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.

This problem doesn’t occur too frequently, but when it does it leaves parents scratching their heads in curiosity. There are a few reasons this can occur and all will require a trip to the dentist for an x-ray and evaluation.

As mentioned in the second section, developing permanent teeth can be affected by a variety of things including high fevers, certain antibiotics and trauma to the baby tooth (transmitting trauma to the underlying permanent tooth). Permanent teeth can also be affected when they are traumatized directly once in the mouth.

How these “damaged” teeth will react really depends on the type and severity of the trauma. Some teeth will still “survive” but may appear malformed or have some kind of distinguishing mark on them. Others may not have been able to tolerate the trauma and eventually “die.” This “death” simply means that the living tissue inside the tooth (called the pulp) are damaged to the extent that they cause death to that tissue. That living tissue, or “pulp” is the nerve and blood vessels which supply the tooth sensation and sometimes, outward color.

When a tooth “dies” or is in the process of “dying,” the entire tooth undergoes multiple changes which can have many effects, many of which differ slightly depending on the individual.

Occasionally, a traumatized tooth may undergo a reaction with the fancy name of “calcific metamorphosis.” Wow-what a word! It simply means that the tooth felt the trauma and reacts to it by laying down extra layers of minerals within the tooth. This layering of extra minerals (which is really just extra tooth structure), results in a “squeezing” down of the pulp or living tissue located inside the tooth. This frequently, but not always, causes death to that living nerve tissue inside the tooth (the pulp).

This death doesn’t always occur, but does eventually in a high percentage of teeth. This strange process of laying down extra layers of tooth actually causes the tooth to turn more yellow that the other teeth. Treating these teeth can be complicated because though they usually do die, they don’t always do so, regardless of how yellow their color becomes.

Typically, if the tooth doesn’t reveal signs of death when the dentist evaluates it, they will choose to do frequent x-rays and re-evaluate at certain time intervals. They will also have the parent keep a watchful eye for any signs of tooth death such as, pain, change in tooth color (grey or further yellowing), swelling, a “bump” on the gum, or a foul odor coming from the child’s mouth.

If the tooth is confirmed to be dead after evaluation by the dentist, then a root canal is usually done to rid the infection that comes with the death. A root canal usually does not hurt, despite popular myth, and is simply the removal of the dead tissue from within the tooth. The tooth is usually numb for the procedure but doesn’t always have to be, depending on the situation. Once the dead tissue is removed, the inside of the tooth is cleaned and sterilized with tooth-friendly substances. The area is then filled with a special rubbery material to seal it off from other possible bacterial invaders.

Unfortunately, this usually will not fix the color change that has occurred, and occasionally it can become more exaggerated. There are several things which can correct the color change, including procedures such as, internal whitening of the single tooth, a veneer or crown. They may also be able to place a simple, tooth-colored filling that is layered on top of the tooth to mask the color. Each of these are too detailed to describe here and require that you discuss the suitable options for your child’s particular circumstance.

This is a question I get asked frequently and has an answer which provides a huge relief for many parents. In most cases, these yellower teeth are completely normal. It’s actually considered to be an optical illusion! You see, baby teeth, as mentioned earlier are actually nick-named “milk-teeth” because of their bright, white color. They are beautiful, delicate and oh-so adorable. Then, our permanent teeth make their appearance right beside those beauties. Permanent teeth are actually much yellower than baby teeth and often appear big and “gangly.” So, when sitting adjacent to something so spectacular such as baby teeth, they can appear downright ugly at times.

If you don’t make mention of it to your child, they often don’t even notice and therefore won’t become self conscious. The issue is that some people truly do have naturally darker teeth than others. Color and whiteness shades are highly variable and can also run in families. This is why whitening products have become so popular in our culture today. Once your child’s permanent teeth have all come in, re-evaluate the color then and see how they appear to you. My guess is that they will not appear as yellow/dark as they first did while next to the “milk-white” teeth. If they are, and if the child is self conscious, whitening toothpaste and possible whitening agents can be considered once the child is at the age appropriate time.

There is also another cause of yellow teeth in children which can be a quick fix-depending on your child. Often times the discoloration is caused by poor oral hygiene. If the child does an inadequate job at brushing, or refuses to brush regularly, a thick layer of yellow plaque builds up on the teeth. This can make teeth appear up to 3-4 shades darker than they actually are. So, look at your child’s teeth carefully. If you see a layer of “fuzzy” looking film that looks as if it could be scraped off, then you likely have your culprit.

There are generally not many foods or drinks that will cause staining at this age, unless you are allowing your child to have red wine or coffee! Iced or hot tea can also cause staining which is easily removed during regular dental check-ups. If your child has the dreaded “fuzzy’ layer and also drinks sodas frequently, the staining may be exaggerated. Smoking can also cause staining, but if your child is smoking at this age, then I suspect you have bigger worries than yellow teeth!

One last note to mention here. There are other causes of darker teeth and if you feel that these above are not the reasons for it, please see your dentist for an evaluation. There are multiple genetic disorders and diseases which can affect tooth color. These disorders can cause yellowing, but more importantly can affect the overall integrity of the teeth.

Examples of these disorders include but are not limited to: Amelogenesis Imperfecta and Dentinogenesis Imperfecta (each with sub-type categories). These disorders, cause defective enamel or other tooth tissues, can give a “flaking away” quality and appearance of tooth, rather than yellowing alone. There are ranging severities of the disorder and thus the appearance will vary from person to person. Though yellowing alone is uncommon in these disorders, it still can be the only obvious sign. When in doubt, check with your dentist, as these disorders need special attention in order to keep the teeth healthy. If the teeth appear red, green or brown or any other abnormal color, please see your dentist or physician immediately.

