CHILDRENS DENTIST, PEDIATRIC DENTIST 

CHILDRENS DENTIST, PEDIATRIC DENTIST:

WHEN DOES MY CHILD NEED TO GO TO THE CHILDRENS DENTIST OR PEDIATRIC DENTIST?

Some say “as soon as they get teeth!” Parents may wonder why, since it's not likely that much can be done on a 6 month old baby; but it is more for the parents. This can be very informative and can go a long way to preventing problems in the future. Remember, while your child may not have many teeth now, they are developing, so what you do now can impact your child's future dental health.

DOES MY CHILD NEED TO SEE A CHILDRENS DENTIST? (PEDIATRIC DENTIST)??

Some general dentists are very good with children. Some are not. It is usually at the discretion of the general dentist to refer the child to a childrens dentist or treat personally. Many factors come into play, such as the age and maturity of the child, the amount of work needed, and the general dentist’s own comfort level. Some 3 year olds are fine seeing general dentists, some 12 year olds are not and will benefit greatly from seeing a childrens dentist. It really depends.

Normally if a child screams and or cries during their appointment, they will be referred to a pediatric dentist. Parents usually think a child cries because they are in pain, but very often the children cry because they are scared. Pediatric dentists are well trained to know the difference.

A childrens dentist can also see special needs adults, who maybe have mental disabilities or other issues which prevent them from receiving dental care from a general dentist.

When children are uncooperative, pediatric dentists often will utilize nitrous oxide in order to help control the child.

Another device commonly used by a childrens dentist is a papoose board. This looks like an ironing board with velcro straps which retrain the child. It may look barbaric, but often times children will settle down once they realize that they are restrained. Also, when a child moves around, it can be very dangerous as many dental instruments are sharp, so restraining a child can actually be more safe.

NURSING/BABY BOTTLE CARIES:

Baby bottle tooth decay is one of the more common problems in children, and can be very destructive. Do NOT let your child go to sleep with a bottle of milk or juice in his/her mouth. This is like soaking your child's teeth in sugar, and your child will get a mouth full of cavities. Water however is ok.

Baby bottle tooth decay can cause the child will have cavities on literally every tooth, and often times will need multiple pulpotomies (root canals on baby teeth) and stainless steel crowns (crowns for baby teeth), which can become very expensive.

Also, the child is often very young and unable to have extensive dental work done in a normal setting, so often times the child will need to be sedated either in the office, or possibly a hospital, which is much more expensive and risky for your child.

Remember, you are the parent and need to be aware of this.  Often times parents come in and try to blame their 2yo, saying s/he won't go to sleep without the bottle.  It may be hard to do, but do not give your child the bottle overnight with anything other than water.


BRUSHING AND FLOSSING:

You should brush your child’s teeth as soon as they appear, and should floss your child’s teeth as soon as they contact each other (usually around 2yo). As a parent, it is your responsibility to brush and floss your child's teeth until s/he has the manual coordination to do so him or herself. This may not happen until about age 7 or later, so please do not tell your 4 year old to "go brush your teeth!", because they are not going to be able to do a good enough job at that age. If you have trouble with home care, ask your childrens dentist as s/he should have some helpful tips to assist in this arena.


FLUORIDE SUPPLEMENTS:

Fluoride has been shown in many studies to reduce the incidence of cavities in teeth. It is very helpful both when teeth are developing and after they have erupted into the mouth. It gets incorporated into the enamel during tooth development to help strengthen the tooth, and has a topical effect after eruption. Fluoride is present in many water systems in the ideal amount, so if your drinking water is fluoridated, you likely do not need to take additional fluoride supplements. But if you do not have fluoride in your drinking water or drink only bottled water, you should consult your dentist about if your child needs to take fluoride supplements. Excess fluoride can cause chalky white staining, which is called, fluorosis, so let your childrens dentist determine if fluoride supplements are needed.

WHAT ABOUT ALL THE CROWDING?

All children go through a phase called the mixed dentition phase. This is when they are losing their primary teeth, and their permanent teeth are erupting. The first permanent tooth comes in around age 6, and they are all usually in by around age 12-13 (except for the wisdom teeth, which come in around age 18). During this mixed dentition phase, there will be a lot of crowding, and your child’s teeth will look like there are too many. In some instances it will correct itself through growth, in some instances orthodontics will be needed to correct the alignment.


