[Back to Top]
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:
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 the patient hold the tooth in place by biting on a gauze. If you
cannot reinsert the tooth, transport the tooth in a cup containing the patients
saliva or milk. If the patient is old enough, the tooth may also be carried in the patients mouth
(beside the cheek). 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 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
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
Radiographs (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.
Radiographs detect much more than cavities. For example, radiographs may be
needed to survey erupting teeth, diagnose bone diseases, evaluate the
results of an injury, or plan orthodontic treatment. Radiographs 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 for your child and more affordable for you.
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
Pediatric dentists are particularly careful to minimize the exposure of
their 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, the dental radiographs represent a far smaller risk
than an undetected and untreated dental problem. Lead body aprons and
shields will protect your child. Today’s equipment filters out unnecessary
x-rays and restricts the x-ray beam to the area of interest. Digital
and proper shielding assure that your child receives a minimal amount of
radiation exposure (significantly less than conventional films).
Wisdom teeth (or third
molars), are the last teeth to erupt in your child’s mouth. This generally
occurs in the late teens to early twenties (between the ages of 17 and 25).
Some people never develop wisdom teeth. Your dentist will periodically
take x-rays to determine the presence and positioning of these teeth.
Wisdom teeth can be a valuable addition to the dentition when healthy and
properly aligned, however, more often they are misaligned and removal by an oral
surgeon is recommended. Wisdom teeth can lead to the following potential
complications when misaligned or impacted underneath soft tissue or bone:
crowding or damage to adjacent teeth or roots, higher potential for cavities to
develop, and the possible formation of infection or cysts. Your dentist
may decide to send you to an oral surgeon for further evaluation when your child
reaches the appropriate age. The oral surgeon may recommend that wisdom
teeth be removed even if they have not caused any problems yet. This is
done to avoid a more difficult removal and potential future complications (as
the wisdom teeth are more likely to cause problems as patients age).
Removal is easier in young people as the teeth roots are not yet completely
formed, the bone is less dense, and there is less chance of damaging nearby
nerves or other structures. In addition, healing and recovery time is
shorter for young adults. The ease at which the oral surgeon can extract
wisdom teeth depends on their position and root development. Impacted
wisdom teeth may require a more involved surgical procedure. The oral
surgeon will discuss anesthetic options with you.
the Best Toothpaste for my Child?
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.
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 using only a "pea size" amount of
[Back to Top]
Does Your Child Grind His Teeth
At Night? (Bruxism)
Parents are often concerned about the nocturnal grinding of teeth
(bruxism). Often, the first indication is the noise created by the child grinding on their
teeth during sleep. Or, the parent may notice wear (teeth getting shorter) to the
dentition. One theory as to the cause involves a psychological component. Stress due to a
new environment, divorce, changes at school; etc. can influence a child to grind their
teeth. Another theory 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 (attrition) is present, then a mouth guard
(night guard) may be indicated. The negatives to a mouth guard are the possibility of
choking if the appliance becomes dislodged during sleep and it may interfere with growth
of the jaws. The positive is obvious by preventing wear to the primary dentition.
The good news is most children outgrow bruxism. The grinding
decreases between the ages 6-9 and children tend to stop grinding between ages 9-12. If you
suspect bruxism, discuss this with your pediatrician or pediatric dentist.
Sucking is a natural reflex and infants and young children may use
thumbs, fingers, pacifiers and other objects on which to suck. It may make them feel
secure and happy, or provide a sense of security at difficult periods. Since
is relaxing, it may induce sleep.
Thumb sucking that persists beyond the eruption of the permanent
teeth can cause problems with the proper growth of the mouth and tooth alignment. How
intensely a child sucks on fingers or thumbs will determine whether or not dental problems
may result. Children who rest their thumbs passively in their mouths are less likely to
have difficulty than those who vigorously suck their thumbs.
Children should cease thumb sucking by the time their permanent front
teeth are ready to erupt. Usually, children stop between the ages of two and four. Peer
pressure causes many school-aged children to stop.
Pacifiers are no substitute for thumb sucking. They can affect the
teeth essentially the same way as sucking fingers and thumbs. However, use
of the pacifier can be controlled and modified more easily than the thumb or finger habit.
If you have concerns about thumb sucking or use of a pacifier, consult your pediatric
A few suggestions to help your child get through thumb
Instead of scolding children for thumb sucking, praise them when they
Children often suck their thumbs when feeling insecure. Focus on
correcting the cause of anxiety, instead of the thumb sucking.
