Utama Your Child's Teeth: A Complete Guide for Parents

Your Child's Teeth: A Complete Guide for Parents


Children’s dental health involves much more than a toothbrush. Dental disease is the number one chronic childhood illness, and avoiding dental disease means paying scrupulous attention to our children’s teeth.

In Your Child’s Teeth, health writers Evelina Weidman Sterling and Angie Best-Boss team up with pediatric dentists and oral health experts to answer parents’ many questions about children’s teeth. Topics include:• how thumb sucking and pacifiers affect teeth• how to brush your young children’s teeth• how to calm a child who is afraid of the dentist• how to help special needs children get proper dental care • how medical problems affect teeth• how fluoride rinses and dental sealants work• how a root canal is done• how to make the orthodontia decision

This book will help parents help children develop good dental habits for a lifetime of healthy teeth—from baby’s first tooth to the young adult’s shining smile.

Tahun: 2013
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Penerbit: Johns Hopkins University Press
Bahasa: english
Halaman: 296
ISBN 13: 9781421410630
ISBN: 142141063X
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your child’s teeth


A Complete Guide for Parents


NOTE TO READER: This book describes how to protect the dental health of children in general. It was not written about your child. The services of a competent dental or medical professional should be obtained whenever medical or other specific advice is needed.

© 2013 The Johns Hopkins University Press

All rights reserved. Published 2013

Printed in the United States of America on

acid-free paper

9 8 7 6 5 4 3 2 1

The Johns Hopkins University Press

2715 North Charles Street

Baltimore, Maryland 21218-4363


Special discounts are available for bulk purchases of this book. For more information, please contact Special Sales at 410-516-6936 or specialsales@press.jhu.edu.




Sterling, Evelina Weidman, 1970–

Your child’s teeth : a complete guide for parents

/Evelina Weidman Sterling, Angie Best-Boss.

pages cm

Includes index.

ISBN-13: 978-1-4214-1062-3 (hardcover : alk.


ISBN-10: 1-4214-1062-1 (hardcover : alk.


ISBN-13: 978-1-4214-1063-0 (pbk. : alk. paper)

ISBN-10: 1-4214-1063-X (pbk. : alk. paper)


1. Children—Dental care. 2. Pedodontics.

I. Best-Boss, Angie. II. Title.

RK55.C5S74 2013

617.6′45—dc23 2012047776



Foreword, by Fern Ingber, M.Ed.



CHAPTER 1. A Guide to Your Child’s Teeth

CHAPTER 2. Basic Care and Cleaning

CHAPTER 3. The Dental Visit

CHAPTER 4. Preventing Decay and Protecting Teeth

CHAPTER 5. Affording Dental Care for Your Child


CHAPTER 6. Pregnancy and Your Baby’s Teeth

CHAPTER 7. Infants and Toddlers (Newborn to Age 4)

CHAPTER 8. Early Childhood (Ages 5 to 8)

CHAPTER 9. Middle Childhood (Ages 9 to 12)

CHAPTER 10. Teenagers and Young Adults (Ages 13+)

CHAPTER 11. Children with Special Health Needs


CHAPTER 12. Tooth Decay

CHAPTER 13. Gum Disease

CHAPTER 14. Tooth Sensitivity and Pain

CHAPTER 15. Conditions of the Mouth, Tongue, and Jaw

CHAPTER 16. Orthodontics

CHAPTER 17. Tooth Appearance

CHAPTER 18. Dental Trauma and Emergencies

CHAPTER 19. Oral Surgery, Extractions, and Root Canals

CHAPTER 20. Dental Anxiety

Appendix. My Child’s Dental Health Record


Additional Resources



As a mother and a grandmother, I find nothing more precious than the smile of a child. A child’s smile can warm your heart on the coldest day and bring joy to all who experience it. As president and CEO of National Children’s Oral Health Foundation: America’s ToothFairy, I have witnessed the devastating effects that poor oral health has on our children, our communities, and our future.

Your Child’s Teeth: A Complete Guide for Parents provides parents and caregivers a clear understanding of how oral health is inextricably linked to overall systemic health, because the mouth is the gateway to the body. Covering everything, including basic preventive strategies, nutrition, oral care for a child with special needs, and various dental problems and treatments for children of all ages, the book is a comprehensive guide on how to make sure your child maintains good oral health for a lifetime. America’s ToothFairy and our pediatric dental experts are proud to have been collaborators from the inception of this book. This important project perfectly aligns with our mission of eliminating children’s pain and suffering caused by the number one chronic childhood disease in America: preventable tooth decay.

Pediatric dental disease has reached epidemic proportions. Every child deserves a healthy smile, yet millions of children suffer tremendous pain and embarrassment from dental disease, more commonly known as severe tooth decay. Covering their smiles and unable to eat, sleep, or concentrate in school, children with dental disease find themselves in a downward spiral that negatively affects their adult lives. With limited or no access to oral health care, disadvantaged children are at great risk for impaired cognitive and social development, educational disparities, and a lifetime of pain and shame associated with tooth decay.

Oral health education is the key to breaking the cycle of pediatric dental disease. We are grateful to Evelina Weidman Sterling and Angie Best-Boss for their vision and commitment in developing this important health resource for parents and caregivers. This book should be part of every family’s library and a vital resource in every child health and welfare institution. By promoting positive oral health behaviors and implementing preventive strategies, we can help make sure that all children have the building blocks they need for happy, healthy futures.


President and CEO

National Children’s Oral Health Foundation: America’s ToothFairy


For over two decades now, we have both been fortunate to participate in various aspects of educating patients about important health issues. Imagine our surprise when we tried to find comprehensive and reliable information whenever one of our children had a dental issue and found almost nothing. We decided to use our skills in health education to change this. We envisioned writing a resource similar to the plethora of pediatric health books available today that families would be able to keep on hand and turn to whenever they had a question or concern (big or small) about their children’s teeth.

We want to thank the many people who helped make this book possible. We could not have done this without the tremendous support of Fern Ingber, president of the National Children’s Oral Health Foundation, also known as America’s ToothFairy, as well as the rest of her fabulous staff. Fern connected us with Dr. Martha Ann Keels and Dr. Rebecca Slay-ton, who graciously shared their expertise about pediatric oral health and were willing to answer all questions we had. We would also like to thank Dr. John H. Taylor, a pediatric dentist practicing in Marietta, Georgia, for giving us invaluable feedback, especially regarding orthodontia, that only someone who genuinely cares about his patients and their families could have provided. Dr. Kenneth A. Murphy of Atlanta, Georgia, was also incredibly helpful as he shared with us the latest and greatest dental technologies. We are especially grateful to our editor, Jackie Wehmueller, for believing in us from the beginning and encouraging us throughout the writing process, and to Melanie Mallon for her editing skills and sharp attention to detail. Finally, we are forever indebted to our families—Dan, Ben, Ellie, DuWain, Kaylyn, Clara, and Katy—for seeing us through yet another book.

Good oral health is a cornerstone for overall health and wellness for everyone. Through this book, we want to share our passion for health and all the knowledge we have gained about children’s oral health in order to keep families far and wide smiling brightly for many years to come.




A Guide to Your Child’s Teeth

Whether it’s your baby’s first smile, toddler’s toothy grin, or adolescent’s shy laughter, you love your child’s smile, and you want to do everything you can to protect it. But for a lot of parents, that’s easier said than done. A glimpse into most parents’ to-do list tells the story. Between helping with homework, making dinner, chauffeuring kids to soccer practice, and other activities, most parents barely have time to brush their children’s teeth, much less spend much time thinking about their overall oral health. As a result, most parents encourage their children to brush regularly, get to the dentist when they can, and hope for the best.

Why Good Dental Health Is Important for All Children

Your child’s oral health is more important than you may realize. Oral health can offer clues about overall health and wellness. Problems with our mouths can affect the rest of our bodies. Understanding the intimate connection between oral health and general health is enormously helpful when you consider what you can do to protect your child’s smile. While it sounds improbable, untreated cavities can lead to painful and sometimes even fatal infections. The National Maternal and Child Oral Health Resource Center identifies this and other potential difficulties from neglecting our teeth and oral health:

• Infections from tooth decay or gum disease: as we get older, chronic oral infections can lead to other serious health problems, including heart disease and diabetes

• Difficulty chewing food, which could result in poor nutrition and, in turn, impaired physical development

• Trouble concentrating and learning, as well as absences from school because of pain: according to the Surgeon General’s Report on Oral Health in America (2000), more than 51 million school hours are lost each year due to dental-related illnesses

• Psychological problems such as low self-esteem and higher risk for social stigma because of decayed teeth and chronic bad breath

• Fewer life opportunities compared to their peers with good oral health

* * *

Can You Repeat That?

You may not realize that your child’s oral health can affect speech. Having teeth in the right places at the right times helps us speak clearly. For example, the shape of the arch inside the mouth affects how we talk. Many letters of the alphabet cannot be properly pronounced without the help of teeth and bite.

* * *

A National Problem

Dental care is the single greatest unmet need for health services among children. More than one in five children—that’s 6 million kids—do not receive the care they need every year. Tooth decay is one of the most common childhood diseases, affecting nearly 60 percent of all children. Most of these children come from less financially secure families who face disproportionately high barriers to getting appropriate dental care. For families who struggle financially, paying for preventive dental care, taking time off work for appointments, and even finding a dentist can be difficult. Some parents do not speak English as a first language, which can be an additional obstacle in interacting with health care providers.

More than 50 percent of 6- to 11-year-olds have had cavities or tooth decay in their primary teeth, and nearly 70 percent of 16- to 19-year-olds have had cavities in some permanent teeth. Unfortunately, tooth decay has significantly increased over the past fifteen years. But cavities aren’t the only problem that can affect teeth. Children face many threats to a healthy smile, including everything from birth defects and tobacco use to sports injuries and crooked teeth. Keeping their children’s teeth clean and healthy can be a challenge for caregivers—especially when those children aren’t always willing to cooperate. Many tooth troubles can be prevented, however, and those that can’t can usually be treated by experienced dentists.

* * *

Your Smile Matters

Nearly all Americans (99.7 percent, in fact) believe a smile is a valuable social asset. A study from the American Academy of Cosmetic Dentistry (AACD) in 2004 found that 96 percent of adults believe an attractive smile makes a person more appealing and that 74 percent of adults feel an unattractive smile can hurt a person’s chances for career success. Do everything you can now to protect your child’s smile for social and professional success down the road.

