F.A.Q. for Parents

My toddler/pre-schooler child still sucks the thumb or uses a pacifier. What should I do?

Sucking is a natural reflex for the infant and the toddler. Infants and young children may use their thumbs, fingers, pacifiers or other objects to satisfy the need to suck. Because thumb-sucking is relaxing, it may induce sleep. However, if this habit persists beyond the eruption of the permanent teeth, there can be problems with the proper growth of the mouth and with mouth alignment.

The intensity of the thumb- or finger-sucking can determine whether dental problems will results. Children who rest their thumbs passively in their mouths are probably less likely to have difficulty than those who vigorously suck their thumbs. Usually children stop this habit between ages two to four. Peer pressure (as in pre-school groups or elementary school) causes many children to drop the sucking habit.

Pacifiers are not a positive replacement for thumb-sucking because they can affect the teeth essentially in the same way. However, use of the pacifier can be controlled and modified more easily than can the child’s use of the thumb or fingers.

Here are some suggestions:

• When parents recognize the need for and provide comfort, children who suck their thumbs will feel less of a need for the habit.
• Reward children when they avoid sucking during difficult periods such as being separated from their parents.
• When other approaches don’t work, try bandaging the child’s thumb or try putting a sock on the child’s hand at bedtime.

What can you tell me about treatment for cavities in my child’s teeth?

Cavities (dental caries) are caused by bacteria, so the dental treatment will address controlling the germs and identifying steps for prevention of future decay. If this is not done, you can expect your child to develop new cavities in untreated areas.

The age of your child at which the dentist identifies the cavities is significant. The younger the child, the more challenging it is to control the caries process. “Baby bottle caries” have been seen in children who nursed at will through the day or night time. Young children require special management techniques.

As for treatment, know that your child’s teeth are made up of two hard layers surrounding a soft core. The visible white layer is called enamel. The underlying hard layer, colored yellow, is the dentin. The soft core is the dental pulp, made up of blood vessels and nerve bundles. Treatment of the cavity is related to its depth. Unlike permanent teeth, baby teeth (primary teeth) have thin outer layers that make it easier for the cavity to extend into the tooth’s pulp area.

Cavities that are limited to the hard layers are cleaned and filled with special dental materials. However, when the cavity extends into the dental pulp, then a removal of the pulp is necessary to preserve the tooth. A special medical application is placed in the pulp area; the tooth is then restored with a little cap.

Where does cavity-causing bacteria come from?

When babies are born, their mouths have no cavity-causing bacteria but they can easily acquire such bacteria transmitted from someone who already has high levels of this bacteria. This can originate with the parents or other caregiver or even from a sibling with a high cavity rate. If a baby eats from the same spoon as a family member or if the toddler uses a family member’s toothbrush, the bacteria can be transmitted.

The higher the cavity rate for parents, the better chance that the child will have germs passed along from them. The easiest way to prevent transmission of the bacteria is the maintenance of optimum oral health practices.

When does prevention of dental cavities begin?

When a woman is pregnant, she will give her baby a better chance of warding off decay by maintaining optimum oral health herself. The baby’s primary teeth and permanent teeth are forming during the pregnancy period. It is extremely important for the woman, even before pregnancy begins, to get regular teeth cleaning and to address any dental problems. Fluoride rinses and chewing gums containing xylitol are simple ways to achieve oral health, incorporated into a daily hygiene routine.

It is also important to establish a “dental home” when your baby is born. Caries prevention requires an early examination to assess the baby’s risk of developing dental caries. This examination should occur by the time the first tooth erupts through the gum and no later than the first birthday. Research has shown that the earlier a child gets a cavity, the stronger and more resistant are the bacteria that cause it.

What can you tell me about gum disease in children?

Gingivitis is an inflammation of the gums, leading to periodontitis, a more severe condition that includes inflammation of the tooth’s supporting tissues of bone and ligament. Periodontitis is a major cause of tooth loss and can be associated with several systemic diseases. The cause of both gingivitis and periodontitis is bacterial, but the groups of germs creating these problems differ from those that cause dental decay.

