Pediatric dentists train for two to three additional years beyond dental school. They take specialized training focused on the oral health of children from infancy through the teenage years. At each stage in a child’s development from one year olds, their early years through to pre-teens and teenagers, child need a different approach dealing with behavior and guidance that will help them to avoid dental problems throughout their lives. A pediatric dentist with that special training is the best person to meet those needs.

Imagine a visit to the dentist without shots and the sound of drills – that is the world of Laser Dentistry, a ground-changing innovation in dentistry. With the advancement of Laser Dentistry we are able to gently clean out most cavities without having to administer an injection. We can work on multiple teeth in different areas of the mouth at a single visit. The laser helps to alleviate painful canker sores and fever blisters. Frenectomies (the removal of small folds of tissue that prevent movement) are done more simply. This superior innovation in dental care helps your child to be more comfortable and allows us to provide superior treatment with less pain, fewer needles and none of the noise that can frighten a child.

Your child’s primary teeth (sometimes called “baby” teeth) are very important. They allow your child to chew properly. They provide space for the permanent teeth and guide them into the correct position. They support the normal development of the jaw bones and muscles. They affect your child’s speech development and add to his/her attractive appearance. The first four front teeth last until six or seven years of age; the back teeth (cuspids and molars) aren’t replace until age 10 to 13. Neglect of the primary teeth frequently does lead to problems in the development of permanent teeth. For all these reasons, we encourage you to start your child’s regular dental care at the age of one.

Your child’s teeth began to form before he or she was born. As early as four months, the first baby tooth will push through the gums. They will be the lower central incisors. The upper central incisors will follow shortly thereafter. All your child’s 20 primary teeth usually appear by age three but the pace and order in which they erupt will vary. Permanent teeth start to come in around age six; first the molars and lower central incisors. Permanent teeth continue to erupt until approximately age 21. Adults have 28 permanent teeth and up to 32 including the wisdom teeth.

Toothache: Clean the area of the affected tooth. Rinse the mouth thoroughly with warm water or use dental floss to dislodge anything that may be caught. If the pain persists, call the dentist. Do not place aspirin or heat on the gum or on the aching tooth. If the face is swollen, apply a cold compress and call the dentist immediately

Cut or Bitten Tongue, Lip or Cheek: 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 a doctor or visit the hospital emergency room.

Knocked Out Permanent Tooth: If possible, find the tooth. Handle it by the crown, not by the root. Rinse the tooth with water only. Do not clean with soap, scrub or handle the tooth any more than necessary. Inspect the tooth for fractures. If it is sound, try to reinsert it in the socket. Have the child hold the tooth in place by biting on a gauze. If you cannot reinsert the tooth, put the tooth in a cup containing the child’s saliva or milk. If the child is old enough, the tooth may be carried in his/her mouth (beside the cheek). Time is critical. The child must see a dentist immediately!

Knocked Out Baby Tooth: This is not usually an emergency and, in most cases, no treatment is required. Contact the dentist’s office during business hours.

Chipped or Fractured Permanent Tooth: Contact the dentist immediately. (Quick action can save the tooth, prevent infection and reduce the need for extensive dental work.) Rinse the mouth with water and apply a cold compress to reduce any swelling. If possible, find and save any broken tooth fragments and bring them to the dentist’s office.

Chipped or Fractured Baby Tooth: Contact the dentist’s office.

Severe Blow to the Head: Take your child to the nearest hospital emergency room immediately.

Possible Broken or Fractured Jaw: Prevent the jaw from moving. Take your child to the nearest hospital emergency room

Without the use of radiographs (X-Rays), certain dental conditions might be missed. They are an important and necessary part of your child’s dental care. An X-Ray will identify erupting teeth, diagnose bone disease or evaluate the extent of an injury. They allow the dentist to see and treat conditions that a clinical examination might not reveal. They are an important tool in early detection, a key factor in making dental care more affordable and more comfortable for your child.

Most pediatric dentists recommend annual X-Rays with a complete set (either a panoramic and bitewing or periapicals and bitewings) every three years. The American Academy of Pediatric Dentistry recommends X-Rays every six months for children who are at high risk for tooth decay.

