Enhanced Pediatric Dental Topics (FAQ)
6 Month Exam
- What is a Pediatric Dentist?
- Eruption of Your Child’s Teeth
- Why are Primary Teeth So Important
- What’s the Best Toothpaste for my Child?
- What is the Best Time for Orthodontic Treatment?
- Dental Emergencies
- What are Dental Radiographs (X-Rays)? Why Does My Child Need Them?
- Does My Child Grind His Teeth at Night? What Causes This?
- My Child Sucks His Thumb. Will This Cause Dental Problems?
- What is Pulp Therapy?
- Perinatal & Infant Oral Health
- Your Child’s First Dental Visit
- When Will My Baby Start Getting Teeth?
- Baby Bottle Tooth Decay (Early Childhood Caries)
- Care of Your Child’s Teeth
- Good Diet = Healthy Teeth
- How Do I Prevent Cavities?
- Seal Out Decay
- Mouth Guards
- Xylitol - Reducing Cavities
For more information concerning pediatric dentistry, please visit the website for the American Academy of Pediatric Dentistry.
General Pediatric Dentistry FAQs
When you’re looking for a pediatric dentist or orthodontist in or around Austin, TX, we at Lone Star Pediatric Dental & Braces aim to be your premier choice. As your trusted pediatric dentist, it’s our goal to put your child on the path toward a healthy smile for life. A lifetime of healthy teeth begins with a child’s primary (baby) teeth and we want to help provide the pediatric dentistry treatments and advice necessary to give your child the best possible head start.
To learn more about pediatric dentistry, we encourage you to read our responses to some of our patients’ most frequently asked questions below. You can also contact us to ask your questions directly or to schedule an appointment with one of our offices in the Austin, TX area. We look forward to hearing from you soon!
A pediatric dentist is a dentist that is dedicated to the oral health of children from infancy through the teenage years. Pediatric dentists require two to three extra years of specialized training after dental school in order to properly treat young patients. The very young, pre-teens, and teenagers all need different approaches in dealing with their dental health, guiding their teeth’s growth and development, and helping them avoid future dental problems. A pediatric dentist is trained to meet these needs, and our pediatric dentists are some of the most qualified pediatric dentists in the Austin, TX area.
Typically, your child’s 20 primary teeth will begin to appear between six and nine months of age. The first ones to erupt are usually the two lower front teeth, shortly followed by the two front upper teeth. After that, the first molars will come in, followed by the canines.
If your baby happens to experience any teething discomfort during this time, please don’t hesitate to let us know and we’ll advise you on how to treat it most effectively.
To properly clean your infant’s gums and newly erupted teeth, you should gently wipe them with a water-soaked gauze pad or a damp washcloth after each feeding. You should start establishing a daily brushing routine for your child by the age of two. When brushing your child’s primary teeth, it’s best to use a small, soft-bristled toothbrush and a thin strip of toothpaste that contains fluoride. You’ll probably need to help your child with this task until the age of six.
Look! My Tooth is Loose!
(with 16"x22" poster and stickers)
By Patricia Brennan Dermuth
Illustrated by Mike Cressy
Many people don’t think that a child’s primary teeth (oftentimes referred to as their “baby teeth”) are all that important. However, this could not be farther from the truth.
Primary teeth will serve as the guides for your child’s permanent teeth. They hold the spots open for the permanent teeth and will naturally fall out when the permanent teeth push against their roots. If your child’s primary teeth fall out too early, the permanent teeth may shift into misalignment, which will result in a need for orthodontic treatment.
These primary teeth will also help your kid with the critical tasks of chewing properly and speaking clearly. And finally, getting into the habit of a proper oral hygiene regimen for primary teeth will help develop healthy dental habits for when your child’s permanent teeth come in.