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 sticky situation to be in. I will be very honest with you, as a mother I want to be privy to everything that goes on with my children. I understand the natural parental instinct that makes you want to protect your children at all costs. We want to shadow doctors and dentists to be sure that they are taking care of our kids the way that they would their own. However, the dentist side of me will tell you that most of the time children do MUCH better when parents are not in the room during treatment. Many of our mini-sized manipulators (including my own) play the “Dr. Jekyll and Mr. Hyde” game while at the dentist.

It is pretty amazing to see how a child is polite and well behaved in my dental chair until the moment a parent walks in the room. Once the parent enters, there is usually a plethora of temper tantrums and a refusal to open their mouths. When mom and dad leave the room, it is back to cooperation with a smile. However, some children actually will do better with a parent in the room, or even while sitting on the parent’s lap during treatment. I would suggest trying it without the parent first unless you know that your child will in no way go for it. We want them to have a good experience, so whatever it takes is what needs to be done.

If a dentist is good with kids and speaks their “language,” often they will let you do most dental work without much hesitation. Of course, that doesn’t apply to all kids, which is why man invented sedation. I very strongly discourage parents from coming back in the treatment room. I never refuse to allow them back and I personally don’t feel that it is appropriate to do so. If a child does well with a parent in the room, then there really isn’t any reason to have them leave. However, leaving the room can often give mom or dad a little “quiet time” and break from the daily grind. I’ll be the first to admit that those little breaks are some of the best opportunities for me to recharge before tackling the remainder of the day!

The dentist side of me also feels very strongly that a parent should not be allowed to compromise a child’s dental experience or dental treatment. So, if a child is unmanageable while a parent is in the room and the parent refuses to attempt treatment with them out of the room, then I simply decide that this is not a patient relationship that I feel comfortable continuing. As dentists, we are providing medical care to your child and so, it is very important that we have a very open line of communication and trust with you. If that relationship does not exist, then perhaps a relationship with another dentist would better suit the needs of both parties. Another thing that can be difficult about having a parent in the room is that is can be very distracting to the dentist, dental assistant and even the child.

As parents, we have a natural curiosity for the process of things and also to help soothe our children. With such a short attention span from children, it makes it very difficult to work quickly and accurately while a parent is asking questions or talking to the child (obviously if the child is asking you a question, that is does not apply). If you decide to stay in the room during treatment, I would recommend trying to be very quiet and keep questions and conversation to a minimum. Try to save questions either before treatment or after and let the staff attempt to soothe the child first. Too many people talking to the child distracts and upsets them. And please, whatever you do, avoid the trigger words that panic children, like “needle,” “shot,” “drill, “hurt,” “pain,” and the list goes on. It truly is in the best interest for your child’s care and their overall experience. Treating children is very much like playing a game of chess in the middle of a preschool classroom. It already takes a lot of concentration to get the moves right in a quiet setting, much less in the midst of noise and physical chaos! Remember, they are a moving target for us, all while we attempt to do procedures at an almost microscopic level, with materials which have to stay completely dry, with instruments that can cause tissue damage. And, all of this is done in a dark, wet place, about the size of pool ball, with a “trap door” that opens and closes without warning. Wow, I am exhausted just thinking about it!

I am sure that different states have different laws pertaining to the refusal of allowing a parent in the room, so check with your state accordingly. However, if you feel you need to check on the law, then it might be prudent to examine the relationship you have with your current dentist, as I am guessing it is not one built on trust or communication. Of course, there are special situations when refusal to allow parents back in the room is acceptable, such as legal guardianship issues and court orders (for example, restraining orders). If you have any questions regarding these specifically, always seek the advice of your attorney. Remember, try to make the experience a good one for your child. One hundred percent of my adult patients who are terrified or fearful of the dentist tell me they are so because they had a bad childhood experience. It just shouldn’t be that way! If all of your efforts still prove fruitless, then sedation may be the best option for your child.

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.

The body is truly amazing in so many ways (and just plain frustrating in others).  While a visit from the tooth fairy can be exciting for some kids, others are left frustrated that she may never pay a visit.  There are so many variations in how/when/where teeth become loose and actually fall out, that it can be stressful for both parents and kids.  Most kids will go along simply following the “normal” pattern and have regular visits from that darn fairy.  Some parents don’t ever have to lay a hand on those slippery little rascals while others are wondering if they need string or pliers.

In most cases, even if a tooth is loose for awhile, it will come out on its own or with the help of the child wiggling it.  If you are unsure, you really should make a visit to your dentist for an evaluation.  There are times when we elect to extract a baby tooth.  Some teeth are stubborn and when they don’t come out on their own, the permanent one tries to come in around it.  This can create orthodontic problems in the future, so in this instance it is generally recommended to remove the baby tooth.  This is usually only done when the tooth is evaluated and determined that it just isn’t going to come out on its own.

Also, on occasion, we will “help” the little guy out of there if we feel there is a choking hazard.  This is rare, but is done  if the tooth is extremely loose and the child or parent just can’t get it out. It is generally very easy to get out without upsetting the child.  If half of the tooth is broken out and the other half is stuck and not loose, it is wise to bring the child to the dentist for an x-ray.  Your dentist may or may not choose to extract the remnant, depending on what the x-ray reveals and other considerations which  they will discuss with you.

I personally do not recommend string tied to doors (OUCH!) or pliers from the garage.  The one tool I do recommend is patience.  Challenging, I know but it will eventually come out with a little twisting and wiggling and a positive attitude!

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.