Click on a topic of interest for more information.

What is a Pediatric Dentist?
Your Child's First Dental Visit
Why are the Primary Teeth so Important?
Dental X-Rays
Care of your Child's Teeth
Good Diet = Healthy Teeth
How Do I Prevent Cavities
Seal Out Decay
Baby Bottle Tooth Decay (Early Childhood Caries)
When will my Baby Start Getting Teeth?
Eruption of your Child's Teeth
Dental Emergencies
Fluoride
What's the Best Toothpaste for my Child?
Does your Child Grind his Teeth at Night? (Bruxism)
Thumb Sucking
Tongue Piercing - Is it Really Cool?
Tobacco - Bad News in Any Form
What is the Best Time for Orthodontic Treatment?
Mouth Guards

What Is A Pediatric Dentist?

The pediatric dentist has an extra two years of specialized training and is dedicated to the oral health of children from infancy through the teenage years. The very young, pre-teens, and teenagers all need different approaches in dealing with their behavior, guiding their dental growth and development, and helping them avoid future dental problems. The pediatric dentist is best qualified to meet these needs.
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 Your Child’s First Dental Visit

Your child should visit the dentist by his/her 1^st birthday. You can make the first visit to the dentist enjoyable and positive. Your child should be informed of the visit and told that the dentist and his staff will explain all procedures and answer any questions. The less to-do concerning the visit, the better.

It is best if you refrain from using words around your child that might cause unnecessary fear, such as needle, pull, drill or hurt. Pediatric dental offices make a practice of using words that convey the same message, but are pleasant and non-frightening to the child.
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 Why Are The Primary Teeth So Important?

It is very important to maintain the health of the primary teeth. Neglected cavities can and frequently do lead to problems which affect developing permanent teeth. Primary teeth, or baby-teeth are important for (1) proper chewing and eating, (2) providing space for the permanent teeth and guiding them into the correct position, and (3) permitting normal development of the jaw bones and muscles. Primary teeth also affect the development of speech and add to an attractive appearance. While the front 4 teeth last until 6-7 years of age, the back teeth (cuspids and molars) aren’t replaced until age 10-13.
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Care of Your Child’s Teeth

Begin daily brushing as soon as the child’s first tooth erupts. A pea-size amount of fluoride toothpaste can be used after the child is old enough not to swallow it. By age 4 or 5, children should be able to brush their own teeth twice a day with supervision until about age seven to make sure they are doing a thorough job. However, each child is different. Your dentist can help you determine whether the child has the skill level to brush properly.

Proper brushing removes plaque from the inner, outer and chewing surfaces. When teaching children to brush, place toothbrush at a 45 degree angle; start along gum line with a soft bristle brush in a gentle circular motion. Brush the outer surfaces of each tooth, upper and lower. Repeat the same method on the inside surfaces and chewing surfaces of all the teeth. Finish by brushing the tongue to help freshen breath and remove bacteria.

Flossing removes plaque between the teeth where a toothbrush can’t reach. Flossing should begin when any two teeth touch. You may wish to floss the child’s teeth until he or she can do it alone. Use about 18 inches of floss, winding most of it around the middle fingers of both hands. Hold the floss lightly between the thumbs and forefingers. Use a gentle, back-and-forth motion to guide the floss between the teeth. Curve the floss into a C-shape and slide it into the space between the gum and tooth until you feel resistance. Gently scrape the floss against the side of the tooth. Repeat this procedure on each tooth. Don’t forget the backs of the last four teeth.
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 Good Diet = Healthy Teeth

Healthy eating habits lead to healthy teeth. Like the rest of the body, the teeth, bones and the soft tissues of the mouth need a well-balanced diet. Children should eat a variety of foods from the five major food groups. Most snacks that children eat can lead to cavity formation. The more frequently a child snacks, the greater the chance for tooth decay. How long food remains in the mouth also plays a role. For example, hard candy and breath mints stay in the mouth a long time, which cause longer acid attacks on tooth enamel. If your child must snack, choose nutritious foods such as vegetables, low-fat yogurt, and low-fat cheese which are healthier and better for children’s teeth.
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Good oral hygiene removes bacteria and the left over food particles that combine to create cavities. For infants, use a wet gauze or clean washcloth to wipe the plaque from teeth and gums. Avoid putting your child to bed with a bottle filled with anything other than water. See "Baby Bottle Tooth Decay" for more information.

