  The pulp contains nerves, blood vessels, connective tissue and reparative cells.  The purpose of pulp therapy in pediatric dentistry is to maintain the vitality of the affected tooth so the tooth does not die and need to be removed.

Dental caries (cavities) and traumatic injury are the main reasons for a tooth to require pulp therapy.  Pulp therapy is often referred to as a "nerve treatment," "children's root canal," "pulpectomy," “partial root canal” or "pulpotomy".  The two common forms of pulp therapy in children's teeth are the pulpotomy and pulpectomy. 

A pulpotomy removes the diseased pulp tissue within the crown portion of the tooth.  Next, an agent is placed to prevent bacterial growth and to calm the remaining nerve tissue.  This is followed by a final restoration (usually a stainless steel crown). 

A pulpectomy is required when the entire pulp is involved into the root canal(s) of the tooth.   During this treatment, the diseased pulp tissue is completely removed from both the crown and root.  The canals are cleansed, disinfected and, in the case of primary teeth, filled with a resorbable material. (A permanent tooth would be filled with a non-resorbing material.) Then a final restoration is placed. 

Pulp therapy is done to save affected teeth, to treat infection and to prevent pain, suffering and swelling.  The best way to save the space for the permanent teeth is to protect and save the baby teeth. Tooth extraction is a last resort in almost every case.

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How can I help my child stop sucking his/her thumb?

Sucking is a natural reflex and a self-calming habit for very young children.  Infants and young children frequently use thumbs, fingers, pacifiers and other objects to suck to create a sense of relaxation and induce sleep. It may make them feel secure and happy or provide a sense of security at difficult periods.

Whether or not dental problems result from thumb sucking depends on how intensely a child sucks on fingers or thumbs.  Children who rest their thumbs passively in their mouths are less likely to have difficulty than those who vigorously suck their thumbs.  Prolonged thumb sucking habits can lead to delayed language skills, speech impediments, tongue thrusting, difficulty in swallowing, prolonged drooling, and cross bites. 

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 when they can begin to verbalize their frustrations. Peer pressure also 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. Please discuss your concerns about thumb sucking or use of a pacifier with the doctor during your child’s dental exam.

Here are a few ideas to help you help your child reduce occurrences of thumb sucking:

• Don’t scold children for thumb sucking.  Instead, praise them when they do not.
• Children often suck their thumbs when feeling insecure or anxious. Focus on correcting the cause of anxiety, instead of the thumb sucking.
• Reward children when they refrain from sucking during difficult periods, such as when being separated from their parents.
• At bedtime, place a bandage on the thumb or cover the entire hand with a sock or mitten.
• Practice “not sucking” while reading a book or watching a video so that the calming behavior of reading or watching isn’t linked to the sucking habit.
• Don’t talk and answer if your child speaks to you with the thumb or fingers in the mouth.  Wait to answer them when their thumb or fingers are OUT.

If the habit continues past age four, we may recommend an appointment with a therapist that specializes in muscle behavior modification, or alternatively, using a dental appliance like a night guard that will block your child’s thumb from entering his or her mouth.

Behavior modification, not criticism, is the best way to encourage your child to stop thumb sucking.

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Help! My child grinds his/her teeth at night!

Parents are often concerned about the nocturnal grinding of teeth called bruxism. Often, the first indication of a problem is the noise created by the child grinding their teeth during sleep or the parent noticing excessive wear – and the teeth getting shorter! 

Bruxism is not uncommon during the ages when teeth are erupting.  The majority of cases of pediatric bruxism do not require any treatment and most children outgrow it on their own. The grinding decreases between ages 6 to 9 years and children tend to stop grinding by age 12.

We don’t know exactly why grinding or bruxism occurs, but there are theories.  Stress due to a new environment, divorce, changes at school, etc. can influence a child to grind his/her teeth. Another theory relates to pressure in the inner ear at night. If there are pressure changes in the atmosphere, similar to in an airplane during take-off and landing, the child may move his/her jaw to relieve this pressure and inadvertently grind his/her teeth.  It may also occur coincidentally with a growth spurt – the child’s jaw grows and the teeth rub together during that time.

If you suspect bruxism may be affecting your child, mention it to the front office when you make the appointment or to the doctor during your child’s dental exam.  If your child also snores, bruxism can be a sign of sleep apnea, so we will want to discuss this with you.

My teenager wants to get his/her tongue, lip or cheek pierced.

There are many risks involved with oral piercing: chipped or cracked teeth, blood clots, blood poisoning and suffocation. Your mouth contains millions of bacteria, and infection is a common complication of oral piercing.  There have been reported cases of a person’s tongue swelling large enough to close off the person’s airway resulting in an emergency tracheotomy.

