Oral Hygiene
Brushing
Use a toothbrush with soft bristles and a small strip of fluoride toothpaste. When you brush your teeth, move the brush in small circular motions to reach food particles that may be under your gum line. Hold the toothbrush at an angle and brush slowly and carefully, covering all areas between teeth and the surface of each tooth. It will take you several minutes to thoroughly brush your teeth. Brush up on the lower teeth, down on the upper teeth and the outside, inside and chewing surface of all of your front and back teeth. Brush your tongue and the roof of your mouth before you rinse.
Brush your teeth four times daily to avoid the accumulation of food particles and plaque:
As soon as the bristles start to wear down or fray, replace your toothbrush with a new one. Do not swallow any toothpaste; rinse your mouth thoroughly with water after you finish brushing. It is important to carefully floss and brush daily for optimal oral hygiene.
Flossing
For areas between the teeth that a toothbrush can’t reach, dental floss is used to remove food particles and plaque. Dental floss is a thin thread of waxed nylon that is used to reach below the gum line and clean between teeth. It is very important to floss between your teeth every day.
Pull a small length of floss from the dispenser. Wrap the ends of the floss tightly around your middle fingers. Guide the floss between all teeth to the gum line, pulling out any food particles or plaque. Unwrap clean floss from around your fingers as you go, so that you have used the floss from beginning to end when you finish. Floss behind all of your back teeth.
Floss at night to make sure your teeth are squeaky clean before you go to bed. When you first begin flossing, your gums may bleed a little. If the bleeding does not go away after the first few times, let a staff member know at your next appointment.
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Early Treatment
Teething
Normally, the first tooth erupts between ages 6 to 12 months. Gums are sore, tender and sometimes irritable until the age of 3. Rubbing sore gums gently with a clean finger, the back of a cold spoon or a cold, wet cloth helps soothe the gums. Teething rings work well, but avoid teething biscuits—they contain sugar that is not good for baby teeth.
While your baby is teething, it is important to monitor the teeth for signs of baby bottle decay. Examine the teeth, especially on the inside or the tongue side, every two weeks for dull spots (whiter than the tooth surface) or lines. A bottle containing anything other than water and left in an infant’s mouth while sleeping can cause decay. This happens because sugar in the liquid mixes with bacteria in dental plaque, forming acids that attack the tooth enamel. Each time a child drinks liquids containing sugar, acids attack the teeth for about 20 minutes. When awake, saliva carries away the liquid. During sleep, the saliva flow significantly decreases and liquids pool around the child’s teeth for long periods, covering the teeth in acids.
Infant’s New Teeth
The primary, or “baby,” teeth play a crucial role in dental development. Without them, a child cannot chew food properly and has difficulty speaking clearly. Primary teeth are vital to development of the jaws and for guiding the permanent (secondary) teeth into place when they replace the primary teeth around age 6.
Since primary teeth guide the permanent teeth into place, infants with missing primary teeth or infants who prematurely lose primary teeth may require a space maintainer, a device used to hold the natural space open. Without a maintainer, the teeth can tilt toward the empty space and cause permanent teeth to come in crooked. Missing teeth should always be mentioned to your family dentist. The way your child cares for his/her primary teeth plays a critical role in how he/she treats the permanent teeth. Children and adults are equally susceptible to plaque and gum problems—hence, the need for regular care and dental checkups.
A Child’s First Dental Visit
A child’s first dental visit should be scheduled around his/her first birthday. The most important part of the visit is getting to know and becoming comfortable with a doctor and his staff. A pleasant, comfortable first visit builds trust and helps put the child at ease during future dental visits. If possible, allow the child to sit in a parent’s lap in the exam room. Children should be encouraged to discuss any fears or anxiety they feel.
Why Primary Teeth Are Important
Primary teeth are important for several reasons. Foremost, good teeth allow a child to eat and maintain good nutrition. Healthy teeth allow for clear pronunciation and speech habits. The self-image that healthy teeth give a child is immeasurable. Primary teeth also guide eruption of the permanent teeth.
Good Diet and Healthy Teeth
The teeth, bones and soft tissue of the mouth require a healthy, well-balanced diet. A variety of foods from the five food groups helps minimize (and avoid) cavities and other dental problems. Most snacks that children eat cause cavities, so children should only receive healthy foods like vegetables, low-fat yogurt and cheeses, which promote strong teeth.
Infant Tooth Eruption
A child’s teeth actually start forming before birth. As early as 4 months of age, the primary or “baby” teeth push through the gums—the lower central incisors are first, then the upper central incisors. The remainder of the 20 primary teeth typically erupt by age 3, but the place and order varies.
Permanent teeth begin eruption around age 6, starting with the first molars and lower central incisors. This process continues until around age 21. Adults have 28 secondary (permanent) teeth—32 including the third molars (wisdom teeth).
