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Pediatric Dentistry

Pediatric Dentistry in Trenton

Pediatric dentistry (formerly Pedodontics/Paedodontics) primarily focuses on children from birth through adolescence. The American Dental Association (ADA), recognizes pediatric dentistry as a specialty, and therefore requires dentists to undertake two or three years of additional training after completing a general dentistry degree. At the end of this training, the American Board of Pediatric Dentistry issues a unique diploma (Diplomate ABPD). Some pediatric dentists (pedodontists) opt to specialize in oral care for children with special needs, specifically children with autism, varying levels of mental retardation, or cerebral palsy.

One of the most important components of pediatric dentistry is child psychology. Pediatric dentists are trained to create a friendly, fun, social atmosphere for visiting children, and always avoid threatening words like “drill,” “needle,” and “injection.” Dental phobias beginning in childhood often continue into adulthood, so it is of paramount importance that children have positive experiences and find their “dental home” as early as possible.

What Does a Pediatric Dentist Do?

Pediatric dentists fulfill many important functions pertaining to the child’s overall oral health and hygiene. They place particular emphasis on the proper maintenance and care of deciduous (baby) teeth, which are instrumental in facilitating good chewing habits, proper speech production, and also hold space for permanent teeth.

Other important functions include:

Education – Pediatric dentists educate the child using models, computer technology, and child-friendly terminology, thus emphasizing the importance of keeping teeth strong and healthy. In addition, they advise parents on disease prevention, trauma prevention, good eating habits, and other aspects of the home hygiene routine.

Monitoring growth – By continuously tracking growth and development, pediatric dentists are able to anticipate dental issues and quickly intervene before they worsen. Also, working towards earlier corrective treatment preserves the child’s self-esteem and fosters a more positive self-image.

Prevention – Helping parents and children establish sound eating and oral care habits reduces the chances of later tooth decay. In addition to providing check ups and dental cleanings, pediatric dentists are also able to apply dental sealants and topical fluoride to young teeth, advise parents on thumb- sucking/pacifier/smoking cessation, and provide good demonstrations of brushing and flossing.

Intervention – In some cases, pediatric dentists may discuss the possibility of early oral treatments with parents. In the case of oral injury, malocclusion (bad bite), or bruxism (grinding), space maintainers may be fitted, a nighttime mouth guard may be recommended, or reconstructive surgery may be scheduled.

If you have questions or concerns about pediatric dentistry, please contact our dental office.

The American Academy of Pediatric Dentistry (AAPD) suggests that parents should make an initial “well-baby” appointment with a pediatric dentist approximately six months after the emergence of the first tooth, or no later than the child’s first birthday.

Although this may seem surprisingly early, the incidence of infant and toddler tooth decay has been rising in recent years.  Tooth decay and early cavities can be exceptionally painful if they are not attended to immediately, and can also set the scene for poor oral health in later childhood.

The pediatric dentist is a specialist in child psychology and child behavior, and should be viewed as an important source of information, help, and guidance.  Oftentimes, the pediatric dentist can provide strategies for eliminating unwanted oral habits (for example, pacifier use and thumb sucking) and can also help parents in establishing a sound daily oral routine for the child.

What potential dental problems can babies experience?

A baby is at risk for tooth decay as soon as the first tooth emerges.  During the first visit, the pediatric dentist will help parents implement a preventative strategy to protect the teeth from harm, and also demonstrate how infant teeth should be brushed and flossed.

In particular, infants who drink breast milk, juice, baby formula, soda, or sweetened water from a baby bottle or sippy cup are at high-risk for early childhood caries (cavities).  To counteract this threat, the pediatric dentist discourages parents from filling cups with sugary fluids, dipping pacifiers in honey, and transmitting oral bacteria to the child via shared spoons and/or cleaning pacifiers in their own mouths.

Importantly, the pediatric dentist can also assess and balance the infant’s fluoride intake.  Too much fluoride ingestion between the ages of one and four years old may lead to a condition known as fluorosis in later childhood.  Conversely, too little fluoride may render young tooth enamel susceptible to tooth decay.

What happens during the first visit?

Pediatric dentists have fun-filled, stimulating dental offices.  All dental personnel are fully trained to communicate with infants and young children.

During the initial visit, the pediatric dentist will advise parents to implement a good oral care routine, ask questions about the child’s oral habits, and examine the child’s emerging teeth.  The pediatric dentist and parent sit knee-to-knee for this examination to enable the child to view the parent at all times.  If the infant’s teeth appear stained, the dentist may clean them.  Oftentimes, a topical fluoride treatment will be applied to the teeth after this cleaning.

What questions may the pediatric dentist ask during the first visit?

The pediatric dentist will ask questions about current oral care, diet, the general health of the child, the child’s oral habits, and the child’s current fluoride intake.

Once answers to these questions have been established, the pediatric dentist can advise parents on the following issues:

  • Accident prevention.
  • Adding xylitol and fluoride to the infant’s diet.
  • Choosing an ADA approved, non-fluoridated brand of toothpaste for the infant.
  • Choosing an appropriate toothbrush.
  • Choosing an orthodontically correct pacifier.
  • Correct positioning of the head during tooth brushing.
  • Easing the transition from sippy cup to adult-sized drinking glasses (12-14 months).
  • Eliminating fussing during the oral care routine.
  • Establishing a drink-free bedtime routine.
  • Maintaining good dietary habits.
  • Minimizing the risk of tooth decay.
  • Reducing sugar and carbohydrate intake.
  • Teething and developmental milestones.

