FAQs

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.

The American Academy of Pediatric Dentists (AAPD) advises parents to make biannual dental appointments for children, beginning approximately six months after the first tooth emerges.

These two important yearly visits allow the pediatric dentist to monitor new developments in the child’s mouth, evaluate changes in the condition of teeth and gums, and continue to advise parents on good oral care strategies.

The pediatric dentist may schedule additional visits for children who are particularly susceptible to tooth decay or who show early signs of orthodontic problems.

What is the purpose of dental checkups?

First, the pediatric dentist aims to provide a “good dental home” for the child.  If a dental emergency does arise, parents can take the child for treatment at a familiar, comfortable location.

Second, the pediatric dentist keeps meticulous records of the child’s ongoing dental health and jaw development.  In general, painful dental conditions do not arise overnight.  If the pediatric dentist understands the child’s dental health history, it becomes easier to anticipate future issues and intervene before they arise.

Third, the pediatric dentist is able to educate parents and children during the visit.  Sometimes the pediatric dentist wants to introduce one or several factors to enhance tooth health - for example, sealants, fluoride supplements, or xylitol.  Other times, the pediatric dentist asks parents to change the child’s dietary or oral behavior - for example, reducing sugar in the child’s diet, removing an intraoral piercing, or even transitioning the child from sippy cups to adult-sized drinking glasses.

Finally, dental X-rays are often the only way to identify tiny cavities in primary (baby) teeth.  Though the child may not be feeling any pain, left unchecked, these tiny cavities can rapidly turn into large cavities, tooth decay, and eventually, childhood periodontal disease.  Dental X-rays are only used when the pediatric dentist suspects cavities or orthodontic irregularities.

Are checkups necessary if my child has healthy teeth?

The condition of a child’s teeth can change fairly rapidly.  Even if the child’s teeth were evaluated as healthy just six months prior, changes in diet or oral habits (for example, thumb sucking) can quickly render them vulnerable to decay or misalignment.

In addition to visual examinations, the pediatric dentist provides thorough dental cleanings during each visit.  These cleanings eradicate the plaque and debris that can build up between teeth and in other hard to reach places.  Though a good homecare routine is especially important, these professional cleanings provide an additional tool to keep smiles healthy.

The pediatric dentist is also able to monitor the child’s fluoride levels during routine visits.  Oftentimes, a topical fluoride gel or varnish is applied to teeth after the cleaning.  Topical fluoride remineralizes the teeth and staunches mineral loss, protecting tooth enamel from oral acid attacks.  Some children are also given take-home fluoride supplements (especially those residing in areas where fluoride is not routinely added to the community water supply).

Finally, the pediatric dentist may apply dental sealants to the child’s back teeth (molars).  This impenetrable liquid plastic substance is brushed onto the molars to seal out harmful debris, bacteria, and acid.

If you have questions or concerns about when to schedule your child’s dental checkups please contact your pediatric dentist.

Primary teeth, also known as “baby teeth” or “deciduous teeth,” begin to develop beneath the gums during the second trimester of pregnancy.  Teeth begin to emerge above the gums approximately six months to one year after birth.  Typically, preschool children have a complete set of 20 baby teeth – including four molars on each arch.

One of the most common misconceptions about primary teeth is that they are irrelevant to the child’s future oral health.  However, their importance is emphasized by the American Dental Association (ADA), which urges parents to schedule a “baby checkup” with a pediatric dentist within six months of the first tooth emerges.

What are the functions of primary teeth?

Primary teeth can be painful to acquire.  To soothe tender gums, biting on chewing rings, wet gauze pads, and clean fingers can be helpful.  Though most three-year-old children have a complete set of primary teeth, eruption happens gradually – usually starting at the front of the mouth.

The major functions of primary teeth are described below:

Speech production and development – Learning to speak clearly is crucial for cognitive, social, and emotional development.  The proper positioning of primary teeth facilitates correct syllable pronunciation and prevents the tongue from straying during speech formation.

Eating and nutrition – Children with malformed or severely decayed primary teeth are more likely to experience dietary deficiencies, malnourishment, and to be underweight.  Proper chewing motions are acquired over time and with extensive practice.  Healthy primary teeth promote good chewing habits and facilitate nutritious eating.

Self-confidence – Even very young children can be quick to point out ugly teeth and crooked smiles.  Taking good care of primary teeth can make social interactions more pleasant, reduce the risk of bad breath, and promote confident smiles and positive social interactions.

