Primary "baby" teeth are designed to function throughout the childhood years. Some of your child's baby teeth are not lost until age 12. They help in the development of face and jaws and support facial structures and tissues (just imagine grandpa without his dentures on). They are also important for eating, and chewing food to aid in proper digestion through your child's "growing" years.
Another vital function of primary teeth is holding space and guiding the permanent teeth in place. Baby teeth have relatively thin enamel (hard outer-layer of teeth) and large pulps compared with adult teeth, and can become decayed and infected (abscessed) easily. Infected baby teeth can damage your child's adult (permanent) tooth developing below them. Healthy, decay-free primary teeth create a healthy environment for your child's permanent teeth and reduce the chance for tooth decay. Give your child a healthy self-esteem with a healthy, beautiful smile.
Look Mom...No Cavities! How To Raise A Cavity-Free Child top
written by Gregory F. George, DDS and illustrated by John D. Valerio
A guide to raising cavity-free children, written by a pediatric dentist with over 17 years of experience. Enjoy reading a simple and effective program for cavity-prevention and dental maintenance. This book explains how cavities form, what you can do to prevent them for your child, where the most common problems occur, why it is so important to avoid cavities, which foods help prevent cavities, and how breast & bottle feeding can cause infant tooth decay.
When Should My Child First Visit The Dentist? top
You should bring your child in for a first dental visit by no later than their first birthday, or even by the time they get their first tooth, usually between 6 to 12 months old, as recommended by the AAPD and ADA. Experience what our team likes to call our Infant Oral "Well-Baby" Exam.
What Can I Expect At My Child's Infant Oral "Well-baby" Exam? top
Your baby's "Well-Baby" Exam is a simple visual exam to evaluate your child's oral health and determine his/her risk for developing dental disease. A gentle prophy cleaning and fluoride application is performed by one of our child-friendly dental assistants. Usually, no radiographs (x-rays) are taken at this appointment.
Feel confident about your child's care as Dr. Hsu also looks for relatively common and uncommon oral conditions affecting infants that you may not have heard of, such as tongue-tie, missing teeth, abnormal teeth, inclusion cysts (Epstein's Pearls, Bohn's Nodules, Dental Lamina Cysts), natal teeth, iron stain and primary herpetic gingivastomatitis.
You'll receive guidance to help you prevent potential problems and dental disease in your child's future. Along the way, feel free to ask any questions you may have about your child's new teeth and oral health. Let your infant become familiarized with the dental office setting in a positive way, before he/she gets bombarded with negative propaganda from older siblings, peers or even dental-phobic parents. Enjoy this primary prevention visit where dentistry is "fun", and future dental disease can be prevented!
Special Bonus! Parents will receive a memento of their baby's first dental visit in a special photo card frame.
Dental Conditions Affecting Young Children (Several Examples): top
(Note - these photos are not intended for diagnosis, please call Dr. Hsu if you believe your child has any abnormal dental/oral conditions)
Tongue-tie (Ankyloglossia) top
Tongue-tie is a common condition where the lingual frenum (a membrane connecting the underneath of the tongue to the floor of the mouth) is connected abnormally "high up" towards or at the tip of the tongue, restricting the movement and extension of the tongue.
At birth, and for a few days after, the newborn's mouth contains a little membrane that "ties" the tongue to the gum just behind the lower arch. This membrane places the tongue in the proper position for nursing. This membrane usually shrinks and disappears in a few days allowing the newborn to stretch the tongue forward. However, in some cases, the membrane turns into heavy tissue thereby "tying" the tongue and preventing the tongue from extending forward. This may result in breast-feeding difficulties.
There is controversy as to whether or not tongue-tie causes speech problems. Research has suggested that tongue-tie does not cause a delay in speech onset, however it may interfere with proper articulation. Tongue-tie is also thought to restrict growth of the mandible (lower jaw) resulting in malocclusion, cause lower incisor deformity, and cause gingival recession; although these associations have not been proven conclusively. Beyond this, children may be teased about their tongue-tie. Children affected by tongue-tie may not be able to lick ice cream, play a musical wind instrument, or even kiss. Surgical correction may be indicated for your child's tongue-tie, however not usually during infancy because of reported postsurgical bilateral infection of the submandibular glands.
When Can I Expect My Child's Pearly Whites? top
When your baby was born, all 20 primary teeth were already present and developing in their jawbones. The first tooth to arrive is usually the lower front incisor, which usually erupts into the mouth at around 6 months of age, but could be earlier or later. There are even a very few babies born with lower front teeth, they are called natal teeth.
By 3 years of age, all of your baby's 20 primary teeth are usually fully erupted. The first permanent tooth to erupt is also usually the lower front incisor and this occurs approximately at 6 years of age.
Girls tend to get their teeth slightly quicker than boys. There is not much difference, but those whose teeth erupt later tend to have somewhat higher resistance to dental decay. By 12-13 years of age, all of the baby teeth are usually gone, and all of the permanent "adult" teeth are in except for the 3rd molars (wisdom teeth), which most often arrive by age 21.
The animations teach about:
- Primary Teeth/Permanent Teeth/Tooth Eruption
- Periodontal Disease
- Root Canal Treatment
Look! My Tooth Is Loose! top
by Patricia Brennan Demuth and
illustrated by Mike Cressy.
"Every kid looks forward to losing that first wobbly, jiggly, loose baby tooth. But why do we have baby teeth in the first place? And why do they fall out? Is pulling teeth really as painful as-well, pulling teeth? From getting and losing their first set of teeth to growing and taking care of their second and last set, kids will learn all about teeth. In addition, there is a great big full-color poster (16 x 22) of a great big open mouth. The book comes with 20 "black hole" tooth-shaped stickers so kids can black out their teeth as they lose them."
What Are Cavities (Tooth Decay), And How Are They Formed? top
Dental caries (the technical name for the disease that can lead to cavities) is an infectious disease caused by bacteria. Here are some interesting facts about cavities:
- It is the most common chronic disease among school-age children (5 times more prevalent than childhood asthma).
- Over 51 million school hours are missed each year in the U.S. due to dental related problems!
There are good and bad bacteria in the mouth. The bad bacteria are transferred to a child during infancy from parent (usually mother) or caregiver. If the good bacteria colonize on teeth before the bad ones do, then the bad ones have a hard time taking hold on the teeth. That is why some people hardly brush their teeth and eat sweets but never seem to get cavities. If the bad bacteria do colonize your baby's teeth, then they will remain there for the rest of their life!