If you have further questions or concerns about the timing or nature of your child’s first oral checkup, please ask your pediatric dentist.

According to AAPD (American Academy of Pediatric Dentistry) guidelines, infants should initially visit the pediatric dentist around the time of their first birthday.  First visits can be stressful for parents, especially for parents who have dental phobias themselves.

It is imperative for parents to continually communicate positive messages about dental visits (especially the first one), and to help the child feel as happy as possible about visiting the dentist.

How can I prepare for my child’s first dental visit?

Pediatric dentists are required to undergo extensive training in child psychology.  Their dental offices are generally colorful, child-friendly, and boast a selection of games, toys, and educational tools.  Pediatric dentists (and all dental staff) aim to make the child feel as welcome as possible during all visits.

There are several things parents can do to make the first visit enjoyable.  Some helpful tips are listed below:

Take another adult along for the visit – Sometimes infants become fussy when having their mouths examined.  Having another adult along to soothe the infant allows the parent to ask questions and to attend to any advice the dentist may have.

Leave other children at home – Other children can distract the parent and cause the infant to fuss.  Leaving other children at home (when possible) makes the first visit less stressful for all concerned.

Avoid threatening language – Pediatric dentists and staff are trained to avoid the use of threatening language like “drills,” “needles,” “injections,” and “bleeding.”  It is imperative for parents to use positive language when speaking about dental treatment with their child.

Provide positive explanations – It is important to explain the purposes of the dental visit in a positive way.  Explaining that the dentist “helps keep teeth healthy” is far better than explaining that the dentist “is checking for tooth decay and might have to drill the tooth if decay is found.”

Explain what will happen – Anxiety can be vastly reduced if the child knows what to expect.  Age-appropriate books about visiting the dentist can be very helpful in making the visit seem fun. Here is a list of parent and dentist-approved books:

  • The Berenstain Bears Visit the Dentist – by Stan and Jan Berenstain.
  • Show Me Your Smile: A Visit to the Dentist – Part of the “Dora the Explorer” Series.
  • Going to the Dentist – by Anne Civardi.
  • Elmo Visits the Dentist – Part of the “Sesame Street” Series.

What will happen during the first visit?

There are several goals for the first dental visit.  First, the pediatric dentist and the child need to get properly acquainted.  Second, the dentist needs to monitor tooth and jaw development to get an idea of the child’s overall health history.  Third, the dentist needs to evaluate the health of the existing teeth and gums.  Finally, the dentist aims to answer questions and advise parents on how to implement a good oral care regimen.

The following sequence of events is typical of an initial “well baby checkup”:

  1. Dental staff will greet the child and parents.
  2. The infant/family health history will be reviewed (this may include questionnaires).
  3. The pediatric dentist will address parental questions and concerns.
  4. More questions will be asked, generally pertaining to the child’s oral habits, pacifier use, general development, tooth alignment, tooth development, and diet.
  5. The dentist will provide advice on good oral care, how to prevent oral injury, fluoride intake, and sippy cup use.
  6. The infant’s teeth will be examined. Generally, the dentist and parent sit facing each other.  The infant is positioned so that his or her head is cradled in the dentist’s lap.  This position allows the infant to look at the parent during the examination.
  7. Good brushing and flossing demonstrations will be provided.
  8. The state of the child’s oral health will be described in detail, and specific recommendations will be made.  Recommendations usually relate to oral habits, appropriate toothpastes and toothbrushes for the child, orthodontically correct pacifiers, and diet.
  9. The dentist will detail which teeth may appear in the following months.
  10. The dentist will outline an appointment schedule and describe what will happen during the next appointment.

If you have questions or concerns about your child’s first dental visit, please contact our office.

Maintaining the health of primary (baby) teeth is exceptionally important.  Although baby teeth will eventually be replaced, they fulfill several crucial functions in the meantime.

Baby teeth aid enunciation and speech production, help a child chew food correctly, maintain space for adult teeth, and prevent the tongue from posturing abnormally in the mouth.  When baby teeth are lost prematurely, adjacent teeth shift to fill the gap, causing impacted adult teeth and the potential need for orthodontic treatment.  This phenomenon can lead to impacted adult teeth, years of orthodontic treatment, and a poor aesthetic result.

Babies are at risk for tooth decay as soon as the first primary tooth emerges – usually around the age of six months.  For this reason, the American Academy of Pediatric Dentistry (AAPD) recommends a “well-baby check up” with a pediatric dentist around the age of twelve months.

What is baby bottle tooth decay?

The term “baby bottle tooth decay” refers to early childhood caries (cavities), which occur in infants and toddlers.  Baby bottle tooth decay may affect any or all of the teeth, but is most prevalent in the front teeth on the upper jaw.

If baby bottle tooth decay becomes too severe, the pediatric dentist may be unable to save the affected tooth.  In such cases, the damaged tooth is removed, and a space maintainer is provided to prevent misalignment of the remaining teeth.

Scheduling regular checkups with a pediatric dentist and implementing a good homecare routine can completely prevent baby bottle tooth decay.

How does baby bottle tooth decay start?

Acid-producing bacteria in the oral cavity cause tooth decay.  Initially, these bacteria may be transmitted from mother or father to baby through saliva.  Every time parents share a spoon with the baby or attempt to clean a pacifier with their mouths, the parental bacteria invade the baby’s mouth.

The most prominent cause of baby bottle tooth decay however, is frequent exposure to sweetened liquids.  These liquids include breast milk, baby formula, juice, and sweetened water – almost any fluid a parent might fill a baby bottle with.

