The 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. The pediatric dentist is best qualified
to meet these needs.
It is very important to maintain
the health of the primary teeth. Neglected cavities can
and frequently do lead to problems which affect
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 4 teeth last
until 6-7 years of age, the back teeth (cuspids and
molars) arenít replaced until age 10-13.
Childrenís 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.
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).
Clean the area of the affected tooth. Rinse the mouth
thoroughly with warm water or use dental floss to
dislodge any food that may be impacted. If the pain
still exists, contact your child's dentist. Do not place
aspirin or heat on the gum or on the aching tooth. If
the face is swollen, apply cold compresses and contact
your dentist immediately.
Cut or Bitten Tongue, Lip or
Cheek: Apply ice to injured areas to help control
swelling. If there is bleeding, apply firm but gentle
pressure with a gauze or cloth. If bleeding cannot be
controlled by simple pressure, call a doctor or visit
the hospital emergency room.
Knocked Out Permanent Tooth:
If possible, find the tooth. Handle it by the crown, not
by the root. You may rinse the tooth with water only. DO
NOT clean with soap, scrub or handle the tooth
unnecessarily. Inspect the tooth for fractures. If it is
sound, try to reinsert it in the socket. Have the
patient hold the tooth in place by biting on a gauze. If
you cannot reinsert the tooth, transport the tooth in a
cup containing the patientís saliva or milk. If the
patient is old enough, the tooth may also be carried in
the patientís mouth (beside the cheek). The patient must
see a dentist IMMEDIATELY! Time is a critical factor in
saving the tooth.
Knocked Out Baby Tooth:
Contact your pediatric dentist during business hours.
This is not usually an emergency, and in most cases, no
treatment is necessary.
Chipped or Fractured Permanent
Tooth: Contact your pediatric dentist immediately.
Quick action can save the tooth, prevent infection and
reduce the need for extensive dental treatment. Rinse
the mouth with water and apply cold compresses to reduce
swelling. If possible, locate and save any broken tooth
fragments and bring them with you to the dentist.
Chipped or Fractured Baby Tooth:
Contact your pediatric dentist.
Severe Blow to the Head:
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.
Radiographs (X-Rays) are a vital
and necessary part of your childís dental diagnostic
process. Without them, certain dental conditions can and
will be missed.
Radiographs detect much more than
cavities. For example, radiographs may be needed to
survey erupting teeth, diagnose bone diseases, evaluate
the results of an injury, or plan orthodontic treatment.
Radiographs allow dentists to diagnose and treat health
conditions that cannot be detected during a clinical
examination. If dental problems are found and treated
early, dental care is more comfortable for your child
and more affordable for you.
The American Academy of Pediatric
Dentistry recommends radiographs and examinations every
six months for children with a high risk of tooth decay.
On average, most pediatric dentists request radiographs
approximately once a year. Approximately every 3 years,
it is a good idea to obtain a complete set of
radiographs, either a panoramic and bitewings or
periapicals and 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 radiographs represent a far smaller risk than an
undetected and untreated dental problem. Lead body
aprons and shields will protect your child. Todayís
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.
brushing is one of the most important tasks for good
oral health. Many toothpastes, and/or tooth polishes,
however, can damage young smiles. They contain harsh
abrasives, which can wear away young tooth enamel. When
looking for a toothpaste for your child, make sure to
pick one that is recommended by the American Dental
Association as shown on the box and tube. These
toothpastes have undergone testing to insure they are
safe to use.
Remember, children should spit out
toothpaste after brushing to avoid getting too much
fluoride. If too much fluoride is ingested, a condition
known as fluorosis can occur. If your child is too young
or unable to spit out toothpaste, consider providing
them with a fluoride free toothpaste, using no
toothpaste, or using only a "pea size" amount of
Parents are often concerned about
the nocturnal grinding of teeth (bruxism). Often, the
first indication is the noise created by the child
grinding on their teeth during sleep. Or, the parent may
notice wear (teeth getting shorter) to the dentition.