Preventing Baby Bottle Tooth Decay
Tooth decay in infants can be minimized or totally prevented by not allowing sleeping infants to breast or bottle-feed. Infants that need a bottle to comfortably fall asleep should be given a water-filled bottle or a pacifier. Our office is dedicated to fighting baby bottle tooth decay. Let us know if you notice any signs of decay or anything unusual in your child’s mouth.
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Sedation Dentistry
Sedation dentistry refers to the use of sedation during dental treatment. Sedation is most commonly used during extensive procedures, for patients with dental phobia or for patients who find it difficult to sit still. There are different types of sedation, including nitrous oxide ("laughing gas"), IV sedation, oral sedatives and general anesthetic.
Sedation can range from the use of nitrous oxide to calm a patient to general anesthetics used to put patients to sleep. Patients with dental phobia, low pain tolerance, major dental treatment, physical handicaps or strong gag reflexes may require sedation. Procedures like fillings, crowns, bridges, root canals, extractions, cosmetic procedures and periodontal treatments often require sedation.
Sedation is endorsed by the American Dental Association and is an effective way to make many patients comfortable during their dental visit. Before using a sedative or anesthetic, it is important to tell your dentist about any medications or medical treatments you are receiving. Before administering any sedative or anesthetic, your dentist will talk to you about the process of sedation and pre- and post-sedation instructions.
"Laughing Gas"
Nitrous oxide, more commonly known as laughing gas, is often used as a conscious sedative during a dental visit. The gas is administered with a mixture of oxygen and has a calming effect that helps phobic or anxious patients relax during their dental treatment. Because it is a mild sedative, patients are still conscious and can talk to their dentist during their visit. After treatment, the nitrous is turned off and oxygen is administered for five to 10 minutes to help flush any remaining gas. The effects wear off almost immediately. Nitrous oxide rarely has side effects, although some patients may experience minor nausea and constipation. Your doctor will provide you with pre- and post-sedation instructions.
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Treatments
Fluoride
How does fluoride work?
When the element fluoride is used in small amounts on a routine basis it helps to prevent tooth decay. It encourages "remineralization," a strengthening of weak areas on the teeth. These spots are the beginning of cavity formation. Fluoride occurs naturally in water and in many different foods, as well as in dental products such as toothpaste, mouth rinses, gels, varnish and supplements. Fluoride is effective when combined with a healthy diet and good oral hygiene.
Will my child need fluoride supplements?
Children between the ages of six months and 16 years may require fluoride supplements. The pediatric dentist considers many different factors before recommending a fluoride supplement. Your child's age, risk of developing dental decay and the different liquids your child drinks are important considerations. Bottled, filtered and well waters vary in their fluoride amount, so a water analysis may be necessary to ensure your child is receiving the proper amount.
What type of toothpaste should my child use?
Your child should use toothpaste with fluoride and the American Dental Association Seal of Acceptance. Young children, especially pre-school aged children, should not swallow any toothpaste. Careful supervision and only a small pea-sized amount on the brush are recommended. If not monitored, children may easily swallow over four times the recommended daily amount of fluoride in toothpaste.
How safe is fluoride?
Fluoride is documented to be safe and highly effective. Research indicates water fluoridation, the most cost effective method, has decreased the decay rate by over 50 percent. Only small amounts of fluoride are necessary for the maximum benefit. Proper toothpaste amount must be supervised, and other forms of fluoride supplementations must be carefully monitored in order to prevent a potential overdose and unsightly spots on the developing permanent teeth. Do not leave toothpaste tubes where young children can reach them. The flavors that help encourage them to brush may also encourage them to eat toothpaste.
What is topical fluoride?
Topical fluoride comes in a number of different forms. Gels and foams are placed in fluoride trays and applied at the dental office after your child's teeth have been thoroughly cleaned. Fluoride varnish is one of the newer forms of topical fluoride applied at the dentist office. It has been documented to be safe and effective to fight dental decay through a long history of use in Europe.
The advantages of varnish are:
This method is especially useful in young patients and those with special needs that may not tolerate fluoride trays comfortably.
Children who benefit the most from fluoride are those at highest risk for dental decay. Risk factors include a history of decay, high sucrose carbohydrate diet, orthodontic appliances and certain medical conditions such as dry mouth.
General Anesthesia
Q: What is general anesthesia?
A: General anesthesia is a management technique that uses medications to cause the child to become unconscious and asleep while receiving dental care. It is provided by a physician or dentist who has special training in anesthesia.
Q: Who should receive dental care with general anesthesia?
A: Children with severe anxiety and/or inability to cooperate are candidates for general anesthesia. These children may be young or have compromised health or special needs. They usually require extensive dental treatment and their anxiety cannot be controlled with conscious sedation techniques.