Common symptoms of dangerous side effects 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 piercing.

My child is curious to try chewing tobacco.

We encourage you to teach your child about the dangers of tobacco.

Tobacco in any form can jeopardize your child’s health and cause incurable damage.  Tobacco introduces cancer-causing chemicals in direct contact to the user’s tongue, gums and cheek.

Smokeless tobacco, also called spit, chew or snuff, is often used by teens because they 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 thus more difficult to quit. One can of snuff per day delivers as much nicotine as 60 cigarettes – the same as a three pack-a-day habit!  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.

The early signs of oral cancer usually are not painful and people often ignore them.  If it’s not caught in the early stages, oral cancer can require extensive, sometimes disfiguring, surgery.  If left untreated, it’s fatal.

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How will I know if my child will need orthodontic treatment?

We encourage you to speak to us if you have any questions or concerns about your child’s development.  Developing malocclusions, or bad bites, can be recognized as early as 2 to 3 years of age.  Many times early steps can be taken to reduce the need for major orthodontic treatment at a later age.

Stage I – Early Treatment: This period of treatment encompasses ages 2 to 6 years. At this young age, we are concerned with underdeveloped dental arches, the premature loss of primary teeth, and harmful habits such as finger or thumb sucking. Treatment initiated in this stage of development is often very successful and many times, though not always, can eliminate the need for future orthodontic/orthopedic treatment.

Stage II – Mixed Dentition: This period covers the ages of 6 to 10 years, with the eruption of the permanent incisor (front) teeth and 6- year molars. Treatment concerns deal with jaw malrelationships and dental realignment problems such as crowding and poor eruption angles of permanent teeth. 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.

Stage III – Adolescent Dentition: This stage deals with the permanent teeth and the development of the final bite relationship.

My child plays sports.  Tell me about mouth guards.

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.

At some point during your child’s exam, be sure to ask us about the differences between custom and store-bought mouth protectors.

Who are patients with special needs?

“Special needs” is a term that refers to persons with medical, mental or psychological disabilities that require additional assistance.  We treat many children and adults with a range of conditions, such as Down syndrome, autism, mental retardation, visual impairments, trauma, hemophilia, and cystic fibrosis, to name a few.  Depending on the patient, sedation in the office or a hospital setting may be necessary to complete treatment.  All of our doctors have taken specialized courses in treating patients with special needs.  We have extensive experience, as does our staff. 

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Sedation

At Pediatric Dental Health Associates, we believe in working with children to help them manage their behavior.  We make sure patients have an age appropriate understanding of what to expect during each appointment, and we keep them entertained so that dentistry is easy for them to handle.  Some children however, need a little extra help to manage their anxiety.  Drs. Mary, Joanne and Marilia are each trained to consider medications to treat anxious patients.  We’ll discuss some of those options here.

Nitrous Oxide

Some children are given nitrous oxide/oxygen, or what you may know as laughing gas, to relax them for their dental treatment. Nitrous oxide/oxygen is a blend of two gases, oxygen and nitrous oxide. Nitrous oxide/oxygen is given through a small breathing mask that is placed over the child’s nose, allowing them to relax, but does not put them to sleep. The American Academy of Pediatric Dentistry recognizes this technique as a very safe, effective method to treat children’s dental needs if the child is anxious. The gas is mild, easily taken, and  with normal breathing, it is quickly eliminated from the body. While inhaling nitrous oxide/oxygen, your child remains fully conscious and keeps all natural reflexes.

Prior to your appointment:

• Please inform us of any change to your child’s health and/or medical condition.
• Tell us about any respiratory condition that makes breathing through the nose difficult for your child. It may limit the effectiveness of the nitrous oxide/oxygen.
• Let us know if your child is taking any medication on the day of the appointment.

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Conscious Sedation

Conscious Sedation is recommended for apprehensive children, very young children, and patients with special needs. It is used to calm your child and to reduce the anxiety or discomfort associated with dental treatments. Your child may be quite drowsy, and may even fall asleep, but they will not become unconscious.

There are a variety of different medications, which can be used for conscious sedation. The doctor will prescribe the medication best suited for your child’s overall health and dental treatment recommendations. We will be happy to answer any questions you might have concerning the specific drugs we plan to give to your child.

