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Frequently Asked Questions
"Robyn is always so friendly and gentle.
We love her because we are not scared to let her work on our teeth."
--Quintana family
 Click on a
topic of interest for more information
For information on special oral health care needs, we've provided
links to the following sites:
National Institute of Dental & Craniofacial Research
Resource & Information on Cleft Lip & Palate
National
Foundation for Ectodermal Dysplasias
Sugar Vs. Sugar Free
In order to appeal to children, many vitamin supplements contain
sugar under a variety of names. Sucrose, fructose, dextrates,
dextrins, and "naturally sweetened" are all different names for
sugar. When these sugars are listed as the first ingredient on a
label, it indicates that sugar is the ingredient in the largest
quantity.
Sugar in vitamins is very cariogenic (cavity-causing). After the
vitamin is chewed, it can remain lodged in your child's molar for
several hours-- eating away at the tooth enamel. Sugar-free chewable
vitamins usually contain sorbitol as the artificial sweetener
instead of sucrose, but sorbitol can still cause cavities.
Therefore, brushing after the meal at which a chewable vitamin is
given is very important.
Time to Administer Vitamins
It is important to give your child his or her vitamin/mineral
tablet only with a meal, ideally breakfast, for several reasons:
- Giving a vitamin before a meal can decrease a child's appetite
for the nutritious foods you are about to serve.
- If iron is in the vitamin tablet, it can upset the child's
stomach or cause intestinal cramping if given on an empty stomach.
- The vitamins and minerals in the tablet and in the meal are
more efficiently absorbed when ingested together.
- Chewing food can help dislodge the sticky vitami tablet that
may have been stuck in the molar. Brushing the teeth after the
meal will remove any remaining piece of the vitamin. breakfast is
a meal that is convenient for most children to brush afterwards
and therefore would be a safe time to give a vitamin tablet.
Fluoride
The nutrient, fluoride, which is essential for the enamel
formation on teeth, is not contained in the over-the-counter vitamin
tablets because it is already in our metro Denver water supply.
Our Recommendation
If you are concerned that your child is not eating a balanced
diet every day, then we feel that one vitamin/mineral tablet each
day will be helpful to your child's health.
We recommend LIQUID vitamins rather than chewables for children
under the age of four because there is no sugar in liquid vitamins
and, therefore, it doesn't stick to the teeth.
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What Is A Pediatric Dentist?
The pediatric dentist has an extra two years of specialized training
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.
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Your Child's First Dental
Visit
Your child should visit the dentist by his/her 1st 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
his 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.
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Why Are The Primary
Teeth So Important?
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) aren't replaced until
age 10-13.
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Dental 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.
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. Children's Dentistry uses
digital radiographs to reduce radiation exposure and to provide the
best available diagnostic imaging. Instead of a bulky sensor, we use
small, light weight phosphate films that are the same size but more
flexible and comfortable than conventional analogue films..
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Care of Your Child's Teeth
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.
Flossing removes plaque between the teeth where a toothbrush can't
reach. Flossing should begin when any two teeth touch. You may wish
to floss the child's teeth until he or she can do it alone. Use
about 18 inches of floss, winding most of it around the middle
fingers of both hands. Hold the floss lightly between the thumbs and
forefingers. Use a gentle, back-and-forth motion to guide the floss
between the teeth. Curve the floss into a C-shape and slide it into
the space between the gum and tooth until you feel resistance.
Gently scrape the floss against the side of the tooth. Repeat this
procedure on each tooth. Don't forget the backs of the last four
teeth.
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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.
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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.
For older children, brush their teeth 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 six-month
visits to the pediatric dentist beginning at your child's 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 child's molars to prevent decay on hard to clean surfaces.
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Seal Out Decay
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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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, 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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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 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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Eruption Of Your Child's
Teeth
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.
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).
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Tooth Development
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Dental
Emergencies
Toothache: Clean the area of the affected tooth thoroughly.
Rinse the mouth vigorously with warm water or use dental floss to
dislodge impacted food or debris. DO NOT place aspirin on the gum or
on the aching tooth. If face is swollen apply cold compresses. Take
the child to a dentist.
Cut or Bitten Tongue, Lip or Cheek: Apply ice to bruised
areas. If there is bleeding apply firm but gentle pressure with a
gauze or cloth. If bleeding does not stop after 15 minutes or it
cannot be controlled by simple pressure, take child to hospital
emergency room.
Knocked Out Permanent Tooth: Find the tooth. Handle the tooth
by the crown, not the root portion. You may rinse the tooth but DO
NOT clean 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 patient's saliva or milk. The tooth may also be carried in the
patient's mouth. The patient must see a dentist IMMEDIATELY! Time is
a critical factor in saving the tooth.
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Fluoride
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 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.
Blending the syrup, carbonation with the city water supply often
makes soft drinks at fast food restaurants – so if fluoride is in
the water – this is another source.
Parents can take the following steps to decrease the risk of
fluorosis in their children's teeth:
- Use baby tooth cleanser on the toothbrush in 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 6 months old.
- Obtain fluoride level test results for your drinking water
before giving fluoride supplements to your child (check with local
water utilities).
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What's the Best
Toothpaste for my Child?
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.
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 toothpaste.
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Does
Your Child Grind His Teeth At Night? (Bruxism)
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 gets
less 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.
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Thumb Sucking
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.
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
to stop.
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 pediatric dentist.
A few suggestions to help your child get through thumb sucking:
- Instead of scolding children for thumb sucking, praise them
when they are not.
- 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 continue.
- If these approaches don't 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.
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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, 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.
So follow the advice of the American Dental Association and give
your mouth a break – skip the mouth jewelry.
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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, 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 your lips, and on or under
your tongue
- Pain, tenderness or numbness anywhere in the mouth or lips
- Difficulty chewing, swallowing, speaking or moving your jaw or
tongue; or a change in the way your 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.
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What is
the Best Time for Orthodontic Treatment?
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.
Stage III – Adolescent Dentition: This stage deals with the
permanent teeth and the development of the final bite relationship.
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Mouth Guards
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.
Ask your pediatric dentist about custom and store-bought mouth
protectors.
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