* * *

Your Child’s Teeth Inside and Out

Teeth have to be pretty tough to survive a lifetime of chewing, crunching, talking, and the occasional nail biting and soccer ball bump. You may already know that teeth are not primarily made of bone. You may not realize, however, that the part of teeth above the gum line is made of different materials than what’s found underneath the gums. Think of your tooth as an iceberg—there’s a lot more to it than you can see with your eyes.

What is the outside of teeth made of?

The part of the tooth that you can see when your child smiles and talks is called a crown. The rounded high parts of the back teeth are cusps. The hard white outer covering of the tooth is the enamel. That thin layer of enamel covers and protects the crown. Tooth enamel is the hardest structure in the human body.

Tooth anatomy. © Can Stock Photo Inc./vectomart

What’s inside the tooth?

Enamel covers the dentin, which is the second hardest substance in the human body. Dentin makes up most of the tooth and is harder and denser than human bone.

Dentin covers the pulp, which primarily contains blood vessels, nerves, connective tissue, and other components that keep the tooth alive and functional. The pulp supplies your teeth with the nutrients to stay “alive” and in your mouth. The blood vessels and nerves in the pulp enter through the root of the tooth, underneath the gum line.

* * *

How Many Teeth?

A baby’s teeth usually begin to come in between 6 and 8 months of age. These teeth are also known as deciduous, primary, or “falling out” teeth. By the age of 30 months, a child usually has a full complement of twenty primary teeth. By age 6, permanent teeth begin to come in. As they grow, they push out the primary teeth, replacing them and filling out the spaces in the jaw.

Adults have thirty-two permanent teeth. Twenty permanent teeth replace the baby teeth that fall out, and another twelve permanent molars will erupt without a primary tooth falling out. Be on the lookout for these molars at around ages 6, 12, and 18. Depending on their age, children may have fewer teeth at any given time because they may lose baby teeth before their adult teeth grow.

Typical ages when primary teeth (baby teeth) come in and when they fall out. © Can Stock Photo Inc./roxanabalint

* * *

The root is connected to the tooth above the gum by the neck of the tooth, the part that narrows as it goes into the gum. The root, which lies in a bony socket, makes up about two-thirds of the length of the tooth. It has the same dentin and pulp, but instead of enamel, the root is covered and protected by a thin, bonelike tissue called cementum. This tissue is calcified (made of tough calcium deposits), although it is not as hard as enamel.

Cementum has an important job—it holds the tooth to the surrounding bone. It does this by forming fibers that connect with fibers from the bone socket. Without these fibers, the tooth would not be attached to the jaw bone and would fall out easily.

* * *

Your Teeth Guide Your Menu

All our teeth grouped together are called our dentition. The variety of different shapes our teeth come in allows humans to be omnivores. This means we eat both meat and plants. Most animals have more specialized teeth. Meat-eating, or carnivorous, animals like wolves and sharks usually have long, sharp, tearing teeth, and plant-eating animals like cows and horses have large flat teeth for grinding up grass and other vegetation.

* * *

A tooth is a tooth, right?

Each tooth is different in shape and size. Overall, similar teeth are grouped together depending on their job, such as biting, chewing, or tearing food.

• Incisors. These are the eight teeth located in the front of the mouth (four on the top and four on the bottom). Their main job is to cut food, so they are sharp and chisel shaped.

• Canines. The four canine teeth (also known as cuspids) are located on either side of the four incisors on top and bottom. Because they are meant to hold and tear food, they have pointed edges.

• Premolars. These are the four pairs of teeth located directly next to the canines. Also called bicuspids, their job is to crush and tear food as you eat.

• Molars. Molars have wide surfaces for grinding food in the back of the mouth. There are eight molars, in sets of two, on the top and bottom on both sides of the mouth. They usually grow in during middle childhood.

• Third molars. These four teeth are located in the far back of the mouth—one at each corner. More commonly known as wisdom teeth, they usually do not appear until late teens or adulthood, if at all. Because there may not be enough room for them to erupt, wisdom teeth can become impacted (stuck under gum or bone) and often require surgical removal.

How do I know which tooth the dentist is talking about?

Dentists and dental assistants communicate about specific teeth using a numbering system. Over the years, more than twenty different teeth-numbering systems have been developed, but most general dentists in the United States use the Universal Numbering System. In charts and paperwork, dentists will refer to a particular tooth using the numeric (or, in some cases, alphabetic) notation. You may see the Universal Numbering System used on insurance paperwork, to identify work done on specific teeth.

Tooth numbering showing the thirty-two adult teeth. © Can Stock Photo Inc./alila

A second numbering system, called the Palmer Notation Method, is used by many orthodontists and oral surgeons.

* * *

When Teeth Go Missing

Hypodontia is the name of a condition in which some of a child’s teeth (primary or permanent) never develop—usually up to six teeth, not including wisdom teeth. When more than six teeth are missing, this condition is called oligodontia. In rare cases, all teeth are missing, which is called anodontia. About 30 to 50 percent of people with missing primary teeth have missing permanent teeth as well.

Although the exact cause for missing teeth is unknown, many believe it has to do with genetics (with more females having missing teeth than males) or environmental factors that affect tooth development. It may also be related to increased maternal age, low birth weight, multiple births, or rubella during pregnancy.

* * *

What’s the big deal about baby teeth? They’re just going to fall out anyway, right?

Unfortunately, many parents think that they don’t need to be concerned about baby teeth. It can be tempting to think that only the permanent ones matter. But broken, missing, or cavity-filled baby teeth can lead to a host of serious problems for those permanent teeth waiting in the wings. Baby teeth serve important functions:

• Help children chew healthy foods, therefore providing nutrition

• Help make speech possible

• Aid in the normal development of jaw bones and facial muscles

• Add to an attractive appearance


While some baby teeth last for only four or five years, those back primary teeth hang in a while longer—sometimes until the child is 11 to 12 years old. If those primary teeth are carrying dental disease, the root can become infected and pass that infection on to the new teeth as they emerge. Or, if that new molar comes in surrounded by cavity-filled teeth, it won’t take long before it is fighting to stay healthy.

If a primary tooth is lost too soon, then the space it was holding will be at risk. In fact, sometimes additional dental work will need to be done to make enough space for an unerupted tooth. Stop thinking of those first teeth as just baby teeth; instead start thinking of them as foundational teeth. Healthy primary teeth are the foundation for a healthy set of secondary, or permanent, teeth.

More than Teeth

Poor oral hygiene can cause problems in several different areas of the mouth, but so can sports injuries, trauma, birth defects, nutritional deficiencies, and other illnesses. Parents need to get in the habit of regularly looking inside their child’s mouth between dental visits to look for any problems. After all, those pearly whites matter, but they aren’t the only parts of your child’s mouth that need attention. Your child’s oral health involves the structures of the mouth, which include the teeth, gums, palate, tongue, inside of the cheeks, bones and associated muscles, nerves, glands, and blood vessels. During regular visual inspections, be on the lookout for

• broken, cracked, or chipped teeth

• dark spots or holes on surfaces of teeth

• pocked, pitted, or discolored teeth

• sores on the child’s gums, tongue, or cheeks

• red, swollen, or puffy gums

If something has changed since the last dental visit, then call your child’s dentist and make an appointment.

How will I know if there is a dental problem?

You may be able to spot a dental problem if your child complains of pain or has trouble chewing, or if something doesn’t look right. Although you can see a lot with visual inspections, early dental problems can be hard to spot in little mouths. Your child will need regular visits with a dentist not only to protect healthy teeth but to rule out existing issues. Plus, tooth problems can show up in other ways, such as ear pain or headaches, or even in dietary deficiencies when children don’t want to eat foods that are difficult to chew. In other words, your child can have dental problems and you could have no idea it’s happening.

No child is immune from dental health problems. By the age of 17, one in ten children has already lost at least one permanent tooth to decay. Millions more children are already on the way to a lifetime of poor dental health, increasing their risk of related physical problems. By taking a few specific steps, you can establish a pattern to help ensure that your child, whether in utero or in high school, has a healthy smile for a lifetime. Children’s teeth, gums, and tongue are critical to overall health and well-being. In addition to helping with eating and talking, oral health affects many other aspects of life, such as smiling, kissing, singing, playing a musical instrument, smelling and crying. A mouth free of cavities, gum disease, and injury contributes to children’s healthy development and success in school and in life.


Basic Care and Cleaning

“This is so cool, Dad. Check it out!” Six-year-old Aaron ran across the kitchen, flashing his toothy grin at his father. After a presentation at school, Aaron had been given plaque-disclosing tablets to use after he brushed his teeth, and although he thought the purple splotches on his teeth were “cool,” his father was less impressed. Looking at their sweet smiles, it can be hard to believe just how dirty children’s teeth can become.

How dirty can your mouth be? There are literally billions of bacteria (germs) in the mouth covering more than six hundred different species. While any bacteria may seem gross, most are not dangerous. They are found in every mouth, even the cleanest. Saliva helps keep bacteria under control, and stomach enzymes kill those you swallow. Still, good oral hygiene is important because bacteria that build up will cause gum disease and tooth decay.

Why Cleaning Teeth Is Important

One of the most important reasons to clean teeth is to get rid of plaque. Plaque is a sticky and colorless film of bacteria and sugars that constantly forms on our teeth. The bacteria use ingredients found in our diet and saliva to grow. The film starts forming just 1 or 2 minutes after brushing your teeth. This is why we need to brush at least twice a day to continue removing these bacteria.

Think of plaque like peanut butter on a knife. Plopping a knife smeared with peanut butter in some water probably isn’t going to clean it very well. Peanut butter is too sticky. Plaque acts like peanut butter on your teeth. The major difference between the two is that the peanut butter isn’t damaging that knife. The plaque, however, is doing serious damage to your teeth. Plaque starts to harden in just 48 hours and begins turning into tartar (or dental calculus, as dentists call it). After approximately ten days, that tartar is rock hard and difficult to remove, collecting at the gum line. Then brushing and flossing become more difficult. As the tartar, plaque, and bacteria continue to increase, cavities can form, and gums become inflamed. This inflammation causes gums to become red and swollen, and they may begin to bleed.

