Children & Family Dental

We love treating patients of all ages.  It can really brighten our day to see children, and we hope to provide a pleasant experience for all members of the family.  When you are a parent, there are so many things to think about, and many questions to ask.  We will try to answer most of the common questions here. 

When Should I Bring My Child to the Dentist?

The ADA (American Dental Association) and AAPD (American Academy of Pediatric Dentists) recommend seeing a dentist within 6 months of your baby’s first tooth appearing in the mouth, or by 1 year of age.  The purpose of this early visit is to check for any problems that may need immediate intervention, but it’s also helpful for your child to meet the dentist and staff early for an easier appointment.  That way, they can be more comfortable if future visits are not so easy.  It is also a good chance for parents to discuss children’s oral hygiene and home care with the dentist and staff. 

If there are any early problems, we can address them before becoming a bigger issue that may not be as easy to manage.  By age 3 or 4 there can already be cavities that have been present for years, so it can be risky to wait until age 4 or until anything is noticed.  

In some cases we may need to refer you and your child to a Pediatric Dental Specialist if we cannot treat him/her here.  These reasons may include:

• Poor behavior or uncooperative
• Too many cavities and will require sedation and/or treatment in a hospital setting
• Any other behavioral issue making it difficult to treat in a general dental setting

Oral Hygiene Tips for Children

Please see our oral hygiene instructions page for more general instructions, but these are a few tips specific to children:

When to start brushing my child's teeth

As soon as the first teeth come in, it is good to start cleaning them.  It doesn’t have to be a brush and you don’t really need toothpaste, but practicing good habits with your child will help them get used to it and may even feel good.  Using a clean finger or a special finger brush for babies is fine.

When to start using fluoride toothpaste

You can start with fluoride toothpaste as soon as you start brushing, however the amount you use depends on their age.  Until your child can spit and not swallow the toothpaste, you should only use a “smear”, which is a tiny amount on the bristles about the size of a grain of rice.  This is to avoid swallowing too much of the fluoride, and a smear amount will not be harmful to your child.  You could also use toothpastes without fluoride if you prefer, but you will be missing the topical protective effect of the fluoride on the enamel.  When your child is old enough to spit, around age 3, you can start using a “pea-sized” amount of toothpaste.

When to start flossing

When 2 teeth start to touch each other is when you need to start flossing.  We recommend the floss picks for children because it is very difficult to adequately floss an impatient, wiggly child with a thread of floss wrapped around your fingers.

Make it fun

Try to avoid forcing brushing and flossing on your child.  If they are crying and screaming, they are going to hate it and it is only going to be worse every time.  If you make it a fun experience in some way, your child might look forward to it.  Take your time and be goofy; let them try and then it’s your turn.  Let them yell to say “aahh!”, and challenge them to be as loud as possible and then as quiet as possible.  These are just a few ideas, but if you make it a game, it can be a bonding experience rather than a resentful one.

At what age can kids brush independently?

Around age 8 or 9, or when they can tie their own shoes is a good rule of thumb.  They need fine motor control to be able to adequately control the tooth brush and clean everywhere.  A parent should supervise until they are sure their child can brush well on their own.

Electric brushes and timers

Electric brushes are great for children because they don’t need as much dexterity to move the brush around to reach every tooth.  The timers help to keep them on track and make sure they are not rushing and doing a poor job.  There are even 2 minute long videos on YouTube from the Ad Council’s "2min2x" campaign, which your child can watch while they brush.

Remember that bacteria is transmissible

Cavity-causing bacteria can be passed on from parents to their children simply by sharing drinks, kissing, licking pacifiers to clean them, etc.  This is important to keep in mind and parents should be taking care of their own oral health as much as their children’s.

Diet is important

Read more about this on our oral hygiene page, but in general, it is very important to regulate how frequently your child is snacking or sipping on any drinks other than water.  Cavities are not only caused by sweets, but by acidic foods and drinks, and by acids produced by bacteria from the carbs that we eat.  Crackers and chips will stick to teeth longer and increase the risk of cavities.  When teeth are exposed to acid for more time during the day, they are more prone to tooth decay.  This is why we advise against giving babies a bottle of milk in the crib.  Even diluted fruit juices contain sugar and acid.  Pay close attention to the time and frequency of snacking and sipping and you can decrease your child’s risk of tooth decay.

Fluoride

Fluoride is an important preventive measure we can use to strengthen teeth as they develop and especially when they are exposed to bacterial acids in the mouth.  The process is discussed more on our oral hygiene instructions page, but for parents of small children, you should know the different types of fluoride available for your kids.

At Home

Most toothpastes have fluoride as the active ingredient.  Daily brushing with a fluoride toothpaste is one of the best ways to keep the enamel reinforced with fluoride.  Fluoride mouthrinses with fluoride are also good if your child is able to swish and spit without swallowing it.

