WHAT IS A PEDIATRIC DENTIST?

Pediatric dentists spend an additional two to three years after dental school specializing in the oral health of children from infancy to adulthood. Since dental development changes dramatically in children as they grow, pediatric dentists are equipped to handle these nuances differently than dentists who have not specialized in pediatrics. They study a wide range of approaches based on ages, behavior, dental growth, problem solving, and prevention to best meet the dental needs of children.

WHy are the primary teeth important? 

The importance of primary teeth cannot be overstated. Cavities that are left untreated in “baby teeth” often lead to a number of other developmental problems with permanent teeth, causing greater damage even into adulthood. Primary teeth are important for chewing and eating, spacing for permanent teeth, and muscle and bone development in the jaw. Speech development and the appearance of the facial features are also tied to the proper flourishing of primary teeth. Typically, a child’s front four teeth remain intact until 6-7 years of age. The back teeth (cuspids and molars) are replaced much later at around 10-13 years.

WHAT IS"eruption" and when does it occur? 

A child’s teeth begin to form in utero as a part of initial development. Parents can expect their baby’s first primary teeth to erupt through the gums as early as 4 months. The lower central incisors are usually first, then come the upper central incisors. On average, all 20 primary teeth usually appear by age 3, although the pace of some children’s development will differ slightly.

WHAT are the most common dental emergencies and how should I respond to them? 

See our "Dental Emergencies" section for full descriptions and best treatment practices. 

WHAT DO I NEED TO KNOW ABOUT DENTAL X-RAYS? 

X-Rays (radiographs) are a crucial part of the diagnostic process for dental care. Without them, certain dental conditions may be missed altogether. X-rays help detect cavities, survey erupting teeth, identify bone diseases, assess the magnitude of an injury, or assist in planning orthodontic treatment. Problems that are detected early are much more likely to be solved without extensive treatment for your child and helps avoid added procedural costs to you.

Radiation is a big concern for parents when considering x-rays for their children. However, it is important to note that pediatric dentists are particularly conservative when it comes to exposing children to radiation, even though the exposure itself is extremely small. Children will be draped with a lead vest or apron for protection while the x-rays are being administered. Modern x-ray technology operates at high speeds and is designed to filter out unnecessary x-rays by restricting the beam to small areas being examined. Ultimately, the risk involved in getting x-rays is far less significant than the risk of leaving potentially serious conditions undiagnosed.

According to the American Academy of Pediatrics, x-rays and accompanying examinations are recommended every 6 months for children who are at high risk of developing tooth decay, while most pediatric dentists require x-rays every year on average for children at normal risk levels. Overall, it is a good rule of thumb to request full x-rays approximately every three years.

WHAT IS the best toothpaste for my child? 

Ensuring that your child brushes his or her teeth regularly is one of the most important oral health habits you can foster. When deciding on a brand of toothpaste for your child, make sure to choose one that is recommended by the American Dental Association. Many types of toothpaste can damage children’s teeth, containing harsh abrasives that wear away young tooth enamel.

Make sure your child is spitting out toothpaste after brushing, not swallowing it. Ingesting too much fluoride can lead to condition known as fluorosis. If your child is too young to spit out toothpaste, consider switching to fluoride-free toothpaste, brushing without toothpaste at all, or only using a pea-sized amount of toothpaste.

WHat if my child grinds his/her teeth at night? 

Bruxism is the term used to describe the nocturnal grinding of the teeth. Parents who suspect their child has the condition report the audible sound of teeth grinding during sleep or notice wear on the teeth themselves. There are two main theories of thought as to why children grind their teeth. The first is psychological and postulates that children who deal with stress or significant life changes are more likely to develop Bruxism. The other theory is anatomical, having to do with added pressure to the inner ear. Like someone on an airplane who yawns or chews gum to relieve air pressure changes, your child might be subconsciously moving his jaw to relieve this pressure.

Despite how alarming the condition is for some parents, pediatric bruxism rarely requires significant treatment. At times, mouth guards may be prescribed, but do present a possible choking hazard and may interfere with the muscular development of the jaw.  An obvious positive to this treatment is the prevention of wear to the primary dentition.