Some of the major bacterial culprits associated with dental caries are:
- streptococcus mutans,
- streptococcus sobrinus,
- lactobacilli casei,
- actinomyces naeslundii, and
- actinomyces vicosus.
Tooth decay is a process in which the acid byproduct of these bacteria feeding on the fermentable carbohydrates (refined sugars and cooked starches) on teeth demineralizes and subsequently weakens the tooth surface and thus forms a cavity! Saliva is a protective factor that helps to wash away plaque, food, and cavity-causing bacteria in your mouth, while minerals in saliva replenish and remineralize your tooth structure. Saliva also helps buffer (neutralize) acids in your mouth to counteract demineralization of teeth.
A Helpful Tip: Teeth cannot remineralize in an acidic environment. When you or your child eats a meal, the pH level drops and acidity rises in your mouth, taking several hours to return to normal levels. That's why we recommend avoiding snacking in between meals as much as possible. To help, try placing a small bottle of water with 2 teaspoons of baking soda in your child's lunchbox and have him or her shake the bottle and rinse with the solution after his/her meal to help return oral pH levels to normal quickly!
How Can I Prevent Cavities For My Baby? top
Prolonged exposure ("pooling") of sugary liquids such as milk, formula, juice, soda and other sweetened drinks on the upper front teeth during bottle-feeding or breastfeeding can cause a serious dental condition, in which the upper front teeth and sometimes upper and lower baby first molars and lower canines decay rapidly. This is known as early childhood caries (ECC), baby bottle tooth decay (BBTD), or informally as "bottle rot". In order to prevent this from happening to your child, do not let your infant/toddler go to bed at night or at naptime with a bottle; or if you must, then use water only. Anything else will cause your baby's teeth to decay.
Do not use the feeding bottle as a pacifier! If you breastfeed at night, please wipe their teeth afterwards with a damp cloth/gauze. Bottle-feeding and breastfeeding beyond 12 months old is associated with a much higher likelihood of bottle rot, thus it is recommended that your infant be weaned off the bottle and/or breastfeeding by 12 to 14 months of age. Your child should not have juice in a sippy cup, bottle or other easily transportable container that would allow him/her to easily consume juice throughout the day.
What Is Early Childhood Caries (ECC) top
What used to be termed Baby Bottle Tooth Decay (BBTD) is now known as Early Childhood Caries (ECC). The severe form of that is Severe-Early Childhood Caries (S-ECC). By AAPD definition, ECC is the diagnosis when there is the presence of at least one white spot lesion (non-cavitated) or cavitated lesion, missing tooth (due to caries) or filled tooth surface in any baby tooth in a child less than 6 years of age. Severe-ECC is diagnosed by any sign of caries on a smooth (non-pit, or fissure) enamel surface, which can simply be a non-cavitated white spot lesion.
Caries is defined by the American Academy of Pediatric Dentistry (AAPD) as, "a biofilm (plaque)-mediated acid demineralization of enamel or dentin".
How Can I Tell If My Child Has It?
The first sign you might see, that a cavity may be starting, is the presence of a brown or white spot on the surface of your child's tooth that cannot be brushed away. In the primary incisors (upper front teeth), early decay can appear as brown/black or white spots on the enamel. Be sure to check the back of the upper incisors for any color changes. This is the most common area for decay to begin if your baby has been put to bed with a bottle of juice or milk.
The "chipping "away of the front teeth (not related to trauma) is usually a result of advanced decay. A white line appearing at the gum line of any tooth is the first sign of decalcification or the first stage of the decay process. This type of white spot lesion is the first visible indication that the bacterial infection called caries is present.
The first sign you might see, that a cavity may be starting, is the presence of a brown or white spot on the surface of your child's tooth that cannot be brushed away. In the upper front teeth, early decay can appear as brown/black or white spots on the enamel. Be sure to check the back of the upper incisors for any color changes. This is the most common area for decay to begin if your baby has been put to bed with a bottle of juice or milk. The "chipping "away of the front teeth (not related to trauma) is usually a result of advanced decay. A white line appearing at the gum line of any tooth is the first sign of decalcification or the first stage of the decay process. This type of white spot lesion is the first visible indication that the bacterial infection called caries is present.
What's In Saliva And What's So Special About It? top
Your saliva is really cool, and here's why! Let's start by defining saliva. Basically saliva is the fluid produced and secreted by your salivary glands, which comprises the vast majority of the oral fluid in your mouth, especially when your oral tissues are in a state of perfect health. Saliva is 98% water and contains many important substances vital to oral health including electrolytes, mucus, proteins, (antibacterial, antifungal, and antiviral compounds) and various enzymes.
You have three saliva producing glands. The ratio of production from these glands varies based on your unique state of oral health. In a number of oral (e.g. - periodontitis) and systemic (e.g. - epilepsy) diseases, the protein composition of saliva changes. Thus, saliva is extremely useful in the diagnosis of many diseases, which include both oral and systemic conditions. Some diseases (e.g. - diabetes, asthma) and treatments for those and other diseases (e.g. - radiation therapy, chemotherapy, albuterol inhaler) can also alter the flow of saliva, which has a detrimental effect on oral health and can increase susceptibility to dental decay and periodontal disease. Most pediatric medications also adversely affect saliva flow and contain sucrose (sugar) as much as 80% by volume.
Look through this table showing the various components of your saliva and their functions:
Just as you have a unique set of bacterial distributions (flora) that inhabit your mouth and contribute to your specific risk of getting cavities, saliva composition can vary widely among people and can also reflect your risk of getting cavities. These variations can include saliva quantity, quality (mucous - thick and ropy or serous - watery) and protein/mineral make-up. May your spit be good!
How Should I Take Care Of My Child's Teeth? top
Decay causing bacteria can colonize on your infant's gums even before his/her first teeth erupt, as early as 3 months of age (recent research suggests this may even occur shortly after birth). Thus, you should clean your infant's gums before his/her first teeth arrive. Use a clean damp cloth or gauze wrapped around your index finger and rub all gum surfaces, particularly after feedings. Alternatively, you also could use a variety of infant teeth cleaning products, such as Tenders, available at your local drugstore that work well too. When your baby's first teeth arrive, use a small dab of fluoride-free toothpaste (such as Orajel® Toddler training Toothpaste) when cleaning his/her teeth. Place your baby with his/her head on your lap and legs facing outward to facilitate cleaning.
