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Patient Education - Babies and Kids

Teaching your child good oral hygiene habits early can lead to a lifelong healthy smile, but did you know that just because babies don't have any visible teeth, doesn't mean they can't get cavities? A baby's 20 primary teeth are already present in the jaws at birth. And those baby teeth that begin coming through the gums around 6 months help set the stage for future smiles by keeping space in the jaw for adult teeth.

Baby teeth matter

When a baby tooth is lost too early, the permanent teeth can drift into the empty space and make it difficult for other adult teeth to find room when they come in. This can make teeth crooked or crowded. That's why starting infants off with good oral care can help protect their teeth for decades to come. The ADA recommends that parents take children to a dentist no later than their first birthday and then at intervals recommended by their dentist.

Your Teeth

Your teeth are composed of four dental tissues. Three of them enamel, dentin and cementum are hard tissues. The fourth tissue pulp, or the center of the tooth that contains nerves, blood vessels and connective tissue is a soft, or non-calcified, tissue.

The Anatomy of a Tooth

  • Enamel - Hard calcified tissue covering the dentin in the crown of tooth. Because it contains no living cells, tooth enamel cannot repair damage from decay or from wear. Only a dentist can correct these conditions.
  • Anatomical Crown - The visible part of your tooth. It is normally covered by enamel.
  • Gums (also called gingiva.) - Soft tissues that cover and protect the roots of your teeth and cover teeth that have not yet erupted.
  • Pulp Chamber - The space occupied by the pulp the soft tissue at the center of your teeth containing nerves, blood vessels and connective tissue.
  • Neck - The area where the crown joins the root.
  • Dentin - That part of the tooth that is beneath enamel and cementum. It contains microscopic tubules (small hollow tubes or canals). When dentin loses its protective covering (enamel), the tubules allow heat and cold or acidic or sticky foods to stimulate the nerves and cells inside the tooth, causing sensitivity.
  • Jawbone (Alveolar Bone.) - The part of the jaw that surrounds the roots of the teeth.
  • Root Canal - The portion of the pulp cavity inside the root of a tooth; the chamber within the root of the tooth that contains the pulp.
  • Cementum - Hard connective tissue covering the tooth root, giving attachment to the periodontal ligament.
  • Periodontal Ligament - A system of collagenous connective tissue fibers that connect the root of a tooth to its socket.

Cavities

Tooth decay is the destruction of your tooth enamel, the hard, outer layer of your teeth. It can be a problem for children, teens and adults. Plaque, a sticky film of bacteria, constantly forms on your teeth. When you eat or drink foods containing sugars, the bacteria in plaque produce acids that attack tooth enamel. The stickiness of the plaque keeps these acids in contact with your teeth and over time the enamel can break down. This is when cavities can form. A cavity is a little hole in your tooth.

Cavities are more common among children, but changes that occur with aging make cavities an adult problem, too. Recession of the gums away from the teeth, combined with an increased incidence of gum disease, can expose tooth roots to plaque. Tooth roots are covered with cementum, a softer tissue than enamel. They are susceptible to decay and are more sensitive to touch and to hot and cold. It's common for people over age 50 to have tooth-root decay.

Decay around the edges, or a margin, of fillings is also common for older adults. Because many older adults lacked benefits of fluoride and modern preventive dental care when they were growing up, they often have a number of dental fillings. Over the years, these fillings may weaken and tend to fracture and leak around the edges. Bacteria accumulate in these tiny crevices causing acid to build up which leads to decay.

You can help prevent tooth decay by following these tips:

  • Brush twice a day with a fluoride toothpaste.
  • Clean between your teeth daily with floss or interdental cleaner.
  • Eat nutritious and balanced meals and limit snacking.
  • Check with your dentist about the use of supplemental fluoride, which strengthens your teeth, and about use of dental sealants (a plastic protective coating) applied to the chewing surfaces of the back teeth (where decay often starts) to protect them from decay.
  • Visit your dentist regularly for professional cleanings and oral examination.

Baby Teeth

A child's primary teeth, sometimes called "baby teeth," are as important as the permanent adult teeth. Primary teeth typically begin to appear when a baby is between age 6 months and 1 year. Primary teeth help children chew and speak. They also hold space in the jaws for permanent teeth that are growing under the gums.

The ADA recommends that a dentist examine a child within six months after the first tooth comes in and no later than the first birthday. A dental visit at an early age is a "well-baby checkup" for the teeth. Besides checking for tooth decay and other problems, the dentist can show you how to clean the child's teeth properly and how to evaluate any adverse habits such as thumbsucking.

When teeth first come in, some babies may have sore or tender gums. Gently rubbing your child's gums with a clean finger, a small, cool spoon or a wet gauze pad can be soothing. You can also give the baby a clean teething ring to chew on. If your child is still cranky and in pain, consult your dentist or physician. Most children have a full set of 20 primary teeth by the time they are 3.

