In the last decade, cosmetic dental services, including tooth whitening, has grown to a multi-billion dollar industry. More, now than ever, even in a down economy, people are still paying top dollar to improve their smiles. Some may argue that even more money is being spent on cosmetic teeth whitening than before, as an aid to increase competition in this already difficult job market.

There are many ways to whiten teeth and much of choosing depends on the person’s goals and personal preferences. Home whitening kits, both professional and over-the-counter can be successful, depending on the magnitude of white teeth a patient desires, as well as the initial color and yellowness of the teeth to be whitened. If teeth are extremely dark, then whitening of the teeth by the dentist may be necessary in order to achieve a patient’s cosmetic desires.

A visit to the dentist prior to starting any teeth whitening treatments is recommended, as there are situations that teeth whitening may be harmful to the teeth. In addition, you may actually save money by whitening in a way specific to your teeth rather than blindly spending money on things that may not work on you.

There are many over-the-counter tooth whitening kits available with many different types and concentration of bleach. Be sure to educate yourself on what you are buying in order to increase your chances of the whitest, brightest smile for the money!

I need to address a widespread problem regarding bottles and sippy-cups. NEVER let your infant or toddler fall asleep with a bottle of milk or juice. I know from personal experience that lack of sleep can cause us to take desperate measures. One of these measures is propping or allowing a child to have a sippy-cup or bottle of milk or juice to help them fall asleep. This is the number one cause of severe tooth decay in children and its effects can be devastating. This situation is called “baby-bottle tooth decay” or “bottle rot.”

Image courtesy of Dr. Martin S. Spiller

Once the baby/child falls asleep, the milk and juice pools in the mouth and those cavity-causing bacteria commence their attack. It can decay a child’s teeth so quickly and so severely, that that the child can actually end up losing all or most of their baby teeth. This is especially troubling considering they don’t start getting their first adult teeth until around age six or seven!

 
This loss of teeth can lead to many disheartening situations, such as the child having to wear a partial or complete denture just to be able to eat. This is a very tough ordeal for a child to have to go through on many levels, including functionally, socially and psychologically. Not to mention the many extra trips to the dentist the child will have to endure throughout their childhood. So please try to remember to reserve those cups and bottles for mealtime only. You can see for yourself the devastating consequences that it can have.

This is perhaps the most commonly asked questions about children’s teeth. In fact, parents who have children in the 0-6 year old range often wonder if they even need to worry about their kid’s teeth at all. I would like to stress that this age range is one of THE MOST IMPORTANT times in the care and maintenance of your child’s teeth. Repeat after me: “This age range is one of THE MOST IMPORTANT times in the care and maintenance of my child’s teeth.” You are officially now more informed than 98% of the world.

I want to first dispel a major dental myth that we touched on briefly in the general questions section. You know, the one that says, “They’re just baby teeth, they are going to fall out anyway.” WRONG. Those cute, milk-white, little-bitty, ankle-biting pearly whites are the foundation that will determine whether or not you may have to pony-up $5000 for braces several years from now. Baby teeth are crucial in holding the space in the dental arch for the future permanent teeth. They predict and help guide the underlying permanent teeth into their future locations and thus will have a huge impact on both the appearance and functionality of adult teeth. Extracting them rather than filling them in many cases can cause mild to severe crowding, spacing and asymmetry of adult teeth that may not have otherwise occurred.

Without those baby teeth, we lose many opportunities to prevent later orthodontic problems. Not to mention when you extract teeth, adult or otherwise, you greatly affect the ability to chew. I think it is only fair that we allow our children to experience the delight of eating as we do, but children need to eat for nourishment to allow for proper growth. The ability to chew can limit what a child is able to eat and thus have effects on both their mental and physical development. So, we can see that in most cases it is better to try to save a baby tooth rather than extract it.

Too often parents consider baby teeth “disposable,” since they will fall out anyway. They are far from disposable and almost always benefit the child most by doing what it takes to save them. There are exceptions to this rule. For example, if a baby tooth has a cavity but no infection present, and the tooth is within 6 months of falling out, your dentist will probably recommend the baby tooth not be treated. This makes sense as it would be pointless to waste money on a tooth that will very soon come out on its own. In addition, removal of baby teeth can sometimes actually help prevent braces altogether. While braces may be unavoidable whether you maintain baby teeth or not, you’ll see that there are other extremely important reasons to keep baby teeth healthy. So, with this new paradigm shift in thought of caring for your child’s baby teeth, let’s go into more detail about these curious topics!

Children are not just little adults and so we can’t treat them as such. Baby teeth are shaped much different than adult teeth, which causes some need for modification when treating them. Because of the shape of baby teeth, we cannot place anything but a very small filling in them, otherwise the filling will break and a new cavity will be created.

