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Why should I bring my child to a Pediatric Dentist?

Just as you would take your child to a pediatrician for his or her general medical care, a pediatric dentist has an extra two to three years of specialized training after dental school. Dr. Rishi Verma is dedicated to the oral health of children from infancy through the teenage years, as well as those children with special needs. As a pediatric dentist, he is best qualified to meet the dental needs of children in dealing with their behavior, guiding their dental growth and development, and helping them avoid future dental problems.

Why is it important to establish a “dental home” for my child?

The concept of the “dental home” is at the forefront of pediatric dental practice today. We recommend that infants establish a dental home either by age one or when the first tooth erupts. This way, we can discuss about preventive dental regimens, consult on growth milestones and patterns, and provide anticipatory guidance in order to keep your child cavity free!

Why are the primary (baby) teeth so important?

Many parents ask why we try to save primary (baby) teeth when they are going to fall out anyway. The primary teeth are important for many reasons. Neglected cavities can, and frequently do, lead to problems such as unnecessary pain and dental infections, which affect developing permanent teeth. The primary teeth are necessary for proper chewing and eating, they provide space for the permanent teeth to erupt, guiding them into the correct position, and they permit normal development of the jaw bones and muscles. Primary teeth also affect the development of speech and add to an attractive appearance. While the front four teeth last until approximately 6-7 years of age, the back teeth (cuspids, bicuspids and molars) aren’t replaced until age 10-13.

What is the usual pattern of tooth eruption?

Children’s teeth begin forming while they are still in the womb. As early as 4 months, the first primary (baby) teeth that begin to erupt through the gums are the lower central incisors, followed closely by the upper central incisors. Although all 20 primary teeth usually appear by age 3, the pace and order of their eruption varies.

Permanent teeth begin appearing around age 6, starting with the first molars and lower central incisors. This process continues until approximately age 21. Adults have 28 permanent teeth, or up to 32 including the third molars (or wisdom teeth).

What should I do in the event of a dental emergency?

Toothache: Clean the area of the affected tooth. Rinse the mouth thoroughly with warm water or use dental floss to dislodge any food that may be impacted. If the pain still exists, please call us. Do not place aspirin, oragel, or heat on the gum or on the aching tooth. If the face is swollen, apply cold compresses and contact us 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 us or visit the hospital emergency room.

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

Knocked Out Baby Tooth: This is not usually an emergency, and in most cases, no treatment is necessary. However, please call us so that we can see your child and evaluate if any treatment is necessary.

Chipped or Fractured Permanent Tooth: Contact us immediately. Quick action can save the tooth, prevent infection and reduce the need for extensive dental treatment. Rinse the mouth with water and apply cold compresses to reduce swelling. If possible, locate and save any broken tooth fragments and bring them with you to the dentist.

Chipped or Fractured Baby Tooth: Contact us immediately so that we can evaluate the tooth and treat if necessary.

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

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

Can dental injuries be prevented?

Your child’s risk for dental injuries can be reduced greatly by following a few simple suggestions. First, reduce risk for severe oral injury in sports by wearing protective gear, including a mouthguard. Second, always use a car seat for young children and require seat belts for everyone else in the car. Third, child-proof your home to prevent falls and electrical injuries. Regular dental check-ups provide your dentist an opportunity to discuss additional age-appropriate preventive strategies with your child.

What’s the best toothpaste for my child?

Tooth brushing is one of the most important tasks for good oral health. Before age one and after the first tooth erupts, your child’s teeth should be brushed with a fluoride-free toothpaste. After age one, your child should be using a fluoridated toothpaste. If they are still swallowing toothpaste, a smear of toothpaste (1/4 of a pea) should be used. As your child develops the ability to spit out toothpaste, a pea sized amount may be used. If too much fluoride is ingested, a condition known as fluorosis can occur, which can lead to a brownish-white appearance of the adult teeth.

Many toothpastes, and/or tooth polishes, however, can damage young smiles. They contain harsh abrasives, which can wear away young tooth enamel. When looking for a toothpaste for your child, make sure to pick one that is recommended by the American Dental Association as shown on the box and tube. These toothpastes have undergone testing to ensure they are safe to use.

What are the causes and treatments for nighttime tooth grinding (bruxism)?

Parents are often concerned about the nocturnal grinding of teeth (bruxism). Often, the first indication is the noise created by the child grinding on his or her teeth during sleep. You may also notice wear (teeth getting shorter) to the dentition. One theory is that the cause is psychological. Stress due to a new environment, divorce, changes at school, etc., can influence a child to grind his or her teeth. Another theory relates to pressure in the inner ear at night. If there are pressure changes the child will grind and move his jaw to relieve this pressure, similar to the effect of yawning or chewing gum in an airplane during take-off and landing to “pop the ears” and equalize pressure.

