Frequently Asked Questions

1. At what age should my child first visit a dentist?

The American Academy of Pediatric Dentistry recommends “the first visit by the first birthday.” This allows new parents the opportunity to establish good oral hygiene, feeding, and oral habits for their child at a very young age. The visit is usually brief and includes a cursory exam of the oral cavity. A professional cleaning is seldom warranted at this age.

We recommend a complete dental examination including a professional prophylaxis (cleaning) and a topical fluoride application at 2 ? to 3 years of age. This gives us the opportunity to establish good dental habits at an early age, and correct any existing problems before they become serious and result in permanent damage. However, it is not unusual to initiate care at a younger age to examine any unusual tooth staining, discoloration, or abnormality; to evaluate injury or trauma to the teeth or oral cavity; or to advise parents concerning bottle feeding, thumbsucking, pacifier use, snacking habits, etc.

2. What should I do to prepare my child for his/her first dental visit?

As a parent you can play an important role in preparing your child for this visit. It is important to demonstrate positive attitudes and encouraging language when describing the dental visit. Avoid using technical terminology unfamiliar to your child to describe dental procedures. Children’s books and videos can assist you in communication by describing the dental visit utilizing age appropriate language and visualizations. Be positive! Describe the first visit as an adventure, much like a visit to the zoo.

3. At what age should I begin brushing my child’s teeth?

Toothbrushing should begin as soon as the first tooth appears in your child’s mouth. You should use a small headed soft toothbrush with polished nylon bristles, with little or no toothpaste. It is the mechanical action of the toothbrush, not the toothpaste, which cleans the teeth and stimulates the surrounding gingival tissue. You should brush thoroughly and vigorously using a circular brushing stroke.

4. At what age should my child begin brushing his/her own teeth?

Children mature at different rates and some children exhibit an interest in toothbrushing before others. Usually by age 3 or 4 years your child can begin participating in the brushing of his/her own teeth. However, you must recognize that at this age you are merely establishing a habit and your child still lacks the knowledge and motor skills to adequately clean his/her teeth. It is always good to encourage this habit but it is usually necessary for you, the parent, to rebrush his/her teeth until 5 or 6 years of age when his/her motor skills and reasoning are more fully developed.

5. At what age should my child get his/her first tooth?

The age of eruption of the first tooth varies greatly among individuals. Typically it is between 3 months and 12 months of age with 6 months being the average. The first tooth erupted is usually a lower incisor, but again the eruption sequence can also vary with individuals. It is very unusual for an erupted primary tooth to be present at birth. Usually any teeth present at birth are neonatal teeth which are extra teeth with very small roots. Many times these teeth are very loose and removal is recommended to avoid aspiration.

6. At what age should my child lose his/her first primary (baby) tooth?

Most children will lose their first tooth between 5 and 8 years of age. Typically, the lower central incisor is the first tooth to be lost. It is not unusual for the permanent central incisor to be partially erupted and visible behind the primary lower incisor before the tooth is lost. Once the primary tooth is lost the permanent incisor will move forward into the available space. The permanent first molars usually erupt about the same time the first tooth is lost.

7. How often should my child brush his/her teeth?

As dentists we recommend brushing after eating. Practically, children should minimally always brush after breakfast and before bed. More frequent brushing is beneficial but it is significant to recognize that thorough toothbrushing is far more important than frequent cursory brushing. It is important for the individual to sequentially brush all tooth surfaces with a vigorous circular or back and forth scrubbing stroke. The toothbrush bristles should be angled toward the gums approximately 45 degrees to the surface of the tooth.

It is most important for the child to go to bed with clean teeth as the natural cleansing of saliva decreases during sleep. In addition it is prudent to give any bedtime oral medications before toothbrushing as the sticky sugary matrix associated with oral medications is frequently a source of decay or tooth discoloration.

8. What type of toothpaste is recommended for children?

The specific type or brand of toothpaste is not as important as finding a toothpaste which your child likes and which will encourage them to establish regular brushing habits. It is the mechanical action of the toothbrush that cleans the teeth and not the toothpaste, although the toothpaste contains some polishing agents and whiteners. Toothpastes containing fluoride are safe for children when applied in a normal amount required for brushing.

9. What type of toothbrush is recommended for children?

Children should use a toothbrush appropriately sized for their mouth and level of dexterity. In general infants and preschoolers should use a small headed soft toothbrush with multitufted polished nylon bristles. The head of the brush, though small, should be fully bristled. Some toothbrushes sold as infant or child brushes lack sufficient bristles to adequately clean the teeth. A thick handle facilitates the grasp of the young child with limited fine motor skills.

