1: What is a pediatric dentist?

2: When should my child visit the dentist for the first time?

3: Why are primary (“baby”) teeth so important?

4Eruption of Child’s Teeth, when will they come in and what are common side effects?

5: Dental Radiographs (“X-rays”), are they necessary?

6: What about brushing my children’s teeth? 

7: What toothpaste is best for my child?

8: What about flossing my child’s teeth?

9: Is it okay for my child to use mouthrinses?

10: What is Pulp Therapy (Pulpotomy) on Primary Teeth

11: What are the advantages to getting a pulpotomy?

12: What are the disadvantages of having a pulpotomy performed?

13: Are there other options to performing a pulpotomy and placing a crown?

Q: What is a pediatric dentist?

A: Pediatric Dentists are the pediatricians of dentistry, receiving an additional 2-3 years of training after dental school to gain advanced knowledge in the dental care of your child.  They are responsible for the treatment of children from infancy through adolescence and patients with special healthcare needs.

Q: When should my child visit the dentist for the first time?

A: We follow the guidelines established by American Academy of Pediatric Dentistry, recommending that patients should establish a dental home by the time that they are 12 months old.  A dental home is “home base” for your child’s dental care.  It gives parents a place to take children for regular recall exams, restorative treatment (fillings), and a familiar place to seek treatment in case of a dental emergency.  Appointments for infants and toddlers will have a heavy emphasis on education and preventative techniques so that we can help the child maintain a cavity free mouth throughout their life.

Q: Why are primary (“baby”) teeth so important?

A: Primary teeth serve many different and important functions while present.  They help in chewing food, development of proper speech, and help to save the space that will be necessary for the adult teeth to properly erupt into the oral cavity.  It is also important to keep these teeth healthy to avoid undesired pain and infection that may have an adverse effect on a child’s quality of life.  Studies have shown that children with cavities are at higher risk of: developing new cavities in the future, increased time and cost required for treatment, delayed physical growth and development, increase absence from school, increased days with restricted activity, diminished ability to learn, and increased hospitalization and emergency room visits.: While baby teeth will eventually be replaced by adult teeth, it is important to keep them as healthy as possible while they are present!

Q: Eruption of Child’s Teeth, when will they come in,what are common side effects?

A: Both the eruption of the first baby teeth and the transition from baby teeth to adult teeth can be an exciting and nerve racking time for both patients and their parents. 

Primary “Baby” teeth: Children typically start getting their first teeth around 6-7 months of age.  Through out the first two years of life, primary teeth will continue to erupt until 20 teeth area present by the age of 24 months.

Permanent “Adult” Teeth: Children will start making the transition to permanent dentition around the age of 5 ½ to 6 years of age, with the loss of their lower central incisors.  Throughout the next few years all four primary incisors will be replaced by permanent teeth and the six year molars will erupt behind the last primary molar.  Around the age of 9-10 years, the primary canines and molars will be replaced by permanent canines and premolars.  Typically, a full permanent (“adult”) dentition will be present by 13 years of age.

Some common side effects of teething in the primary dentition include increased salivation, and increased frequency of the child placing their fingers and hands in their mouth.  There are some conditions that have been attributed to eruption of teeth.  Parents should be careful when “blaming” these conditions on eruption of teeth as not to overlook a more serious medical condition.

Q: Dental Radiographs (“X-rays”), are they necessary?

A: Dental radiographs are essential for a complete diagnosis of  your childs oral health.  Radiographs will allow the dentist to check for cavities that might not be able to be visualized by just looking in the mouth.  Radiographs can check for cavities that are between the teeth, infections involving structures of both tooth and bone, and are helpful in evaluating proper growth and development.  Although advances in modern technology have made dental radiographs very safe for patients, your child will be individually evaluated to determine what radiographs are necessary for proper diagnosis while minimizing exposure to x-rays.

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Home Care for Your Child

Q: What about brushing my children’s teeth? 

A: Brushing your child’s teeth on a regular basis is the best way to help prevent cavities from developing.  Many young children may be resistant to letting their parents brush their teeth, but it is better to have the child be a little fussy while brushing than to have a mouth full of cavities.

Parents are encouraged to brush their children’s teeth until the child is 7-8 years old.  Before then, the patient does not have the manual dexterity (coordination) to properly manipulate the toothbrush and thoroughly clean their teeth.  It is alright to let the patient brush first, but parents must follow up on a regular basis to ensure that proper oral hygiene is maintained.

