Pediatric Dentistry

Child's First Pediatric Dental Visit

According to guidelines from the American Academy of Pediatric Dentistry (AAPD), your child should be seen by his/her pediatric dentist no later than six months after the eruption of the first tooth.

This visit mainly will involve counseling on oral hygiene, habits, and on the effects that diet can have on his/her teeth. It is NOT recommended to wait until age 3 to visit your dentist and as a general rule, the earlier the dental visit, the better the chance of preventing dental problems.

Children with healthy teeth chew food easily, learn to speak clearly, and smile with confidence. Start your child now on a lifetime of good dental habits.

The AAPD also recommends a dental check-up at least twice a year; however some children that may be at a higher-than-average caries risk may need to be seen more often.

Cute baby

Pediatric Dental X-Rays

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.

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.

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.

Happy kids

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.

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. If your child is a candidate for a conscious sedation, please make sure you follow the instructions provided by your pediatric dentist.

Toothpaste for my Child

We ONLY recommend 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 young children that swallow toothpaste during regular brushing. A child may face the condition called enamel fluorosis in which too much fluoride can result in defects in tooth enamel.

Baby Tooth Care

Healthy teeth are important to your baby's overall health. Teeth help your baby chew food and form words and sounds when speaking. They also affect the way your baby's jaw grows.

Generally, the 2 front teeth start to appear between 4 and 7 months of age. Teething is usually painless, but it can make some babies uncomfortable and fussy. Giving your baby a cold teething ring or a cold washcloth to chew or suck on may help.

Start cleaning your baby's teeth twice a day as soon as the first tooth appears. Until your child is 1 year old, you can use a wet wash cloth or gauze to clean your baby's teeth and gums. At about 1 year to 18 months of age, you should start using a soft baby toothbrush and a small dab of toothpaste that does not have fluoride, it being safe for your baby to swallow.

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.

Ankylosis

This refers to a tooth or teeth (primary or permanent) that have become "fused" to the bone, preventing it or them from moving "down" with the bone as the jaws grow. This process can affect any teeth in the mouth, but it is more common on primary first molars and teeth that have suffered trauma (typically the incisors). Treatment can vary depending on the degree of severity of the ankylosis (how "sunken into the gums" a tooth may appear). The degree of severity usually will vary depending on how early the process started, and as a general rule, the earlier it starts, the more severe the ankylosis becomes with age. Several considerations must be taken before any treatment is provided, and your dentist will discuss all the risks and benefits of each treatment option.

Mucocele

This is a common benign lesion in children and adolescents that results from the rupture of the excretory ducts (very small tubes) that deliver saliva to the top tissues of the lips. More than 75% of mucocele are located on the lower lip and their size and color may vary, however, they tend to be relatively painless for the most part. Most of the time, patients report that these "bumps" grow until they burst spontaneously, leaving small ulcers that heal within a few days. This does not mean the lesion is gone, as they often tend to re-appear weeks or months later. Most dentists will recommend surgical treatment for these lesions.

Pulpotomy

Baby teeth that have large caries (cavities) and some degree of pain occasionally require that the "coronal" (top) portion of that tooth's nerve be removed before a filling or a crown (preferably) is placed. The main goal of this procedure is to preserve the baby tooth, since baby teeth help to maintain adequate room for the permanent teeth. Pulpotomies have published success rates that range from 60% to 90% and represent a good and reliable way to save a badly decayed baby tooth.

Common Questions Or Issues

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.

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.

When a baby tooth changes color, it can mean many things. Baby teeth can and do normally change in color, particularly close to the time that they become loose; however, this change is minimal and should not be confused with a carious lesion (cavity). The best way to determine if your child has a stain or a true cavity is to take him or her to a pediatric dentist.

Teeth with cavities typically assume a darker (brown) discoloration; and depending on the extent, may exhibit loss of tooth structure. Teeth that have been previously "bumped" may also change in color. Traumatized baby teeth can assume a yellow or a dark discoloration, which may or may not be associated with pain.

Other less common causes of changes in color may be: fluorosis, food staining (particularly tea or colas), systemic disease (hepatitis), etc.

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.

It is completely normal and healthy for your baby or young child to suck on a thumb, finger, or pacifier. Children usually give up sucking habits on their own by the time they are 4 to 5 years old. If they stop the habit at this age, the shape of the jaw is usually not affected and the teeth grow in normally. Children who continue sucking on a pacifier, finger, or thumb when their permanent adult teeth start to come in are more likely to have bite problems such as the top teeth slant out, bottom teeth tilt in, the upper and lower jaws become misaligned and the roof of the mouth becomes narrow. This can result in the need for braces.

Your doctor may decide to construct an appliance to discourage thumb sucking as treatment.

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 is that going to affect him or her? Children require extraction of one or more primary teeth in certain situations. These situations may include extensive decay on their front teeth, and/or localized infection (for example an abscess or a gum boil). Extractions are also necessary in cases of trauma, where the baby teeth have been pushed back, pushed forward, broken or simply knocked out.

Parents are obviously concerned of the aesthetic and functional effects (on speech, feeding, and breathing) of removing one or more front baby teeth.There is good evidence that has shown NO long-term speech impediments on these cases. We also know from our professional experience that once the gums heal, children will be able to eat almost anything, since they can still bite-and-cut with the remaining teeth.

As far as aesthetics is concerned, your pediatric dentist can offer you information on fixed appliances that can replace the missing tooth/teeth, assuming your child meets the right criteria.

Crooked or crowded teeth are very common in the growing patient. Even patients that get braces may develop a minor degree of crooked (crowded) teeth, particularly in the front teeth of the jaws, as they grow old.

The first step in determining the need for treatment is what we call an orthodontic consult. During this appointment, we may obtain special records and special x-rays of your child's jaw. This information will allow us to make a decision based on predicted growth patterns that your child may show later. In orthodontic terms, we refer to this as Early Treatment.

Early Treatment refers to ANY orthodontic (braces) or orthopedic appliances (like Headgear) treatment that begins when the child is in primary dentition or in early mixed dentition (when the first permanent teeth begin to erupt). This has been proven to be effective despite objections by some people in the orthodontic community.

The American Academy of Pediatric Dentistry (AAPD) recognizes that early diagnosis and successful treatment of developing malocclusions can have both short-term and long-term benefits, while achieving the goal of occlusal harmony, function, and facial aesthetics.

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.

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