Preventative Dentistry

  • Regular Cleaning and Exams
  • Good Diet, Healthy Teeth
  • Preventing Cavities
  • Seal Out Decay
  • Fluoride 
  • Mouth Guards
  • Using Xylitol to Reduce Cavities

Early Infant Oral Care

  • Perinatal and Infant Oral Health
  • Your child’s first dental visit—establishing a “dental home”
  • When will my baby start getting teeth
  • Baby Bottle Tooth Decay (Early Childhood Caries)
  • Sippy Cups

Adolescent Dentistry

  • Tongue Piercing: Is it Worth It
  • Tobacco: Bad News in Any Form

Restorative/Cosmetic Dentistry 

  • Arch Expansion
  • Pedi-Partials
  • Space Maintainers
  • Bonding
  • Crowns
  • Digital X-Rays 
  • Extractions
  • Pulp Therapy 
  • Sealants
  • Teeth Whitening 

Sedation Dentistry 

  • Nitrous Oxide
  • Conscious (Oral) Sedation
  • IV Sedation

Dental Emergencies 

  • Toothache
  • Cut or Bitten Lip, Tongue, or Cheek
  • Broken, Chipped, Fractured Tooth
  • Knocked-out Tooth
  • Object Caught in Teeth 
  • Broken Jaw/Head Trauma
  • Avoiding Injury 


  • What is a pediatric dentist?
  • Why are the primary teeth important? 
  • What is “eruption” and when does it occur?
  • What are the most common dental emergencies and how should I respond to them?
  • What do I need to know about dental X-Rays?  
  • What's the best toothpaste for my child?
  • What do I do if my child grinds his/her teeth at night? (Bruxism)
  • How does thumb sucking affect oral health? 
  • What is pulp therapy?
  • What is the best time to start orthodontic treatment?




Great dental hygiene is, first and foremost, a result of good habits started early. This is one of the best gifts you can give your child, setting him or her on the path to a lifetime of dental health. And this is no small matter—a child with a healthy mouth tends to be healthier and happier in general. Dental pain can lead to all sorts of issues with nutrition, self-esteem, academics and even speech.

The good news is you are not on your own. With Barrie Barber Choate, DDS, MSD, PA as your child's dental "home," our team's goal is to provide a nurturing and positive experience for each patient. We will help by teaching you and your children good habits, educating you about common pitfalls and fixing any little problems before they become big. We will meet with you every six months to monitor the dental needs of your children and keep building on their base of good dental habits. Consistency is crucial to ongoing dental health.



A healthy diet can go a long way towards preventing cavity formation. Just like the rest of the body, the teeth, bones, and soft tissues of the mouth thrive when given a variety of nutritious foods.  Unfortunately, most popular children’s snacks are high in sugar and are the chief perpetrators behind cavities. Giving your child candy, mints, sugary gum, or anything else that stays in the mouth for a prolonged period greatly increases the formation of plaque and cavities. Offer your child other healthy options like veggies, cheese, nuts, and yogurt (check the sugar content—many children’s yogurt contain a lot!).  



The purpose of oral hygiene is to remove bacteria deposits that combine with leftover food particles to form cavities. If you are a parent to a baby or young child, use a wet washcloth or gauze to wipe plaque from teeth and gums after feedings. Do not send your child to bed with a bottle or sippy cup containing any other beverage besides water. 

Parents of older children: make sure your child’s teeth are brushed at least twice a day and every other time they have been eating a sweet snack. 

Get your child in a regular routine of seeing the pediatric dentist. The American Academy of Pediatric Dentistry recommends visits every six months, beginning after a child’s first birthday.  Some pediatric dentists may offer protective sealants or home fluoride treatments to prevent decay on hard to clean surfaces. 



Dentists sometimes recommend sealants for children, who have a high susceptibility for developing cavities. A sealant is a clear or shaded plastic material that is applied to the chewing surfaces of the back of the teeth, where four out of five cavities in children are found. This material serves as a barrier to food, plaque, and acid, protecting the teeth from decay. 



