Pediatric Dental Problems
G U A R A N T E E D S M I L E
When Should My Child First Visit the Dentist?
Around 24 months is an excellent time to schedule you baby’s first Happy Visit. At that time we’ll introduce your child to dentistry, and begin to educate your family on oral hygiene and answer any questions you might have about caring for your child’s teeth.
An early introduction to proper oral care habits, including regular checkups, will help keep your child’s smile healthy for a lifetime.
What Will Happen At The First Visit?
After making your child feel comfortable, we will begin examining their mouth. The examination will include the teeth, gums, tongue, lips, and roof of the mouth. Depending upon your child’s age, number of teeth present and the ability to cooperate, we may order a few x-rays to detect cavities if decay is suspected. X-Rays are also helpful for determining the normal development of permanent teeth. We may also clean your child’s teeth and apply fluoride.
How Should I Prepare My Child for the First Visit?
Your attitude should convey the message that dental visits are pleasant experiences. Emphasize the attention your child will get while in the chair and try to schedule the appointment for the time of day when your child is most rested and cooperative. To prepare your child, read a story together about a trip to the dentist, or play dentist and take turns, etc.
How Can I Keep My Child’s Teeth Healthy?
It is important to begin a daily oral care routine for your child before the first tooth appears. After each feeding, wipe your child’s gums with a warm, wet cloth or a small gauze pad to remove excess food and bacteria. As soon as the first teeth appear, brush them with a small, soft-bristled brush moistened with warm water.
When teeth begin to touch each other, add daily flossing to the routine. With adult supervision, most children are able to brush their own teeth by about the age of four; however, we recommend assisting your child at least once a day to ensure a thorough job. You should continue to monitor their oral care throughout childhood. Remember, by maintaining your own healthy oral care habits, you can be an important role model for your children.
What Else Do I Need to Know About Brushing?
Have your child brush with a pea-sized dot of fluoride toothpaste. Fluoride will help strengthen teeth against decay. Your child will go through toothbrushes quickly, so check the brush often and replace it when it is worn out. Have your child hold the tooth brush at a 45-degree angle and brush gently back and forth with short strokes. Make sure to brush the outside, inside and chewing surfaces of each tooth. Teach your child to finish by brushing her tongue to freshen her breath and remove bacteria.
Why Are Primary (Baby) Teeth Important?
Primary teeth are important to your child’s development for a number of reasons: they encourage the development of the jaw bone, reserve the space required for the permanent teeth that follow and also enable your child to chew solid food. Moreover, baby teeth assist in speech development and contribute to your child’s positive feelings about his or her appearance, which helps build self confidence.
How Can I Protect My Child’s Primary (Baby) Teeth?
Baby bottle tooth decay is the leading cause of decay and tooth loss in very young children. This condition usually occurs when a baby is allowed to continuously nurse from a bottle of milk, formula or fruit juice at nap time or bed-time. You can help prevent this condition by always cleaning your infant’s mouth and teeth after nursing, and by giving your infant only water in a bottle or a pacifier at bedtime. You can also safeguard the health of your baby’s teeth by weaning your child from the bottle by the age of one.
What Else Can I Do To Safeguard My Child’s Smile?
A balanced diet is essential for children’s’ teeth to develop properly. Teeth, bones and soft tissue in the mouth will benefit from a diet consisting of a variety of healthy foods. Your child’s diet should include foods from all the five major food groups:
Breads, cereals and grains
Milk, cheese and yogurt
Meat, poultry and fish and their alternatives, such as beans, eggs and nuts
Discourage sugary and starchy snacks. Provide bite-sized fresh vegetables instead.
What If My Child Damages Or Knocks Out A Tooth?
Active children may chip or dislodge a tooth completely. Call us as soon as possible after the accident occurs. If the tooth is chipped, take the broken piece with you because we may be able to bond the piece back onto the tooth. If a healthy permanent tooth is completely knocked out, keep the tooth moist in milk or water and get to the dentist immediately. In most cases, teeth can be successfully replanted if they are brought to a dentist within the first hour after an accident. Do not wrap the tooth in tissue or gauze or let it dry out. If the tooth is a primary (baby) tooth, we may insert a space maintainer to keep the space open for a permanent tooth.
Are There Other Preventive Measures To Consider As The Child Gets Older?
At the appearance of your child’s first permanent molars, usually about age six, you should consider sealants to protect your child’s back teeth to help “seal out” decay. In some cases, we might also recommend applying sealants to primary teeth as well. This involves applying a thin plastic coating to the chewing surfaces of the back teeth. If your local water supply does not contain fluoride, we usually recommend a fluoride mouth rinse or other sources of extra fluoride.
