- What is a Pediatric Dentist?
- Why are the Primary Teeth so Important?
- Eruption of Your Child's Teeth
- DENTAL EMERGENCIES
- Dental Radiographs (X-rays)
- What's the Best Toothpaste for my Child?
- Does Your Child Grind His Teeth at Night? (Bruxism)
- Thumb Sucking
- What is Pulp Therapy?
- What is the Best Time for Orthodontic Treatment?
- Adult Teeth Coming in Behind Baby Teeth
- Care of Your Child's Teeth
- Good Diet = Healthy Teeth
- How Do I Prevent Cavities?
- Seal Out Decay
- Xylitol - Reducing Cavities
- Beware of Energy and Sports Drinks
For more information concerning pediatric dentistry, please visit the website for the American Academy of Pediatric Dentistry.
What Is A Pediatric Dentist?
A pediatric dentist has an extra two to three years of specialized training after dental school, and is dedicated to the oral health of children from infancy through the teenage years. The very young, pre-teens, and teenagers all need different approaches in dealing with their behavior, guiding their dental growth and development, and helping them avoid future dental problems. A pediatric dentist is best qualified to meet these needs.
Why Are The Primary Teeth Important?
It is very important to maintain the health of the primary teeth. Neglected cavities can and frequently do lead to problems which affect the developing permanent teeth. Primary teeth, or baby teeth are important for (1) proper chewing and eating, (2) providing space for the permanent teeth and guiding them into the correct position, and (3) permitting normal development of the jaw bones and muscles. Primary teeth also affect the development of speech and add to an attractive appearance. While the front four teeth last until 6-8 years of age, the back teeth aren’t replaced until age 10-12.
Eruption Of Your Child's Teeth
Children’s teeth begin forming before birth. As early as 3 months, the first primary (or baby) teeth to erupt through the gums are the lower central incisors, followed closely by the upper central incisors. Although all 20 primary teeth usually appear by age 2 1/2, the pace and order of their eruption varies.
Permanent teeth begin appearing around age 6, starting with the first molars and lower central incisors. This process continues until approximately age 21.
Adults have 28 permanent teeth, or up to 32 including the third molars (or wisdom teeth).
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 or if the face is swollen, apply cold compresses and contact Rutledge Pediatric Dentistry immediately. Also, do not place aspirin or heat on the gum or on the aching tooth.
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 or milk. 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 or clean cloth. If you cannot reinsert the tooth, transport the tooth in a cup containing the patient’s saliva or milk, NOT WATER. The patient must see a dentist IMMEDIATELY! Time is a critical factor in saving the tooth.
Knocked Out Baby Tooth: Contact Rutledge Pediatric Dentistry. Unlike with a permanent tooth, the baby tooth SHOULD NOT BE REINSERTED due to possible damage to the developing permanent tooth. In most cases, no treatment is necessary.
Chipped/Fractured Permanent Tooth: Time is a critical factor, contact Rutledge Pediatric Dentistry immediately so as to reduce the chance for infection or the need for extensive dental treatment in the future. Rinse the mouth with water and apply a cold compress to reduce swelling. If you can find the broken tooth piece, bring it with you.
Chipped/Fractured Baby Tooth: Contact Rutledge Pediatric Dentistry.
Severe Blow to the Head: Call 911 immediately or take your child to the nearest hospital emergency room.
Possible Broken or Fractured Jaw: Keep the jaw from moving and take your child to the nearest hospital emergency room.Top
Dental Radiographs (X-Rays)
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 monitor erupting teeth, diagnose bone abnormalities, 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 visual examination. If dental problems are found and treated early, dental care is more comfortable for your child and more affordable for you.
On average, most pediatric dentists request radiographs approximately once a year. The American Academy of Pediatric Dentistry recommends radiographs every six months for children with a high risk of tooth decay. Every 3-5 years, it is a good idea to obtain a panoramic radiograph which allows us to have a clear overview of the entire mouth.
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 x-rays and proper shielding assure that your child receives a minimal amount of radiation exposure.
What's The Best Toothpaste For My Child?
Tooth brushing is one of the most important tasks for good oral health. 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.