Fluoride is a substance that, used in correct amounts, can be greatly beneficial to teeth. Too much fluoride can actually hurt teeth, while too little can leave teeth weak and susceptible to cavity development. When young children ingest too much fluoride, they may develop an unpleasant dental condition called fluorosis, which can leave chalky white or brown discoloration on permanent teeth. Many foods and beverages contain fluoride, which is why it is extremely important as a parent to be aware of how much your child is ingesting on a regular basis. Some sources include, but are not limited to: 

  • Fluoridated toothpaste—exposing your child to too much fluoride at early age can be detrimental. 

  • Misuse of fluoride supplements 

  • Fluoride in drinking water or other foods 

Young children may not be physically able yet to spit out fluoridated toothpaste when brushing, leading to the swallowing of excessive amounts of fluoride.  If this is the case, it’s ok to brush with a fluoride-free toothpaste or just water until your child is able to spit out toothpaste. 

Fluoride drops and tablets as well as fluoride-fortified vitamins should not be given to infants younger than six months of age. As a general rule, these supplements should only be administered to children (of any age) under a pediatrician or pediatric dentist’s recommendation. 

Foods with high levels of fluoride include powdered infant formula, soy-based formula, infant dried cereals, creamed spinach, and infant chicken products. Make sure to read the label on all foods before giving them to your child. Beverages that often contain fluoride include decaffeinated teas, white grape juice, and juice drinks manufactured in locations where water sources are treated with fluoride. 

Here are some ways you can decrease your child’s chances of developing fluorosis: 

  • Use baby tooth cleanser on the toothbrush of very young children

  • Use no more than a pea-sized drop of toothpaste when brushing

  • Make sure you can account for all supplemental sources of fluoride your child receives

  • Do not give fluoride-containing supplements to infants younger than 6 months of age. 

  • Check with your local water utilities to obtain a fluoride level test of your drinking water. 



If your child is interested in participating in recreational sporting activities, it is safe to assume the possibility of injury at one time or another. This is why it’s a good idea to supply your child with a properly fitted mouth guard, or mouth protector to use during activities where a blow to the face or mouth is possible. Usually this applies to all team sports, and certainly all contact sports. 

Using a mouth guard is an easy way to prevent broken teeth and injuries to the lips, tongue, face, or jaw. It’s also important to make sure the mouth guard fits properly, staying in place during movement and allowing your child to talk and breathe normally. 

Ask your pediatric dentist about a fitting or a custom mouth guard or some recommended ready-made options. 



Xylitol has been recognized by the AAPD for the benefits it brings to the oral health of infants, children, adolescents, and people with special health requirements. It appears in nature in small amounts, being found in fruits, berries, mushrooms, lettuce, hardwoods, and corncobs. 

Research has shown that using xylitol consistently as a sugar substitute or dietary addition has an extremely positive effect on curbing new tooth decay, and in some cases, can even reverse existing dental caries. Xylitol’s most notable characteristic is that it enhances all existing prevention methods for tooth decay, with long lasting and possibly permanent effects. 

Mothers who start using xylitol gum (2-3 times per day) beginning 3 months after delivery till their children turned two experienced 70% less cavities in the first five years after giving birth. 

Positive results from the intake of xylitol begin with as little as 4 grams up to 20 and are typically divided into 3-7 consumption periods. Higher or lower intake amounts or frequencies than these were not effective in the same way. 

An easy way to incorporate xylitol in your diet is to use gum or other products made from 100% xylitol. These can be found at local heath food stores and online. 

Beware of Sports Drinks

Sports drinks contain a deceivingly high amount of sugar and can erode away enamel, leading to cavities. 

Children should be encouraged to hydrate with water before, during, and after participating in sports, avoiding sports drinks entirely if possible. In situations where sports drinks are consumed, keep in mind the following:

  • Try reducing the frequency and time-lengths of consumption 

  • Swallow immediately; do not swish in mouth 

  • Alternate sips of sports drinks with sips of water to neutralize effect

  • Rinse mouth guards with water only 

  • Try to purchase low-sugar or no-sugar sports drinks as a dentally-friendly alternative


It is recommended by the American Academy of Pediatric Dentistry that all pregnant women receive counsel concerning oral health care during pregnancy. Periodontal disease can increase the chance of preterm birth and the likelihood of low birth weight. If you are expecting, make sure to talk to your doctor or dentist about periodontal disease prevention. 

