Care and treatment of kids’ pearly whites
Two years ago my daughter-with-the-dazzling-smile fell and cracked one of her newly-minted top front teeth. On a Friday night. I picked up the tooth stub from the floor and frantically tried to figure out how to save her from a life of gap-toothedness.
In what turned out to be a Very Important Referral, I called our family dentist, who recommended a pediatric dentist.
Dr Jill Decker and her assistant came into her otherwise closed office the first thing on Saturday morning to fix up Tessa’s tooth. Doing so required not only technical expertise, but also finesse in dealing with a very scared and obstinate 6 year-old. And a panicked mom.
Dr Jill was the perfect person for the job. I recently interviewed Dr Jill of Young Dentistry for Children about her insider tips on kids and teeth and dentists.
How do you help kids be comfortable with you, especially when you may need to insert sharp objects into their mouths?
Dr Jill: We use the tell-show-do technique to relieve dental anxiety. Children are first told what will be done. “Mr Tooth Tickler will wash your tooth — like going to the carwash! Mr Thirsty will drink up all the water in your mouth.”
Then we show the instrument and explain in an age-appropriate way. “Touch Mr Thirsty — see? He’s just like a straw. Let’s touch Mr Tooth Counter. He looks silly, but let me show you on your fingernail how it will feel on your tooth.” The tool is then applied to complete the care.
For dental work beyond cleaning, like cavities and extractions, how do you handle anesthesia?
Many parents are concerned about how their child will tolerate local anesthesia. We take great care to explain to the child, without actually showing the child the needle, what can be expected. For most procedures that require numbing, we use nitrous oxide and oxygen (“laughing gas”) prior to administering the local anesthesia to help provide relaxation to the child.
[Interviewer's note: The parent should get in on that action, too.]
“Here is the Buzz Lightyear nose. Feel how soft and squish it is! It smells like orange popsicles. You may start to feel floaty and tingly, and when we are finished that feeling will go away.” We then use topical anesthetic on a cotton cloth to numb the gums before the local anesthesia is given.
During procedures we welcome parents into our treatment rooms. However, many kids are better able to tolerate treatment without a parent in the room. Most parents are surprised by how well their child does on his/her own.
When should a parent begin thinking about braces, and what are the first steps?
Most of us adults remember receiving braces after all our baby teeth fell out. Recent research shows, though, that children can sometimes be treated at a younger age, while some baby teeth are still present. Earlier treatment can take advantage of a child’s rapid growth and the ability to modify potentially unfavorable oral growth patterns. The current recommendation is for a child to receive his or her first orthodontic evaluation at 7 years old.
The orthodontist will review treatment options, including the ideal age at which your child should begin treatment. Among the most common benefits of treatment at a younger age is the ability to guide jaw growth. There are some orthodontic conditions that, if not treated early enough, require surgical correction in the future.
There is typically more than one approach to any given orthodontic problem. We at Young Dentistry for Children refer our patients to the orthodontist at age 7 so parents may become educated to make well-informed decisions about when to begin their own child’s orthodontic care.
What should parents know about tooth trauma?
Baby teeth that are knocked completely out of the mouth as a result of trauma are NOT put back into the socket. However, if a permanent tooth is knocked out completely, it is ideal to place the tooth back into the socket as soon as possible. Care should be taken to not handle the root, which is the cone-shaped portion of the tooth. Keeping this in mind, the root should be gently rinsed with water (plug the sink) prior to placement back into the socket. The dentist should be called as it will be necessary to meet the child in the office to stabilize the tooth. If the tooth cannot be placed back into the socket at the time of injury, the tooth may be transported to the dental office in cold milk, saline or water or held in the mouth against the cheek.
A more common and less dramatic type of injury is a bump to the mouth that does not knock out a tooth entirely. Whether this injury involves a baby or permanent tooth, the dentist should be called as different treatment approaches are indicated, depending on the injury.
We realize parents can’t possibly be with their children all the time to avoid injuries but there are common-sense precautions that should be taken. We at Young Dentistry for Children recommend athletic mouthguards for all organized sports, whether or not they are considered “contact sports.” Helmets must be worn on bikes, scooters and skis/snowboards and great care must be taken on recreational equipment such as trampolines.
What else can parents do to keep their children’s teeth healthy?
So many wonderful advances have been made in preventive dentistry. It is exciting to share with parents all the ways they can drastically reduce the chances of cavities and gum disease. The traditional recommendation of cleanings every six months, brushing and flossing and avoiding sugar still hold true. Here are some of the new or revised recommendations.
Topping the prevention list is the recommendation by the American Dental Association and the American Academy of Pediatric Dentistry that a child receive his or her first dental visit by the age of 1 year old, or within six months of the first tooth growing into the mouth. The purpose of seeing children at such a young age is to impart all the needed preventive information to parents early, to avoid getting cavities in the first place! The additional benefit is the child becomes quite comfortable in the dental environment because they are exposed to multiple easy preventive visits to enhance their confidence. We feel so strongly about children coming to see us by age one that at Young Dentistry for Children we offer initial examinations FREE OF CHARGE for children 18 months old and younger.
One of the most effective preventive measures is avoiding the introduction of cavity-causing bacteria into a child’s mouth. The specific oral bacteria that causes cavities is called Streptococcus Mutans. This bacteria is a necessary component to cavity formation. Children are not born with this bacteria in their mouths but acquire it from the saliva of adults. The age at which children are susceptible to acquiring this bacteria is from the time they get their first teeth (around 6 months old) until 3 years old. For this reason it is recommended that adults not share utensils and cups with their young children, not wipe off pacifiers with their own mouths and avoid placing a baby’s fingers into their adult mouths.
Diet plays an enormous role in a child’s overall general and dental health. Many drinks, including milk if it’s consumed more frequently than only with meals or snacks, can cause cavities. The in-between surfaces of teeth are especially vulnerable to cavities if sugary drinks are consumed. Likewise, food that adheres to the teeth gives the bacteria ample time to feed on it and cause decay. The deep grooves and crevices on back molars are susceptible to cavities because food adheres at the depth of the grooves and cannot be brushed away. Avoiding adhesive foods such as raisins, fruit roll-ups, caramel, taffy, and even gummy vitamins, will help prevent cavities.
Preventive sealants have been in use for years but are mentioned here because they are so effective in preventing cavities on those deep molar crevices. Sealants are routinely placed on permanent molars and are a coating that fills in the deep grooves, shutting out the food and bacteria. Sealants are usually well tolerated by children and do not require local anesthesia. After the sealants are placed, children will be instructed to avoid sticky candy, which can pull off the sealants. But remember, sticky candy causes cavities anyway, so it’s better instead to eat chocolate as an occasional treat.
It has been shown that the use of the sweetener xylitol is helpful in preventing cavities, especially in gum. Research shows adults and children who chew xylitol gum at least 3 times a day, especially after meals, have less cavity-causing bacteria in their mouths.
How can parents get in touch with you?
In addition, Young Dentistry will have a booth at Thorntonfest on Saturday, May 22 from 10 am to 5 pm. Stop by and smile! Thorntonfest is a fun family activity that includes food, music, games and crafts. Admission and parking are free.
Thank you, Dr Jill, for repairing my daughter’s tooth, for sealing the molars of both my children, and for making Tessa and Reed comfortable coming to the dentist.
Image: Consumers Research