Dental Frequently Asked Questions

A PEDIATRIC DENTIST is a specialist with several year of extra training in the dental care of children and adolescents. In Canada, in addition to the extra training to be a specialists one must pass the specialty board exam and become a Fellow of the Royal College of Dentists of Canada — FRCD(C). The training involves special techniques for dealing with young children, teens, and children with special needs, and is focused on guiding these patients through their dental and emotional development into adulthood.

Primary teeth are important for

guiding the adult teeth into correct position
normal growth of the jaw bones and muscles
proper speech development
chewing and smiling.

While the front 4 teeth last until 7 years of age, the back teeth (cuspids and molars) are not replaced until age 9 to 13.

The primary teeth begin to form during the 2nd trimester in-utero, while the permanent teeth begin to form at and around the time of birth. As early as 2- 4 months of age, the first primary (ie. baby) teeth erupt through the gums. These 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 lower central incisors and first molars. This process continues until approximately age 16 to 18 and which time the permanent dentition is complete.

Radiographs (X-Rays) are a vital and necessary part of your child’s dental diagnostic process. Without them, certain dental conditions can and will be missed.

Radiographs detect much more than cavities. For example, radiographs may be needed to survey erupting teeth, diagnose bone diseases, evaluate the results of an injury, or plan orthodontic treatment. Radiographs allow dentists to diagnose and treat health conditions that cannot be detected during a clinical examination. If dental problems are found and treated early, dental care is more comfortable for your child and more affordable for you.

On average, most pediatric dentists request radiographs approximately once every 12 to 24 months. However, with children that are at high risk of caries, The American Academy of Pediatric Dentistry recommends radiographs and examinations every 6 to 12 months. Approximately every 2 years, it is a good idea to obtain a complete set of radiographs, either a panoramic and bite-wings or periapical and bite-wings.

Pediatric dentists are particularly careful to minimize the exposure of their patients to radiation. With contemporary safeguards, the amount of radiation received in a dental x-ray examination is extremely small and risk is negligible. In fact, the dental radiographs represent a far smaller risk than an undetected and untreated dental problem. Lead body aprons and shields will protect your child. Today’s equipment filters out unnecessary x-rays and restricts the x-ray beam to the area of interest. High-speed film and proper shielding assure that your child receives a minimal amount of radiation exposure.  Because of the small film size and the relatively thin thickness of tissue that is being examined, dental x-rays use far less radiation than medical x-rays.

The vast majority of Simcoe Muskoka’s municipal water not fluoridated. It is wise to start brushing your child’s teeth with a fluoridated toothpaste when the first baby teeth erupt (by age 12 month) once a day.  Once your child is about two years old, start using fluoridated toothpaste twice daily. Pick a toothpaste your child likes, preferably one with the Canadian Dental Association seal of approval, and make sure it does not have harsh abrasives. When in doubt, use a major brand. If your child does not spit well and swallows most of the tooth past the you put in their mouth, use a smear or rice kernel amount on the brush. For children that do spit well, use a pea size amount. After brushing is done, do not rinse the mouth out with water. Instead, leave some of the toothpaste residue. This will help retain some fluoride so that it strengthen the teeth. Think of it as a mini fluoride treatment twice a day.  Click here for Ontario Dental Association tips on keeping kids cavity-free.

Parents are often concerned about the nocturnal grinding of teeth (bruxism). Many children brux, but few have any problems as a result.

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 your pediatrician or pediatric dentist.

Sucking is a natural reflex and infants and young children may use thumbs, fingers, pacifiers and other objects on which to suck. It fulfills the need to suckle. Since thumb sucking is relaxing, it may induce sleep.

Thumb sucking that persists beyond the fifth birthday 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.

It is important that children cease thumb sucking by the time their permanent front teeth are ready to erupt. Usually, children stop between the ages of two and four. 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 your pediatric dentist.

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

Do not scold 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.
Your pediatric dentist can encourage children to stop sucking and explain what could happen if they continue.

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 remains alive and 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”, “children’s root canal”, 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. Next, medicine 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 diseased (into the root canal(s) of the tooth).  During this treatment, the diseased pulp tissue is completely removed from both the crown and roots. The canals are cleansed, disinfected and, in the case of primary teeth, filled with a resorbable material. Then, a final restoration is placed (usually a stainless steel crown).

The success rate for pulp therapy is high.  About 90% of treated teeth have no trouble until they shed.  The remaining 10% may have signs of inflammation or resorption, but that in and of itself does not mean something must be done. Only if the case of an abscess or interference with the adult tooth does a pulp treated primary tooth need to be removed.

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, and avoid chewing on the sore tooth. If the pain still exists, use Advil or Tylenol and contact your child’s dentist. If the face is swollen, you should call a dentist and seek urgent care.

Cut / 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 for 10 minutes, call a dentist / doctor or visit the hospital emergency room.

Knocked Out Tooth: A knocked-out baby tooth is seldom a serious problem. Contact your dentist during business hours. A knocked out permanent tooth needs urgent treatment if it is to be saved. Find the tooth and handle it by the crown, not by the root. You may rinse the tooth with water only. DO NOT clean with soap, scrub or handle the tooth unnecessarily. Inspect the tooth for fractures. If it is sound, try to reinsert it in the socket immediately. 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). Contact your dentist or the hospital immediately.  Time is critical if the tooth is to be saved.

Chipped or Fractured Permanent Tooth: 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. This is not an emergency and you should contact your dentist during business hours.

Severe Blow to the Head: Especially if there has been loss of consciousness, or your child is lethargic or nauseous, seek immediate medical attention at the nearest hospital emergency room.