Toothache: Clean the area of the affected tooth. Rinse the mouth thoroughly with warm water or use dental floss to dislodge any food that may be impacted. If the pain still exists, contact your child’s dentist. Do not place aspirin or heat on the gum or on the aching tooth. If the face is swollen, apply cold compresses and contact your dentist immediately.
Cut or Bitten Tongue, Lip or Cheek: Apply ice to injured areas to help control swelling. If there is bleeding, apply firm but gentle pressure with a gauze or cloth. If bleeding cannot be controlled by simple pressure, call a doctor or visit the hospital emergency room.
Knocked Out Permanent Tooth: With proper action, permanent teeth can be saved after they’ve been knocked out. Carefully follow the instructions below if this happens to your child.
If possible, find the tooth. Handle it by the crown, not by the root. You may rinse the tooth with water only. DO NOT clean with soap, scrub or handle the tooth unnecessarily. Inspect the tooth for fractures. If it is sound, try to reinsert it in the socket. Have your child hold the tooth in place by biting on a gauze. If you cannot reinsert the tooth, transport the tooth in a cup containing the patient’s saliva or milk. If the patient is old enough, the tooth may also be carried in the patient’s mouth (inside the cheek area). The patient must see a dentist IMMEDIATELY! Time is a critical factor in saving the tooth.
Knocked Out Baby Tooth: Contact your pediatric dentist during normal business hours. This is not usually an emergency, and in most cases, no treatment is necessary.
Chipped or Fractured Permanent Tooth: Contact your pediatric dentist IMMEDIATELY. Quick action can save the tooth, prevent infection and reduce the need for extensive dental treatment. Rinse the mouth with water and apply cold compresses to reduce swelling. If possible, locate and save any broken tooth fragments and bring them with you to the dentist.
Chipped or Fractured Baby Tooth: Contact your pediatric dentist.
Severe Blow to the Head: Take your child to the nearest hospital emergency room immediately.
Possible Broken or Fractured Jaw: Keep the jaw from moving and take your child to the nearest hospital emergency room.
Radiographs (also called x-rays) are a vital and necessary part of your child’s dental diagnostic process. Without them, certain dental conditions can and will be missed. They are used to:
- See how your child's teeth are erupting (coming into the mouth)
- See the number, size and position of teeth that are still inside the gums
- Find out whether there are missing teeth or extra teeth
- Monitor mouth and teeth injuries
- Determine whether the teeth or mouth are infected
- Prepare for braces and other orthodontic treatment
- Detect problems that can't be seen with a visual exam
- Identify bone diseases
- Diagnose cavities in between teeth that are touching each other
The American Academy of Pediatric Dentistry recommends radiographs and examinations every six months for children with a high risk of tooth decay. On average, most pediatric dentists request radiographs approximately once a year. Approximately every 3 years, it is a good idea to obtain a complete set of radiographs, either a panoramic and bitewings or periapicals and bitewings.
Dental X-rays are very safe and expose your child to a minimal amount of radiation. When all standard safety precautions are taken, today's X-ray equipment is able to prevent unnecessary radiation and allows the dentist to focus the X-ray beam on a specific part of the mouth. High-speed film enables the dentist to reduce the amount of radiation the patient receives. A lead body apron or shield will be placed over the child's body. Make sure the shield covers your child's neck to protect the thyroid gland. It also should extend all the way to the thighs to protect the genitals and reproductive organs.
Tooth brushing is one of the most important tasks for good oral health. Many toothpastes, and/or tooth polishes, however, can damage young smiles. They contain harsh abrasives, which can wear away young tooth enamel. When looking for a toothpaste for your child, make sure to pick one that is recommended by the American Dental Association as shown on the box and tube. These toothpastes have undergone testing to insure they are safe to use.
A fluoride-containing toothpaste is one way to guarantee that your children’s teeth get enough fluoride exposure. Make sure that only a tiny smear or pea-sized amount is used for your child to brush with.