It is important to minimize exposure to radiation. We take special precautions to avoid risk. The amount of radiation exposure is very small thanks to high-speed film and filters on modern, digital equipment. In addition, we use lead body aprons and shield to protect your child. The amount of exposure is negligible. In fact, it is a smaller risk than the possibility of an untreated dental problem.

Dr. Maria Castaneda utilizes the award winning STA ® unit that combines patented, state-of-the-art, computer-controlled injection technology. This is an effective and comfortable injection solution that is both convenient and safe. It allows her to deliver a more precise injection that is more comfortable for her patients.

Good oral health begins with tooth brushing. Your choice of toothpaste, however, should be one that bears the recommendation of the American Dental Association as shown on the box. They have been tested to insure that they are safe. Some toothpastes and polishes on the market could damage young tooth enamel because they contain harsh abrasives.

Remind your child to spit out toothpaste after brushing. This will avoid him or her getting too much fluoride which, if ingested, can cause a cause a condition called fluorosis (a tooth discoloration). If your child is too young or unable to spit, you can use fluoride free toothpaste, use a very small amount of toothpaste, or don’t use toothpaste at all.

Parents may become concerned if they notice their child grinding his or her teeth at night. They might hear the sound or notice wear on the teeth. There are several theories about the cause of tooth grinding (bruxism) including stress due to environmental changes in the child’s situation and pressure in the inner ear at night causing the child to move his jaw to relieve the pressure.

The good news is that most children outgrow bruxism and in the majority of case it does not require any treatment. However if there is excessive wear of the teeth, a mouth night guard may be called for. There is a possibility of choking if the appliance becomes dislodged during sleep. It could also interfere with the growth of the jaw. On the obvious positive side, it will prevent ear of the primary teeth. If you suspect bruxism, you should consult with your dentist.

In infants and young children, sucking is a natural reflex that gives them a feeling of security. They may use a thumb, fingers, a pacifier or other objects. It is relaxing and may induce sleep.

If thumb sucking continues beyond the eruption of the permanent teeth, however, it can cause problems with tooth alignment and the proper growth of the mouth. Most child stop thumb sucking between the age of two and four. It should stop by the time the permanent front teeth are ready to come through. The more intensely the child sucks can affect the extent of dental problems. The child who passively rests a thumb in the mouth is less likely to have problems than the one who actively sucks his or her thumb.

Although a pacifier has the same effect as thumb sucking, the advantage is that it can be controlled and modified more easily.

Here are some suggestions that will help your child through thumb sucking:

• Thumb sucking is often a response to feeling insecure. Try to correct the cause of insecurity instead of focusing on the thumb sucking.
• If your child is sucking because he or she needs comforting, your comfort will be more effective.
• Rewards are effective – if your child does not resort to sucking during a difficult period, praise and a reward will reinforce the desired behavior.
• ven to a young child, knowledge is powerful. Your pediatric dentist can explain how sucking can damage his or her beautiful teeth.
• If all else fails, remind your child of the habit by bandaging the thumb or putting a sock on the hand at night. Your dentist might recommend the use of a mouth appliance.

The pulp of a tooth is the inner, central core where the nerves, blood vessels, connective tissue and reparative cells are located. The purpose of pulp therapy in pediatric dentistry is to maintain the life of the affected tooth so the tooth is not lost. Cavities and traumatic injury are the main reasons why a tooth to may require pulp therapy. Pulp therapy is often called “nerve treatment,” “children’s root canal,” “pulpectomy” or “pulpotomy.”

The two common forms of pulp therapy in children’s teeth are the pulpotomy and pulpectomy:

A pulpotomy removes the diseased pulp tissue within the crown portion of the tooth. An agent is then placed to prevent bacterial growth and to calm the remaining nerve tissue. This is followed by a final restoration, usually a stainless steel crown.

A pulpectomy is required when the entire pulp is involved all the way into the root canal(s) of the tooth. During this treatment, the diseased pulp tissue is completely removed from both the crown and the root. The canals are cleansed, disinfected and, in the case of primary teeth, filled with a resorbing material. A final restoration is placed. A permanent tooth would be filled with a non-resorbing material.

