What is a Pediatric Dentist?

Pediatric dentists have an extra 2-3 years of specialized training after their 4-year dental school education and are dedicated to the oral health of children from infancy through the teenage years.  The very young, pre-teens, and teenagers all need different approaches in dealing with behavior, guiding their growth and development, and helping them avoid future dental problems.  With the additional education, pediatric dentists have the training which allows them to offer the most up-to-date and thorough treatment for a wide variety of pediatric dental problems.

 

How old should my child be to come to the dentist?

According to the American Academy of Pediatrics (AAP) and the American Academy of Pediatric Dentistry (AAPD), your child should visit the dentist by their 1st birthday or within no more than 6 months after the eruption of their first tooth. Beginning dental care at an early age allows guidance for caring for your child's teeth and opportunities to address preventive issues that are important for healthy teeth and a pleasing smile. Early visits also help establish a positive relationship between the dentist and your child.

 

After meeting you and your child, we will use their behavior (and yours!) to determine how quickly we introduce different tools and verbiage.  When appropriate, we will build up to comprehensive preventive care visits which may include examination, cleaning, fluoride treatments, and appropriate radiographs.

 

Why are baby teeth so important?

It is very important to maintain the health of the primary teeth. Neglected cavities can and frequently do lead to problems which affect developing permanent teeth. Primary teeth, or baby teeth are important for (1) proper chewing and eating, (2) providing space for the permanent teeth and guiding them into the correct position, and (3) permitting normal development of the jaw bones and muscles. Primary teeth also affect the development of speech and add to an attractive appearance. While the front 4 teeth last until 6-7 years of age, the back teeth (cuspids and molars) aren’t replaced until age 10-13.

 

Eruption of your child's teeth:

Children’s teeth begin forming before birth. As early as 4 months, the first primary (or baby) teeth to erupt through the gums are the lower central incisors, followed closely by the upper central incisors. Although all 20 primary teeth usually appear by age 3, the pace and order of their eruption varies. Permanent teeth begin appearing around age 6, starting with the first molars and lower central incisors. At the age of 8, you can generally expect the bottom 4 primary teeth (lower central and lateral incisors) and the top 4 primary teeth (upper central and lateral incisors) to be gone and permanent teeth to have taken their place. There is about a one to two year break from ages 8-10 and then the rest of the permanent teeth will start to come in. This process continues until approximately age 21.

Adults have 28 permanent teeth, or up to 32 including the third molars (or wisdom teeth).

 

 

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Why does my child need x-rays?

Radiographs (x-rays) are a necessary part of your child's dental diagnostic process.  Without them, certain cavities and pathologies will be missed.  They help survey developing teeth, sinuses, bones, and other structures, identify missing or extra teeth, evaluate results of an injury, observe cysts and tumors, identify periodontal disease, and plan orthodontic treatment.  If dental problems are found and treated early, dental care is more comfortable for your child and more affordable for you.

 

On average, our office will request bitewing radiographs approximately once a year and panoramic radiographs every 3-5 years.  In children with a high risk of tooth decay, we will recommend radiographs and examinations every six months.

 

With contemporary safeguards, the amount of radiation received in a dental x-ray examination is extremely small.  The risk is negligible.  In fact, the dental radiographs represent a far smaller risk than an undetected and untreated dental problem.  Lead body aprons and shields will protect your child. Today's equipment restricts the beam to the area of interest.  Our office also employs digital radiography which allows us to decrease the amount of radiation exposure.

 

What are sealants, fillings and crowns?

Sealants are used to help prevent decay by protecting the deep grooved and pitted surfaces of the teeth, especially the chewing surfaces of back molars where most toothbrushes cannot reach. This is where the majority of cavities are found!  The sealant acts as a barrier to the invasion of bacteria, food, plaque, and acid, and therefore protects the high-risk areas of the molars. We match the color of your child’s tooth so that the material is hardly noticeable, like an invisible forcefield of protection. Research shows that sealants help protect against cavities for many years with the help of good oral hygiene and avoiding biting into hard objects or foods like ice or hard candy that might chip the sealants.

 

If your child has a cavity, a filling is placed after the deceased portion of the tooth is cleaned away.  We use tooth-colored (white) fillings.  In our practice, when a tooth needs a filling, a sealant is placed over the filling and the remaining tooth grooves for added protection.

