Children’s Dental Questions

After months of preparation – painting the nursery, picking out patterns, shopping for endless baby gear, reading every book ever written on caring for a baby – it finally happened…your baby is here!  Now you get to put into action everything you learned in your baby classes.  Perhaps you didn’t get instructions on caring for your baby’s mouth (or perhaps the lack of sleep your getting has altered your memory!) so here is an overview of what you should know.

My advice as a dentist:

Cleaning a baby’s mouth before they have teeth is important because plaque and bacteria begin to build up in a baby’s mouth within the first few days after birth.  To clean your baby’s mouth, it is suggested that you wipe and massage the baby’s gums and cheeks with a clean, soft, damp cloth or gauze twice a day.  By starting a dental health care routine now, it will be easier for you and your baby to incorporate a brushing routine later.

My advice as a real world dad:

Ummm, in the midst of changing 15+ diapers a day, multiple feedings, being woke up every few hours … did my wife and I clean our babies’ mouths twice a day?  Heck no!  Don’t feel bad if you don’t either.  The important idea here is to not let your baby’s mouth go un-cleaned the whole time during their developmental process.  The more you make it a habit now, the better off you’ll be in the long run.

Bottles

Many parents do not realize that unrestricted use of a bottle can lead to a serious dental condition known as Baby Bottle Tooth Decay. Baby Bottle Tooth Decay is a specific kind of tooth decay and can be prevented by not giving your baby a bottle when lying down for a nap or for bedtime. Baby Bottle Tooth Decay occurs when baby’s teeth are not properly tended to (brushed and flossed), and sugars attach to their teeth over an extended period (typically from excessive amounts of juice and/or milk in between meals and when the baby is put down for a nap) causing plaque build-up in the child’s mouth. The suggested ways to keep your baby protected from getting Baby Bottle Tooth Decay are as follows:

If you feel you must give them a bottle to keep during nap time, fill the bottle with water instead of milk or juice.
Giving them water in between meals instead of milk or juice.
Make sure that your whole family has good dental health habits, as this reduces any risk of tooth decay or bacteria being transferred to your child.
Around the age of one, you should try to wean your baby off a bottle and encourage them to try to drink from a cup.

Pacifiers and Thumbsucking

Before the age of two or three many children habitually use a pacifier or thumbsucking as a way to soothe themselves. This is a natural process and not something you should be overly concerned about until your child reaches the age of three. We do recommend if your child continues to use a pacifier or suck his/her thumb beyond the age of 3 to consult your dentist, as excessive or prolonged sucking can lead to malformation of the child’s mouth, can cause speech impediments, and can cause crowding, crooked teeth, and bite problems.

One way to try to help your child stop sucking on their thumbs or using a pacifier would be to try and limit times and places when the child is allowed to do so. Another way to help your child to stop would be to offer praise and small rewards when the child does not suck on their thumb/pacifier. Additionally, some parents have had success with weaning their child off of thumbsucking by placing socks on the child’s hands at night.

When Should Teeth Come In

In general, baby’s first teeth typically appear between 4 to 10 months old. Most likely all of your baby’s 20 primary teeth will come in before your child turns three. Your child will tend to lose their primary teeth between 6 and 13 years old, as this is when their permanent teeth come in.

Comforting your Baby through the Experience

I’m sure you have heard that most babies become irritable, cranky, and/or fussy when they are teething. During this process you may notice that your baby cries more, bites or chews on things, is restless and seems to have a never ending supply of drool. These are all natural responses for babies who are cutting teeth.

So now you’re probably thinking to yourself, “You mean just when my precious newborn has started to sleep through the night and I’m getting more than 3 hours sleep at a time I’m going to be faced with a baby waking up crying as their teeth poke in?” Yep, that’s pretty much the deal. Hopefully the following suggestions will help your baby feel more comfortable (and thus, you get some sleep!)

1. Try to keep your baby’s mouth clean (brushing).
2. Try using a damp cloth or your clean finger to gently massage the baby’s gums.
3. Try using a cool teething ring.
4. Try calming the baby by rocking and/or singing to them.
5. How to Care for your Baby’s First Teeth

When your child begins to cut teeth, it is time to begin brushing the baby’s tooth or teeth twice daily using a baby toothbrush and a pea-sized drop of fluoride-free toothpaste. This is to help ensure that bacteria and plaque do not attack these new teeth.

