FAQ

Pediatric Dentists are dentists that have a passion to provide the best dental care possible to our children. So much so that we have attended accredited Pediatric Specialty programs for an additional two to three years after dental school. We are the pediatricians of dentistry. Our training has focused on providing the same level of care that an adult receives. We provide this care to children from birth through the late teens, not only to our patients whom meet their milestones, but also to those with special health needs.

Find out more about Pediatric dentistry from our professional associations:

Find out more  about Dr. Maggie Davis:

The American Academy of Pediatric Dentistry recommends a dental check-up at least twice a year. It is important to see the dentist once every six months even if your child has never had a cavity. Your child’s dentist will perform an exam on them once every six months, not only to check for cavities, but also to examine the oral tissues and jaws. Your child will also have a cleaning at these visits, to remove build-up on their teeth, and a fluoride treatment to help strengthen the teeth and prevent cavities. Each child is given oral hygiene instructions during their visit, to review proper brushing and flossing techniques.

Parents Magazine: The Surprising Truth About Cavities

The reason to fix baby (primary) teeth when they have decay (caries – dental disease) is quite simply to return them to health. Nowhere on our bodies would we neglect a disease process and let it continue unchecked. While it is true that the baby teeth will fall out eventually, the problems that may arise from not treating them when needed can vary from an esthetic issue, to pain, infection, and in some cases death. Healthy primary teeth are important for:

  • Maintaining the space for the permanent teeth to erupt into
  • Proper nutrition through effective chewing of food
  • Esthetics for positive self-esteem
  •  Proper development of the permanent teeth and jaws

More advice on dental care for your child

Dental plaque is a thin, sticky, colorless deposit of bacteria that constantly forms on teeth.

When plaque build-up on the outside of the tooth combines with sugars and starches in the food you eat, it produces acids that attack the tooth enamel.

With time and repeated acid attacks, the enamel breaks down and a cavity forms.

If a cavity is left untreated, it can lead to more serious oral health problems.

Brush:

  • It is recommended that you begin brushing your child’s teeth twice a day as soon as the first tooth comes in.
  • Prior to the age of 2, use a ‘smear’ of fluoridated toothpaste on a toothbrush.
  • For children 2-5 years old, dispense a small ‘pea-size’ amount of fluoridated toothpaste and perform or assist your child’s brushing
  • Some amount of toothpaste swallowing can be expected, however, swallowing excessive amounts of fluoridated toothpaste can cause stains to form on the permanent teeth. This is why it is important to use only the recommended amount, and encourage your child to spit into the sink after brushing.

Floss:

  • Flossing should begin as soon as any two adjacent baby teeth are touching!
  • Daily flossing is very important for your child’s oral health as it helps to prevent tooth decay in places the toothbrush cannot reach.
  • Flossing takes practice, much like learning to tie shoes or to write in cursive handwriting. Parents should assist children with flossing until they are able to floss properly on their own.

Diet:

  • Feed your children healthy foods such as fresh fruits, vegetables, and protein.
  • Sugary candies, and drinks like Gatorade, sodas, and juices, should be given in moderation.
  • If your child is going to have a sugary treat or drink, try to limit it to a 10-15 minute time period. (Drinking a sugary drink, sucking hard candies, or chewing sugary gum throughout the day is like a constant sugar bath for your teeth!)
  • Help keep your child hydrated by giving him/her plenty of water to drink between meals.
  • To prevent nursing/bottle decay, wean your child from bottle use and/or at-will breast feeding around his/her first birthday.
  • Avoid putting your child to bed with a bottle or sippy cup containing anything other than water.

Tips on Sippy Cups
How to Protect Your Baby’s Teeth From Cavities

Fluoride is a naturally occurring compound that helps teeth become stronger and more resistant to decay. Your child’s pediatric dentist will likely recommend an in-office topical application of fluoride after each cleaning, as well as a daily fluoride intake through their drinking water or a fluoride supplement. When using the optimal amount, fluoride is very beneficial to a child’s dental health.

