Baby teeth (or primary teeth) can begin to erupt as early as six months of age and can stay in your child’s mouth until he or she is 12 years old. People often think that because baby teeth aren’t permanent they’re not important. Nope.
Primary teeth help children develop bones and muscles and speak more easily. They also promote a positive self-image for the child and help guide the child’s permanent teeth into the right spot.
So be sure to take care of and monitor the health of the child’s teeth. Practice good hygiene and be on the lookout for discomfort and infections. Know that keeping your child’s teeth healthy helps keep your child healthy.
Check out Healthy Mouth for the ADA for a guide to Tooth Eruption
At Pediatric Dental Associates, we encourage all parents and caregivers to schedule their child’s first visit for shortly after the child’s first teeth come in. (This could be as early as six months of age.)
Coming early has it benefits. It allows for important education on proper dental health for infants and toddlers. It also helps start acclimating children to our office.
As children get to two to three years of age, our pediatric team will start cleaning the child’s teeth and performing more thorough examinations. Even if the child is hesitant to let us clean his or her teeth, these visits will help the child grow more comfortable with our surroundings and treatment approach.
At any age, it’s important to remember the role parents and caregivers play in promoting positive dental experiences and outcomes. Practice good dental hygiene yourself. And when it comes to appointments and dental visits, avoid words that might scare your child and add to the stress. These include words like pain, shot, needle, and drill. We don’t use these words at our offices and encourage you to not use them at home.
Brushing & Hygiene
The best way to develop healthy dental habits is to start them early. Even as infants, parents and caregivers should be brushing the child’s gums with a washcloth or soft-bristled brush and warm water. Once most of your child’s teeth have come in — around two years of age — you can begin using toothpaste. Brush in small circles, counter-clockwise, using only a smear of toothpaste. (We encourage non-fluoridated toothpaste for children under two or children who can’t spit. After that, it’s your call.)
As children get older, they can begin taking more control over their dental health and hygiene. Children under ten will still need some guidance, and regardless of age, parents should be inspecting afterwards; following in their footsteps or letting them follow in yours.
Click here for a guide from the Ad Council with tips to keep mouths healthy.
Diet & Nutrition
Teeth are a living part of the body, and they need vitamins and minerals to grow strong and healthy. We feel that all children should eat a healthy diet. It’s not only good for their teeth, but also good for their bodies and minds. When it’s time to eat, explore all that’s out there. Mix it up with fruits and vegetables, cereals, dairy products, and meats.
As for snacks, keep them to a minimum and keep them healthy. More snacking means more chances for sugar to stick to the teeth. Stay away from sugary snacks and drinks (including soda and juice), and encourage your child to eat fruits and vegetables, meats and cheeses, yogurt, ice cream, chocolate, popcorn, and nuts and peanut butter if they are not allergic.
No matter what you eat or when you eat it, be sure to brush afterwards.
More information can be found here.
Download our Nutrition Guide
Teething, Thumbs, & Pacifiers
“Teething” is when a child’s teeth erupt into the mouth. It’s uncomfortable for many children. Symptoms can include a slight fever, an increase in drooling and saliva, ear pulling, and constant chewing on any available object.
So what can you do?
To reduce discomfort during teething, give the child frozen teething toys, or try cold or frozen foods such as bagels or carrots. The cold helps decrease the pain and reduce the inflammation, and the hardness will hasten the eruption of the tooth.
Thumbs and Pacifiers
When it comes to thumbs and pacifiers, there’s a lot to know and a lot you can do. First and foremost, know it’s normal for babies and children to suck on any object that’s placed near their mouth, thumbs and pacifiers included. It’s how babies learn and receive nutrition, and find safety and comfort.
The things to keep in mind when it comes to thumbs and pacifiers are that if over-used, children could experience dental problems like protruding teeth or teeth that don’t erupt properly.
We encourage all parents and caregivers to monitor the sucking habits of children, especially around the time that the permanent teeth erupt. The pediatric dentist will provide important dental health information, and inform your child about the long-term consequences of this habit.
Cavities & Prevention
Cavities are caused by bacteria or germs that live in the mouth and grow by sugary and sticky foods and drinks.
When the bacteria digest food they create acids that soften our teeth. This is a gradual process. With proper care, it can be avoided. Everything we eat and drink — with the exception of water has the potential to cause cavities if the teeth are not cared for properly.
Cavities and decay can start early. We often see infants and toddlers with “Early Childhood Caries.” It is a disease that is caused by improper or prolonged use of the bottle, sippy cup, and/or improper breastfeeding. Appropriate oral hygiene measures will reduce the risk of nursing-pattern decay, both for the breast-fed and bottled fed baby.
When it comes to cavity prevention, here are a few things to keep in mind:
- No bottle after one year of age.
