What is a Pediatric Dentist?
Your Child's First Dental Visit
Why are the Primary Teeth so Important?
Dental X-rays
Care of your Child's Teeth
Good Diet = Healthy Teeth
How Do I Prevent Cavities
Seal Out Decay
Baby Bottle Tooth Decay (Early Childhood Caries)
When will my Baby Start Getting Teeth?
Eruption of your Child's Teeth
Dental Emergencies
Fluoride
What's the Best Toothpaste for my Child?
Does your Child Grind his Teeth at Night? (Bruxism)
Thumb Sucking and Other Oral Habits 
Tongue Piercing - Is it Really Cool?
Tobacco - Bad News in Any Form
What is the Best Time for Orthodontic Treatment?
Mouth Guards

 Your Child’s First Dental Visit

According to the American Academy of Pediatric Dentistry (AAPD), your child should visit the dentist by his/her 1^st birthday. You can make the first visit to the dentist enjoyable and positive. 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, the better.

 Why Are The Primary Teeth So Important?

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.

X-Ray’s detect much more than cavities. For example, X-Rays may be needed to survey erupting teeth, diagnose bone diseases, evaluate the results of an injury, or plan orthodontic treatment. X-Rays 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 X-rays 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 bitewings.

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 X-rays 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. High-speed film and proper shielding assure that your child receives a minimal amount of radiation exposure.
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Begin daily brushing as soon as the child’s first tooth erupts. A pea size amount of fluoride toothpaste can be used after the child is old enough not to swallow it. By age 4 or 5, children should be able to brush their own teeth twice a day with supervision until about age seven to make sure they are doing a thorough job. However, each child is different. Your dentist can help you determine whether the child has the skill level to brush properly.

Proper brushing removes plaque from the inner, outer and chewing surfaces. When teaching children to brush, place toothbrush at a 45 degree angle; start along gum line with a soft bristle brush in a gentle circular motion. Brush the outer surfaces of each tooth, upper and lower. Repeat the same method on the inside surfaces and chewing surfaces of all the teeth. Finish by brushing the tongue to help freshen breath and remove bacteria.

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.

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.

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.
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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, 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 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.
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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 are usually the lower front (anterior) teeth and usually begin erupting between the age of 6-8 months. See "Eruption of Your Child’s Teeth" for more details.
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Children’s teeth begin forming before birth. As early as 4 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 3, the pace and order of their eruption varies.

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 child’s 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 child’s 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 pediatric dentist.

Certain foods contain high levels of fluoride, especially powdered 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. Another source of fluoride can be found in soft drinks at fast food restaurants, when blending the syrup and carbonation with the city water supply.

Parents can take the following steps to decrease the risk of fluorosis in their children’s teeth:

• Use baby tooth cleanser on the toothbrush of the very young child.

• Place only a pea sized drop of children’s toothpaste on the brush when brushing.

• Account for all of the sources of ingested fluoride before requesting fluoride supplements from your child’s 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).

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. These toothpastes have undergone testing to insure they are safe to use.

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 position of the permanent teeth is influenced by many environmental factors. Some of these are linked to oral habits present in early infancy. These habits might be thumb sucking, finger sucking, tongue-thrusting, or grinding and clenching the teeth. Dr. McIlwain can usually read signs of these habits by looking at a child's teeth and can make the parent aware of accompanying changes. He can also suggest the methods that are available to correct the habit, and can advise when the corrective treatment should be instituted.

It is generally accepted that there is a connection between the development of the dental arches and the action of the surrounding muscles associated with the tongue and lips. Pediatric dentists are concerned with the way the baby is held while nursing, how the child nurses, and the kind of nipple that is used if he or she is bottle fed. The professional is also interested in other signs of oral habits such as chapped lips, clean thumbs from thumb sucking, and bitten fingernails. Pressures exerted by habits such a these can create an imbalance of the muscle system that directs the erupting teeth into place or holds them where they belong.