One theory as to the cause involves a psychological
component. Stress due to a new environment, divorce,
changes at school; etc. can influence a child to grind
their teeth. Another theory relates to pressure in the
inner ear at night. If there are pressure changes (like
in an airplane during take-off and landing, when people
are chewing gum, etc. to equalize pressure) the child
will grind by moving his jaw to relieve this pressure.
The majority of cases of pediatric
bruxism do not require any treatment. If excessive wear
of the teeth (attrition) is present, then a mouth guard
(night guard) may be indicated. The negatives to a mouth
guard are the possibility of choking if the appliance
becomes dislodged during sleep and it may interfere with
growth of the jaws. The positive is obvious by
preventing wear to the primary dentition.
The good news is most children
outgrow bruxism. The grinding decreases between the ages
6-9 and children tend to stop grinding between ages
9-12. If you suspect bruxism, discuss this with your
pediatrician or pediatric dentist.
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.
Thumb sucking that persists beyond
the eruption of the permanent teeth can cause problems
with the proper growth of the mouth and tooth alignment.
How intensely a child sucks on fingers or thumbs will
determine whether or not dental problems may result.
Children who rest their thumbs passively in their mouths
are less likely to have difficulty than those who
vigorously suck their thumbs.
Children should cease thumb sucking
by the time their permanent front teeth are ready to
erupt. Usually, children stop between the ages of two
and four. Peer pressure causes many school-aged children
Pacifiers are no substitute for
thumb sucking. They can affect the teeth essentially the
same way as sucking fingers and thumbs. However, use of
the pacifier can be controlled and modified more easily
than the thumb or finger habit. If you have concerns
about thumb sucking or use of a pacifier, consult your
A few suggestions to help your
child get through thumb sucking:
Children often suck their thumbs when feeling
insecure. Focus on correcting the cause of anxiety,
instead of the thumb sucking.
Children who are sucking for comfort will feel
less of a need when their parents provide comfort.
Reward children when they refrain from sucking
during difficult periods, such as when being
separated from their parents.
Your pediatric dentist can encourage children to
stop sucking and explain what could happen if they
If these approaches donít work, remind the
children of their habit by bandaging the thumb or
putting a sock on the hand at night. Your pediatric
dentist may recommend the use of a mouth appliance.
The pulp of a tooth is the inner,
central core of the tooth. The pulp contains nerves,
blood vessels, connective tissue and reparative cells.
The purpose of pulp therapy in Pediatric Dentistry is to
maintain the vitality of the affected tooth (so the
tooth is not lost).
Dental caries (cavities) and
traumatic injury are the main reasons for a tooth to
require pulp therapy. Pulp therapy is often referred to
as a "nerve treatment", "children's root canal",
"pulpectomy" or "pulpotomy". The two common forms of
pulp therapy in children's teeth are the pulpotomy and
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.
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
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
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 childís hard and soft tissues are
usually very responsive to orthodontic or orthopedic
Stage III - Adolescent
Dentition: This stage deals with the permanent teeth and
the development of the final bite relationship.
American Academy of Pediatric Dentistry (AAPD)
recommends that all pregnant women receive oral
healthcare and counseling during pregnancy. Research has
shown evidence that periodontal disease can increase the
risk of preterm birth and low birth weight. Talk to your
doctor or dentist about ways you can prevent periodontal
disease during pregnancy.
Additionally, mothers with poor
oral health may be at a greater risk of passing the
bacteria which causes cavities to their young children.
Mother's should follow these simple steps to decrease
the risk of spreading cavity-causing bacteria:
Visit your dentist regularly.
Brush and floss on a daily basis to reduce
Proper diet, with the reduction of beverages and
foods high in sugar & starch.
Use a fluoridated toothpaste recommended by the
ADA and rinse every night with an alocohol-free,
over-the-counter mouth rinse with .05 % sodium
fluoride in order to reduce plaque levels.