Remember, children should spit out toothpaste after brushing to avoid getting too much fluoride. If too much fluoride is ingested, a condition known as fluorosis can occur. If your child is too young or unable to spit out toothpaste, consider providing them with a fluoride free toothpaste, using no toothpaste, or taking extra precaution to use only a "pea size" amount of toothpaste.
Parents are often concerned about the nocturnal grinding of teeth, a condition called bruxism. Often, the first indication is the noise created by the child grinding on their teeth during sleep. Sometimes, the parent may notice wear on the teeth, causing them to look shorter.
The primary cause of bruxism involves a psychological component. Stress due to a new environment, divorce, changes at school, and other causes can influence a child to grind their teeth. Another cause relates to pressure in the inner ear at night. If there are pressure changes (like in an airplane during take-off and landing, when people are chewing gum, etc. to equalize pressure) the child will grind by moving his jaw to relieve this pressure.
The majority of cases of pediatric bruxism do not require any treatment. If excessive wear of the teeth is present, then a mouth guard (night guard) may be indicated.
The good news is most children outgrow bruxism. The grinding decreases between the ages six to nine and children tend to stop grinding between ages nine to 12. If you suspect bruxism, discuss this with your pediatrician or pediatric dentist.
Sucking on a thumb or finger is a completely normal habit that some babies develop even before they're born. It's soothing, and it also helps babies make contact with and explore their environment. However, if sucking habits go on much past the age of three,it's possible that bite problems may arise.
In a normal bite, the upper teeth grow to overlap the lower teeth. But it's possible for the pressure of a thumb, finger or pacifier resting on the gums to interfere with normal tooth eruption and even jaw growth. Some thumb-suckers develop an “open bite,” meaning the teeth don't overlap when a child bites together; instead, there is an open space between the upper and lower teeth. That's why thumb sucking is definitely something we should keep an eye on, though we don't want to intervene too soon.
If your child has a thumb-sucking habit past the age of three, please consult with one of our pediatric dentists as soon as possible so that we can determine the best treatment plan to stop this habit.
David Decides About Thumbsucking-A Story for Children, A Guide for Parents
by Susan Heitler PHD
Paula Singer (Photographer)
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 that the tooth is not lost.
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." or "pulpotomy.” The two common forms of pulp therapy in children's teeth are the pulpotomy and pulpectomy.
- Pulpotomy: 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 in the form of a stainless steel crown.
- Pulpectomy: A pulpectomy is required when the entire pulp is involved, including the root canals 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. Then, a final restoration is placed. A permanent tooth would be filled with a non-resorbing material.
By the age of seven, most orthodontic problems will be apparent. Interceptive orthodontic treatment is useful at this age because we’re able to help direct proper tooth positioning and jaw growth in order to simplify or eliminate the need for later treatment. Most orthodontic problems can be identified early, which is why it’s important to have a trained professional evaluate your child at a young age.
The American Academy of Pediatric Dentistry (AAPD) recommends that all pregnant women receive oral healthcare and counseling during pregnancy. Research has shown evidence that periodontal disease can increase the risk of preterm birth and low birth weight. Talk to your doctor or dentist about ways you can prevent periodontal disease during pregnancy.
Additionally, mothers with poor oral health may be at a greater risk of passing the bacteria which causes cavities to their young children. Mother’s should follow these simple steps to decrease the risk of spreading cavity-causing bacteria:
- Visit your dentist regularly.
- Brush and floss on a daily basis to reduce bacterial plaque.
- Proper diet, with the reduction of beverages and foods high in sugar & starch.
- Use a fluoridated toothpaste recommended by the ADA and rinse every night with an alocohol-free, over-the-counter mouth rinse with .05 % sodium fluoride in order to reduce plaque levels.
- Don’t share utensils, cups or food which can cause the transmission of cavity-causing bacteria to your children.
- Use of xylitol chewing gum (4 pieces per day by the mother) can decrease a child’s caries rate.