Did you know that mothers with poor oral health may be able to pass on cavity-causing bacteria to their babies? If you are pregnant, keep these tips in mind to ensure the greatest possibility of oral health for your child: 

  • Visit your dentist regularly

  • Brush your teeth and use floss every day to reduce plaque. 

  • Reduce your sugar intake in the foods and beverages you consume

  • Use fluoride toothpaste recommended by the ADA and a mouth rinse with .05% sodium fluoride. 

  • Refrain from sharing cups, utensils, and food as this may cause the transmission of bacteria. 

  • Ask your dentist about xylitol chewing gum,  (4 pieces per day by the mother) which can also aid in bacterial transmission from mother to child.



The American Academy of Pediatrics and the Academy of Pediatric Dentistry both recommend establishing a “dental home” for your child by one year of age.  Children with regular, stable access to dental care are more likely to avoid preventable conditions that can lead to greater problems. 

Talk to your child before his or her visit, but keep things simple. When discussing dental procedures, avoid using words like “drill,” “needle,” “shot,” or “hurt”. Pediatric dentists train their teams to use other non-threatening terms that convey the same meaning, but in a much more pleasant manner to make your child feel comfortable. 



Every child is different and will begin showing signs of teething at different times. Generally, a baby’s first primary teeth (usually the lower front (anterior) teeth) appear between 6-8 months. 



Babies and young children can develop significant tooth decay at an early age from long exposures to liquids containing sugar. Oftentimes, the child is put down for a nap or for the night with a bottle full of fruit juice, milk, (even breast milk) or another sweetened drink, exposing the teeth to sugar for a prolonged period of time. 

Only give a child water in a bottle when falling asleep. Sugary liquid accumulates in a child’s mouth overnight, forming plaque rapidly and causing tooth decay. If you are giving your child a beverage other than water, try diluting it over a period of days or weeks to transition your child gradually to water-only. 

Another preventative method for tooth decay in infants and young children is to wipe the child’s gums and teeth with a damp washcloth or gauze pad after each feeding. This prevents plaque from building up and can be done quickly and easily with your child’s head in your lap, on the floor, or on a changing table. 



As with baby bottles, sippy cups filled with beverages containing sugar (breast milk, milk, juice, etc.) and given to a child during nap or bedtime can seriously increase the risk of tooth decay. If your child requires a sippy cup or bottle at bedtime, make sure it contains water only.


Having a pierced tongue might be a bold fashion statement, but it can actually be really dangerous for your oral health. In fact, the American Dental Association advises strongly against it, and for good reason. 

With millions of bacteria living in your mouth at any given time, infection is a common complication for people with tongue piercings. Plus, a swollen tongue can get so big that it may even block your airway! Other risks associated with oral piercings include chipped or cracked teeth, blood clots, blood poisoning, heart infections, brain abscess, nerve disorders, receding gums, or scar tissue. 

A misplaced needle during the piercing process can cause excessive bleeding, or even nerve damage. Other common side effects include pain, swelling, infection, increased saliva production, and gum tissue damage. 



Tobacco education and prevention starts with you as a parent. Starting at an early age, talk to your child about the dangers of tobacco use. 

It’s important to remember that tobacco in any form (including smokless tobacco, “chew” or “snuff”) can cause irreparable damage to your child’s health. In fact, chewing tobacco may even cause more harm than smoking with stronger addictive properties. Just one can of snuff contains as much nicotine as 60 cigarettes! Smokeless tobacco can cause periodontal disease and even pre-cancerous legions called leukoplakias with just one month of use. 

Here are some easily identifiable signs of early oral cancer: 

  • A sore that will not heal

  • Leathery patches on the lips or under the tongue, white or red in color

  • Pain, tenderness, or numbness anywhere in the mouth or lips

  • Difficulty chewing, swallowing, speaking, or moving the jaw or tongue; a change in tooth alignment 

Several of these early signs are usually not very painful, leading tobacco users to think nothing of them. However, if oral cancer is not identified in its early stages, it can cause extensive, sometimes disfiguring surgery, or at it’s worse, death.

Although our focus is on preventative care, sometimes cavities happen; in fact, even the most careful brusher and flosser could end up with a cavity or two. That’s where restorative dentistry comes in. It’s good to know that your child is getting the benefit of the most up-to-date knowledge and techniques in dental repair and restorations, from minor cavities to more involved procedures.