Even as a dentist I found it difficult to get my children to willingly let me brush their teeth at such a young age and was often tempted to give up. Just as I had to continue to tell myself, “keep at it!” I would encourage you to do the same. Do not become too concerned if you miss brushing your baby’s first teeth on occasion or if you feel you’re not able to get them as clean as you would like. The important idea here is to get your baby used to having their teeth brushed and to establish a teeth cleaning routine. As with all things with small children, it will get better and the time invested will be well worth it!

Sometimes parents take a laid back approach when it comes to the care of their child’s baby teeth. After all, they’re just going to fall out sooner or later, right? I would like to caution you to avoid this line of thinking. Baby teeth serve numerous important purposes and, as such, should be kept free of cavities and/or fixed if a problem occurs.

Reasons why baby teeth are worth maintaining:

1. Baby teeth help guide proper eruption of permanent teeth. They maintain the proper spacing and alignment of the teeth so that permanent teeth have enough room to come in.
2. Baby teeth are crucial in helping the child’s speech development.
3. Baby teeth help maintain proper nutrition by allowing the child to effectively chew.
4. Healthy baby teeth help avoid dental disease spreading to the permanent teeth as they develop underneath the baby teeth.
5. Healthy and nice looking teeth are important in building a child’s self esteem. This can be especially important in the early years, as young children are quick to tease peers over unsightly teeth or bad breath resulting from poor oral hygiene. 6. A great smile truly is priceless!
7. Baby teeth need to be repaired to avoid the pain and suffering your child can experience from an abscess. An abscess can be very painful and very serious, even leading to hospitalization.
8. Extracting a baby tooth creates the potential of damaging the permanent tooth underneath.

Parents often get conflicting information regarding when it is best for children to begin seeing a dentist. Some dentists tell parents to wait until their child is three to bring them to the dentist for the first time. Often they suggest this for the simple reason that it is easier for the dentist to manage a three year old than a one year old. To me, that reasoning is not what is best for the child. I suggest, along with the American Dental Association, that children have their first visit by age one.

Research shows that early dental visits can lower dental costs. In an October 2004 journal titled Pediatrics, a study showed that the dental costs for children who have their first dental visit before the age of one are 40% lower in the first 5 years than those who do not see a dentist before their first birthday.

Not only is a baby’s first visit important, but it is also important for your child to continue seeing the dentist every 6 months, because it is important for the dentist to monitor your child’s development, and to treat any possible problems. Children should see the dentist regularly because, not only do dental visits teach children good care, but this also helps diagnose the possibility of problems sooner, which can save money.

Sometimes children have dental problems due to injuries, diseases, or developmental problems, and as such, these children should see a dentist as soon as possible, even if this means the first dental visit is before the baby turns 1 year old.

A child’s first dental visit entails minimal treatment and is shorter than an adult’s visit. While I encourage parents to follow the American Dental Association’s recommendation that children see the dentist for the first time by the age of one, some parents are unaware of this recommendation or are seeing a dentist who won’t see the child that early. So, depending on the age of your child, the first visit will be slightly different, but the following is a good guideline.

For children under the age of three

The visit will be more about the dentist or hygienist providing you with valuable information on caring for your child’s teeth and answering your questions than actually cleaning your child’s teeth. You should expect the dental team to discuss proper brushing and flossing techniques and proper nutrition for a healthy mouth. Most likely the dentist will conduct a short examination of the child’s mouth to make sure no dental problems are developing. I like to have the parent be present with the child during this entire visit and especially encourage the parent to let the child sit on his/her lap in the dental chair during the examination.

For children over the age of three,

This visit will entail a short examination by the dentist which will encompass checking your child’s teeth for any signs of decay, checking their bite, counting their teeth, and looking for any possibility of potential issues. Either the dentist or hygienist will also review with you proper dental hygiene and nutrition tips for healthy teeth. Depending on the child’s age, the hygienist might also clean teeth and assess the possible need for fluoride and/or x-rays. You may be asked to sit in the chair and hold your child during the examination and cleaning, as the child will feel comforted that you are there holding them, and this can make it easier for the dental staff to do their job.