Once the child reaches an age where they are able to brush their teeth on their own, parents must continue to supervise their children to ensure that proper oral hygiene is maintained and the patient is not just “getting the toothbrush wet”.  It is not uncommon for parents of older children to still have to brush their children’s teeth because the child is not doing an adequate job.

Q: What toothpaste is best for my child?

A: Studies have shown that fluoride use is effective in reducing the chances of patients getting cavities in all age groups, especially those that have certain factors that place them in the high risk category.  The American Academy of Pediatric Dentistry now recommends that children of all ages can use a fluoride toothpaste to help protect your child from getting cavities.


This photograph taken from the American Academy of
Pediatric Dentistry’s Clinical Guideline on Fluoride Therapy shows the proper
amount of toothpaste that should be used when brushing your children’s teeth.

Left: A “smear” of toothpaste is all that is needed for children younger than 2 years of age.  This small amount will ensure that your child receives the topical benefits from using a fluoride toothpaste without worrying that they may get sick from swallowing too much toothpaste.

Right: A “pea-sized” amount of toothpaste is recommended for children between the ages of 2-5 year old.  Remember that your child still does not have the hand coordination at this time to adequately clean their own teeth.  Parental supervision and help with brushing is key to getting the areas that your child may miss on their own.

Q: What about flossing my child’s teeth?

A: Flossing your child’s teeth becomes important when two teeth that are next to one another are in contact.  When this is the case, it becomes impossible for a toothbrush to reach these areas during daily brushing.  Flossing on a regular basis ensure that the teeth are adequately cleaned and helps to prevent against cavities, gingivitis, and periodontal disease.

The type of floss used is not as important as the act of flossing itself.  Many parents find that using “floss picks” are convenient for them because it is easier to manipulate this instrument in the child’s small mouth.

Q: Is it okay for my child to use mouthrinses?

A: Mouthrinses can be a good adjunct to maintaining good oral health.  Many provide ingredients that aid in keeping both the teeth and gums healthy.  However, using mouthrinse should not take place of daily brushing and flossing.  Children can start using mouthrinses when they can properly spit, and not swallow, the mouthrinse that they are using.  Ingestion of too much fluoride could make your children sick and could possibly affect the development of the permanent teeth.

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Pulp Therapy (Pulpotomy) on Primary Teeth

Q: What is it?

A: When cavities in primary teeth are not diagnosed and treated early, the diseased tooth structure can reach the pulp of the tooth.  The pulp is composed of nerves and blood vessels that helped to form and nourish the tooth.  Once the bacteria from a cavity reaches the pulp, it can cause pain, infection, and other unwanted symptoms in your child.  If caught in time there is still a chance to save the tooth by performing a pulpotomy.  In this procedure, the top portion of the pulp is removed by the dentist and the tooth is treated with medicine to help remove any bacteria present and help maintain the vitality of the remaining nerve left in the tooth’s roots.  The tooth is then restored with a stainless steel crown that will cover the remaining tooth structure, reinforcing it until it is time for the tooth to fall out and be replaced by an adult tooth.

Q: What are the advantages to getting a pulpotomy?

A: The main advantage to pulpotomy treatment is that the patient is able to maintain the tooth until it is time for it to fall out on it’s own.  Teeth are important for many different reasons, including chewing food, proper speech development, and maintaining space for the permanent teeth to eventually erupt into the oral cavity.

Q: What are the disadvantages of having a pulpotomy performed?

A: The main disadvantage to having a pulpotomy performed is that there is usually not enough healthy tooth structure remaining after the removal of decay and accessing the nerve for the tooth to be restored with a traditional silver or tooth colored filling.  Using these materials leads to a greater risk of the tooth fracturing in the future.  In this case, a stainless steel crown is then placed over the tooth to help protect the remaining tooth structure and give the tooth its best chance of remaining in the mouth until it is ready to fall out on its own. 

Q: Are there other options to performing a pulpotomy and placing a crown?

A: Alternative treatment to having a pulpotomy performed includes extraction (removal of the tooth) and placement of a space maintainer to prevent the remaining teeth from shifting and moving once the infected tooth has been removed. 

Not having treatment performed is not an alternative to the pulpotomy procedure because if the cavity is allowed to progress it can lead to undesired outcomes, including: pain, infection/abscess, damaging to the developing permanent tooth that will replace the primary tooth.  Once symptoms such as pain and infection arise, there is usually no treatment that can be performed to save the tooth and removal of the infected tooth is indicated.