Healthy Habits - Start Early

Your child's baby teeth are at risk for decay as soon as they first appear which is typically around age 6 months. Tooth decay in infants and toddlers is often referred to as Baby Bottle Tooth Decay. It most often occurs in the upper front teeth, but other teeth may also be affected. In some cases, infants and toddlers experience decay so severe that their teeth cannot be saved and need to be removed.

The good news is that tooth decay is preventable! Most children have a full set of 20 primary teeth by the time they are 3-years-old. As your child grows, their jaws also grow, making room for their permanent teeth.

Cleaning Your Child's Teeth

  • Begin cleaning your baby's mouth during the first few days after birth by wiping the gums with a clean, moist gauze pad or washcloth. As soon as teeth appear, decay can occur.
  • When your child's teeth begin to come in, brush them gently with a child-size toothbrush and water. A baby's front four teeth usually push through the gums at about 6 months of age, although some children don't have their first tooth until 12 or 14 months.
  • For children older than 2, brush their teeth with a pea-sized amount of fluoride toothpaste. Be sure they spit out the toothpaste. (Ask your child's dentist or physician if you are considering using fluoride toothpaste before age 2.)
  • Until you're comfortable that your child can brush on his or her own, continue to brush your child's teeth twice a day with a child-size toothbrush and a pea-sized amount of fluoride toothpaste. When your child has two teeth that touch, you should begin flossing their teeth daily.

Teething

Teething is one of the first rituals of life. Although newborns usually have no visible teeth, most baby teeth begin to appear generally about six months after birth. During the first few years of your child's life, all 20 baby teeth will push through the gums and most children will have their full set of these teeth in place by age 3. A baby's front four teeth usually erupt or push through the gums at about six months of age, although some children don't have their first tooth until 12 or 14 months. As their teeth erupt, some babies may become fussy, sleepless and irritable, lose their appetite or drool more than usual. Diarrhea, rashes and a fever are not normal symptoms for a teething baby. If your infant has a fever or diarrhea while teething or continues to be cranky and uncomfortable, call your physician.

First Dental Visit

As soon as your child's first tooth appears, it's time to schedule a dental visit. The ADA recommends that the first dental visit take place within six months after the first tooth appears, but no later than a child's first birthday. Don't wait for them to start school or until there's an emergency. Get your child comfortable today with good mouth healthy habits.

Although the first visit is mainly for the dentist to examine your child's mouth and to check growth and development, it's also about your child being comfortable. To make the visit positive:

  • Consider making a morning appointment when children tend to be rested and cooperative.
  • Keep any anxiety or concerns you have to yourself. Children can pick up on your emotions, so emphasize the positive.
  • Never use a dental visit as a punishment or threat.
  • Never bribe your child.
  • Talk with your child about visiting the dentist.

During this visit, you can expect the dentist to:

  • Inspect for oral injuries, cavities or other problems.
  • Let you know if your child is at risk of developing tooth decay.
  • Clean your child's teeth and provide tips for daily care.
  • Discuss teething, pacifier use, or finger/thumbsucking habits.
  • Discuss treatment, if needed, and schedule the next check-up.

Fluoride

Fluoride is a mineral that occurs naturally in all water sources, including oceans, rivers and lakes. Fluoride is also added to some community tap water, toothpastes and mouth rinses. Infants and toddlers who do not receive an adequate amount of fluoride may be at an increased risk for tooth decay since fluoride helps make tooth enamel more resistant to decay. It also helps repair weakened enamel. Bottled water may not contain fluoride; therefore, children who regularly drink bottled water or unfluoridated tap water may be missing the benefits of fluoride. If you are not sure if your tap water has fluoride, contact your local or state health department or water supplier.

Note: Discuss your child's fluoride needs with your dentist or pediatrician. They may recommend a fluoride supplement if you live in an area where the community water is not fluoridated.

Pacifiers

Infants and young children may suck on thumbs, other fingers or pacifiers. Pacifiers dipped in sugar, honey, juice or sweetened drinks, can lead to tooth decay. Tooth decay can also begin when cavity-causing bacteria pass from saliva in a mother or caregiver's mouth to the infant. When the mother or caregiver puts the baby's feeding spoon in her mouth, or cleans a pacifier in her mouth, the bacteria can be passed to the baby.

Concerns - Baby Teeth

Anesthesia and Sedation - Your dentist might recommend that your child be administered anesthesia or sedation to relax them in order to safely complete some dental procedures. Click here to download questions to ask your dentist before your child undergoes any type of anesthesia.

Baby Bottle Tooth Decay - You can help prevent your baby from getting cavities or developing what is calledBaby Bottle Tooth Decay or Early Childhood Caries, by beginning an oral hygiene routine within the first few days after birth. Start by cleaning your baby's mouth by wiping the gums with a clean gauze pad. This helps removes plaque that can harm erupting teeth. When your child's teeth begin to come in, brush them gently with a child's size toothbrush and water. For bottle feedings, place only formula, milk or breast milk inside and avoid using sugary beverages such as juice or soda. Infants should finish their bedtime and naptime bottle before going to bed.