- Never allow your child to sleep with a bottle or sippy cup.
- Avoid extended and repetitive feeding times (nursing, bottle or food even.) Focus on meals, not snacks.
- Limit the juice and soda. None is ideal, but allow children no more than three 8 oz. servings daily.
- Snack healthfully on things like fresh fruits, vegetables, cheese or plain popcorn.
- Avoid chips, crackers, cheese curls, cookies, cake, and candy.
- Help your child brush his or her teeth twice daily until the age of eight. At this point, you can begin supervising your child’s brushing.
- Remember that liquid medicines also may contain high levels of sugar. Always clean your child’s teeth after he/she takes medicine.
Injuries & Emergencies
Ever wonder what to do when?
Rinse the mouth with warm water, and use floss to remove any food that may be causing discomfort. Use ice to reduce the pain and swelling. Try to get to a dentist as soon as possible.
Bumps, falls and bruises are a normal part of childhood. But any injury that causes bleeding, loosens teeth, or results in a broken tooth should be evaluated by a dentist…even if the child doesn’t complain of pain.
A tooth that is fractured or discolored may become infected. Infection in a baby tooth can cause damage to the permanent tooth. Infection of a permanent tooth can lead to tooth loss if left untreated.
If a primary tooth is knocked out, do not scrub or clean the tooth. Place the tooth in saline (contact lens solution) or milk, and call your dentist immediately. The tooth may be able to be replanted if treatment is sought promptly. Also, save any broken pieces of tooth that are found after an injury as they may be bonded back in place. If a baby tooth is broken, notify the dentist immediately, but know that primary teeth are rarely re-planted.
For many children, sealants can be helpful in getting through the candy and sugar years. These protective coatings help prevent cavities from forming on the top surfaces of the teeth.
Sealants are generally placed over the permanent molars as soon as they erupt into the mouth. This can be as young as six years of age. Baby teeth can also be sealed if your child is cooperative and at a high risk for developing decay.
Ask us if sealants on your child’s baby teeth would be appropriate.
Fillings are sometimes indicated for the restoration of primary (baby) and permanent teeth with caries, dental defects or dental trauma. There are several different types of filling materials, each material offers its own benefits.
Resin-based composite is an aesthetic material used primarily for anterior (front) teeth but can also be utilized on certain posterior (back) teeth. There are a variety of products with each having different qualities and benefits. Resin- based composites require longer time for placement and are more sensitive than amalgam (silver) fillings. In cases where patient cooperation is compromised, composites may not be the restorative material of choice. Your doctor will discuss the risks and benefits of composite fillings and will determine the best treatment option for your child.
Amalgam (silver) is a material used primarily for posterior (back) teeth. Dental amalgam has been reviewed and studied extensively for its safety and effectiveness. Amalgam fillings are often chosen for their durability and ease of placement. Your doctor will discuss the risks and benefits of amalgam fillings and will determine the best treatment option for your child.
Download the Amalgam Consent Form from the Philadelphia Department of Health
Crowns have been indicated for the restoration of primary (baby) and permanent teeth with caries, dental defects or dental trauma. Crowns are sometimes completed in conjunction with pulpal therapy. Crowns are considered more successful than fillings for multi-surface restorations. There are differnet options for types of crowns. Your doctor will discuss the risks and benefits of crowns and will determine the best treatment option for your child.
Nerve treatments consist of treatment of the nerve with various medicines or techniques, depending on the age of the patient and health of the nerve tissue.
Baby nerve treatments, or pulpotomies, are performed when a large carious lesion is into or extremely close to the nerve tissue. The tissue is removed and a sedative medicine placed into the tooth. These teeth may or may not have experienced pain or discomfort up until that point.
Nerve treatment performed on adult teeth vary greatly and may be a result of trauma to the tooth or from a carious lesion that has reached the pulp. Every effort is made to allow the tooth to remain vital and new biocompatible materials are used to allow the pulp to in effect form a protective barrier. By allowing the pulp of the tooth and body to heal itself will lengthen the life of the tooth, but it still made need a full nerve treatment.
When the nerve of a permanent tooth can not be repaired conservatively with biocompatible materials, a referral to an endodontist or root canal specialist will occur to allow for the best care.
Extractions & Supernumerary Teeth
Extractions of baby teeth can occur for various reasons. If a baby tooth becomes infected, it can negatively impact the adult tooth that is developing behind the baby tooth. If an infection or abscess of a baby tooth is not addressed, the child can develop a larger infection or cellulitis and possibly be admitted to the hospital for inpatient treatment. These infected teeth may need antibiotics prior to extraction to help lessen the infection and allow for the tooth to become numb. The antibiotic is only to serve to help lessen the infection in and around the tooth and allow the dentist to achieve better anesthesia prior to extraction. If the infected tooth is not extracted in a timely fashion, the infection will likely return.