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

Major North American Medical and Dental pediatric association all agree on the same recommendation.  The Canadian Academy of Pediatric Dentistry (CAPD), the American Academy of Pediatric Dentistry (AAPD), the Canadian Pediatric Society (CPS), and the American Academy of Pediatrics (AAP) and  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, and are less likely to be affected by Early Childhood Caries (ie. cavities).

The Dental Home is intended to provide a place other than the

Emergency Room for urgent dental care for children.

You can make the first visit to the dentist enjoyable and positive. If you are anxious, try not to project your anxiety about dental treatment onto your child. It is best if you refrain from using words around your child that might cause unnecessary fear, such as drill or hurt, or telling them they should be “brave”. Pediatric dental offices make a practice of using words that convey the same message, but are pleasant and non-frightening to the child.

Teething, the process of baby (primary) teeth coming through the gums into the mouth, is variable among individual babies. Some babies get their teeth early and some get them late. In general, the first baby teeth to appear are usually the lower front (anterior) teeth and they usually begin erupting between the age of 4-8 months.

One serious form of decay among young children is baby bottle tooth decay, a form of Early Childhood Caries. This condition is caused by frequent and long exposures of an infant’s teeth to liquids that contain sugar. Among these liquids are juice, sweetened drinks, formula, and  milk (including breast milk) – in order of potential to cause early childhood cavities.

Putting a baby to bed for a nap or at night with a bottle with anything other than water can cause serious and rapid tooth decay. Sweet liquid pools around the child’s teeth giving plaque bacteria an to grow and flourish.  If you must give the baby a bottle as a comforter at bedtime, it should contain only water. If your child won’t fall asleep without the bottle and its usual beverage, gradually dilute the bottle’s contents with water so that your baby gets used to less and less sweet drinks.

After each feeding, wipe the baby’s gums and teeth with a damp washcloth or gauze pad to remove plaque. The easiest way to do this is to sit down, place the child’s head in your lap or lay the child on a dressing table or the floor. Whatever position you use, be sure you can see into the child’s mouth easily.

Begin daily brushing as soon as the child’s first tooth erupts. A smear amount of fluoride toothpaste (ie. a rice kernel amount) should be used when the first baby teeth come it (by 12 months of age). Children should have their teeth brushed by an adult until at least age seven, and longer if you suspect that they cannot do an adequate job of brushing the far back teeth.

Proper brushing removes plaque from the inner, outer and chewing surfaces. When teaching children to brush, place the toothbrush at a 45 degree angle; start along gum line with a soft bristle brush in a gentle back and forth motion. Brush the outer surfaces of each tooth, upper and lower. Repeat the same method on the inside surfaces and chewing surfaces of all the teeth.

Flossing removes plaque between the teeth and breaks up bacterial colonies that start to grow where a toothbrush cannot reach. Flossing should begin when any two teeth touch. You should floss the child’s teeth until he or she can do it alone. Use a disposable floss holder. Use a gentle, back-and-forth motion to guide the floss between the teeth. Curve the floss into a C-shape and slide it into the space between the gum and tooth until you feel resistance. Gently scrape the floss against the side of the tooth. Repeat this procedure on each tooth. It is most important to floss the back teeth .

Healthy eating habits lead to healthy teeth. Like the rest of the body, the teeth, bones and the soft tissues of the mouth need a well-balanced diet. Children should eat a variety of foods from the major food groups. Most snacks that children eat can lead to cavity formation. The more frequently a child snacks, the greater the chance for tooth decay. How long food remains in the mouth also plays a role. The major sources of sugar in a child’s diet are juice, chocolate milk, cereals, and fruits. Most of the snack that are marketed to children and full of sugar.  If your child must snack, choose nutritious foods such as vegetables,  cheese, or nuts which are healthier and better for children’s teeth.

To prevent cavities, you must make the mouth an unpleasant place for the specific bacteria that cause cavities to grow.  To do that, you can do three things

Keep the mouth clean by brushing, and flossing when appropriate
Provide adequate fluoride, usually by way of fluoridated toothpaste but in some cases with fluoride supplements (fluor-a-day)
Avoid sugars in the diet, especially juice and chocolate milk, and regular snacking.

The fourth strategy is take advantage of preventative procedures like dental sealants, that can reduce the chance of cavities by up to 90%.

A sealant is a clear or white plastic material that is applied to the chewing surfaces (grooves) of the back teeth (premolars and molars), where four out of five cavities in children are found. This sealant acts as a barrier to food, plaque and acid, thus protecting the decay-prone areas of the teeth.  It is a simple, non-invasive, cost effective procedure that has been proven to greatly reduce the chance of pit and fissure cavities.

Fluoride is an naturally occurring element, just as calcium, iodine, and sodium are.  It has been shown to be beneficial to teeth, and is the best tool science has for cavity prevention. However, just as with those other elements, too little or too much fluoride can be detrimental to the teeth.  Without sufficient fluoride, teeth are more susceptible to cavities.  Excessive fluoride ingestion between birth and age 3 can lead to dental fluorosis, which causes the permanent teeth to be chalky white (in mild fluorosis) to even brown discoloration (in severe fluorisis — which is rare).  Because municipal water supplies are not fluoridated, even mild fluorosis is rare.

Sources of too much fluoride::

Eating fluoridated toothpaste at an early age.
The inappropriate use of fluoride supplements.
Hidden sources of fluoride in the child’s diet (some soy based formulas are high in fluoride).

The internet is not a reliable and sensible source of information on fluoride because the most radical voice is usually the loudest.

For reasonable objective information check Health Canada, Ontario Dental Association, and the National Institute of Health (USA).