Here are some explanations of the restorative/cosmetic services we provide: 


Arch Expansion - Sometimes, children’s dental arches are too small to accommodate all of their permanent teeth. Interceptive orthodontic treatment can widen the dental arch to create space for permanent teeth to properly emerge. Arch expansion minimizes or eliminates the risk of crowding and results in a healthier, more attractive smile.

Pedi-Partials - Your child fell on the playground and lost two teeth. Every parent dreads this scenario, but it doesn’t have to permanently mar your child’s smile. A pedi-partial contains prosthetic teeth to restore smiles and safeguard oral health. Your child’s pedi-partial will be permanently secured to existing teeth, so there’s no fear of your child losing it or leaving it on a school lunchroom tray!

Space Maintainers - Space maintainers are appliances made of metal or plastic that are custom fit to your child’s mouth. They are small and unobtrusive in appearance. Most children easily adjust to them after the first few days.

Space maintainers hold open the empty space left by a lost tooth. They steady the remaining teeth, preventing movement until the permanent tooth takes its natural position in the jaw. It is more affordable — and easier on your child — to keep teeth in normal positions with a space maintainer than to move them back in place with orthodontic treatment.


A procedure where tooth-colored material (composite resin) is used to rebuild chipped, broken, or irregularly shaped teeth, to close gaps and to improve the look of teeth permanently discolored. However, the composite resin used in bonding isn't nearly as strong as a natural tooth. Biting your fingernails or chewing on ice or pens can chip the material. Bonding usually lasts several years before it needs to be repaired. How long it actually lasts depends on how much bonding was done and your oral habits.

Composite (tooth colored) Fillings - A filling is used to repair a tooth that is affected by decay, cracks, fractures, and so forth. In just one appointment, the decayed or affected portion of the tooth will be removed, cleaned, and filled.


NuSmile Zirconium Crowns - Zirconium crowns  can be used on any tooth that a metal crown can be used. They are composed entirely of one solid tooth-colored material and look extremely aesthetic. Each crown is glazed with a hint of natural color, making them very smooth, shiny, and impermeable to staining. They are exceptionally strong, and their unsurpassed aesthetics allows them to blend in seamlessly with surrounding natural teeth.


Digital X-rays offer unparalleled benefits over traditional radiographs: they’re convenient, safe for the environment, provide a great opportunity for patient education, can be transferred and copied accurately, and best of all, they’re safer for our patients. 

A tiny sensor is placed in your child’s mouth to detect a small amount of radiation – up to 90-percent less than traditional X-rays required. This creates an detailed image of your internal oral structures that is immediately viewable on a chairside monitor, carrying with it all the conveniences of other digitized images. We can rotate and magnify it, adjust it for contrast, and even color-code it for educational purposes. The digital images store easily and efficiently in our computer files, safe and sound. For insurance purposes, referrals, or patient education, digital X-rays can be easily, inexpensively, and accurately reproduced indefinitely.


Generally, unless we are are discussing "wisdom teeth," we would rather not extract a tooth from your child. However, it can be required when a tooth is not lost naturally or if dental decay or trauma results in an infection surrounding the root surface.


As you may be aware, early loss of primary teeth can affect the way permanent teeth develop and grow in. Therefore, if your child has cavities that extend into the primary tooth pulp, Dr. Choate  may use pulp therapy to prevent nerve and root death. In addition, if young adult teeth break, or the pulp is exposed, a vital pulpotomy may be necessary to prevent infection that could extend to your child's gums and surrounding teeth. 

A pulpotomy consists of removal of a part of an infected or irritated portion of the nerve and blood vessels within your child's tooth. A sedative material is placed to help allow the remaining nerve and blood vessel tissue to heal while a restorative material such as a crown is placed over the tooth for strength.

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.


Dr. Choate strongly believes in being proactive about preventing decay. She recommends sealants for teeth that have a high susceptibility for developing cavities. A sealant is a clear or tooth colored resin material that is applied over deep grooves on the chewing surfaces of the molars. This material serves as a barrier to food, plaque, and acid, protecting the teeth from decay. 