10. At what age should I begin flossing my child’s teeth?

Flossing is usually not necessary for the very young child, as most children have spaces between the primary teeth during the early years and all tooth surfaces can be easily accessed through toothbrushing. It is usually not until permanent teeth erupt that the spaces begin to close and flossing becomes necessary. However, in very crowded individuals with tight contacts between the teeth flossing is required at a younger age. Typically the primary molars are the first areas in the mouth to exhibit closed contacts and hence interproximal decay, and likewise benefit most from the cleansing action of floss. It is generally not recommended that children be allowed to floss independently until they have achieved a level of understanding and the motor skills required to floss correctly. Until that time flossing should remain a parental responsibility.

11. At what age do children first get cavities?

Children can exhibit dental decay at any age. In some instances teeth can erupt with anomalies and enamel defects resulting in almost instant decay through no fault of the individual. In other instances the likelihood of decay in children at any early age is significantly increased by prolonged bottle feeding, bedtime bottle feeding, frequent snacking, poor dietary habits, and inadequate oral hygiene. Typically, most pediatric dentists notice an increase in decay in the molar region once posterior spaces close and tooth to tooth contacts tighten.

12. What types of food cause dental decay in children?

Any food can cause decay although sticky, gooey, sugary foods are potentially more harmful because of their ability to naturally adhere to the tooth surface for longer periods of time, and the presence of sugars which can be readily utilized by the plaque forming bacteria in the mouth. However, most studies have shown that the frequency of eating is far more harmful than the type of food consumed. Parents should recognize that it takes approximately 30 minutes for the saliva in the mouth to naturally eliminate food particles after eating, and any food particles remaining in the mouth at bedtime are potentially more harmful since natural saliva flow decreases during sleep.

13. Is it OK for my child to suck his/her thumb or fingers?

Children exhibit a natural sucking reflex during the first years of life and while one should never encourage the habit, parents must recognize it is normal during the first 2 to 3 years of life. In most instances the habit extinguishes itself with no harmful effects and parents should avoid drawing unnecessary attention to it during these early years.

14. At what age should my child stop sucking his/her thumb or fingers?

In general pediatric dentists recommend the termination of thumb or finger habits between ages 3 and 4 years. At this age most children no longer require the thumb or fingers to satisfy a natural sucking reflex and most of the deleterious effects upon the growth and development of the teeth and jaws are self correcting or easily reversed upon termination of the habit. When the habit continues past 3 years of age the consequences and deformation of tooth and jaw structures become much more severe and permanent.

15. Is it OK for my child to use a pacifier?

Again, children exhibit a natural sucking reflex during the first years of life and it is perfectly normal to provide your child with a pacifier to satisfy this instinct. The pacifier, due to its shape, is usually far less detrimental to the growth and development of the teeth and jaws than a thumb or finger habit. When selecting a pacifier for your child, be certain to choose an orthodontic pacifier which is specifically shaped to minimize the deleterious effects of a prolonged sucking action. Like the thumb or finger habit, the pediatric dentist recommends termination of pacifier usage at 3 years of age.

16. How do I get my child to stop sucking his/her thumb or fingers?

As previously stated the sucking reflex is normal for the first few years of life and no attempt should be made to correct the habit until at least 3 years of age or until your child can cognitively understand your request. It should be recognized that prolonged thumb or finger habits are psychological in nature and the thumb or finger is merely a symptom of the problem. To effectively terminate the habit it is necessary to give your child a reason to stop the habit. Constant verbal scolding or coating of the thumb or finger with an ill-tasting deterrent is usually unsuccessful and many times only further ingrains the habit. Initially, you should describe and visually demonstrate the ill effects of the habit and appeal to your child’s cognitive abilities. In many instances this request is all that is necessary. If still unsuccessful, your pediatric dentist can assist you in formulating a positive reinforcement plan.

17. Should my child use a fluoride rinse?

While fluoride can exhibit beneficial effects on both the developing and erupted teeth, it should be noted that a fluoride rinse is designed to benefit only the erupted teeth and when used as instructed has no effect on the developing (unerupted) dentition and should not be ingested (swallowed). Although children with no cavity problem do not require a fluoride rinse, it is not harmful when used only as a rinse and fully expectorated. The fluoride acts to replenish the amount of the fluoride ion in the surface enamel of the erupted teeth and hence make the teeth more resistant to decay. It also can assist in the recalcification of decalcified enamel and arrest the decay process in cavity prone individuals. However, it should only be utilized by older children able to fully expectorate the rinse solution and should never be given to young children who may ingest a significant amount of the rinse. Too much ingested fluoride over a period of time can cause discoloration and damage to the developing teeth.

18. Does my child need to take a fluoride vitamin or supplement?

Typically most children do not need a fluoride vitamin or supplement. Most local water systems are fluoridated at an optimum level. Only individuals utilizing unfluoridated water systems such as local well or bottled water require fluoride supplement. In all instances it is first necessary to test the water for natural fluoride content. To ingest additional fluoride results in little gain in benefits, but significantly increases the likelihood of tooth mottling and other damaging effects associated with high fluoride concentrations.