Starting at age 2 (and up until age 5), use a tiny smear or (less than "pea"-sized) dab of child fluoride toothpaste pushed into the bristles of a small child-sized toothbrush with your finger (to minimize swallowing the toothpaste). Brush over all of your child's tooth surfaces after breakfast and right before bedtime for 1 minute each time. Although your toddler will likely not be able to "spit out" the toothpaste after brushing at this age, persevere and keep trying to teach your young child to spit out. Your child will acquire the skill much faster with continuous teaching. Be sure to help minimize swallowing of toothpaste while your toddler is learning to spit out. The last thing your child's teeth should touch before going to bed and for the rest of the night is the toothpaste from their brush. At night, your saliva-producing glands shut down, and you don't get the protective effect of saliva, putting your teeth in a vulnerable state.
Make brushing fun for your child by using an electric toothbrush, or let your child choose a toothbrush with a favorite character (e.g. - Sponge Bob, Dora). Sing songs while brushing your child's teeth, using the "Dental Songbook". Find a way to brush your toddler's teeth even if he/she resists. Proper hygiene habits need to be established at an early age to provide the foundation for a lifetime of great oral health.
Five and Older
Up until your child is 7 years old, you should assist him/her while brushing because children often lack the motor skills to do it right. After that, observe your child's technique and assist where necessary until he/she can effectively brush without supervision. Brush your teeth at the same time to help teach your child to brush by mimicking you. Although a regular children's brush is perfectly fine for cleaning teeth, sometimes a children's electric brush can make the experience more fun for your child, increasing motivation to brush. Once again, toothbrushing should happen twice a day - once in the morning after breakfast and right before bedtime. Brushing after snacks is ideal too. At age 6 and above, brushing should take 2 minutes each time.
When brushing your teeth and your child's teeth, angle the toothbrush at a 45° angle towards the gum-line and use small circular strokes. Brush the front of the teeth, behind the teeth and the chewing surfaces. Don't forget to brush the tongue to remove potential bad breath bacteria and other harmful microorganisms. Take 2 full minutes to brush properly.
Change your child's toothbrush once every 3 months because worn bristles can diminish effective plaque removal. Also change your child's toothbrush after each flu or cold episode to avoid repeat illness.
Begin flossing when and where your child's teeth touch. Back molars usually begin touching at age 3 or 4. At this point, food can easily get trapped between your child's teeth and lead to cavities. Your child's baby teeth, in particular, have wider contact areas than adult teeth do and have thinner enamel, making those tight areas between your child's teeth especially problematic. Carefully slide the floss through the point where your child's teeth contact and wrap it around each tooth in a "C" shape, then gently glide the floss up and down to clean the surface of his/her teeth. After you are done, gently pull the floss straight out, not through the contact area, keeping debris on the floss from pushing back into the contact.
Feel free to use these charts to create your own reward system for forming healthy habits.
Flossing Super Star
No Thumb, Finger,
or Pacifier Club
What Should I Do When My Child Is Teething? top
Be prepared to deal with your child's first oral event - teething! It usually happens without problem and is a completely natural occurrence. During the time your infant's teeth start to come out, your child may become restless and fretful. Your baby may also start to salivate excessively and exhibit the desire to put hands and fingers into his/her mouth. Relieve your baby with a clean teething ring, chilled teething ring, cool spoon, cold wet washcloth or toothbrush. If your infant has a fever, diarrhea, abdominal discomfort or other unusual problem, it may not be related to teething. In that case, consult your family physician as soon as possible to rule out any other common diseases and conditions of infancy.
What Are Tooth Friendly And Unfriendly Foods? top
Carbohydrates are the food of choice for decay-causing bacteria; the acid they produce while feeding causes demineralization and leads to tooth decay. There are two basic types of carbs:
- Sugars - simple carbohydrates like candies, sweets, juice, sodas.
- Cooked Starches - complex carbohydrates like bread, crackers, chips. An enzyme in saliva breaks down cooked starches into simple sugars.
Sticky foods (raisins, fruit roll-ups, chips, crackers, cheetos) are bad for teeth!
Some cheeses (aged cheddar, mozzarella, Swiss, Monterey jack) have properties that help prevent the development of cavities when eaten as a snack or at the end of your child's meal. They increase your child's saliva flow, which cleanses his/her teeth and neutralize the acids that attack them. Plain milk, or chocolate milk if preferred, contains proteins, calcium and vitamins essential for tooth development. Just please don't stick it in a bottle at nighttime for your child. Sugar-free gum after a meal stimulates saliva production, which can help protect against cavities. Sugar-free gum containing the sugar-substitute xylitol can be particularly helpful by preventing decay-causing bacteria from sticking to your child's teeth.
Other Dietary Recommendations And Information
Your infant gets all the nutrients he/she needs from breastmilk up until 6 months of age. Conversely, fruit juice provides no nutritional benefit for your infant less than 6 months of age. After your baby is 6 months old, consider supplements of iron (brain, mental development), vitamin D (bone/teeth growth) and fluoride after consulting with your child's pediatrician and dentist. Do not give your child more than 4 to 6 oz of fruit juice per day, and please do not allow your child to drink powdered beverages or soda pop at all. Give your infant (6 months or older) iron-fortified infant cereals mixed only with breastmilk or formula. Avoid cow's milk in the first year of your child's life and restrict to less than 24 oz per day in the second year. Wean your infant from the bottle or breastfeeding at 12 to 14 months of age.
Please review the table below to see the relative cariogenicity (ability to produce cavities) of various snacks as determined by the Palmer Classification.
Score (lower #'s are better)
|Peanut Butter, Nuts, Vegetables||0|
|Fruit Juice, Fresh Fruit (excluding Bananas)||3|
|Tortillas, Pasta, Rice, Beans||4|
|Apple Sauce, Yogurt, Ice Cream, Pudding, Jell-O®||9|
|Cookies, Donuts, Chips||10|
|Banana, Raisins, Jam>||11|
GERD (Gastro-Esophageal Reflux Disorder): top
Stomach - Click to Enlarge
Silver Star Dental GERD Handout
Keels-Coffield Clinical Severity
Scale of Dental Erosion
A relatively common digestive disorder characterized by frequent passage of stomach acid (pH 2) from the stomach back into the esophagus. Causes of GERD include relaxation of the muscle that connects the esophagus and the stomach (lower esophageal sphincter), delayed emptying of the esophagus or stomach, hiatal hernia or obesity. Women who are pregnant also are at a high risk of experiencing GERD.
