Pediatric Dentistry FAQ's
Baby Bottle Tooth Decay
Baby bottle tooth decay or syndrome is a form of tooth decay that can destroy the teeth of an infant. This decay may even enter the underlying bone structure, which can hamper development of the permanent teeth. The teeth most likely to be damaged are the upper teeth.
Baby bottle decay is caused by frequent and long exposure of a child's teeth to liquids containing sugar such as milk, formula, fruit juices, pop and other sweetened liquids. These liquids fuel the bacteria in a child's mouth, which produces acids that attack enamel.
Children's Tooth Development
Children continually get new teeth from age 3 months to the age 6 years. Most children have a full set of 20 primary teeth by the time they are 3 years old. As a child nears the age 6, the jaw grows making room for the permanent teeth. At the same time, the roots of the baby teeth begin to be resorbed by the tissues around them and the permanent teeth under them begin to erupt.
Primary teeth are just as important as permanent teeth for chewing, speaking and appearance. They also serve as placement holders for the permanent teeth. Primary teeth also provide structure to help shape the child's face.
Early Childhood Caries
Childhood cavities, also now known as "Early Childhood Caries" is an aggressive form of caries that occurs in infants and very young children. It is typically associated with prolonged consumption of liquids containing sugar and affects initially the top front teeth, later spreading to other "baby teeth." Because of the aggressive nature of this disease, early intervention is necessary.
The American Academy of Pediatric Dentistry (AAPD) and the American Academy of Pediatrics (AAP) recommend that ALL children should see a dentist before age one.
There are gaps between my child's teeth, is this normal?
It is normal and even "ideal" for baby teeth to have spacing between each other.
Keep in mind that when permanent teeth erupt, their size will be considerably larger than that of baby teeth. As the baby teeth are lost, the erupting permanent tooth will quickly take advantage of this excess space.
Children who do not have spacing in their primary dentition can have a higher incidence of crowding (crooked teeth) in the permanent dentition.
How does enamel fluorosis occur?
By swallowing too much fluoride for the child's size and weight during the years of tooth development, a child can develop enamel fluorosis. This can happen in several different ways.
First, a child may take more of a fluoride supplement than the amount prescribed.
Second, the child may take a fluoride supplement when there is already an optimal amount of fluoride in the drinking water.
Third, some children simply like the taste of fluoridated toothpaste. They may use too much toothpaste, and then swallow it instead of spitting it out.
My child is getting shark teeth; what can I do?
One of our most common consults occurs when children around the age of seven begin to lose their lower front teeth. Many of our parents become overly worried about this phenomenon. It is VERY NORMAL for permanent lower incisors (front teeth) to erupt behind their predecessors (baby teeth); however, if a baby tooth is not loose by the time half of the permanent incisor has erupted, it may be necessary to pull it.
Toothpaste for my child
There is no such thing as the best toothpaste. We recommend ONLY products that have been ADA (American Dental Association) accepted or approved.
The selection is usually made on a case-by-case basis, however the main consideration when selecting toothpaste is your child's age.
This is due to the risk of fluorosis in younger children that swallow toothpaste during regular brushing. A child may face the condition called enamel fluorosis if he or she gets too much fluoride during the years of tooth development. Too much fluoride can result in defects in tooth enamel.
What is oral sedation?
A conscious oral sedation is a procedure in which a child is given an oral medication that causes a depressed level of consciousness. The American Academy of Pediatric Dentistry (AAPD) has clearly defined the indications for this procedure, and they are as follows:
- Preschool children who cannot understand or cooperate for definitive treatment.
- Patients requiring dental care who cannot cooperate due to a lack of psychological or emotional maturity.
- Patients requiring dental treatment who cannot cooperate due to a cognitive, physical or medical disability.
- Patients who require dental care but are fearful, anxious and cannot cooperate for treatment.
As with any procedure in which a child's conscious state is altered, there are some risks involved. The main risks (serious complications) associated with conscious sedation include, but are not limited to: aspiration, respiratory arrest, cardiac arrest, and death. Because your child will be partially awake, local dental anesthesia (a lidocaine shot) is still needed; and this may limit the extent of work that we can provide. Sedation dentistry is also an option in cases of accidents or trauma; but in these situations, the decision to administer the medication must take into consideration the risk of aspiration (breathing vomit into the lungs) and any head trauma that may have occurred. If your child is a candidate for a conscious sedation, please make sure you follow the instructions provided by your pediatric dentist.
Will you need to give my child a shot to do the dental work?
This is one of the most commonly asked questions that we get from our patient's parents. We try to minimize the discomfort of the injection by placing a gel that works as a local anesthetic to numb the tissue were the injection will be administered.
Profound local anesthesia is usually obtained five to ten minutes after the injection, depending on the area of the mouth where the anesthetic was placed. We always check to confirm that the area is numb before we begin to work. In cases of localized infection or trauma (like broken teeth), it is very difficult to obtain profound anesthesia. However, we do have other means of supplementing the anesthetic (like conjoined use of nitrous-oxide gas, medications, or conscious sedation).
Younger children, particularly pre-schoolers, may interpret the feeling of numbness as pain, and therefore cry. Please follow the post-operative instructions that we give you, in order to minimize complications such as lip biting.
Can you do all the work at once with a sedation?
In cases with extensive decay, we are limited by the maximum dosage of local anesthetic that we can use. As a rule, we also consider your child's comfort after he/she leaves the clinic in order to determine how much local anesthetic we can use.
Very young children are at high risk of biting their lips or chewing on the inside part of their cheeks after they receive local anesthetic (a lidocaine shot). This usually happens because of their natural curiosity; they try to feel the area or areas that are numb.
For these and other reasons, it is unlikely that we could work on all of your child's teeth at once. An exception to this rule would be a child that is taken to the operating room.
Pediatric Dental X-Rays
In general, children need x-rays more often than adults. Their mouths grow and change rapidly. They are more susceptible to tooth decay than adults. The American Academy of Pediatric Dentistry recommends x-ray examinations 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.
X-rays 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 and affordable.
X-ray films detect:
- Erupting teeth
- Diagnose bone diseases
- Evaluate the results of an injury
- Plan orthodontic treatment
Particular care is applied to minimize the exposure of young patients to radiation. With contemporary safeguards, the amount of radiation received in a dental x-ray examination is extremely small. The risk is negligible. In fact, dental x-rays represent a far smaller risk than an undetected and untreated dental problem.