How do I know if my child’s teeth are clean?

Although plaque is colorless and difficult to see at first, when plaque builds up, it looks like a thick white film stuck to the teeth. You can also feel plaque on your teeth with your tongue. The plaque biofilm feels like a sticky layer of fuzz or fur. Clean teeth should feel slick and smooth as you run your tongue across them.

If you want to know if your child’s tooth-brushing regimen is effective, buy a plaque-disclosing tablet. They are relatively inexpensive and can be found at your local pharmacy or online. The tablets are usually made of vegetable dye and are very easy to use. Once the tablet dissolves in the mouth, it temporarily stains the plaque bright red, blue, or purple so that you can see it more easily. You can then brush and floss until the stain is gone. Your child will remember what the colored teeth looked like and will know where to brush better from then on.

How to Brush Your Child’s Teeth

You will need to help with tooth brushing until your child is 7 or 8 years old, to be sure all surfaces are properly brushed. Be sure to brush teeth, gums, and mouth in little circles, not in a back and forth motion. Scrubbing horizontally can create grooves in the teeth and lead to gum recession.

Also be careful not to brush too hard. Many people think that the harder they brush, the cleaner they can get their teeth, but this is not true. Hard brushing can damage tooth surfaces.

1. Wash your hands first, to make sure you get rid of any germs you may be carrying around. It is often easiest to cradle your child’s head in your one arm while keeping your other hand free to brush. Brush the teeth from behind, which will help you reach the top and bottom rows. Place the toothbrush alongside the teeth, with the bristles at a 45-degree angle to the gum line.

2. Gently move the brush in a small circular motion, cleaning the front surface of one tooth at time. Be sure to follow a system so you don’t miss any teeth. You can start with the bottom back tooth and work your way to the front, then repeat on the opposite side of the mouth before switching to the top teeth.

3. Brush across the chewing surfaces, making sure the bristles get into the grooves and crevices. Clean the side of the teeth that face the tongue using the same circular motion. Again, start in the back and work your way forward. Move the “toe” of the brush up and down to clean inside front teeth.

4. Brush your child’s tongue lightly to remove bacteria and keep breath smelling good.

5. Have your child rinse her mouth with water.

6. Encourage her every time you successfully clean her teeth by clapping your hands or cheering.

This is the correct method and toothbrush angle to use when brushing teeth. Make sure to reach every tooth surface. Courtesy of Alila Sao Mai / Shutterstock.com

Cleaning my daughter’s tongue seems a little gross. Is it really necessary?

Although you can buy a tongue scraper to remove bacteria and food particles clinging to your child’s tongue, a special tool isn’t necessary. A quick couple of swipes with the toothbrush are just as effective to remove bacteria, alleviate bad breath, and cut down on cavities and gum disease. It takes just an extra few seconds for an added boost of oral health.

How long should tooth brushing take?

Each day, on average people spend 8.5 hours sleeping, 1 hour eating, 7.2 minutes volunteering, and only 50 seconds brushing their teeth. Dentists recommend brushing for at least 2 or 3 minutes each time we brush. Without making any changes in your child’s normal routine, grab a timer and secretly record just how long your child’s average tooth brushing lasts. You might be surprised.

* * *

Two Minutes, Two Times

For more ideas about how to get your kids to brush for at least two minutes two times at day, visit www.2min2x.org This interactive Web site, sponsored by the Partnership for Healthy Mouths, Healthy Lives, contains lots of games, videos, rewards, and other fun materials to get children excited about keeping their teeth clean.

* * *

Want to boost the brushing? Let her favorite pop star’s newest release be the tooth-brushing anthem. Most songs are 2 or 3 minutes long. When it starts, so does the brushing. She can’t stop until the song is done. For younger children, get a timer or a musical tooth-brush that lets you know when the time is up.

* * *

Can You Brush Too Much?

Yes, you can brush your child’s teeth too heavily, too much, or in the wrong way. Rubbing the toothbrush as hard as you can against the teeth or gums can be damaging. It can destroy tooth enamel, making teeth look yellow, or push up the gums, causing them to weaken and recede. Learning good brushing habits and techniques is important for protecting your child’s teeth. If you are unsure, your dentist or dental hygienist will be happy to show you.

* * *

How often should I brush my child’s teeth?

Most dentists suggest brushing at least twice a day. Ideally, we would all brush after every snack and meal. Try to get your child in the habit of at least rinsing with water within 10 minutes of eating or drinking, to help minimize acid destruction to teeth and gums. Although brushing is always best, rinsing with water can be helpful in a pinch. It will not remove plaque, but it should help get rid of debris on the teeth.

* * *

Set a Good Example

Make sure your child sees you brushing your teeth throughout the day, and make a point of showing off your shiny, clean teeth. Ham it up with your best grin to show what a treat and privilege it is to have such a shiny smile. Encourage your child to show off his own sparkly smile after brushing.

* * *

Keep a bag with a tube of toothpaste and disposable toothbrushes (or a toothbrush with a cap) in your car and in your child’s school backpack to make it easier to brush on the go. Although your child may not use it often, seeing the toothbrush is a good reminder to make tooth-friendly choices. At the very least, your child’s teeth should be brushed in the morning and before bedtime and after eating sweet or sticky foods. Any other times are healthy bonuses.

How do I teach my child to brush her own teeth?

As your child grows, always talk about what you’re doing when you brush her teeth. Teach her to put the brush at a 45-degree angle against her gums; move it back and forth gently in wide strokes over all teeth; move the “toe” of the brush up and down to clean inside front teeth; and brush her tongue gently to remove bacteria and freshen breath. In no time, she’ll be able to carry on the family tradition of cleaning her teeth well.

When should I let my son brush his own teeth?

You can begin to teach your child proper brushing techniques when he is about 2 or 3 years old. Follow up with brushing and gentle flossing until age 7 or 8, when he has the dexterity to do it alone. Allow younger children to brush first, then follow up with your more thorough cleaning until you are sure they can do it alone. Most children cannot floss well on their own until they reach age 9 or 10.

How to Find and Care for Toothbrushes

What kind of toothbrush should I choose for my child?

From glow-in-the-dark to singing, there are dozens of different types of toothbrushes on the market for children. The average toothbrush is plastic and has around 2,500 bristles grouped into about 40 tufts. Whether they are motorized or not or have tons of special features, most toothbrushes do a pretty good job of removing plaque. Check the label for the ADA seal as well as for the recommended age to ensure the appropriate size and bristle softness for your child. Choose a toothbrush with

• a small brush head that will fit in your child’s mouth

• an angled head to clean hard-to-reach places

• a flexible neck to absorb brushing pressure that may cause gum irritation

• a large handle for a secure grip whether it is wet or dry

There are electric toothbrushes with vibrating heads available for children to help remove plaque and debris. Some dentists believe that these toothbrushes are more effective in removing plaque, but there’s little data to support this. The best toothbrush for children is one that they like and will use often.

Keep in mind your child’s preferences and particular needs. For example, a child with sensory issues might love (or hate) an electric toothbrush, while a child with small hands or poor fine motor skills might do better with a large, easy-to-grip, or flexible handle. If it’s in your budget, specialty toothbrushes decorated with favorite characters, colors, or sparkles may generate more tooth-brushing enthusiasm, at least in the short term.

* * *

What Is the ADA Seal?

When browsing the toothbrush aisle, look for the ADA seal on toothbrushes, which means they have met the minimum standards set by the American Dental Association. The ADA does not recommend any specific brand of toothbrush, but it does give its seal of approval to brands that meet basic standards. The ADA seal indicates that the toothbrush is effective for cleaning teeth and safe for a child to use without adult supervision—the bristles have no sharp or jagged edges or endpoints, the handle won’t break during normal use, and the bristles won’t fall out. The seal also indicates that the brush has been evaluated by scientists to show that it provides a “significant decrease in mild periodontal disease and plaque.”

* * *

I just leave all the toothbrushes in a jar on the bathroom counter. Is that ok?

Simply allow your toothbrush to air-dry and then store it in an upright position. Do not cover your toothbrush, such as with a cap, because humid air is more likely to promote bacterial growth. Storing toothbrushes some space apart from each other will reduce the possibility of cross-contamination, especially important for people with compromised immune systems or infectious diseases. If multiple brushes are stored in the same holder, do not allow them to come in contact with each other. It may sound obvious, but keep your toothbrush container away from the toilet. If someone flushes the toilet with the lid up, the particulate can spray and reach those brushes. Keep those brushes far away from the flushes!

* * *

Nontoxic Toothbrushes

Many parents want to avoid any products that contain bisphenol-A (BPA), PVC, or phthalates due to increasing concerns about the potential harmful effects of these chemicals on growing bodies. If you want your little ones brushing in nontoxic style, look for toothbrushes made from polypropylene (#5) and nylon (for the bristles).

* * *

Everyone should have his or her own toothbrush, and if your kids’ brushes look alike, clearly label each brush with the name of its owner. Do not allow toothbrush sharing, because it puts everyone at an increased risk for cross-contamination. Family members can become infected with all kinds of bacteria if they share toothbrushes.

A friend of mine soaks her family’s toothbrushes in mouthwash every week. Should I do that?

Toothbrush care is pretty simple, and you don’t need to soak your toothbrushes in mouthwash. It won’t hurt your toothbrush if you do, but soaking your whole family’s brushes in the same bowl of mouthwash can spread the bacteria from brush to brush.

Rinsing the brush with warm water after brushing is surprisingly effective. Bleaching a toothbrush leaves a chlorine residue on the bristles that can affect the taste the next time the brush is used. Soaking a toothbrush in hot water from the faucet or in the dishwasher will cause the bristles to degrade and reduce the life of the brush.

Researchers have found that microwaving toothbrushes kills common germs; however, the metal staples that hold the bristles in the manual toothbrush head can interfere with the energy waves and destroy the microwave. Experts caution that microwave sterilization is not a good idea. After all, new toothbrushes cost a lot less than new microwaves.

You can buy a toothbrush sanitizer, although be aware that some manufacturers make claims not yet widely accepted. The U.S. Food and Drug Administration (FDA) allows manufacturers to make only these two claims for toothbrush sanitizers: (1) the product is designed to sanitize toothbrushes, and (2) the product is intended for use in reducing bacterial contamination that accumulates naturally on toothbrushes. Claims that go beyond these are largely unsubstantiated. A good rinse in warm water after brushing should serve your purposes equally well.