Thumb sucking is probably the most prevalent oral habit and receives the most attention. It also generates the most questions.

Sucking is one of a baby's inherent reflexes, and if this reflex were not present the infant would not seek food or nourishment. It is a natural normal infant habit and gives the baby a feeling of security, pleasure and considerable satisfaction during the first year of life. If the infant chooses this habit it should not be discouraged in the early years. The parent or care giver can try gently moving the infant's hand away from the mouth and attempt to interest him or her in a favorite toy. The parent can also try to encourage the use of a pacifier as an alternative to thumb sucking, or as a replacement for excessive use of a nursing bottle.

After age two, thumb sucking usually decreases, appearing only at bedtime or when the child is under stress or overly tired. Gradually it will stop altogether. Even up to the age of four or five, the parent probably does not have to worry about the child sucking his or her thumb unless heavy vigorous pressure is being applied by the thumb. Any irregularity in the position of the teeth that is directly due to the sucking habit is generally self-correcting as long as the child abandons the habit by the time the permanent teeth begin erupting.

There are two types of thumb suckers, "active" and "passive". The "passive" thumb sucker places the thumb in the mouth and it just lies there exerting no undue pressure and causing no bone changes. On the other hand, the "active" thumb sucker exerts, heavy, vigorous pressure with the thumb against the dentition, and when this habit is continued for a prolonged period of time it can affect the position of the incoming permanent teeth and the shape of the jaws. This pressure may force the teeth out of position and narrow the dental arches, thus bringing the upper teeth too close together and resulting in the child having an "open bite" (the teeth do not contact all the way around when the mouth is closed). "Active" thumb sucking may also interfere with the child's speech patterns.

It cannot be stressed strongly enough, however, that if a child has this habit, do not scold, nag, ridicule, scorn, punish or belittle him in an attempt to stop it. Rather than helping stop the habit, these methods may increase the anxiety and resultant sucking, and the attention gained may reinforce the habit. The child may even thumb suck for security or to get attention. With some children thumb sucking can lead to severe dental difficulties which can be corrected by orthodontia; however, with other children, thumb sucking can lead to social difficulties and must be managed in a different manner.

There are many training aids, techniques, and types of therapy available today to help a child overcome the habit. Dr. McIlwain will be glad to discuss this matter with you and explain the many avenues that can be pursued in helping your child correct this habit.

Most professionals feel that pacifiers should be encouraged as an alternative to thumb sucking. If one is used, care must be taken in purchasing it for the protection of the infant. It should be of one-piece construction, thus making it unable to be pulled apart by the child. Also, the pieces cannot be ingested or cause choking. It should have a large, ventilated shield, and should be made of a non-toxic material which is capable of being sterilized. The pacifier should not be tied around the infant's neck and the parent should avoid putting sweets such as sugar or honey on it to encourage its use! The orthodontic nipple construction of the pacifier is preferable to the thumb shape construction.

An "open bite" can occur when a child sucks a finger or fingers in preference to the thumb. This same result can happen if a child is a "tongue-thruster", since this individual places his tongue between the upper and lower front teeth each time he swallows and thus puts force on the teeth preventing the erupting teeth from coming down into their normal position.

Some children have the habit of "grinding" their teeth, especially during sleep. This habit is fairly common among children and its causes are many and varied; however, it is not to be considered in the same vein as adult grinding and malocclusion. The baby teeth flatten and wear with the grinding because the tooth enamel is thinner. If it persists after the permanent teeth have erupted the dentist will then discuss the problem with the parent.

Another oral habit that can affect the normal dental development is "clenching" or "locking" the teeth, and the parent should be sure to mention this to the dentist.

If these various habits occurring during childhood are diagnosed and corrected early in the transition between a child's primary and permanent dental development, the chances of the child having beautiful, straight teeth are greatly improved.

A few suggestions to help your child get through thumb sucking:

There are many risks involved with oral piercings including chipped or cracked teeth, blood clots, or blood poisoning. 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.

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, 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 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.

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.

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 breathe.