Commonly Asked Pediatric Dental Questions

Six months is the average time for plaque and tartar to form on the teeth and for tooth decay to be evident by X-ray.

At this recurrent care visit, the pediatric dentist will:

• Check your child’s gums, teeth, jaw, and any irregularities in facial structure, bite and arch form.
• Clean your child’s teeth and apply appropriate fluoride to the teeth.
• Recommend any dietary changes and show you and your child how best to clean their teeth at home.

The most important feature is to look for the Seal of the ADA (American Dental Association). This seal ensures the product’s safety and effectiveness.

For children 2 and younger, we recommend to only use a smear of tooth paste on an age-appropriate soft toothbrush. For children 2-5 use only a pea size amount. Practice spitting out the toothpaste and always assist your child until your child can handle a knife and fork…usually around 8 years old.

It is the most common disease known to man…five times more prevalent than asthma, which is the most common chronic medical condition in children.

The bacteria that causes dental decay is not present when the baby is born. It is introduced into the child from parents or other care givers. For this reason, it is important that parents attend to their own dental needs as this may help prevent problems with your child’s teeth.

The enamel, the outer part of the tooth, is primarily made of minerals. This enamel is in a constant state of de-mineralization and re-mineralization. When a child eats and drinks, certain types of bacteria create acid which can de-mineralize the enamel. The time between meals allows for the saliva to help re-mineralize the enamel. Children who eat many small meals during the day or who are grazers with frequent consumption of snack foods have a much higher risk for tooth decay. The more parents brush and floss a child’s teeth the better chance that their teeth will win the battle against tooth decay.

Most tooth decay in children under 6 occurs between the back molars. That’s why it is very important for parents to floss the molars as soon as they begin to touch.

Parents should try to limit fruit juices, other sugary drinks and snacks. Children should be encouraged to drink water freely.

We strongly recommend that parents continue to help their children brush and floss until they are at least 8 years old. A good rule of thumb is that if children can’t tie their shoes or handle a knife and fork, they can’t do an adequate job on their own. Continue to keep regular re-care appointments every 6 months.

We also see a greater frequency in tooth decay in teenagers due to excess soft drink and sports drink intake at school and after school. This can bathe the teeth in sugar and acid leading to decay. We recommend a greater use of water to give the teeth a break from sugar-producing acid and provide a chance for re-mineralization.

Dental sealants lower the chance for tooth decay on the biting surfaces of the back teeth. Studies show about an 80% reduction. A sealant is a hardened plastic material that cover the pits and grooves in these teeth. It acts as a barrier to food debris, plaque and bacteria in these cavity prone areas of the teeth.

Nitrous oxide plus oxygen is a blend of two gasses: oxygen and nitrous oxide. It is also referred to as “laughing gas” or “happy air”. It creates a relaxed state for your child that helps them respond more favorable to treatment. It is very safe as used in the dental office. Your child will remain fully awake and alert and can respond easily to stimuli. It is eliminated quickly form the body with normal breathing of oxygen and room air.

We use as many disposable items as possible. The chair and other areas are cleaned with products that kill bacteria and viruses. All non-deposable items such as handpieces and instruments are rinsed, scrubbed and placed into an ultrasonic cleaner to remove debris. Then they are autoclaved with extremely high heat and pressure.

Fluoride enhances the remineralization of the enamel surface and reduces the tooth decay potential of dental plaque. Too little or too much fluoride can be bad for teeth. The proper dose is important. In Jacksonville, the water is naturally fluoridated at the proper dose. Therefore, fluoride tablets or supplements are not necessary. If you are on well water, it probably has the optimal amount of fluoride as it comes from the North Florida aquifer. Even so we still do not proscribe fluoride supplements as we don’t know how much you child gets out of the house. There are other sources of fluoride such as processed foods produced with fluoridated water.

Topical fluoride is different from ingestible fluoride. We highly recommend fluoride rinses and fluoride toothpaste. Rinses should only be used if your child is able to rinse and spit and toothpaste should properly be supervised…a smear for 2 and younger, pea size for 2-5 years old.

Baby teeth are very important for your child’s health, development and holding space for the permanent teeth. They serve a critical function as a child learns to eat and speak and are very important for the normal development and growth of the face. A child does not lose their baby teeth all at once. The front teeth are lost around 6 to 7 on the lower and 7 to 9 on the upper arches. The back molars can remain until 12 to 15 years old. If the baby teeth are not properly cared for, the teeth can decay or abscess which can cause the child unnecessary pain and can lead to serious health issues. The number one reason for missing days at school for children is dental pain.

Baby teeth should be cleaned from the moment they begin to erupt. Use a wet washcloth to wipe them off. As they erupt, use a soft child’s toothbrush. A training toothpaste (without fluoride) can be used before the age of two. A fluoridated toothpaste can be used, but only use a smear on the brush. Don’t put your baby to sleep with a bottle to prevent nursing bottle tooth decay. If you are nursing, the studies show that if your baby sleeps with you and nurses at will, 15% may get nursing tooth decay.

Part of pediatric dentist’s training concentrates on children’s dental development. Your child’s complete dental condition will be evaluated at every re-care visit. This includes orthopedic – position of facial bones and orthodontic – position of the teeth. We will inform you when your child is ready for an orthodontic evaluation. Our office provides orthodontic care with Dr. Jessica Crews at our Bayberry office and Dr. Goldknopf at our Ponte Vedra office.