Most children outgrow bruxism.  More often than not, children grind less and less between ages 6-9 and stop altogether between ages 9-12. If you are concerned about a child with this condition, don’t hesitate to contact your pediatric dentist for further recommendations.

how does thumb sucking affect oral health? 

The sucking reflex is a natural impulse of infants and young children to self-soothe, relax, induce sleep, or provide a sense of security in new situations. Some children prefer to suck on thumbs and fingers while others use pacifiers, and other objects.

Thumb sucking that continues after permanent teeth have erupted can interfere with proper growth of the mouth and tooth alignment. The intensity of suction also comes into play in determining whether or not the habit will result in future dental problems.

It is important that your child ceases thumb sucking before their permanent teeth emerge. Most children are able to break the habit between the ages of 2-4.

Pacifiers can have the same effect as thumb or finger sucking, but are far easier to control than the latter habit. If you have concerns about thumb sucking or using a pacifier, consult your pediatric dentist.

Here are some more important facts and suggestions to help your child graduate from thumb sucking:

  • Children tend to suck their thumbs when they feel insecure or uncertain. Turn your attention first towards easing the cause of anxiety instead of focusing on the thumb sucking habit.

  • Those who are sucking for comfort may feel less inclined if their parents provide an extra measure of comfort when the impulse arises.

  • Reward your child when she refrains from using her pacifier during certain times of the day (in the car, during nap time, bedtime, etc.) or during times of transition, like being dropped off with a babysitter.

  • Ask your pediatric dentist to explain to your child why it is important for he or she to stop the habit and what will happen to their teeth if they continue.

  • If you’re still having trouble, try reminding your child of their habit by bandaging their thumb, or putting a sock or mitten over the hand at night. Your dentist might have other creative suggestions and may even recommend a mouth appliance to aid with the process. 

WHAT IS pulp therapy? 

The pulp of the tooth refers to the inner, central substance of the tooth. The pulp houses nerves, blood vessels, connective tissue, and reparative cells. In pediatric dentistry, the purpose of pulp therapy is to bolster the strength of the affected tooth so that it may be salvaged.

Pulp therapy is most often needed when cavities or traumatic injury inflict damage on a tooth. Other terms for the therapy are “nerve treatment,” “children’s root canal,” “pulpotomy,” or “pulpectomy”. The latter two are the most common forms of pulp therapy in children.

A pulpotomy extracts the infected or diseased pulp tissue within the crown portion of the tooth, after which an agent is administered to curb bacterial growth and calm remaining nerve tissue. Usually a stainless steel crown is used to complete what is known as a final restoration of the tooth.

A pulpectomy is needed when the entirety of a tooth’s pulp has decayed, from the crown down into the root canal. For this procedure, the diseased tooth pulp must be completely removed from both portions of the tooth. Next, the canals must be completely cleansed, disinfected, and oftentimes filled with a resorbable material. Lastly, a final restoration is placed.

WHAT IS THE BEST TIME TO START ORTHODONTIC TREATMENT?

Pediatric dentists can often spot malocclusions, or bad bites, in patients as young as 2-3 years of age. Beginning treatment for these conditions early can help reduce the need for drastic orthodontic treatment later in life.

Stage I-Early Treatment, Ages 2-6: The main concern at this point in time is underdeveloped dental arches, losing primary teeth too early, and habits such as thumb, finger, and pacifier sucking. There has been a great deal of success in patients who began receiving treatment for malocclusions at this stage of development.

Stage II-Mixed Dentition, Ages 6-12: This period of time includes the eruption of the permanent incisor (front) teeth and 6-year molars. The main points of concern are jaw malrelationships and dental realignment problems. This phase is ideal for beginning orthodontic treatment since a child’s hard and soft tissues are very responsive to orthodontic or orthopedic forces.

Stage III-Adolescent Dentition, Ages 12 and up: In this phase the permanent teeth develop and the final bite relationship is formed.