 

In a primary tooth, if a cavity is too large to restore with a filling, a crown may be recommend or the tooth may need to come out.  If the cavity is too large and has involved the nerve of the tooth, then the nerve will be removed (pulpotomy) along with the cavity, and a crown will be placed.  A crown can either be tooth colored or stainless steel.  For front teeth, white crowns are routinely used for esthetics.  For back teeth, stainless steel crowns are used for their durability and longevity.  The purpose of the crown is to help provide structural rehabilitation for the tooth, to help maintain space for permanent teeth to erupt properly, and to help protect the remaining tooth from breakage or further compromise.

 

What about sedation?

Small procedures in cooperative children can often be done under local anesthesia with nitrous oxide.  The most common form of sedation we routinely use in our office is nitrous oxide (laughing gas).  This is given through a small breathing mask that is placed over your child's nose.  The AAPD recognizes this technique as a very safe, effective technique to help relax your child during treatment.

 

Slightly more involved procedures in certain children may require the use of an oral medication along with nitrous oxide to help relax your child and facilitate cooperation with the procedure.  These procedures are scheduled carefully.  We require your child to be fasting the morning of the procedure and be free of any respiratory symptoms in the two weeks preceding the procedure.  There are some medical conditions that make oral sedation inappropriate for certain children.  This is why providing us with all the details of your child's medical history is critical for their safety.  Often we ask that two adults be present so that one is able to sit in the back seat with your child on the drive home.

 

Some children require an extensive amount of dental work or have high anxiety levels.  In these situations, it is difficult for a small child to cooperate fully, and often the treatment cannot be done properly.  For these children, we may recommend treating your child under general anesthesia.  In this circumstance, your child would be treated by a team including an anesthesiologist in addition to our dental team. The child would be completely asleep just like if they were getting ear tubes or their tonsils removed.

 

Can I go back with my child?

We do not have any policy that restricts parents from being with their child during their visit.  We do feel that children vary as individuals.  It has been our experience that most children do better with the parents waiting in the reception area.  There are exceptions, and there are certain children who will have a better experience if the parents are with them throughout the visit.

 

We require that one parent or legal guardian be present with the child for their initial visit.  We need to discuss details of the child's medical, dental and social history and a legal guardian must be present to give consent for care on the first day and for future appointments.  If the child requires treatment during another visit, the need for parental presence should be discussed between the dentist and the parent and decided on a case-by-case basis.  It is important to refrain from bringing several family members to your child's appointments.  We set this time aside to treat one child; it can be detrimental to the quality of care if the treatment room has other distractions for the dental team and the child.  It works best if one person or less accompanies the child during their treatment appointments.  Please respect our expertise in this situation.

 

What can I do about my child’s toothache?

Start by cleaning the area of the affected tooth.  Rinse the mouth thoroughly with warm water, brush, and use dental floss to dislodge any food that may be impacted.  If the pain still exists, contact your child's dentist.  Do not place aspirin or heat on the gum or on the aching tooth.  Pain medications like aspirin, Tylenol, and 7iburpofen work best if swallowed.  Please follow the dosage instructions on the package.  If the face is swollen, apply cold compresses and contact your dentist immediately.

 

Cut or Bitten Tongue, Lip or Cheek: Rinse the mouth or area of injury with warm salt water or hydrogen peroxide diluted with water (50% water & 50% hydrogen peroxide). If the patient's lip or cheek is swollen, apply cold compresses. Take the patient to a dentist.  Apply ice to injured areas to help control swelling. If there is bleeding, apply firm but gentle pressure with a gauze or cloth. If bleeding cannot be controlled by simple pressure, call your dentist, physician, or visit the hospital emergency room.

 

Knocked Out Permanent Tooth: If possible, find the tooth. Handle it by the crown, not by the root. You may rinse the tooth with water only. DO NOT clean with soap, scrub or handle the tooth unnecessarily. Inspect the tooth for fractures. If it is sound, try to reinsert it in the socket. Have the patient hold the tooth in place by biting on a gauze or clean cloth. If you cannot reinsert the tooth, transport the tooth in a cup containing the patient’s saliva or milk, NOT water. If the patient is old enough, the tooth may also be carried in the patient’s mouth (beside the cheek). The patient must see a dentist IMMEDIATELY! Time is a critical factor in saving the tooth.