When sweetened liquids are used as a naptime or bedtime drink, they are a heightened risk because they remain in the mouth for an extended period of time.  Oral bacteria feed on the sugar around teeth and emit harmful acids.  These acids wear away tooth enamel, resulting in painful cavities and pediatric tooth decay.

Infants who are not receiving an appropriate amount of fluoride are at increased risk for tooth decay.  Fluoride works to protect tooth enamel, simultaneously reducing mineral loss and promoting mineral reuptake.  Through a series of questionnaires and examinations, the pediatric dentist can determine whether a particular infant needs fluoride supplements or is at high-risk for baby bottle tooth decay.

What can I do at home to prevent baby bottle tooth decay?

Baby bottle tooth decay can be completely prevented by a committed parent.  Making regular dental appointments and following the guidelines below will keep each child’s smile bright, beautiful, and free of decay:

  • Try not to transmit bacteria to your child via saliva exchange.  Rinse pacifiers and toys in clean water, and use a clean spoon for each person eating.
  • Clean gums after every feeding with a clean washcloth.
  • Use an appropriate toothbrush along with an ADA-approved toothpaste to brush when teeth begin to emerge.  Fluoride-free toothpaste is recommended for children under the age of two.
  • Use a pea-sized amount of ADA-approved fluoridated toothpaste when the child has mastered the art of “spitting out” excess toothpaste.  Though fluoride is important for the teeth, too much consumption can result in a condition called fluorosis.
  • Do not place sugary drinks in baby bottles or sippy cups.  Only fill these containers with water, breast milk, or formula.  Encourage the child to use a regular cup (rather than a sippy cup) when the child reaches twelve months old.
  • Do not dip pacifiers in sweet liquids (honey, etc.).
  • Review your child’s eating habits.  Eliminate sugar-filled snacks and encourage a healthy, nutritious diet.
  • Do not allow the child to take a liquid-filled bottle to bed.  If the child insists, fill the bottle with water as opposed to a sugary alternative.
  • Clean your child’s teeth until he or she reaches the age of seven.  Before this time, children are often unable to reach certain places in the mouth.
  • Ask the pediatric dentist to review your child’s fluoride levels.

If you have questions or concerns about baby bottle tooth decay, please contact our office.

Pediatric oral care has two main components: preventative care at the pediatric dentist’s office and preventative care at home. Though infant and toddler caries (cavities) and tooth decay have become increasingly prevalent in recent years, a good dental strategy will eradicate the risk of both.

The goal of preventative oral care is to evaluate and preserve the health of the child’s teeth. Beginning at the age of twelve months, the American Dental Association (ADA) recommends that children begin to visit the pediatric dentist for “well baby” checkups. In general, most children should continue to visit the dentist every six months, unless instructed otherwise.

How can a pediatric dentist care for my child’s teeth?

The pediatric dentist examines the teeth for signs of early decay, monitors orthodontic concerns, tracks jaw and tooth development, and provides a good resource for parents. In addition, the pediatric dentist has several tools at hand to further reduce the child’s risk for dental problems, such as topical fluoride and dental sealants.

During a routine visit to the dentist: the child’s mouth will be fully examined; the teeth will be professionally cleaned; topical fluoride might be coated onto the teeth to protect tooth enamel, and any parental concerns can be addressed. The pediatric dentist can demonstrate good brushing and flossing techniques, advise parents on dietary issues, provide strategies for thumb sucking and pacifier cessation, and communicate with the child on his or her level.

When molars emerge (usually between the ages of two and three), the pediatric dentist may coat them with dental sealant. This sealant covers the hard-to-reach fissures on the molars, sealing out bacteria, food particles, and acid. Dental sealant may last for many months or many years, depending on the oral habits of the child. Dental sealant is an important tool in the fight against tooth decay.

How can I help at home?

Though most parents primarily think of brushing and flossing when they hear the words “oral care,” good preventative care includes many more factors, such as:

Diet – Parents should provide children with a nourishing, well-balanced diet. Very sugary diets should be modified and continuous snacking should be discouraged. Oral bacteria ingest leftover sugar particles in the child’s mouth after each helping of food, emitting harmful acids that erode tooth enamel, gum tissue, and bone. Space out snacks when possible, and provide the child with non-sugary alternatives like celery sticks, carrot sticks, and low-fat yogurt.

Oral habits – Though pacifier use and thumb sucking generally cease over time, both can cause the teeth to misalign. If the child must use a pacifier, choose an “orthodontically” correct model. This will minimize the risk of developmental problems like narrow roof arches and crowding. The pediatric dentist can suggest a strategy (or provide a dental appliance) for thumb sucking cessation.

General oral hygiene – Sometimes, parents clean pacifiers and teething toys by sucking on them. Parents may also share eating utensils with the child. By performing these acts, parents transfer harmful oral bacteria to their child, increasing the risk of early cavities and tooth decay. Instead, rinse toys and pacifiers with warm water, and avoid spoon-sharing whenever possible.

Sippy cup use – Sippy cups are an excellent transitional aid when transferring from a baby bottle to an adult drinking glass. However, sippy cups filled with milk, breast milk, soda, juice, and sweetened water cause small amounts of sugary fluid to continually swill around young teeth – meaning acid continually attacks tooth enamel. Sippy cup use should be terminated between the ages of twelve and fourteen months or as soon as the child has the motor skills to hold a drinking glass.

