If your dentist determines that your child’s teeth are in fact darker than normal and your child is concerned with their appearance, then there are a few things to consider. I get this question often, and my answer is always the same: wait until your child is at least 18. There isn’t necessarily a specific age that is appropriate for your child to use whiteners. I base my opinion on what little research exists on the use of whitening agents in adolescents. Always consult your family dentist prior to trying any over-the-counter whiteners on your child.

As you may or may not know, there are several ways to whiten teeth. All have one similar feature: the use of a whitening agent such as hydrogen peroxide, carbamide peroxide or other agents. Some techniques use a special light during the application of the whitener to enhance whiteness (i.e., Zoom Whitening Sytem). Others use customized trays in which the whitener is placed and worn on the teeth for a certain period of time and for a certain length of time. These are both considered to be professional grade whiteners, and my personal preference is for the custom tray method, as whitening can be controlled by the patient and there is typically less sensitivity. Over-the-counter methods include “Crest Whitestrips” and its “Rembrandt” competitor.

Whitening agents can cause sensitivity to both the teeth and gums, and can sometimes be much more exaggerated in young teeth. This can be a painful experience, and quite troubling for teens and adolescents. The other main concern, particularly with the accompaniment of the light accelerator, is damage to the nerve tissue within the tooth (also called dental pulp). Few studies have been done on teeth whitening in adolescents, but some hypotheses of whitening in youth are, that it could cause damage (either irreversible or reversible) to a child’s teeth. This thought pertains to any method used for whitening.

Damage to the pulp can be reversible or irreversible and so symptoms may be as minimal as sensitivity, but can also result in death of the dental pulp. If death of the pulp occurs, a root canal is then needed to permanently eliminate the pain. There are not a lot of studies done in this area, because as you can image it raises some ethical dilemmas in order to gather the data. In adults, however, whitening is considered to be very safe and non-damaging, assuming you follow the direction for the brand of whitener. Though adults may experience some sensitivity, generally it is transient and not a problem.

So, my personal philosophy is, I don’t whiten teeth unless the child is at least eighteen, so that the tooth tissue has time to mature. If the child’s teeth appear to inadequately matured, regardless of age, I may still suggest waiting a little while. This maturity will hopefully allow for minimal sensitivity and hopefully no tooth damage. While in general whitening teeth is perfectly safe, we still must use caution when considering them as options.

Sealants are a very popular procedures these days and for good reason.  Sealants are different from a regular filling in several ways.  First and foremost, a sealant is placed as a preventative measure on a tooth in order to help protect it from getting a cavity in the future.  Sealants are usually only placed on permanent molars and usually only if the teeth show deep grooves which appear susceptible to tooth decay.  A “filling” is done because a tooth already has existing decay which needs to be removed, followed by “filling” the hole back in.

Sealants material is just slightly thicker than finger nail polish and is either clear or white and isn’t strong enough to be used for “filling”.  The sealant material bonds to the tooth’s deep grooves and coats them with an almost invisible layer.  The sealant, once placed, is hard and impenetrable and  therefore keeps food and cavity-causing bacteria from accumulating in the grooves of the tooth.  The theory is then that the tooth will be less susceptible to decay because both the bacteria and their food source for causing decay cannot easily stay on the tooth without the presence of these deep grooves to hang out in.  This would then lessen the likelihood that the bacteria could cause a cavity.

A  “filling’s”  composition is similar to the sealant material except that it contains very hard glass crystal particles.  These glass particles make it much stronger and less prone to wear and breakage than a sealant.

This property is not necessary with a sealant, as you are generally not removing any tooth structure (creating the hole from removing decay).  You are simply laying a protective coating down on the tooth.   The sealant material should NEVER be used alone as a filling and if you notice this during your child’s visit, be sure to ask why.  Sometimes you will find that your dentist places sealant material over the top of a new filling.  This is actually a good thing and is done to help protect any grooves on the tooth that were not affected by decay.

Sealants are placed by cleaning the grooves of the teeth to be treated with a lightly abrasive cleansing paste. The teeth are then prepared by placing a special acidic cleaner, which will be rinsed off and dried.  The sealant material is then placed on the tooth, followed by a special dental light, used to harden the material.  Once placed, the sealant is almost invisible or just barely white.

The child does not need to be numbed for the procedure and is generally very quickly finished, depending on the behavior and opening ability of the child.  The most challenging part of the procedure for both  the child and the dentist, is that the teeth have to stay completely dry the entire time.  If the teeth become contaminated with saliva at all, the sealant material will not stay long-term.  You can only imagine how tricky this can be on squirmy little ones who also happen to have saliva that flows like a fountain!  You think getting them to eat vegetables is tricky-try this out and you’ll feel honored to be the vegetable monitor!

My personal philosophy on sealants is this:  Sealants are a fantastic preventative tool if they are done correctly.  Though it is a simple procedure, it is very technique sensitive and requires precision work for it have a good outcome.  Unfortunately, there are two mistakes I have seen which can not only cause the sealant to fail, but ultimately lead to a cavity, which is the exact thing we are trying to prevent!

Dental assistants and dental hygienists in some states are legally allowed to place sealants without help from the dentist, provided the dentist authorizes it and is they are present in the building at the time.  Most assistants and hygienists are more than capable of placing them correctly.  However, as a dentist who works on children frequently (including my own), I will tell you that those kids are big wigglers!  I have rarely treated a child (unless much older) that can sit still and hold their mouth open long enough to do the procedure adequately all by myself.  So, if I am the dentist, the “top dog” so to speak,  and I am telling you it is already tough to do well with two people helping, then how good will the sealants be if someone with less experience and training are placing them alone?

It is definitely a two-man job most of the time. A second person is really necessary to hand the other person materials/instruments, suction the saliva and rinse the cleanser while the other is soothing the child, keeping the mouth open and placing the sealant, all in a matter of seconds.              If you are a parent of a child in this age range, you can only imagine the difficulty of this, all the while not getting a single drop of saliva on the tooth before the sealant hardens up.  In fact, children’s saliva flow increases significantly when dental procedures are being performed, adding even more difficulty to the process!

In addition, placement of too much sealant during this chaotic process can also have the same poor outcome.  Sealant material becomes very weak when thick, and is then more prone to fracture.  I frequently see new decay around sealants that have fractured because of excessive thickness of the material.  So, if you look in your child’s mouth and can see the material easily after the sealants are placed, there may be too much material placed.  This is not always the case, as sealant material color can vary from manufacturer to manufacturer.  However,  the sealant should definitely appear confluent with the anatomy of the grooves of the tooth rather than a “blob” of white stuff in the middle of the tooth.

Contamination with saliva and sealant fracture can actually lead to a cavity faster than if not placed at all.  However, a sealant placed properly can have dramatic results in preventing cavities for years!  Most dental offices do a great job in their placement, but at least now you are informed of the process and if something doesn’t seem right to you, then always ask!  All if this being said, I am not saying to blame your dentist/hygienist if the sealant fractures or gets a cavity around it.  This can still happen even if the sealant was placed absolutely perfect.  But minimizing these technique errors can certainly raise the chances of having a successful sealant.

So, if it were me at the dentist with my child getting sealants, I would always request two people to help during their placement.  This may agitate the staff a little, because they probably hadn’t planned for this and may cause them to run behind schedule.  But, rest assured, they will get over it and you will get a better sealant!   If they are still sour about the request or refuse it altogether, then it may not be the place you want to go for dental care!  You can blame it on me if you like, I don’t mind! I would rather your child not receive a lousy sealant!