Dental Topics

Taking your child to the dentist...

How does the food we eat causes cavities and gum disease?

Food alone does not cause cavities and gum disease. Food is the fuel used by the bacteria in our mouths. When the food and the bacteria are together an acid is created that can cause cavities. Plaque is the term for bacteria which collects on the teeth. Certain foods which are high in acids such as soft drinks accelerate the activity of the bacteria, and can enhance the opportunity for tooth decay. Bacterial plaque causes gum inflammation and if not removed on a daily basis can lead to gum disease.

Since children are going to lose their baby teeth anyway, why are they important?

Baby teeth are important for chewing food, smiling and the child’s self confidence, and learning to make sounds that are our language. Baby teeth also hold the space for the developing permanent teeth. If a baby tooth is lost early, the space for the permanent tooth can close, and may result in the need for orthodontic treatment.

What are some of the common mistakes parents make in caring for their children’s teeth?

The most common mistake parents make is allowing very young children to care for their teeth by themselves. Children develop adequate coordination to make small deliberate hand movements at about the time they learn to write in cursive. Younger children are not usually able to effectively clean their teeth. Parents sometimes believe that because the toothbrush is in the mouth, the teeth have been cleaned. Parents should recline the child in the lap, lift the lip and brush the teeth. This should be done daily.

What can parents expect to happen at each visit?

At the initial examination appointment, the child’s teeth will be examined, as well as the soft tissues of the cheek, gums, tongue and throat. Disclosing solution (shows the plaque) will be painted on the child’s teeth, and thorough tooth brushing and flossing instructions will be given. A fluoride treatment will be given. Depending on the child’s age, and dental health, certain x-rays will be taken. Children 6 years and older receive a full mouth x-ray. The same procedures will be repeated at the recall exam. Typically x-rays to check for decay are taken one time a year, and the typical schedule for full mouth x-rays are every five years.

What is a pediatric dentist, and how can they be helpful to families? How are they different from a general dentist?

Pediatric dentists are trained for 2-3 years after dental school specifically for children. Education for pediatric dentists emphasizes behavior management, growth and development, and treatment of children with special healthcare needs.

What is fluoride solution or varnish – and when is it recommended?

Topical fluoride, or fluorides painted on the teeth, such as fluoride in toothpastes or rinses, and those used in the dental office, are thought to be the most effective in preventing dental decay. Fluoride acts on the outer tooth surface, and changes the surface so that it is harder than enamel, and more resistant to decay.

Why is it important to schedule regular checkups, rather than waiting until something is wrong?

There are at least three good reasons to have regular checkups. First, coming to the dentist can be frightening for young children. Having regular checkups help children feel comfortable in the surroundings, and give them an opportunity to know the dentist, and the staff before difficult procedures are needed.

Second, prevention is much less expensive than treatment. Fluoride and sealants are wonderful preventive measures to help the child not have dental decay. Regular applications of fluoride in the dental office, combined with fluoridated tooth paste is the best way we currently have to prevent dental decay. Baby teeth have very thin enamel, and a small cavity can proceed very quickly. It is important to detect these cavities at a very early stage, so that a small filling can be placed. A nerve treatment and crown (necessary for advanced decay) is more than 2 times as expensive as a one surface white filling. The most drastic treatment for primary teeth is removal, which can rob the child of his smile, his ability to eat and chew, and cause future orthodontic problems.

The third reason for regular checkups is that it can prevent pain. Children in pain do not make good dental patients. Children who have not previously visited a dentist have the added problem of not feeling comfortable in a dental office.

Before birth...

What can a woman do, while pregnant, to help the health of her baby’s teeth?

There is evidence in the literature that mothers pass the decay germs to her children, therefore it is important for the mother to be as cavity free as possible before the baby is born. Dental treatment is safe during pregnancy. Dentists may prescribe antibacterial rinses or gum for moms with significant disease. Parents should be careful about their saliva coming into contact with the infant’s mouth. There are simple ways to prevent the transmission of decay causing bacteria. Do not share food, or pre taste the child’s food. Do not use the same fork or spoon. Do not allow the child to place his/her fingers in your mouth. Do not clean pacifiers in your mouth.

