Dental Health Guide

A Guide to Your Child’s Dental Health from Birth through Adolescence
By: L. Scott Chong, DDS, MSD

INFANTS (0-36M)
Milestones:
• The first teeth (lower central incisors) usually erupt around the age of 6 months.
• More teeth will continue to erupt every 1-3 months until the age of 2 ½ - 3yrs. (See the attached Tooth Eruption Guide)

Care/Cleaning:
• Gently wipe the erupting teeth at least once a day with a soft washcloth, finger toothbrush, or soft-bristled children’s tooth brush.
• Use either tap water or a baby tooth cleaner (non-fluoridated cleaner)
• As your baby gets older, cleaning will become more difficult. Try to make it fun and part of a normal routine.
• Never put your child to bed with a bottle. Long exposure to milk or juice can greatly increase the risk of tooth decay.

Fluoride:
• Do not supplement unless directed by your dentist. The fluoride provided from tap water is usually sufficient.
• If you use exclusively bottled water, there are brands which have fluoride.

Pacifiers and Thumb/Finger Sucking:
• Up until 24 months, pacifiers and thumb/finger sucking will not hurt the developing teeth.
• By age 3, pacifier and thumb/finger sucking should have ceased, or should be discouraged. It gets harder to stop as the child becomes older.
• By age 4, continued pacifier and thumb/finger sucking can cause problems with the developing teeth and jaws. (Cross Bites and Open Bites) Both conditions mean that your child is not biting/chewing properly and this may affect the development of their permanent teeth and jaws.

Dental Checkups:
• The first checkup should be with a pediatric dentist after the first tooth erupts between age 6-12 months and no later than 18 months.
• Early visits are important to help prevent any developing problems (like cavities).
• A pediatric dentist has two to three years of specialty training following dental school and limits his/her practice to treating children only.
• Early visits help your child get used to going to the dentist so that later visits are easy.
• Prevention is the best way to treat dental and orthodontic problems.
• Your pediatric dentist may recommend sealants on the back baby teeth. Sealants work by filling in the crevasses on the chewing surfaces of the teeth. This shuts out food particles that could get caught in the teeth, causing cavities. The application is fast and comfortable (no shots required) and can effectively protect teeth for many years.

CHILDREN: (3-10 YEARS)

Milestones:
• The first permanent teeth begin to erupt around age 6. (See the attached Tooth Eruption Guide)

Care/Cleaning:
• At age 3, you can begin cleaning your child’s teeth twice a day with a pea-sized ball of toothpaste. Your toothpaste should have the ADA seal of approval (which confirms it is safe and effective) and will contain fluoride.
• Have your child spit out as much as possible after brushing. Do not be concerned if they swallow some of the toothpaste.
• Do not use supplements unless your pediatric dentist prescribes them.
• As your child gets older (age 4-5), they can start brushing their own teeth while supervised. You should always brush their teeth afterwards yourself until at least age 6.
• By age 6, a child has enough coordination to brush their own teeth properly. Be sure to get them settled in a twice-a-day routine and to check to make sure that they are doing a good job.
• In particular, pay attention to the backs of the teeth, next to the gums, and the molars. Children will often brush their front teeth and miss other areas.
• Over the counter Disclosing Tablets and Disclosing Mouth Wash can be a good way to teach your child how to brush properly. When used before or after brushing, any plaque on your child’s teeth will temporarily change color.

Dental Checkups:
• Continue regular visits to your pediatric dentist.
• As the permanent first molars erupt, your dentist will probably recommend sealants to reduce the risk of tooth decay. Many children who have sealants done and learn proper brushing habits never get any cavities, even as teenagers and adults.

Orthodontic Checkups:
• In particular, you should see an orthodontist if you notice an underbite, crossbite, or if it looks like the permanent teeth do not have enough space to erupt properly. (See the attached Seven Warning Signs in 7-year Olds Guide)
• If necessary, your orthodontist may recommend early treatment (Phase I) to correct crowding, to help the permanent teeth erupt, and to help the jaws develop properly.
• Be sure that your orthodontist is experienced in treating children. Some orthodontists prefer to wait until all the permanent teeth have erupted.

PRE-TEEN/EARLY TEEN (11-14 YEARS)
Milestones:
• Your child’s last baby teeth will fall out as the permanent bicuspids and 2nd molars erupt.

Care/Cleaning:
• Continue to encourage your child to maintain good brushing/flossing habits.
• Teens are more susceptible to gum disease and cavities because growth hormones stimulate oral bacteria.
• Encourage a healthy diet. Minimize sodas and sugary snacks if possible.

Dental Checkups:
• Continue to see your pediatric dentist for regular checkups.
• Your dentist will probably recommend sealants on the 2nd molars and may recommend sealants on your permanent bicuspids.

Orthodontic Checkups:
• When your 2nd molars have erupted, your orthodontist may recommend full treatment with braces. (Phase II if you had early treatment)
• Because it typically takes two years to complete full treatment, most orthodontists recommend an evaluation by age 14 so that your child will be done before they graduate from high school.

LATE TEENS (15-18 YEARS)
Milestones:
• Your pediatric dentist may refer your child to an adult dentist for their future care.
• Wisdom teeth are typically evaluated between ages 15-17 years.
• Your orthodontist or your dentist can advise you as to when to have your wisdom teeth checked. They may refer you to an oral surgeon for an evaluation.