At What Age Should My Child’s Teeth Appear?
Please refer to the list below to find out the approximate ages for tooth appearance. Since these are only averages, however, don’t be concerned if your child’s tooth development varies somewhat from this timetable.
When Primary (Baby) Teeth Appear
Central incisors : 8-12 mos.
Lateral incisors : 9-13 mos.
Cuspids : 16-22 mos.
First molars : 3-19 mos.
Second molars : 25-33 mos.
Second Molars : 23-31 mos.
First molars : 14-18 mos.
Cuspids : 17-23 mos.
Lateral incisors : 10-16 mos.
Central incisors : 6-10 mos.
When Permanent Teeth Appear
Central incisors : 7-8 yrs.
Lateral incisors : 8-9 yrs.
Cuspids : 11-12 yrs.
First bicuspids : 10-11 yrs.
Second bicuspids : 10-12 yrs.
First molars : 6-7 yrs.
Second molars : 12-13 yrs.
Third molars : 17-21 yrs. (wisdom teeth)
Third molars : 17-21 yrs. (wisdom teeth)
Second molars : 11-13 yrs.
First molars : 6-7 yrs.
Second bicuspids : 11-12 yrs.
First bicuspids : 10-12 yrs.
Cuspids : 9-10 yrs.
Lateral incisors : 7-8 yrs.
Central incisors : 6-7 yrs.
Cavities occur as a result of tooth decay. Tooth decay is the destruction of tooth structure. Tooth decay can affect both the enamel (the outer coating of the tooth) and the dentin layer of the tooth.
Tooth decay occurs when foods containing carbohydrates (sugars and starches) such as breads, cereals, milk, soda, fruits, cakes, or candy are left on the teeth. Bacteria that live in the mouth digest these foods, turning them into acids. The bacteria, acid, food debris, and saliva combine to form plaque, which clings to the teeth. The acids in plaque dissolve the enamel surface of the teeth, creating holes in the teeth called cavities, or caries.
Who Gets Cavities?
Many people think cavities only affect children, but changes that occur with aging make cavities an adult problem too. Recession of the gums (a pulling away of gum tissue from the teeth), often associated with an increased incidence of gingivitis (gum disease), can expose tooth roots to plaque. Also, sugary food cravings in pregnant women can make them more vulnerable to developing cavities.
Decay around the edges of fillings is also common in older adults. Because many older adults lacked the benefits of fluoride and modern preventive dental care when they were growing up, they often have a number of dental fillings. Over the years, these fillings may weaken and can fracture, allowing bacteria to accumulate in the tiny crevices causing tooth decay.
How Do I Know if I Have a Cavity?
Your dentist can discover cavities during your regular dental check-up. The tooth surface feels soft when probed by your dentist with a dental instrument. X-rays can also show cavities before they become visible to the eye.
In advanced stages of tooth decay, you might experience a toothache, especially after consuming sweet, hot, or cold foods or drinks. Other signs of tooth decay are visible pits or holes in the teeth.
How Are Cavities Treated?
Cavities are treated in a number of different ways depending on the extent of tooth decay. If decay is not extensive, the decayed portion of the tooth is removed by drilling and replaced with a filling made of silver alloy, gold, porcelain, or a composite resin. Restorative materials used in fillings are considered safe. Concerns have been raised over the safety of mercury-based, silver amalgams in particular, but the ADA, FDA, and other public health agencies continue to support the safety of this restorative material. Allergies to silver amalgam are rare as are allergies to other restorative materials.
If the decay is extensive and there is limited tooth structure remaining, crowns will be used. If a crown is needed, the decayed or weakened area of the tooth is removed and repaired and a crown is fitted over the remainder of the tooth. Crowns are made from gold, porcelain, or porcelain fused to metal.
If the decay causes the nerve or pulp of the tooth to die, a root canal will be performed. During the procedure, the center of the tooth (including the nerve, blood vessel, and tissue) is removed along with the decayed portions of the tooth. The roots are then filled with a sealing material. If necessary, a crown can be placed over the filled tooth.
Several new treatments are under development. One experimental technique uses fluorescent light to detect the development of cavities long before they can be detected by traditional means, such as x-rays or dental examination. In many cases, if cavities can be detected early, the decay process can be stopped or reversed.
What Causes Tooth Sensitivity?
Tooth sensitivity occurs when the underlying layer of your teeth – the dentin – becomes exposed as a result of receding gum tissue (the protective blanket that covers the tooth roots). The roots, which are not covered by hard enamel, contain thousands of tiny tubules leading to the tooth’s never center (the pulp). These dentinal tubules (or channels) allow the stimuli – for example, the hot, cold, or sweet food – to reach the nerve in your tooth, which results in the pain you feel.