Seal Out Decay

A sealant is a clear or shaded plastic material that is applied to the chewing surfaces (grooves) of the back teeth (premolars and molars), where four out of five cavities in children are found. This sealant acts as a barrier to food, plaque and acid, thus protecting the decay-prone areas of the teeth.
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 Baby Bottle Tooth Decay (Early Childhood Caries)

One serious form of decay among young children is baby bottle tooth decay. This condition is caused by frequent and long exposures of an infant’s teeth to liquids that contain sugar. Among these liquids are formula, fruit juice and other sweetened drinks.

Putting a baby to bed for a nap or at night with a bottle other than water can cause serious and rapid tooth decay. Sweet liquid pools around the child’s teeth giving plaque bacteria an opportunity to produce acids that attack tooth enamel. If you must give the baby a bottle as a comforter at bedtime, it should contain only water.

After each feeding, wipe the baby’s gums and teeth with a damp washcloth or gauze pad to remove plaque. The easiest way to do this is to sit down, place the child’s head in your lap or lay the child on a dressing table or the floor. Whatever position you use, be sure you can see into the child’s mouth easily.
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Teething, the process of baby (primary) teeth coming through the gums into the mouth, is variable among individual babies. Some babies get their teeth early and some get them late. In general the first baby teeth are usually the lower front (anterior) teeth and usually begin erupting between the age of 6-8 months. See "Eruption of Your Child’s Teeth" for more details.
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Eruption Of Your Child’s Teeth

Children’s teeth begin forming before birth. As early as 4 months, the first primary (or baby) teeth to erupt through the gums are the lower central incisors, followed closely by the upper central incisors. Although all 20 primary teeth usually appear by age 3, the pace and order of their eruption varies.

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Dental Emergencies

Toothache: Clean the area of the affected tooth thoroughly. Rinse the mouth vigorously with warm water or use dental floss to dislodge impacted food or debris. DO NOT place aspirin on the gum or on the aching tooth. If face is swollen apply cold compresses. Take the child to a dentist.

Cut or Bitten Tongue, Lip or Cheek: Apply ice to bruised areas. If there is bleeding apply firm but gentle pressure with a gauze or cloth. If bleeding does not stop after 15 minutes or it cannot be controlled by simple pressure, take child to hospital emergency room.

Knocked Out Permanent Tooth: Find the tooth. Handle the tooth by the crown, not the root portion. You may rinse the tooth but DO NOT clean or handle the tooth unnecessarily. Inspect the tooth for fractures. If it is sound, try to reinsert it in the socket. Have the patient hold the tooth in place by biting on a gauze. If you cannot reinsert the tooth, transport the tooth in a cup containing the patient’s saliva or milk. The tooth may also be carried in the patient’s mouth. The patient must see a dentist IMMEDIATELY!  Time is a critical factor in saving the tooth.
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Fluoride

Fluoride is an element, which has been shown to be beneficial to teeth. However, too little or too much fluoride can be detrimental to the teeth. Little or no fluoride will not strengthen the teeth to help them resist cavities. Excessive fluoride ingestion by preschool-aged children can lead to dental fluorosis, which is a chalky white to even brown discoloration of the permanent teeth. Many children often get more fluoride than their parents realize. Being aware of a child’s potential sources of fluoride can help parents prevent the possibility of dental fluorosis.

Some of these sources are:

• Too much fluoridated toothpaste at an early age.

• The inappropriate use of fluoride supplements.

• Hidden sources of fluoride in the child’s diet.