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Recycle Your Toothbrush

What can you do with an old toothbrush? We all go through several per year. You could pull out the bristles, boil it for an hour, and mold it into a bracelet or use it for other craft projects. For the less creative, old toothbrushes make great cleaning tools for hard-to-reach places (just soak it in disinfectant first). Some toothbrushes now have handles made from recyclable plastics. These can be put in your recycle bin at home and will then be melted down and repurposed. Next time you buy a toothbrush, look for the recycle symbol on the packaging.

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How often should I replace toothbrushes?

Remember—this piece of plastic is the foundation of your family’s oral care. This is not the place to skimp. Plan to replace everyone’s toothbrush every three to four months, or when the toothbrush bristles become splayed or spread out. According to the American Dental Association, replacing your brush this often is based on the expected wear of the toothbrush, not on its bacterial contamination. A worn toothbrush is less effective in doing its job—cleaning teeth and removing plaque.

Note that toothbrushes are not required to be sold in sterile packages, so rinse your toothbrush in warm water before using it the first time. Also, replace your toothbrush (or your child’s) any time after having a sore throat or other illness so that you do not risk reinfecting yourself or infecting your children.

How to Find the Right Toothpaste

Are all toothpastes the same?

There are almost as many kinds of toothpaste on the market as there are types of toothbrushes, but choosing the right toothpaste for your child isn’t as complicated as it looks.

Most of the toothpastes designed for specific purposes like gingivitis control, tartar control, and whitening are made for adults and aren’t ideal for children. Some parents look for the American Dental Association (ADA) seal, which shows that the association has tested the product and says that it is safe and effective.

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What’s in Toothpaste?

Toothpaste is made up of about 20 to 42 percent water. The other main components include abrasives, which account for about 50 percent of the toothpaste and are insoluble particles that help remove plaque from the teeth; fluoride, which helps to prevent cavities; and detergents, which mainly serve as foaming agents and enable the uniform distribution of toothpaste, improving its cleansing power. Additional components may include antibacterial agents to prevent gingivitis and reduce tartar and bad breath; flavorants, which improve the taste and therefore encourage brushing; remineralizers to help re-form the enamel; and other miscellaneous components that are usually added to prevent the toothpaste from drying out, reduce sensitivity, whiten teeth, or further minimize the formation of tartar.

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Regardless of what kind of toothpaste you choose, make sure your child does not swallow it. Help him develop the habit of spitting out the paste, to reduce the risk of developing white spots on the teeth (called fluorosis) or swallowing too much of the fluoride contained in toothpaste, because too much fluoride can also be harmful.

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How Much Toothpaste?

For young children, a pea-sized squirt is all you need.

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Some children need prescription toothpaste to help protect against cavities. (Health insurance may help cover the cost.) Prescription-strength fluoride toothpaste contains a higher concentration of fluoride than regular toothpaste. It may be prescribed to children who frequently develop cavities, who get little fluoride, or who are at higher risk for tooth decay. Read the directions carefully. Some dentists suggest that the prescription toothpaste be used only once a day, and then regular toothpaste for the rest of the day’s brushings. Note that the ADA does not offer a seal program for prescription toothpaste products.

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Hold a Toothpaste Taste Test

Want to generate some enthusiasm for tooth brushing? Buy several different brands and flavors of toothpaste and hold a taste test. Try a new one every night or have a tooth-brushing frenzy and try them all in an evening.

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Is it harmful to swallow toothpaste?

It is important for children to learn the skill of spitting out toothpaste. Until they can do so, make sure you use a nonfluoridated or low-fluoridated toothpaste. Most toothpaste contains about 1,000 to 1,500 parts per million fluoride. Children under 6 should be offered toothpaste with fluoride in the lower ranges, in case they inadvertently swallow a large amount. Fluoride is fine for your child in moderation, but fluoridated toothpaste should not be regularly swallowed.

Too much fluoride can cause fluorosis, marked by discolored spots on the teeth. Talk to your dentist about the amount of fluoride in your water, and ask if your child should avoid fluoride-added toothpaste. If so, it’s easy to find toothpastes that do not contain fluoride by reading toothpaste labels carefully. You may have to go to a natural foods store or order toothpaste online.

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Fluoride: What Parents Need to Know

Fluoride is a mineral that prevents tooth decay and helps harden tooth enamel. Because very few foods contain fluoride, most people get the mineral through fluoridated water, toothpastes, and sometimes even supplements when needed. Fluoride is important for oral health, and inadequate amounts can significantly increase the risk for tooth decay. However, fluoride can be toxic if consumed in excessive amounts. This often causes parents to wonder if fluoride is even safe, especially since some critics have linked it to cancer.

The Centers for Disease Control and Prevention and the American Dental Association concluded in 2001 that “when used appropriately, fluoride is a safe and effective agent that can be used to prevent and control tooth decay. Fluoride has contributed profoundly to the improved dental health of persons in the United States and other countries. To ensure additional improvements in oral health among all children, water fluoridation should be extended to additional communities, and fluoride toothpaste should be used widely.” Furthermore, the American Cancer Society asserts that there is no strong evidence for a link between cancer and fluoride.

To protect your child’s teeth, talk with his dentist about how much fluoride your child is getting based on environment, diet, and other factors. (For more information about fluoride, see chapter 4, Preventing Decay and Protecting Teeth.)

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Sensitivity Alert

Some people are sensitive to the foaming agent found in some toothpastes, and they develop mouth sores. If your child tries a new toothpaste and develops a tender spot on the inside of his mouth, it might be sodium laureth (or lauryl) sulfate, or SLS, that’s to blame. Commercial toothpastes usually contain SLS, but you can find SLS-free options at most health food stores. If not, a quick online search will yield several options.

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Are there gluten-free toothpastes?

Many toothpastes are gluten-free, although not all companies are willing to certify that their products are gluten-free because they may be manufactured in facilities the make products containing gluten. You may need to pay extra for certified gluten-free products. Contact your child’s dentist before your visit to let the staff know about your child’s gluten sensitivity. Most products used in dental offices are gluten-free, but the dental staff should be made aware of your child’s needs.

Seven manufacturers verify that all their toothpastes are gluten-free.

• Aquafresh

• Arm & Hammer

• Crest

• Nature’s Gate

• Orajel

• Oral-B

• Tom’s of Maine

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Is Baking Soda Dangerous to Enamel?

Some people worry that, because baking soda is so effective as a cleaning polish, it may take the enamel off teeth along with plaque. But it’s brushing too vigorously, particularly brushing horizontally, that’s hard on the teeth and gums. So whether you’re brushing with baking soda or regular toothpaste, the important thing is to brush in little circles and not horizontally.

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What if my child hates the taste of toothpaste?

Toothpaste should be at least pleasant for children. Some people have more sensitive palates than others, and flavors that are okay for some are disgusting to others. For years, bubble gum was the only available kid’s flavor, but the choices are expanding. Look to online drugstores for a host of flavors, including light salt, tropical, peppermint, fresh yogurt, rose, monkey banana, honey, cafe au lait, apple, vanilla, strawberry, orange, green tea, lavender, cinnamon, lemon tea, bitter chocolate, blueberry, caramel, espresso, grapefruit, and cola. Even the pickiest child can find an appealing flavor on that list. Flavored toothpaste won’t hurt as long as your child doesn’t eat it.

Another option is to make your own toothpaste. You might find that your child pays more attention to dental care and brushing because you’ve worked together to make the toothpaste. Making your own toothpaste can be messy, however, and many people agree that it doesn’t always taste that great either.

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What’s in Homemade Toothpaste?


4 teaspoons baking soda

1 teaspoon sea or kosher salt

1 teaspoon flavoring (vanilla, almond, or peppermint extract)

Xylitol (optional)

Air-tight container


Mix the ingredients together and use as needed. Be sure to cover the container with a tight-fitting lid after each use. To limit exposure to bacteria, make sure you use a container that won’t require you to dip your toothbrush into it every time you want to use it.

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Is toothpaste even necessary?

As we said before, dental plaque is like peanut butter smeared on your teeth. Water alone won’t get it off. The most effective way to remove that sticky plaque is to scrape it off with a good soft-bristled brush, water, and lots of gentle scrubbing action, followed by flossing. Toothpaste isn’t absolutely necessary, but it is helpful. It tastes good and makes your mouth feel fresh and clean. And for most children, the added fluoride in toothpaste helps keep tooth enamel hard and cavity resistant. So you don’t need it, but toothpaste is a good investment for a healthy smile. Whatever kind you use, limit the amount to pea-sized.

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The History of Toothpaste

In 5000 BC, Egyptians were making a tooth powder consisting of myrrh, pumice, and even powdered ashes of ox hooves or powdered and burnt eggshells. Using their fingers, they rubbed the powder on their teeth. The Greeks improved the recipes by adding abrasives like crushed bones and oyster shells, which helped remove debris from teeth. Later, the Romans, concerned about bad breath, added powdered charcoal, powdered bark, and more flavoring agents. In 1000 AD, the Persians advised their people to be wary of the possible dangers of using hard abrasives as tooth powders. It was recommended that people use burnt hartshorn, the burnt shells of snails, and burnt gypsum. Other Persian recipes involved dried animal parts, herbs, honey, and minerals.

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Dry Brush Your Teeth

If you want to be extra thorough, dry brush your teeth without toothpaste first. Do it before you brush with toothpaste and water and you’ll cut tartar by 60 percent and reduce the risk of bleeding gums by about 50 percent. Use a dry, soft brush to scrub the insides of your top and bottom teeth, then buff the outer and front surfaces. Rinse, spit, and then brush again with toothpaste.

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Should I use natural products?

Toothpaste is an artificial product, created with different blends of chemicals, additives, and flavorings. Some parents may wish to avoid certain chemicals in their children’s diets, even though children ingest a relatively small amount of product. You can easily find toothpastes for children that contain no saccharin or other artificial sweeteners, preservatives, colors, or flavors, or animal ingredients. You can even find certified kosher or vegan toothpaste.

There are “natural” toothbrushes on the market as well. Most toothbrush bristles are made from nylon, but some companies have created bristles made from the root of trees and other products. You might find toothbrushes with brown bristles that are reportedly softer than nylon bristles. Although such toothbrushes won’t hurt your teeth, there’s no indication that forking over more money will translate into better oral care.

