Commonly Asked Questions
The American Academy of Pediatric Dentistry (AAPD) suggests that parents should make an initial “well-baby” appointment with a pediatric dentist approximately six months after the emergence of the first tooth, or no later than the child’s first birthday. Although this may seem surprisingly early, the incidence of infant and toddler tooth decay has been rising in recent years. Tooth decay and early cavities can be exceptionally painful if they are not attended to immediately, and can also set the scene for poor oral health in later childhood. The pediatric dentist is a specialist in child psychology and child behavior, and should be viewed as an important source of information, help, and guidance. Oftentimes, the pediatric dentist can provide strategies for eliminating unwanted oral habits (for example, pacifier use and thumb sucking) and can also help parents in establishing a sound daily oral routine for the child.
The American Academy of Pediatric Dentists (AAPD) advises parents to make biannual dental appointments for children, beginning approximately six months after the first tooth emerges. These two important yearly visits allow the pediatric dentist to monitor new developments in the child’s mouth, evaluate changes in the condition of teeth and gums, and continue to advise parents on good oral care strategies. The pediatric dentist may schedule additional visits for children who are particularly susceptible to tooth decay or who show early signs of orthodontic problems.
The condition of a child’s teeth can change fairly rapidly. Even if the child’s teeth were evaluated as healthy just six months prior, changes in diet or oral habits (for example, thumb sucking) can quickly render them vulnerable to decay or misalignment. In addition to visual examinations, the pediatric dentist provides thorough dental cleanings during each visit. These cleanings eradicate the plaque and debris that can build up between teeth and in other hard to reach places. Though a good homecare routine is especially important, these professional cleanings provide an additional tool to keep smiles healthy. The pediatric dentist is also able to monitor the child’s fluoride levels during routine visits. Oftentimes, a topical fluoride gel or varnish is applied to teeth after the cleaning. Topical fluoride remineralizes the teeth and staunches mineral loss, protecting tooth enamel from oral acid attacks. Some children are also given take-home fluoride supplements (especially those residing in areas where fluoride is not routinely added to the community water supply). Finally, the pediatric dentist may apply dental sealants to the child’s back teeth (molars). This impenetrable liquid plastic substance is brushed onto the molars to seal out harmful debris, bacteria, and acid.
The best preparation for your child’s first visit to our office is maintaining a positive attitude. Children pick up on adults’ apprehensions, and if you make negative comments about trips to the dentist, it is likely that your child will anticipate an unpleasant experience and act out accordingly. Show your little one the pictures of the office and staff on the website. Read a book about first dental visits, such as "The Berenstain Bears Visit the Dentist." Let your child know that it is important to keep the teeth and gums healthy, and that the doctor will help him or her do that. Remember that your dentist is trained to handle fears and anxiety, and our staff excels at putting children at ease during treatment.
The age at which dental radiographs (x-rays) are initially taken can vary. Usually, the first set is taken around age 3. In many cases, the first set consists of easy-to-take pictures of the upper & lower front teeth, which familiarizes your child with the process and builds confidence. Once the baby teeth in back are touching one another, then regular (at least yearly) X-rays are recommended. Permanent teeth start coming in around age six, and X-rays help us make sure your child’s teeth and jaw are healthy and properly aligned. If your son or daughter is at a high risk of dental problems, we may suggest having X-rays taken at an earlier age.