We recommend using a fluoride-free toothpaste until your child learns to spit (3-4 years old), unless there are signs of early decay. Once your child has learned to spit, use a "pea-size" amount of toothpaste and perform or assist your child’s tooth brushing. Remember that young children do not have the ability to brush their teeth effectively on their own. We recommend parents assist with tooth brushing until 7-8 years of age and flossing until 10-12 years of age.
Does Your Child Grind His Teeth At Night? (Bruxism)
Parents are often concerned about their child grinding their teeth during the night. Often, the noise created by the teeth grinding is the first indication. Or, the parent may notice the front teeth getting shorter. 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 good news is most children outgrow bruxism. The grinding decreases between the ages of 6-9 and children tend to stop grinding between the ages of 9-12. If you suspect bruxism, discuss this with your pediatrician or Dr. Rutledge.
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 thumb sucking is relaxing, it may induce sleep.
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. Usually, children stop the habit between the ages of two and four. Peer pressure causes many school-aged children to stop. Thumb sucking that persists beyond the eruption of the permanent teeth can cause problems with the proper growth of the mouth and tooth alignment.
Pacifiers are no substitute for thumb sucking. They can affect the teeth essentially the same way as sucking the 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 Dr. Rutledge.
What Is Pulp Therapy?
The pulp of a tooth is the inner, central core of the tooth. The pulp contains nerves, blood vessels and connective tissue. The purpose of pulp therapy in pediatric dentistry is to maintain the vitality of the affected tooth.
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" or "baby root canal". 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 material.
What Is The Best Time For Orthodontic Treatment?
Developing malocclusions, or incorrect teeth alignment, can be recognized as early as 2 to 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 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 and dental malalignment 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 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
This 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 Dr. Rutledge, where she can easily remove the baby tooth. The permanent tooth should then slide into the proper place, if space allows.Top
Early Infant Oral Care
Infant Oral Health
Mothers with poor oral health may be at a greater risk of passing the bacteria which causes cavities to their young children. Mother's should follow these simple steps to decrease the risk of spreading cavity-causing bacteria:
- Visit your dentist regularly.
- Brush and floss on a daily basis to reduce bacterial plaque.
- Eat a proper diet and reduce beverages and foods high in sugar and starch.
- Use a fluoridated toothpaste recommended by the ADA.
- Don't share utensils, cups or food which can pass 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.
Establishing A "Dental Home"
Our office, as well as the American Academy of Pediatrics (AAP), the American Dental Association (ADA), and the American Academy of Pediatric Dentistry (AAPD) all recommend establishing a "Dental Home" for your child by one year of age. Children who have a dental home are more likely to receive appropriate preventive and routine oral health care.
The Dental Home is intended to provide a place other than the Emergency Room for parents.
When 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 (3-4 months old) and some get them late (12-13 months old). In general, the first baby teeth to appear are usually the lower front (anterior) teeth and they usually begin erupting between the ages of 6-8 months.
Baby Bottle Tooth Decay (Early Childhood Caries)
One serious form of decay among young children is baby bottle tooth decay. This condition is caused by frequent and long exposures of an infant’s teeth to liquids that contain sugar. Among these liquids are milk (including breast milk), formula, juice and other sweetened drinks
Putting a baby to bed for a nap or at night with a bottle other than water can cause serious and rapid tooth decay. Sweet liquid pools around the child’s teeth giving plaque bacteria an opportunity to produce acids that attack tooth enamel. If you must give the baby a bottle as a comforter at bedtime, it should contain only water. If your child won't fall asleep without the bottle and its usual beverage, gradually dilute the bottle's contents with water over a period of two to three weeks.
After each feeding, wipe the baby’s gums and teeth with a damp washcloth or gauze pad to remove plaque. The easiest way to do this is to sit down, place the child’s head in your lap or lay the child on a dressing table or the floor. Whatever position you use, be sure you can see into the child’s mouth easily.
Bottles should be discontinued by the first birthday, and sippy cups should be used as a training tool to go from the bottle to a regular cup. 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, kool aid, etc.) and allowing a child to drink from it throughout the day, it soaks the child’s teeth in cavity causing bacteria.Top
Care Of Your Child's Teeth
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 children’s teeth. Foods that can cause cavities that parents may not be aware of include: gummy snacks, chips, crackers, granola, and white bread products.