All of us experience GER and have some reflux from time to time. For instance, when you lie down too soon after eating. GERD, however, is a disease state, which is a problem!
Pediatric Clinical Symptoms
- Your child reports burning or acidic taste in mouth
- Your child reports frequent "hot burps" or "baby vomit", especially after meals
- Your child reports burning sensation in the area of their heart, or a stomach ache
- Your child displays neck stretching after eating (in doing this, the child is trying to prevent reflux)
- Your child's breath has an acidic odor
- Your child is continuously coughing during sleep (usually GERD, not asthma)
- Your child has chronic hoarseness/laryngitis/pharyngitis
- Your child reports that it is painful to swallow
Conditions Associated with GERD include:
- Cerebral Palsy
- Premature birth
- Failure to thrive
- Vomited frequently as infant
- Enamel erosion from the stomach acid washing over the teeth; usually appearing as glossy moon craters on the cusps of the primary "baby" and/or permanent "adult" molars and canines
- Tooth sensitivity can develop once the enamel covering is gone
- Acid reflux can make untreated cavities worse
- Dental Fillings will start to appear taller than surrounding tooth structure
- In severe cases of GERD, the tooth nerve can be exposed - OUCH!
- Reflux and Bruxism (grinding) - a bad combination!
When no symptoms exist
Sometimes patients do not realize they have GERD because they do not notice any of the symptoms listed above. There can be several reasons for this. Like asthma, GERD is episodic. In other words, GERD may not be active all the time. Also, GERD episodes happen most frequently at night when you sleep, and thus may go unnoticed. Lastly, for someone who has always had GERD, the way they feel is normal to them. After 6 to 8 weeks on Zantac, if the medication is stopped, the patient may notice feeling better when taking Zantac.
Suggested tips to help reduce reflux
- Avoid dietary causes of acid erosion (sour candies, pickles, citrus exposure, acidic juices such as OJ with pulp)
- Avoid potential triggers for GERD such as fried foods, mints, carbonated drinks, supersizing, and spicy foods
- Avoid eating over eating (super sizing) and eating too fast - enjoy every bite
- Don't lie down for 2 hours after eating
- Don't eat near bedtime
- Sleep on an inclined bed. Place a 2x4 under the head of the bed or use two pillows
- See a pediatrician if there are symptoms consistent with GERD
Your Pediatrician may recommend
- Zantac, Prilosec, Prevacid or Reglan (medications to prevent reflux)
- Note: Tums does not work well since each dose only lasts 2 hours (not practical)
- A referral to a Pediatric GI Specialist for diagnostic testing (endoscopy, 24 hour pH probe, etc.) Please Note: Due to the "on and off again"(episodic) nature and nighttime tendency of GERD activity, 24 hour intra-esophageal pH monitoring would be an effective test. Proton Pump Inhibitor (PPI) testing may also be an option. However, since fewer than 50% of GERD patients have evidence of esophagitis on endoscopy, it is not considered a sensitive test for GERD.
- In more severe cases, possible surgical correction may be necessary (e.g. Pyloroplasty or Nissen Fundoplication)
Long term Dental Risks - if untreated, GERD can...
- Cause irreversible tooth structure loss
- Increase Caries (decay risk that can be 6 times greater)
- Predispose you to esophageal (throat) problems in adulthood (possibly even esophageal cancer - adenocarcinoma of the esophagus) In Fact: untreated GERD increases your risk of adeno-esophageal carcinoma by 43 times!
What Are These Painful Recurring Sores In My Child's Mouth? top
Any time you're unsure, visit Dr. Hsu to get a professional opinion. There is a good chance that your child has Recurrent Apthous Stomatitis (RAS). These usually appear as painful white ulcerated (dished-out) sores that can range in size and appear alone or in multiples. Although there is still much that is unknown about this disease, it is thought to be the result of localized immune system dysfunction. About 20-30% of children have this disorder. The sores can generally last about 2 weeks and go away on their own.
Most often this condition appears alone, but can be associated with other diseases such as Bechet's disease, Reiter's syndrome, Crohn's disease, Ulcerative Colitis, Celiac disease, Neutropenia and certain immunologic disorders. The ulcers can be triggered by trauma (biting the lip), tiredness from lack of sleep and viral infections (common cold).
Food allergies may be the culprit. Common examples are: chocolate, coffee, peanuts, almonds, strawberries, cheese, tomatoes, citrus and wheat. Other allergies or sensitivities can include the foaming agent in toothpaste, menthol, peppermint, nickel, chromium and NSAIDS such as Tylenol, Advil and Motrin.
As mentioned above, sodium lauryl sulfate (SLS), which is a foaming agent used in most toothpastes, has been linked as a common trigger for apthous ulcers. Here is a list of toothpastes without SLS:
- Biotene Dry Mouth Toothpaste (Laclede)
- Orajel Dry Mouth Toothpaste (Del Pharma)
- Oral-B Rembrandt For Canker Sore Sufferers
- Squigle Enamel Saver Toothpaste
- Sensodyne (SLS-free, TC & anti-cavity cool gel)
- Tooth and Gum Paste (Dental Herb Co)
- PreviDent Gel NaF 1.1% (Colgate)
- Baby Orajel Tooth & Gums Cleanser
Although there is no cure, if your child's apthous ulcers are severe and causing great pain and suffering, please see Dr. Hsu for some therapeutic options to give your child some relief from the symptoms.
Should I Be Concerned About Dental Health During Pregnancy? top
Yes! Hormonal changes during pregnancy can make your mouth more susceptible to disease. Your gums may bleed and become inflamed, and you may get a cavity or cavities even though you haven't had one for a while. Proper dental care is especially important at this time because of risks associated with periodontal disease, a serious progressive gum disease where there is loss of attachment of bone and gums to the roots of teeth. Periodontal disease can lead to premature and low birth weight births and increase your risk for cardiovascular disease, diabetes and respiratory infection. In general during pregnancy, avoid x-rays and elective dental treatment that requires the use of local ancosmetic (particularly containing epinephrine) in the first trimester and second half of the third trimester. Be sure to continue regular dental visits!