Brushing – Children’s teeth should be brushed a minimum of two times per day using a soft bristled brush and a pea-sized amount of toothpaste. Parents should help with the brushing process until the child reaches the age of seven and is capable of reaching all areas of the mouth. Parents should always opt for ADA approved toothpaste (non-fluoridated before the age of two, and fluoridated thereafter). For babies, parents should rub the gum area with a clean cloth after each feeding.

Flossing – Cavities and tooth decay form more easily between teeth. Therefore, the child is at risk for between-teeth cavities wherever two teeth grow adjacent to each other. The pediatric dentist can help demonstrate correct head positioning during the flossing process and suggest tips for making flossing more fun!

Fluoride – Fluoride helps prevent mineral loss and simultaneously promotes the remineralization of tooth enamel. Too much fluoride can result in fluorosis, a condition where white specks appear on the permanent teeth, and too little can result in tooth decay. It is important to get the fluoride balance correct. The pediatric dentist can evaluate how much the child is currently receiving and prescribe supplements if necessary.

If you have questions or concerns about how to care for your child’s teeth, please ask your pediatric dentist.

Dental radiographs, also known as dental X-rays, are important diagnostic tools in pediatric dentistry.  Dental radiographs allow the dentist to see and treat problems like childhood cavities, tooth decay, orthodontic misalignment, bone injuries, and bone diseases before they worsen.  These issues would be difficult (in some cases impossible) to see with the naked eye during a clinical examination.

The American Academy of Pediatric Dentistry (AAPD) approves the use of dental radiographs for diagnostic purposes in children and teenagers.  Although radiographs only emit tiny amounts of radiation and are safe to use on an occasional basis, the AAPD guidelines aim to protect young people from unnecessary X-ray exposure.

What are dental X-rays used for?

Dental x-rays are extremely versatile diagnostic tools.  Some of their main uses in pediatric dentistry include:

  • Assessing the amount of space available for incoming teeth.
  • Checking whether primary teeth are being shed in good time for adult teeth to emerge.
  • Evaluating the progression of bone disease.
  • Monitoring and diagnosing tooth decay.
  • Planning treatment (especially orthodontic treatment).
  • Revealing bone injuries, abscesses, and tumors.
  • Revealing impacted wisdom teeth.

When will my child need dental X-rays?

Individual circumstances dictate how often a child needs to have dental radiographs taken.  Children at higher-than-average risk of childhood tooth decay (as determined by the pediatric dentist) may need biannual radiographs to monitor changes in the condition of the teeth.  Likewise, children who are at high risk for orthodontic problems, for example, malocclusion, may also need sets of radiographs taken more frequently for monitoring purposes.

Children at average or below average risk for tooth decay and orthodontic problems should have a set of dental X-rays taken every one to two years.  Even in cases where the pediatric dentist suspects no decay at all, it is still important to periodically monitor tooth and jaw growth – primarily to ensure there is sufficient space available for incoming permanent teeth.

If the oral region has been subject to trauma or injury, the pediatric dentist may want to X-ray the mouth immediately.  Developments in X-ray technology mean that specific areas of the mouth can be targeted and X-rayed separately, reducing the amount of unnecessary X-ray exposure.

What precautions will be taken to ensure my child’s safety?

Though dental radiographs are perfectly safe for use on children, the pediatric dentist will take several precautions to ensure the X-ray process does not unduly damage the child’s cells and bodily tissues.

First, the child will be covered in a lead apron to protect the body from unnecessary exposure.  Second, the dentist will use shields to protect the parts of the face that are not being X-rayed.  Finally, the pediatric dentist will use high-speed film to reduce radiation exposure as much as possible.

If you have questions or concerns about dental radiographs or X-rays, please contact your pediatric dentist.

Fluorine, a natural element in the fluoride compound, has proven to be effective in minimizing childhood cavities and tooth decay.  Fluoride is a key ingredient in many popular brands of toothpaste, oral gel, and mouthwash, and can also be found in most community water supplies.  Though fluoride is an important part of any good oral care routine, overconsumption can result in a condition known as fluorosis.  The pediatric dentist is able to monitor fluoride levels, and check that children are receiving the appropriate amount.

How can fluoride prevent tooth decay?

Fluoride fulfills two important dental functions.  First, it helps staunch mineral loss from tooth enamel, and second, it promotes the remineralization of tooth enamel.

When carbohydrates (sugars) are consumed, oral bacteria feed on them and produce harmful acids.  These acids attack tooth enamel – especially in children who take medications or produce less saliva.  Repeated acid attacks result in cavities, tooth decay, and childhood periodontal disease.  Fluoride protects tooth enamel from acid attacks and reduces the risk of childhood tooth decay.

Fluoride is especially effective when used as part of a good oral hygiene regimen.  Reducing the consumption of sugary foods, brushing and flossing regularly, and visiting the pediatric dentist biannually, all supplement the work of fluoride and keep young teeth healthy.

How much fluoride is enough?

Since community water supplies and toothpastes usually contain fluoride, it is essential that children do not ingest too much.  For this reason, children under the age of two should use an ADA-approved, non-fluoridated brand of toothpaste.  Children between the ages of two and five years old should use a pea-sized amount of ADA-approved fluoridated toothpaste, on a clean toothbrush, twice each day.  They should be encouraged to spit out any extra fluid after brushing.  This part might take time, encouragement, and practice.

The amount of fluoride children ingest between the ages of one and four years old determines whether or not fluorosis occurs later.  The most common symptom of fluorosis is white specks on the permanent teeth.  Children over the age of eight years old are not considered to be at-risk for fluorosis, but should still use an ADA-approved brand of toothpaste.