Below is a diagram of the PRIMARY TEETH: Click to compare to the PERMANENT TEETH.

primary tooth  numbers diagram

ERUPTION TABLE:

Below is an approximate table of when the permanent teeth should erupt. This is just a guide and there is a normal variation of a couple of years, therefore, one should not be alarmed if your child does not follow this table exactly. Whether a child is ahead or behind schedule is not an indication of mental or other development.


APPROXIMATE ERUPTION PATTERN

AGE TOOTH 6-7 1st Molar 6-8 Central Incisor 6-8 Lateral Incisor 8-10 Canine 9-11 1st Premolar* 10-12 2nd Premolar* 11-13 2nd Molar 16-20 3rd Molar**

*- These teeth come in underneath the PRIMARY molars **- WISDOM TEETH


CHILD GRINDING, AIRWAY, AND OTHER HABITS:

There are many habits that can influence a child's bite, jaw size, and tooth positioning.

  • Thumb/Finger sucking can constrict the palate and lead to a narrow, overly arched palate, which will lead to cross bites in the back teeth.
  • Airway issues, such as enlarged tonsils or adenoids causes the tongue to be advanced forward which can cause affect the shape of jaw formation.
  • Allergies can cause the tonsils or adenoids to increase in size, which further complicates airway issues.
  • Child Grinding is often caused by enlarged tonsils or adenoids constricting the child's airway. Often times when they are removed, the grinding issues goes away.
  • If a child breastfeeds or bottle feeds affects jaw formation because a conventional bottle contricts the palate just like a finger. NUK makes some pacifiers which are designed to mimic a breast and prevent this phenomenon.

Facial Growth: The upper and lower jaws also grow at different times and different rates, so while this is happening your child may look disproportionate.


SPACE MAINTAINERS:

If a child loses a primary tooth prematurely, your childrens dentist will often recommended to place a space maintainer in order to allow the succeeding permanent tooth to have room to erupt. These are cemented into the mouth, and are removed when the permanent tooth starts to erupt.

If space maintainers aren't utilized, it can block out the permanent teeth from erupting and cause further issues.

WHY ARE MY CHILD’S TEETH SO YELLOW?

The teeth may lighten up as they mature, so at least wait until your child has stopped growing before considering it. Also, all children look a little bit awkward when they are going through that mixed dentition phase, so please be patient.

DO I NEED TO GET THE CAVITY FIXED? ISN’T THE TOOTH GOING TO FALL OUT ANYWAY?

Usually yes to both. If it is on a primary tooth, the tooth will fall out eventually. The problem is, by leaving a decayed tooth in the child’s mouth, the cavity causing bacteria are allowed to stay in the mouth as well! Thus, increasing the chance of getting cavities on the permanent teeth. On the other hand, if the primary tooth is extremely loose, often times you can ask your childrens dentist if it is beneficial to remove it rather than fill it.

SPEAKING OF TEETH FALLING OUT…

Children often come in complaining about DISCOMFORT WHEN THEY CHEW. The most common ages are around 9-11. If your child is complaining about DISCOMFORT when they CHEW, before you go rushing off to your dentist, LOOK at the tooth.

IS IT LOOSE? Or is there a BIG HOLE in it??

If it is very loose, there is a good chance it is causing the discomfort because of it moving back and forth on the gum. The child has 2 options… remove it him/herself, or let the pediatric dentist do it (they usually opt for the first option!) BTW… if there is a hole in the tooth, you should see the pediatric dentist!!

PULPOTOMIES:

Pulpotomies are like root canals for children. Instead of removing the nerve, the nerve is “mummified”, but it serves the same purpose. Remove the pain, and allow function again. Often times after a tooth has had a pulpotomy, it will need a stainless steel crown. In children, the pulpotomy and crown are placed at the same appointment, unlike in an adult (where the root canal and crown will take several appointments).


STAINLESS STEEL CROWNS:

After baby teeth have had pulpotomies, they normally will need stainless steel crowns (SSCs). Unlike crowns on permanent teeth which are made at a lab, these are prefabricated crowns that the childrens dentist can mold and cement onto the tooth in one visit.

These are also used when a tooth has substantial tooth structure missing due to decay, fracture, or other cause.

These are silver in color, but for the front teeth, they also make ones that are tooth colored; but not all pediatric dentists have/use them.


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