Don't share utensils, cups or food which can
cause the transmission of cavity-causing bacteria to
Use of xylitol chewing gum (4 pieces per day by
the mother) can decrease a childís caries rate.
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
You can make the first visit to the
dentist enjoyable and positive. If old enough, your
child should be informed of the visit and told that the
dentist and their staff will explain all procedures and
answer any questions. The less to-do concerning the
visit, the better.
It is best if you refrain from
using words around your child that might cause
unnecessary fear, such as needle, pull, drill or hurt.
Pediatric dental offices make a practice of using words
that convey the same message, but are pleasant and
non-frightening to the child.
Teething, the process of baby
(primary) teeth coming through the gums into the mouth,
is variable among individual babies. Some babies get
their teeth early and some get them late. In general,
the first baby teeth to appear are usually the lower
front (anterior) teeth and they usually begin erupting
between the age of 6-8 months.
of Your Childís Teeth" for more details.
serious form of decay among young children is baby
bottle tooth decay. This condition is caused by frequent
and long exposures of an infantís teeth to liquids that
contain sugar. Among these liquids are milk (including
breast milk), formula, fruit juice and other sweetened
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 childís 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 babyís
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 childís 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 childís
Sippy cups should be used as a
training tool from the bottle to a cup and should be
discontinued by the first birthday. If your child uses a
sippy cup throughout the day, fill the sippy cup with
water only (except at mealtimes). By filling the sippy
cup with liquids that contain sugar (including milk,
fruit juice, sports drinks, etc.) and allowing a child
to drink from it throughout the day, it soaks the
childís teeth in cavity causing 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. 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 childrenís teeth.
Good oral hygiene removes bacteria
and the left over food particles that combine to create
cavities. For infants, use a wet gauze or clean
washcloth to wipe the plaque from teeth and gums. Avoid
putting your child to bed with a bottle filled with
anything other than water. See "Baby
Bottle Tooth Decay" for more information.
For older children, brush their
teeth at least twice a day. Also, watch the
number of snacks containing sugar that you give your
The American Academy of Pediatric
Dentistry recommends visits every six months to the
pediatric dentist, beginning at your childís first
birthday. Routine visits will start your child on a
lifetime of good dental health.
Your pediatric dentist may also
recommend protective sealants or home fluoride
treatments for your child. Sealants can be applied to
your childís molars to prevent decay on hard to clean
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.
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 childís potential sources of fluoride
can help parents prevent the possibility of dental
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 childís 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.
Parents can take the following
steps to decrease the risk of fluorosis in their
Use baby tooth cleanser on the toothbrush of the
very young child.
Place only a pea sized drop of childrenís
toothpaste on the brush when brushing.
Account for all of the sources of ingested
fluoride before requesting fluoride supplements from
your childís 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).
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 childís 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.
Ask your pediatric dentist about
custom and store-bought mouth protectors.
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.
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
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.
Xylitol is widely distributed
throughout nature in small amounts. Some of the best
sources are fruits, berries, mushrooms, lettuce,
hardwoods, and corn cobs. One cup of raspberries
contains less than one gram of xylitol.
Studies suggest xylitol intake that
consistently produces positive results ranged from 4-20
grams per day, divided into 3-7 consumption periods.
Higher results did not result in greater reduction and
may lead to diminishing results. Similarly, consumption
frequency of less than 3 times per day showed no effect.
To find gum or other products
containing xylitol, try visiting your local health food
store or search the Internet to find products containing
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 in any form can jeopardize
your childís 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 wonít 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 itís 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.
Diplomate of the American Board of Pediatric Dentist - San Antonio, TX 78229 -
Dr. Carlen Blume Serving patients in the surrounding cities and
areas of San Antonio, Shavano Park,
Balcones Heights, Castle Hills, Helotes, Leon Springs, and Boerne,