Dental Emergencies - Accidents can happen anywhere, anytime. Knowing how to handle a dental emergency can mean the difference between saving and losing your child's permanent tooth. For all dental emergencies, it's important to take your child to the dentist or an emergency room as soon as possible.

Here are some tips if your child experiences a common dental emergency:

  • For a knocked-out tooth, keep it moist at all times. If you can, try placing the tooth back in the socket without touching the root. If that's not possible, place it in between your child's cheek and gum, or in milk. Call your dentist right away.
  • For a cracked tooth, immediately rinse the mouth with warm water to clean the area. Put cold compresses on the face to keep any swelling down.
  • If your child bites his tongue or lip, clean the area gently and apply a cold compress.
  • For toothaches, rinse the mouth with warm water to clean it out. Gently use dental floss to remove any food caught between the teeth. Do not put aspirin on the aching tooth or gum tissues.
  • For objects stuck in the mouth, try to gently remove with floss but do not try to remove it with sharp or pointed instruments.

Thumbsucking

Sucking is a natural reflex and infants and young children may suck on thumbs, fingers, pacifiers and other objects. It may help them relax or make them feel safe or happy. Most children stop sucking by age 4. If your child continues to thumb suck that after the permanent teeth have come in, it can cause problems with tooth alignment and your child's bite. The frequency, duration and intensity of a habit will determine whether or not dental problems may result. Children who rest their thumbs passively in their mouths are less likely to have difficulty than those who vigorously suck their thumbs. If you are worried about your child's sucking habits, talk to your dentist.

Space Maintainers

Space maintainers help "hold space" for permanent teeth. Your child may need one if he or she loses a baby tooth prematurely, before the permanent tooth is ready to erupt. If a primary tooth is lost too early, adult teeth can erupt into the empty space instead of where they should be.When more adult teeth are ready to come into the mouth, there may not be enough room for them because of the lost space. To prevent this from happening, the dentist may recommend a space maintainer to hold open the space left by the missing tooth.

Sealants

Sealants are a fast and easy way of protecting your child's teeth that act as barriers to cavity-prone areas. They are usually applied to the chewing surfaces of back teeth and sometimes used to cover deep pits and grooves. Sealing a tooth is fast and there is virtually no discomfort. As long as the sealant remains intact, the tooth surface will be protected from decay. Sealants hold up well under the force of normal chewing but may have to be reapplied if needed. Both primary and permanent teeth can benefit from sealants. Ask your dentist if sealants will help your child.

Mouthguards

Mouthguards can help protect your child from a dental emergency. They should be worn whenever your child is participating in sports and recreational activities. Mouthguards cushion blows that would otherwise cause broken teeth, injuries to the lips and face and sometimes even jaw fractures. If your child participates in such pastimes, ask your dentist about custom-fitted mouth protectors.

Malocclusion

Malocclusion, or bad bite, is a condition in which the teeth are crowded, crooked or out of alignment, or the jaws don't meet properly. This may become particularly noticeable between the ages of 6 and 12, when a child's permanent teeth are coming in. If not treated early, a bad bite can make it difficult to keep teeth and gums clean where teeth are crooked or crowded, increasing the risk for cavities and gum disease.

Bad bites can also:

  • Affect proper development of the jaws.
  • Make the protruding teeth at risk for chips and fractures.
  • Affect eating and speaking.
  • Make some teeth more likely to wear abnormally or faster than those that are properly aligned.

Nutrition

Children need strong, healthy teeth to chew their food, speak and have a good-looking smile. What's more, a good diet is essential for a child's growth and development. Almost all foods, including milk or vegetables, have some type of sugar, which can contribute to tooth decay. To help control the amount of sugar your child consumes, always try to read food labels and choose foods and beverages that are low in added sugars. Also, select beverages, such as water, that hydrate and contribute to good nutrition.

What to Eat

According to MyPlate, a website from the Center for Nutrition Policy and Promotion, an agency of U.S. Department of Agriculture, a balanced diet should include:

  • Fruits and vegetables - Combined these should be half of what your child eats every day.
  • Grains - Make sure at least half of their grains are whole grains, such as oatmeal, whole wheat bread and brown rice.
  • Dairy - Choose low-fat or fat-free dairy foods.
  • Lean proteins - Make lean protein choices, such as lean beef, skinless poultry and fish. Try to vary protein choices to include eggs, beans, peas and legumes, too. Eat at least 8 oz. of seafood a week.

In addition to a nutritious diet, snacking habits, bottles and pacifiers also impact your child's oral health. Here are some tips to keep your child's mouth healthy:

  • Place only formula, milk or breast milk in bottles. Avoid filling the bottle with liquids such as sugar water, juice or soft drinks.
  • Infants should finish their bedtime and naptime bottles before going to bed.
  • If your child uses a pacifier, provide one that is clean don't dip it in sugar or honey, or put it in your mouth before giving it to the child.
  • Encourage children to drink from a cup by their first birthday and discourage frequent or prolonged use of sippy cups.
  • Serve nutritious snacks and limit sweets to mealtimes.

For tips on how to get your children to eat more fruits and vegetables, visit the Academy of Nutrition and Dietetics.