 

Knocked Out Baby Tooth: Contact your pediatric dentist.  Unlike with a permanent tooth, the baby tooth should not be replanted in the socket due to possible damage to the developing permanent tooth underneath, however, prompt care by a dentist is recommended.

 

Chipped/Fractured Permanent Tooth: Time is a critical factor, contact your pediatric dentist immediately so as to reduce the chance for infection or the need for extensive dental treatment in the future. Rinse the mouth with water and apply a cold compress to reduce swelling.  If you can find the broken tooth piece, bring it with you to the dentist.

Chipped/Fractured Baby Tooth: Contact your pediatric dentist.

 

Severe Blow to the Head: Call 911 immediately or take your child to the nearest hospital emergency room.

 

Possible Broken or Fractured Jaw: Keep the jaw from moving and take your child to the nearest hospital emergency room or oral surgeon.

 

Broken Braces and Wires: If a broken appliance can be removed easily, take it out. If it cannot, cover the sharp or protruding portion with wax. If a wire is stuck in the gum, cheek or tongue, do not remove it. Take the patient to a dentist immediately. Asymptomatic loose or broken appliances do not usually require emergency attention.

 

What's The Best Toothpaste For My Child? Tooth brushing is one of the most important tasks for good oral health. Many toothpastes, and/or tooth polishes, however, can damage young smiles. They contain harsh abrasives, which can wear away young tooth enamel. When looking for a toothpaste for your child, make sure to pick one that is recommended by the American Dental Association as shown on the box and tube. These toothpastes have undergone testing to insure they are safe to use. Use only a smear of toothpaste (the size of a grain of rice) to brush the teeth of a child less than 3 years of age. For children 3 to 6 years old, use a "pea-size" amount of toothpaste and perform or assist your child’s toothbrushing. Remember that young children do not have the ability to brush their teeth effectively on their own. Children should spit out and not swallow excess toothpaste after brushing.  Rinsing is not always recommended, ask your dentist.

 

 

Helpful links on brushing:

 

The Perfect Technique

 

25IdeastoMakeBrushingFun

 

3WaysToPrevent8Cavities

 

Natural Toothpastes

 

What is a Pediatric Dentist?

Pediatric dentists have an extra 2-3 years of specialized training after their 4-year dental school education and their 4-year baccalaureate degree and are dedicated to the oral health of children from infancy through the teenage years, including those with special health care needs.  The very young, pre-teens, and teenagers all need different approaches in dealing with behavior, guiding their growth and development, and helping them avoid future dental problems.  With the additional education, pediatric dentists have the training which allows them to offer the most up-to-date and thorough treatment for a wide variety of pediatric dental problems.

 

When should my child first come to the dentist?

While we often see children much earlier, according to the American Academy of Pediatrics (AAP) and the American Academy of Pediatric Dentistry (AAPD), your child should visit the dentist by their 1st birthday or within no more than 6 months after the eruption of their first tooth. Beginning dental care at an early age allows guidance for caring for your child's teeth and opportunities to address preventive issues that are important for healthy teeth and a pleasing smile. Early visits also help establish a positive relationship between the dentist and your child.  Starting by age 1 can also save your family time and money; studies have shown that compared to kids that started dental care at age 1, those that started later ended up with more expenses and more required treatment.

 

After meeting you and your child, we will use their behavior (and yours!) to determine how quickly we introduce different tools and verbiage.  When appropriate, we will build up to comprehensive preventive care visits which may include examination, cleaning, fluoride treatments, and appropriate radiographs.

 

One purpose of this visit is to educate parents on proper oral hygiene, nutrition, and oral habits. We will assess growth and dental development of your baby and offer recommendations that will help lead to a lifetime of beautiful smiles. You’ll have the opportunity to ask as many questions as you desire, because we all know that babies don’t come with a handbook!

 

Why are baby teeth so important?

It is very important to maintain the health of the primary teeth. Neglected cavities can and frequently do lead to problems which affect developing permanent teeth. Primary teeth, or “baby teeth”, are important for (1) proper chewing and eating, (2) providing space for the permanent teeth and guiding them into the correct position, and (3) permitting normal development of the jaw bones and muscles. Primary teeth also (4) affect the development of speech and (5) add to an attractive appearance. While the front 4 teeth last until 6-7 years of age, the back teeth (cuspids and molars) aren’t replaced until age 10-13.