Q: Is general anesthesia safe?
A: Although there is some risk associated with general anesthesia, it is safe when administered by an appropriately trained individual in an appropriately equipped facility. Many precautions are taken to provide safety for the child during general anesthesia care. Patients are monitored closely during the general anesthesia procedure by personnel who are trained to manage complications. Your pediatric dentist will discuss the benefits and risks involved in general anesthesia and why it is recommended for your child.
Q: What special considerations are associated with the general anesthesia appointment?
A physical examination is required prior to general anesthesia for dental care. This physical examination provides information to ensure the safety of the general anesthesia procedure. Your pediatric dentist and/or your general anesthesia provider will advise you about evaluation appointments that are required.
Parents are instructed to report to the pediatric dentist any illness that occurs prior to the general anesthesia appointment. It may be necessary to reschedule the appointment. It is very important to follow instructions regarding preoperative fasting from fluids and foods.
Usually patients are tired following general anesthesia. Your child will be discharged when alert and ready to depart. You will be instructed to let the child rest at home with minimal activity planned until the next day. Post-operative dietary recommendations will also be given.
Space Maintenance
Q: Why do children lose their baby teeth?
A: A baby tooth usually stays in until a permanent tooth underneath pushes it out and takes its place. Unfortunately, some children lose a baby tooth too soon. A tooth might be knocked out accidentally or removed because of dental disease. When a tooth is lost too early, your pediatric dentist may recommend a space maintainer to prevent future space loss and dental problems.
Q: Why all the fuss? Baby teeth fall out eventually on their own!
A: Baby teeth are important to your child's present and future dental health. They encourage normal development of the jaw bones and muscles. They save space for the permanent teeth and guide them into position. Remember: Some baby teeth are not replaced until a child is 12 or 14 years old.
Q: How does a lost baby tooth cause problems for permanent teeth?
A: If a baby tooth is lost too soon, the teeth beside it may tilt or drift into the empty space. Teeth in the other jaw may move up or down to fill the gap. When adjacent teeth shift into the empty space, they create a lack of space in the jaw for the permanent teeth. So, permanent teeth are crowded and come in crooked. If left untreated, the condition may require extensive orthodontic treatment.
Q: What are space maintainers?
A: Space maintainers are appliances made of metal or plastic that are custom fit to your child's mouth. They are small and unobtrusive in appearance. Most children easily adjust to them after the first few days.
Q: How does a space maintainer help?
A: Space maintainers hold open the empty space left by a lost tooth. They steady the remaining teeth, preventing movement until the permanent tooth takes its natural position in the jaw. It's more affordable -- and easier on your child -- to keep teeth in normal positions with a space maintainer than to move them back in place with orthodontic treatment.
Q: What special care do space maintainers need?
A: Pediatric dentists have four rules for space maintainer care. First, avoid sticky sweets or chewing gum. Second, don't tug or push on the space maintainer with your fingers or tongue. Third, keep it clean with conscientious brushing and flossing. Fourth, continue regular dental visits.
Tooth-Colored Fillings
Q: What are tooth-colored fillings?
A: Tooth-colored fillings are made from durable plastics called composite resins. Similar in color and texture to natural teeth, the fillings are less noticeable, and much more attractive, than other types of fillings.
Q: What are the advantages of tooth-colored fillings?
A: Because composite resins are tooth-colored, they look more natural than other filling materials. Your child can smile, talk, and eat with confidence. In addition, tooth-colored fillings are compatible with dental sealants. A tooth can be filled and sealed at the same time to prevent further decay.
Q: What are disadvantages?
A: First, tooth-colored fillings are not for every tooth. They work best in small restorations and low-stress areas. For example, your pediatric dentist may not recommend a tooth-colored filling for a large cavity or for the chewing surface of a back tooth. Second, tooth-colored fillings may cost a bit more than silver fillings because they take longer to place.
Q: How do I decide if tooth-colored fillings are right for my child?
A: Talk to your pediatric dentist. Together you will decide what type of filling is best for your child.
Q: How do I care for a tooth-colored filling?
A: Take care of a tooth-colored filling the same way you take care of a silver filling: Brush, floss, and visit your dentist. Any filling will last longer with good oral hygiene. Your pediatric dentist will regularly check the fillings for color change, leakage, or unusual wear and inform you of the need for repair or replacement.
Malocclusion
Malocclusion is the improper positioning of the teeth and jaws. It is a variation of normal growth and development which can affect the bite, the ability to clean teeth properly, gum tissue health, jaw growth, speech development and appearance.
Q: What causes malocclusion?
A: Both heredity and environmental factors can play a role in developing malocclusions. The shape and size of the face, jaws and teeth are determined mostly by inheritance. Environmental factors can also have a large impact and these are the types of problems which the pediatric dentist is well trained to manage.