It is important to check with your child’s dentist on the amount of fluoridated water they are drinking to ensure your child is receiving the proper amount. Ingesting too much fluoride can lead to stains on the permanent teeth, while too little can leave them more susceptible to decay.

More Information on Fluoride from the Centers for Disease Control
More Information on Fluoride from the Campaign for Dental Health

Radiographs (X-rays) are an important and necessary part of your child’s dental diagnostic process. They allow us to detect dental decay, survey erupting teeth, diagnose bone/periodontal diseases, identify and evaluate the results of an injury, or plan orthodontic treatment. X-rays allow dentists to diagnose and treat health conditions that cannot be seen during a clinical/visual exam. Dental problems that are noted and treated early can create more comfortable care for your child and are more affordable for you.

The American Academy of Pediatric Dentistry recommends x-rays and examinations every six months for children with a ‘high risk’ of tooth decay. For the ‘average risk’ patient, most pediatric dentists prescribe radiographs approximately once a year.

We are particularly careful to minimize the exposure of our patients to radiation. All of our x-rays are digital, which uses a smaller dose of radiation than the standard x-ray film. The radiation exposure to dental x-rays is a much smaller risk than undetected and untreated dental disease. Lead body aprons and shields will also protect your child. With both digital x-rays and the proper shielding you can be assured that your child will receive the smallest amount of radiation exposure.

More on x-ray use and safety

Sometimes brushing and flossing is not enough. The pits and grooves that form the chewing surfaces of the back teeth are extremely difficult (if not impossible) to clean of bacteria and food. This is because these pits and grooves can be too small for a toothbrush bristle to fit into and properly clean away plaque.

Dental sealant is a plastic resin coating that is placed in the pits and grooves of the teeth as an attempt to prevent decay from starting and/or progressing in these areas, which is where the vast majority of tooth decay occurs. It is the same material as white fillings, only without the coloring.

The sealant process is painless, quick and easy! First, the tooth is isolated, conditioned, and dried. Sealant is then applied to the tooth, flowing into the pits and grooves, and a special blue light dries the sealant adhering it to the tooth.

Sealants usually last about 2-5 years. Like a new pair of shoes, they need to be replaced periodically. Over time, portions of the sealant may break off and require a “touch up” to ensure the tooth is protected.

It is important to note that sealants have their limitations. While sealants protect the chewing surfaces of teeth (the most likely place to get a cavity), don’t forget brushing and flossing daily is still necessary to prevent cavities on the other areas of your teeth.

  • On average, the first baby tooth comes in at 6 months of age; this is usually a lower front tooth.
  • There are 20 baby teeth all together. The last baby teeth usually come in between age 2-2 ½ years.
  • Permanent teeth usually begin to come in around age 6. This may start with the 6-year molars.
  • The first “wiggly” baby tooth is usually a lower front tooth and should become loose around the same time as the permanent 6-year molars are erupting.
  • The remaining permanent teeth (except for wisdom teeth) come in between ages 6-13, keeping the tooth fairy very busy!

Sucking is a natural reflex and infants and young children may use thumb, fingers, pacifiers, and other objects on which to suck. Around age 3 is the time to take note, and gently encourage your child to stop the habit. Thumb/pacifier sucking that continues beyond age 3 may cause problems with proper growth of the mouth and tooth alignment.

Here are some helpful tips for getting your child through thumb/pacifier sucking:

  • Wait until the time is right (low stress)
  • Use positive reinforcement by praising your child when he/she is not sucking
  • Use a reward system
  • Some suggest a pacifier habit is easier to break than a thumb habit, because you can throw away a pacifier.
  • One helpful trick to wean your child off a pacifier is to progressively cut off a small piece of the tip each week until, eventually, the entire nipple is gone. If the child has multiple pacifiers, do this on all of them, and do not replace any lost pacifiers.
  • If your child has a thumb or finger habit, try placing a sock over their hand at night, or using tape on the fingers they suck to remind them to stop.
  • Ask your child’s pediatric dentist to speak to your child about stopping the habit, and what could happen to their teeth if they continue.
  • Ask your child’s pediatric dentist for other tips on helping your child stop their habit.