Babies...

Does daily brushing begin even before teeth appear? Why, and how?

Babies’ mouths should be cleaned after each feeding. This can be accomplished with gauze or a finger cot made for the purpose. Once the teeth erupt, a toothbrush can be added. It is important for the infant to have a clean mouth, and know the feeling of a clean mouth.

What is fluoride, and what kind of conversation should parents have with the dentist, about whether their child is getting enough?

Fluoride is a naturally occurring mineral that has proven to reduce tooth decay significantly. In some areas of the United States, fluoride occurs naturally in the drinking water. Topical fluorides change the outermost layer of enamel, and makes it more resistant to decay. Ingested fluorides, such as the fluoride found in the water supply helps the developing teeth be more resistant to decay. If topical fluorides are not swallowed, the child cannot receive too much fluoride. For instance, a child can use fluoridated toothpaste, fluoridated mouth rinse, and have fluoride in the dental office without concern. Ingested fluorides need to be controlled. The fluoride in the water is at a specific amount. If the child is in day care in a fluoridated area, he or she should not receive a fluoride supplement (tablet or drops). This would be too much fluoride. Fluoride is a good preventive measure and fluoridated drinking water has significantly lowered the incidence of tooth decay. The discussion about fluoride should be the appropriate amount for the child’s age and size.

What kind of brush is appropriate for a baby’s first teeth?

The first toothbrush should have a small head, and soft bristles.

When should the first dental visit take place – and what happens at that visit?

The first visit should come by the first birthday. At this visit the teeth will be examined for decay. The soft tissues of the mouth, the gums, the tongue, cheeks, and palate will be examined. The eruption of the primary teeth will be evaluated. Disclosing solution will be placed on the child’s teeth. This helps the parent know which areas have been missed with the toothbrush. A topical fluoride will be placed on the teeth. This is usually a fluoride varnish, and should remain on the teeth for 24 hours. Some brands of the varnish leave a light yellow stain on the teeth until it is brushed off the teeth. The child may eat or drink at any time after the fluoride varnish treatment.

Why is letting a baby fall asleep with a bottle of milk or juice a bad idea?

Both milk and juice contain sugar. When we sleep we do not swallow as often as we do while awake. Children who fall asleep with the bottle hold the liquid near the teeth for a long period of time. We also do not produce much saliva while sleeping, so there is nothing to wash the sugars away from the teeth. Any bacteria left on the teeth can use the sugars to cause tooth decay. This decay usually starts on the tongue side of the teeth, and parents do not notice it at an early stage. When the decay is noticeable on the front sides of the teeth, it is usually progressed to a severe stage.

Toddlers & Preschool...

How can you tell your toddler is ready to brush his or her teeth, and why is it important to help?

Toddlers are never ready to brush by themselves. Adequate tooth brushing requires coordination toddlers do not possess. Most children develop the coordination necessary to do a good job about the time they learn to tie their shoes, and for some children when they are able to write in cursive. If children do not do a good job with brushing, and leave plaque on their teeth, they will have tooth decay.

How long should brushing last, and what’s the best technique?

Brushing should last as long as it takes to clean all of the surfaces of all of the teeth. It is best to start at the same place each time. For example, brush the cheek sides of the teeth starting on the upper right, continuing to the upper left, then to the lower left and around to the lower right. The tongue sides of the teeth can be brushed in the same manner. At that time the chewing surfaces of the teeth can be brushed. It is a good idea for children to count to 5 for each time the brush is placed on a tooth.

Should a parent then “finish the job?” after watching the toddler brush?

A parent should always assume the responsibility of brushing a toddler’s teeth. It really does not matter if the child starts or the parent starts. One good way to do this is have the child recline in the parent’s lap in a place where there is good light. This may be the couch or the child’s bed. The parent then has a good view of the child’s mouth. Obviously tooth paste should not be used when the child is in this position. When the parent has brushed all surfaces, tooth paste can be placed on the brush and the child can finish the job. Whatever method used, make sure that all surfaces of the child’s teeth are cleaned. Hint—it is almost impossible to do a thorough job facing the child.