The following steps provide some guidance in making the decision to consult with an orthodontist. Your pediatric dentist will help guide you in this decision.

Early Treatment: This period covers ages two to six. At this young age, we are concerned with underdeveloped dental arches, the premature loss of primary teeth, and harmful habits such as finger or thumb sucking. Treatment at this stage of development is often very successful and may eliminate the need for future orthodontic/orthopedic treatment. 

Mixed Dentition: This period covers the ages of six to twelve when the permanent incisor (front) teeth and six-year molars erupt. Treatment concerns deal with jaw and dental realignment problems. If indicated, this is an excellent time to start treatment, as your child’s hard and soft tissues are usually very responsive to orthodontic or orthopedic forces.

Adolescent Dentition: This stage deals with the permanent teeth and the development of the final bite relationship.

The American Academy of Pediatric Dentistry recommends that all pregnant women receive oral healthcare and counseling during pregnancy. Research has shown that periodontal disease can increase the risk of preterm birth and low birth weight. Consult with your doctor or dentist about ways you can prevent periodontal disease during pregnancy.

A mother with poor oral health may pass the bacteria which causes cavities to her young children. Mother’s should follow these simple steps to decrease the risk of spreading cavity-causing bacteria:

• Maintain regular dental visits.
• Brush and floss daily to reduce bacterial plaque.
• Eat a nutritious diet – reduce high sugar drinks and starches in the diet.
• Use fluoridated toothpaste recommended by the ADA. Rinse every night with an alcohol-free, over-the-counter mouth rinse with .05% sodium fluoride in order to reduce plaque levels.
• Don’t share utensils, cups or food which can cause the transmission of cavity-causing bacteria with your children.
• The use of xylitol chewing gum (four pieces per day for the mother) can decrease a child’s caries rate.

The American Academy of Pediatrics, the American Dental Association, and the American Academy of Pediatric Dentistry all recommend establishing a “dental home” for your child by one year of age. Children who have a dental home are more likely to receive appropriate preventive and routine oral health care.

Your “dental home” will provide a better place than the emergency room should an emergency occur.

You and your pediatric dentist can make sure that the first visit to the dentist is enjoyable and positive. If your child is old enough, he or she should be told all about the visit. The dentist and the staff will explain all procedures and answer all questions, yours and your child’s. The less “to-do” concerning the visit, the better.  Avoid using words that might cause your child unnecessary fear: i.e., needle, pull, drill or hurt. Pediatric dental offices make a practice of using words that have the same message, but are pleasant and non-frightening to your child.

Teething, the process of baby teeth coming through the gums, is different for every baby. Some start early and some start late. In general, the first baby teeth to appear are the lower front (anterior) teeth and they begin erupting between the ages of six to eight months. See “Eruption of Your Child’s Teeth” for more details.

A serious and sometime unrealized cause of tooth decay among young children is what we call “baby bottle tooth decay.” It is caused by frequent and long exposures of an infant’s teeth to liquids that contain sugar. Those liquids include not only sweetened drinks but also milk (including breast milk), formula and fruit juices.

Putting a baby to bed for a nap or at night with a bottle other than water can cause serious and rapid tooth decay. Sweet liquid pools around the child’s teeth. Plaque bacteria then produce acids that attack tooth enamel. If your baby needs a bottle as a comfort at bedtime, give him or her a bottle that only contains water. If your child has become accustomed to a usual beverage and won’t fall asleep without it, gradually dilute the bottle’s contents with water. You should be able to train him or her to water only within two to three weeks.

After each feeding, it is important to “wash” your baby’s mouth. You can do this by laying the baby’s head on your lap or laying him on a dressing table and wiping his gums and teeth with a damp cloth or gauze to remove the plaque. Be sure that you can see into the baby’s mouth easily so that you can clean her mouth thoroughly.

