Pediatric oral care has two main components: preventative care at the pediatric dentist’s office and preventative care at home. Though infant and toddler caries (cavities) and tooth decay have become increasingly prevalent in recent years, a good dental strategy will eradicate the risk of both.

The goal of preventative oral care is to evaluate and preserve the health of the child’s teeth. Beginning at the age of twelve months, the American Dental Association (ADA) recommends that children begin to visit the pediatric dentist for “well baby” checkups. In general, most children should continue to visit the dentist every six months, unless instructed otherwise.

How can a pediatric dentist care for my child’s teeth?

The pediatric dentist examines the teeth for signs of early decay, monitors orthodontic concerns, tracks jaw and tooth development, and provides a good resource for parents. In addition, the pediatric dentist has several tools at hand to further reduce the child’s risk for dental problems, such as topical fluoride and dental sealants.

During a routine visit to the dentist, the child’s mouth will be fully examined, the teeth will be professionally cleaned, topical fluoride may be coated onto the teeth to protect tooth enamel, and any parental concerns can be addressed. The pediatric dentist can demonstrate good brushing and flossing techniques, advise parents on dietary issues, provide strategies for thumb sucking and pacifier cessation, and communicate with the child on his or her level.

When molars emerge (usually between the ages of two and three), the pediatric dentist may coat them with dental sealant. This sealant covers the hard-to-reach fissures on the molars, sealing out bacteria, food particles and acid. Dental sealant may last for many months or many years, depending on the oral habits of the child. Dental sealant provides an important tool in the fight against tooth decay.

How can I help at home?

Though most parents primarily think of brushing and flossing when they hear the words “oral care,” good preventative care includes many more factors, such as:

Diet – Parents should provide children with a nourishing, well-balanced diet. Very sugary diets should be modified and continuous snacking should be discouraged. Oral bacteria ingest leftover sugar particles in the child’s mouth after each helping of food – emitting harmful acids that erode tooth enamel, gum tissue, and bone if left unchecked. Space out snacks where possible, and provide the child with non-sugary alternatives like celery sticks, carrot sticks, and low-fat yogurt.

Oral habits – Though pacifier use and thumb sucking generally cease over time, both can cause the teeth to misalign. If the child must use a pacifier, choose an “orthodontically” correct model. This will minimize the risk of developmental problems like narrow roof arches and crowding. The pediatric dentist can suggest a strategy (or provide a dental appliance) for thumb sucking cessation.

General oral hygiene – Sometimes, parents cleanse pacifiers and teething toys by sucking them. Parents may also share eating utensils with the child. Harmful oral bacteria are transmitted from parent-to-child in these ways, increasing the risk of early cavities and tooth decay. Instead, rinse toys and pacifiers with warm water and avoid spoon-sharing wherever possible.

Sippy cup use – Sippy cups are an excellent transitional aid for the baby bottle-to-adult drinking glass period. However, sippy cups filled with milk, breast milk, soda, juice, and sweetened water cause small amounts of sugary fluid to continually swill around young teeth – meaning continuous acid attacks on tooth enamel. Sippy cup use should be terminated between the ages of twelve and fourteen months – or whenever the child has the motor capabilities to hold a drinking glass.

Brushing – Children’s teeth should be brushed a minimum of two times per day using a soft bristled brush and a pea-sized amount of toothpaste. Parents should help with the brushing process until the child reaches the age of seven and is capable of reaching all areas of the mouth. Parents should always opt for ADA approved toothpaste (non-fluoridated before the age of two, and fluoridated thereafter). For babies, parents should rub the gum area with a clean cloth after each feeding.

Flossing – Cavities and tooth decay form more easily between teeth. Therefore, the child is at risk for between-teeth cavities wherever two teeth grow adjacent to each other. The pediatric dentist can help demonstrate correct head positioning during the flossing process, and suggest tips for making flossing more fun!

Fluoride – Fluoride helps prevent mineral loss and simultaneously promotes the remineralization of tooth enamel. Too much fluoride can result in fluorosis, a condition where white specks appear on the permanent teeth, and too little can result in tooth decay. It is important to get the fluoride balance correct. The pediatric dentist can evaluate how much the child is currently receiving and prescribe supplements if necessary.

If you have questions or concerns about how to care for your child’s teeth, please ask your pediatric dentist.

Bruxism, or the grinding of teeth, is remarkably common in children and adults. 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, depending on the frequency of the behavior, the intensity of the grinding, and the underlying causes of the grinding.