More on thumb, finger, and pacifier habits

The best way to prevent dental injuries caused by sports related activities is to always have your child wear a mouth guard during sports. Athletic mouth guards protect the teeth, lips, cheeks, and tongue from injury, as well as reduce the chance of concussion or jaw fracture after a blow to the mouth. Be sure to choose a mouth guard that your child can wear comfortably and ask your child’s dentist for any suggestions.

Here is what the American Academy of Pediatric Dentistry has to say about Mouth Guards:

Q: What Are Athletic Mouth Protectors?

Athletic mouth protectors, or mouth guards, are made of soft plastic. They are adapted to fit comfortably to the shape of the upper teeth.

Q: Why are Mouth Guards Important?

Mouth guards hold top priority as sports equipment. They protect not just the teeth, but the lips, cheeks, and tongue. They help protect children from such head and neck injuries as concussions and jaw fractures. Increasingly, organized sports are requiring mouth guards to prevent injury to their athletes. Research shows that most oral injuries occur when athletes are not wearing mouth protection.

Q: When Should My Child Wear a Mouth Guard?

Whenever he or she is in an activity with a risk of falls or of head contact with other players or equipment. This includes football, baseball, basketball, soccer, hockey, skateboarding, even gymnastics. We usually think of football and hockey as the most dangerous to the teeth, but nearly half of sports-related mouth injuries occur in basketball and baseball.

Q: How Do I Choose a Mouth Guard for My Child?

Any mouth guard works better than no mouth guard. So, choose a mouth guard that your child can wear comfortably. If a mouth guard feels bulky or interferes with speech, it will be left in the locker room.

The American Academy of Pediatric Dentisty also mentions that there are several options in Mouth Guards:

1. Preformed or “boil-to-fit” mouth guards are found in sports stores. Different types and brands vary in terms of comfort, protection, and cost.

2. Customized mouth guards are provided through your pediatric dentist. They cost a bit more, but are more comfortable and more effective in preventing injuries.

Your pediatric dentist can advise you on what type of mouth guard is best for your child.

If you are having this problem, you are not alone! Many young children either do not want to brush their teeth, or do not want to have help with brushing. However, brushing and flossing effectively is extremely important for your child’s health and parental help is needed for young children. Your pediatric dentist can give you helpful tips for encouraging children of any age.

Here are some great tips from former AAPD President Dr. William C. Berlocher (2009-2010), who shares his insight on those hard-to-brush preschoolers:

Dr. Berlocher reminds us that fear of the unknown is usually handled quite easily using several basic behavior guidance tools:

  • Tell/Show/Do – This technique involves explanation of procedures in age-appropriate levels (Tell), demonstration of the procedure in a carefully defined, nonthreatening setting (Show) and then without deviating from the explanation and demonstration, completion of the procedure (Do).
  • Positive Reinforcement – Positive feedback is used to reward desired behavior and strengthen the recurrence of these behaviors.
  • Modeling – This technique involves allowing children to observe activities that are new to them by watching other more experienced children engage in these activities.

Dr. Berlocher says, “Children who have discovered they have some control in their lives and are resistive to their parent’s direction and instruction can be a more challenging issue.

A term that I’ve found to be extremely useful in these situations is “cheerful persistence.”

First of all, parents need to be positive and keep a smile on their face when working with their child. Parents give many nonverbal cues to their children. If you go into a tooth-brushing session looking like you’re going to war, more than likely it will be just that!

Secondly, oral hygiene is something that works only if it is undertaken on a regular basis. Therefore, daily brushing is a must. Avoiding tooth brushing because of the potential for a clash between a child and parent dramatically increases the potential for development of dental cavities.”

Dental emergencies are best handled under the guidance of a trained pediatric dentist. It is best to establish a dental home with a local pediatric dentist before an emergency occurs, so that in an urgent situation your child can be seen expeditiously and the dentist is familiar with your child’s medical history. This also ensures that your child will be treated in an environment that they are comfortable and familiar with, which is invaluable when children are under stress.

