Pediatric Basics

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Tooth Brushing

As children’s hands and mouths are different than those of adults, they need to use toothbrushes designed for them. Both adults and children should use brushes with soft, rounded bristles for gentle cleaning. Change to a new brush approximately every three months.

For infants, wipe teeth gently (including the tongue) with a moist, soft cloth or piece of gauze. As babies grow, introduce your child to brushing with a toothbrush designed for infants, adding a small, pea-sized dab of non-fluoridated or “training” toothpaste. By the age of 2 or 3, begin to teach your child to brush more adequately. You may still need to brush in places they miss.

Suggestions for making tooth brushing less of a battle for young children may include:

  • Allowing your children to brush and floss your teeth
  • Allowing your children to pick a few toothbrushes with their favorite characters and providing a choice of which brush to use each time
  • Allowing your children to brush their own teeth first, then go over
  • Reading children’s books about tooth brushing
  • Having everyone brush their teeth at the same time
  • Give praise
  • Do not forget to brush the tongue

It is also helpful to create a “tooth brushing routine” and to stick to the same routine each day.

Click Here for Brushing and Flossing Instructions

Thumb Sucking

Thumb or finger sucking are habits that occur in infants. Children usually give up thumb-sucking by the age of four. If your child continues the habit past the age when permanent teeth begin to erupt – they may develop an open bite, crooked teeth, and a malformed palate (roof of the mouth). This results from the frequency, duration, intensity, and position of the thumb in the child’s mouth. Prolonged thumb-sucking can also affect the position of the upper and lower jaw, as well as affect speech.

Suggestions for breaking a thumb-sucking habit:

  • Wait until the time is right (Low Stress)
  • Motivate your child by showing 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
  • Dr. Cris’ glove technique

Prolonged use of pacifiers can harm the teeth just like prolonged thumb-sucking, although it is often easier to wean a child from a pacifier than a thumb. Pacifier use during the first few years of life does not cause long-term dental problems. However, prolonged pacifier use may cause a child’s top front teeth to slant outward to erupt improperly.

Early Childhood Decay

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

What is “early childhood” or “baby-bottle” decay? Baby bottle decay or ECC (early childhood caries) infant tooth decay results when babies fall asleep with breast milk, milk, or formula and juice from a bottle on their teeth. Babies are not able to clear the pooling liquid from their mouths. Because the sugar in formula, milk or juice stays in contact with the teeth for an extended period of time, while infants sleep the teeth can decay quickly.

Tips to avoid ECC (early childhood caries) or 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
  • Do not let your child walk around using a bottle of milk or juice
  • Begin to teach your child to drink from a cup at about 6 months of age
  • Plan to stop using a baby bottle or breastfeeding by 12-24 months of age
  • Don’t dip your child’s pacifier in honey, sugar or anything sweet
  • Do not use a bottle as a pacifier
  • If you child’s teeth have white spots and look dull, it is a sign of tooth decay

Cavity Prevention

Saliva is the body’s mechanism for fighting the destructive forces of acids formed by plaque. Saliva acts as a buffer and a re-mineralizing agent. Sugarless gum is one way to stimulate the flow of saliva in the mouth in between brushings. The best way to prevent cavities, however, is to brush and floss the teeth twice daily. When your child is able to expectorate (spit), use a mouthwash with fluoride.

Children are most susceptible to developing cavities. Heredity also may play a major role in how susceptible your child’s teeth are to the formation of a cavity. For example, tooth structure, size, and shape may be passed down through many generations. This includes deep pits and grooves, which are ideal for trapping plaque. Many cavities originate in the hard-to-clean areas between teeth and in the pits of teeth.

Common symptoms of a possible cavity may include:

  • A painful tooth
  • Higher sensitivity in the teeth to hot or cold temperatures, liquids, or sugary foods
  • Tenderness and swelling of the gum, or in more severe cases, the cheek
    white spots, which are the presence of decay
  • Tooth discolorations
  • Food trapped between 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. Many snacks that children eat can lead to the formation of cavities. The more frequently a child snacks, the greater the chances of tooth decay.

The time food remains in the mouth also plays a role. For example, hard candy, chewing gum with sugar, and breath mints stay in the mouth for extended periods of time, causing longer acid attacks on tooth enamel. We understand that children love chocolate! Offer them dark chocolate, as it dissolves faster and has more nutritional value. Always have your child brush after eating candy.

Often cavities develop without any pain or other symptoms – the reason it is so important to schedule your child for regular, routine visits to our office. Because the threshold for pain varies, some children do not complain of pain until there is severe decay or abscess.

Gum Disease

While many people believe periodontal (gum) disease is an adult problem, studies indicate gingivitis (the first stage of periodontal disease) is nearly a universal problem among children and adolescents. Advanced forms of periodontal disease are rarer in children, but can occur.

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.

Early diagnosis is important for successful treatment of gum disease. Advanced forms of periodontal disease in children may be an early sign of other systemic disorders. The generalized aggressive periodontal disease may begin around puberty and involve the entire mouth. It is marked by inflammation of the gums and heavy accumulations of plaque and calculus, plus normal changes. Eventually, it can cause the teeth to become loose due to the loss of dental bone.

You can check your child’s mouth for signs of periodontal disease, which include bleeding, swollen or bright red gums, gums that are receding (shrinking) away from the teeth, bad breath, or blood on the toothbrush. In our office, adolescent and teenage children regularly receive a periodontal examination as part of their routine dental visit.

Tooth Eruption

Twenty baby teeth are already forming before birth. An infant’s front four teeth usually erupt first, typically around 6-8 months of age, although, some children don’t have a first tooth appear until 12 months of age. After the eruption of the front four teeth, the remaining teeth typically appear “in pairs” along the sides of the mouth until the child is approximately 3 years of age. The pace and order of tooth eruption varies.

The first permanent teeth typically begin to erupt at about the age of 5 or 6 and include molars behind the back baby teeth, as well as front incisors. Some permanent teeth replace baby teeth, while others do not. This process of eruption continues until approximately the age of 14.

Don’t worry if it seems your child’s teeth are a few months early or late, as all children have different eruption patterns. The pattern (order in which teeth erupt) is more important than the exact time teeth come in.

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