Does my child need fluoride supplements?

The pediatric dentist is the best person to decide whether a child needs fluoride supplements.  First, the dentist will ask questions in order to determine how much fluoride the child is currently receiving, gain a general health history, and evaluate the sugar content in the child’s diet.  If a child is not receiving enough fluoride and is determined to be at high-risk for tooth decay, an at-home fluoride supplement might be recommended.

Topical fluoride can also be applied to the tooth enamel quickly and painlessly during a regular office visit.  There are many convenient forms of topical fluoride, including foam, liquids, varnishes, and gels.  Depending on the age of the child and their willingness to cooperate, topical fluoride can either be held on the teeth for several minutes in specialized trays or painted on with a brush.

If you have questions or concerns about fluoride or fluorosis, please contact our office.

A child’s general level of health often dictates his or her oral health, and vice versa. Therefore, supplying children with a well-balanced diet is more likely to produce healthier teeth and gums. A good diet provides the child with the many different nutrients he or she needs to grow. These nutrients are necessary for gum tissue development, strong bones, and protection against certain illnesses.

According to the food pyramid, children need vegetables, fruits, meat, grains, beans, and dairy products to grow properly. These different food groups should be eaten in balance for optimal results.

How does my child’s diet affect his or her teeth?

Almost every snack contains at least one type of sugar. Most often, parents are tempted to throw away candy and chocolate snacks – without realizing that many fruit snacks contain one (if not several) types of sugar or carbohydrate. When sugar-rich snacks are eaten, the sugar content attracts oral bacteria. The bacteria feast on food remnants left on or around the teeth. Eventually, feasting bacteria produce enamel-attacking acids.

When tooth enamel is constantly exposed to acid, it begins to erode – the result is childhood tooth decay. If tooth decay is left untreated for prolonged periods, acids begin to attack the soft tissue (gums) and even the underlying jawbone. Eventually, the teeth become prematurely loose or fall out, causing problems for emerging adult teeth – a condition known as childhood periodontal disease.

Regular checkups and cleanings at the pediatric dentist’s office are an important line of defense against tooth decay. However, implementing good dietary habits and minimizing sugary food and drink intake as part of the “home care routine” are equally important.

How can I alter my child’s diet?

The pediatric dentist is able to offer advice and dietary counseling for children and parents. Most often, parents are advised to opt for healthier snacks, for example, carrot sticks, reduced fat yoghurt, and cottage cheese. In addition, pediatric dentists may recommend a fluoride supplement to protect tooth enamel – especially if the child lives in an area where fluoride is not routinely added to community water.

Parents should also ensure that children are not continuously snacking – even in a healthy manner. Lots of snacking means that sugars are constantly attaching themselves to teeth, and tooth enamel is constantly under attack. It is also impractical to try to clean the teeth after every snack, if “every snack” means every ten minutes!

Finally, parents are advised to opt for faster snacks. Mints and hard candies remain in the mouth for a long period of time – meaning that sugar is coating the teeth for longer. If candy is necessary, opt for a sugar-free variety or a variety that can be eaten expediently.

Should my child eat starch-rich foods?

It is important for the child to eat a balanced diet, so some carbohydrates and starches are necessary. Starch-rich foods generally include pretzels, chips, and peanut butter and jelly sandwiches. Since starches and carbohydrates break down to form sugar, it is best that they are eaten as part of a meal (when saliva production is higher), than as a standalone snack. Provide plenty of water at mealtimes (rather than soda) to help the child rinse sugary food particles off the teeth.

As a final dietary note, avoid feeding your child sticky foods if possible. It is incredibly difficult to remove stickiness from the teeth – especially in younger children who tend not to be as patient during brushing.

If you have questions or concerns about your child’s general or oral health, please contact our office.

Childhood cavities, also known as childhood tooth decay and childhood caries, are common in children all over the world.  There are two main causes of cavities: poor dental hygiene and sugary diets.

Cavities can be incredibly painful and often lead to tooth decay and childhood periodontitis if left untreated. Ensuring that children eat a balanced diet, embarking on a sound home oral care routine, and visiting the pediatric dentist biannually are all crucial factors for both cavity prevention and excellent oral health.

What causes cavities?

Cavities form when children’s teeth are exposed to sugary foods on a regular basis.  Sugars and carbohydrates (like the ones found in white bread) collect on and around the teeth after eating.  A sticky film (plaque) then forms on the tooth enamel.  The oral bacteria within the plaque continually ingest sugar particles and emit acid.  Initially, the acid attacks the tooth enamel, weakening it and leaving it vulnerable to tooth decay.  If conditions are allowed to worsen, the acid begins to penetrate the tooth enamel and erodes the inner workings of the tooth.

Although primary (baby) teeth are eventually lost, they fulfill several important functions and should be protected.  It is essential that children brush and floss twice per day (ideally more), and visit the dentist for biannual cleanings.  Sometimes the pediatric dentist coats teeth with a sealant and provides fluoride supplements to further bolster the mouth’s defenses.

How will I know if my child has a cavity?

Large cavities can be excruciatingly painful, whereas tiny cavities may not be felt at all.  Making matters even trickier, cavities sometimes form between the teeth, making them invisible to the naked eye.  Dental X-rays and the dentist’s trained eyes help pinpoint even the tiniest of cavities so they can be treated before they worsen.

Some of the major symptoms of cavities include:

  • Heightened sensitivity to cool or warm foods
  • Nighttime waking and crying
  • Pain
  • Sensitivity to spicy foods
  • Toothache

If a child is experiencing any of these symptoms, it is important to visit the pediatric dentist.  Failure to do so will make the problem worse, leave the child in pain, and possibly jeopardize a tooth that could have been treated.