Primary teeth, also known as “baby teeth” or “deciduous teeth,” begin to develop beneath the gums during the second trimester of pregnancy. Teeth begin to emerge above the gums approximately six months to one year after birth. Typically, preschool children have a complete set of 20 baby teeth – including four molars on each arch. One of the most common misconceptions about primary teeth is that they are irrelevant to the child’s future oral health. However, their importance is emphasized by the American Dental Association (ADA), which urges parents to schedule a “baby checkup” with a pediatric dentist within six months of the first tooth emerges. What are the functions of primary teeth? Primary teeth can be painful to acquire. To soothe tender gums, biting on chewing rings, wet gauze pads, and clean fingers can be helpful. Though most three-year-old children have a complete set of primary teeth, eruption happens gradually – usually starting at the front of the mouth. The major functions of primary teeth are described below: Speech production and development – Learning to speak clearly is crucial for cognitive, social, and emotional development. The proper positioning of primary teeth facilitates correct syllable pronunciation and prevents the tongue from straying during speech formation. Eating and nutrition – Children with malformed or severely decayed primary teeth are more likely to experience dietary deficiencies, malnourishment, and to be underweight. Proper chewing motions are acquired over time and with extensive practice. Healthy primary teeth promote good chewing habits and facilitate nutritious eating. Self-confidence – Even very young children can be quick to point out ugly teeth and crooked smiles. Taking good care of primary teeth can make social interactions more pleasant, reduce the risk of bad breath, and promote confident smiles and positive social interactions. Straighter smiles – One of the major functions of primary teeth is to hold an appropriate amount of space for developing adult teeth. In addition, these spacers facilitate the proper alignment of adult teeth and also promote jaw development. Left untreated, missing primary teeth cause the remaining teeth to “shift” and fill spaces improperly. For this reason, pediatric dentists often recommend space-maintaining devices. Excellent oral health – Badly decayed primary teeth can promote the onset of childhood periodontal disease. As a result of this condition, oral bacteria invade and erode gums, ligaments, and eventually bone. If left untreated, primary teeth can drop out completely – causing health and spacing problems for emerging permanent teeth. To avoid periodontal disease, children should practice an adult-guided oral care routine each day, and infant gums should be rubbed gently with a clean, damp cloth after meals.
Though there are some individual differences in the timing of tooth eruption, primary teeth usually begin to emerge when the infant is between six and eight months old. Altogether, a set of twenty primary teeth will emerge by the age of three. In general, teeth emerge in pairs, starting at the front of the infant’s mouth. Between the ages of six and ten months, the two lower central incisors break through. Remember that cavities may develop between two adjacent teeth, so flossing should begin at this point. Next (and sometimes simultaneously), the two upper central incisors emerge – usually between the ages of eight and twelve months. Teething can be quite an uncomfortable process for the infant. Clean teething rings and cold damp cloths can help ease the irritation and discomfort. Between the ages of nine and sixteen months the upper lateral incisors emerge – one on either side of the central incisors. Around the same time, the lower lateral incisors emerge, meaning that the infant has four adjacent teeth on the lower and upper arches. Pediatric dentists suggest that sippy cup usage should end when the toddler reaches the age of fourteen months. This minimizes the risk of “baby bottle tooth decay.” Eight more teeth break through between the ages of thirteen and twenty three months. On each arch, a cuspid or canine tooth will appear immediately adjacent to each lateral incisor. Immediately behind (looking towards the back of the child’s mouth), first molars will emerge on either side of the canine teeth on both jaws. Finally, a second set of molars emerges on each arch – usually beginning on the lower arch. Most children have a complete set of twenty primary teeth before the age of thirty-three months. The pediatric dentist generally applies dental sealant to the molars, to lock out food particles, bacteria, and enamel-attacking acids.
It’s never too early to begin a healthy oral care routine. In fact, you should begin caring for your child’s gums long before their first tooth emerges, which is usually around the six-month mark of their life. Healthy gums are an important predictor of healthy teeth, and maintaining clean gums will help ensure that your child has healthy, cavity-free baby teeth. You can clean your infant’s gums – or their first teeth – by simply using a cold, clean washcloth. Simply rinse a clean, soft washcloth with cool water and wring it out. After your child has finished eating, or drinking a sugary drink, use the damp washcloth to gently wipe out their mouth. This will remove any sugar or acid that’s left by their food, and help prevent early cavities. Once your child has a few more baby teeth – usually between 8 and 12 months – then you can graduate from a washcloth to a toothbrush designed for toddlers. There are a lot of toothbrushes designed for babies and toddlers from which to choose. Generally speaking, toothbrushes designed for babies have much softer bristles and a smaller head than those meant for older children. Use only a smear of fluoride toothpaste – about the size of a grain of rice – to brush their teeth. When they’ve gotten older and have more teeth, use a pea-sized amount of toothpaste. Always be sure to rinse their mouth out with cool water after you’re done brushing, and try to keep them from swallowing any toothpaste. Flossing is also important for baby teeth. Flossing helps remove the plaque and food that can become lodged between teeth. Be sure to floss your child’s teeth daily.
