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.

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.

First, if the tooth is only fractured part of the way off, call your dentist immediately. The child will need an x-ray, evaluation and treatment right away to help prevent further complications.

If the tooth has come all the way out (called and avulsed tooth), there are a few things which need to be done and all must be done quickly for the tooth to have any chance of surviving. First, find the tooth and lightly wipe it off with a moist, clean cloth to remove any debris. Ideally, the tooth should be placed in the child or parent’s cheek in an area where it won’t be accidentally swallowed or inhaled. (I know, pretty gross, but it is for the sake of your child). If this is too upsetting or you are afraid it will be swallowed, the tooth can be placed in a glass of milk.

You should immediately take your child to the dentist, ideally within the first 10 minutes of the occurrence. The dentist will likely try to place the tooth back into the socket once it is clean and lacking debris which might cause later infection. The tooth will then likely be splinted to the adjacent teeth for support, to help minimize movement. This support will help the tooth re-tighten back into the socket and is sometimes left for up to two to three weeks. The tooth will likely need a root canal since the nerve was severed, but this likely won’t be done for two or three days after.

If the tooth has been out of the mouth for longer than fifteen minutes, your child still needs to see the dentist immediately to avoid more complication or possible permanent loss of the tooth. Bring the tooth with you as mentioned above.

If you are far from the dentist, the tooth is clean and you feel that the tooth is intact, you can attempt to put it back in the socket yourself. Be sure that if you are going to attempt this, you place it in the correct way! The child should immediately be taken to the dentist for an evaluation. If the tooth cannot be found, the dentist may refer you to the emergency room for a chest x-ray to be sure that it has not been inhaled during the accident.

I won’t go into great discussion about the further treatment sequence in dealing with an avulsed tooth, as it is varies with the child and the extent of the injury. The biggest point being that you should take your child to the dentist immediately to avoid further complications which can be both emotionally and financially draining.

The other item I want to discuss is something called “Hank’s Solution” or “Hank’s Balanced Salt Solution.” This is a special liquid formulated by a scientist that is extremely compatible with living tissues and can help to stabilize an avulsed tooth until it can be placed back in the mouth. This solution is better than milk or any others that I am aware of and can help to increase the likelihood that the tooth will be successfully re-implanted. The only catch is that you have to have it before the injury happens! A great addition to your home first-aid assortment is the “save-a-tooth” kit. It Uses the specially formulated pH balanced solution, as well as a unique removable basket and net container that protects tooth root cells crucial to the success of the re-implantation process.

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!

When we are first-time parents, we often have many new gadgets and gizmos to figure out how to use. Luckily, taking care of your child’s teeth is fairly devoid of a fancy products needed to complete the task. When your child is in the infant stage, you may want to consider using one of those super-cool finger brushes. You do not want to put toothpaste on them yet. They are made primarily to massage the gums during the teething stage to help the teeth come in more comfortably for the baby. It may also help in getting the child prepared for having a toothbrush at a later time. You could also have the same effect with a wet washcloth-just be sure it is clean before using.

Once the baby has teeth, we usually recommend the child chew on a toothbrush without toothpaste. It is my preference to place the child in a highchair or on your lap where they cannot fall or slip and become injured by the brush. Always supervise the child and no time restrictions are necessary at this point-just watch and enjoy! At around age two to four you can introduce fluoride toothpaste to the brush. They make special toddler toothpaste with tastes that are more appealing to your little tike. You should use a very small, less than pea-sized amount!

As a general rule, I usually tell parents that if your child tries to swallow the paste or is not able to spit, then do not use a fluoridated paste yet, regardless of their age. Fluoride can have toxic effects to the body and to the teeth if taken in larger amounts, so always be sure that you monitor your child while brushing. Rinses are generally not recommended until children reach age six years old and can definitely spit out with no problems. Again, I rely less on the child’s age and more on their ability to spit the rinse out without swallowing it.

Flossing. Let’s face it, we all hate flossing. It takes too much time, we forget, we don’t like it, we don’t have time for it. All valid reasons. However, flossing happens to be one of the most important things you can do for your gums and also for your body. Flossing helps prevent gum disease, which can lead to premature tooth loss, bad breath and a multitude of other dental problems. In recent studies, scientists have also linked gum disease to other health problems such as pre-term labor, heart disease, stroke and diabetic complications. So, though we hate it, we really need to do it (sort of like paying taxes, right?). The earlier we can introduce the habit of flossing to our children, the easier it will be to incorporate as part of their daily routine.

When kids finally have multiple teeth, you can start by demonstrating on yourself and then see if they will let you try it out on them. If you are unsuccessful, continue to show them while you do it and eventually you will find that they might at least try on themselves. You will also find that your child may have spaces in between their teeth and thus not much there to floss. The spaces are actually there for a reason and so just go through the flossing motions for now, and let your child practice. The spaces will likely go away once permanent teeth come in and so they will already be a pro at it! The child may complain that the floss stings a little bit. This is normal and is because the gums are not used to having floss touch them. This will be the same for adults. Be sure that they are gentle when they floss and occasionally a little bleeding will occur at first. This is normal, so reassure your child that flossing will make it go away and the more they floss, the happier their gums and teeth will be! Occasionally, flosses coated with mint flavoring can cause stinging during use. So consider buying flavorless floss.

