Local Dental Care - Teething Age

Toddler And Pre-Schooler Dental Care

Almost half of the three-year-olds whom I see for a first dental examination have one or more cavities. Primary (baby) teeth do not have the enamel-strengthening advantage of fluoride during their development, because only trace amounts of fluoride pass through the placenta to the fetus. The primary teeth begin to develop during the sixth week and are calcifying at twenty weeks during pregnancy. Infants may be infected with the bacteria that cause tooth decay as early as ten months of age. This occurs when the caretaker tastes or blows on baby's food or by kissing. The decay-causing bacteria are transferred in saliva. Constant exposure of the teeth to juices, milk, or other sweetened drinks, either in a baby bottle or sippie cup, may also cause decay. Early childhood decay may result in a tendency to experience decay for the rest of your child's life. Good oral hygiene is just as important for the primary teeth as it is for the permanent teeth.

Pediatric dentists believe that toothpaste should not be used until after two years of age. A match head-sized amount should be dispensed. Some toothbrushes have a colored area on the brush head to indicate how much toothpaste to use. Do not permit your toddler to eat toothpaste from the tube. If your little one does not like toothpaste, do not use any. The fluoride in toothpaste does help to decrease decay, but sometimes brushing without toothpaste is necessary. Do not use tartar control toothpaste until the teen years. There are too many additives.

Toddler's teeth should be brushed at least once each day. Bedtime is always the most important time to brush the teeth. During the day, saliva flows over the teeth to aid in removing any food residues. Brushing should be done only by the parents, not the toddler or preschooler. A serious injury can result from permitting your child to run with a toothbrush in his or her mouth. Once all 20 primary teeth have erupted (come in), begin to brush after breakfast too. Do not permit your little one to brush first. The benefit of the fluoride in the toothpaste will be lost. Brushing the toothpaste directly onto the tooth's enamel surface will add to fluoride's strengthening effect. The toothbrush is not a toy. Chewing on the bristles will bend them. The brush must be replaced if this occurs, because it can no longer properly remove plaque. The brush should have a small, rounded head with soft bristles.

Most parents find brushing in a seated position to be easiest. Sit on the floor, the bed, or the couch and place your child's head on your lap. If your toddler is not cooperating, wrap one of your legs around both of his/her legs. Use your free hand to hold his/her hands. Your child will probably be protesting with the mouth wide open. Take advantage of the moment and brush! Brushing does not have to take two minutes. Thirty seconds may be enough time to cover all baby tooth surfaces. Do not think about time, just be sure to brush all surfaces.

A back and forth or small circular motion may be used for brushing primary teeth. Covering every tooth surface is most important. If you brush with the same pattern every time, you will be more efficient. Begin with the upper right or left primary molars. Brush from one side of the mouth to the other. Include the chewing surfaces and the side of the teeth next to the roof of the mouth. Move on to the bottom primary molars. Brush in the same manner as the upper teeth, moving from right to left, or vice versa, including the chewing surfaces and the side of the teeth next to the tongue. Ask your little one to close his or her mouth and brush the sides of the teeth all the way around next to the cheeks. Gently pull the bottom lip away from the bottom incisors (front teeth) and brush upward and away from the gum line. You may notice some light staining on these teeth when your little one is taking an oral antibiotic.

If there are no spaces between the primary teeth, flossing should begin. The same reclined position used for brushing should be used for flossing. Pretend like you are the dentist. This can become a time for not only cleaning teeth, but a time for desensitizing your child. Each time you brush or floss, he/she will become more accustomed to being in a reclined position with this activity occurring in his/her mouth. There are so many varieties of floss. If the teeth are tight together, use waxed floss. Your child may like the flavored floss, which also is easy to use with tight teeth. Use a piece of floss the length of your wrist to your elbow. Wrap the floss around your middle fingers on each hand. Palms will face upward for the top teeth and downward for the bottom teeth. Use your thumbs and index fingers to gently slide the floss between the teeth. In this case, begin with the front teeth first because they are easier to reach. Wrap the floss in a C-shape around each tooth and use an up and down motion (not back and forth) to floss. After a short time, you will be a pro! If you can manage to floss each day, that would be great, but two to three times a week is adequate.

