The use of an American Dental Association approved fluoridated toothpaste at least twice a day for at least two minutes each time is a great start. Any toothpaste with the ADA approval seal is sufficient for use. I don’t personally recommend non-fluoride toothpaste, as I have seen a dramatic difference in the number of cavities in children and adults who use it. Fluoride helps to strengthen, protect and harden teeth, making them more resistant to tooth decay. However, the decision is ultimately up to you as the parent, so do whatever you feel is best for your child.

If I had a quarter for each time I was asked this question, I would be retired on a beach, relaxing with an umbrella drink in my hand! This question, as well as the one after it, has many different answers, depending on who you talk to. The reason being is this: Removal of wisdom teeth is predominantly a practice philosophy rather than an exact science. What I mean is, there is much leeway, discussion and debate among all types of dentists as to what is the best treatment of wisdom teeth is. So, what I will give you is my personal philosophy, but the decision is ultimately yours!

Wisdom teeth are the last teeth to erupt and are the teeth furthest toward the back of the mouth. They are also referred to as “third molars,” and will frequently never appear in mouth. This can be due to lack of space in the mouth or simply because many people are born without them. Often times, there is no room for the wisdom teeth to erupt, leaving them trapped in the jaw or only partially erupted. So let’s discuss a few of the problems which arise from extracting them vs. leaving them and you will quickly see why there is so much debate.

If the wisdom teeth do have space to come in completely, then a few scenarios can occur. If your child is able to reach all the way back there and keep them immaculate, then typically there are not any problems with keeping them. However, it has been my experience that few adults are able to keep them clean enough to avoid cavities or gum disease around the teeth. It is extremely rare that I actually get to witness the miracle of cavity-free wisdom teeth. Generally, it takes awhile to get a cavity back there (it usually shows up in your mid-twenties to mid-thirties.)

Once a cavity is present, the tooth either needs to be filled or extracted. Attempts to fill wisdom teeth are mediocre at best, unless you have the ability to open very wide. Because the teeth are so close the jaw-joint, it is very difficult for the dentist to see if all the decay has been removed, or keep the tooth dry enough to retain the filling.

In most cases, the filling eventually fails and the tooth has to be extracted anyway. The same holds true for gum disease. Because they are hard to clean, they very often are afflicted with moderate to severe gum disease. If left, the gum disease can cause bone loss around the tooth, bad breath and possibly increase the risk for spreading the disease to the rest of the mouth.

As adults, we heal much slower, experience more pain and have the added trouble of having to take time off of work. I personally tend to be more pro-active with recommending extraction of wisdom teeth, especially those that will likely fully erupt into the mouth. This is because I know the child will be thankful I did once they are an adult!

The other advantage is, that when you remove the wisdom teeth before they are completely developed, they are actually much easier to remove. This results in less pain after surgery, faster healing time and less of a risk of complications from the procedure. So, the possibility of reducing these risks by extracting them as an adolescent is very appealing to me as a mom and a dentist!

Well, let’s suppose that the wisdom tooth is not in at all, partially in (but stuck that way), or has no space whatsoever to come in. An x-ray (a panorex or panoramic film) will have to be evaluated by the dentist or oral surgeon before a decision can be made. Most times the teeth can still be removed with relative ease and without complication. However, there are situations which may predispose your child to temporary or permanent complications.

Close proximity of the lower wisdom teeth to the main nerve supplying all the teeth can be a concern. Injury to this or any other nerves in the areas can cause partial or complete, permanent or temporary numbness to the lip, chin, teeth, gums, tongue or skin in the area. In addition, the top teeth may be so high up in the jaw that risk of damage to the sinuses and other structures can occur. Your oral surgeon will be aware of these complications and any others as they apply to your child.

So, if the wisdom teeth seem risky to extract and the likelihood of the teeth ever erupting is low, then I typically recommend leaving them. The benefits of extraction must be carefully measured against the risks involved and be sure to discuss them in detail with your surgeon.

I also want to bring up the importance of the oral surgeon here. As we discussed earlier, specialists exist in dentistry because they are necessary! While there are general dentists who can take out wisdom teeth with great proficiency, I still strongly encourage having an oral surgeon perform the procedure.

An oral surgeon does this procedure every day, many times a day and they are simply better, faster at it and are more familiar with the complications which can occur from their removal. They are also more familiar with the internal jaw anatomy which is rarely seen by a general dentist. This is not to say that a general dentist is not capable, as there are plenty out there that would do just as good as any oral surgeon. However, my experience has been that this is the exception and not the rule.