Whitening or "bleaching" of the teeth has become very popular over the last several years. For many of our younger patients with primary (baby) teeth remaining, Dr. Choate does not recommend the products used in our office as they may cause children's teeth to develop extreme sensitivity. Also because of the difference in the tooth structure of permanent and deciduous teeth an uneven pattern may result. However, should your child desire or have a need for whitening please feel free to discuss this with us, as there are many options available.

Sedation dentistry is a term that describes the use of sedatives for children during a dental procedure. There are different types of sedation methods and we will discuss with you which technique is suitable for your child depending on age, weight, and health.

During the sedation process, your child will be in a calm, relaxed state, yet still responsive. It promotes cooperation and provides your child with an overall better dental experience.

nitrous oxide 

Some children are given nitrous oxide/oxygen, or what you may know as laughing gas, to relax them for their dental treatment. Nitrous oxide/oxygen is a blend of two gases, oxygen and nitrous oxide. Nitrous oxide/oxygen is given through a small breathing mask which is placed over the child’s nose, allowing them to relax, but without putting them to sleep. The American Academy of Pediatric Dentistry, recognizes this technique as a very safe, effective technique to use for treating children’s dental needs. The gas is mild, easily taken, then with normal breathing, it is quickly eliminated from the body. It is non-addictive. While inhaling nitrous oxide/oxygen, your child remains fully conscious and keeps all natural reflexes.

Prior to your appointment:

  • Your child should not consume food or liquids for at least 2 hours prior to their appointment.
  • Please inform us of any change to your child’s health and/or medical condition.
  • Tell us about any respiratory condition that makes breathing through the nose difficult for your child. It may limit the effectiveness of the nitrous oxide/oxygen.
  • Let us know if your child is taking any medication on the day of the appointment.


Conscious Sedation is recommended for apprehensive children, very young children, and children with special needs. It is used to calm your child and to reduce the anxiety or discomfort associated with dental treatments. Your child may be quite drowsy, and may even fall asleep, but they will not become unconscious.

There are a variety of different medications, which can be used for conscious sedation. The doctor will prescribe the medication best suited for your child’s overall health and dental treatment recommendations. We will be happy to answer any questions you might have concerning the specific drugs we plan to give to your child. 

Prior to your appointment:

  • Your child should not have solid food for at least 8 hours prior to their sedation appointment and only clear liquids for up to 4 hours before the appointment. 
  • Please notify us of any change in your child’s health and/or medical condition. Do not bring your child for treatment with a fever, ear infection or cold. Should your child become ill, contact us to see if it is necessary to postpone the appointment.
  • You must tell the doctor of any drugs that your child is currently taking and any drug reactions and/or change in medical history. 
  • Please dress your child in loose fitting, comfortable clothing.
  • Please make sure that your child goes to the bathroom immediately prior to arriving at the office.
  • The child's parent or legal guardian must remain at the office during the complete procedure.
  • Please watch your child closely while the medication is taking effect. Hold them in your lap or keep close to you. Do not let them "run around."
  • Your child will act drowsy and may become slightly excited at first. 

After the sedation appointment:

  • Your child will be drowsy and will need to be monitored very closely. Keep your child away from areas of potential harm.
  • If your child wants to sleep, place them on their side with their chin up. Wake your child every few hours and encourage them to have something to drink in order to prevent dehydration. At first it is best to give your child sips of clear liquids to prevent nausea. The first meal should be light and easily digestible.
  • If your child vomits, help them bend over and turn their head to the side to insure that they do not inhale the vomit.
  • Because we use local anesthetic to numb your child’s mouth during the procedure, your child may have the tendency to bite or chew their lips, cheeks, and/or tongue and/or rub and scratch their face after treatment. Please observe your child carefully to prevent any injury to these areas.

Please call our office for any questions or concerns that you might have.


IV Sedation is recommended for apprehensive children, very young children, and children with special needs that would not work well under conscious sedation. The dentist performs the dental treatment in our office with the child anesthetized under IV sedation, which is administered and monitored by an anesthesiologist.

Prior to your appointment:

  • Your child should not have milk or solid food after midnight prior to the scheduled procedure and clear liquids ONLY (water, apple juice, Gatorade) for up to 6 hours prior to the appointment.
  • Please notify us of any change in your child’s health and/or medical condition. Do not bring your child for treatment with a fever, ear infection or cold. Should your child become ill, contact us to see if it is necessary to postpone the appointment.
  • You must tell the doctor of any drugs that your child is currently taking and any drug reactions and/or change in medical history.
  • Please dress your child in loose fitting, comfortable clothing.
  • Please make sure that your child goes to the bathroom immediately prior to arriving at the office.
  • The child’s parent or legal guardian must remain at the office during the complete procedure. 