Children who are sucking for comfort will feel less of a need when
their parents provide comfort.
Reward children when they refrain from sucking during difficult
periods, such as when being separated from their parents.
Your pediatric dentist can encourage children to stop sucking and
explain what could happen if they continue.
If these approaches dont work, remind the children of their
habit by bandaging the thumb or putting a sock on the hand at night. Your pediatric
dentist may recommend the use of a mouth appliance.
is Pulp Therapy?
The 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 the tooth is
Dental caries (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.
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 a stainless steel crown).
A pulpectomy is required when the entire pulp
is involved (into the root canal(s) 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
[Back to Top]
is the Best Time for Orthodontic Treatment?
Developing malocclusions, or bad bites, can be
recognized as early as 2-3 years of age. Often, early steps can be taken to
reduce the need for major orthodontic treatment at a later age.
Stage I – Early Treatment: This period of treatment
encompasses ages 2 to 6 years. At this young age, we are concerned with
underdeveloped dental arches, the premature loss of primary teeth, and
harmful habits such as finger or thumb sucking. Treatment initiated in this
stage of development is often very successful and many times, though not
always, can eliminate the need for future orthodontic/orthopedic treatment.
Stage II – Mixed Dentition: This period covers the
ages of 6 to 12 years, with the eruption of the permanent incisor (front)
teeth and 6 year molars. Treatment concerns deal with jaw malrelationships
and dental realignment problems. This is an excellent stage to start
treatment, when indicated, as your child’s hard and soft tissues are
usually very responsive to orthodontic or orthopedic forces.
Stage III – Adolescent Dentition: This stage deals
with the permanent teeth and the development of the final bite relationship.
Adult Teeth Coming in Behind Baby Teeth
is a very common occurrence with children, usually the result of a lower,
primary (baby) tooth not falling out when the permanent tooth is coming in.
In most cases if the child starts wiggling the baby tooth, it will usually
fall out on its own within two months. If it doesn't, then contact your
pediatric dentist, where they can easily remove the tooth. The permanent
tooth should then slide into the proper place.
EARLY INFANT ORAL CARE
Perinatal & Infant Oral Health
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
- 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.
Your Childs First Dental Visit
- Establishing a "Dental Home"
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.
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,
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.
Will My Baby Start Getting Teeth?
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
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
[Back to Top]
Baby Bottle Tooth Decay (Early
One serious form of decay among young children is baby bottle tooth
decay, also referred to by dentists as early childhood caries. This condition is caused by frequent and long exposures of an infants 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 childs
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 contents with water over a period of two to
After each feeding, wipe the babys 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 childs 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 childs mouth easily.
Sippy cups should be used as a training tool from the bottle to a cup and
should be discontinued by the first birthday. If your child uses a sippy cup
throughout the day, fill the sippy cup with water only (except at
mealtimes). By filling the sippy cup with liquids that contain sugar
(including milk, fruit juice, sports drinks, etc.) and allowing a child to
drink from it throughout the day, it soaks the child’s teeth in cavity
Care of Your Child’s Teeth & Gums
Good Diet = Healthy Teeth
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
[Back to Top]
Do I Prevent Cavities?
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
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.
Seal Out Decay
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.
Before Sealant Applied
After Sealant Applied
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 childs 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 childs 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
Certain foods contain high levels of fluoride,
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 childrens teeth:
Use baby tooth cleanser on the toothbrush of the very young child.
Place only a pea sized drop of childrens toothpaste on the
brush when brushing.
Account for all of the sources of ingested fluoride before requesting
fluoride supplements from your childs 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).
[Back to Top]
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
Ask your pediatric dentist about custom and
store-bought mouth protectors.
Xylitol - Reducing Cavities
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.
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
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.
Beware of Sports Drinks
to the high sugar content and acids in sports drinks, they have erosive
potential and the ability to dissolve even fluoride-rich enamel, which can
lead to cavities.
To minimize dental problems, children should avoid sports drinks and
hydrate with water before, during and after sports. Be sure to talk to your
pediatric dentist before using sports drinks.
If sports drinks are consumed:
- reduce the frequency and contact time
- swallow immediately and do not swish them around the mouth
- neutralize the effect of sports drinks by alternating sips of water
with the drink
- rinse mouthguards only in water
- seek out dentally friendly sports drinks
Piercing – Is it Really Cool?
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
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.
– Bad News in Any Form
Tobacco in any form can jeopardize your child’s
health and cause incurable damage. Teach your child about the dangers of
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
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.
[Back to Top]