Also consider that the bacteria that cause tooth decay can be transmitted from mother to child at a very early age. In fact, there is recent evidence that there is colonization of the bacteria on oral soft tissues as early as around the time of birth! It has also been shown that the more of these bacteria the mother has in her mouth when the child is an infant, the more likely that child will have cavities in the future.
Xylitol: Magic In The Making top
Xylitol is a naturally occurring sugar alcohol, harvested from birch trees, that is a non-fermentable (thus non-acid forming) carbohydrate. It is just as sweet as sucrose and can be used in the same way. It has 40% less calories and 75% less carbs than sucrose and a low glycemic index of 7 (range 1-100). Most amazingly, it has unique dental benefits.
- Non-cariogenic - does not contribute to cavity formation
- Clinically proven to be cariostatic - reduces the incidence of new cavities and inhibits the growth of s. mutans (the main bacterial culprit in tooth decay)
- Inhibits the transmissibility of s. mutans (from parent or caregiver to child)
- Stimulates salivary flow, thus helping teeth to remineralize
- Reduces plaque quantity and adhesivity (the ability for plaque to stick to teeth)
There are an increasing number of products on the market containing xylitol. Carefree Koolerz™ is an example. It is important when choosing a xylitol product to look at the ingredients list on the package and see xylitol listed as the first ingredient. This means that it contains the correct concentration for maximum dental benefit. It has been determined by research that 5 grams per day of xylitol is recommended for therapeutic dental benefits to occur. After every meal and snack (4 times a day), chew for 5 minutes. Benefits will take place even without any change to existing diet. When xylitol is consumed daily for several months, the s. mutans is shed from plaque to saliva. Xylitol is safe for pregnant women and newborn infants (not in gum form). Please ask about the convenient and cost-effective xylitol products for infants, children, teens and adults that we have for sale in our office.
Note: While Xylitol is perfectly safe for humans, it can be deadly for dogs. Ingesting even one stick of xylitol gum can lead to hypoglycemic attack in dogs! It causes insulin production and resultant dangerous drop in a dog's blood sugar. There is also evidence that Xylitol can cause severe liver damage in dogs within 24 hours. So be careful not to drop Xylitol gum on the floor if you own a dog!
How Can Fluoride Help My Child's Teeth? top
The fluoride ion is a naturally occurring substance found everywhere - in soil, air, water, plant and animal life. Teeth that are developing require minerals that they receive from the bloodstream. It was once believed that fluoride, when ingested and delivered systemically in the form of a supplement, is incorporated into the enamel of the tooth resulting in a mineral structure that is stronger and more cavity resistant. Although some fluoride does indeed get incorporated into your enamel when systemically delivered, it has been shown by modern research that this has a negligible effect on caries resistance.
Your real benefit is derived from the topical effect. It may seem odd then that studies show that children who drink fluoridated tap water have 50% to 75% less dental disease. The real reason behind that interesting fact is due to the topical effect of the fluoridated drinking water passing through the teeth as it is swallowed or from its use during brushing and rinsing. However, too much ingested fluoride at an early age (particularly between the ages 3 to 6 years) can discolor your child's developing teeth making them irregular (mottled) in appearance with whitish or brownish stains.
Although you may not realize it, your child may be receiving fluoride from many sources: tap water, infant formulas, reconstituted juices, toothpaste and even the food they eat. The American Academy of Pediatric Dentistry recommends using non-fluoridated bottled water to mix with infant formula if your infant derives nutrition solely from infant formula that's not ready-made, particularly if your water supply is fluoridated.
Depending upon the level of fluoridation of the water in your area, Dr. Hsu may prescribe a fluoride supplement for your child. If so, ensure your child swishes fluoride drops around the mouth with the tongue before swallowing, lets fluoride tablets slowly dissolve in the mouth or chews the tablets and spreads them around the teeth with the tongue. The best time for your child to take fluoride supplements is after brushing the teeth at night, right before bedtime, because the fluoride will coat the teeth and exude its topical effect for a far longer period of time with the greatly diminished saliva flow during sleep.
Recommendations for fluoride regimens performed in the dental office have also been updated to take caries risk into consideration:
- Children with moderate caries risk should have 6-month fluoride applications,
- High caries risk patients are recommended to have up to one fluoride application every 3 months, and
- Low caries risk patients may not benefit from in-office fluoride applications at all.
If needed, your child will enjoy up to 6 months of benefits from one application of fluoride varnish - the solely used topical fluoride treatment at Silver Star Dental due to its proven benefits over fluoride gels and foam. Brushing with a pea-size amount of fluoride toothpaste is also important. If your child is very young, only a smear of toothpaste should be used and then wiped away right after to prevent ingestion. At home fluoride rinses such as ACT mouth-rinse can provide further dental benefits as well.
What Is Enamel Fluorosis? top
Your child may acquire a condition called enamel fluorosis if he/she gets too much fluoride during the years of tooth development, with 3 to 6 years of age being the greatest risk factor. Too much fluoride can result in defects in tooth enamel formation and color. In severe cases of enamel fluorosis, the appearance of the teeth is marred by discoloration or brown markings. The enamel may be pitted, rough, and hard to clean. In mild cases of fluorosis, the tiny white specks or streaks (lines) are often barely perceptible.
mild case of fluorosis
severe case of fluorosis
How Does A Child Get Enamel Fluorosis? top
Swallowing too much fluoride for the child's size and weight during the years of tooth development causes Enamel Fluorosis. This can happen in several different ways. First, a child may take more of a fluoride supplement than the amount prescribed. Second, the child may take a fluoride supplement when there is already an optimal amount of fluoride in the drinking water. Third, some children simply like the taste of fluoridated toothpaste. They may use too much toothpaste then swallow it instead of spitting it out. There is even fluoride in certain foods (due to the way they're processed with fluoridated water) your child may eat such as deboned processed meats (chicken, bologna, hot-dogs), tea, infant dry cereal, juice, soda and others. Be sure to consult Dr. Hsu if you have any concerns.
How Can Enamel Fluorosis Be Prevented? top
Talk to Dr. Hsu as the first step. Dr. Hsu can tell you how much fluoride is in your drinking water. (Your local water treatment plant is another source of this information.) If you drink well water or bottled water, Dr. Hsu can assist you in getting an analysis of its fluoride content. After you know how much fluoride your child receives, decide with Dr. Hsu whether your child needs a fluoride supplement. Watch your child's use of fluoridated toothpaste as the next step. A pea-sized amount or smear on the brush is plenty for fluoride protection. Teach your child to spit out the toothpaste, not swallow it, after brushing. Recently, the American Academy of Pediatric Dentistry has issued a statement that infants fed primarily with liquid concentrate or powdered infant formula should use water labeled purified, demineralized, deionized, distilled or reverse-osmosis filtered to mix with the formula. Ready-to-feed formula is preferred.