At the Dental Office

• Fluoride Varnish - You may remember the days when we used the fluoride trays and you sat there for minutes biting on the soft chewy trays with the nasty gel in your mouth and trying not to drool on yourself.  Today we have a varnish that we can simply paint on your child’s teeth and that’s it.  They just have to avoid brushing for 4 hours afterward.  It feels gritty or sticky for a little while, but kids these days don’t know how good they have it.  This is usually done at the end of a cleaning and check-up appointment.  Some insurances will only pay once a year for a fluoride treatment and some will pay twice a year, so it will help if you know ahead of time what your insurance covers.
• Fluoride Tablets – Your doctor may recommend a prescription for fluoride tablets for your child.  This is a daily supplement to help get a measured dose of fluoride on the teeth and into the body to help reinforce the developing adult teeth.  The dose is based on the guidelines from the ADA, which depends on the child’s age and the amount of fluoride in the water.  In Oakdale and our local surrounding area there is no fluoride in the water supply, so we typically recommend this supplemental fluoride prescription for most children.  The recommended dose changes at ages 6 months, 3 years, 6 years and up to 16 years.

Is Fluoride Dangerous?

There is a vocal minority claiming that fluoride is poison or a neurotoxin.  There is only some truth to this, in that almost everything can be a poison at the right dose.  Even water can be harmful if you ingest too much.  Fluoride has been tested many times and has been shown to be very safe at the low doses that we recommend.  At slightly higher doses, there is a risk of mild dental fluorosis, which is a condition that discolors the teeth as they are developing.  Much higher doses would be required to have any poisonous or neurotoxic effects.  We plan to write more in depth on this topic at some point, but more information can be found here.

Sealants

Your dentist may recommend sealants for your child’s adult molars when they erupt around ages 6 and 12.  Read our page on sealants for more information, but put simply they are a way to seal off the grooves and pits, which often develop in the molars.  This is an attempt to prevent cavities from developing by keeping bacteria from burrowing into these grooves and pits and by making the teeth easier to keep clean.

Orthodontics

During your child’s check-up we will check the bite and evaluate the potential need for braces to straighten his/her teeth.  Sometimes this is only for esthetic purposes, although misaligned teeth and/or bites can lead to other problems like trouble chewing, increased tooth wear, increased risk of cavities and gum disease, as well as jaw pain.  It can also lead to psychological problems or a lack of self-confidence for children who are not happy with their smiles.

There are certainly genetic reasons why your child’s teeth may need braces, however other habits during the growth stages can play a role as well.  Here are a few to be aware of:

• Pacifiers and thumb sucking – These can be very calming (and quieting) for infants to use.  Most children will stop this habit well before age 4, however if it continues, your child should be encouraged to stop when they turn 4.  Prolonged use of pacifiers or thumb sucking can cause the teeth to tilt inward as they grow and can cause other problems with the development of the jaw, palate, and airway.
• Tongue thrusting – Some children form a habit of pushing their tongue out against their teeth, which pushes the teeth and causes them to flare out.  This can create an open bite and other problems with the development of the jaw, palate, and airway.
• Mouth breathing – Mouth breathing can negatively affect the developing bite and shape of the palate, which can cause problems with the airway and with the bite.  It can also lead to, or be a sign of sleep apnea or other minor airway issues.
• Nail biting – frequent nail biting through the growing ages puts a lot of pressure on the front teeth and can cause misalignment and a need for braces.  Teeth are not meant to be chewing that frequently and this could cause more wear to the teeth and even jaw soreness.   

At what age do children need braces?

These days, many orthodontists are favoring a two stage approach to orthodontics.  This means around age 8, when all the front adult teeth have erupted, the orthodontist can start shaping the growth of the jaw and hold space for the later adult teeth to erupt.  This first stage will avoid difficulties if the treatment is started later after the jaws have grown more and may require surgery to correct.  The second stage would be a full set of braces to align the teeth when all the adult teeth are present around age 12 or 13.  It may seem more expensive to go through both stages, but it may be well worth it and can avoid more expensive fixes later on.  You should discuss all the options with the orthodontist during your consultation.