Prior to your appointment:

• Please notify us of any change in your child’s health and/or medical condition. Do not bring your child for treatment with a fever, ear infection or cold. Should your child become ill, contact us to see if it is necessary to postpone the appointment.
• You must tell the doctor of any drugs that your child is currently taking and any drug reactions and/or change in medical history.
• Please dress your child in loose fitting, comfortable clothing.
• Please make sure that your child goes to the bathroom immediately prior to arriving at the office.
• Your child should not have solid food for at least 6 hours prior to their sedation appointment and only clear liquids for up to 4 hours before the appointment.
• The child's parent or legal guardian must remain at the office during the complete procedure.
• Please watch your child closely while the medication is taking effect. Hold them in your lap or keep close to you. Do not let them "run around."
• Your child will act drowsy and may become slightly excited at first.

After the sedation appointment:

• Your child will be drowsy and will need to be monitored very closely. Keep your child away from areas of potential harm.
• If your child wants to sleep, place them on their side with their chin up. Wake your child every hour and encourage them to have something to drink in order to prevent dehydration. At first it is best to give your child sips of clear liquids to prevent nausea. The first meal should be light and easily digestible.
• If your child vomits, help them bend over and turn their head to the side to insure that they do not inhale the vomit.
• Because we use local anesthetic to numb your child’s mouth during the procedure, your child may have the tendency to bite or chew their lips, cheeks, and/or tongue and/or rub and scratch their face after treatment. Please observe your child carefully to prevent any injury to these areas.
• Please call our office for any questions or concerns that you might have.

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I.V. Sedation

I.V. Sedation is recommended for apprehensive children, very young children, and patients  with special needs who  would not respond  well under conscious sedation. The dentist performs the dental treatment in our office with the child anesthetized under I.V. sedation, which is administered and monitored by a medical or dental anesthesiologist.

Prior to your appointment:

• Please notify us of any change in your child’s health and/or medical condition. Do not bring your child for treatment with a fever, ear infection or cold. Should your child become ill, contact us to see if it is necessary to postpone the appointment.
• You must tell the doctor of any drugs that your child is currently taking and any drug reactions and/or change in medical history.
• Please dress your child in loose fitting, comfortable clothing.
• Please make sure that your child goes to the bathroom immediately prior to arriving at the office.
• Your child should not have milk or solid food after midnight prior to the scheduled procedure and clear liquids ONLY (water, apple juice, Gatorade) for up to 6 hours prior to the appointment.
• The child’s parent or legal guardian must remain at the office during the complete procedure.

After the sedation appointment:

• Your child will be drowsy and will need to be monitored very closely. Keep your child away from areas of potential harm.
• If your child wants to sleep, place them on their side with their chin up. Wake your child every hour and encourage them to have something to drink in order to prevent dehydration. At first it is best to give your child sips of clear liquids to prevent nausea. The first meal should be light and easily digestible.
• If your child vomits, help them bend over and turn their head to the side to insure that they do not inhale the vomit.
• Please call our office for any questions or concerns that you might have.

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Outpatient General Anesthesia

Outpatient General Anesthesia is recommended for apprehensive children, very young children, and children with special needs who  would not respond  well under conscious sedation or I.V. sedation. General anesthesia renders your child completely asleep. It is the same anesthesia that would be used if your child were having his/her tonsils removed, ear tubes inserted, or a hernia repaired.

There are more risks with general anesthesia compared to conscious sedation or IV sedation. Your doctor will review the pros and cons and discuss the risks with you so you may make an informed decision. Treatment may be possible without general anesthesia, but will likely involve multiple appointments, the use of physical restraints, and possible emotional trauma. 

The risks of NO treatment include tooth pain, infection, swelling, the spread of new decay, damage to the patient’s developing adult teeth, and possible hospitalization from a life threatening dental infection.

Prior to your appointment:

• Please notify us of any change in your child’s health. Do not bring your child for treatment with a fever, ear infection or cold. Should your child become ill, contact us to see if it is necessary to postpone the appointment.
• You must tell the doctor of any drugs that your child is currently taking and any drug reactions and/or change in medical history.
• Please dress your child in loose fitting, comfortable clothing.
• Your child should not have milk or solid food after midnight prior to the scheduled procedure and clear liquids ONLY (water, apple juice, Gatorade) for up to 6 hours prior to the appointment.
• The child’s parent or legal guardian must remain at the hospital or surgical site waiting room during the complete procedure.

After the appointment:

• Your child will be drowsy and will need to be monitored very closely. Keep your child away from areas of potential harm.
• If your child wants to sleep, place them on their side with their chin up. Wake your child every hour and encourage them to have something to drink in order to prevent dehydration. At first it is best to give your child sips of clear liquids to prevent nausea. The first meal should be light and easily digestible.
• If your child vomits, help them bend over and turn their head to the side to insure that they do not inhale the vomit.
• Prior to leaving the hospital/outpatient center, you will be given a detailed list of "Post-Op Instructions" and an emergency contact number if needed.

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