The American Academy of Pediatrics (AAP), the American Dental Association (ADA), and the American Academy of Pediatric Dentistry (AAPD) all recommend establishing a "Dental Home" for your child by one year of age. Children who have a dental home are more likely to receive appropriate preventive and routine oral health care.
The Dental Home is intended to provide a place other than the Emergency Room for parents.
You can make the first visit to the dentist enjoyable and positive. If old enough, your child should be informed of the visit and told that the dentist and their staff will explain all procedures and answer any questions. The less to-do concerning the visit, the better.
It is best if you refrain from using words around your child that might cause unnecessary fear, such as needle, pull, drill or hurt. Pediatric dental offices make a practice of using words that convey the same message, but are pleasant and non-frightening to the child.
Teething, the process of baby (primary) teeth coming through the gums into the mouth, is variable among individual babies. Some babies get their teeth early and some get them late. In general, the first baby teeth to appear are usually the lower front (anterior) teeth and they usually begin erupting between the age of 6-8 months.
See "Eruption of Your Child’s Teeth" for more details.
One serious form of decay among young children is baby bottle tooth decay. This condition is caused by frequent and long exposures of an infant’s teeth to liquids that contain sugar. Among these liquids are milk (including breast milk), formula, fruit juice and other sweetened drinks.
Putting a baby to bed for a nap or at night with a bottle other than water can cause serious and rapid tooth decay. Sweet liquid pools around the child’s teeth giving plaque bacteria an opportunity to produce acids that attack tooth enamel. If you must give the 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 dcontents with water over a period of two to three weeks.
After each feeding, 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.
Healthy eating habits lead to healthy teeth. Like the rest of the body, the teeth, bones and the soft tissues of the mouth need a well-balanced diet. Children should eat a variety of foods from the five major food groups. Most snacks that children eat can lead to cavity formation. The more frequently a child snacks, the greater the chance for tooth decay. How long food remains in the mouth also plays a role. For example, hard candy and breath mints stay in the mouth a long time, which cause longer acid attacks on tooth enamel. If your child must snack, choose nutritious foods such as vegetables, low-fat yogurt, and low-fat cheese, which are healthier and better for children’s teeth.
Good oral hygiene removes bacteria and the left over food particles that combine to create cavities. For infants, use a wet gauze or clean washcloth to wipe the plaque from teeth and gums. Avoid putting your child to bed with a bottle filled with anything other than water. See "Baby Bottle Tooth Decay" for more information.
For older children, brush their teeth at least twice a day. Also, watch the number of snacks containing sugar that you give your children.
The American Academy of Pediatric Dentistry recommends visits every six months to the pediatric dentist, beginning at your child’s first birthday. Routine visits will start your child on a lifetime of good dental health.
Your pediatric dentist may also recommend protective sealants or home fluoride treatments for your child. Sealants can be applied to your child’s molars to prevent decay on hard to clean surfaces.
A sealant is a clear or shaded plastic material that is applied to the chewing surfaces (grooves) of the back teeth (premolars and molars), where four out of five cavities in children are found. This sealant acts as a barrier to food, plaque and acid, thus protecting the decay-prone areas of the teeth.
Fluoride is an element, which has been shown to be beneficial to teeth. However, too little or too much fluoride can be detrimental to the teeth. Little or no fluoride will not strengthen the teeth to help them resist cavities. Excessive fluoride ingestion by preschool-aged children can lead to dental fluorosis, which is a chalky white to even brown discoloration of the permanent teeth. Many children often get more fluoride than their parents realize. Being aware of a child’s potential sources of fluoride can help parents prevent the possibility of dental fluorosis.
Some of these sources are:
- Too much fluoridated toothpaste at an early age.
- The inappropriate use of fluoride supplements.
- Hidden sources of fluoride in the child’s diet.
Two and three year olds may not be able to expectorate (spit out) fluoride-containing toothpaste when brushing. As a result, these youngsters may ingest an excessive amount of fluoride during tooth brushing. Toothpaste ingestion during this critical period of permanent tooth development is the greatest risk factor in the development of fluorosis.