Some dentists want to spend some time with the child (especially older children) a little bit on their own, without the parents. This is so that the dentist can try to build a friendly relationship with the child. Sometimes parents become nervous or anxious when they are told that they will be separated from their child for a little while. Not to worry, dentists are experienced and realize that sometimes parents’ nervousness can wear off onto the child, and as such, it is usually better to separate the parents and children for a little while. However, if you feel the need to be with your child during this process, it is important to inform the dental staff of this in advance, so that a plan is in place ahead of time.

Please note that children are very receptive and pick up on how their parents feel about their dental visit, as such, it is important for parents to try and stay calm, positive, and to discuss the dental visit before and after with their child. For tips on preparing your child for their first dental visit, see page 7.

You play a key role in how your child will feel before their dental visit and there are steps you can take to make this new process easier.

You can begin by explaining to your child what will happen at their dental visit.  Some key messages to share with your child are:

• 1.0Let them know what will happen at the dental visit in positive, easy-to-understand terms.  Explain that the dentist will count their teeth and look in their mouth.  They may also use special tools that will take “pictures” of the teeth and “tickle” the teeth and gums.
• 2. Tell them that the dentist went to a special school to learn how to take care of teeth, and as such, knows just how to care for their mouth and be gentle.
• 3. Explain to your child that it is important to sit extremely still, as it is hard for the dentist to look at the child’s mouth when they are moving, and inform the child that holding their mouth open nice and wide will help the dentist see.  It is also important that you let the child know that they will be able to rest their mouth when they need to.

These steps are just guidelines to look at, as each child and each parent-child relationship is different, however, it is important that parents are relaxed about taking their child to the dentist, as children do look to their parents for many cues, such as how to respond to new situations.

Some other tips to help you prepare your child for this first visit are as follows:

• 1. Answer all of your child’s questions in a positive manner, as this will help to reassure your child, and make them feel more comfortable.
• 2. It might help to read your child a story about a character that had a good dental visit, you can look for one at your local library, or ask if your dentist has any books like this available.
• 3. Never bribe your child to go to the dentist, or use a dental visit as a threat or punishment.
• 4. Do not use any words that could spark fear in your child, as this will make them uneasy.
• 5. Do not tell your child that it will not hurt or that it is not going to be that bad, as this will lead many children to think that there is something to be afraid of.
• 6. Do not let anyone tell your child negative experiences or spark fear in your child, as this will leave them uneasy and nervous.
• 7. Be positive by using positive words and phrases and encourage your child.
• 8. Do not refer to the dentist as a doctor, because many children are afraid or nervous, as the doctor is where they have to get shots.

In some cases, children may need a dental procedure, in which case it is good to explain to them that this dental visit will be slightly different than their regular visit.  Try talking about this visit in a positive way, as not to scare or worry the child.  Remember if you are nervous, anxious, or tense, your child will be able to sense these negative feelings, and may begin to feel this way as well.

Brushing

When to Start

You should begin brushing a child’s teeth as soon as they begin to cut teeth. Beyond this, some important milestones would be:

By around the age of three, children should know what brushing their teeth is, the basics of how to brush their teeth (though they probably shouldn’t be doing it on their own, they should know that all surfaces of the teeth need to be cleaned and to use circular motions), and have a routine established with brushing.
Before the age of 8 years old, you should assist your child with brushing to ensure proper techniques are being used, and that your child is cleaning all surfaces
By the age of 8 years old, your child should be able to brush his or her teeth on their own.
How Often to Brush

You should brush your child’s teeth at least twice a day, as this helps to clean away any plaque build-up. Some parents have found that it is most helpful to brush and floss their child’s teeth in the morning and at night, and to associate this action with a morning/bed-time routine.

Correct Brushing Technique

Once your child’s baby teeth begin to come in, you should use a soft-tooth brush, and only a pea-sized amount of non-fluoride toothpaste. Around age 2 – 3 you should begin to use fluoride toothpaste. Wait until you feel confident your child won’t be swallowing a significant amount of the toothpaste, as too much fluoride can be bad for children. Occasionally swallowing toothpaste by accident is okay, but you should try to avoid letting them swallow the toothpaste on a regular basis.

Make sure that once a child’s back baby teeth come in that these teeth are being brushed properly, as these teeth are most likely to develop cavities (children tend to miss these teeth). Also, never share your toothbrush with your child, as this can spread bacteria to and from you and your child. Whenever a child is brushing or learning how to brush remember always be a positive role model and correct any mistakes they make in a positive way.