Q: How long does it take to treat a malocclusion?
A: Every child is unique and must be treated individually. The pediatric dentist will provide an estimate of the length of time required prior to initiating treatment. In complex malocclusions the treatment may be divided into several phases which are scheduled to coincide with the child's particular pattern of growth and development.
Q: Is it necessary to remove healthy teeth to correct a malocclusion?
A: Carefully controlled removal of selected primary teeth may be necessary to guide the permanent teeth into proper position. This procedure requires frequent monitoring over a period of time and usually in combination with the use of some type of appliance. The removal of permanent teeth depends specifically upon the circumstances for that particular child. There are some malocclusions which cannot be treated successfully without removing permanent teeth and there are other situations where permanent teeth should definitely not be removed. This is a decision which must be made very carefully after thoroughly evaluating all of the diagnostic materials available for that patient.
Q: What information does the pediatric dentist need to evaluate a developing malocclusion?
A: The complexity of each child's individual problem will dictate the extent of examination and diagnostic procedures. Following a thorough clinical examination with a review of past medical and dental history, impressions of the teeth are taken from which plaster models are made. These study models provide a baseline reference of the current relationship of the teeth and jaws and also provide a method to monitor the progress of any treatment. Photographs of the face and teeth also provide a record of the child's facial appearance prior to treatment. Several types of X-rays may be needed to properly diagnose a developing malocclusion. Most commonly used are a panoramic X-ray, which shows all the upper and lower teeth in biting position as well as any teeth still developing within the jaws, and a lateral X-ray of the entire head, known as a cephalometric X-ray which shows the relationship of the teeth and jaws to the face and skull.
Q: What types of appliances are used to correct malocclusion?
A: There are two basic types of tooth movement appliances, removable and fixed. Removable appliances are made of wires and plastic and can be removed from the mouth by the patient. Some fit the upper and lower teeth at the same time. Their success is totally dependent on the patient's compliance in wearing the appliance exactly as instructed by the pediatric dentist. An advantage of removable appliances is that they are easy to keep clean. Fixed appliances are what we know as "braces." Because this type of appliance is attached directly to the teeth, there is better control of tooth movement. However, cooperation from the patient in maintaining scrupulous oral hygiene while wearing fixed appliances is essential in preventing cavities in areas where food collects easily around these appliances.
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Emergencies
Toothache
Clean the area around the sore tooth thoroughly. Rinse the mouth vigorously with warm saltwater to dislodge trapped food or debris. DO NOT place aspirin on the gum or on the aching tooth. If face is swollen, apply a cold compress. Take acetaminophen for pain and see a dentist as soon as possible.
Cut or Bitten Tongue, Lip or Cheek
Apply ice to bruised areas. If there is bleeding, apply firm but gentle pressure with a clean gauze or cloth. If bleeding does not stop after 15 minutes or it cannot be controlled by simple pressure, take the child to a hospital emergency room.
Broken Braces and Wires
If a broken appliance can be removed easily, take it out. If it cannot, cover the sharp or protruding portion with cotton balls, gauze or chewing gum. If a wire is stuck in the gums, cheek or tongue, DO NOT remove it. Take the child to a dentist immediately. Loose or broken appliances which do not bother the child do not usually require emergency attention.
Broken Tooth
Rinse dirt from injured area with warm water. Place a cold compress over the face in the area of the injury. Locate and save any broken tooth fragments. Immediate dental attention is necessary.
Knocked Out Permanent Tooth
Find the tooth. Handle the tooth by the top (crown), not the root portion. You may rinse the tooth but DO NOT clean or handle the tooth unnecessarily. Try to reinsert the tooth in its socket. Have the child hold the tooth in place by biting on a clean gauze or cloth. If you cannot reinsert the tooth, transport the tooth in a cup containing milk or water. See a dentist IMMEDIATELY! Time is a critical factor in saving the tooth.
Other Emergency Conditions
Possible Broken Jaw: If a fractured jaw is suspected, try to keep the jaws from moving by using a towel, tie or handkerchief. Take the child to the nearest hospital emergency room.
Bleeding after Baby Tooth Falls Out: Fold and pack clean gauze or cloth over the bleeding area. Have the child bite on the gauze for 15 minutes. This may be repeated once; if bleeding persists, see a dentist.
Cold / Canker Sores: Many children occasionally suffer from cold or canker sores. Usually over-the-counter preparations give some relief. Because some serious diseases may begin as sores, it is important to have a dental evaluation if these sores persist.
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Randy Smith Pediatric Dentistry | 3365 S. Holmes Ave. Idaho Falls, ID 83404 | Phone 208-542-1333 | Fax 208-552-7296 | Sitemap