How 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.
Teeth should be brushed at least twice a day. Also, watch the number of snacks containing sugar that you give your children.
The American Academy of Pediatric Dentistry recommends visits every six months to the pediatric dentist, beginning at your child’s first birthday. Routine visits will start your child on a lifetime of good dental health.
Dr. Rutledge 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 the chewing surfaces.
Seal Out Decay
A sealant is a protective coating that is applied to the chewing surfaces (grooves) of the back teeth (premolars and molars), where four out of five cavities in children are found. This sealant acts as a barrier to food, plaque and acid, thus protecting the decay-prone areas of the teeth.
Fluoride is a naturally occurring element, which has shown to prevent tooth decay by as much as 50-70%. However, too little fluoride can be detrimental to the teeth. With little or no fluoride, the teeth aren’t strengthened enough to help them resist cavities. Excessive fluoride ingestion by young children can lead to dental fluorosis, which is typically a chalky white discoloration (brown in advanced cases) of the permanent teeth. Children should spit out and not swallow excess toothpaste after brushing, in order to avoid fluorosis. Be sure to follow Dr. Rutledge’s recommendations on fluoride use.
Xylitol - Reducing Cavities
Xylitol is a natural sweetner that is found in certain fruits, vegetables, and oats, and is safe for diabetics. The American Academy of Pediatric Dentistry (AAPD) recognizes the benefits of xylitol on the oral health of infants, children, adolescents, and persons with special health care needs.
Studies using xylitol as either a sugar substitute or a small dietary addition have demonstrated a dramatic reduction in new tooth decay, along with some reversal of existing dental caries. Xylitol provides additional protection that enhances all existing prevention methods. This xylitol effect is long-lasting and possibly permanent. Low decay rates persist even years after the trials have been completed.
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.
The use of XYLITOL GUM by mothers (2-3 times per day) starting 3 months after delivery and until the child was 2 years old, has proven to reduce cavities up to 70% by the time the child was 5 years old.
Xylitol is widely distributed throughout nature in small amounts. Some of the best sources are fruits, berries, mushrooms, and lettuce. One cup of raspberries contains less than one gram of xylitol.
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 Energy and Sports Drinks
Due to the high sugar content and acids in energy and 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 energy and sports drinks and hydrate with water before, during and after sports.
Energy and sports drinks contain so much acid that they start destroying teeth after only five days of consistent use. Each acid attack lasts for around twenty minutes, and every time you take a sip of the drink, the acid damage begins all over again. Studies show that energy drinks cause twice as much damage as sports drinks.
If energy or sports drinks are consumed:
- Reduce the frequency and contact time (use a straw so your teeth are less exposed to the sugar and acid in the drink)
- Swallow immediately and do not swish them around in the mouth
- Neutralize the effect of energy and sports drinks by alternating sips of water with the drink
- Rinse mouthguards only in water
- Wait at least one hour to brush your teeth directly after consuming energy or sports drinks because your toothbrush can wear away the weakened enamel
Tongue 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 airway!
Common symptoms after piercing include pain, swelling, infection, an increased flow of saliva and injuries to gum tissue. Difficult-to-control bleeding or nerve damage can result if a blood vessel or nerve bundle is in the path of the needle.
So follow the advice of the American Dental Association and give your mouth a break – skip the mouth jewelry.
Tobacco - 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 tobacco.
Smokeless tobacco, also called spit tobacco, 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, cheeks, and on or under the tongue
- Pain, tenderness or numbness anywhere in the mouth or lips
- Difficulty chewing, swallowing, speaking or moving the jaw or tongue; or a change in the way the teeth fit together
Because the early signs of oral cancer usually are not painful, people often ignore them. If it’s not caught in the early stages, oral cancer can require extensive, sometimes disfiguring, surgery. Even worse, it can kill.
Help your child avoid tobacco in any form. By doing so, they will avoid bringing cancer-causing chemicals in direct contact with their tongue, gums and cheek.