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Floss is Handy to Have Around

Keep lots of dental floss at your house. In a pinch, dental floss works well as a cake cutter, makeshift clothesline, fishing line, picture hanger, and more. If flossing properly, the average person should use 122 yards of floss per year. About a third of adults claim to floss daily, but sales data show an average of only 18 yards of floss are sold per person a year, so our dental habits aren’t as good as we report.

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Flossing and Mouthwash

Do I really need to floss my child’s teeth?

Few people love flossing. Most Americans admit they would rather grocery shop than floss their teeth. But it’s an important part of your child’s (and your) dental routine. Even the best tooth brushing touches only 70 percent of tooth surfaces. Flossing removes plaque and food particles caught between teeth, where multiple cavities can form if you are just brushing alone.

Your child should be able to floss her own teeth by about 8 or 9 years old. Until then, flossing is a parent’s job. You should start flossing your child’s teeth as soon as she has two teeth that touch each other.

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Flossing Correctly

1. Take about 18 inches of dental floss and wrap one end around each of your middle fingers.

2. Using your thumbs and index fingers as guides, slide the floss between two teeth, using a gentle saw-like motion.

3. At the gum line, pull both ends of the floss in the same direction to form a C shape against one tooth. Pull the floss tightly and move it up and down against one tooth.

4. Pull the floss against the other tooth and repeat the motion.

5. Repeat this for all teeth. Be sure to floss both sides of the teeth farthest back in the mouth, too.

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What kind of dental floss is best for kids?

Dental floss comes in many different forms, including a flosser (a short piece of floss held by a small plastic “y”), an electric flosser, unwaxed or waxed floss, and woven and shred-resistant floss. There are even brightly colored kid-friendly flossers decorated with the likes of princesses, sea creatures, and super heroes. Like toothbrushes and toothpaste, the kind your child will use most is the best kind for him. Flossers can be tricky to use in the back of the mouth once molars arrive, and you’ll have to wipe off the plaque after each use. Waxed flosses or dental “gloss” are often easiest to work in between tight teeth, but otherwise, most dental flosses are fine for children.

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Is Cupcake-Covered Dental Floss a Bad Idea?

You can choose from dozens of dental floss flavors, though you have to find the more esoteric ones online. Who wouldn’t want to floss with the flavor of crispy fried bacon or vanilla cupcakes? Flavored dental floss seems like a great idea. After all, who can argue about a product that makes children want to floss their teeth? Keep in mind, though, that some children will like the flavor so much they’ll want to chew on it, and it’s easy to swallow if a caregiver isn’t supervising closely. Although it’s likely that what goes in will eventually come out the other end, more than one child has had to have an endoscopy to remove a mass of tangled floss.

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Should my child use mouthwash?

Mouthwashes are not necessary for young children. In fact, sometimes people who use mouthwash do a less thorough job of tooth brushing, assuming that mouthwash covers a multitude of sins. It can taste good and can help give a just-brushed feeling, but it doesn’t help remove plaque.

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Lock Up Your Mouthwash

If you buy mouthwash designed for adults, look for alcohol-free versions, and choose bottles with childproof caps. Children have had to be rushed to the hospital after ingesting alcohol-laden mouthwash. After all, it’s brightly colored, easily accessible, and designed to taste good. Always keep it in a safe place, away from curious little ones.

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If you decide to buy mouthwash for your child, look for one designed for children, because it is more likely to have a pleasing flavor and it won’t contain alcohol, as many adult versions do. Some dentists may recommend an antibacterial mouthwash for short-term use in children who are especially susceptible to cavities. Regardless of the kind, always supervise when your child uses mouthwash. Children under age 6 should not use mouthwash at all because they have a harder time swishing and spitting and are more likely to swallow it.


The Dental Visit

Like most parents, Leslie had a running internal list of things she needed to do. Between writing a check for piano lessons and signing the field trip permission slip, she remembered the crumpled reminder notice from the dentist. Both kids were now way overdue for their six-month checkup. She sighed, mentally pushing aside the note and promising herself that she’d deal with it tomorrow.

Admittedly, it’s hard to be enthusiastic about going to the dentist. With the inconvenience, expense, previous personal experiences, and our often unfounded fears about our children’s discomfort, we can easily talk ourselves into postponing regular dental visits for our kids. But considering how important oral care is to your child’s overall health, those regular dentist visits are every bit as important as regular pediatrician visits, where your child gets immunizations and checkups. Routine dental checkups are the cornerstone of your child’s oral health.

How to Find a Dentist

Picking the first dentist that a Google search turns up isn’t the best plan. Although that dentist may be excellent, he or she may also have been the only one in your area to pay Google for advertising. A willingness to spend money on ads says nothing about quality, no matter how nice the ads are. Consider several factors when looking for a new dentist for your child. Start with making a list of your specific preferences and needs. These questions might help you figure those out.

• What does the “right” dentist mean to you? Does it mean an office that’s convenient to your work or your child’s school? One that’s open on Saturday or late in the day to fit your schedule? One that reminds you of your dentist growing up, or where you get a live person whenever you call instead of an answering service?

• Is the dentist up to date on the latest in cutting-edge pediatric dental treatments?

• Is your child more comfortable around certain types of people, such as men or women or those that are more quiet and gentle or more talkative and animated?

• Does your child have fears about the dentist or other special needs?

After you have made a list of what’s important to you, it’s easier to match your needs with the right dentist for your child. Here are some other factors to consider.

Referrals. Ask around. Who does your pediatrician recommend? Who does your neighbor recommend? How about other parents in the Scout troop? Are there dentists they recommend and dentists they don’t recommend? Ask about their experiences and what they did and didn’t like about the dental practice. You’re looking for more than a dentist—you need to know about the office staff and dental hygienists, too. You can contact the local or state dental society or a local community listing. If you’re moving, your current dentist may be able to make a recommendation for a dentist in your new area.

Insurance. Is this dentist in or out of your dental insurance network? Can office staff assist patients in working with their insurance companies? Will they precertify with the insurance company for procedures, or will you need to do that? Will they bill your insurance, or will you have to pay at the time of the visit and then get reimbursed?

Policies. You want to know what the policies are for emergencies before you’re holding a broken tooth in the middle of a soccer field on a Saturday afternoon. Do they have emergency hours or an emergency contact number? What is their cancellation policy? Children are unpredictable. If your child wakes up with the flu on the morning of a dental appointment, you don’t want to be surprised with a $50 cancellation fee.

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The Pediatric Dentist Locator Service

The American Academy of Pediatric Dentistry’s (AAPD) online Find a Pediatric Dentist service provides quick access to information on pediatric dentists for the general public. The directory is updated weekly and contains the names, addresses, telephone numbers, and fax numbers of pediatric dentists in the United States who are members in good standing of the AAPD. Simply type in your zip code and the search radius (from 5 to 150 miles) in the Find a Pediatric Dentist search box at www.aapd.org.

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Should I call a dental referral company?

Use a referral company with care. Dental referral companies prescreen participants, and they generally can supply you with information on the dentists’ educational background, experience, and specialty. They can usually provide other information as well, such as a dentist who can speak a second language or who has the specific office hours you want. Be aware, however, that most of these services list only dentists who pay to be included.

What questions should I ask dentists to help me choose the right one?

After you’ve come up with a list of two or three dentists, consider whether they are conveniently located. If their offices are not near where you live or work, you may have trouble keeping appointments. Next, call their offices and ask some preliminary questions:

• At what age does the dentist recommend seeing patients for their first visit?

• Does the dentist regularly treat children or patients with special health care needs?

• Is the office child-friendly, including the waiting room and the treatment areas?

• What are the office hours? (Is the dentist available when you’re available?)

• Does the practice accept your dental plan?

• Is payment requested at each visit, or will the dentist file a claim with your insurance company and bill you for the balance?

• What are the fees for standard treatments (e.g., x-rays or cleaning)?

• Is information about fees provided before treatment is scheduled, including a pretreatment estimate?

• Is the practice willing to set up a payment plan for more expensive treatments? Will they work with you to come up with a plan you can afford?

• Does the dental staff use universal precautions for infection control, such as gloves, masks, protective clothing, and sterilized instruments and work areas?

• What is the protocol for patients who have emergencies during office hours, after office hours, or when the dentist is away?

• If you call the practice with a problem, can you speak to the dentist? Are there established times for calls to and from the dentist? Are telephone calls returned the same day?

• Are patients notified when it’s time for a checkup? Will you receive a reminder call, text, or e-mail the day before a scheduled appointment? (This can be a very helpful service.)

• Does the dental office have a Web site? How much information is shared online or through e-mail?

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Some dentists have DDS after their names, while others have DMD. DDS stands for doctor of dental surgery, and DMD stands for doctor of dental medicine. Because of standardized regulation of U.S. dental schools, there is no difference in the educational qualifications of a dentist with a DDS degree and one with a DMD degree. Today, the degrees simply indicate the history of the dental school.

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If you like what you hear, schedule an appointment for a meet-and-greet with the dentist. Taking the time to meet a dentist can help you gauge if the person and office is a good fit for your family. If possible, bring your child to meet the new dentist.

Be sure to ask plenty of questions. For example, if your child is anxious about dental visits, ask what techniques are available to soothe children. Ask about dental emergency hours. And while you’re there, take a good look around. Look for special amenities like toys, designated play areas, and TVs in the treatment rooms. Special touches can help calm even the most anxious child and can give you insight into the office’s attitude toward accommodating the needs of children. If you cannot tour the office in advance, then see if you can view the office on the dentist’s Web site. Many dental practices include photographs of the office and their staff online.

Types of Dentists

What is a pediatric dentist?

A pediatric dentist is a specialized type of dentist just for infants, children, and teens, like a pediatrician for teeth. In addition to a four-year college education, then dental school, pediatric dentists complete two to three years of additional specialized training focused on dentistry for children. This focus includes extra attention to proper care of baby teeth and permanent teeth, once they start to erupt. Although general dentists are certainly capable of treating children, pediatric dentists have chosen this field because they are passionate about working with little ones. Pediatric dentistry is one of the fastest growing specialties for dentists.

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A Growing Field

Pediatric dentistry is the fastest growing dental specialty in the United States.