Studies show that most children grind their teeth at some time during their childhood. It is usually not due to stress, as it is in older teenagers and adults. For children grinding (bruxism) may be due to the anatomy of the immature joint, position of the teeth, ear infections, allergies, and breathing difficulties through the nose. Pin worms can also cause grinding. Typically grinding ceases once all the permanent are present and the jaw joint matures. Also, as airway enlarges through growth, the other reasons stated seem to reduce the incidence of grinding.

It is normal for permanent teeth to appear yellower or grayer than the baby teeth. This is due to the thickness of the enamel (outer layer of the teeth).  This becomes less obvious as your child loses their baby teeth. Other factors can cause the permanent teeth to look yellow such as poor oral hygiene, staining and enamel defects caused by early injuries to baby teeth or hereditary dental problems. Please address your concerns with one of our pediatric dentists.

Tooth sensitivity is not uncommon for children. The enamel in primary teeth is much thinner than permanent teeth which can cause sensitivity to hot and cold.

Young permanent teeth have large nerves which get smaller as the teeth mature. The inner part of the tooth, the dentine gets thicker and insulates hot and cold better thus reducing discomfort. However, some 6-year molars erupt with enamel defects (hypoplasia) and can be more sensitive to temperature change. Please discuss tooth sensitivity with one of our dentists.

At each re-care visit we will check your child’s tooth alignment which includes preserving space and eruption guidance. Many times, a permanent tooth will come in crooked if the baby tooth hangs on too long. Some children are very reluctant to wiggle out a loose baby tooth which can cause this problem. Extractions of baby teeth may be recommended to help restore alignment. Early orthodontic care may also be indicated.

It is true that some dental care can cause discomfort. Our objective is to make your child as comfortable as we can. Options that we can use are topical anesthetics, local anesthetics, laughing gas (nitrous oxide), oral sedation and IV sedation by our anesthesiologist. For some patients especially those with medical issues we can complete treatment at Wolfson Children’s Hospital under general anesthesia. Parents will always have the opportunity to discuss options to best treat their child. Please feel free to discuss your concerns with one of our pediatric dentists.

There are boney changes (orthopedic) that result from prolonged use of the thumb/finger or pacifier. However, this is not typically an issue in very young children and is known as non-nutritive sucking. Children usually stop sucking their thumb/finger naturally as they get more active and begin to require both hands for their activities. Pacifier habits are easier to break, and a child should be weaning off of it by 3.

Children who continue to suck their thumbs/fingers frequently or with great intensity after 4 or 5 ARE at risk for dental or speech problems. Such problems include improper jaw growth, tooth alignment issues and malformed shape of the dental arches. Speech problems such as mispronouncing T’s and D’s, lisping, and tongue thrusting may occur. Please ask questions about this at your re-care appointment and ask us what we can do to help your child quit their habit. A good book about thumb sucking is David Decides About Thumbsucking: A Story for Children, A Guide for Parents, by Susan Heitler, Ph.D.

We recommend a panoramic x-ray at around age 6 or when the first permanent molar erupts, which could be earlier. This x-ray helps us see the presence or absence of permanent teeth as well as your child’s eruption pattern. It may also show infrequent extra teeth and even more infrequent pathological conditions. This x-ray helps us make decisions concerning your child’s restorative and orthodontic care. Follow up panoramic x-rays are taken around 12 or when orthodontic care is recommended. Another one is recommended before the end of high school to check the possible need for removal of the third molars (wisdom teeth).

We recommend mouth guards for any contact sports. These include football, basketball, soccer, hockey and even baseball. Mouthguards protect the teeth and can reduce concussions, brain injuries and injuries to the joints. Unfortunately, there are social issues that keep children from using mouthguards in sports and in our area only mandated sports like football force children to wear them. Boil and bite over the counter mouthguards are the most frequently used for children however custom-made mouthguards are more ideal for teenagers with all of their permanent teeth. We are happy to make a custom mouthguard for your child. If your child is in braces, our orthodontists can fit an over braces mouthguard.

We recommend that children use chewing gum that contains xylitol sweetener. Xylitol has been shown to help lower the decay risk as it inhibits dental plaque acid production. An example of xylitol containing chewing gum is Spry. Very young children should be supervised when chewing gum. Unfortunately, there is a risk for aspiration if young children are running around with the gum in their mouth.

Since many teenagers are concerned with their appearance and having white teeth, tooth whitening can boost their self-esteem. Over-the-counter teeth whitening products can be safe and effective but consult with us before using them to be sure. Some teenagers are all for whitening their teeth, but some will quit quickly after starting due to discomfort or loss of interest. We can make custom trays for cosmetic teeth whitening which is faster and more stable than the over- the- counter products however don’t waste your money if your teenager is potentially not going to follow through with the process.

We don’t recommend teeth whitening for children under 14 as the teeth are not fully mature and it may cause more sensitivity to hot and cold.

Our advice for this issue is to adequately brush teeth, gums and tongue. Several toothpastes such as Crest Pro-Health and Colgate Total may be a good option. It is important to note that if your child has allergies, asthma, or sinus infections, he will often have secondary halitosis that can’t be brushed away. In these cases, seeing your child’s physician may be the best option.

Other options may be to use several over-the-counter mouth washes such as: TheraBreath and Smart Mouth…BE SURE TO Check if your child is old enough to use the product. Age recommendations are listed on the bottle.