How can I prevent cavities at home?

Biannual visits with the pediatric dentist are only part of the battle against cavities.  Here are some helpful guidelines for cavity prevention:

  1. Analyze the diet – Too many sugary or starchy snacks can expedite cavity formation.  Replace sugary snacks like candy with natural foods where possible, and similarly, replace soda with water.
  2. Cut the snacks – Snacking too frequently can unnecessarily expose teeth to sugars.  Save the sugar and starch for mealtimes, when the child is producing more saliva, and drinking water.  Make sure they consume enough water to cleanse the teeth.
  3. Lose the sippy cup – Sippy cups are thought to cause “baby bottle tooth decay” when they are used beyond the intended age (approximately twelve months).  The small amount of liquid emitted with each sip causes sugary liquid to continually swill around the teeth.
  4. Avoid stickiness – Sticky foods (like toffee) form plaque quickly and are extremely difficult to pry off the teeth.  Avoid them when possible.
  5. Rinse the pacifier – Oral bacteria can be transmitted from mother or father to baby.  Rinse a dirty pacifier with running water as opposed to sucking on it to avoid contaminating the baby’s mouth.
  6. Drinks at bedtime – Sending a child to bed with a bottle or sippy cup is bad news.  The milk, formula, juice, or sweetened water basically sits on the teeth all night – attacking enamel and maximizing the risk of cavities.  Ensure the child has a last drink before bedtime, and then brush the teeth.
  7. Don’t sweeten the pacifier – Parents sometimes dip pacifiers in honey to calm a cranky child.  Do not be tempted to do this.  Use a blanket, toy, or hug to calm the child instead.
  8. Brush and floss – Parents should brush and floss their child’s teeth twice each day until the child reaches the age of seven years old.  Before this time, children struggle to brush every area of the mouth effectively.
  9. Check on fluoride –When used correctly, fluoride can strengthen tooth enamel and help stave off cavities.  Too much or too little fluoride can actually harm the teeth, so ask the pediatric dentist for a fluoride assessment.
  10. Keep to appointments – The child’s first dental visit should be scheduled around his or her first birthday, as per the American Academy of Pediatric Dentistry (AAPD) guidelines.  Keep to a regular appointment schedule to create healthy smiles!

If you have questions or concerns about cavity prevention, please contact our office.

Mouth guards, also known as sports guards or athletic mouth protectors, are crucial pieces of equipment for any child participating in potentially injurious recreational or sporting activities.  Fitting snugly over the upper teeth, mouth guards protect the entire oral region from traumatic injury, preserving both the esthetic appearance and the health of the smile.  In addition, mouth guards are sometimes used to prevent tooth damage in children who grind (brux) their teeth at night.

The American Academy of Pediatric Dentistry (AAPD) in particular, advocates for the use of dental mouth guards during any sporting or recreational activity.  Most store-bought mouth guards cost fewer than ten dollars, making them a perfect investment for every parent.

How can mouth guards protect my child?

The majority of sporting organizations now require participants to routinely wear mouth guards.   Though mouth guards are primarily designed to protect the teeth, they can also vastly reduce the degree of force transmitted from a trauma impact point (jaw) to the central nervous system (base of the brain).  In this way, mouth guards help minimize the risk of traumatic brain injury, which is especially important for younger children.

Mouth guards also reduce the prevalence of the following injuries:

  • Cheek lesions
  • Concussions
  • Gum and soft tissue injuries
  • Jawbone fractures
  • Lip lesions
  • Neck injuries
  • Tongue lesions
  • Tooth fractures

What type of mouth guard should I purchase for my child?

Though there are literally thousands of mouth guard brands, most brands fall into three major categories: stock mouth guards, boil and bite mouth guards, and customized mouth guards.

Some points to consider when choosing a mouth guard include:

  • How much money is available to spend?
  • How often does the child play sports?
  • What kind of sport does the child play? (Basketball and baseball tend to cause the most oral injuries).

In light of these points, here is an overview of the advantages and disadvantages of each type of mouth guard:

Stock mouth guards – These mouth guards can be bought directly off the shelf and immediately fitted into the child’s mouth.  The fit is universal (one-size-fits-all), meaning that that the mouth guard doesn’t adjust.  Stock mouth guards are very cheap, easy to fit, and quick to locate at sporting goods stores.  Pediatric dentists favor this type of mouth guard least, as it provides minimal protection, obstructs proper breathing and speaking, and tends to be uncomfortable.

Boil and bite mouth guards – These mouth guards are usually made from thermoplastic and are easily located at most sporting goods stores.  First, the thermoplastic must be immersed in hot water to make it pliable, and then it must be pressed on the child’s teeth to create a custom mold.  Boil and bite mouth guards are slightly more expensive than stock mouth guards, but tend to offer more protection, feel more comfortable in the mouth, and allow for easy speech production and breathing.

Customized mouth guards – These mouth guards offer the greatest degree of protection, and are custom-made by the dentist.  First, the dentist makes an impression of the child’s teeth using special material, and then the mouth guard is constructed over the mold.  Customized mouth guards are more expensive and take longer to fit, but are more comfortable, orthodontically correct, and fully approved by the dentist.

If you have questions or concerns about choosing a mouth guard for your child, please contact our office.

Tooth decay has become increasingly prevalent in preschoolers.  Not only is tooth decay unpleasant and painful, it can also lead to more serious problems like premature tooth loss and childhood periodontal disease.