Straighter smiles – One of the major functions of primary teeth is to hold an appropriate amount of space for developing adult teeth.  In addition, these spacers facilitate the proper alignment of adult teeth and also promote jaw development.  Left untreated, missing primary teeth cause the remaining teeth to “shift” and fill spaces improperly.  For this reason, pediatric dentists often recommend space-maintaining devices.

Excellent oral health – Badly decayed primary teeth can promote the onset of childhood periodontal disease.  As a result of this condition, oral bacteria invade and erode gums, ligaments, and eventually bone.  If left untreated, primary teeth can drop out completely – causing health and spacing problems for emerging permanent teeth.  To avoid periodontal disease, children should practice an adult-guided oral care routine each day, and infant gums should be rubbed gently with a clean, damp cloth after meals.

If you have questions or concerns about primary teeth, please contact your pediatric dentist.

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.

Although thorough brushing and flossing removes most food particles and bacteria from easy to reach tooth surfaces, they do not reach the deep grooves on chewing surfaces of teeth.  More than 75 percent of dental decay begins in these deep grooves (called pits and fissures). Toothbrush bristles are often too large to clean most of these areas, thus sealants play an important role.

A sealant is a thin plastic coating that covers and protects the chewing surfaces of molars, premolars, and any deep grooves or pits on teeth. Sealant material forms a protective, smooth barrier covering natural depressions and grooves in the teeth, making it much easier to clean and help keep these areas free of decay.

Who may need sealants?

Children and teenagers - As soon as the six-year molars (the first permanent back teeth) appear or any time throughout the cavity prone years of 6-16.

Infants - Baby teeth are occasionally sealed if the teeth have deep grooves and the child is cavity prone.

Adults - Tooth surfaces without decay that have deep grooves or depressions that are difficult to clean.

Sealants are easily applied by your dentist or dental hygienist and the process only takes minutes per tooth. After the chewing surfaces are roughened with an acid solution that helps the sealant adhere to the tooth, the sealant material is “painted” onto the tooth surface, where it hardens and bonds to the teeth. Sometimes a special light will be used to help the sealant material harden.

After sealant treatment, it’s important to avoid chewing on ice cubes, hard candy, popcorn kernels, or any hard or sticky foods. Your sealants will be checked for wear and chipping at your regular dental check-up.

Combined with good home care, a proper diet, and regular dental check-ups, sealants are very effective in helping prevent tooth decay.

We’re all at risk for having a tooth knocked out.  More than 5 million teeth are knocked out every year!  If we know how to handle this emergency situation, we might be able to save the tooth.  Teeth that are knocked out can possibly be re-implanted if we act quickly and follow these simple steps:

1. Locate the tooth and handle it only by the crown (chewing part of the tooth), NOT by the roots.
2. DO NOT scrub or use soap or chemicals to clean the tooth.  If it has dirt or debris on it, rinse it gently with your own saliva or whole milk.  If that is not possible, rinse it very gently with water.
3. Get to a dentist within 30 minutes.  The longer you wait, the less chance there is for successful reimplantation.

Ways to transport the tooth

• Try to replace the tooth back in its socket immediately.  Gently bite down on gauze, a wet tea bag or on your own teeth to keep the tooth in place.  Apply a cold compress to the mouth for pain and swelling as needed.
• If the tooth cannot be placed back into the socket, place the tooth in a container and cover with a small amount of your saliva or whole milk.  You can also place the tooth under your tongue or between your lower lip and gums.  Keep the tooth moist at all times.  Do not transport the tooth in a tissue or cloth.
• Consider buying a “Save-A-Tooth” storage container and keeping it as part of your home first aid kit.  The kit is available in many pharmacies and contains a travel case and fluid solution for easy tooth transport.

The sooner the tooth is replaced back into the socket, the greater the likelihood it has to survive.  So be prepared, and remember these simple steps for saving a knocked-out tooth.

You can prevent broken or knocked-out teeth by:

• Wearing a mouthguard when playing sports
• Always wearing your seatbelt
• Avoiding fights
• Avoid chewing hard items such as ice, popcorn kernels, hard breads, etc.

Straighter teeth perform chewing, biting, and speaking functions more effectively than crooked teeth.   In addition, a straight smile boosts confidence, is aesthetically pleasing to look at, and can help stave off a wide variety of dental ailments.