The guidelines for treating baby teeth are that if a cavity is of moderate or larger size, a procedure called a “stainless steel crown” is done. This little, silver crown or “cap” is glued down over the existing tooth (after it is specially prepared for it). By having this fairly strong metal covering the entire surface of the tooth, the underlying tooth and filling is protected from breaking from the forces of chewing. As mentioned earlier, a filling or stainless steel crown is usually only needed on a baby tooth which is not due to fall out on its own any time soon. The dentist will evaluate the extent of root development on the underlying permanent tooth with an x-ray. This information, combined with the patient’s age, will be used to determine the approximate amount of time until the baby tooth would likely fall out on its own. If the dentist feels that it will be less than six to nine months, they may recommend no treatment of the tooth unless there is infection present. In this case, they may elect to proceed with the crown (and baby root canal) or simply extract the baby tooth.

Images courtesy of Dr. Martin S. Spiller

This stainless steel crown is similar to a crown or “cap” that an adult may have, except that it is cheaper and meant to come out when the baby tooth falls out. They are usually silver but occasionally for cosmetic reasons can be tooth-colored when needed on front teeth. If your child needs a crown on a baby tooth in the front, be sure to tell your dentist BEFORE the start of the procedure if you want it tooth-colored. They won’t always ask and once it is placed it is usually not easily removed.

 
A stainless steel crown may or may not also have a root canal done at the same time. Yes-baby teeth can have a root canals done on them. Once again though, the concept is different from an adult tooth. Your dentist may call the root canal by several names (each meaning something slightly different to the dentist but making no real difference to you as a parent). Some of those names you may hear are: root canal, pulpotomy, pulpectomy, pulpal debridement and pulp therapy. There are others, but these are the most commonly used.

A root canal in simple terms is the removal of nerve or pulp tissue from the inside of the tooth. It can be removed for many reasons, but for children it is usually done because of a cavity that extends into the pulp/nerve tissue or because of a dead nerve/pulp that is causing an abscess. Baby tooth root canals are different from adult teeth in a few ways. Unlike permanent teeth root canals, those performed on baby teeth do not usually have the rubberized material placed in the canals afterward. They usually only receive a sedative paste which hardens inside the tooth and keeps the infection away. This material is also easily deteriorated by the body as the roots of the baby teeth resorb away and prepare for eruption and loss. They are not as exact of a procedure as root canals on permanent teeth and take much less time. They are not painful and nowhere near as expensive.

So, we can see that sometimes both procedures may be done simultaneously or independently, depending on the child’s unique situation. Your dentist should discuss options with you and don’t be afraid to ask questions. You are your child’s advocate and so you should always attempt to keep yourself informed of any procedure being done

So, what happens if you don’t have the root canal or don’t treat the tooth in any way? Well, if you refuse treatment and also refuse then to have the baby tooth taken out, many things can happen, most of which are bad. The child can end up in the hospital with an infection, particularly if the child is diabetic. I have been unfortunate to have been witness to this and it is truly heartbreaking for me. Not only is this sad for the child, but it puts the dentist in an uncomfortable situation regarding appropriate care and treatment of a child. Proper authorities have to be notified if the child is put in danger. Thankfully this is not extremely common but it does occur.

If hospitalization does not occur, then the abscess will find a way to drain, usually by a small hole made in the gum to relieve pressure and drain puss-right into the mouth. This can cause bad breath and an upset stomach, not to mention it is just disgusting. The other major concern is that an infection left in the tooth can cause damage to the permanent tooth below the offending tooth. Damage may appear as a misshapen, malformed or discolored permanent tooth. It can also cause defects to the underlying developing jaw bone. The affected permanent tooth may then need treatment when the child is older to correct cosmetic problems which may arise as a result.

Unfortunately, it is true.  It doesn’t happen too frequently, but when it does, it can have many possible effects.  The fever has to be pretty high and for a pretty descent length of time.  This fever was likely when the child was younger than age ten, and usually affects the permanent teeth that are in the same sequence of development.  When the adult teeth come in, you will likely see the same marking across all of those particular teeth that were developing during the time of the fever.

Markings may appear anywhere from faint lines and ridges, to an almost unrecognizable tooth.  The latter is less common and when it does happen,  is not usually the entire tooth but the area undergoing the most development at the time.  Unfortunately, the enamel strength may have also been effected, causing the teeth in question to be slightly more susceptible to decay in the future.  It may also cause damage to only one tooth.  It really isn’t that common but does happen and I have seen it several times.  If you have any concerns, be sure to ask your dentist.  Usually your dentist will notice it during an exam and ask if you recall an illness where the child had a high fever.