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Besides their additional training, pediatric dentists often have dental offices designed with children’s comfort in mind. From books, toys, and DVD players to pillows, blankets, and themed treatment rooms, every effort is made to help your little ones feel safe and cared for.

What other dental specialties are there?

Understanding dental specialties can be confusing. Family, or general, dentists can be an appropriate choice for children’s oral care needs. These dentists focus on the diagnosis and treatment of dental problems in people at any age. There are several advantages to using a family dentist, including having the entire family cared for by one office, a convenient location, and, in some cases, lower fees. Some general dentists have received additional training in working with children and consider them a valuable part of their practice, while others prefer to focus on adults.

Orthodontics is a branch of dentistry many families with children encounter. Orthodontists specialize in preventing and treating tooth and facial irregularities, including problems with bites, jaw alignment, tooth crowding, and more. Treatment involves braces, retainers, and other corrective “appliances.” Some pediatric dentists have additional training in orthodontics, providing a “one-stop shop” for patients, while others refer patients to a specialist for orthodontic work.

Endodontics is a dental specialty that deals with diseases inside the tooth that affect tissue, blood vessels, and nerves. The most common endodontic treatment is a root canal—the removal of infected tissue and refilling of the nerve canal inside the tooth.

Oral surgery is the specialty involving surgical treatment of diseases, injuries, and deformities of the mouth, teeth, gums, and jaws. This includes treating problems caused by wisdom teeth, facial injuries, and jaw disorders. Oral surgeons are also skilled in reconstructive and dental implant surgery.

Periodontics refers to the diagnosis and treatment, including gum surgery, of problems with the gums and bone that hold teeth in place.

Prosthodontics, also called prosthetic dentistry, involves replacing teeth with artificial substitutes, or false teeth. Prosthodontists often work with tooth replacement implants, crowns and bridges, partial dentures, and complete dentures.

Cosmetic dentistry is another term used by dentists which generally refers to any dental work that improves the appearance (although not necessarily the function) of a person’s teeth or bite.

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Green Dentists

Some dentists have made a concerted effort to decrease the environmental effects of their dental practices by using digital x-rays, electronic charting, and eco-friendly products. If you are interested in finding a dentist committed to incorporating green practices in the office, look for a certified green dentist at the Eco-Dentistry Association, www.ecodentistry.org.

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What do dental hygienists and dental assistants do?

Dental hygienists are licensed health care providers who specialize in preventing and treating oral diseases. Before they can practice, they must graduate from an accredited dental hygiene program and pass written and clinical exams. Dental hygienists play a key role in the oral health care of their clients through in-office preventive services and education about home care. They are great resources for oral health care tips—from more effective brushing and flossing techniques to selecting oral health care products.

Your dental office may also employ dental assistants. They usually assist the dentist or dental hygienist in preparing the patient for treatment, sterilizing instruments, passing instruments to the dentist during the procedure, holding a suction device, doing dental x-rays, taking impressions, and getting crowns ready. Their help enables dentists and dental hygienists to focus more time on the procedure and provide more efficient dental treatments. Dental assistants are regulated on a state-by-state basis, so there could be differences in how dental assistants are trained or what they can do depending on your state.

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Private Dental Hygienists

In rural and underserved areas across the country, dental hygienists have gone into private practice to offer cleanings for less cost than a typical dentist visit. Although the fees are much less, they do not include x-rays or other screenings—only a cleaning is provided. If you want more frequent cleanings, these offices may offer a helpful service, but keep in mind that these cleanings should be done in addition to, and not replace, regular dental exams.

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Preparing for Your Child’s First Visit

Why does our dentist need to know our family’s health history and my child’s medical history?

Most dentists ask you to fill out a medical history form on your first visit to their office. All of this information helps decrease the likelihood of complications during dental treatments. Take the time to read over each question and answer it accurately. You should always inform the dentist of all existing medical conditions, treatments, and medications. Let your child’s dentist know about diabetes, allergies, and medications for kidney, lung, heart, or liver disease. Also, be honest about your child’s habits, such as eating choices and smoking, including exposure to secondhand smoke. Update your child’s records at each visit if there are any changes to health status or medications.

Certain medications or conditions may affect the way your child’s teeth react to treatment. For example, pregnancy may increase the risk of gum disease, and bleeding gums and arthritis can make it difficult for patients to maintain a clean mouth. If your child’s dentist and staff don’t know about underlying problems, they run the risk of performing unsuccessful treatments.

Expect to answer these questions, or similar ones, regarding your child’s health history:

• What was the date and purpose of your child’s last visit to a doctor?

• Does your child suffer from any disability? If yes, describe.

• Has your child ever taken or been exposed to illegal drugs? If yes, what drugs and when taken?

• Is your child HIV-positive or does your child have hepatitis?

• List all medications your child is now taking or has taken previously on a regular basis; describe the strength and purpose for each.

• Has your child ever had an allergic reaction to medication? If yes, describe.

• Describe any surgeries your child has had.

• Is your child on a special diet? If yes, for what reason? Describe the diet.

• Does your child smoke? If yes, describe type and quantity.

• Has your child consulted or been treated by a psychiatrist, psychologist, or counselor? If yes, when and for what purpose?

• Are you aware of any other concerns about your child’s health?

• For children under 10 years old: Was your child born by Cesarean section? Was your child born full term or premature?

• Is your child allergic to latex? If yes, what was the reaction?

• Has your child ever been treated for (or with):

Rheumatic fever, rheumatic heart disease, heart murmur, or congenital heart disease?

Heart trouble, heart attack, angina, heart surgery, a pacemaker, or irregular beats?

Stomach or intestinal disease?

Breathing problems, asthma, tuberculosis, or hay fever?


Kidney problems or renal dialysis?

Tumors or growths?

Arthritis or rheumatism?

Behavioral problems such as ADHD (attention deficit hyperactivity disorder), ODD (oppositional defiant disorder), PDD (pervasive developmental disorder), or autism spectrum disorder?

If you are concerned about how the information will be used or who will have access to the information, speak to the dentist or the office manager directly. Dentists are required to protect all health information in the same way that other health care providers do because of the strict HIPAA privacy rule, which protects the privacy of individually identifiable health information. You have the right to feel confident that the information you share will be protected.

What is included in an initial dental cleaning or basic checkup?

Checkups usually include a complete cleaning, by either the dentist or a dental hygienist. Using special instruments, the dentist or hygienist will gently scrape below the gum line, removing built-up plaque and tartar that can cause gum disease, cavities, bad breath, and other problems. Your child’s dentist or hygienist may also polish and floss your child’s teeth and possibly apply a fluoride solution.

After reviewing your child’s medical and dental history, the dentist will perform a thorough examination of your child’s teeth, gums, and mouth, looking for signs of disease or other problems. The goal is to help maintain your child’s good oral health and to prevent problems from becoming serious by identifying and treating them as soon as possible.

The dentist will first look in your child’s mouth using a mirror and perhaps a light, looking for staining, cracked or broken teeth, and cavities as well as counting how many teeth there are. The dentist or an assisting staff member will chart the findings, using the number or letter assigned to each tooth. Then the dentist will use a dental probe, called an explorer, to gently feel the bumps and valleys on the surface of each tooth. Any tackiness or stickiness on the surface might be a soft area indicating decay. Some dentists have a device called diagnodent, a gentle light device that rests on the tooth and shines a light that reveals any decay. Teeth usually need to be cleaned first, to remove debris and allow the device to work properly. Some dentists use an intra-oral camera, a form of video examination, which allows both the doctor and the patient (and the patient’s caregiver) to see the condition of the mouth at the same time, and then discuss treatment options.

How do I prepare my child for a first dental visit?

It may help to explain to your child that the dentist is a friendly person who helps take care of children’s teeth. After all, going to the dentist is an exciting part of growing up. Emphasize the positive parts of the visit. You could explain to your child that the dentist will count his teeth, clean them with a special tickling toothbrush, and take some pictures of his mouth. Never tell your child that the dentist will not “hurt” him, for that may have never even occurred to him. Don’t bribe your child into going to the dentist—this only makes it seem like there must be danger ahead. Visit the American Dental Association Web site (www.ada.org) with your child for games and stories to prepare him for his dental visit.

Should I go back with my child or let her go alone?

Some dental offices prefer that children go alone once they are school age. Most pediatric dentists, however, encourage parents to sit with their children during appointments. If you choose to accompany your child, most dental offices suggest that you be a silent observer. Offer a hand to hold if needed, but let the staff be the ones who direct your child’s movements. It is important for the dentist and staff to establish cooperation and trust directly with your child, and your child may become easily confused if more than one person is speaking to her. Look for a dental practice that considers it important to gain children’s friendship and trust and where they use all their resources to achieve this goal.

Ideally, a dental practice will implement the Tell, Show, Do method, where staff members explain everything to your child in age-appropriate terms, demonstrate what they are going to do, then do it. If you are with your child, follow the dentist’s instructions closely. If you do as the dentist asks, then your child will follow your example. Turn off your cell phone, and if you can, leave other children at school or with a sitter for the first visit.

What if my son starts crying or screaming?

Some children cry during a dental visit, especially the first visit, and most dental staff are comfortable handling upset children. If they cannot readily comfort your child, you may be asked to help calm him and reassure him that he is safe. It can be difficult to hear your child cry, but you know your child’s cries best. If your little one is becoming hysterical, then you may need to insist that you provide a time-out for a quick hug and reassurance. Keep in mind that although you don’t want your child to be terrified, his crying can actually help the dentist see inside his mouth better, so most of the time, dental staff can work around upset children. Your child’s dentist may encourage you to reschedule the visit if it becomes too overwhelming. If this happens, ask the office staff for specific advice about what you can do differently next time to try to avoid problems.

Dental Tools and X-Rays

Mouth mirror. This is usually a small, round mirror at the end of a metal grip. The tool allows the dentist to examine a person’s mouth from various directions. Sometimes this mirror has a light attached or magnifies the person’s mouth and teeth for easier viewing.

Explorer. This is the metal hook-shaped pick that the dentist uses to check for cavities in teeth.

Periodontal probe. Also a metal hook, the probe measures the depth of the pocket in the gum and around the tooth to check for periodontal disease. The dentist can also use this probe to scrape beneath the gums to prevent plaque from hardening around the tooth.