19. Is it OK to put my child to bed with a bottle?

Absolutely not! Children allowed to bottle feed or nurse while falling asleep exhibit a significantly increased risk of dental decay, particularly smooth surface decay of the upper anterior teeth. Milk, breast milk, and juice are carbohydrate-containing liquids and when allowed to puddle in the mouth of a sleeping child, continue to bathe the teeth throughout the night and provide an excellent nutrient source for cavity-producing bacteria. Typically, the upper anterior teeth are first affected with chalky white spots of decalcification and eventual rampant decay sometimes resulting in tooth abscess and premature tooth loss. If children accidentally fall asleep while bottle feeding or nursing, it is important to wipe any excess fluid from the mouth with a damp gauze or washcloth before laying the child down for the night.

20. At what age should my child drink from a cup?

It is recommended that all children terminate bottle feeding by 1 year of age. Prolonged bottle feeding not only increases the risk of dental decay due to the puddling of fluids in the mouth but also can alter normal jaw and tooth development due to the effects of the forces generated by the sucking action.

21. What should I do if my child knocks out his/her tooth?

If the tooth is a permanent tooth it should be immediately replaced into the socket and the child should immediately see a pediatric dentist to have the tooth properly positioned and stabilized. If the tooth is dirty or contains any foreign debris it should be gently rinsed with water before replacing it into the socket. Do not scrub the tooth vigorously as removal of the attachment fibers will significantly reduce the success of reimplantation. If it is not possible to immediately reimplant the tooth, it should be kept moist and preferably stored in milk during transport until the dentist can reimplant it. Time is of the essence for successful reimplantation of permanent teeth.

If the tooth is a primary (baby) tooth it usually cannot be successfully reimplanted. However, it is important to have both the child and tooth evaluated as soon as possible by a pediatric dentist. The dentist needs to determine if the whole tooth or only a portion was lost, and if any contiguous structures in the oral cavity are injured and require additional care.

22. What are tooth sealants?

Tooth sealants are a plastic-type material, similar to an epoxy resin, which bonds to and fills the crevices or grooves on the chewing surfaces of the posterior teeth. The tooth surface is cleaned and etched during preparation and the sealant material is flowed onto the surface of the tooth and light cured (hardened). The procedure is totally painless and no drilling is required.

Previous to sealants, the grooves on the chewing surfaces of the posterior teeth were harbingers of food and bacteria which were inaccessible to toothbrushing due to the narrowness and depth of the crevices. By sealing the grooves, a smooth surface is created which your child is able to effectively and completely clean with his/her toothbrush. It is important to note that the sealant only protects the chewing surface of the tooth and flossing is still necessary to adequately clean the surfaces between the teeth.

23. Is it necessary to restore primary (baby) teeth?

The simple answer is yes! The primary teeth provide an important function during the childhood years and it is imperative to maintain the integrity of the teeth throughout the development of the permanent dentition. The primary teeth serve as a template for the permanent dentition, and premature loss of teeth or tooth structure can result in loss of arch space and increased crowding of the permanent dentition. In addition, untreated dental caries, although seldom associated with pain in the primary dentition, can result in damage to the underlying developing permanent teeth or in severe cases a life threatening infection. In addition, the presence of severe and/or multiple cavities can produce both speech and chewing difficulties. Dental decay is a progressive disease of the tooth and if untreated always results in more serious consequences.

24. What should I do if my child’s tooth exhibits a spot or change in color?

Any change in the color, shape, or appearance of a tooth should be evaluated by your dentist. Changes in the tooth appearance can be as innocuous as extrinsic staining or as serious as pulp necrosis requiring immediate care.

25. When do I know if my child needs braces?

Since pediatric dentists are trained in the growth and development of the child, an orthodontic evaluation is usually a part of every exam. The most common orthodontic problems such as tooth crowding, crossbites, and anterior/posterior jaw discrepancies are usually evident in the primary dentition, and therefore it is usually obvious at a very young age if your child is going to require orthodontic correction. However, it is very uncommon and usually unnecessary to initiate orthodontic therapy before the eruption of any permanent teeth. Your pediatric dentist can advise you as to the appropriate age to initiate treatment for your child and his/her particular problem.

26. How old should my child be before starting braces?

There is no one universal age or stage of development that is appropriate for beginning orthodontic treatment for all children and all orthodontic problems. The optimum age for the initiation of orthodontic therapy varies greatly and is dependent on both the type of orthodontic problem and the dental age of the child. It is very rare that it is necessary to initiate treatment before the eruption of any permanent teeth. However, in most instances it is advantageous to begin therapy before all the primary teeth are lost. Each individual is uniquely different and it is important that your dentist discuss and fully explain to you the expectations and limitations of any proposed orthodontic treatment before beginning therapy.

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