This answer is very similar to the one above. Let’s face it. We all have a crutch that helps us get through the tough times. Some people rely on faith, others on food and some on other addictions.
So, it should come as no surprise to you that our children have their own little “fixes” to get them through the tough times. One of the biggest of these is thumb-sucking or finger-sucking, with or without the use of a “blankie.” I would never dare ban the coveted “blankie.” In fact, I know several adults who still sleep with theirs! I sucked my thumb as a child, and oh, the relief was amazing! But again, at some point certain addictions have to end before they have damaging consequences.

Generally it is safe to let your kids suck away until age four. Before age four, you may notice the effects of sucking on their front teeth. What you will likely see is that your child’s front teeth are “bucked out” and perfectly fit the offending thumb like a key in a lock. Prior to age four, if the child stops, the teeth will usually drift back into their normal position. After age four, however, the effects become more permanent and may also affect the path of eruption of the permanent teeth and shape of the palate (roof of the mouth). This can result in your child’s permanent teeth also appearing “bucked,” crowded, spaced or some combination of these. And, you guessed it, an expensive trip to the orthodontist!

Alright, let’s face it-most adults do a poor job of brushing their teeth on their own. So, it should be no surprise that most kids do an even worse job (including my own). My oldest boy is nine and highly intelligent. However, if I let him brush on his own and then check after him, you would swear that he just ate a plaque sandwich right before I looked. Disgusting, I know, but incredibly true.

Now, we of course have to let our children acquire their independence whether we like it or not. Trust me, if I had it my way, I would drive him everywhere and keep his curfew at 10 PM until he was 30. But I can’t, so I have to go with the flow. With brushing, this too is the road I must take. You need to allow them the independence to brush on their own, even from a young age (at 2 or 3 years old). However, like all parents, we must be undercover detectives and be sure they are doing an okay job. So, I will often check after brushing and give helpful hints on areas they may have missed.

Another completely covert method of checking up to ensure adequate brushing is the use of those plaque dyes made just for kids. They swish it in their mouth for a few seconds (the child must be old enough to spit it out to use it) and it will stain any plaque on their teeth. The child will think this is so cool to see and then has the job of removing all the colorful stain. You can obtain these dyes in a few different ways: First, you can ask your dentist if they can give you the little pink or blue tablets (chewable) that stain their plaque (called disclosing tablets). Then, your child just chews them up, spits out the excess and voila-a beautiful bounty of stained bacteria to brush off! Second, you can use a plaque staining rinse for children (i.e. Agent Cool Blue by Listerine). Then they simply rinse instead of chew. I personally prefer the tablets, as they work much better and stain much brighter. They can be harder to find over the counter however.

Speaking of stain-those little tablets and swishes are also fabulous as staining lots of other items, so you may want to supervise the process! As mentioned earlier, the child should be old enough to rinse and spit the mouthwash out without swallowing to avoid any potential toxicity. As a side note, teenagers seem to be the worst at brushing. So be prepared for some dental challenges. Don’t fret too much, however, for us dentists are fantastic at giving lectures and guilt-trips to teens, especially in front of their parents. You can use this tactic however you choose. Parental threats to teenagers have ranged from taking away TV and video games, all the way to making the child help pay for any cavities found at the next appointment!

This is a very common question from parents.   Most often, if a child’s breath still smells after brushing, it is because they are not brushing their tongue.  The tongue is a haven for bacteria and makes a nice “home” for them to grow and reproduce.  These normal occurring bacteria, when allowed to grow excessively, can cause a quite foul smelling aroma if not brushed away.  This can happen to adults as well, and so as part of your brushing routine you should include a thorough scrubbing of the entire tongue.  Your child’s tongue should appear pink, including at the back.  If they have a yellow or whitish-looking  coating, they likely are not brushing their tongue.

This could also, however, be “thrush,” a fungal overgrowth common in babies, but less common in toddlers.  So, if they brush their tongue well and it still does not come off, consider a quick trip to  the dentist for an evaluation.   Thrush is easily treated but if left untreated can spread or be uncomfortable for the child.

There is actually a specialized dental aid, called a tongue cleaner , which works very well also.  It’s not very appealing, and works by simply scraping the layer of bacterial tongue film off.  They are safe for adults and children to use, but I prefer brushing just because I already have enough “icky” things at my house from parenting two boys!  Be sure when brushing that you are reaching far enough back on the tongue.  Sometimes this will cause the child (or adult) to gag in response.  Just do your best to reach where you can!

Another common cause of this amazing “phenomenon” is poor brushing technique and/or not spending enough time brushing.  Those of you who have kids in the older age range are probably all too familiar with these types of amazing “phenomena” in other areas of your family life!  Your child should spend at least two minutes brushing their teeth at least twice a day with an American Dental Association approved, fluoridated toothpaste (please refer to the next section of the book for age-appropriate times for introduction of toothpaste).  Poor brushing technique and lack of adequate time leaves that layer of “fuzzy” plaque on your teeth.  That plaque is actually a thick film layer of bacteria and food debris and can be quite smelly.