Some teeth may become too badly broken down, have poor root structure remaining or need to be removed to allow for the adult teeth to properly grow into the mouth. The orthodontist may also request certain adult teeth be removed to allow for orthodontic treatment and a better esthetic and functional end result.
As the patient approaches the mid to late teen years we often take a panoramic radiograph to assess for the presence of absence of third molars or wisdom teeth. Depending on the angle, amount of root development and space left in the mouth for these teeth to erupt, we may or may not refer you to an oral surgeon to have these removed. It is much easier to remove these teeth at a younger age when the teeth are less developed and the root is shorter. These wisdom teeth may not have any pain or discomfort at the time, but we are sending you for an evaluation to have the teeth assessed prior to pain and problems present.
In rare cases, supernumerary teeth - or true extra teeth - are found in some patients. This typically happens in specific ethnic groups, but everyone is evaluated for these. The most common area is in the upper jaw and between the front teeth and is called a mesoden. This extra tooth, and at times teeth, can negatively impact the eruption of the upper adult front teeth. Depending on the location, positioning and age of the patient will determine if we would address this in the office or refer the patient out to the oral surgeon for extraction. Supernumary teeth can occur in the lower jaw and in the back of the mouth, too. For the extraction of the front mesoden(s), a small area of the gums is opened to allow access to the extra tooth. In some cases the removal of one or more of the front teeth may be needed to help locate and access the extra tooth. We typically will wait to the age of 5 to perform these extractions, unless otherwise indicated.
Tongue and Lip Ties
Release or revision of the frenulum can occur at various ages and for various reasons. Frenulum's are typically located between the front upper and/or lower jaw (Labial Frenulum), under the tongue (Lingual Frenulum) and in some cases on the sides of the jaws and connecting out to the cheeks (Buccal Frenulum).
Everyone has these frenulum's and they are all part of our anatomy and make-up. Where the frenulum attaches and how it effects the oral structure it is connected to determines if a frenectomies procedure is needed or not.
Infant and Newborn Tongue and Lip Ties
Patients that have been referred for an evaluation for a suspected nursing issue that is impacting the child and parent breastfeeding relationship will be evaluated for a potential lingual and or labial frenulum issue. Lingual and/or labial frenectomies are deemed necessary after a thorough examination of the newborn or infant and an in depth history of both the mother and child’s symptoms. It is highly recommended that all patients that seek an evaluation have seen a lactation consultant or specialist to help rule out other potential problems.
A large body of very useful knowledge can be found on Dr. Bobby Ghaheri’s Website at http://drghaheri.squarespace.com/ . Please refer to the download section for various articles that will elaborate on specific topics.
PDA no longer sees patients under 2 years of age for evaluation and treatment of Tongue & Lip Ties.
Please click here if you are interested in scheduling an evaluation for your infant with Dr. Bahn.
Read about Why a Tongue or Lip Tie Matters
Healthy smiles and positive dental experiences are a responsibility shared with parents and pediatricians. Prevention and education are key. Parents should know how to take care of their children’s teeth and how to manage hygiene at home. As pediatric dentists, we’re passionate about sharing what we know with doctors, pediatricians, and parents. Here are a few things to think about.
- Primary teeth begin to develop four weeks in utero and secondary teeth begin to form from birth to age eight. Together, this makes nutrition an important consideration from the time a woman knows she wants to conceive until the time of delivery and after she is breastfeeding.
- “Brushing” should begin almost immediately. Start with a warm washcloth (water only) on the gums, then move to brushes as teeth begin to erupt.
- Bottle caries or bottle rot is a common problem caused by improper breastfeeding and bottle use, in particular, putting a child to bed with a bottle.
- A child’s first dental visit should be no more than 6 months after the first tooth comes in or age one at the latest. First visits often include a review of the patient’s medical history, an examination with possible X-rays, prophylaxis and fluoride if age-appropriate, and oral hygiene instructions.
- Fluoride has pros and cons. As pediatric dentists, we recognize the benefits of topical applications and that it should not be swallowed. At the same time, we ultimately feel that fluoride is a parent’s decision. If parents elect to use fluoridated toothpaste, it should not be until a child is old enough to spit, and only a smear should be used.
- Parents play a critical role in their child’s dental health, not simply through hygiene and nutrition, but through their own dental health. A child’s initial exposure to bacteria often comes from parents and caregivers. If their mouth is unhealthy, their child’s mouth is more likely to be unhealthy.
- Prevention at any age is key. Abscesses and infections in their baby teeth and oral cavity can cause damage to permanent teeth. In severe cases, these infections can be life-threatening.
- Proper care at home means less invasive and more positive experiences at the dentist’s office.
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