There are many factors that may lead to the development of tooth sensitivity, including.
Brushing too hard. Over time, brushing too hard or using a hard-bristled toothbrush can wear down enamel and cause the dentin to be exposed. It can also cause recession of the gums (the gum tissue pulls away from the teeth)
Recession of the gums. As gums move away from a tooth due to conditions such as periodontal disease, the root surface becomes exposed.
Gum disease (gingivitis). Inflamed and sore gum tissue may cause sensitivity due to the loss of supporting ligaments, which exposes the root surface that leads directly to the nerve of the tooth.
Cracked teeth. Chipped or broken teeth may fill with bacteria from plaque and enter the pulp causing Inflammation.
Teeth grinding. grinding or clenching your teeth may wear down the enamel and expose underlying dentin.
Tooth whitening products or toothpaste with baking soda and peroxide. These products are major contributors to teeth sensitivity.
Your age. Tooth sensitivity is highest between the ages of 25 and 30.
Plaque build-up. The presence of plaque on the root surfaces can cause sensitivity.
Mouthwash use. Long-term use of some mouthwashes. Some over-the-counter mouthwashes contain acids that can worsen tooth sensitivity if you have exposed dentin (the middle layer of the tooth). The acids further damage the dentin layer of the tooth. If you have dentin sensitivity, ask your dentist about the use of a neutral fluoride solution.
Acidic foods. Regular consumption of foods with a high acid content, such as citrus fruits, tomatoes, pickles and tea, can cause enamel erosion.
Recent routine dental procedures. Sensitivity can occur following teeth cleaning, root planing, crown placement, and tooth restoration. Sensitivity caused by dental procedures is temporary, usually disappearing in 4 to 6 weeks.
What Can I Do to Reduce Tooth Sensitivity?
Maintain good oral hygiene. Continue to follow proper brushing and flossing techniques to thoroughly clean all parts of your teeth and mouth.
Use a soft bristled toothbrush. This will result in less toothbrush abrasion to the tooth surface and less irritation to your gums. Brush gently and carefully around the gum line so you do not remove more gum tissue.
Use desensitizing toothpaste. There are several brands of toothpaste available for sensitive teeth. With regular use you should notice a decrease in sensitivity. You may need to try several different brands to find the product that works best for you. Another tip. spread a thin layer of the toothpaste on the exposed tooth roots with your finger or a Q-tip before you go to bed. Do not use a tartar control toothpaste; rather, use a fluoridated toothpaste.
Watch what you eat. Frequent consumption of highly acid foods can gradually dissolve tooth enamel and lead to dentin exposure. They may also aggravate the sensitivity and start the pain reaction.
Use fluoridated dental products. Daily use of a fluoridated mouth rinse can decrease sensitivity. Ask your dentist about available products for home use.
Avoid teeth grinding. If you grind or clench your teeth, use a mouth guard at night.
See your dentist at regular intervals. Get professional tooth cleaning, oral hygiene instructions, and fluoride treatments every 6 months.
If you still have discomfort, talk to your dentist. There may be some dental procedures that may help reduce sensitivity, including the use of:
White fillings (bonding) to cover exposed root surfaces
Fluoride varnishes applied to the exposed root surface
Dentin sealers applied to the exposed root surface
Gingivitis and Periodontal Disease
Gingivitis, also generally called gum disease or periodontal disease, describes the events that begin with bacterial growth in your mouth and may end – if not properly treated – with tooth loss due to destruction of the tissue that surrounds your teeth.
What’s the Difference Between Gingivitis and Periodontics?
Gingivitis usually precedes periodontics. However, it is important to know that not all gingivitis progresses to periodontics.
In the early stage of gingivitis, bacteria in plaque build up, causing the gum’s to become inflamed (red and swollen) and often easily bleed during tooth brushing. Although the gums may be irritated, the teeth are still firmly planted in their sockets. No irreversible bone or other tissue damage has occurred at this stage.
When gingivitis is left untreated, it can advance to periodontists. In a person with periodontists, the inner layer of the gum and bone pull away from the teeth and form pockets. These small spaces between teeth and gum’s collect debris and can become infected. The body’s immune system fights the bacteria as the plaque spreads and grows below the gum line.
Toxins or poisons – produced by the bacteria in plaque as well as the body’s “good” enzymes involved in fighting infections – start to break down the bone and connective tissue that hold teeth in place. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. When this happens, teeth are no longer anchored in place, they become looser, and tooth loss occurs. Gum disease, in fact, is the leading cause of tooth loss in adults.