No matter how much your child prefers to delay or avoid brushing, do it! It is much better for you to have a battle at home than for your child to experience early decay and have to undergo dental treatment at age two or three. In most cases, decay is preventable. Here's to a cavity-free future!

by Jane A. Soxman, DDS

+Jim Du Molin is a leading Internet search expert helping individuals and families connect with the right dentist in their area. Visit his author page.

Management of Injury to Children's Permanent Teeth

Recent studies indicate that 25% of Americans between the ages of 6 and 50 years have experienced traumatic injury to permanent teeth. Ninety percent of traumatized teeth involve the upper incisors. The focus of contemporary treatment of dental traumatic injuries is conservative management of the affected tissues to maximize their excellent healing potential in children. The most important element in this process is the reduction of the time interval between the traumatic episode and the dental treatment. Dental treatment should therefore be sought immediately. It is for this reason that public information on dental trauma management is so critical, particularly in the following three areas.

Coronal Fractures -- Broken Crowns of Teeth

The predominant treatment goal in tooth crown fractures includes protecting the underlying pulp (nerve tissue) within the tooth from bacterial contamination and infection. Additional goals include keeping the adjacent teeth from moving into the space created by the missing tooth portion and restoring the esthetic appearance and function of the traumatized tooth.

Dental treatment of crown fractures involves the following steps. The affected teeth and surrounding soft tissues are cleansed with an antibacterial mouthwash and the exposed dental hard tissues are protected with either an applied protective medicament or an adhesive resin material. These measures provide a seal against bacterial penetration into the porous tooth structure and subsequent infection of the underlying pulp. A resin (plastic) restoration of the lost tooth portion is placed for esthetics and function. In cases where the missing tooth fragment can be found, it can be reattached to the remaining tooth portion with dental adhesives. The treated teeth are then monitored post-operatively for signs of possible infection over a period of several months to a year.

Tooth Displacement Injury -- Loosened or Dislodged Teeth

The predominant treatment goal for displaced teeth focuses on protecting the supporting tissue known as the periodontal ligament from bacterial invasion and subsequent infection resulting from the injury. This tissue surrounds the root of the affected tooth and has the primary function of attaching the tooth to the bone.

Dental treatment includes stabilizing the excessively loosened or displaced tooth by means of short-term splinting. The splinting device consists of an orthodontic brace wire attached to the affected tooth and adjacent teeth with resin adhesive for a one to two-week period. Additional treatment may include esthetic restoration of tooth portions damaged by the injury as previously mentioned, and post-treatment monitoring for signs of healing.

Tooth Avulsion -- Teeth That Have Been Knocked Out

Treatment goals for knocked-out teeth are focused on enhancing periodontal ligament survival. The critical variable is the length of time that the tooth has been out of the mouth without any means of providing hydration and nutrition to the periodontal ligament cells attached to the avulsed root surface. This time length is known as Extra-Oral-Dry-Time (EODT). If the EODT is less than one hour, the chances for periodontal ligament survival is quite good, provided the appropriate management is started immediately.

Dental treatment of avulsion involves minimizing the EODT by immediately replacing the tooth back into the socket or immediately placing it in a transport/storage solution to hydrate and nourish the periodontal ligament cells still attached to the root. The most readily available transport media is cool milk. Special tissue culture fluids are even better, but generally are available only from a dentist, drug stores, or school health clinics. On-site tooth avulsion management includes the following:

1) Rinse the knocked-out tooth under tap water only if there is dirt.

2) Replant the tooth in its socket and keep it held in position, or place it in milk (or culture fluid, if available).

3) Immediately take the child to a pediatric dentist who will stabilize the tooth with splinting devices previously mentioned and provide the necessary treatment of the pulp and the periodontal ligament.

The more we can do to enhance the excellent healing potential of the traumatized tissues in children, the better the outcome.

By Clifton O. Dummett, Jr., DDS

+Jim Du Molin is a leading Internet search expert helping individuals and families connect with the right dentist in their area. Visit his author page.