There are many handy devices to make flossing easier and more appealing. One of my personal favorites is the “floss-pick“. It is a little plastic toothpick with floss attached to it. There are many brands, but I will warn you that cheaper is not better, as the less expensive ones tend to break after the first attempt. If your teeth are very tight, I also recommend Glide brand floss. It is a little more expensive but well worth the price! Also, regular floss is really the best, but if it is too difficult for you or your child to use, then you simply won’t use it. So, the bottom line is, use whatever you will use!

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.

First, dentists are definitely not all the same.  True, most of us start off with the same initial dental degree (Doctor of Dental Surgery) however, what happens after this may or may not make a huge difference.  Like medicine, dentistry has a multitude of specialties. I know, you may be thinking, “How could there possibly be that much to know about teeth?”  The truth is, that there really is that much to know about teeth. Not to mention the teeth are connected to the mouth, which are connected to the head, which is connected to the body, etc., etc.

The problem with teeth is just that. They are connected to everything else in one way or another.  The amazing thing is that so many disorders actually show up in the mouth before they appear anywhere else in the body.  So, the mouth can be a fantastic place for a first diagnosis that physicians often miss.  In addition, we prescribe and use many of the same medications and anesthetics that physicians do.  It really isn’t as simple as “drill and fill.”

Though we all start out with the same initial dental degree, some doctors choose to specialize in a particular area of dentistry.  There are a few reasons for dental specialties. First, there are many different dental needs and levels of complexity.  One type of dentist cannot adequately fulfill all the treatment needs of all individuals.  In addition to this, the type of patient (i.e. adult, child, elderly) and the medical needs of the patient all impact treatment and thus the type of individual care needed.

Dental treatment can range from very simple to highly complex, involving multiple specialties in order accomplish a final outcome.  It really isn’t possible to know everything about everything (But don’t tell my husband I said that)!  Just as I wouldn’t want my family practice doctor to perform brain surgery on me, I would not want a general practice dentist to perform my jaw surgery.

There are currently nine dental specialties recognized by the American dental association. These specialties are Oral Pathology, Oral Radiology, Endodontics, Periodontics, Pedodontics, Prosthodontics, Oral Surgery, Orthodontics and Public health.   Each of these specialists will have the same initial degree as your general/family dentist (Doctor of Dental Surgery) but have continued their education for an additional 2-6 years in specialty training for a specific type of dental treatment.  They are the highest trained in their area of expertise and are limited to performing only those procedures for that specialty.  For example, a pediatric dentist does sees only children and will not provide care for those over 18 years of age.  An Endodontist does only root canals and root canal surgeries, never fillings, crowns, etc.

The chart below lists the above named specialist and the type of treatment they provide.

Oral Pathologist:  Evaluation, diagnosis and treatment of oral or head and neck diseases out of the comfort or expertise level of any other type of dentist.

Oral Radiologist: Evaluation and diagnosis of x-ray findings of the head, neck and jaw out of the comfort or expertise level of any other type of dentist.

Endodontist:  Evaluation, diagnosis and treatment of root canal related problems or procedures out of the comfort or expertise level of any other type of dentist.

Periodontist:  Evaluation, diagnosis and treatment of gum disease or gum procedures out of the comfort or expertise level of any other type of dentist.  Periodontists also place dental implants and perform regular cleanings to patients with a history of gum disease.

Pedodontist:  Evaluation, diagnosis and dental treatment of children 18 years or younger.  They are typically certified to perform most sedations types and have privileges to practice in a hospital setting if needed to complete child’s care.

Prosthodontist:  Evaluation, diagnosis and treatment of any patient that requires more complex dental care beyond the comfort or expertise level of any other type of dentist.  These dentists will be more experienced with treating patients requiring very complex crown/bridge work, dentures or implants.  There is also a subspecialty of prosthodontists trained in facial reconstruction with prosthetic noses, eyes, oral structures, etc.

Oral Surgeon:  Evaluation, diagnosis and treatment requiring surgical methods or advanced laser procedures.  Some of these surgical procedures include wisdom teeth or other complicated extractions, placement of dental implants, oral/facial biopsy service, facial cosmetic surgery, jaw reconstruction and much more.  They are certified to use the wide range of sedation and anesthesia techniques and also have privileges for hospital-requiring treatment.  Many oral surgeons are also physicians.  This will depend on the oral surgery training program they decide to go through.

Orthodontist:  Evaluation, diagnosis and treatment of dental and skeletal problems requiring orthodontic care (braces and orthodontic appliances) out of the comfort level or expertise of any other type of dentist.

Public Health Dentist:  Evaluation, diagnosis and dental treatment in dental under served areas.  Research and statistic oriented and spends a significant amount of time studying, education and publishing information related to dental health of the public, especially in dental under served areas.