Severe Blow to the Head:

Call 911 for emergency transportation to the nearest hospital.

Possible Broken or Fractured Jaw:

Keep the jaw from moving and take your child to the nearest hospital emergency room.

Knocked Out Tooth:

Please call your pediatric dentist immediately for advice as sometimes there is confusion about whether it is a baby or permanent tooth. If it is in fact a permanent tooth, quick action can save the tooth if it can be reinserted correctly. Locate the tooth and place it in cold milk, avoiding excessive handling. The dentist may be able to walk you through the steps of reinserting the tooth over the phone and you can then meet your dentist at his or her office. Time is a critical factor in saving the tooth!

Chipped or Fractured Tooth:

Please call your pediatric dentist immediately for advice. If possible, locate the chipped portion of the tooth. There are different treatments for baby and permanent teeth so it will be important to describe the chip to the dentist. Often times baby teeth can be examined in the office the next day; however permanent teeth may be chipped so severely that they need immediate treatment. Again, timing is critical so contact your dentist immediately.

Toothache:

Thoroughly brush and floss the painful tooth to remove any food that may be lodged in a cavity. Check for any signs of a bump on the gum or swelling either inside the mouth or outside on the face. If there is any sign of swelling please call your pediatric dentist immediately, otherwise administer Tylenol or Ibuprofen and call the office during normal business hours to schedule an exam.

Tongue, Lip, or Cheek Bites:

If there is bleeding, apply firm pressure with a gauze or cloth. Apply ice to injured areas to help control swelling. Keep area clean to prevent secondary infection. Use Tylenol or Ibuprofen to control pain. Contact your pediatric dentist for advice and to see if a follow up visit to the office is needed.

Cut or Lacerated Tongue, Lip or Cheek:

Control bleeding by applying firm pressure with gauze or cloth. Once bleeding is controlled, apply ice to injured area to help minimize swelling. Contact your pediatrician or pediatric dentist for guidance in seeking emergency care as there may be a need to clean dirty wounds or place sutures.

Almost all children grind their teeth while sleeping. This is referred to as bruxism, which is habitual but nonfunctional forceful grinding of the upper and the lower teeth together. Sometimes parents may notice wear on their child’s teeth (teeth appear shorter). There are several different theories as to why children grind their teeth, including psychologic stress due to new environments, divorce, or changes at school. Other physiologic theories point towards problems with a child’s ‘bite’ or inner ear pressure. Reported complications include attrition (tooth wear), headaches, TMJ dysfunction, and soreness of masticatory muscles. Every child is unique and the reason they grind is likely a combination of several factors that can be discussed with us.

Fortunately, in most children. the grinding sounds worse than it is. The majority of babies and children that grind their teeth do not require any treatment. If excessive wear of the teeth (attrition) is present, then a mouth guard may be used to prevent further loss of tooth structure. However, most children under the age of seven may not tolerate wearing a mouth guard.

The good news is that most children outgrow bruxism without intervention. The grinding can begin as early as when the first few teeth erupt. These teeth are something new to the baby and they are exploring their new ‘toys’. The grinding tends to decrease between the ages of 6-9 and children often stop grinding between ages 9-12, while a few continue bruxing as adults. Mention your child’s grinding to one of our doctors so they can check their teeth for wear and any resulting problems like nerve exposure or fractures.

Assuming the child has not injured their teeth, in most cases it is normal for the permanent teeth to look darker or yellow. It’s actually considered to be an optical illusion! The baby teeth are actually nick-named “milk-teeth” because of their bright, white color. When permanent teeth come in next to them, it gives them the appearance of being very yellow. Our permanent teeth have thicker layers of underlying dentin (layer of tooth beneath the outer enamel) which naturally has hues of yellow, red, or grey.

If you dont discuss the issue with your child, chances are they wont even notice and will not become self conscious. Once your child’s permanent teeth have all come in, together we will re-evaluate the color and see how they appear. If you and your child are still concerned, please discuss tooth whitening options with us.