 

When will my child get teeth?

Eruption of your child's teeth:

Children’s teeth begin forming before birth. As early as 4 months, the first primary (or baby) teeth to erupt through the gums are the lower central incisors, followed closely by the upper central incisors. Although all 20 primary teeth usually appear by age 3, the pace and order of their eruption varies. Permanent teeth begin appearing around age 6, starting with the first molars and lower central incisors. At the age of 8, you can generally expect the bottom 4 primary teeth (lower central and lateral incisors) and the top 4 primary teeth (upper central and lateral incisors) to be gone and permanent teeth to have taken their place. There is about a one-to-two-year break from ages 8-10 and then the rest of the permanent teeth will start to come in. This process continues until approximately age 21.

Adults have up to 32 permanent teeth including the third molars (aka wisdom teeth).

 

 

 

 

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Does my child need x-rays?

Radiographs (x-rays) might be a necessary part of your child's dental diagnostic process.  We embrace the use of digital x-ray technology which reduces your child’s radiation exposure by up to 90% and eliminates the use of chemicals. We use pediatric-sized x-ray sensors along with up-to-date technology that gives us the ability to operate in a chartless environment. This allows us quick and easy access to your child’s important information all while giving them the most optimal care tailored to their age and size – not to mention helps us save a ton of trees. It’s better for children and the environment.

 

Digital x-rays allow the doctor to get a view of your child’s teeth and jaws that she can’t see with her eyes. Without them, certain cavities and pathologies will be missed.  They help survey developing teeth, sinuses, bones, and other structures, identify missing or extra teeth, evaluate results of an injury, observe cysts and tumors, identify periodontal disease, and plan orthodontic treatment.  If dental problems are found and treated early, dental care is more comfortable for your child and more affordable for you.

 

The American Academy of Pediatric Dentistry recommends x-rays every six months to help detect cavities that can’t be seen by the naked eye, but the frequency is often less depending on your child’s risk for cavities. On average, our office will request intraoral radiographs approximately once a year and panoramic radiographs every 3-5 years.  In children with a high risk of tooth decay, we may recommend radiographs and examinations every six months. Keeping your child cavity-free will reduce the need for radiographs.  In cases of trauma, an appropriate radiograph frequency will be developed for each affected tooth and area of the oral cavity.

 

With contemporary safeguards, the amount of radiation received in a dental x-ray examination is extremely small.  Moreover, our team uses the utmost caution in protecting and minimizing your child’s exposure to radiation by using lead aprons and up-to-date equipment.  In fact, the dental radiographs represent a far smaller risk than an undetected and untreated dental problem.  While we’re all for the best possible early dental care, we also believe in an “Image Gently” approach. Though x-rays can be a necessary component of preventative health, we do believe there is a balance. We only take x-rays when we feel they are necessary and do not believe in taking them if not needed.

 

 

What are sealants, fillings and crowns?

Sealants are used to help prevent decay by protecting the deep grooved and pitted surfaces of the teeth, especially the chewing surfaces of back molars where most toothbrushes cannot reach. This is where many cavities are found!  The sealant acts as a barrier to the invasion of bacteria, food, plaque, and acid, and therefore protects the high-risk biting surface areas of the molars. We use clear sealants or match the color of your child’s tooth so that the material is hardly noticeable, like an invisible forcefield of protection. Research shows that sealants help protect against cavities for many years with the help of good oral hygiene and avoiding biting into hard objects or foods like ice or hard candy that might chip the sealants.

 

If your child has a cavity, a filling is placed after the deceased portion of the tooth is cleaned away.  We use tooth-colored (white) fillings.  In our practice, when a tooth needs a filling, a sealant is placed over the filling and the remaining tooth grooves for added protection.  Our office uses only mercury-free restorative materials.

