Dental Topics

A pediatric dentist completes an extra two to three years of specialized training after dental school and is dedicated to the oral health of children from infancy through the teenage years. Children at different developmental stages require different approaches in dealing with their behavior, guiding their dental growth and development, and teaching them oral hygiene techniques to prevent future dental problems.

Primary teeth are important for (1) proper chewing and eating, (2) providing space for the permanent teeth and guiding them into the correct space, (3) permitting normal development of the jaw bones and muscles, and (4) speech development. Primary teeth enhance your child’s smile. Lack of proper oral hygiene can lead to cavities that will result in infection if left untreated. The front eight primary teeth last until 6-8 years of age while the back twelve primary teeth (canines and molars) are not replaced until age 10-13.

Your child’s primary teeth begin forming before birth. The first primary tooth usually erupts at an average age of 6-7 months but can erupt as early as 4 months. The first primary teeth to erupt are the lower central incisors followed by the upper central incisors. The pace and order of primary tooth eruption can vary amongst children but all 20 primary teeth usually erupt by age 3.

Permanent teeth begin erupting at an average age of 6, starting with the first molars and lower central incisors. By about age 8, the top and bottom 8 primary incisors have been replaced by permanent incisors. There is then a two to three-year break before your child starts to lose their back primary teeth and the rest of the permanent teeth start to erupt. Adults have 28 permanent teeth or up to 32 permanent teeth if they have their third molars (wisdom teeth).

Avoid toothpastes that contain harsh abrasives that can damage primary teeth. When purchasing a toothpaste for your child, pick one that is recommended by the American Dental Association as shown by the ADA Seal of Acceptance on the box and tube. These toothpastes have undergone testing to ensure that they are safe to use.

For children less than 3 years of age, use only a smear of fluoridated toothpaste that is the size of a grain of rice. You can use a “pea-size” amount of fluoridated toothpaste on children 3 to 8 years old. Young children do not have the ability to brush their teeth effectively on their own and they should spit out to avoid swallowing excess toothpaste that can cause fluorosis (mild discoloration on the permanent teeth due to frequently ingesting too much fluoride during the first 8 years of life).

Bruxism is nonfunctional clenching or grinding of the teeth. Parents often hear the noise created by their children grinding their teeth or notice wear to their dentition. Although research on bruxism is extensive, its etiology remains debatable. The literature suggests that bruxism is correlated with both experienced and anticipated life stress such as a new environment, divorce, changes at school, etc. Another theory suggests pressure in the inner ear or pressure due to teething at night that triggers children to move their jaws to equalize the pressure they are feeling.

Most cases of pediatric bruxism do not require any treatment. Your pediatric dentist will assess your child’s teeth for wear (attrition). If excessive wear is present, she can place bite blocks (acrylic buttons) on your children’s molars to alleviate the wear on their teeth. Heavy bruxism may require that bite blocks be replaced every few months.

Most children outgrow bruxism. Teeth grinding decreases between the ages of 6-9 and children tend to stop grinding between the ages of 9-12. If bruxism continues later in life, a night guard is the treatment of choice when your child is done growing and is more likely to tolerate such an appliance.

Sucking is a natural reflex and infants and young children may suck thumbs, fingers, pacifiers, and other objects to self-soothe. It often makes them feel more secure and happy and because thumbsucking is relaxing, it may induce sleep.

Thumbsucking that persists beyond the eruption of the permanent teeth can interfere with proper jaw growth and tooth alignment. The intensity of the sucking habit determines whether or not dental problems will occur. Children who rest their thumbs passively in their mouths are less likely to have bite problems than those who vigorously suck their thumbs.

Ideally, children should stop thumbsucking by the time their permanent teeth start to erupt. Children usually stop between the ages of 2 and 4 and peer pressure eventually causes many school-aged children to stop.

Pacifiers should not be used as a substitute for thumbsucking because they can affect teeth essentially the same way as fingers and thumbs. The benefit of using a pacifier is that it can be controlled and modified more easily than a finger or thumb habit.

Here are a few suggestions to help discontinue thumbsucking:

• Children often suck when they are feeling insecure. Focus on correcting the cause of the anxiety, instead of the habit.
• Children who are sucking for comfort will feel less of a need when their parents provide comfort.
• Reward children when they refrain from sucking during difficult times
• You can bandage the thumb or put socks on the hands at night to help remind your child not to suck.
• Your pediatric dentist can encourage your child to stop sucking and explain what can happen if they continue.

This is a very common occurrence with children, usually the result of a permanent tooth not erupting directly underneath the primary tooth. In most cases when the child starts to wiggle the baby tooth consistently, it usually falls out within two months. If it does not exfoliate, your pediatric dentist can easily remove the tooth and the permanent tooth will then slide into its proper position.

Malocclusion, the misalignment of teeth and bite problems, can be recognized as early as 2-3 years of age. Your pediatric dentist will determine the timing of your child’s referral to an orthodontist based on the severity of their malocclusion and the degree of crowding present. Early orthodontic intervention often reduces the need for major orthodontic treatment at a later age.

Radiographs (X-rays) are a vital part of your child’s dental diagnostic process. Without them, certain dental conditions can be missed. In addition to detecting cavities, radiographs are needed to diagnose bone diseases, survey erupting teeth, evaluate the results of an injury, and plan orthodontic treatment. The American Academy of Pediatric Dentistry recommends radiographs every six months for children who are at high risk for tooth decay. X-rays are usually taken once a year on patients who are not at high risk for tooth decay.

East Bench Pediatric Dentistry chooses to use digital x-rays due to their important advantages over traditional x-rays. Our patients deserve 70% less radiation exposure, less discomfort, less time in the chair, and better diagnostic imaging.