What Causes Periodontal Disease?
Plaque is the primary cause of periodontal disease. However, other factors can contribute to gum disease. These include:
Hormonal changes such as those occurring during pregnancy, puberty, menopause, and monthly menstruation-make gums more sensitive, which makes it easier for gingivitis to develop.
Illnesses may affect the condition of your gum’s. This includes diseases such as cancer or HIV that interfere with the immune system. Because diabetes affects the body’s ability to use blood sugar, patients with this disease are at higher risk of developing infections, including periodontal disease.
Medications can affect oral health because some lessen the flow of saliva, which has a protective effect on teeth and gums. Some drugs, such as the anticoagulant medication Dilantin and the anti-angina drug Procardia and Adalat, can cause abnormal growth of gum tissue.
Bad habits such as smoking make it harder for gum tissue to repair itself.
Poor oral hygiene habits such as not brushing and flossing on a daily basis, make it easier for gingivitis to develop.
Family history of dental disease can be a contributing factor for the development of gingivitis.
What Are the Symptoms of Periodontal Disease?
Periodontal disease may progress painlessly, producing few obvious signs, even in the late stages of the disease. Although the symptoms of periodontal disease often are subtle, the condition is not entirely without warning signs. Certain symptoms may point to some form of the disease. They include:
Gum’s that bleed during and after tooth brushing
Red, swollen, or tender gum’s
Persistent bad breath or bad taste in the mouth
Formation of deep pockets between teeth and gum’s
Loose or shifting teeth
Changes in the way teeth fit together upon biting down, or in the fit of partial dentures.
Even if you don’t notice any symptoms, you may still have some degree of gum disease. In some people, gum disease may affect only certain teeth, such as the molars. Only a dentist or a periodontist can recognize and determine the progression of gum disease
How Does My Dentist Diagnose Periodontal Disease?
During a periodontal exam, your dentist or periodontist typically checks for these things:
Gum bleeding, swelling, firmness, and pockets (the space between the gum and tooth; the larger and deeper the pocket, the more severe the disease)
Teeth movement and sensitivity and proper teeth alignment
Your jawbone to help detect the breakdown of bone surrounding your teeth
How Is Periodontal Disease Treated?
The goals of periodontal treatment are to promote reattachment of healthy gums to teeth; reduce swelling, the depth of pockets, and the risk of infection; and to stop disease progression. Treatment options depend on the stage of disease, how you may have responded to earlier treatments, and your overall health. Options range from nonsurgical therapies that control bacterial growth to surgery to restore supportive tissues. A full description of the various treatment options is provided in Gum Disease Treatments.
How Can Gingivitis Be Prevented?
Gingivitis can be reversed in nearly all cases when proper plaque control is practiced. Proper plaque control consists of professional cleanings at least twice a year and daily brushing and flossing. Brushing eliminates plaque from the surfaces of the teeth that can be reached; flossing removes food particles and plaque from in between the teeth and under the gum line.
Other health and lifestyle changes that will decrease the risk, severity, and speed of gum disease development include:
Stop smoking. Tobacco use is a significant risk factor for development of periodontitis. Smokers are seven times more likely to get periodontitis than nonsmokers, and smoking can lower the chances of success of some treatments.
Reduce stress. Stress may make it difficult for your body’s immune system to fight off infection.
Maintain a well-balanced diet. Proper nutrition helps your immune system fight infection. Eating foods with antioxidant properties, for example, those containing vitamin E or vitamin C (vitamin E-containing foods include vegetable oils, nuts, green leafy vegetables; vitamin C-containing foods include citrus fruits, broccoli, potatoes) can help your body repair damaged tissue.
Avoid clenching and grinding your teeth. These actions may put excess force on the supporting tissues of the teeth and could increase the rate at which these tissues are destroyed.
Despite following good oral hygiene practices and making other healthy lifestyle choices, the American Academy of Periodontology says that up to 30% of the Americans may be genetically susceptible to gum disease. And those who are genetically predisposed may be up to six times more likely to develop some form of gum disease. If anyone in your family has gum disease, it may mean that you are at greater risk as well. If you are more susceptible to gum disease, your dentist or periodontist may recommend more frequent check-ups, cleanings, and treatments to better manage the condition.
Is Periodontal Disease Linked to Other Health Problems?
According to the CDC, researchers have uncovered potential links between periodontal disease and other serious health conditions. In people with healthy immune systems, the bacteria in the mouth that makes its way into the bloodstream is usually harmless. But under certain circumstances, the CDC says these microorganisms are associated with health problems such as stroke and heart disease. Diabetes is not only a risk factor for periodontal disease, but periodontal disease may make diabetes worse.
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