My decision to create this site was made because of the many questions I get as a dentist from parents regarding their children’s oral health. It seems that many of the “What to Expect ” books and childcare guides omit something very critical in raising and caring for children. A subject that is so simple but so easily dismissed as common knowledge or topics that your pediatrician will discuss with you. Unfortunately, most pediatricians know VERY LITTLE about the dental health of your child. So, this leaves many parents wondering if they are providing adequate dental care for their children. Too often this lack of knowledge causes irreversible damage to their kid’s teeth and a serious dent in their wallets.

I hope you find the information on this site to be a  mildly humorous, very informative, myth-busting, easy to understand guide that should help you feel confident that you are on the right track with your child’s oral health. My other hope is that this knowledge will allow you to save money when it can be saved, and to spend it when it really needs to be spent.

These questions were chosen because they are by far the most common I receive at the dental office or more often, when I am at social functions for my own kids! The answers are then provided in a way which I think just about everyone can understand. I hope after reading some of these posts, you find yourself empowered and fully informed.
I hear all of these questions far too often, which leads me to believe that there is a serious lack of knowledge on the subject. Since dental decay in children is the #1 childhood disease, it is very important that parents are well educated on the subject. I feel strongly that we can better help the future of our children if we can share the knowledge to prevent these dental problems. These problems are far too often physically, mentally and financially challenging for parents and children, both short and long term. So, my hope is that after you find something useful or helpful, you feel confident in sharing the vital information with others so that they too can avoid some of the costly or worrisome situations.
You may also have friends in your social circle with younger children who may have questions that you will now feel confident answering for them. Even though you may only have a teenager now, life can be full of many unplanned miracles-so it is always better to be prepared now! Whatever the reason, share the knowledge with your friends and family.

My biggest piece of advice is this: Do not allow or at least minimize the amount of soda, diet soda, sports-energy drinks and fruit juices you allow your children to have. This is particularly so with teenagers. With all of soda “hype” and advertising geared toward kids these days, there’s been a significant increase in the number and frequency of cavities in kids of all ages. Advertisers have been successful in their marketing and the results have been devastating. Kids are getting so many more cavities, and much, much earlier. This has had a huge ripple-effect in many areas of health, not just teeth, including obesity, diabetes, high blood pressure and more.

Dental work is not an exact science, Things wear out, break down, stop working and need to be replaced eventually. At some point, teeth can no longer be filled and fixed. After multiple fillings or other procedures, there sometimes just isn’t enough tooth left to work with. With so much soda exposure (diet and regular), teeth are being filled much earlier in our children.

This increases the rate at which this “dental fatigue” occurs, leading to earlier and more abundant tooth loss. Because of the way in which sodas and all of these new sugary drinks work, they almost always cause cavities in multiples. Rather than a single cavity in few years, kids now come in with 10 or more at one time before they are even 18 years old. This can be very traumatic to the child, very expensive for the parents and result in continual dental problems throughout the child’s life.

So I hope that my message was loud and clear and that you will take it very seriously. Even if your child is not a soda-drinker or a sweets-lover, they may still be prone to getting cavities for other reasons such as poor hygiene or even a family history. There are other things you can do to help prevent tooth decay which are discussed in the “General Information” category.

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.

The answer is absolutely! In fact, many sugar-free gums today contain an amazing substance called Xylitol. Xylitol has been shown in studies to actually help decrease tooth decay and acts as a mild antibacterial agent. Some of the brands which contain xylitol are, Orbitz, Koolerz and Trident’s sugar free gum. There are more brands now on the market, so just read the package to see if it is in the gum. Generally, the closer the desired ingredient is to the beginning of the list on the package (in this case xylitol), the more it contains.

In addition, chewing gum stimulates saliva flow which helps to fight further against cavities. Saliva contains many natural anti-cavity substances in it and is just one more hopeful way to protect teeth. So let them chew like crazy!

There are various aids to help fend off cavities caused by dry mouth, including anti-cavity rinses, prescription toothpastes and more (discussed in the general questions section). There are also several over-the-counter items that can be used to help stimulate saliva flow and moisten a dry mouth, such as Biotene brand products (sold in pharmacy area of most grocery stores). Chewing sugar-free gum is also a great way to increase saliva flow and helps with the effects of dry mouth syndrome.

If your child suffers from a dry mouth, have them drink water throughout the day. Do not allow them to sip on soda, diet soda or fruit juice, or you will likely see cavities very quickly. A dry mouth alone can increase the rate of getting cavities significantly, as saliva contains many anti-cavity substances. So, once you add sugars to the mix, it is a recipe for disaster!