A wide range of psychological, physiological, and physical factors may lead children to brux. In particular, jaw misalignment (bad bite), stress, and traumatic brain injury are all thought to contribute to bruxism, although grinding can also occur as a side effect of certain medications.

What are some symptoms of bruxism?

In general, parents can usually hear intense grinding – especially when it occurs at nighttime. Subtle daytime jaw clenching and grinding, however, can be difficult to pinpoint. Oftentimes, general symptoms provide clues as to whether or not the child is bruxing, including:

• Frequent complaints of headache.
• Injured teeth and gums.
• Loud grinding or clicking sounds.
• Rhythmic tightening or clenching of the jaw muscles.
• Unusual complaints about painful jaw muscles – especially in the morning.
• Unusual tooth sensitivity to hot and cold foods.

How can bruxism damage my child’s teeth?

Bruxism is characterized by the grinding of the upper jaw against the lower jaw. Especially in cases where there is vigorous grinding, the child may experience moderate to severe jaw discomfort, headaches, and ear pain. Even if the child is completely unaware of nighttime bruxing (and parents are unable to hear it), the condition of the teeth provides the pediatric dentist with important clues.

First, chronic grinders usually show an excessive wear pattern on the teeth. If jaw misalignment is the cause, tooth enamel may be worn down in specific areas. In addition, children who brux are more susceptible to chipped teeth, facial pain, gum injury, and temperature sensitivity. In extreme cases, frequent, harsh grinding can lead to the early onset of temporomandibular joint disorder (TMJ).

What causes bruxism?

Bruxism can be caused by several different factors. Most commonly, “bad bite” or jaw misalignment promotes grinding. Pediatric dentists also notice that children tend to brux more frequently in response to life stressors. If the child is going through a particularly stressful exam period or is relocating to a new school for example, nighttime bruxing may either begin or intensify.

Children with certain developmental disorders and brain injuries may be at particular risk for grinding. In such cases, the pediatric dentist may suggest botulism injections to calm the facial muscles, or provide a protective nighttime mouthpiece. If the onset of bruxing is sudden, current medications need to be evaluated. Though bruxing is a rare side effect of specific medications, the medication itself may need to be switched for an alternate brand.

How is bruxism treated?

Bruxing spontaneously ceases by the age of thirteen in the majority of children. In the meantime however, the pediatric dentist will continually monitor its effect on the child’s teeth and may provide an interventional strategy.

In general, the cause of the grinding dictates the treatment approach. If the child’s teeth are badly misaligned, the pediatric dentist may take steps to correct this. Some of the available options include: altering the biting surface of teeth with crowns, and beginning occlusal treatment.

If bruxing seems to be exacerbated by stress, the pediatric dentist may recommend relaxation classes, professional therapy, or special exercises. The child’s pediatrician may also provide muscle relaxants to alleviate jaw clenching and reduce jaw spasms.

In cases where young teeth are sustaining significant damage, the pediatric dentist may suggest a specialized nighttime dental appliance such as a nighttime mouth guard. Mouth guards stop tooth surfaces from grinding against each other, and look similar to a mouthpiece a person might wear during sports. Bite splints, or bite plates, fulfill the same function, and are almost universally successful in preventing grinding damage.

If you have questions or concerns about bruxism or grinding teeth, please contact your pediatric dentist.

The eruption of primary teeth (also known as deciduous or baby teeth) follows a similar developmental timeline for most children. A full set of primary teeth begins to grow beneath the gums during the fourth month of pregnancy. For this reason, a nourishing prenatal diet is of paramount importance to the infant’s teeth, gums, and bones.

Generally, the first primary tooth breaks through the gums between the ages of six months and one year. By the age of three years old most children have a “full” set of twenty primary teeth. The American Dental Association (ADA) encourages parents to make a “well-baby” appointment with a pediatric dentist approximately six months after the first tooth emerges. Pediatric dentists communicate with parents and children about prevention strategies, emphasizing the importance of a sound, “no tears” daily home care plan.

Although primary teeth are deciduous, they facilitate speech production, proper jaw development, good chewing habits – and the proper spacing and alignment of adult teeth. Caring properly for primary teeth helps defend against painful tooth decay, premature tooth loss, malnutrition, and childhood periodontal disease.

In what order do primary teeth emerge?

As a general rule-of-thumb, the first teeth to emerge are the central incisors (very front teeth) on the lower and upper jaws (6-12 months). These (and any other primary teeth) can be cleaned gently with a soft, clean cloth to reduce the risk of bacterial infection. The central incisors are the first teeth to be lost, usually between 6 and 7 years of age.