Should My Child Avoid Fluorides Altogether? top
No! Fluoride prevents tooth decay and is an important part of helping your child keep a healthy smile for a lifetime. Consult Dr. Hsu to easily ensure your child is getting enough, but not too much, fluoride. Topical fluoride (fluoride applied directly to teeth that have already erupted into your child's mouth) has proven great benefits.
How Can Enamel Fluorosis Be Treated? top
Once fluoride is part of your child's tooth enamel, it can't be taken out. But if the appearance of your child's teeth is affected by fluorosis, it can be greatly improved by a variety of treatments available in cosmetic dentistry. A great option for a beautiful, natural-looking smile is composite or porcelain veneers. This procedure is usually deferred until 13 or 14 years of age or later when your child's baby teeth are gone, the bite is stabilized, and after completion of necessary orthodontic work. If your child suffers from severe enamel fluorosis, Dr. Hsu can tell you about dental techniques that can enhance your child's smile and self-confidence.
Common Types Of Teeth Stains top
Black Line Stain - Also known as pellicle stains. These appear as dark or black lines running along the teeth near the gum-line. Iron supplements, raisins, iron-rich foods and even iron salts generated by certain types of bacteria can cause these stains. They are generally tenacious and don't come off easily, although they can usually be removed in the dental office. They tend to re-form rather quickly, but tend to disappear as the permanent teeth come in and the child reaches 9 - 10 years of age. On a positive note, those who get pellicle stains tend to have strong resistant teeth and develop few or no cavities!
Orange Stain - These orange stains usually appear near the gum-line of upper and lower teeth. Color-producing (chromogenic) bacteria are the culprits. It is thought that these bacteria tend to grow in children who drink lots of milk. Using gauze and a little bit of toothpaste, these stains can be removed at home by rubbing vigorously at the gum-line.
Green Stain - These usually occur at the gum-line of upper front teeth. Believe it or not, algae cause these stains - the same green algae plant that grows in your fish tank. They grow where there is light (at the front of the mouth), and along the gum-line where it is moist and food is easily obtained. Using gauze and a little bit of toothpaste, these stains can be removed at home by rubbing vigorously at the gum-line.
Tetracycline Stain - - This antibiotic is less commonly used now for pregnant women and young children. When it is given to a pregnant mother (especially during the 3rd trimester), or given to a very young child (up to 5 years of age), these stains can form on the child's developing teeth making them appear yellow, brownish or orange in the baby teeth and dark-gray, brownish, or yellowish in the permanent teeth. Once the permanent teeth come in, if they exhibit this type of staining, there are various cosmetic dental options that can be used to correct their appearance.
Fluorosis - Too much fluoride (for example - fluoride toothpaste swallowed on a regular basis at an early age before baby learns to spit out) can discolor your child's developing teeth making them irregular (mottled) in appearance with whitish or brownish stains. These can also be covered up by cosmetic dentistry as a teenager or adult.
What Are Dental Sealants? top
Your child's first permanent molars appear (erupt) around age 6. These teeth have deep grooves and fissures on the chewing surfaces that can harbor cavity-causing plaque, bacteria and acids that are difficult or impossible for toothbrush bristles to reach. Your child can protect these molars with sealants, a clear composite (plastic) material that is flowed into the grooves and fissures and then instantly hardened with a special light to act as a "shield" to harmful plaque, bacteria and acids. After they are placed, your child's sealants are checked at each 6 month check-up and touched up if necessary.
What Are Pulpotomies and Pulpectomies? (The Baby Root Canal): top
If decay has reached the pulp (living portion) of your child's tooth, Dr. Hsu may recommend a pulpotomy for a baby tooth. In this case the cavity is too deep to merely place a filling because there are bacteria in the pulp that will eventually lead to an infection around the tooth, painful abscess (swelling), potential damage to the adult tooth developing underneath and possible greater health risks.
A pulpotomy is removal of the diseased nerve in the crown portion of the tooth while leaving the healthy root portion of the pulp intact. This (now empty) pulp chamber is filled with a putty-like filling material to keep bacteria out and protect the remaining pulp stumps in the roots. Even if the cavity doesn't physically cover the entire top (chewing) surface of the tooth, a large opening is made on the top (chewing) surface of the tooth in order to ensure complete removal of the diseased pulp. Because this leaves a relatively thin and weak wall of tooth structure around the top (chewing) surface of the tooth, the tooth is generally "capped" with a stainless steel crown to protect the remaining walls of the tooth.
The success rate is high (approximately 90%) with this procedure In some cases failures can result over time due to microscopic bacteria remaining in the tooth and/or inflammation of the pulpal tissue that inevitably results from the procedure itself. This can cause the root to resorb away at the site of inflammation and (worse case scenario) disappear completely until the tooth becomes loose and simply falls out. Some resorption of the roots is common and does not necessarily constitute a failure. However, call our office if the tooth becomes abscessed (gums next to tooth swollen) and/or painful; the tooth will probably need to be extracted.
Pulpectomies differ from pulpotomies in that they consist of the complete removal of the pulp of a tooth (like an adult root canal), including the root portion. This procedure takes longer than a pulpotomy and is indicated for anterior (front) teeth and posterior (back) teeth with symptomatic pain and/or beginning abscess. It is a heroic measure to save a tooth with a relatively poor prognosis. In particular, it is important to try to save the 2nd primary molar (the baby molar furthest back in the mouth, towards the throat), especially before the 1st permanent molar (6 year molar) arrives. This is because the 2nd baby molar guides the 6 year "adult" molar into place. The same filling material used in pulpotomies is used to fill the tooth and its roots, and the tooth then "capped" with a stainless steel crown.
(Note: Stainless Steel Crowns used in the posterior (back of the mouth) region are generally silver in color. Anterior stainless steel crowns have the option of being white in the front (white -veneered) for cosmetics. In some situations, beautiful all-white (composite) strip crowns can be used for maximum cosmetics. White-veneered crowns are also available for posterior teeth (baby molars); however not highly recommended due to the fact the veneered part of the crown is fairly thick (for strength) thus requiring excessive removal and weakening of tooth structure. Since baby molars are used for chewing and are subject to a lot of stress, chipping of the white-veneer is a common result. Discuss these options with Dr. Hsu if your child needs a crown.)