Over time, if this layer is not removed, it starts to become hard and cannot be removed without scraping with a special instrument at the dentist.   This “hard stuff” is called tartar (your dentist calls it calculus).  When it gets stuck on the teeth and not removed, it is the culprit that causes gum disease.  This tartar layer then starts to build upon itself, sticking to one layer after another, ultimately spreading beneath the gums.  The body then views this concrete-like stuff as a foreign substance and tries its best to be rid of it.  The entire process is really astounding, really.  Pretty nifty when you think about how well our bodies are at fighting invaders!  Unfortunately, this nifty little process has some big, bad side-effects.

In the body’s great attempt to get rid of this villain called tartar, it emits some harmful chemicals to other parts of the mouth.  These tiny little chemicals are actually destructive to the bone which hold the teeth in place.  They slowly erode that bone away and little by little the teeth become loose.  So loose in fact, that the teeth can eventually fall out on their own or have to be extracted by your dentist.

This viscous, destructive cycle is what we call “gum disease” but your dentist will refer to it as “periodontal disease.”  Don’t get confused, they mean the same thing!  Gum disease can range from mild to severe and treatment for it depends on the severity of the disease.  Another term you may here is “gingivitis.”  Gingivitis is the early stage of gum disease. At this stage, no bone has actually been lost, but the process is on its way if not treated with a professional cleaning and better oral hygiene

As a dentist, the gum disease process is one of the most devastating and saddest of all dental problems for me to see.  The reason for this is because in most cases, it is completely preventable and curable if treated early.  The cure is so simple but the effects of no treatment are life altering.  I have seen more tears than I care to share with you from premature loss of teeth in young and otherwise healthy people.  Loss of teeth can be a very emotionally upsetting experience for many people, especially when it occurs in the front of the mouth.

Now going back to our non-compliant little adults and tykes. I know what you’re thinking.  I have tried to make my child brush their teeth.  I tell them all the time and they just don’t do it.  How am I supposed to get a teenager to brush?  I don’t have time to look over their shoulder.  The great news is, no shoulder looking is usually required, because you can smell it from a mile away!  The only suggestion I have to offer here is using whichever form of discipline you use normally (assuming it doesn’t involve lashings or something similar)!  For me, personally, I find taking favorite toys, gadgets or privileges away to be handy and often successful!

Another way is to be able to show the child the amount of “grime” on their teeth.  This is also one of my personal favorites, as it tends to “gross-out” most older kids and encourage them to brush better.  For younger kids, it is actually fun and a form of entertainment!  There are several ways you can show them.  One of the best is to ask your dentist for plaque tablets (called disclosing tablets).  They are usually purple or pink and about the size of an aspirin tablet.  The child will chew it up, swish it around in their mouth and then spit it out. Then, voila-you have a brightly stained layer of bacterial fuzz which they have to brush off!  Not only will this show them how much they are missing while brushing, but it will also get them used to how long and how much pressure they need to use to adequately brush their teeth.

There are also over-the-counter plaque dyes that can be used such as “Agent Cool Blue” by Listerine and a few others.  However, my experience has been that the professional dyes (disclosing tablets) work much better but are a little trickier to find.  Your dentist should be able to help you find the tablets if you are not satisfied with the results of the over-the-counter stains.

Speaking of stain-those little tablets and swishes are also fabulous as staining lots of other items, so you may want to supervise the process!  As mentioned earlier, the child should be old enough to rinse and spit the mouthwash out without swallowing to avoid any potential toxicity.

There are also other more concerning reasons for the malodor.  Though uncommon, other reasons include tooth decay, gum disease, gastro-esophageal reflux and other disease processes.  So be sure to take your child to the dentist for a thorough exam if tongue brushing or better brushing  doesn’t remove the odor.

Some of the more serious causes of yellow teeth are genetic disorders, high childhood fevers, or damaged or dying teeth. These types of discolorations can be more difficult to treat but most of the time they can be treated effectively by a dental professional. In fact, I recommend going to the dentist for an evaluation prior to starting any tooth whitening or tooth bleaching system. Starting treatment with a healthy mouth is extremely important. Attempts at self treatment with over the counter products can result in unwanted reactions if not treated appropriately. If you get an A+ at your dental check up, then most dentists will recommend trying over-the-counter products first if you meet the recommendations.

Children can suffer from yellow teeth as well. Most parents will notice that when their child gets their first set of permanent teeth, they appear more yellow than the “baby” or toddler teeth. This is normal and is usually nothing to worry about. However, many genetic disorders such as amelogenesis imperfecta, and several others can cause yellow teeth. Have your child’s teeth evaluated and hopefully it will provide you with relief that all is normal. Whether they are normal or determined to be truly yellow, treating children’s yellow teeth will be different from adults.