Little ones love their sippy cups but they should only be used as a training tool from bottle to cup. They should be discontinued by your child’s first birthday. If your child uses a sippy cup throughout the day, fill it with water only (except at mealtimes). By filling the sippy cup with liquids that contain sugar (including milk, fruit juice, sports drinks, etc.) and allowing a child to drink from it throughout the day, you are promoting the formation of cavities.

Healthy eating habits will support the formation of healthy teeth. Teeth, bones and the mouth’s soft tissue, like the rest of the body, thrive on a well-balanced diet. Children should eat a variety of foods from the five major food groups. Children need and look forward to snacks but, unfortunately, most snacks foods lead to cavity formation. The more frequently a child snacks, the greater the chances for tooth decay. The longer the food stays in the mouth, the more it will lead to the conditions that cause decay. For example, hard candy and breath mints stay in the mouth a long time, giving the acid more time to attacks the tooth enamel.

Give your child nutritious foods such as vegetables, low-fat yogurt, or low-fat cheese for snacks. The pay-off will be healthier teeth and good oral health.

Frequent brushing and good oral hygiene removes bacteria and the leftover food particles that combine to create cavities.

For infants, use a wet gauze or clean washcloth to wipe the plaque from teeth and gums. Avoid putting your child to bed with a bottle filled with anything other than water. (See “Baby Bottle Tooth Decay” for more information.) For older children, brush their teeth at least twice a day. Avoid snacks that contain sugar.

The American Academy of Pediatric Dentistry recommends that regular visits to a pediatric dentist begin by the child’s first birthday and every six months hereafter. Regular, routine visits to the dentist will start your child on a lifetime of good dental health.

Your pediatric dentist may also recommend protective sealants or home fluoride treatments. Sealants can be applied to your child’s molars to prevent decay on hard to clean surfaces. A sealant is a clear or shaded plastic material that is applied to the chewing surfaces (grooves) of the back teeth (premolars and molars), where most cavities in children are found. This sealant acts as a barrier to food, plaque and acid, protecting the decay-prone areas of the teeth.

Before Sealant Applied	After Sealant Applied

Fluoride is a mineral that occur natural in many foods and water. Fluoride helps prevent tooth decay by making the tooth more resistant to acid attacks from plaque bacteria and sugars in the mouth. But, too much or too little fluoride can be detrimental to the teeth. If there is too little or no fluoride, the teeth not strengthen and resist cavities. Excessive fluoride ingestion by preschool-aged children can lead to dental fluorosis, which is a chalky white to even brown discoloration of the permanent teeth. Sometimes children get more fluoride than their parents realize. Being aware of potential sources of fluoride can prevent the possibility of dental fluorosis.

Some of these sources are:

• Too much fluoridated toothpaste at an early age.
• The inappropriate use of fluoride supplements.
• Hidden sources of fluoride in the child’s diet.

Two and three year olds may not be able to spit out fluoride-containing toothpaste. They may ingest an excessive amount of fluoride during tooth brushing. Swallowing toothpaste during this critical period of permanent tooth development is the greatest risk factor in the development of fluorosis.

Excessive and inappropriate intake of fluoride supplements may also contribute to fluorosis. Fluoride drops and tablets and/or fluoride fortified vitamins should not be given to infants younger than six months of age. Thereafter, fluoride supplements should only be given to children after all of the sources of ingested fluoride have been accounted for and only as recommended by your pediatrician or pediatric dentist.

Certain foods contain high levels of fluoride, especially powdered concentrate infant formula, soy-based infant formula, infant dry cereals, creamed spinach, and infant chicken products. Read the label or contact the manufacturer. Some beverages also contain high levels of fluoride, especially decaffeinated teas, white grape juices, and juice drinks manufactured in fluoridated cities. 

The following steps outline ways to decrease the risk of fluorosis:

• Use baby tooth cleanser on the toothbrush of the very young child.
• Place only a pea sized drop of children’s toothpaste on the brush when brushing.
• Account for all of the sources of ingested fluoride before requesting fluoride supplements from your child’s physician or pediatric dentist.
• Do not give any fluoride-containing supplements to infants until they are at least six months old.
• Obtain fluoride level test results for your drinking water (check with local water utilities) before giving fluoride supplements to your child.

