Pediatric Dentistry

Kindergarten Law

This landmark legislation requires that children have a dental check-up by May 31 of their first year in public school, at kindergarten or first grade. Dental evaluations that have happened within the 12 months prior to school entry also meet this requirement. If a dental check-up cannot be obtained, parents may get an excuse from this requirement by filling out the form provided by the child's school. Copies of the required forms are available at the child’s school, or at the California Department of Education Website:

http://www.cde.ca.gov/ls/he/hn/documents/oralhlthassess.doc

Cavity Prevention

Most of the time cavities are due to a diet high in sugary foods and a lack of brushing.

Limiting sugar intake and brushing regularly, of course, can help. The longer it takes your child to chew their food, the longer the residue stays on their teeth and the greater the chances of getting cavities.

Every time someone eats, an acid reaction occurs inside their mouth as the bacteria digests the sugars. This reaction lasts approximately 20 minutes. During this time the acid environment can destroy the tooth structure, eventually leading to cavities. When children snack, they have a tendency to keep food particles on the teeth or in their mouth. It is extremely important to remove all food particles after snacks in the middle of the day by simply keeping a toothbrush handy in the kitchen and rinsing afterwards with fluoridated water.

Consistency of a person's saliva also makes a difference as thinner saliva breaks up and washes away food more quickly. When a person eats foods high in carbohydrates and sugars, they tend to have thicker saliva, which in turn produces more of the acid-producing bacteria that causes cavities.

Some tips for cavity prevention:

Limit frequency of meals and snacks.
Encourage brushing, flossing, and rinsing.
Watch what you drink.
Avoid sticky foods.
Make treats part of meals.
Choose nutritious snacks.

Baby Bottle Decay (Early Childhood Caries)

What Causes Tooth Decay?

Several specific types of bacteria that live on the teeth cause decay. When sugar is consumed, the bacteria uses the sugar and then manufacture acids that dissolve the teeth and cause an infection in the tooth. This infection is called decay.

What Is Baby Bottle Tooth Decay? (Early Childhood Caries)

Babies who go to bed with a bottle of milk, formula, or juice are more likely to get tooth decay. Because the sugar in formula, milk, or juice stays in contact with the teeth for a long time during the night, this makes them more susceptible to dental cavities.

Some Tips To Avoid Baby Bottle Tooth Decay

Put your child to bed with a bottle of plain water, not milk or juice.
Stop nursing when your child is asleep or has stopped sucking on the bottle.
Try not to let your child walk around using a bottle of milk or juice as a pacifier.
Start to teach your child to drink from a cup at about six months of age. Plan to stop using a bottle by 12 to 14 months at the latest.
Don't dip your child's pacifier in honey or sugar.

Tooth Brushing

Depending on the age and ability of your child, we will review the best tooth brushing technique with you and your child. Some children are capable of brushing on their own, but most require parental supervision or even brushing done by the parents up to the age of 10.

Brushing & Flossing Instructions

Children’s hands and mouths are different than adults. They need to use toothbrushes designed for children. Both adults and children should use brushes with soft, rounded bristles for gentle cleaning. Change to a new brush about every three months.

Brush infant’s teeth and gums gently with a small, soft bristled toothbrush. As babies grow, use a child’s toothbrush. You will still need to brush where they miss. Dentists and hygienists often advise children to use a gentle, circular motion to remove plaque.

Hold the brush at a 45 degree angle towards teeth and gums.
Brush the inside and outside surfaces of each tooth, top and bottom.
Gently brush the tongue to remove debris.
Floss between teeth daily.

When To Begin Brushing

Once your child's teeth begin erupting, (at or around 6 months of age) you can begin cleaning them with a soft bristled toothbrush. You should just smear the tips of the bristle with toothpaste as this is an ample amount.

For most toddlers, getting them to brush their teeth can be quite a challenge.

Some suggestions for making tooth brushing less of a battle can include:

Let your child brush your teeth at the same time.
Let your child pick out a few toothbrushes with his favorite characters and giving him a choice of which one he wants to use each time (this will give him some feeling of control over the situation).
Let your child brush his own teeth first (you will likely have to "help out").
Let your child read some children's books about tooth brushing.
Have everyone brush their teeth at the same time.

To help your child understand the importance of brushing, it can be sometimes fun and helpful to let them eat or drink something that will “stain“ their teeth temporarily and then brush them clean. LIsterine makes a product called Agent Cool Blue.

It can also be a good idea to create a "tooth brushing routine". And stick to the same routine each day.