 

In a primary tooth, if a cavity is too large to restore with a filling, a crown may be recommended, or the tooth may need to come out.  If the cavity is too large and has involved the nerve of the tooth, then the nerve will be treated (pulpotomy) along with the cavity, and a crown will be placed.  A crown can either be tooth colored (white) or stainless steel (silver).  Stainless steel crowns are mercury free.  For front teeth, white crowns are routinely used for esthetics.  For back teeth, stainless steel crowns are used for their durability and longevity.  We can offer white crowns for back teeth if we feel that treatment is appropriate for that tooth and that child.  The purpose of the crown is to help provide structural rehabilitation for the tooth, to help maintain space for permanent teeth to erupt properly, and to help protect the remaining tooth from breakage or further compromise.

 

 

What about sedation?

Small procedures in cooperative children can often be done under local anesthesia with nitrous oxide.  The most common form of sedation we routinely use in our office is nitrous oxide (laughing gas).  This is given through a small breathing mask that is placed over your child's nose.  The AAPD recognizes this technique as a very safe, effective technique to help relax your child during treatment.

 

Slightly more involved procedures in certain children may require the use of additional medications to help relax your child and facilitate cooperation with the procedure.  These procedures are scheduled carefully.  We require your child to be fasting the morning of the procedure and be free of any respiratory symptoms preceding the procedure.  There are some medical conditions that make sedation inappropriate for certain children.  This is why providing us with all the details of your child's medical history is critical for their safety.  Often, we ask that two adults be present so that one can sit in the back seat  of the car with your child on the drive home.

 

Some children require an extensive amount of dental work or have high anxiety levels.  In these situations, it is difficult for a small child to cooperate fully, and often the treatment cannot be done properly.  For these children, we may recommend treating your child under general anesthesia.  In this circumstance, your child would be treated by a team including an anesthesiologist in addition to our dental team. The child would be completely asleep just like if they were getting ear tubes or their tonsils removed.  Bluebird provides this service at the office and at Watauga Medical Center.  Our team will help you determine which is appropriate for your child.

 

 

Can I go back with my child?

Yes.  We invite you to stay with your child during the initial examination. We believe that parents have a huge responsibility in their child’s oral health.  Because of this, we always invite parents to join their child in their private exam room and share their first experiences.

 

While we do not have any policy that restricts parents from being with their child during their visit, for some visits we MAY suggest you allow your child to accompany our staff through the dental experience. We can usually establish a closer rapport with your child when you are not present. Our purpose is to gain your child's confidence and overcome apprehension. However, if you choose, you may come with your child to the treatment room.

We all know that children vary as individuals.  It has been our experience that most children do better with the parents waiting in the Bluebird Lounge.  There are exceptions, and there are certain children who will have a better experience if the parents are with them throughout the visit.

 

We require that one parent or legal guardian be present with the child for their initial visit.  We need to discuss details of the child's medical, dental, and social history and a legal guardian must be present to give consent for care on the first day and for future appointments.  If the child requires treatment during another visit, the need for parental presence should be discussed between the dentist and the parent and decided on a case-by-case basis.

 

For the safety and privacy of all patients, other children who are not being treated or seen on the same day should not come to the office or be prepared for them to wait in the Bluebird Lounge with an adult.

 

It is important to refrain from bringing several family members to your child's appointments.  We set this time aside to treat one child; it can be detrimental to the quality of care if the treatment room has other distractions for the dental team and the child.  It works best if one person or less accompanies the child during their treatment appointments.  Please respect our expertise in this situation.

 

 

Sedation and General Anesthesia:

Sedation dentistry refers to the use of sedation during dental treatment. Our office offers nitrous oxide (laughing gas), general anesthesia at Bluebird, and general anesthesia at Watauga Medical Center.

 

A consultation and thorough review of health history is required to help us determine which option is best.

 

 

What's the best toothpaste for my child?

Tooth brushing is one of the most important tasks for good oral health. The best toothpaste for your child is the one they like and are willing to use.  We will make recommendations for you based on health and dental history.  We may recommend a toothpaste with or without fluoride, or with chlorhexidine, without SLS, or a white paste instead of a gel, depending on your child’s needs.  When looking for a toothpaste for your child, make sure to pick one that is recommended by the American Dental Association as shown on the box and tube. These toothpastes have undergone testing to insure they are safe to use. Use only a smear of toothpaste (the size of a grain of rice) to brush the teeth of a child less than 3 years of age. For children 3 to 6 years old, use a "pea-size" amount of toothpaste and perform or assist your child’s toothbrushing. Remember that young children do not have the ability to brush their teeth effectively on their own. Children should spit out and not swallow excess toothpaste after brushing.  Rinsing is not always recommended, ask your dentist.