Pulpectomies differ from pulpotomies in that they consist of the complete removal of the pulp of a tooth (like an adult root canal), including the root portion. This procedure takes longer than a pulpotomy and is indicated for anterior (front) teeth and posterior teeth with symptomatic pain and/or beginning abscess. It is a heroic measure to save a tooth with a relatively poor prognosis. In particular, it is important to try to save the 2 nd primary molar (the baby molar furthest back in the mouth, towards the throat), especially before the 1 st permanent molar (6 year molar) arrives. This is because the 6 year "adult" molar is guided into place by the 2 nd baby molar. The same filling material used in pulpotomies is used to fill the tooth and its roots, and the tooth then "capped" with a stainless steel crown.
(Note: Stainless Steel Crowns used in the posterior (back of the mouth) region are generally silver in color. Anterior stainless steel crowns have the option of being white in the front (white -veneered) for esthetics. In some situations, beautiful all-white (composite) strip crowns can be used for maximum esthetics. White-veneered crowns are also available for posterior teeth (baby molars), however not highly recommended due to the fact the veneered part of the crown is fairly thick (for strength) thus requiring excessive removal and weakening of tooth structure. Since baby molars are used for chewing and are subject to a lot of stress, chipping of the white-veneer is a common result. Dr. Hsu will discuss these options with you if your child needs a crown.)
What is Bruxism top
Bruxism is another word for teeth grinding and is a fairly common among children. Bruxism generally occurs at night (nocturnal) and is usually first noticed by the unique sound that is produced when the child grinds their teeth during sleep. You may also notice your child's teeth wearing down (attrition) and getting shorter. In adults, bruxism is thought to be brought on by stress; although in children, this has not proven to be so. No treatment is usually necessary for bruxism in children. Your child's grinding habit will likely diminish around age 6 and cease altogether between ages 9-12. If your child is still grinding at age 13 and up, and the permanent (adult) teeth start to wear; a custom night guard is usually indicated.
What To Do About Pacifiers Or Thumbsucking? top
Thumb sucking is a habit that often starts while your child is still in the womb. It is a natural instinct that helps prepare your infant for nursing. Infants and young children often use thumbs, fingers, pacifiers or other available objects to satisfy their sucking needs. This can give your child a sense of security, happiness, and relaxation that can even lull them to sleep.
Most children quit their thumb/pacifier sucking by age 4, or at least by school age (due to peer pressure). At this stage, any dental problems (tooth movement, jaw-shape changes) that have resulted from your child's sucking habit will usually correct on its own. If your child's thumb sucking or pacifier use continues past 5 years of age (or when permanent teeth arrive), full self-correction is far less likely, and there are possibly other issues that are perpetuating the habit that should be explored. Stress may exacerbate the thumb-sucking problem, thus scolding your child for thumb sucking is not recommended. It is better to use positive reinforcement to motivate your child to quit the habit. Finding and eliminating the source of stress can also be really helpful.
If your child is over 5 years of age and all other attempts to help your child stop thumbsucking fail, a more aggressive approach is indicated to stop the habit. If your child's habit is with a pacifier, consult Dr. Hsu for a simpler solution to the problem.
You may want to read a very good book with information and tips on breaking the habit of thumb sucking entitled "David Decides About Thumbsucking: A Story For Children, A Guide For Parents" written by Susan Heitler, PhD.
How Can Mouth Guards Help My Active Child? top
If your child plays sports or other similar activities, mouth guards are a great way to protect their teeth from potential injury. They are easy to clean, come in many color combinations and are custom made to fit comfortably in your child's mouth.
Is Smokeless (Chewing) Tobacco Harmful To My Child's Oral Health? top
Smokeless (chewing) tobacco use in the United States continues to increase each year, especially among teens who mistakenly believe that it is a safe alternative to smoking cigarettes. It may be smokeless, but it isn't harmless. Why should you care if someone you love uses smokeless tobacco? Keep reading.
Tooth Abrasion - Grit and sand in smokeless tobacco products scratches teeth and wears away the hard surface or enamel. Premature loss of tooth enamel can cause added sensitivity and may require corrective treatment.
Increased Tooth Decay - Sugar is added to smokeless tobacco during the curing and processing to improve its taste. The bacteria found in plaque, the colorless, sticky film that forms daily on teeth, use this sugar to produce acid. The acid damages tooth enamel and leads to decay.
Gum Recession - Constant irritation to the spot in the mouth where a small wad of chewing tobacco is placed can result in permanent damage to periodontal (gum) tissue. It also can damage the supporting bone structure. The injured gums pull away from the teeth, exposing root surfaces and leaving teeth sensitive to temperature and vulnerable to decay. Erosion of critical bone support leads to loosened teeth that can be permanently lost.
Nicotine Dependence - Nicotine blood levels achieved by smokeless tobacco use are similar to those from cigarette smoking. Nicotine is a highly addictive substance that produces withdrawal symptoms when use is discontinued. Nicotine constricts the blood vessels that are necessary to carry oxygen-rich blood throughout the body. This raises both heart rate and blood pressure and increases the risk for heart disease. Additionally, athletic performance and endurance levels are decreased by this reaction.
Tooth Discoloration And Bad Breath - Common traits of long-term smokeless tobacco users are stained teeth and bad breath. Moreover, the habit of continually spitting can be both unsightly and offensive.
Unhealthy Eating Habits - Chewing tobacco lessens a person's sense of taste and ability to smell. As a result, users tend to eat more salty and sweet foods, both of which are harmful if consumed in excess.
Oral Cancer - With the practice of "chewing" and "dipping," tobacco and its irritating juices are left in contact with gums, cheeks and/or lips for prolonged periods of time. This can result in a pre-cancerous condition called leukoplakia. Leukoplakia appears either as a smooth, white patch or as leathery-looking wrinkled skin.
Other Cancers - All forms of smokeless tobacco contain high concentrations of cancer-causing agents. These substances subject users to increased cancer risk not only of the oral cavity, but also the pharynx, larynx and esophagus.