In addition, there are other causes of yellow teeth which can be caused by poor oral hygiene. If the child does an inadequate job at brushing, or refuses to brush routinely, a thick coating of yellow plaque builds up on the teeth. This can make the teeth appear up to 3-4 shades darker than they actually are. If you see a layer of “fuzzy” looking film that looks as if it could be scraped off, then your child needs to improve their brushing and flossing to prevent discoloration and most importantly, decay!

There are generally not many foods or drinks that will cause staining at this age (i.e. coffee, tea, wine). If you are seeing dark stains on your toddler’s teeth, it may be due to the iron in their multivitamin. If your child is prone to this kind of stain, you’ll have to be a little more attentive about brushing thoroughly and regularly staying on top of it. The good news is that most stains caused by food or vitamins wont affect the health of your child’s teeth and usually can be removed during regular dental check-ups.

Above all, remember to check with us so that we can perform a thorough exam and definitively rule out trauma, infection, and developmental disturbances in the tooth’s formation.

When a tooth has been disturbed during its formation, it may develop atypical or abnormal enamel. If you child’s teeth grew in with white, brown, or yellow spots on them, they may have a condition called hypocalcified enamel. We most commonly see this on the first permanent molars and on the permanent incisors (front teeth) though it can happen to any or all teeth. It is often difficult to trace back the cause, but can be due to illness or trauma during infancy or early childhood. This could include infections, high fever, malnutrition, or medications used for prolonged periods of time.

In milder forms, it shows as white spots on the teeth which can cause a cosmetic concern. We do not recommend treatment of these hypocalcified areas until your child is at least in their early teens, when a more adult gingival height has developed. At that time, there are procedures that can be done to give your child’s teeth a more uniform color. Treatment may include microabrasion of the tooth, bleaching, or in some cases, removal of the hypocalcified area and replacement with a white filling.

In more severe cases, especially when involving the first permanent molars, hypocalcified teeth can result in enamel that is weaker, and more susceptible to chipping or decay. When this occurs, it is important to remove the chipped or decayed enamel and replace with a white filling. In certain severe cases, it is necessary to use a stainless steel crown as temporary treatment to protect the tooth until your child is only enough to have a white porcelain crown placed. This is usually around the age of 18, when all permanent teeth are erupted, growth is finished, and the bite is stable.

Other conditions such as dental decay or decalcified areas can be mistaken for hypocalcified teeth by the untrained eye. These other types of white spots are usually not present when the teeth first come in, but can develop quickly if your child has an acidic or sugary diet paired with poor brushing and flossing habits. It is extemely important to differenciate the cause of your child’s white spots, which our doctors are trained to diagnose and clarify for you.

Braces are used to correct a number of different problems, all with the goal of having beautiful, straight teeth at the end. However, many times poor oral hygiene during treatment can wreak havoc on your smile and leave permanent white scars, gingivitis and decay. It is imperative that you practice good oral hygiene during your braces treatment to avoid unsightly spots on your teeth.

When plaque sits on your teeth for too long it begins to decalcify your tooth enamel and eventually this decalcification can turn into a cavity. The brackets on braces create lots of places for unwanted plaque to hang around. If the plaque is not removed quickly with brushing and flossing, it can cause white spots or lines (decalcified tooth enamel) on your teeth which will remain on your teeth for life.

Plaque also irritates the gums causing gingivitis. Gingivitis is the earliest stage of gum disease. Gums may be red, puffy or swollen and may bleed during brushing or flossing. Gingivitis causes bad breath. As it advances, the gums fill with fluid and may bleed quite easily. The gum tissue loses its healthy pink color as the bacterial infection takes hold. Eventually, this can lead to periodontitis which if left untreated can destroy the bone that anchors your teeth in. More teeth are lost due to gum disease rather than cavities. Early gum disease is reversible with professional help and good oral hygiene at home. Be sure you see your dentist at least every six months for your routine dental cleaning and check-up.

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