There are several types of malocclusion including overbite, underbite, crossbite, and overcrowding.  Each of these alignment problems negatively impacts the functionality and cosmetic appearance of the teeth.

Here is a brief overview of some of the main disorders associated with crooked teeth:

Periodontitis – Periodontitis or gum disease begins with a bacterial infection.  The bacterial infection is caused by inadequate oral hygiene. Crooked teeth are hard to effectively clean, which means that debris, plaque, and bacteria can build up in hard-to-reach areas. Straight teeth are much easier to clean and are at less risk of contracting gum disease.

Temporomandibular Disorder (TMJ) - Crooked teeth can lead to improper jaw alignment, which in turn causes a painful condition known as TMJ. Severe headaches, jaw pain, lockjaw, and grinding of teeth characterize this debilitating disorder. 

Tooth injury – Straight teeth create a strong wall, which means injuries are less likely to occur.  Crooked teeth are weaker and often protrude, making them far more vulnerable to external injury.

Uneven wear – Crooked teeth cause some of the teeth to work harder than others when biting and chewing.  Straight teeth share the workload evenly, meaning less risk of injury and better aesthetics.

Teeth can be straightened using either orthodontic braces or customized aligning trays.  Orthodontic braces are usually affixed to the teeth for a set duration.  The brackets and archwires are tightened regularly by the orthodontist and removed when treatment is complete.  Fixed braces can be placed on the front side or back side of the teeth and are effective for most types of malocclusion.

Aligning trays are fully removable and are used where the malocclusion is less severe, and the teeth need to move a shorter distance.  These trays are replaced every few weeks for the duration of the treatment, and have proven to be equally effective for straightening teeth.

If you have questions about orthodontics and straightening teeth, please contact our office.

Bruxism, or the grinding of teeth, is remarkably common in children and adults.  For some children, this tooth grinding is limited to daytime hours, but nighttime grinding (during sleep) is most prevalent.  Bruxism can lead to a wide range of dental problems, depending on the frequency of the behavior, the intensity of the grinding, and the underlying causes of the grinding.

A wide range of psychological, physiological, and physical factors may lead children to brux.  In particular, jaw misalignment (bad bite), stress, and traumatic brain injury are all thought to contribute to bruxism, although grinding can also occur as a side effect of certain medications.

What are some symptoms of bruxism?

In general, parents can usually hear intense grinding – especially when it occurs at nighttime.  Subtle daytime jaw clenching and grinding, however, can be difficult to pinpoint.  Oftentimes, general symptoms provide clues as to whether or not the child is bruxing, including:

• Frequent complaints of headache.
• Injured teeth and gums.
• Loud grinding or clicking sounds.
• Rhythmic tightening or clenching of the jaw muscles.
• Unusual complaints about painful jaw muscles – especially in the morning.
• Unusual tooth sensitivity to hot and cold foods.

How can bruxism damage my child’s teeth?

Bruxism is characterized by the grinding of the upper jaw against the lower jaw.  Especially in cases where there is vigorous grinding, the child may experience moderate to severe jaw discomfort, headaches, and ear pain.  Even if the child is completely unaware of nighttime bruxing (and parents are unable to hear it), the condition of the teeth provides your pediatric dentist with important clues.

First, chronic grinders usually show an excessive wear pattern on the teeth.  If jaw misalignment is the cause, tooth enamel may be worn down in specific areas.  In addition, children who brux are more susceptible to chipped teeth, facial pain, gum injury, and temperature sensitivity.  In extreme cases, frequent, harsh grinding can lead to the early onset of temporomandibular joint disorder (TMJ).

What causes bruxism?

Bruxism can be caused by several different factors. Most commonly, “bad bite” or jaw misalignment promotes grinding.  Pediatric dentists also notice that children tend to brux more frequently in response to life stressors.  If the child is going through a particularly stressful exam period or is relocating to a new school for example, nighttime bruxing may either begin or intensify.

Children with certain developmental disorders and brain injuries may be at particular risk for grinding.  In such cases, your pediatric dentist may suggest botulism injections to calm the facial muscles, or provide a protective nighttime mouthpiece.  If the onset of bruxing is sudden, current medications need to be evaluated.  Though bruxing is a rare side effect of specific medications, the medication itself may need to be switched for an alternate brand.

How is bruxism treated?

Bruxing spontaneously ceases by the age of thirteen in the majority of children.  In the meantime however, your pediatric dentist will continually monitor its effect on the child’s teeth and may provide an interventional strategy.