Danger Signs - If you use smokeless tobacco, or have in the past, you should be on the lookout for some of these early signs of oral cancer:
- A sore that does not heal
- A lump or white patch
- A prolonged sore throat
- Difficulty in chewing
- Restricted movement of the tongue or jaws
- A feeling of something in the throat
Pain is rarely an early symptom. If not caught early on, oral cancer can require extensive and potentially disfiguring surgery, and even death! For this reason, all tobacco users need regular dental check-ups.
Check out Oral Health America's NSTEP program cessation resources specifically for smokeless tobacco users. Visit www.nstep.org to access The Cessation Process, 7 Steps to Recovery.
Tobacco Use and Tobacco Cessation Facts & Stats According to the Centers for Disease Control and Prevention (CDC), more than 46 million Americans smoke cigarettes while nearly 9 million develop at least one serious illness in their lifetime due to smoking. CDC also reports that tobacco use causes more than 440,000 deaths each year in the United States. Smoking is the number one cause of death in America, killing more people than alcohol, illegal drugs, car accidents, suicide, homicide and AIDS combined.
Key Tobacco Use Statistics
- Smoking is the most preventable cause of death in America
- Of the 46 million Americans who smoke, 70 percent say they want to quit
- One in every five deaths is attributed to tobacco use
- The chance of heart attack decreases 24 hours after ending tobacco use
- Nerve endings regenerate, enhancing the ability to smell and taste, within 48 hours after stopping tobacco use
- Two weeks to three months after quitting tobacco use, circulation improves, walking becomes easier and lung function improves
- One year after ending tobacco use, risk of coronary disease decreases to half that of a smoker
- Five years after quitting, the risk of stroke is reduced to that of a non-smoker
- Former pack-a-day smokers save about $120 to $190 per month
- Spit tobacco is not a safe substitute for cigarettes
- Spit tobacco contains nicotine, the same addictive drug in cigarettes
- Spit tobacco causes chronic bad breath, discoloration of teeth, gum disease and recession, tooth decay and tooth loss, high blood pressure and an increased risk for heart disease
Tongue Piercing, Is It Harmful? top
As with any new fashion trend, many people rush to try it, and body piercing is no exception. But when people pierce their tongues and lips, they risk numerous dental problems.
Tongue piercing involves punching a hole in the tongue and placing a decorative metal stud in the hole. Due to the numerous nerve endings in the tongue, piercing often results in severe swelling and pain, making eating and talking very difficult, not to mention that a severely swollen tongue can block a person's airway. Infection is also a real danger with tongue piercing. Allergic reactions may occur if the stud is not pure metal. Blood poisoning and blood clots are other potential concerns. And because the tongue is constantly moving, healing from tongue piercing is slow, sometimes taking up to a month. Tongue and lip piercing also affect teeth and gums. Teeth can become cracked or chipped from the metal stud or barbell moving around inside the mouth. Gum tissue may also be damaged by continuous contact with the metal stud. Extra dental care needs to be taken with pierced tongues.
When brushing your teeth be sure to also brush your tongue. The barbell should be removed daily and thoroughly cleaned, although not with jewelry cleaner, warm water and soap will work fine. The hole in the tongue should also be rinsed with a small stream of water.
What If My Child Has A Dental Emergency?top
Dental injuries for children are fairly common, yet they can be stressful and nerve-wracking for you and your child. Here are some helpful tips when assessing your child's dental emergency.
Periodontal or gum disease can range from gingivitis (swollen gums that bleed easily) to the more serious periodontitis (disease affecting the gums and supporting bone). Although less frequently seen in children than in adults, gingivitis is still relatively common in children and can lead to periodontitis and eventual tooth loss! Furthermore, children with periodontal disease have an increased chance of having periodontal disease as adults.
There are many forms of gingivitis and periodontitis that have a variety of different underlying causes. Most of the time, gingivitis is caused by improper oral hygiene and plaque accumulation. Certain medications or hormonal changes during puberty may intensify the problem. There are also some very rare forms of gingivitis that are not induced by plaque and may have bacterial, viral, fungal, genetic, systemic or traumatic injury origins.
Your child is most likely to be affected by periodontitis during the hormonal changes of puberty when it is called aggressive periodontitis. Those affected by this condition are usually otherwise healthy. This may occur as a localized problem (localized aggressive periodontitis - LAP) that only affects certain areas of the mouth and may involve bone loss around the teeth of the molars (back teeth) or incisors (front teeth). There may not seem to be a lot of plaque in this form of aggressive periodontitis and hygiene may be generally good. In fact the gums may seem perfectly healthy. It most likely has a genetic/hereditary basis.
The generalized form (generalized aggressive periodontitis - GAP), however, involves rapid bone loss around most of the teeth in an affected mouth and is accompanied by much more plaque and inflammation of the gums. GAP rarely affects individuals over the age of 30.
One rare form of periodontitis that affects very young children is called Leukocyte Adhesion Deficiency (LAD). This can affect infants shortly after their baby teeth arrive and also come in localized and generalized forms. Leukocytes are white blood cells responsible for fighting off infections, and in LAD, there is a defect in their normal action. If your child has advanced periodontal disease that, in particular, is not responsive to treatment, he/she may also have underlying systemic disease and should be evaluated by their pediatrician.
Gum disease can cause bad breath, affect appearance and is certainly detrimental to your child's health. A bright smile, pleasant breath and healthy teeth heighten your child's interpersonal relationships, boost self-esteem and maintain positive psychological well-being. Feel confident as Dr. Hsu checks your child's x-rays and evaluate your child's gums during exams to catch these potential problems early!
Parents. Help your child prevent gum disease by practicing good oral hygiene and establishing healthy dietary habits early for your child (for brushing and flossing tips, please see the topic "How Should I Take Care Of My Child's Teeth?" in the Dental Q & A section). Thoroughly check your child's gums and teeth periodically by asking your child to open his/her mouth and lifting his/her lip. If you see visible plaque and gums that are red, swollen and/or bleeding; then your child has gum disease. Bad breath may also be an indication of periodontal disease.
Be a good role model for your child by practicing good hygiene and nutrition habits and visiting Dr. Hsu regularly. Also, research shows the pathogenic bacteria responsible for periodontal disease are transmitted from one family member to another. Periodontal disease is linked to systemic diseases such as heart disease, stroke, obesity and low birth weight, or pre-term babies. It can also pose a serious threat to those whose health is compromised by diabetes, or respiratory disease.