Your child should take 2 to 3 minutes to brush their teeth. When brushing, it is best to insert the toothbrush at about a 45-degree angle and to brush in a circula
r motion applying only slight pressure. Keep in mind though, that too much pressure can hurt the gums, possibly causing them to bleed. Be sure that you or your child brushes all the sides of the teeth and the tongue, and make sure that when brushing the inside surfaces of the teeth that the toothbrush is in a vertical position, and that you or your child use an up and down stroke. When brushing the tongue, it should be brushed from the back to the front. When your child and you (helping) are finished, rinse the mouth out with water and rinse the toothbrush’s bristles thoroughly with water to ensure bacteria are removed.

Product Recommendations

It is best if the child has a soft-bristled toothbrush with a wide handle, that way it is easier for your child to brush. You should try to replace your child’s toothbrush every 2-4 months and immediately following illnesses like the cold or the flu. If the toothbrush becomes frayed sooner, replace it because a worn toothbrush is not nearly as effective. I realize that keeping track of how the age of your child’s toothbrush is really low on the “to do list” so just remember to replace the toothbrush when you notice wearing on the bristles of the toothbrush.

For children (or us parents for that matter!) who need help with keeping track of how long to brush their teeth there are timers or sand timers just for brushing teeth. There are also timers build into some electric toothbrushes.



Flossing

When to Start

Flossing should begin once your child’s baby teeth begin to touch each other. Make sure that you floss your child’s teeth gently at first, as their teeth and gums are sensitive. Beyond this, some important milestones would be:

By around the age of three, children should know what flossing their teeth is, and how to floss their teeth.
Before the age of 8 years old, you should assist your child with flossing to ensure proper techniques are being used, and that your child is cleaning all surfaces
By the age of 8 years old, your child should be able to floss his or her teeth on their own.
How Often to Floss

Flossing should be done once or twice a day, typically at the time that you brush your teeth. It is best to floss between teeth prior to brushing, so that any debris lifted out from flossing can be brushed away with the toothbrush. Some parents have found that it is most helpful to brush and floss their child’s teeth in the morning and at night, and to associate this action with a morning/bed-time routine.

Correct Flossing Technique

It is important for a child to floss their teeth because brushing alone cannot get the plaque that sits between the teeth and that rests at the base of the teeth by the gums. To start, take a long piece of floss and wrap it around the middle fingers, holding the floss between the thumbs and fingers, curve the floss around each tooth and ease the floss in between the teeth, making sure to use a fresh section of the floss. Many people forget to floss behind their back teeth, remember, plaque sits there too.

Product Recommendations

Floss comes in many different types, but I suggest that you use the kind that is recommended by your dental professional or the one that feels most comfortable to you. Some parents find it easier to use floss picks. The kind of floss you use is not nearly as important as making sure that you and your child flosses every day.

What tips do you have for getting my child to brush and floss?

Getting children to brush and floss their teeth can be like, well, pulling teeth! (Pun intended.) I know this is challenging as I have faced it myself. Below I have listed some of the tips I have received over the years from other parents on things that worked for them.

1. Incorporate a song or a story into your child’s brushing/flossing routine. Sing the song or tell the story as you help your child clean their teeth.
2. Have or develop some set brushing and flossing routine, such as brushing before bed as this will help the child to remember when to brush and floss.
3. Have the whole family brush together, as children tend to enjoy seeing their parents or siblings brush their teeth as well.
4. Allow the child to pick out his or her toothbrush or toothpaste; the child will then want to brush their teeth more because they were able to pick out what they liked.
5. Try to ensure that your child does not go to bed without brushing their teeth, if a child skips brushing once they are more likely to skip brushi
ng other times.

In this day and age I think everyone has heard that sugar is bad for teeth. Most parents know that they’re taking a gamble on their child getting cavities if they feed the child candy, soda pop or other sugary treats. What a lot of parents don’t know, however, is that there are other not so obvious sources of sugar in our children’s diets that can be just as dangerous. Any food that is sticky or leaves residue on your teeth is a cavity hazard.

Some of the sticky culprits that parents don’t often consider are raisins or other dried fruits, fruit roll-ups, crackers, bread or other starchy foods.

The following are some additional suggestions to help you have and keep a nutritious and healthy baby.