Dental sealants are an important tool in preventing childhood caries (cavities) and tooth decay.  Especially when used in combination with other preventative measures, like biannual checkups and an excellent daily home care routine, sealants can bolster the mouth’s natural defenses, and keep smiles healthy.

How do sealants protect children’s teeth?

In general, dental sealants are used to protect molars from oral bacteria and harmful oral acids.  These larger, flatter teeth reside toward the back of the mouth and can be difficult to clean.  Molars mark the site of four out of five instances of tooth decay.  Decay-causing bacteria often inhabit the nooks and crannies (pits and fissures) found on the chewing surfaces of the molars.  These areas are extremely difficult to access with a regular toothbrush.

If the pediatric dentist evaluates a child to be at high risk for tooth decay, he or she may choose to coat additional teeth (for example, bicuspid teeth).  The sealant acts as a barrier, ensuring that food particles and oral bacteria cannot access vulnerable tooth enamel.

Dental sealants do not enhance the health of the teeth directly, and should not be used as a substitute for fluoride supplements (if the dentist has recommended them) or general oral care.  In general however, sealants are less costly, less uncomfortable, and more aesthetically pleasing than dental fillings.

How are sealants applied?

Though there are many different types of dental sealant, most are comprised of liquid plastic.  Initially, the pediatric dentist must thoroughly clean and prepare the molars, before painting sealant on the targeted teeth.  Some sealants are bright pink when wet and clear when dry.  This bright pink coloring enables the dentist to see that all pits and fissures have been thoroughly coated.

When every targeted tooth is coated to the dentist’s satisfaction, the sealant is either left to self-harden or exposed to blue spectrum natural light for several seconds (depending on the chemical composition of the specific brand).  This specialized light works to harden the sealant and cure the plastic.  The final result is a clear (or whitish) layer of thin, hard, durable sealant.

It should be noted that the “sealing” procedure is easily completed in one office visit, and is entirely painless.

When should sealants be applied?

Sealants are usually applied when the primary (baby) molars first emerge.  Depending on the oral habits of the child, the sealants may last for the life of the primary tooth, or need replacing several times.  Essentially, sealant durability depends on the oral habits of the individual child.

Pediatric dentists recommend that permanent molars be sealed as soon as they emerge.  In some cases, sealant can be applied before the permanent molar is full grown.

The health of the sealant must be monitored at biannual appointments.  If the seal begins to lift off, food particles may become trapped against the tooth enamel, actually causing tooth decay.

If you have questions or concerns about dental sealants, please contact your pediatric dentist.

Tobacco use is one of the leading causes of death in society.  Fortunately, it is also among the most preventable.  Aside from being a sociably undesirable habit, smoking can result in oral cancer, reduce smelling and tasting abilities, compromise recovery after oral surgery, stain the teeth, and increase the risk of contracting periodontal disease.  The American Dental Association (ADA) and all pediatric dentists encourage children, adolescents, and adults to abstain from all forms of tobacco use.

Almost all adult smokers have tried smoking before the age of nineteen.  In all likelihood, an individual who abstains from smoking throughout the teenage years will never pick up the habit.  Therefore, it is essential that parents strongly discourage preadolescent and adolescent tobacco use.

Is smokeless tobacco less dangerous for teens?

Tobacco use in any form brings the oral region into direct contact with carcinogens (cancer causing agents).  These carcinogens and other harmful chemicals cause irreparable damage to the child’s oral health.

Parents and teens often mistakenly evaluate smokeless tobacco as the “safer” option.  In fact, smokeless tobacco has been proven to deliver a greater concentration of harmful agents into the body, and to be far more addictive.  One snuff of tobacco has approximately the same nicotine content as sixty regular cigarettes.  In addition, smokeless tobacco causes leukoplakias in the mouth, which are dangerous pre-cancerous lesions.

What are the signs of oral cancer?

Oral cancer can be difficult to detect without the aid of the dentist.  In some cases, oral cancer is not noticeable or even painful until its later stages.  Parents of tobacco users must be aware of the following symptoms:

  • Changes in the way the teeth fit together.
  • Difficulty moving the jaw.
  • Mouth sores that don’t heal.
  • Numbness or tenderness.
  • Red or white spots on the cheek, lip, or tongue.

Oral cancer is treatable if caught early.  Disfiguring surgery can be avoided by having the child abstain from tobacco use and getting regular preventative dental checkups.

How can I stop my child from using tobacco?

There are several ways to discourage children and adolescents from using tobacco products.  First, talking to the child personally about the dangers of tobacco use (or asking the dentist to talk to the child) has proven an effective preventative strategy.  Second, parents should lead by example. According to research studies, children of non-smokers are less likely to pick up this dangerous habit.  Third, monitor the child closely.  If the child will not cooperate, screenings for tobacco can be requested at the dental office.

If you have questions or concerns about your childhood tobacco use, please contact your pediatric dentist.

The “pulp” of a tooth cannot be seen with the naked eye. Pulp is found at the center of each tooth, and is comprised of nerves, tissue, and many blood vessels, which work to channel vital nutrients and oxygen.  There are several ways in which pulp can be damaged.  Most commonly in children, tooth decay or traumatic injury lead to painful pulp exposure and inflammation.

Pediatric pulp therapy is known by several other names, including: root canal, pulpotomy, pulpectomy, and nerve treatment.  The primary goal of pulp therapy is to treat, restore, and save the affected tooth.