Two and three-year olds may not be able to expectorate (spit out) fluoride-containing toothpaste when brushing. As a result, these youngsters may ingest an excessive amount of fluoride during tooth brushing. Toothpaste ingestion during this critical period of permanent tooth development is the greatest risk factor in the development of fluorosis.

Excessive and inappropriate intake of fluoride supplements may also contribute to fluorosis. Fluoride drops and tablets, as well as fluoride fortified vitamins should not be given to infants younger than six months of age. After that time, fluoride supplements should only be given to children after all of the sources of ingested fluoride have been accounted for and upon the recommendation of your pediatrician or pediatric dentist.

Certain foods contain high levels of fluoride, especially: powdered concentrate infant formula, soy-based infant formula, infant dry cereals, creamed spinach, and infant chicken products. Please read the label or contact the manufacturer. Some beverages also contain high levels of fluoride, especially: decaffeinated teas, white grape juices, and juice drinks manufactured in fluoridated cities. Blending the syrup, carbonation with the city water supply often makes soft drinks at fast food restaurants – so if fluoride is in the water – this is another source.

Parents can take the following steps to decrease the risk of fluorosis in their children’s teeth:

• Use baby tooth cleanser on the toothbrush in the very young child.

• Place only a pea-sized drop of children’s toothpaste on the brush when brushing.

• Account for all of the sources of ingested fluoride before requesting fluoride supplements from your child’s physician or pediatric dentist.

• Avoid giving any fluoride-containing supplements to infants until they are 6 months old.

• Obtain fluoride level test results for your drinking water before giving fluoride supplements to your child (check with local water utilities).

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Does Your Child Grind His Teeth At Night? (Bruxism)

Parents are often concerned about the nocturnal grinding of teeth (bruxism). Often, the first indication is the noise created by the child grinding on their teeth during sleep. Or, the parent may notice wear (teeth getting shorter) to the dentition. One theory as to the cause involves a psychological component. Stress due to a new environment, divorce, changes at school; etc. can influence a child to grind their teeth. Another theory relates to pressure in the inner ear at night. If there are pressure changes (like in an airplane during take-off and landing when people are chewing gum, etc. to equalize pressure) the child will grind by moving his jaw to relieve this pressure.

The majority of cases of pediatric bruxism do not require any treatment. If excessive wear of the teeth (attrition) is present, then a mouth guard (night guard) may be indicated. The negatives to a mouth guard are the possibility of choking if the appliance becomes dislodged during sleep and it may interfere with growth of the jaws. The positive is obvious by preventing wear to the primary dentition.

The good news is most children outgrow bruxism. The grinding gets less between the ages 6-9 and children tend to stop grinding between ages 9-12. If you suspect bruxism, discuss this with your pediatrician or pediatric dentist.
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 Thumb Sucking

Sucking is a natural reflex and infants and young children may use thumbs, fingers, pacifiers and other objects on which to suck. It may make them feel secure and happy or provide a sense of security at difficult periods. Since thumb sucking is relaxing, it may induce sleep.

Thumb sucking that persists beyond the eruption of the permanent teeth can cause problems with the proper growth of the mouth and tooth alignment. How intensely a child sucks on fingers or thumbs will determine whether or not dental problems may result. Children who rest their thumbs passively in their mouths are less likely to have difficulty than those who vigorously suck their thumbs.

Children should cease thumb sucking by the time their permanent front teeth are ready to erupt. Usually, children stop between the ages of two and four. Peer pressure causes many school-aged children to stop.

Pacifiers are no substitute for thumb sucking. They can affect the teeth essentially the same way as sucking fingers and thumbs. However, use of the pacifier can be controlled and modified more easily than the thumb or finger habit. If you have concerns about thumb sucking or use of a pacifier, consult your pediatric dentist.

A few suggestions to help your child get through thumb sucking:

• Instead of scolding children for thumb sucking, praise them when they are not.

• Children often suck their thumbs when feeling insecure. Focus on correcting the cause of anxiety, instead of the thumb sucking.

• Children who are sucking for comfort will feel less of a need when their parents provide comfort.