Next, the lateral incisors (immediately adjacent to the central incisors) emerge on the upper and lower jaws (9-16 months). These teeth are lost next, usually between 7 and 8 years of age. First molars, the large flat teeth towards the rear of the mouth then emerge on the upper and lower jaws (13-19 months). The eruption of molars can be painful. Clean fingers, cool gauzes, and teething rings are all useful in soothing discomfort and soreness. First molars are generally lost between 9 and 11 years of age.

Canine (cuspid) teeth then tend to emerge on the upper and lower jaws (16-23 months). Canine teeth can be found next to the lateral incisors, and are lost during preadolescence (10-12 years old). Finally, second molars complete the primary set on the lower and upper jaw (23-33 months). Second molars can be found at the very back of the mouth, and are lost between the ages of 10 and 12 years old.

What else is known about primary teeth?

Though each child is unique, baby girls generally have a head start on baby boys when it comes to primary tooth eruption. Lower teeth usually erupt before opposing upper teeth in both sexes.

Teeth usually erupt in pairs – meaning that there may be months with no new activity and months where two or more teeth emerge at once. Due to smaller jaw size, primary teeth are smaller than permanent teeth, and appear to have a whiter tone. Finally, an interesting mixture of primary and permanent teeth is the norm for most school-age children.

If you have questions or concerns about primary teeth, please contact your pediatric dentist.

The “pulp” of a tooth cannot be seen with the naked eye. Pulp is found at the center of each tooth, and is comprised of nerves, tissue, and many blood vessels, which work to channel vital nutrients and oxygen. There are several ways in which pulp can be damaged. Most commonly in children, tooth decay or traumatic injury lead to painful pulp exposure and inflammation.

Pediatric pulp therapy is known by several other names, including: root canal, pulpotomy, pulpectomy, and nerve treatment. The primary goal of pulp therapy is to treat, restore, and save the affected tooth.

Pediatric dentists perform pulp therapy on both primary (baby) teeth and permanent teeth. Though primary teeth are eventually shed, they are needed for speech production, proper chewing, and to guide the proper alignment and spacing of permanent teeth.

What are the signs of pulp injury and infection?

Inflamed or injured pulp is exceptionally painful. Even if the source of the pain isn’t visible, it will quickly become obvious that the child needs to see the pediatric dentist.

Here are some of the other signs to look for:

• Constant unexplained pain.
• Nighttime pain.
• Sensitivity to warm and cool food temperatures.
• Swelling or redness around the affected tooth.
• Unexpected looseness or mobility of the affected tooth.

When should a child undergo pulp therapy?

Every situation is unique. The pediatric dentist assesses the age of the child, the positioning of the tooth, and the general health of the child before making a recommendation to extract the tooth or to save it via pulp therapy.

Some of the undesirable consequences of prematurely extracted/missing teeth are listed below:

• Arch length may shorten.
• In the case of primary tooth loss, permanent teeth may lack sufficient space to emerge.
• Opposing teeth may grow in a protruding or undesirable way.
• Premolars may become painfully impacted.
• Remaining teeth may “move” to fill the gap.
• The tongue may posture abnormally.

How is pulp therapy performed?

Initially, the pediatric dentist will perform visual examinations and evaluate X-rays of the affected areas. The amount and location of pulp damage dictates the nature of the treatment. Although there are several other treatments available, the pediatric pulpotomy and pulpectomy procedures are among the most common performed.

Pulpotomy – If the pulp root remains unaffected by injury or decay, meaning that the problem is isolated in the pulp tip, the pediatric dentist may leave the healthy part alone and only remove the affected pulp and surrounding tooth decay. The resulting gap is then filled with a biocompatible, therapeutic material, which prevents infection and soothes the pulp root. Most commonly, a crown is placed on the tooth after treatment. The crown strengthens the tooth structure, minimizing the risk of future fractures.

Pulpotomy treatment is extremely versatile. It can be performed as a standalone treatment on baby teeth and growing permanent teeth, or as the initial step in a full root canal treatment.

Pulpectomy – In the case of severe tooth decay or trauma, the entire tooth pulp (including the root canals) may be affected. In these circumstances, the pediatric dentist must remove the pulp, cleanse the root canals, and then pack the area with biocompatible material. This usually takes several office visits.

In general, reabsorbable material is used to fill primary teeth, and non-reabsorbable material is used to fill permanent teeth. Either way, the final treatment step is to place a crown on the tooth to add strength and provide structural support. The crown can be disguised with a natural-colored covering, if the child prefers.

If you have questions or concerns about the pediatric pulp therapy procedure, please contact your pediatric dentist.