Excessive and inappropriate intake of fluoride supplements may also contribute to fluorosis. Fluoride drops and tablets, as well as fluoride fortified vitamins should not be given to infants younger than six months of age. After that time, fluoride supplements should only be given to children after all of the sources of ingested fluoride have been accounted for and upon the recommendation of your pediatrician or pediatric dentist.
Certain foods contain high levels of fluoride, especially powdered concentrate infant formula, soy-based infant formula, infant dry cereals, creamed spinach, and infant chicken products. Please read the label or contact the manufacturer. Some beverages also contain high levels of fluoride, especially decaffeinated teas, white grape juices, and juice drinks manufactured in fluoridated cities.
Parents can take the following steps to decrease the risk of fluorosis in their children’s teeth:
- Use baby tooth cleanser on the toothbrush of the very young child.
- Place only a pea sized drop of children’s toothpaste on the brush when brushing.
- Account for all of the sources of ingested fluoride before requesting fluoride supplements from your child’s physician or pediatric dentist.
- Avoid giving any fluoride-containing supplements to infants until they are at least 6 months old.
- Obtain fluoride level test results for your drinking water before giving fluoride supplements to your child (check with local water utilities).
When a child begins to participate in recreational activities and organized sports, injuries can occur. 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.
Ask your pediatric dentist about custom and store-bought mouth protectors.
The American Academy of Pediatric Dentistry (AAPD) recognizes the benefits of xylitol on the oral health of infants, children, adolescents, and persons with special health care needs.
The use of XYLITOL GUM by mothers (2-3 times per day) starting 3 months after delivery and until the child was 2 years old, has proven to reduce cavities up to 70% by the time the child was 5 years old.
Studies using xylitol as either a sugar substitute or a small dietary addition have demonstrated a dramatic reduction in new tooth decay, along with some reversal of existing dental caries. Xylitol provides additional protection that enhances all existing prevention methods. This xylitol effect is long-lasting and possibly permanent. Low decay rates persist even years after the trials have been completed.
Xylitol is widely distributed throughout nature in small amounts. Some of the best sources are fruits, berries, mushrooms, lettuce, hardwoods, and corn cobs. One cup of raspberries contains less than one gram of xylitol.
Studies suggest xylitol intake that consistently produces positive results ranged from 4-20 grams per day, divided into 3-7 consumption periods. Higher results did not result in greater reduction and may lead to diminishing results. Similarly, consumption frequency of less than 3 times per day showed no effect.
To find gum or other products containing xylitol, try visiting your local health food store or search the Internet to find products containing 100% xylitol.
You might not be surprised anymore to see people with pierced tongues, lips or cheeks, but you might be surprised to know just how dangerous these piercings can be.
There are many risks involved with oral piercings, including chipped or cracked teeth, blood clots, blood poisoning, heart infections, brain abscess, nerve disorders (trigeminal neuralgia), receding gums or scar tissue. Your mouth contains millions of bacteria, and infection is a common complication of oral piercing. Your tongue could swell large enough to close off your airway!
Common symptoms 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 needle.
So follow the advice of the American Dental Association and give your mouth a break – skip the mouth jewelry.
Tobacco in any form can jeopardize your child’s health and cause incurable damage. Teach your child about the dangers of tobacco.
Smokeless tobacco, also called spit, chew or snuff, is often used by teens who 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 may be more difficult to quit. Teens who use it may be interested to know that one can of snuff per day delivers as much nicotine as 60 cigarettes. 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.
Because the early signs of oral cancer usually are not painful, people often ignore them. If it’s not caught in the early stages, oral cancer can require extensive, sometimes disfiguring, surgery. Even worse, it can kill.
Help your child avoid tobacco in any form. By doing so, they will avoid bringing cancer-causing chemicals in direct contact with their tongue, gums and cheek.