• Reward children when they refrain from sucking during difficult periods, such as when being separated from their parents.

• Your pediatric dentist can encourage children to stop sucking and explain what could happen if they continue.

• If these approaches don’t work, remind the children of their habit by bandaging the thumb or putting a sock on the hand at night. Your pediatric dentist may recommend the use of a mouth appliance.
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Tongue Piercing – Is it Really Cool?

You might not be surprised anymore to see people with pierced tongues, lips or cheeks, but you might be surprised to know just how dangerous these piercings can be.

There are many risks involved with oral piercings including chipped or cracked teeth, blood clots, or blood poisoning. Your mouth contains millions of bacteria, and infection is a common complication of oral piercing. Your tongue could swell large enough to close off your airway!

Common symptoms after piercing include pain, swelling, infection, an increased flow of saliva and injuries to gum tissue. Difficult-to-control bleeding or nerve damage can result if a blood vessel or nerve bundle is in the path of the needle.

So follow the advice of the American Dental Association and give your mouth a break – skip the mouth jewelry.
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Tobacco – Bad News in Any Form

Tobacco in any form can jeopardize your child’s health and cause incurable damage. Teach your child about the dangers of tobacco.

Smokeless tobacco, also called spit, chew or snuff, is often used by teens who believe that it is a safe alternative to smoking cigarettes. This is an unfortunate misconception. Studies show that spit tobacco may be more addictive than smoking cigarettes and may be more difficult to quit. Teens who use it may be interested to know that one can of snuff per day delivers as much nicotine as 60 cigarettes. In as little as three to four months, smokeless tobacco use can cause periodontal disease and produce pre-cancerous lesions called leukoplakias.

If your child is a tobacco user you should watch for the following that could be early signs of oral cancer:

• A sore that won’t heal

• White or red leathery patches on your lips, and on or under your tongue

• Pain, tenderness or numbness anywhere in the mouth or lips

• Difficulty chewing, swallowing, speaking or moving your jaw or tongue; or a change in the way your teeth fit together

Because the early signs of oral cancer usually are not painful, people often ignore them. If it’s not caught in the early stages, oral cancer can require extensive, sometimes disfiguring, surgery. Even worse, it can kill.

Help your child avoid tobacco in any form. By doing so, they will avoid bringing cancer-causing chemicals in direct contact with their tongue, gums and cheek.
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What is the Best Time for Orthodontic Treatment?

Developing malocclusions, or bad bites, can be recognized as early as 2-3 years of age. Often, early steps can be taken to reduce the need for major orthodontic treatment at a later age.

Stage I – Early Treatment: This period of treatment encompasses ages 2 to 6 years. At this young age, we are concerned with underdeveloped dental arches, the premature loss of primary teeth, and harmful habits such as finger or thumb sucking. Treatment initiated in this stage of development is often very successful and many times, though not always, can eliminate the need for future orthodontic/orthopedic treatment.

Stage II – Mixed Dentition: This period covers the ages of 6 to 12 years, with the eruption of the permanent incisor (front) teeth and 6 year molars. Treatment concerns deal with jaw malrelationships and dental realignment problems. This is an excellent stage to start treatment, when indicated, as your child’s hard and soft tissues are usually very responsive to orthodontic or orthopedic forces.

Stage III – Adolescent Dentition: This stage deals with the permanent teeth and the development of the final bite relationship.
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Mouth Guards

When a child begins to participate in recreational activities and organized sports, injuries can occur. A properly fitted mouth guard, or mouth protector, is an important piece of athletic gear that can help protect your child’s smile, and should be used during any activity that could result in a blow to the face or mouth.

Mouth guards help prevent broken teeth, and injuries to the lips, tongue, face or jaw. A properly fitted mouth guard will stay in place while your child is wearing it, making it easy for them to talk and breathe.