In general, the cause of the grinding dictates the treatment approach.  If the child’s teeth are badly misaligned, your pediatric dentist may take steps to correct this.  Some of the available options include: altering the biting surface of teeth with crowns, and beginning occlusal treatment.

If bruxing seems to be exacerbated by stress, your pediatric dentist may recommend relaxation classes, professional therapy, or special exercises.  The child’s pediatrician may also provide muscle relaxants to alleviate jaw clenching and reduce jaw spasms.

In cases where young teeth are sustaining significant damage, your pediatric dentist may suggest a specialized nighttime dental appliance such as a nighttime mouth guard.  Mouth guards stop tooth surfaces from grinding against each other, and look similar to a mouthpiece a person might wear during sports.  Bite splints or bite plates fulfill the same function and are almost universally successful in preventing grinding damage.

If you have questions or concerns about bruxism or grinding teeth, please contact our office.

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.

The initial growth period for primary (baby) teeth begins in the second trimester of pregnancy (around 16-20 weeks).  During this time, it is especially important for expectant mothers to eat a healthy, nutritious diet, since nutrients are needed for bone and soft tissue development.

Though there are some individual differences in the timing of tooth eruption, primary teeth usually begin to emerge when the infant is between six and eight months old.  Altogether, a set of twenty primary teeth will emerge by the age of three.

The American Academy of Pediatric Dentistry (AAPD) recommends a first “well-baby” dental visit around the age of twelve months (or six months after the first tooth emerges).  This visit acquaints the infant with the dental office, allows the pediatric dentist to monitor development, and provides a great opportunity for parents to ask questions.

Which teeth emerge first?

In general, teeth emerge in pairs, starting at the front of the infant’s mouth.  Between the ages of six and ten months, the two lower central incisors break through.  Remember that cavities may develop between two adjacent teeth, so flossing should begin at this point.

Next (and sometimes simultaneously), the two upper central incisors emerge – usually between the ages of eight and twelve months.  Teething can be quite an uncomfortable process for the infant.  Clean teething rings and cold damp cloths can help ease the irritation and discomfort.

Between the ages of nine and sixteen months the upper lateral incisors emerge – one on either side of the central incisors.  Around the same time, the lower lateral incisors emerge, meaning that the infant has four adjacent teeth on the lower and upper arches.  Pediatric dentists suggest that sippy cup usage should end when the toddler reaches the age of fourteen months. This minimizes the risk of “baby bottle tooth decay.”

Eight more teeth break through between the ages of thirteen and twenty three months.  On each arch, a cuspid or canine tooth will appear immediately adjacent to each lateral incisor.  Immediately behind (looking towards the back of the child’s mouth), first molars will emerge on either side of the canine teeth on both jaws.

Finally, a second set of molars emerges on each arch – usually beginning on the lower arch.  Most children have a complete set of twenty primary teeth before the age of thirty-three months.  The pediatric dentist generally applies dental sealant to the molars, to lock out food particles, bacteria, and enamel-attacking acids.

How can I reduce the risk of early caries (cavities)?

Primary teeth preserve space for permanent teeth and guide their later alignment.  In addition, primary teeth help with speech production, prevent the tongue from posturing abnormally, and play an important role in the chewing of food.  For these reasons, it is critically important to learn how to care for the child’s emerging teeth.

Here are some helpful tips:

1. Brush twice each day – The AAPD recommends a pea-sized amount of ADA approved (non-fluoridated) toothpaste for children under two years old, and the same amount of an ADA approved (fluoridated) toothpaste for children over this age.  The toothbrush should be soft-bristled and appropriate for infants.
2. Start flossing – Flossing an infant’s teeth can be difficult but the process should begin when two adjacent teeth emerge.  The pediatric dentist will happily demonstrate good flossing techniques.
3. Provide a balanced diet – Sugars and starches feed oral bacteria, which produce harmful acids and attack tooth enamel.  Ensure that the child is eating a balanced diet and work to reduce sugary and starchy snacks.
4. Set a good example – Children who see parents brushing and flossing are often more likely to follow suit.  Explain the importance of good oral care to the child; age-appropriate books often help with this.
5. Visit the dentist – The pediatric dentist monitors oral development, provides professional cleanings, applies topical fluoride to the teeth, and coats molars with sealants.  Biannual trips to the dental office can help to prevent a wide range of painful conditions later.

If you have questions or concerns about the emergence of your child’s teeth, please contact your pediatric dentist.