Fillings for Children

When it comes to fillings we typically offer the choice of white (composite) bonded fillings, or silver (amalgam) metal fillings.  If your child needs a filling, you have the choice of which filling you prefer.  Many parents prefer to choose white fillings for their children, which is understandable, but you should be aware that the white fillings fail more frequently on baby teeth.  There are many reasons this may occur:

1. Enamel is thinner on baby teeth, and bonding is much more effective and reliable on enamel than the inner layer of dentin.  This means the layer we can bond best to is not as abundant in baby teeth compared to adult teeth.
2. Children typically have poorer hygiene habits and are not as diligent at brushing and flossing well, which is required to maintain a good long-term prognosis for a bonded restoration.
3. Placing a composite filling is more technique sensitive and any moisture can interfere with the bond.  Placing a composite takes more time and care.  Children can be impatient and fidgety, especially near the end of a long appointment, which makes us try to rush to finish them up.  We do our best to provide the best quality we can, but a patient that moves or cries increases the difficulty of the procedure.
4. Metal fillings can be placed more quickly, a small amount of moisture doesn’t affect them, and they are not bonded.  Metal fillings are packed into a dovetail-like preparation instead of bonding to lock them in tightly.  For these reasons, amalgams are generally more successful and will have a higher chance of lasting until a baby tooth falls out.

Crowns for Baby Teeth

Our goal for any baby tooth restoration is to last until the tooth falls out naturally.  Crowns may be required if the decay is extensive enough to make a filling an unreliable option.  Crowns for baby teeth are different than for adult teeth.  They are prefabricated crowns with a few standard sizes to choose from for each tooth.  This allows us to place an affordable crown that is a close fit and will last a few years until the tooth is lost.  These are not custom lab-fabricated crowns, so they can be placed in one appointment instead of two, and the price is lower than a custom crown for adult teeth.  If your dentist recommends a crown for your child, there are a few options for you to choose from.

Stainless Steel Crowns (SSC) have been used for many years.  They are not pretty, but they are tried and true and will almost always last until the tooth falls out.  They are quick and easy to place in a single appointment.

Resin Form Crowns are made with composite filling material, which is placed in a tooth-shaped plastic matrix that can be used to make a crown surrounding the tooth.  This option may work for some front teeth as a more esthetic option, although it is not as durable as the Stainless Steel Crown.  These resin crowns are not strong enough to be used in back teeth where the chewing force is much stronger.

Zirconia Crowns are a new esthetic option compared to SSC’s.  They are a strong porcelain material that can be used on any teeth.  As with the SSC’s they are prefabricated with about 7 sizes to choose from.  They are a standard white color to match most baby teeth, so many parents prefer them.  The cost is slightly higher than SSC’s due to the cost of the crowns and the extra time and technique needed to place them.

Pulpotomy or Root Canal Treatment

If the cavity extends into the nerve (pulp) of the baby tooth, a pulpotomy will need to be performed.  A pulpotomy involves removing just part of the pulp, without removing each canal as for a root canal procedure.  This is done for baby teeth because it is quick and it is definitive enough until the baby tooth falls out.  A root canal may still be required if the canals are infected.  If that is the case, it may be necessary to pull the tooth depending on the severity and extent of the infection.

Instructions for Parents with Small Children

A trip to the dentist with your child can be a stressful experience for everyone involved: the parents, the child, as well as the dental staff.  But it doesn’t have to be, and there are steps we can take to set up the appointment for success.  Here are a few tips for parents to consider when planning a trip to the dentist.

Before the appointment:

• Inform your child about the appointment ahead of time.  Try to use positive words, and if they have questions tell them that the dentist can answer any questions at their appointment. 
• Avoid negative words to describe the dentist and if you have anxiety about the dental office, try to keep it to yourself.  Your child can sense your apprehension, and the appointment will be more difficult for everyone if the child is nervous too. 
• Avoid certain words like “shot”, “needle”, “hurt,” “drill,” etc.  You may mean well by explaining things ahead of time, but we try to be strategic in using alternative words to describe what is going to happen.  For example:

• Even saying things like, “the dentist isn’t going to hurt you” can backfire as it may signal to children that something unpleasant is going to happen.
• Chances are, older siblings or peers at school will break some of these rules despite your best efforts, but your positive attitude and temperament toward the appointment will still go a long way to help.

During the appointment:

• Feel free to accompany your child to the treatment room, and allow your child to look around and ask questions.  Make it a fun learning experience. 
• Let your child know that at the end of the appointment there is a toy box and they can pick out a toy when they’re done.  Other bribes can work sometimes too, but use your own judgement with your child and don’t expect them to be perfect patients from the start.  Rewards for small achievements over multiple appointments work well.  
• Try to allow the dentist and staff to speak freely with your child. 
• Some children do better when parents are not in the room during a dental procedure.  If you are comfortable leaving your child, you may choose to move to the reception area when we are ready to get started.  However, for routine check-up appointments it is best to have the parent/guardian available to discuss any treatment options.

More Resources

Mouth Healthy – ADA (American Dental Association) Guide for Parents

The Mouth Monsters – AAPD (American Academy of Pediatric Dentistry) Guide for Parents