Fluoridated toothpaste should be introduced when a child is 2-3 years of age. Prior to that, parents should clean the child’s teeth with water and a soft-bristled toothbrush. When toothpaste is used after age 2-3, parents should supervise brushing and make sure the child uses no more than a pea-sized amount on the brush. Children should never swallow any excess toothpaste.
A child's overall health impacts their oral health, and vice versa. A well-balanced diet supports strong teeth, gums, and overall growth by providing essential nutrients. The food pyramid suggests children consume a mix of vegetables, fruits, grains, proteins, and dairy. Most snacks contain sugar, which attracts bacteria that produce acid, leading to tooth decay. We recommend healthier snacks like carrots sticks, yogurt, and cottage cheese. Avoid frequent snacking, as it keeps teeth constantly exposed to sugar and acid. Choose quick-eating snacks over long-lasting candies, and opt for sugar-free alternatives when possible. Limit the consumption of sugary drinks like fruit juice and soda. Carbohydrates like chips and pretzels break down into sugars, so they're best consumed with meals when saliva washes away particles. Provide water instead of soda to rinse the mouth. Avoid sticky foods, as they are hard to clean from teeth, especially for young children.
Bruxism, or grinding of teeth, is remarkably common in children. For some children, this tooth grinding is limited to daytime hours but nighttime grinding (during sleep) is most prevalent. Bruxism can lead to a wide range of dental problems such as moderate of severe jaw discomfort, headaches and ear pain. Bruxism can be caused by several different factors. Most commonly a "bad bite" or jaw misalignment promotes grinding. Children with certain developmental disorders or brain injuries may also be at particular risk of grinding. Bruxism may spontaneous cease at the age of thirteen in the majority of children. In general, the treatment is dictated by the cause. If the teeth are misaligned, some options may include orthodontic intervention or altering the biting surface of teeth with crowns. In cases with significant damage, your dentist may recommend a specialized dental appliance such as a nighttime mouth guard. If you have any questions or concerns about bruxism or grinding teeth, please contact our office.
We recommend mouthguards for children active in sports such as baseball, soccer or other sports to protect his or her teeth. Ask us about custom-fitted mouthguard made to protect the teeth, lips, cheeks and gums.
For most infants, the sucking of thumbs and pacifiers is a happy, everyday part of life. Since sucking is a natural, instinctual baby habit, infants derive a sense of comfort, relaxation, and security from using a thumb or pacifier as a sucking aid. According to research from the American Academy of Pediatric Dentistry (AAPD), the vast majority of children will cease using a pacifier before the age of four years old. Thumb sucking can be a harder habit to break and tends to persist for longer without intervention. Children who continue to suck thumbs or pacifiers after the age of five (and particularly those who continue after permanent teeth begin to emerge) are at high-risk for developing dental complications such as jaw misalignment, roof narrowing, crooked teeth, mouth sores, and tooth decay. Here are some helpful suggestions to help encourage the child to cease thumb sucking or pacifier use: Ask the dentist to speak with the child about stopping. Often, the message is heard more clearly when delivered by a health professional. Buy an ADA recommended specialized dental appliance to make it difficult for the child to engage in sucking behaviors. Implement a reward system (not a punishment), whereby the child can earn tokens or points towards a desirable reward for not thumb sucking or using a pacifier. Wrap thumbs in soft cloths or mittens at nighttime. If the above suggestions do not seem to be working, your dentist can provide more guidance. Remember: the breaking of a habit takes time, patience, and plenty of encouragement!
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