The only other significant effect that steroid inhalers can have on the mouth is increasing the risk of getting oral yeast infections. You may have also heard it called “thrush” or “candidiasis.” “Thrush” is a condition caused by the overgrowth of a normal bodily fungus called, “Candida Albicans.” This fungus is normally present, but occasionally (especially while taking antibiotics or steroid-containing medicines) can grow in more abundance than usual. Thrush is very frequently seen in babies during the bottle or nursing stage, but less often with inhaler use It can range in severity but looks like “curdled milk” in the mouth that won’t wipe off. If it caused by an inhaler, it is usually seen on the roof of the mouth and throat.

It doesn’t usually hurt anything but can cause irritation or burning to the oral cavity and look unsightly. However, you don’t want to leave it untreated, as it is possible for the fungus to infect the blood or other areas of the body. This is rare but should be mentioned, as to avoid a potentially life threatening situation.

Both children and adults can get candidiasis, but adults typically get it in others areas of the body and is experienced much more by women. The best way to avoid both “thrush” and dry mouth from inhaler use is to rinse the mouth out with water out after each use. This is true for both children and adults who use steroid inhalers. There are medications to treat oral yeast overgrowth and they are usually very simple and work very well. Again, if you see any white areas in your child’s mouth anywhere, always consult your dentist or pediatrician, as it could be caused by other more serious things.

Believe it or not, this situation is relatively common. This too tends to run in families, but not always. This brings back the important topic of x-rays. This situation is usually first noted when they child has the panoramic film taken around age 5-7. Typically, though not always, teeth will be missing in pairs. They are also usually missing the same tooth but on different side of the jaw. For example, the child might be missing both lower first premolars/bicuspids on the right and left bottom, but not on the top.

When this does occur, most dentists will give you the same advice: Do everything you can to take care of and keep the baby tooth so it can maintain the space and function of the missing permanent tooth. This is because it holds the space open for future treatment (if needed), which may otherwise be complicated by loss of the space.

If the tooth cannot be maintained, the dentist may suggest the use of a space maintaining appliance (discussed in the general questions section). There are situations where the baby tooth may actually be better of being extracted. For example, if the child already has abundant crowding, then this may actually alleviate the need for braces.

So, always talk to your dentist or orthodontist about what the best option for your child may be. If the baby tooth is unable to be retained permanently due to looseness or an extensive cavity, there are options to replace the tooth in adulthood if necessary. A few examples of what those options may be are: Dental implants, fixed bridges, denture or retainer with a tooth on it. Again, discuss these options with your dentist and see which one will best suit your child.

The good news is that it could also be nothing. There are other causes of tooth pain which may be transient. If your dentist can find no apparent source for the pain, then they will likely search for other possible sources for it. Some of these may include simple things, such as night-time grinding (to be discussed later), food impacting in the gum, and irritation from flossing (this is not typical, since kids in the range usually refuse to floss)!

There are other reasons for tooth pain that can be a sign of something more serious. This is unusual, however, the possibility should not be overlooked. Your dentist should be aware of these and will likely evaluate for them if the problem continues with no apparent cause for the pain.

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.

Unfortunately, this is not a simple question to answer because of its high variability. “Shots” or anesthetic are given according to body weight and percent concentration of the anesthetic being used. I won’t bore you with the exciting details, but there is a formula that is used to calculate the maximum dose which can be given for each child. Generally, we don’t give anywhere near that dosage to even have to use the formula, but it does happen on occasion.

You can’t really go by the number of “shots” your child gets because the amount of times your child is “stuck” may have nothing to do with how much anesthetic is actually being placed. For example, I may “stick” a child three separate times, but use that same cartridge of anesthetic for all three areas. So even though the child got “stuck” three separate times, I am well below any maximum dosage (unless the child is an infant, which is very uncommon).

The time to be concerned is if you see several cartridges used on a very small child. In general, I personally do not usually give more than two cartridges on a very small child, but again this is all calculated by body weight and percentage of the anesthetic and so may be perfectly acceptable to proceed with more.

Older children, especially teenagers may receive a similar amount of anesthesia as an adult if there approximate weight is the same. Some medical conditions may also alter the amount required to give, but if your dentist is already familiar with your child’s health history, they will likely already have adjusted the amount without you even knowing so.

There are certainly cases of anesthetic toxicity in children, so this again goes back to becoming your child’s advocate. If something doesn’t seem right, question it. It isn’t to say that you need to be abrasive, but if you have a concern you should always express it to your dentist. Go with your gut instinct and if you aren’t happy with what you experience, then go get a second opinion.

Something else to be concerned about when a child receives local anesthetic is lip and cheek biting. Being numb for a kids feels pretty cool. It feels like your mouth is made of rubber when you chew it. The problem is that it is not rubber and if they chew on it while it is numb, a large hole can be made that will surely be felt later. It may sometimes even require stitches if enough damage is done.

So, your job as a parent when leaving the dental office is to be sure your little one isn’t in the back seat gnawing on their own body parts. You can ask the dentist for some gauze to have the child rest on, and when you get home you can place warm, moist compresses on the anesthetized area to help it wear off more quickly.

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.