Thumb Sucking

Digit sucking is a habit that occurs in infants. Children usually give up digit sucking by the age of one. If the child continues past the age when their permanent teeth start to erupt, (at or around 6 months of age) they may develop crooked teeth and a malformed roof of their mouth. This results from the frequency, duration, intensity, and position of the digit in the child’s mouth. This can also affect the position of the upper and lower jaw and can also affect speech. Ultimately, continued digit sucking, or any oral habits similar to digit sucking, can lead to irreversible bone changes which may require surgery to fix the problem when the children reaches around 20 years of age.

Suggestions to break the habit:

Wait till the time is right (low stress).
Motivate your child (show examples of what could happen to their teeth and fingers/thumbs).
Use a reward system (small incentives will encourage your child to stick with it).

Tooth Eruption

The first baby teeth come into the mouth are the two bottom front teeth. You will notice this when your baby is about six to eight months old. Next to follow will be the two upper front teeth and the remainder of your baby's teeth will appear periodically. They will usually appear in pairs along the sides of the jaw until the child is about 2-1/2 years old.

At around 2-1/2 years old, your child should have all 20 teeth. Between the ages of five and six, the first permanent teeth will begin to erupt. Some of the permanent teeth replace baby teeth and some don't. Don't worry if some teeth are a few months early or late as all children are different.

Baby teeth are important as they not only hold space for permanent teeth, but they are important for chewing, biting, as well as for speech, and appearance.

For this reason it is important to maintain a healthy diet and daily hygiene.

Pain Control

The doctors of Brea Pediatric Dental Practice make every effort to administer local anesthetics (lidocaine) in a slow, gentle, and comfortable manner, thus eliminating any pain that may accompany dental treatment. The duration of numbness after treatment varies from patient to patient and depends on what drug was used. Generally the numbness wears off after two to three hours. Parents must be careful to watch their child from chewing or biting their lips, inner cheeks or tongue and to avoid face scratching that can cause them to be injured.

Gum Disease

While many people believe periodontal disease is an adult problem, studies indicate that gingivitis (the first stage of periodontal disease) is nearly a universal problem among children and adolescents. Advanced forms of periodontal disease are more rare in children than adults, but can occur. Thus, it is extremely important to see a pediatric dentist if your child has lost some teeth (not from trauma) if before the age of four.

Chronic gingivitis is common in children. It can cause gum tissue to swell, turn red, and bleed easily. Gingivitis is preventable and treatable with a regular routine of brushing, flossing, and professional dental care. If left untreated, it can eventually advance to more serious forms of periodontal disease.

Localized aggressive periodontitis can affect young healthy children. It is found in teenagers and young adults and mainly affects the first molars and lower incisors. It is characterized by the severe loss of alveolar bone, and ironically, patients generally form very little dental plaque or calculus.

Generalized aggressive periodontitis may begin around puberty and involve the entire mouth. It is marked by inflammation of the gums and heavy accumulations of plaque and calculus. Eventually it can cause the teeth to become loose.

Both conditions can be properly diagnosed with radiographs and timely referrals to gum specialists.

Conditions that make children more susceptible to periodontal disease include:

Type I diabetes
Down syndrome
Papillon-Lefevre syndrome
Hypophosphatasia

For example, in a survey of 263 Type I diabetics, 11 to 18 years of age, 10 percent had overt periodontitis.

Adolescence and Oral Care

There is evidence that demonstrates how periodontal disease may increase during adolescence due to lack of motivation to practice oral hygiene. Children who maintain good oral health habits up until the teen years are more likely to continue brushing and flossing than children who were not taught proper oral care.

Advice For Parents

Early diagnosis is important for successful treatment of periodontal diseases. Therefore, it is important that children receive a periodontal examination as part of their routine dental visits. Be aware that if your child has an advanced form of periodontal disease, this may be an early sign of systemic disease. A general medical evaluation should be considered for children who exhibit severe periodontitis, especially if it appears resistant to therapy.

An important step in the fight against periodontal disease is to establish good oral health habits with your child early. When your child's first teeth erupt, you can begin using toothpaste when brushing their teeth. Remember to only smear the tips of the toothbrush with toothpaste. And, when the gaps between your child's teeth close, it's important to start flossing.

Serve as a good role model by practicing good oral health care habits yourself and schedule regular dental visits for family check-ups, periodontal evaluations, and cleanings.

Check your child's mouth for the signs of periodontal disease, including bleeding gums, swollen and bright red gums, gums that are receding away from the teeth, and bad breath.

If your child currently has poor oral health habits, work with your child to change these now. It's much easier to modify these habits in a child than in an adult. Since your child models behavior after you, it follows that you should serve as a positive role model in your oral hygiene habits. A healthy smile, good breath, and strong teeth all contribute to a young person's sense of personal appearance, as well as confidence and self-esteem.