Dental instruments. © Len Neighbors/Photos.com

The bur. Commonly called the drill, this dental tool is often the most intimidating to patients. The bur is used to fill cavities and generally smooth out and polish teeth. Because this instrument can be painful, it is usually used with some type of numbing agent.

X-ray equipment. X-ray equipment varies from one dental office to another. All x-rays help detect any deep-lying problems in the teeth before they become visible to the human eye.

Cotton pliers. Cotton pliers look a lot like tweezers and function in the same way. They can be used to pick up small items and remove small items from the mouth. They also help avoid contamination.

Saliva ejector. A saliva ejector is a curved tube that acts as a vacuum inside the mouth to suction out saliva and other liquids. Since patients have to keep their mouths open for long periods at the dentist, saliva can become plentiful and interfere with the examination and treatment.

Will the staff use the actual names of the tools with my child?

Dental staff often use various phrases to describe what’s happening in more kid-friendly language. Here are some of the terms your child may hear at the dentist:

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Words Matter

Kids will live up (or down) to expectations, so talk to your child as if you expect her to have a good experience at the dentist. Don’t use these words with your child when talking about the dentist:

• Hurt

• Shot

• Pain

• Sting

• Pull

• Drill

• Poke

• Needle

• Yank

• Cut

• Pliers

• Strap down

• Tie up

• Don’t be scared

• Are you scared?

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• “Mr. Bumpy”: an instrument that cleans out tooth decay slowly

• “Water whistle”: an instrument that cleans out tooth decay quickly

• “Mr. Thirsty,” “silly straw,” or “tooth vacuum”: the straw (saliva ejector) that removes water or saliva from the mouth

• “Sleepy juice”: anesthetic that makes teeth feel tingly

• “Snugglie”: protective stabilization to keep children safe

• “Sugar bugs”: bacteria (germs) on the teeth

• “Tooth chair” or “Tooth pillow”: tightly packed cotton rolls to help keep the mouth open or used in between teeth

• “Tooth pictures”: x-rays

• “Tooth print”: impression for an appliance, such as braces

• “Tooth raincoat and tooth ring”: rubber square and ring that keep teeth dry

• “Tooth towel”: gauze square

• “Tooth vitamins”: fluoride treatment to keep teeth strong

How do dental offices clean and protect children against cross-contamination?

Several agencies set infection-control standards for all health care facilities, including dental practices. Involved agencies include the Joint Commission on Accreditation of Healthcare Organizations, the FDA, the Centers for Disease Control and Prevention (CDC), the National Institute of Health, and the Occupational Safety and Health Administration (OSHA), as well as state agencies. Depending on their assigned roles, dental staff wear safety items such as gloves, masks, outer protective clothing, and protective eyewear or shields as appropriate. Experts agree that the chance of contracting an infectious disease during a routine visit is extremely rare. However, you should always feel free to ask about the office’s sterilization process and their procedures for reducing the risk of cross-contamination.

Much of the office equipment, like air and water syringe tips, saliva ejectors, and high-speed suction tips, is disposable. Other instruments are cleaned after each use, using an ultrasonic scrubbing system, and then sterilized in an autoclave, a pressurized steam oven. One of the most important facets of operating a clean and safe practice is the frequency of staff hand washing.

Many offices post a list in their reception area or elsewhere of the infection-control procedures they follow. If you don’t see this information, ask about it. Look around and see if the office looks clean and well cared for. If you see something that causes you concern, don’t hesitate to ask questions.

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Does Your Dental Practice Follow These Safety Guidelines?

To ensure the CDC and OSHA safety standards, the American Dental Hygienists’ Association recommends that all dental offices:

• Use protective clothing, including gloves, masks, gowns or laboratory coats, and protective eyewear for all treatment procedures.

• Change gloves after each patient contact.

• Wash hands thoroughly before and after treating each patient.

• Heat-sterilize all nondisposable instruments and disinfect surfaces and equipment after treating each patient.

• Discard disposable needles, syringes, and other sharp instruments in puncture-resistant containers.

• Place all potentially infectious waste in closable, leak-proof containers or bags that are color-coded, labeled, or tagged in accordance with applicable federal, state, and local regulations.

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What do dentists look for in x-rays?

Dental x-rays are diagnostic tools to allow dentists to diagnose problems accurately and treat dental conditions that might not be detected during a routine examination. X-rays can reveal problems such as damage to jawbones, impacted teeth, abscesses, cysts or tumors, and decay between the teeth. They are also important for recognizing cavities and erupting teeth as well as for diagnosing the effects of trauma and planning orthodontic treatment.

What types of x-rays are done on children’s teeth?

A modern dental office uses machines that emit virtually no radiation—no more than your child would receive from a day in the sun or a weekend watching TV. As a precaution, however, your child should always wear a lead apron with a thyroid collar when having an x-ray.

Two main types of x-rays are used in dentistry: intra-oral (meaning the x-ray film goes in the mouth) and extra-oral (meaning the x-ray film is outside the mouth).


By far, intra-oral x-rays are the most common. They include several different types.

Bitewing x-rays show details of the upper and lower teeth in one area of the mouth. Each bitewing shows a tooth from its top to the bottom near the bone. These types of x-rays are used to detect decay between teeth and changes in bone density caused by gum disease. If the bitewing x-ray reveals cavities starting between the teeth, then the dentist can coach you and your child on better flossing techniques. These x-rays can also help with properly fitting a crown as well as determining the integrity of fillings.

Periapical x-rays show the entire tooth from the top to beyond the end of the root, where the tooth is anchored into the jaw. These x-rays are used to detect any abnormalities of the root structure and surrounding bone, including changes in the bone as a result of a tooth infection.

Occlusal x-rays are larger and show the full tooth development and placement. Each x-ray shows the entire arch of the teeth in either the upper or lower jaw.


There are also several types of extra-oral x-rays, which use film outside the mouth.

Panoramic x-rays show the whole mouth—all the teeth in both the upper and lower jaws—on a single x-ray. For this, a special type of x-ray machine is used that moves around the head. Panoramic x-rays are useful for detecting the position of fully emerged teeth as well as emerging teeth. They can also help identify impacted teeth or diagnose tumors in the mouth.

Tomograms show a particular layer or slice of the mouth while blurring out all other layers. This type of x-ray helps point out structures that are difficult to see clearly because other structures are in the way.

Cephalometric projections show the entire side of the head as a profile picture, often as a way to see teeth in relation to the jaw. Orthodontists find this type of x-ray especially helpful.

Sialography uses a contrasting dye injection to see the salivary glands. This x-ray is typically used only if a problem with the salivary gland is suspected.

Computed tomography, also known as a CT scan, shows the body’s interior structures as a 3-D image. CT scans for dental purposes are usually performed in hospitals to identify problems in the bones of the face, such as tumors or fractures. However, more and more dental offices now have their own CTs, also called cone beam CTs. These are used most often by orthodontists. Oral surgeons also turn to CT scans to assess the quality and thickness of bone before placing implants, and endodontists use CT scans to complete root canal fillings.

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How Safe Are Dental X-Rays?

There is very little risk in dental x-rays. Dentists are keenly aware of the potential hazards of radiation exposure and recognize varying needs of each child based on risk factors. Lead aprons and high-speed film are used to ensure safety and minimize the amount of radiation. In addition, you are encouraged to bring x-rays from previous dentists to minimize unnecessary exposure. To put it into perspective, the risk of undiagnosed and untreated dental problems is far greater than the risk posed by radiation exposure from dental x-rays.

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How often do children’s teeth need to be x-rayed?

As a general rule, children need x-rays more often than adults because a child’s mouth grows and changes rapidly. Children are also more susceptible than adults to tooth decay. For children with a high risk of dental disease, the American Academy of Pediatric Dentistry recommends x-ray examinations every six months to detect cavities developing between the teeth. On average, most pediatric dentists request x-rays about once a year, especially for children with a low risk of tooth decay.

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Digital X-Rays

Digital imaging is becoming more popular in dental offices, including those that treat children. Instead of developing an x-ray film in a dark room, the x-rays are sent directly from the machine to a computer. Images can then be viewed on a computer screen almost immediately, and they can be stored or printed out. There are many benefits to digital x-rays, particularly that digital imaging is easier and saves a lot of time. The images can be enhanced or enlarged, minimizing the need to take additional x-rays. If necessary, the images can be easily sent to other dentists or specialists, and because the x-rays can be stored electronically, it is easy to compare images of certain teeth or changes even after many years. A disadvantage is that some digital sensors, which are placed in the mouth, are more bulky than film and may be difficult for a child to tolerate.

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After the Appointment

What should I expect from the dentist at the end of the appointment?

The dentist should present you with an assessment of your child’s oral health, instructions on oral home care, and information about the risks of cavities and, if relevant, finger, thumb, and pacifier habits. They may also provide you with information on dental growth and development and on preventing injury to the teeth and mouth. Expect to make your next dental appointment before you leave.

How long after the dental visit can my child eat or drink?

Normally, your child can eat or drink immediately following a dental visit. After a fluoride treatment, however, avoiding food or drink for the first 10 minutes can maximize the amount of fluoride available in the mouth during uptake. Although the fluoride sticks to the teeth immediately during a treatment, fluoride uptake in the enamel continues up to 12 hours. If you aren’t sure exactly how long your child should hold off on eating or drinking after a dental visit, ask the dentist or other staff member before you leave the appointment.

How often should I take my child to the dentist?

If your child’s teeth and gums are in good shape, you probably won’t need to return for six months. If your child has a greater risk for oral health problems such as cavities, then she may need to see the dentist every three to four months. If further treatment is required, such as filling a cavity, you will need to come back for a follow-up appointment. Don’t forget to ask the dentist any questions you have—this is your chance to get the answers you need.


Preventing Decay and Protecting Teeth

Susan peered into her daughter’s mouth as she brushed her teeth before bed. Even though she was dog-tired, she was faithful in making sure she always helped her 7-year-old brush and floss. Rebecca complied without complaining, used to her mom’s diligent attention to her teeth. Susan knew how important it was to get her first grader to the dentist regularly, but she wasn’t sure how long it had been since she’d made an appointment. Everything looked fine—with no dark spots anywhere. Susan made a mental note to make an appointment as soon as she had time.