Sports Safety
• All children and teens should wear mouthguards when playing contact sports.
• For best results, a child should practice wearing the mouthguard at home and during light exercise before using it during competition.
• Children with braces should absolutely wear mouthguards while playing sports.
• Over-the-counter mouthguards will still work – but you need to place wax over the braces before fitting the mouthguard. (Ask an orthodontist for wax and help as needed)
• Some orthodontists offer custom-fit mouthguards which are less bulky, more comfortable, and provide superior protection.

Tooth Eruption Guide (On Average)

Seven warning signs in 7-year-olds

1. Do the upper teeth protrude?
Excessive protrusion of the upper front teeth – "buck teeth"– is by far the most common orthodontic problem.

2. Is there an underbite?
The upper teeth fit inside the arch of the lower teeth.

3. Is there a deep bite?
The upper front teeth cover the lower front teeth too much.

4. Is there an open bite?
The child can stick his or her tongue between the upper and lower front teeth when the back teeth are together.

5. Is there too little or too much room for the teeth?
Crowded or overlapped teeth...

...or noticeably large gaps between teeth.

6. Do the front teeth line up?
The spaces between the two upper front teeth and the two lower front teeth should line up with each other and both should line up with the bridge of the nose. When they do not, the probable cause is drifted teeth or a shifted lower jaw, resulting in an improper bite.

7. Is there a crossbite?
The upper back teeth fit inside, rather than outside of the lowers.

Seek treatment earlier than age seven if your child has:
* difficulty chewing.
* open-mouth breathing.
* thumb or finger sucking.
* overlapping or crowding of erupting permanent teeth.
* jaws that click or pop.
* biting of the cheek or into the roof of the mouth.
* speech problems.
* grinding or wearing down of teeth.
* obvious abnormal bite development of any kind.

*Original guide is available from the California Association of Orthodontists

Emergency Care

What should I do if my child has a toothache?
First, look for food caught between the teeth. Gently floss it out if possible. Rinse the irritated area with warm salt water and place a cold compress or ice bag on the face if it is swollen. If warm water doesn’t work, sometimes cold water helps. Stick to soft, bland foods. Over-the-counter medicines such as Motrin or Tylenol can help relieve pain. *Be sure to check with your pediatrician for safe dosages*
Also, call your dentist immediately for a check-up.

What should I do if my child's baby tooth is knocked out?
Contact your pediatric dentist as soon as possible.

What should I do if my child falls and knocks out a permanent tooth?
Remain calm. Find the tooth. Hold it by the crown rather than the root and try to reinsert it in the socket. If the tooth is dirty, it can be gently immersed in milk or water.
*Do NOT scrub the tooth. The cells on the surface of the tooth are fragile and must be kept alive.*
If you cannot reinsert the tooth yourself, put the tooth in a glass of milk. If no milk is available, have your child spit into a cup and place the tooth in the saliva. Nutrients in the milk or saliva will keep the tooth alive.

Take your child and the tooth immediately to your dentist or orthodontist (whomever is available first). If the tooth can be re-implanted within 15-30 minutes, there is a good chance that the tooth will survive.

You should see your child’s dentist for an x-ray to confirm that there is no damage to the jaw or surrounding bone.

You should see your child’s orthodontist to confirm that the tooth is positioned properly. Your orthodontist may also place a protective splint to stabilize the tooth and to help with healing.

What if a tooth is chipped or fractured?
Contact your pediatric dentist immediately. Quick action can save the tooth, prevent infection and reduce the need for extensive dental treatment. Rinse the mouth with water and apply cold compresses to reduce swelling. If you can find the broken tooth fragment, bring it with you to the dentist.

What about a severe blow to the head or jaw fracture?
Go immediately to the emergency room of your local hospital. A blow to the head can be life threatening.

Frequently Asked Questions

How safe are dental X-rays?
There is very little risk in modern dental X-rays. A long plane flight exposes you to the same amount of radiation as a set of x-rays. Lead aprons and high-speed film are used to ensure safety and minimize the amount of radiation. Many offices are now using digital x-rays which use even less radiation.

What type of toothpaste should my child use?
Your child should use toothpaste with fluoride and the American Dental Association Seal of Acceptance. Careful supervision and only a small pea-sized amount on the brush are recommended. Do not leave toothpaste tubes where young children can reach them. If not monitored, children may easily swallow over four times the recommended daily amount of fluoride in toothpaste. Excess fluoride consumption can cause permanent staining to the teeth (fluorosis). In extremely high doses, fluoride can be toxic.

How do I know if my child is getting enough fluoride?
Check with your pediatric dentist. Most children get plenty of fluoride from water that is either ingested, used for cooking, or from fruits/vegetables grown with fluoridated water.

How does fluoride work?
When the element fluoride is used in small amounts on a routine basis it helps to prevent tooth decay. It encourages "remineralization," a strengthening of weak areas on the teeth. These spots are the beginning of cavity formation. Fluoride occurs naturally in water and in many different foods, as well as in dental products such as toothpaste, mouth rinses, gels, varnish and supplements. Fluoride is most effective when combined with a healthy diet and good oral hygiene.
What causes cavities?
Bacteria in your mouth use the sugars and carbohydrates from your diet to create a plaque which adheres to the teeth. If left in place, the acidic plaque can eat through the hard outer layer (enamel) and infect the softer inside layer (dentin). If the decay is allowed to continue, it can infect the tooth’s nerve region (pulp). This can be very painful.

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Chong Orthodontics

Drs. Leonard and Scott Chong