Ask your pediatric dentist about custom and store-bought mouth protectors.
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The consequences of the affected children laboring and compensating to increase the airflow are many.   The facial development and tooth alignment may be affected.  The concomitant mouth breathing can predispose the children to a dry mouth, tooth decay, and gum irritation.  The children may also exhibit poor school performance due to excessive daytime sleepiness, hyperactivity, aggressive behavior, and social withdrawal and on rare occasions brain damage, seizures, or coma.

Whereas adults with OSA are prone to sleep arousal without complete awakening, children may suffer from hours of partial airway obstruction without sleep arousal.

Some leading causative factors for OSA in children are enlarged tonsils and adenoids, craniofacial anomalies, and obesity.  Children with Down’s Syndrome are at high risk.  However, not all children with enlarged tonsils or adenoids, or craniofacial anomalies, or obesity, or Down’s Syndrome, are necessarily affected.

Parents describe OSA episodes as labored breathing with no airflow followed by gasping or choking.  Breathing is usually normal while the child is awake.  A special test called a polysomnograph can help diagnose OSA.  Treatments include the removal of the tonsils and adenoids; continuous positive airway pressure treatment; weight loss for obese patients; special mouth devices to reposition the tongue and/or the lower jaw (adults mostly); and surgery on the uvula, tonsils, palate, and pharynx (adults mostly).

Early diagnosis and treatment can avoid needless suffering.  Parents who are unsure if their children are affected by this problem should speak to their pediatrician or  ask Dr. Kochman.

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In striving to be more physically fit, our bodies are experiencing new problems.  Aside from the obvious post-exercise aches and pains, there are specific concerns for our mouths.

Most coaches, trainers, and sports medicine personnel are aware that properly fitted mouth protectors can avoid tragic and costly sports related oral injuries such as fractured teeth, mouth lacerations, and also concussions.  The exact type of mouth protector to be used is determined by the type of sport that the athlete participates in.  Mouth protectors for boxers are different from those for hockey players, which in turn are different from those for soccer players. 

Swimmers, even individuals with excellent oral hygiene, may get ‘swimmer’s calculus. Unlike regular dental calculus, this can quickly form even following a thorough dental cleaning.  A chemical reaction between the athlete’s more alkaline saliva and the more acidic pool chemicals causes this calculus.   Olympic caliber swimmers are more prone to tooth decay since their teeth are regularly exposed to the acidic pool chemistry.  Excellent oral hygiene measures, regular dental visits, and supplemental topical fluorides are helpful.

‘Sports-drinks’ have become popular with athletes to re-hydrate themselves following vigorous exertion.  Unfortunately, frequent use of these carbo-loading liquids can cause tooth enamel erosion.   The British Journal of Sports Medicine reported that of eight brands of sports-drinks tested, all increased the risk of developing cavities.  All were acidic enough to erode enamel, and many had high sugar concentrations.  Although no true ‘safe’ consumption level exists, researchers recommended that one not consume more than 6 of these 8-ounce beverages a day.  Use of a straw was preferable over sipping them or swishing them around the mouth.

Some simple precautions can help maintain healthy mouths while we strive to make our bodies physically fit.  For additional information, or if you have specific concerns, please ask Dr. Kochman.

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The frequency of latex allergic people in the general population is estimated at 6%.  The true culprit of ‘latex allergies’, is a protein of natural rubber, that is used in the production of latex.  A rare but serious allergic reaction called anaphylactic shock, can occur, which without proper immediate treatment, can result in death!  Synthetic latex substitutes such as silicone have not been implicated.

In dentistry, latex products are common in items such as suction lines, examination gloves, plungers in local anesthetic, some chair coverings, dental gowns, latex gaskets in the dentists’ hand pieces, and orthodontic elastics to name but a few.  This poses a serious health concern for the patient, and a technical dilemma for the dentist and dental staff.

Some children at higher risk are: those who have chronic urological conditions with a history of multiple surgeries, children who are highly allergic to other products, and children with spina bifida.  Children with food allergies to avocado, water chestnuts, kiwi, and banana are more susceptible.  Other foods that have been implicated to a lesser degree are: cherries, peaches, potatoes, celery, tomatoes, plums, wheat, and oats.  Daily exposure of adolescents to school supplies such as rubber bands, erasers, and gym floors; to fast foods handled with latex gloves by food servers; and, to athletic supplies such as sneaker soles, elastics on socks, and racquet handles, can lead to sensitization to latex products.