The majority of cases of pediatric bruxism do not require any treatment. If excessive wear of the teeth (attrition) is present, then a mouth guard (night guard) may be indicated. The negatives to a mouth guard are the possibility of choking if the appliance becomes dislodged during sleep, and it may interfere with growth of the jaws.

The good news is most children outgrow bruxism. The grinding decreases between the ages 6-9 and children tend to stop grinding between ages 9-12. If you suspect bruxism, discuss this with us at your child’s next visit.

Should I be concerned about thumb sucking? When and how do I stop it?

Sucking is a natural reflex and infants and young children may use thumbs, fingers, pacifiers and other objects on which to suck and satisfy this instinct. It may make them feel secure and happy, or provide a sense of security at difficult periods or induce sleep.

Thumb sucking that persists beyond the eruption of the permanent teeth can cause problems with the proper growth of the mouth and tooth alignment. How intensely a child sucks on fingers or thumbs will determine whether or not dental problems may result. Children who rest their thumbs passively in their mouths are less likely to have difficulty than those who vigorously suck their thumbs.

Research shows that the most critical period to stop this habit is between 3-4 years of age. If this habit persists past this point, then irreversible changes may occur to the growth pattern of the jaws and eruption of teeth. Children should cease thumb sucking by the time their permanent front teeth are ready to erupt. Usually, children stop between the ages of two and four, and peer pressure causes many school-aged children to stop.

Pacifiers are no substitute for thumb sucking. They can affect the teeth essentially the same way as sucking fingers and thumbs. However, use of the pacifier can be controlled and modified more easily than the thumb or finger habit. If you have concerns about thumb sucking or use of a pacifier, consult Dr. Verma at your next visit.

A few suggestions to help your child get through thumb sucking:

• Instead of scolding children for thumb sucking, praise them when they are not.
• Children often suck their thumbs when feeling insecure. Focus on correcting the cause of anxiety, instead of the thumb sucking.
• 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 periods, such as when being separated from their parents.
• As your child’s pediatric dentist, Dr. Verma can encourage children to stop sucking and explain what could happen if they continue.
• If these approaches don’t work, remind the children of their habit by bandaging the thumb or putting a sock on the hand at night. Dr. Verma may recommend the use of a mouth appliance, nail polishes, or other treatment modalities.

What is Pulp Therapy?

The pulp of a tooth is the inner, central core of the tooth. The pulp contains nerves, blood vessels, connective tissue and reparative cells. The purpose of pulp therapy in Pediatric Dentistry is to maintain the vitality of the affected tooth so the tooth is not lost.

Dental caries (cavities) and traumatic injury are the main reasons for a tooth to require pulp therapy. Pulp therapy is often referred to as a “nerve treatment”, “pulpectomy” or “pulpotomy.” It is not a “baby root canal.”

A pulpotomy removes the diseased pulp tissue within the crown portion of the tooth. Next, an agent is 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 (into the root canal(s) of the tooth). During this treatment, the diseased pulp tissue is completely removed from both the crown and root. The canals are cleansed, disinfected and, in the case of primary teeth, filled with a resorbable material. Then, a final restoration is placed. A permanent tooth would be filled with a non-resorbing material.

When is the best time for orthodontic treatment?

Developing malocclusions, or bad bites, can be recognized as early as 2-3 years of age. Often, early steps can be taken to reduce the need for major orthodontic treatment at a later age.

Stage I – Early Treatment: This period of treatment encompasses ages 2 to 6 years. 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 initiated in this stage of development is often very successful and many times, though not always, can eliminate the need for future orthodontic/orthopedic treatment.

Stage II – Mixed Dentition: This period covers the ages of 6 to 12 years, with the eruption of the permanent incisor (front) teeth and 6 year molars. Treatment concerns deal with jaw malrelationships and dental realignment problems. This is an excellent stage to start treatment, when indicated, as your child’s hard and soft tissues are usually very responsive to orthodontic or orthopedic forces.

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

What are mouth guards?

When a child begins 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’s smile, and should be used during any activity that could result in a blow to the face or mouth.

Mouth guards help prevent broken teeth, and injuries to the lips, tongue, face or jaw. A properly fitted mouth guard will stay in place while your child is wearing it, making it easy for them to talk and breathe.

Ask us about custom and store-bought mouth protectors.

What is xylitol?

Xylitol is a natural sugar alcohol sweetener that helps prevent cavities. Unlike sugar, certain cavity-causing bacteria in the mouth cannot utilize xylitol to grow. With regular use, xylitol changes the quality of the bacteria in the mouth, and fewer decay-causing bacteria are able to survive on the teeth, which in turn makes it more difficult for plaque to form.

There are many products that contain xylitol, including certain gums, mints, toothpastes, rinses, topical syrups and tooth wipes. How much and how often xylitol is needed for it’s cavity-preventing properties to be effective will vary depending on the product used and the person using it. Also keep in mind that gum and/or mints may be a choking hazard to very young children, so ask Dr. Verma to recommend the best products containing xylitol to suit your family’s needs.