After the sedation appointment:

  • Your child will be drowsy and will need to be monitored very closely. Keep your child away from areas of potential harm.
  • If your child wants to sleep, place them on their side with their chin up. Wake your child every few hours and encourage them to have something to drink in order to prevent dehydration. At first it is best to give your child sips of clear liquids to prevent nausea. The first meal should be light and easily digestible.
  • If your child vomits, help them bend over and turn their head to the side to insure that they do not inhale the vomit.

Please call our office for any questions or concerns that you might have.

If your child faces a dental emergency, give us a call immediately.

If you need urgent treatment after hours, you can call our emergency number. We are always here to assist when your child’s dental health is at risk. Below are some tips on dealing with urgent dental situations.


Attempt to clean the area around the tooth that seems to be causing trouble for your child. If they are old enough to understand, instruct them to gargle and rinse their mouth thoroughly with warm water and help them use dental floss to dislodge any food particles that may be trapped around the tooth. Refrain from using a warm compress or applying aspirin topically on the tooth or gum. If pain persists, or if the child’s face becomes swollen, contact your child’s pediatric dentist immediately for an assessment.


Chipped or fractured permanent tooth: Call your pediatric dentist right away. If possible, locate the chipped or broken fragments and bring them with you to the dentist in a cup of your child’s saliva or milk. Immediate action can save the tooth and prevent the need for extensive treatment. Using water only, rinse the child’s mouth and apply a cold compress to control inflammation.

Chipped or fractured primary tooth (“baby tooth”): Get in touch with your pediatric dentist for a recommendation.

knocked-out tooth

Knocked Out Permanent Tooth: In this situation, getting your child to a dentist immediately is your number one priority. In the meantime, do your best to preserve the tooth that has been dislodged. If possible, locate the tooth and rinse it with water only. Handle the tooth by the crown, not the roots, and whatever you do, DO NOT clean it with soap or a brush. Look for fractures or chips in the tooth and attempt to reinsert it into the socket. If your child is able, instruct he or she to bite down on folded gauze to hold the tooth in place, or have them place the tooth in their mouth (against the cheek) while you wait to be seen by your pediatric dentist. If your child is young or you’re having trouble reinserting the tooth, place it in a container with the patient’s saliva or a small amount of milk.or a special storage media for avulsed teeth if available (e.g. Hanks balanced storage medium or saline).

Time is a critical factor in saving the tooth—the patient must see a dentist right away!

Knocked out primary tooth (“baby tooth”):  This is not typically a dental emergency. Contact your pediatric dentist for their recommendation, but no need to panic—in most cases, treatment for this injury will not be necessary.

Cut or BITTEN LIP, tongue, or cheek 

Use ice to help control swelling around the affected area. To control bleeding, apply firm but gentle pressure on the area with a clean cloth or gauze. If bleeding persists and becomes uncontrollable, call your doctor or go to the emergency room for immediate help.


If your child has something caught between his or her teeth, use dental floss to gently remove it. Never use a metal, plastic, or sharp tool to remove a stuck object. If you are unable to remove the item with dental floss, give us a call.

BROKEN JAW/head trauma 

Possible Broken or Fractured Jaw: If you know or suspect your child has sustained a broken jaw, use a cold compress to reduce swelling. Immediately take your child to the nearest emergency room for evaluation. Gently keep the jaw as still as possible.

Severe head trauma or concussion: Severe blows to the head can be dangerous and even life-threatening.Immediately take your child to the nearest emergency room for evaluation.


You can help your child avoid dental emergencies. Child-proof your house to avoid falls. Don't let your child chew on ice, popcorn kernels, or other hard foods. Always use car seats for young children and require seatbelts for older children. And if your child plays contact sports, have him or her wear a mouthguard. (Ask us about creating a custom-fitted mouthguard for your child.) Finally, prevent toothaches with regular brushing, flossing, and visits to our office.


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. 


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.


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.