Pediatric dentists perform pulp therapy on both primary (baby) teeth and permanent teeth.  Though primary teeth are eventually shed, they are needed for speech production, proper chewing, and to guide the proper alignment and spacing of permanent teeth.

What are the signs of pulp injury and infection?

Inflamed or injured pulp is exceptionally painful.  Even if the source of the pain isn’t visible, it will quickly become obvious that the child needs to see the pediatric dentist.

Here are some of the other signs to look for:

  • Constant unexplained pain.
  • Nighttime pain.
  • Sensitivity to warm and cool food temperatures.
  • Swelling or redness around the affected tooth.
  • Unexpected looseness or mobility of the affected tooth.

When should a child undergo pulp therapy?

Every situation is unique.  The pediatric dentist assesses the age of the child, the positioning of the tooth, and the general health of the child before making a recommendation to extract the tooth or to save it via pulp therapy.

Some of the undesirable consequences of prematurely extracted/missing teeth are listed below:

  • Arch length may shorten.
  • In the case of primary tooth loss, permanent teeth may lack sufficient space to emerge.
  • Opposing teeth may grow in a protruding or undesirable way.
  • Premolars may become painfully impacted.
  • Remaining teeth may “move” to fill the gap.
  • The tongue may posture abnormally.

How is pulp therapy performed?

Initially, the pediatric dentist will perform visual examinations and evaluate X-rays of the affected areas.  The amount and location of pulp damage dictates the nature of the treatment.  Although there are several other treatments available, the pediatric pulpotomy and pulpectomy procedures are among the most common performed.

Pulpotomy – If the pulp root remains unaffected by injury or decay, meaning that the problem is isolated in the pulp tip, the pediatric dentist may leave the healthy part alone and only remove the affected pulp and surrounding tooth decay.  The resulting gap is then filled with a biocompatible, therapeutic material, which prevents infection and soothes the pulp root. Most commonly, a crown is placed on the tooth after treatment.  The crown strengthens the tooth structure, minimizing the risk of future fractures.

Pulpotomy treatment is extremely versatile.  It can be performed as a standalone treatment on baby teeth and growing permanent teeth, or as the initial step in a full root canal treatment.

Pulpectomy – In the case of severe tooth decay or trauma, the entire tooth pulp (including the root canals) may be affected.  In these circumstances, the pediatric dentist must remove the pulp, cleanse the root canals, and then pack the area with biocompatible material.  This usually takes several office visits.

In general, reabsorbable material is used to fill primary teeth, and non-reabsorbable material is used to fill permanent teeth.  Either way, the final treatment step is to place a crown on the tooth to add strength and provide structural support.  The crown can be disguised with a natural-colored covering, if the child prefers.

If you have questions or concerns about the pediatric pulp therapy procedure, please contact your pediatric dentist.

Evaluating the many brands of oral products claiming to be “best for children” can be an overwhelming task.  Selecting an appropriately sized toothbrush and a nourishing, cleansing brand of children’s toothpaste is of paramount importance for maintaining excellent oral health.

Why brush primary teeth?

The importance of maintaining the health of primary (baby) teeth is often understated.  Primary teeth are essential for speech production, chewing, jaw development, and they also facilitate the proper alignment and spacing of permanent adult teeth.  Brushing primary teeth prevents bad breath and tooth decay, and also removes the plaque bacteria associated with childhood periodontal disease.

What differences are there among toothpaste brands?

Though all toothpastes are not created equal, most brands generally contain abrasive ingredients to remove stains, soapy ingredients to eliminate plaque, fluorides to strengthen tooth enamel, and some type of pleasant-tasting flavoring.

The major differences between brands are the thickness of the paste, the level of fluoride content, and the type of flavoring.  Although fluoride strengthens enamel and repels plaque bacteria, too much of it can actually harm young teeth – a condition known as dental fluorosis.  Children between the ages of one and four years old are most at risk for this condition, so fluoride levels should be carefully monitored during this time.

Be aware that adult and non-ADA approved brands of toothpaste often contain harsher abrasives, which remove tooth enamel and weaken primary teeth.  In addition, some popular toothpaste brands contain sodium lauryl sulfate (shown as “SLS” on the package), which cause painful mouth ulcers in some children.

So which toothpaste brand should I choose?

The most important considerations to make before implementing an oral care plan and choosing a toothpaste brand is the age of the child.  Home oral care should begin before the emergence of the first tooth.  A cool clean cloth should be gently rubbed along the gums after feeding to remove food particles and bacteria.

Prior to the age of two, the child will have many teeth and brushing should begin.  Initially, select fluoride-free “baby” toothpaste and softly brush the teeth twice per day.  Flavoring is largely unimportant, so the child can play an integral role in choosing whatever type of toothpaste tastes most pleasant.

Between the middle and the end of the third year, select an American Dental Association (ADA) accepted brand of toothpaste containing fluoride.  The ADA logo is clear and present on toothpaste packaging, so be sure to check for it.  Use only a tiny pea or rice-sized amount of fluoride toothpaste, and encourage the child to spit out the excess after brushing.  Eliminating the toothpaste takes practice, patience, and motivation – especially if the child finds the flavoring tasty.  If the child does ingest tiny amounts of toothpaste, don’t worry; this is perfectly normal and will cease with time and encouragement.

Dental fluorosis is not a risk factor for children over the age of eight, but an ADA accepted toothpaste is always the recommended choice for children of any age.

If you have questions or concerns about choosing an appropriate brand of toothpaste for your child, your pediatric dentist will be happy to make recommendations.

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