What is the right amount of fluoridated toothpaste to use?

The American Academy of Pediatric Dentistry recommends that children under three years of age use a smear of fluoridated toothpaste on the brush. This is a very small amount, and covers only the tips of the tooth brush bristles. When the child is three years old, or can effectively spit out the toothpaste, a pea sized amount can be used. Young children should not be allowed to use fluoride tooth paste unsupervised. Fluoride tooth paste can offer great cavity preventing effects for children. Eating large amounts of fluoridated tooth paste can cause staining of the permanent teeth.

What is your advice to parents whose children are resisting brushing twice a day?

Children who are resistant to brushing are not unusual. Parents have the best opportunity to train children by brushing twice a day as they first get teeth. After that time, it is important for parents to understand that brushing twice a day with a fluoridated tooth paste is the very best way to prevent tooth decay. Toddlers and young children are not capable of thoroughly cleaning their teeth, so they need either assistance or guidance with tooth brushing. As with any other care delivered to children such as bathing and hair washing, there should be no discussion about whether or not it is done.

What should a parent watch for, to make sure the child is brushing correctly?

Parents should be aware if their child has other skills that will mark his ability to properly clean the teeth. Can the child color within the lines of a drawing, can they tie their shoes? If the answer to these questions is no, then it is not physically possible for the child to effectively clean their own teeth. During the transition from the parent brushing to the child brushing, the parent can observe the child brushing. There are products on the market that disclose the plaque, or make it a color, so that the parent can easily determine if the child has brushed effectively.

When can flossing begin? What’s the best way to do it?

Teeth should be flossed when there is no longer a visual space between them. Very young children usually do not require flossing because of the large spaces between their teeth. Some children have all of their primary teeth by age three, and it is possible that the teeth will touch at this time. The space can easily be checked with the floss. If the teeth touch, the floss will meet resistance. Parent can floss for young children, and often the last two teeth on each side are the only ones that need to be flossed. The flossers (plastic tools that hold the floss) can make the job easier.

Ages 4 & Up...

Can a built in timer help?

Timers can offer motivation to children, and help them learn that thorough brushing cannot occur in a matter of seconds.

Is a power brush appropriate for children?

A power brush can be a motivator for children, and can be used effectively to clean the teeth. Sometimes parents incorrectly assume that the brush does the job. The power brush should be used in the same manner as the manual brush. Parents should make certain that the brush is firmly placed at the gum line, and that the power brush does not skim the outsides of the teeth.

What advice do you give parents, for healthy eating for their kids?

Parents should remember that sugar is not a good choice for a snack. These choices should be made from a very early age. The American Academy of Pediatrics recommends one eight ounce glass of juice per day. This juice should be taken at meal times for toddlers. They should not be allowed to carry a juice cup with them to drink at will. Water should be taken between meals and night. Toddlers should never, never take a juice or milk cup to bed. Healthy snacks include fruits and vegetables and cheeses. Cookies, crackers and candy all contain carbohydrates which can be easily transformed into sugars by our saliva. Carbohydrates such as crackers may stick to the teeth for a long time, increasing the time sugars are in the mouth.

What are tips for brushing manually?

The bristles of the tooth brush should be placed at the gum line and soft circles made with the brush. Brushing should begin in the same area each time. For instance, one could start on the upper right, and continue on the lip sides of the teeth to the left. At that time the tongue side of the teeth can be brushed from the left side to the right. The lower teeth should be brushed in the same manner, and brushing can be completed by brushing the chewing surfaces. If, for example, the tooth brush covers three teeth, one tooth should be overlapped as the tooth brush is moved around the mouth.

When are children ready to brush independently?

Each child develops at a different rate, and some children have good dexterity at an early age. If the child can tie his shoes, or write in cursive, it is a good bet that he/she can brush independently.