Remember that once your child starts to participate in recreational activities and organized sports, injuries can occur. A properly fitted mouth guard, or mouth protector, is an important piece of athletic gear that can help protect your child. It should be used during any activity that could result in a blow to the face or mouth. A properly fitted mouth guard helps prevent broken teeth and injuries to the lips, tongue, face or jaw.

The American Academy of Pediatric Dentistry recognizes the benefits of xylitol, a synthetic sweetener, on the oral health of infants, children, adolescents, and persons with special health care needs. Xylitol is widely distributed throughout nature in small amounts. Some of the best sources are fruits, berries, mushrooms, lettuce, hardwoods, and corn cobs. One cup of raspberries contains less than one gram of xylitol.

The use of Xylitol Gum by mothers (two to three times per day) starting three months after delivery and until the child is two years old, has proven to reduce cavities up to 70% by the time the child reached five. It decreases the amount of cavity causing bacteria that may be transmitted to the child.

Studies using xylitol as either a sugar substitute or a small dietary addition have demonstrated a dramatic reduction in new tooth decay, along with some reversal of existing dental caries. Xylitol provides additional protection that enhances all existing prevention methods. This xylitol effect is long-lasting and possibly permanent. Low decay rates persist even years after the trials have been completed.

Studies suggest xylitol intake that consistently produces positive results ranged from 4 to 20 grams per day, divided into three to seven consumption periods. Higher results did not result in greater reduction and may lead to diminishing results. Similarly, consumption frequency of less than three times per day showed no effect.

To find gum or other products containing xylitol, visit your local health food store or search the Internet to find products containing 100% xylitol.

The high sugar and acid content of sports drinks make them a risk for dissolving even fluoride rich enamel leading to cavities. Children should avoid sports drinks and hydrate with water before, during and after taking part in sports activities. Talk to your pediatric dentist before giving sports drinks to your child.

If your child drinks sports drinks:

• Tell her to swallow immediately and not swish them around the mouth
• Have him neutralize the effect of sports drinks by alternating sips of water with the drink
• Rinse mouth guards only in water
• Look for dentally friendly sports drinks

Piercing has become popular and common place. You see young people with pierced tongues, lips, and cheeks. You might be surprised to know just how dangerous these piercings can be. 

Among the many risks are cracked teeth, blood clots, blood poisoning, heart infections, brain abscess, nerve disorders (trigeminal neuralgia), receding gums or scar tissue. The mouth contains millions of bacteria, and infection is a common complication of oral piercing. The tongue could swell large enough to close off the airway!

Common symptoms after piercing include pain, swelling, infection, an increased flow of saliva and injuries to gum tissue. Difficult-to-control bleeding or nerve damage can result if a blood vessel or nerve bundle is in the path of the needle.

Follow the advice of the American Dental Association and give your mouth a break – skip the mouth jewelry and warn your teenagers about how risking they are.

Tobacco in any form can jeopardize your child’s health and cause incurable damage. Be a positive example and teach your child about the dangers of tobacco.

Smokeless tobacco (also called spit, chew or snuff) is often used by teens who believe that it is a safe alternative to smoking cigarettes. This is not true. Studies show that spit tobacco may be more addictive than smoking cigarettes making it more difficult to quit. Teens who use it should know that one can of snuff per day delivers as much nicotine as 60 cigarettes. In as little as three to four months, smokeless tobacco use can cause periodontal disease and produce pre-cancerous lesions called leukoplakia.

If your child is a tobacco user you should watch for the following early signs of oral cancer:

• A sore that won’t heal.
• White or red leathery patches on the lips, and/or under the tongue.
• Pain, tenderness or numbness anywhere in the mouth or lips.
• Difficulty chewing, swallowing, speaking or moving the jaw or tongue; or a change in the way the teeth fit together.

People often ignore the early signs of oral cancer because they are not usually painful. If not caught in the early stages, oral cancer can require extensive, sometimes disfiguring, surgery. Even worse, it can kill.

Help your child avoid tobacco in any form.