With special precautions the latex allergic child can undergo all dental procedures safely.  If you suspect that your child may be developing any allergy, please advise Dr. Kochman or a member of our staff immediately.   We will  take the necessary precautions to ensure that your child’s treatments are uneventful.

For more information you may contact:
American College of Allergy, Asthma & Immunology, (847) 427-1200

Delaware Valley Latex Allergy Support Network, (800) 528-3966

E.L.A.S.T.I.C. (Education for Latex Allergy Support Team & Information Coalition) (610) 436-4801
 

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Dental X-rays rank second in frequency of use by the public.  Dentists use specific guidelines, and consider the clinical examination of the child, and the child’s health history, to determine which X-rays to take and when to take them.

To reduce radiation exposure, modern low radiation-emitting X-ray equipment is used.  Lead aprons and shields are always worn, and, all equipment is inspected regularly.

Advances with new digital radiographic equipment helps reduce radiation exposure for your child.  With this equipment, a computer sensor replaces the traditional X-ray film.  The image may be  displayed on a computer screen rather than being developed on a dental X-ray film.

With children and adolescents, dental X-rays help detect many problems that might otherwise go undetected.  Some of these include cavities, missing/extra permanent teeth, permanent teeth growing in the wrong position within the bone, developing teeth growing into and destroying other teeth, abscesses with/without any clinical symptoms, tumors, to name but a few.  With facial injuries X-rays can detect  clinically unseen fractured roots, fractured jaws, and embedded foreign objects.

Parents should be consulted before X-rays are taken on their children.  Parents should also feel comfortable declining the X-rays if, after the dentist’s explanation for the need and risks, they do not want them taken.  

Some common dental X-rays are: 

• Bitewing X-rays are used to check for cavities between the back teeth when no spaces exist for the dentist to probe the teeth directly.    They may be repeated at 6 to 24 month intervals depending on the child’s cavity susceptibility. 

• Occlusal X-rays evaluate growth of teeth and structures in the palate.  

• Periapical X-rays evaluate pathology in a specific region of the mouth. 

• Panoramic X-rays show the teeth and bones in the whole mouth with a single X-ray. 

• Cephalometric X-rays evaluate facial growth for orthodontic or oral surgical corrections.

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Bleeding from the gums of a healthy person, when they are brushed or flossed, is a sign of gum disease.  Until recently, gum disease during pregnancy has not been taken seriously.  We now know that the bacteria responsible for the gum disease can also cause problems in places other than the mother’s mouth.

Past studies have demonstrated that alcohol consumption during pregnancy can increase the probability of a low birth-weight baby by one and half times.  Smoking during pregnancy can increase the chances by one fold.  Smoking and alcohol in combination increase the probability by two and a half times.  Studies have now demonstrated the alarming fact, that a gum infection with the specific bacteria P. gingivalis, in a pregnant woman, can increase the chances of a low birth-weight baby by sevenfold.

Certain gum disease-producing bacteria have been implicated in the development of other medical problems.  For example, a link between some forms of heart disease and a bacterium causing gum disease has now been recognized.

At birth, newborn babies do not have any of the bacteria that are responsible for either gum disease or tooth decay in their mouths.  These germs are inoculated into their mouths after birth by close contact with family members.  We also know now that children that develop gross tooth decay in the first few years of life, are predisposed to developing more tooth decay for the rest of their lives.

So, the greater the populations of all of these germs in the parent’s mouth, the greater the risk for transmission of these germs to the baby.  It should be apparent from these facts that there are many reasons for parents to maintain a high degree of oral health, even before the baby is born, to ensure that their babies will be healthier. 

Regular brushing, flossing and routine visits to the dentist are essential.  For more information ask your dentist.