Although we usually tell the children we are “counting their teeth,” the examination is an integral part of the visit. We actually are counting the teeth, to see if there are too many or if there are missing teeth. We are also looking for any growths on the gums, cheeks, palate and tonsils. Checking for cavities involves looking and feeling, using the “counter” to feel if there are any cavities. If there is possible decay, we may ask for x-rays to confirm the diagnosis. Although we use digital x-rays, which use relatively little radiation, we do not take x-rays unless there is a particular diagnostic need.
Depending on the age of your child when we find a cavity, we may or may not recommend a filling. The baby teeth perform many functions. Sure, they may look beautiful, but the most important role of the baby teeth is to hold the space needed for the developing permanent teeth, which are developing in the bone underneath the baby teeth. In many cases, if your child loses the baby teeth too early, that may create a crowding situation that may or may not be able to be corrected with braces at a later time. There are different stages of dental eruption that may require fillings in certain teeth. Knowing when teeth generally fall out enables me to make a better recommendation as to whether you would have me fill the cavities or not. Sometimes we fill the teeth to prevent the cavities from spreading to the next tooth. If your child gets a cavity, we will discuss all treatment options with you.
One of the advantages of using a pediatric dentist is that we are specialty trained in different techniques for pain management and behavior management. We are trained in the use of Nitrous Oxide, for both pain management and anxiety management. Local anesthesia is used, but we are very careful to make “getting a shot” as painless as possible. We always use child-friendly phrases, such as” using sleepy juice to put the tooth to sleep”, “using a whistle or a power washer to wash the cavity bugs out”, “wiggling to tooth out so you can have a visit from the tooth fairy”. We always go through “tell-show-do” a technique where your child is told exactly what we are going to do in child-friendly terms. Another behavior guidance tool we use is “ask-tell-ask” which is inquiring about your child’s understanding, emotional reactions, and concerns. We ask that when you prepare your child for a filling, do not suggest that we will give them a shot or that it will hurt. Sometimes the best preparation is to say you don’t know but that Dr. Mital Spatz and her team will explain everything.
There has been a movement towards white fillings, so if the cavity is relatively small, it can be fixed with a tooth colored filling. If the cavity is so large that the nerve is involved, a pulpotomy (the removal of the top portion of the nerve) is performed, and a stainless steel crown will be placed on top of the tooth. A white colored crown is available but is not as likely to last the lifetime of the baby tooth and usually costs more.
Sealants have been around for about 30 years as an effective way to prevent chewing surface cavities. On the chewing surfaces of the molars, in particular the permanent molars, there are deep grooves that are too narrow for the toothbrush bristles to keep clean. Application of a plastic type material to the grooves acts as a barrier to food and plaque, thus protecting the decay-prone chewing surfaces. Let’s discuss whether sealants are a good option for your child.
Fluoride is an element that has been proven to prevent cavities. When teeth are developing, having fluoride in the diet allows the teeth to develop stronger enamel. The fluoride in the toothpaste strengthens the outer layer of enamel of the teeth in the mouth but do not help with the developing teeth. Too little fluoride won’t help; too much will cause fluorosis (a chalky white or brown discoloration of the permanent teeth). Fluorosis is commonly a result of a toddler eating too much fluoridated toothpaste or inappropriate use of fluoride supplements. Please discuss your exposure to fluoride with your child’s pediatrician or us.
The American Academy of Pediatrics, the American Dental Association and the American Academy of Pediatric Dentistry recommend the first dental check-up at 12 months of age. Children have a total of 20 baby (primary) teeth. Some baby teeth can remain in the mouth until age 13 or longer. Baby teeth need to be cleaned regularly starting as soon as teeth enter the mouth. More than 40% of children have tooth decay by age 5.
FIRST DENTAL VISIT BY AGE 1– A child should visit the dentist by their first birthday. By starting at this early age, the dentist will be able to identify any developing problems and discuss how to care for your baby’s teeth. Children should continue to visit the dentist at least twice a year.
CLEAN TEETH TWICE A DAY – Using a toothbrush or finger brush with a small amount of toothpaste twice daily will help to prevent tooth decay and keep the gums healthy. Assist school aged children with their brushing and flossing. Floss once daily as teeth begin to touch.
NO BOTTLES TO BED – Any liquid besides water has the potential to cause tooth decay. Children should go to bed with clean teeth and not be given a bottle to drink while falling asleep.
PACIFIER OR THUMB? – The American Academy of Pediatric Dentistry suggests using pacifiers to calm babies because pacifier habits are usually easier to stop than thumb-sucking. Both of these habits should be discouraged beyond age 3. A continued habit could lead to growth disturbances and malocclusions. Consult your pediatric dentist for suggestions on breaking the habit.
TOOTH FRIENDLY SNACKS – Whether packing school lunches or preparing snacks at home, remember to avoid sugary and sticky foods. Cheese, apple slices, carrot sticks, bananas, milk, and nuts are examples of foods that are nutritional, as well as good for your smile!