Treatment will depend on the severity and location of the defect.  There may not be any treatment needed at all.  Most often no treatment is needed and when does, typically requires only a filling to mask any unsightly or unappealing marks which may cosmetically bother the patient.

You may be aware that your child grinds their teeth either because you hear them grinding or the child’s dentist advised you of it.  This process of grinding has the fancy dental name of “bruxism.” So, what will you hear if your child grinds their teeth?  It sounds much like two rough stones rubbing together, with added bonus feeling you get when fingernails run down a chalkboard!

What will your dentist see or how will you know if you never hear the child do it?  They will see flattened areas or “cupped-out” areas on the teeth which should normally be sharp.  This cupped area is called a “wear facet” and is caused by the eroding away of enamel that grinding causes.  They may also notice small chips or fractures on the edges of the front teeth.  Our teeth should resemble a true carnivore’s and not that of a cow!  Occasionally they may see enlarged muscles in the jaw from the huge amount of force that is exhibited.

Grinding in children is actually quite common and in most cases nothing to worry about.  Children and adults grind their teeth for many reasons, however, the complications from this are slightly different in adults than in children.  We’ll discuss that in a moment, but first let’s talk about why grinding occurs.

Common causes for grinding in children include some of the following:  A change in their existing bite due to the eruption and movement of the permanent and baby teeth.  This transition from baby teeth to adult teeth is called “mixed dentition” and, as you can imagine, is always in a continuous state of change.  Due to this rapid change, the body will sometimes make attempts by grinding to put the jaw in a more natural position as it relates to the jaw joint.

Other reasons can be from stress or tension.  Our kids are truly resilient, but make no mistake, they experience daily stress just as we do.  They won’t likely show it by telling you directly, just as adults don’t express our stresses by having a tantrum in from of our boss.  So children tend to act out, misbehave or some variation of this during times of stress.  Other children may have no behavioral changes other than grinding their teeth.  These minor and major stresses in life can cause the body to tense up at night and the jaws are no exception.  Kids can clench and grind their teeth just like adults, and like adults it may ebb and flow with the amount of stress they are under.

Some children grind their teeth for no apparent reason.  The same holds true for adults. Occasionally you find that a parent or sibling is also a grinder, or clenches their teeth, appearing to run in the family.  There are other reasons why adults may do it, but that is for another post!

So, now we know why, let’s discuss what we do about it.  Most often we do nothing about it at this age unless it is extremely severe.  Part of the reason is that the child’s mouth is changing so rapidly that it is difficult to make an appliance that fits for any length of time to help the problem.  If it is severe enough, a soft plastic protective guard may be made every few months to keep from damaging the teeth.

Once all of the permanent teeth are in and stable, your dentist may choose to make a custom acrylic night guard for your child.  This clear, hard, plastic guard is custom fit to your child’s teeth and has two purposes.  The first obvious purpose is to protect the teeth from doing damage to one another by the constant wear from the friction action of grinding.

The second purpose is to establish an ideal placement of the teeth and jaw joints during the grinding process.  The jaw muscles, jaw joints and often the teeth can become quite sore from grinding due to the constant tension created.  This tension can also cause headaches, neck aches, backaches and added bodily stress and fatigue.  When a custom night guard is designed, special features are built into it which minimize the amount of force generated on the jaw, muscles and teeth.  So, for adults or children suffering daily from these symptoms, a custom night guard can increase the quality of life significantly.

For an adult or child who has no symptoms at all, the goal is simply to protect the teeth from grinding away excessive tooth structure.  If left untreated, this excessive damage can lead to speedy tooth decay, fractured teeth, root canals and many other problems.  If your child still has many baby teeth and grinds severely, have an evaluation by your dentist to see if a temporary guard needs to be made so that the baby teeth don’t become excessively damaged.

Also, you would be wise to talk to your child or observe what stresses they may have in their life which may be contributing to the problem.  It is amazing how even little things can upset kids such as “Billy thinks my new favorite toy is stupid” or “Rachel is dating the boy I like.”  Remember, what seems trivial to us may have a large impact on them.  Sometimes a simple conversation can relieve a lot of tension for a child.

The answer I am going to give you is going to sound ridiculous at first, but if you listen to my reasons, you will see exactly why we recommend the following:  In general, a child should first see the dentist when their first tooth comes in.  There are two reasons for this.  The biggest one, at least the one they teach us in dental school, is because teeth exhibit many possible signs of underlying bodily diseases that may otherwise not be discovered until a much later time.  There are many genetic disorders and syndromes that show their signs first in the teeth before in any other part of the body.  A few examples include ectodermal dysplasia, amelogenesis and dentinogenesis imperfecta and many more. While most of these disorders are indeed somewhat rare, I think common sense tells us that the sooner we can catch them, the better opportunity we have to treat them.