In many cases your family dentist can treat a multitude of dental problems which could also be treated by specialists.  However, specialist treat dental issues in their area of expertise which are much more complex and difficult that a general dentist would.   So, you family/general dentist may choose to refer a patient to a specialist on occasion.  This usually occurs when the level of training or experience your family dentist has is out of their scope of care, or they are not comfortable performing the needed treatment.

So the fact that your family dentist recognizes that they cannot be a master of all things is actually a very good thing, albeit an inconvenience for you.  This suggests that your dentist understands their limitations and wants what is best for the patient rather than what they can gain financially.

What you will find if you see enough general/family dentists is this: There is a significantly wide range of comfort and skill levels between general/family dentists.  While some dentists are perfectly happy and skilled at treating children, another dentist may prefer not to treat children because they are not comfortable or patient enough to work on children.  The same principle applies to many other areas of dentistry.

At the other end of the spectrum, there are dentists who elect not to refer out certain procedures to a specialist that they really should. There are plenty of procedures that practitioners are legally allowed to do but really should.  This could be from their lack of experience with the procedure or because they really just don’t have the skill or ability to do it.

One thing you must understand is that we, as practitioners cannot be perfect at everything.  We, of course want to be great at it all, but it is my strong feeling that we must recognize when a procedure done by a specialist rather than ourselves is in the best interest of the patient.  Sure, we could probably do it, but if we don’t do it really well, then I believe we are doing a disservice.

So, my general rule of thumb is that if you feel in the pit of your gut that something just isn’t right with the dentist you are seeing, then pay a little extra to have a second and possibly third opinion.  In our world today, we like to believe that everyone has great morals and ethics and everyone who graduates with a professional degree “knows their stuff”.  This just isn’t always true.  Always go with your gut instinct whether the dental visit is for yourself or for your child.  Remember the old joke, “What do they call the guy who graduates last in medical school?”  That’s right, they call him “Doctor.”  The same joke applies to dentists!

The other item on the agenda to discuss is, when choosing a dentist, you should always take into consideration the facility itself. Again, this is a go-with-your-gut kind of thing.  Does the facility appear clean and tidy?  When you are in the treatment rooms does it appear that the sinks and counter tops where dental tools are placed are wiped down? Understand though, that we use a lot of products which stain counter tops and chairs, regardless of how much you attempt to scrub it off.  It’s a lot like the impossible grass stains on the baseball uniform.  But an overall clean and organized facility can be an important reflection on the quality of care you or your child may receive.

Does the technology appear to be current or does it feel like you are in an antique store rather than at the dentist?  Technology has evolved considerably in the last ten years and you should start to see that same evolution in one form or another in the office.  Some of these changes may include patient education literature, computers in the office, possibly digital x-rays and just an overall appearance if being current with the times.

Are the staff, including the dentist wearing gloves and a mask while they work on you/your child?  Are they taking check-up x-rays every 12 to 18 months?  Do they ask about your child’s health history at every check up to see if it has changed?  Do you feel that the staff and dentist speak with confidence and sound generally knowledgeable? Also, don’t confuse arrogance with knowledge, which can sometimes cause things to be missed during a dental exam! Does your child’s dentist and staff try to educate you on dental procedures needed and ways to prevent future problems?  Does your dentist actually listen to you when you talk?

For adults, does the dentist actually take more than a minute to look around your mouth at everything?  Or do they just look quickly with a mirror and say that “everything looks good?”  Do they actually look at your x-rays?  Does the dentist or hygienist check your gums with a special instrument to check for gum disease (this likely won’t be done on your child unless the doctor suspects it, as gum disease is uncommon in children). Does the dentist or hygienist check deliberately for “lumps and bumps” inside and outside of you or your child’s mouth?  This is called a head and neck exam and should be done every six months to be sure that there is no evidence of cancers, tumors or other pathology.  Do you never have anything wrong at every check-up for years?  It is common to have small cavities or cracks come up throughout the years.  It is actually more abnormal to have patient that NEVER has anything wrong, even if it is minor.

It does happen, but if you see or feel changes in/on your teeth and your dentist always says “it’s fine,” and/or never takes an x-ray of the area, you may want to get a second opinion.  Many times dentists choose to “watch” things rather than fill them in an effort to be conservative.  Sometimes these things we “watch” are truly just stains but sometimes they are not and cavities can grow quite large without getting a “stick,” as your dentist might say.  That “stick” is a sticky sensation when we touch a special dental instrument to a suspicious tooth.  If the instrument “sticks” or “pulls back” when we push on it, generally that means there is a cavity.  However, cavities can grow beneath the surface of the tooth and the tip of that special instrument may be too large to fit into the hole. Therefore, there may not be a “stick” even though a cavity is present.

These are all questions that you should think about at your visits.  If these things are not being done, then I strongly suggest that you get a second opinion to be sure that things are not being missed.  Always go with your instinct.  If your “gut” tells you that something is not right, don’t second guess yourself.  It is always better to be on the safe side.  It can’t hurt to have a second opinion and you may feel comforted after doing so.