Avoid adding sugar to foods that are low in sugar, as excessive amounts of sugar leads to tooth decay.

1. Try encouraging your baby or child to pick/eat snacks that are healthier, the idea is that if a child learns to eat healthy when they are young, they are more likely to continue eating healthy throughout their life.
2. Try to limit the baby’s juice intake to approximately 10% or less of the baby’s daily diet; this is because juices tend to be high in their sugar content.
3. Make sure that your child’s diet has enough calcium, as this is very important for your child’s diet and helps build strong teeth.
4. Make sure your child is eating sufficient amounts of whole grains, vegetables, cheese, and fruits, and is avoiding eating foods that are high in their sugar content, sticky foods and foods with processed carbohydrates (pastries, pasta, white bread, cakes, cookies, candies etc.) as these can cause tooth decay. Rather, when consuming whole grains it is better for them to eat whole wheat bread and pasta.
5. If your child eats foods high in sugar, sticky foods, or foods with processed carbohydrates, your child’s teeth should be brushed afterward.
6. A better alternative to high sugar foods, sticky foods, or foods with processed carbohydrates are foods that are sugar-free, low in sugar, or unsweetened.

On average, the cost of a mouthguard is significantly less than the cost associated with any injury sustained during contact sports. The National Youth Sports Foundation for the Prevention of Athletic Injuries, Inc. (www.nyssf.org) reports that injury to teeth is 60 times more likely in athletes that do not wear mouthguards.

There are three different types of mouthguards: a ready-made mouthguard, a boil-and-bite mouthguard, and a custom fitted mouthguard made by a dentist. Any mouthguard should fit firmly around the teeth and the child should still be able to speak and breathe comfortably. Each type of mouthguard varies in their level of protection, comfort and cost. While mouthguards range in price from a ready-made mouthguard for about $10 to a custom-fitted mouthguard made by a dentist for about $200, this is certainly a case of ‘You Get What You Pay For’. Both ready-made and boil-and-bite mouthguards tend to be bulky and restrict speech and breathing, which is a major disadvantage when playing sports. These can also come out easily with blows to the face. On the other hand, a custom-fitted mouthguard will be comfortable and offers the highest level of protection. For more information on mouthguards, talk to your family dentist or call Dr. Omeltschenko’s office at (513) 449-2454.

If a tooth is knocked completely out of its socket, there is a big chance the tooth can be saved by simply following the steps listed below.

Step 1: Place the tooth back in the socket within 15 minutes of it being knocked out.  Make sure you do not touch the root of the tooth!  The oils on your fingers will contaminate the root and your body may reject it.  Pick the tooth up only by the crown of the tooth.

If the tooth root contains debris, such as grass or dirt, the root should be rinsed off with water.  Run the root under water for only a second and do not scrub it in any way.  Regular water will kill the nerves on the root surface very quickly.  Then immediately place the tooth back into the socket.

Step 2: Be seen immediately by a dentist with trauma training.  If injury occurs on a weekend, we recommend going to Children’s Hospital, which has a dental center.

If for any reason you cannot get the tooth back into the socket, it must be placed in a liquid of some sort while transporting the patient to the dentist.  Do not place the tooth in water or ice, a cloth, paper towel or tissues.  This will kill the cells on the surface of the tooth.  Time is of the essence.  The tooth must not dry out for more than 15 minutes before being placed back in the socket.

Your choices for keeping the tooth from drying out, in order of best to worst are:

1. 1. The best thing to store the tooth in is a Save-A-Tooth kit.  This jar contains a sterile liquid designed to cleanse the root and keep the microscopic cells on the surface of the tooth root alive for at least 24 hours.  Just open the lid, drop the tooth into the liquid, and close the lid. Save-A-Tooth kits can be purchased at www.save-a-tooth.com
2. 2. Cold milk (preferably whole milk) is the second best option if it is readily available on the spot.  Place the tooth in the milk, and transport the patient and tooth to a dentist as soon as possible.
3. 3. Place the tooth in saline (some emergency kits contain saline.)
4. 4. Place the tooth in contact lens solution.
5. 5. Saliva is the last choice. Have the patient, or parent of the patient, place the tooth under his/her tongue until reaching the dentist.  Alternatively, the patient or parent may spit saliva into a small cup and place the tooth in the saliva while transporting to the dentist.