 

Some toothpastes, and/or tooth polishes, however, can damage young smiles.  As an example, tartar control and whitening toothpastes contain harsh abrasives, which can wear away young tooth enamel and are not often recommended for children.

 

 

What is baby bottle tooth decay?

One of the most common forms of early childhood caries is “baby bottle tooth decay,” which is caused by the continuous exposure of a baby’s teeth to sugary drinks. Baby bottle tooth decay primarily affects the upper front teeth, but other teeth may also be affected.

 

The earliest symptoms of baby bottle tooth decay are white spots on the surface of teeth or on the gum line. This can be followed by tooth sensitivity. Children may exhibit tooth sensitivity by trying to avoid toothbrushing.  More severe symptoms can appear in advanced stages of baby bottle tooth decay, and include brown or black spots on teeth, broken teeth, bleeding or swollen gums, fever, and bad breath. If your child shows any of these symptoms, you need to see your pediatric dentist immediately to prevent further, more complicated problems from occurring.

 

How can I prevent baby bottle tooth decay?

1 - Don’t send your child to bed with a bottle, cup, or sippy cup of anything EXCEPT water.

2 - Clean your baby's gums after each meal, even before they have teeth.

3 -Begin brushing teeth twice daily as soon as you see their first tooth.

4 - Limit sugary drinks and foods.

 

 

What are "shark teeth"?

When adult teeth come in behind the baby teeth can be called “Shark Teeth” because there is more than one row of teeth, like a shark! It is common and occurs as the result of a lower baby tooth not falling out when the permanent tooth is arriving. In most cases, the baby tooth will fall out on its own within a couple of weeks. If the baby tooth is not loose and does not fall out in a few weeks, please call our office for advice.

 

 

My child snores and often seems to stop breathing during sleep. What could cause this?

If your child snores or shows other signs of disturbed sleep including pauses in breathing, tossing and turning in the bed, chronic mouth breathing, tooth grinding, night sweats, this may be an indication of sleep disordered breathing (SDB) or even sleep apnea.  This is far more common than parents realize and is most often seen in children between 2 and 8 years old, although it can present itself at any age.

 

If your child is suffering from these symptoms, we can help determine underlying causes.  We will evaluate your child for tethered oral tissues that can cause these issues.  We may refer your child to an Ear, Nose and Throat (ENT) doctor or a sleep medicine facility for further evaluation.  While there is a possibility that affected children will grow out of their sleep disorders, the evidence is steadily growing that untreated pediatric sleep disordered breathing can affect attention-deficit hyperactivity disorder (ADHD), bed-wetting, sleep walking, and even failure to thrive.

 

 

Can my child's diet affect their teeth?

Children should eat a variety of foods including grains, fruits, protein, and vegetables. Raw vegetables like carrots, celery, and bell pepper are excellent snacking alternatives to unhealthy chips and crackers. Starchy carbs like dry cereal, goldfish, potato chips and crackers stick to teeth and cause unhealthy buildup, which can lead to cavities. Fibrous vegetables like celery can actually clean your teeth as you eat them! That is also true of fibrous fruits like apples, strawberries and banana.

 

So, choose raw fruits and vegetables instead of chips and crackers, they are better for your overall health, and they won’t stick to your teeth like starchy carbs and sugars. Limit drinks that are not water to mealtimes only.  You will hear us say this in the office "Water anytime, milk with meals, juice and soda only on special occasions."

Gummy and sticky foods can stick to the teeth even longer!  Granola bars, fruit snacks, gummy candy, gummy vitamins, raisins and similar snacks get stuck all over the teeth and can take a long time to wash away (think hours or even days!).  Avoid these foods unless you know you will be brushing and flossing your child's teeth soon after.

 

Click this link to see even more recommendations for healthy shopping, eating, and packed lunch ideas.

 

 

Emergencies:

Please click here for our emergencies page. For the most up to date information on how to handle a dental trauma, please access this website: https://dentaltraumaguide.org/

 

 

 

Helpful links on brushing:

 

25IdeastoMakeBrushingFun

 

3WaysToPrevent8Cavities

 

Natural Toothpastes