Your child gets only two sets of teeth. That may seem like plenty, but once those secondary teeth come in during elementary school, they need to be healthy and strong enough to last for the next six or seven decades. Caregivers have a unique responsibility to make sure their child’s choppers are in good condition into adulthood.

Protecting Your Child’s Teeth

Protecting your child’s teeth is a multipronged effort. Parents and caregivers must provide access to regular preventive dental care and treatment, brush and floss their children’s teeth at least twice per day, provide tooth-healthy nutritional choices, and protect their children’s teeth from injury. Protecting children’s teeth also requires becoming fully informed about dental treatment options for children. For example, you will need to decide if fluoride and sealant treatments are appropriate.

Why Fluoride Is Important

Fluoride, a mineral that occurs naturally, makes the tooth’s enamel more resistant to decay. Fluoride can be provided either systemically or topically. Fluoride in toothpaste, rinses, and applications at the dentist are all topical forms. Systemic fluoride is ingested, which allows it to be incorporated into the structure of tooth enamel as it forms. However, many believe topical fluoride is more effective because it aids in the remineralization (hardening) of enamel. Fluoridated water incorporates both systemic and topical contact and exposes children to very low levels of fluoride. Children who drink fluoridated water from birth experience up to 65 percent less tooth decay than those who don’t.

Indirectly, fluoridation programs also help reduce the incidence of malocclusion, or improper bite, which can result in the premature loss of primary teeth or tooth structure. With fluoridation, there’s less decay, which means fewer first teeth are lost prematurely. Children who brush regularly with fluoridated toothpaste have 24 percent fewer cavities than those who brush with nonfluoridated toothpaste.

Is fluoride safe?

The biggest risk with fluoride is fluorosis, when too much fluoride causes defects in the enamel of permanent teeth in children under 8 years of age. By age 8, the enamel of the permanent teeth has formed, and the risk of fluorosis is diminished. Fortunately, most cases are mild and will appear as tiny white specks or streaks that are often unnoticeable. In severe cases of enamel fluorosis, however, the appearance of the teeth is marred by discoloration or brown markings. The enamel may be pitted, rough, and hard to clean. Cosmetic dentistry can usually correct the appearance of such flaws, but the damage can’t be reversed.

The best way to prevent fluorosis is to understand all the possible fluoride sources your child is exposed to and to discuss your child’s risks with her dentist. Fluoride provides extraordinary benefits to children’s teeth, and getting the right amount can protect your child’s teeth for years to come. Still, there is a risk of toxicity from ingestion of too much fluoride, which is why toothpaste should be kept out of reach of young children and applied to the toothbrush by a parent.

What other sources of fluoride are there?

If you are concerned about the amount of fluoride your child may be consuming, talk to the dentist about your child’s specific risks. The following foods and beverages may also contain fluoride.

Bottled water. Because the FDA does not require that fluoride content be listed on labels, it is difficult for consumers to know the fluoride content in their bottled water. If bottled water is your child’s only source of water, you can probably assume she is receiving very low amounts of fluoride, if any.

Commercial beverages and foods. Many foods and beverages in stores and restaurants are made with community-fluoridated water. In addition, some foods naturally contain fluoride, such as seafood and some teas and fruit juices.

Infant nutrition. Human breast milk contains almost no fluoride. Even when the nursing mother drinks fluoridated water, the fluoride is not passed through the breast milk. Unless mixed with fluoridated water, powdered infant formula also contains little or no fluoride.

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Do Water Filters Affect Fluoride Levels?

The fluoride content of fluoridated community water may be affected by water filters commonly used in homes. Most water filters use activated charcoal filters and cellulose filters, which do not really decrease fluoride content. Reverse osmosis filters, however, remove almost all fluoride from water. Distilled water does not contain any fluoride either.

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Does my child need fluoride supplements?

Supplements should be considered for people whose community water source does not have fluoride and for children who are identified as being at high risk for developing tooth decay. Supplements are available in liquid, tablet, or lozenge form and aren’t typically prescribed in children younger than 6 months of age. Don’t add fluoride, however, without making sure your water sources do not have sufficient fluoride. Get a thumbs-up from your health care provider before supplementing your child’s diet.

Does my child need fluoride treatments?

Professionally applied fluoride treatments are usually recommended twice per year. Fluoride treatments offer an average 21 percent reduction in decayed, missing, and filled tooth surfaces. Some dentists apply a fluoride varnish instead. A varnish is a professionally applied, sticky resin of highly concentrated fluoride. Typically, dental insurance dictates application frequency but not which type of fluoride is used. Many dental insurance agencies reimburse for fluoride once a year.

After the application of a fluoride varnish, your child will feel a coating over his teeth, and you may notice a difference in the color of your child’s teeth while the varnish remains on them. To obtain the maximum benefit during the 4- to 6-hour treatment period, make sure your child follows these instructions after leaving the office:

• Do not eat or drink for 10 minutes following a fluoride varnish application.

• Do not remove the varnish by brushing or flossing for at least 4 to 6 hours.

• If possible, wait until tomorrow morning to resume normal brushing and flossing.

• Maintain a soft food diet during the treatment period.

• Avoid hot drinks and products containing alcohol, such as beverages, oral rinses, etc.

A thorough brushing and flossing the next day will easily remove any remaining varnish from your child’s teeth. They will return to the same shine and brightness as before the treatment.

Does it matter if we have city or well water?

Fluoride has been added to public water systems since the 1940s, and fluoridated water has been hailed as one of the top ten greatest achievements in public health in the twentieth century. Chances are, if you have city water, you probably have fluoride. About 65 percent of the population in the United States now has access to optimally fluoridated water, defined as 0.7 parts per million (ppm).

How does your water compare? Although routine monitoring ensures appropriate fluoride levels, the U.S. Environmental Protection Agency (EPA) requires that all community water suppliers provide an annual report on the quality of water, including the fluoride concentration. Some post their annual reports on the EPA’s Web site. You can also contact your local water authority directly for this information or find out the fluoride content of your town water by accessing the CDC Web site My Water’s Fluoride, http://apps.nccd.cdc.gov/MWF/Index.asp.

If you have well water, be aware that wide variations in the natural fluoride concentration of well water sources exist. Private wells should be tested for fluoride concentration before fluoride supplements are taken. Testing can be done through local and state public health departments or private laboratories.

Do mouth rinses help prevent cavities?

Several different types of fluoride mouthwashes are available over-the-counter (without a prescription). Frequency of use ranges from daily to weekly. Schools used to have fluoride mouth-rinse programs, but most school systems have stopped using them because they are the least effective method for delivering fluoride to the teeth. Talk to your child’s dentist about the use of fluoride-containing mouthwashes, especially if your child already uses fluoride toothpaste, drinks fluoridated water, and receives regular fluoride treatments. As with any type of dental mouthwash, fluoride rinses should only be used by children who can spit and won’t swallow it.

Dental Sealants

Dental sealants may be one of the best-kept secrets in pediatric dentistry, with only one in four children having this cost-effective tooth defender on their molars. A plastic material applied to the chewing surface of permanent molars, dental sealants provide a physical barrier to bacterial invasion of pits and fissures. Some back teeth, especially molars, can be difficult for a person to clean because the grooves found on their chewing surface (the tooth’s “pits and fissures”) are deep and narrow. Even tooth brushing can’t remove all the dental plaque because individual toothbrush bristles are too large to get into the depths of these teeth’s grooves. When plaque isn’t completely cleared away, these teeth are at risk of decay.

By bonding plastic resin, otherwise known as the dental sealant, into the grooves of a tooth, the dentist creates a smoother tooth surface. There aren’t any areas left on the chewing surface of the tooth that the bristles of a toothbrush can’t get to. Since dental plaque can be removed more effectively, there is less of a chance that tooth decay will form. Another difficulty associated with a tooth having deep grooves is that in some instances, the thickness of the enamel at the base of the grooves is thinner than the enamel that encases other aspects of the tooth. This means any decay that does form will have an easier time penetrating the enamel layer and will therefore progress more quickly into the inner parts of the tooth.

Sealants are effective because 90 percent of cavities in school-aged children occur in the pits and fissures of molars, the place a sealant covers. The first permanent molars erupt at age 6, and the second permanent molars around age 12, so these are the target ages for sealants, although they can be applied any time. For an individual tooth, a properly applied sealant is virtually 100 percent effective in preventing a cavity at the site of the sealant. Properly applied means applied when the tooth is dry and isolated, so that the sealant bonds to the enamel and grooves and doesn’t have an area of leakage. Sealants are only effective as long as they remain on the tooth.

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School-Based Sealant Programs

If you live in an area with a high percentage of students who receive free or reduced lunch, free sealant clinics may be offered at your child’s school or community center. Check with your child’s school nurse or guidance counselor to see if such services are available.

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Using sealants is a cost-effective strategy because they typically last five to ten years, and one sealant costs less than half that of a single filling. Sealants should be applied in all high-risk children around the ages of 6 and 12. They need to be used in addition to fluoride, because fluoride primarily benefits the smooth surfaces of teeth, whereas sealants protect the grooved surfaces.

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Allergy Alert

Dental sealants should not be given to children with an allergy to methacrylate. Methacrylate is contained in the sealant material, and the oral tissues may come in contact with it during sealant placement. Make sure your child’s dentist office is aware of any allergies your child has.

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Which teeth are best for sealants?

Permanent molars are the most likely to benefit from sealants. The sealant is most effective if applied soon after the teeth have erupted, before they have a chance to decay. Any tooth with deep grooves that place it at risk for tooth decay should be sealed. For example, if a child cannot easily clean a groove in a molar, then that groove needs a sealant. To identify teeth that need sealants, ask your child if any food feels caught on the tops of his back teeth that he can’t fish out with his tongue. Sealants should be checked at your child’s regular dental appointment and can be reapplied if they are no longer in place.

How are sealants applied and how do they work?

Applying sealants is relatively simple and does not require drilling or disturbing the tooth. X-rays are usually performed first to make sure the sealants are not placed over existing tooth decay. Once those x-rays are completed, the process is quick and easy.

1. The tooth is cleaned.

2. The tooth is dried, and cotton is put around the tooth to keep it dry.

3. Because the sealant sticks better to a slightly rough surface, a solution is put on the tooth to roughen it.

4. The tooth is rinsed and dried again. Having a dry tooth is important so that the sealant will adhere well.