Good oral hygiene and an individualized dental plan are important in putting a stop to gum disease. The dental plan will involve a careful assessment of your child and family history.

What  advice can you give on brushing and flossing for my child?

Brushing: Begin to brush your child’s teeth twice a day as soon as the teeth erupt through the gums and continue to help with brushing through the toddler years. Most children learn how to brush their teeth on their own by age 4 or 5. Parental supervision will still be necessary to make sure that the brushing is done properly.

Flossing: Begin flossing your child’s teeth as soon as you see a contact point or tight spot between any two teeth. Toothbrush bristles are not able to clean contact points where two teeth touch, but harmful bacteria can lodge there. A very common contact point in babies is between the upper front teeth.

My child participates in school sports programs. How can I prepare against sports accidents involving the teeth?

The Academy for Sports Dentistry (ASD) recommends use of a properly fitted mouthguard for children involved in sports programs. This will help prevent broken teeth and injuries to the lips, tongue, face, and jaw. A properly fitted mouthguard will stay in place while your child is wearing it, without interfering with speech or breathing. These appliances should be custom-fitted and checked continuously by your pediatric dentist.

What do I need to know about braces for my child?

As early as age two or three, a child may show evidence of a malocclusion (“bad bite”). At that point, some steps can be taken to reduce the need for major orthodontic treatment at a later age. We are trained to recognize, prevent, and treat these early problems in an age-appropriate way. Over all, orthodontic treatment can be accomplished in three stages:

Stage 1: Early Treatment. Ages two through six years. We are concerned with underdeveloped dental arches, the premature loss of primary teeth and harmful habits such as finger- or thumb-sucking. Treatment during this stage is often successful. In many cases, the need for future orthodontic/orthopedic treatment can be eliminated.

Stage 2: Mixed dentition. Ages six through 12 years. The eruption of the permanent incisor (front) teeth and the six-year molars occur during this period. Treatment at this stage deals with poor jaw relationships, crowding and dental realignment problems. When orthodontic treatment is indicated, this is an excellent stage to start treatment because the child’s hard and soft tissues are usually very responsive to orthodontic or orthopedic influences.

Stage 3: Adolescent dentition. 12 years and up.  This stage deals with your child’s permanent teeth and the development of the final bite relationship. Although various problems can be treated or reduced in the earlier two stages of treatment, you will find that working closely with the orthodontist during this stage is extremely important. The goal is to give your child a beautiful, healthy smile for the lifetime ahead.

Do you provide dental services for special needs children?

Yes, we do. The American Academy of Pediatric Dentistry defines “special needs children” as those with special health care needs due to a physical developmental, mental, sensory, behavioral, cognitive or emotional impairment or a living condition requiring medical management, health care intervention and/or use of specialized services programs.”

These children require specialized knowledge, increased awareness and attention and accommodation. Children in this group have an increased risk of oral diseases so it is important to gain an early understanding of the child’s specific oral and dental needs. Prevention of dental problems is very important.

We address the needs of such children, making an assessment of the child’s risk for developing dental problems. We assist the parents  in providing an oral hygiene plan, with individualized treatment that involves current issues and that looks ahead to prevention of future issues A team approach for the best results will involve the family, the pediatrician, the occupational therapist (if applicable), and other health care providers.

Do you provide fluoride treatments for children? What do you recommend in terms of a toothpaste to use?

According to the American Academy of Pediatric Dentistry, the most beneficial and inexpensive method of reducing dental caries is the adjustment of the fluoride level in community water supplies. Fluoride makes the teeth less soluble to decay acids.

Our office can supply professional fluoride treatments. The newest type comes in a varnish form and will stick to the child’s teeth for several hours, providing more benefit for the enamel. Fluoride applications are part of a comprehensive prevention program for your child.

When your child has learned to expectorate (spit out) properly, you can add a fluoride rinse to the oral hygiene plan.

As for toothpaste. Use one that is approved by the American Dental Association. Do not start the use of fluoridated toothpaste until the child is two years of age because the fluoride concentration is high and very young children can swallow it. An amount of toothpaste the size of a half-pea is sufficient for the small child to use in brushing teeth.