In addition to this, parents must remember a long used phrase about children: “Kids are NOT little adults.”  Now, I am sure this makes complete sense to you when you think about the daily things, like why kids think it is fine to eat mac n’ cheese for every meal or why they still can’t put their shoes on the right feet at 10 years old.  Or how they can have 103 degree fever and still be functional when us adults would be bedridden and begging to be put out of our misery.   So, this phrase is applicable in many areas, but is particularly true in the world of dentistry.

One thing parents need to know about their kid’s teeth is that children’s teeth are “softer” than adult teeth and therefore decay at a much faster and easier rate.  Not only are they more susceptible to decay, their nerve tissue within the tooth is much closer to the outside of the tooth than an adult.  This makes it much more likely that they will need a “child root canal” or extractions, even with the presence of only small amounts of decay.  So, with this in mind, we can see how an early trip to the dentist can minimize problems which may have otherwise become huge problems by waiting.

Another important thing to know is that those baby teeth which seem so unimportant are actually a blessing in disguise.  As you will read in subsequent chapters, those little teeth will help pave the way for the future position of the permanent teeth.  Extracting them prematurely can cause many cosmetic and functional problems which can be very costly later on.

While I am a dentist, my most challenging job is being a mom.  That is why I actually feel that this next reason for going to the dentist at an earlier age is one of the most important. I have rarely seen a child in this age range that is eager and excited to hop up in a large, squeaky chair, in an unfamiliar place and open their mouths for a total stranger wearing latex gloves and a scary mask.

To top it off we expect them to open willingly and let us come at them with large, sharp instruments. Yikes!  If they scream just sitting on Santa’s lap, what makes us think they will be excited about going to the dentist?  If we take our children young enough and make it a fun place without all the scary stuff first, then their visits will be an experience to look forward to rather than fear.  So, the mom side of my persona always wants me to create fun and wonderful experiences for my kids and the kids I treat.  The earlier they start seeing the dentist, the less fearful they will be.

I usually suggest that you bring them in with you when you have your own cleanings done every six months (provided you, yourself are not a big chicken).  This will reinforce that you are not scared and get them familiarized with the office so that they are comfortable with the surroundings.  Eventually, the child will recognize your dental office and look forward to coming with you because they always get a toothbrush, a sticker and a sugar-free lollipop!  The biggest miracle of all is, that after a few times, you’re little one will actually beg the dentist to look at their teeth and will ask them to be cleaned.  Easy as taking candy from a baby (which, by the way, your baby shouldn’t have candy in the first place-but we’ll talk about that more later)!

If you, as a parent, are a dental-phobe, then have your spouse or someone else take your child so that they ALWAYS begin their dental journey with nothing but a positive experience.  Keep in mind that if someone other than the child’s legal guardian takes the child, you will need to give the caretaker some form of written and/or verbal consent for treatment.  The laws vary by state, so be sure to inform yourself and also keep good communication with the dental office staff about treatment and finances involved in your child’s care.

If your child is still uncooperative despite all efforts, or your current dentist is not great with kids, then I would highly recommend seeing a pediatric dentist.  This kind of dentist sees only children and has the entire office set up for kids, from music, TV, giant kid-friendly murals, puppets and most importantly…sedation.

My general feeling about sedation is that if it is necessary to help your child have a great dental experience, then strongly consider it.  If you have to consider sedation as an option, please be sure to discuss with your dentist all of the risks involved with this type of chosen sedation.  While sedation is a great opportunity to complete your child’s dental care with ease, there are risks you should be aware of.  Though rare, there is the possibility of accidental death as a result of sedation and so the procedure should be considered only if truly necessary.  Due to the wide variety of sedation options and the fact that selection of the type of sedation varies by child,  I will not go into specific details.  Just inform yourself well and use that information to aid in making your decision.

By and large, the number one complaint I hear from my adult patients who are terrified to go to the dentist is that they had a traumatic childhood dental experience.  If we start out positively as a child, then we will have no reason to fear the dentist as an adult.  Going to the dentist regularly will become a desired, regular occurrence, like birthdays or  holidays.  Okay, okay, maybe I am exaggerating a little, but they still can be fun experiences for kids!

These bi-annual check-ups and cleanings allow us to catch problems while they are small, thereby keeping most dental procedures extremely conservative for both kids and adults.  I know it may seem hard to believe, but going to the dentist really can be an enjoyable (not just a tolerable) experience.