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Why is managing children at the dentist any different to managing adults?

Treating children is very different from treating adults. The most important part is for your child to establish trust and rapport with all members of the dental team. This is never immediate, and will be different for all children. In time your child will develop confidence in the dental environment. Please understand that treatment at the first visit is not likely to help your child grow up to be a confident dental patient, and that is our priority. How do we manage children?

  • We ensure that the first visit is a consultation only. We would like to stress that this is for the benefit of your child
  • Our staff focus on your child at all stages of the appointment – from the initial greeting in the practice to the final farewell
  • We will explain to your child what we need to do in simple terms you child understands
  • Dr Kylie will use all types of behaviour management strategies to attempt to connect with your child
  • By creating a fun and non-threatening environment we try to ensure your child enjoys dental visits!

Why restore baby teeth, they just fall out?

The baby teeth are essential for:

  • Eating
  • Speaking
  • Aesthetics
  • Providing space for the permanent teeth

For all of these reasons it is important to restore these teeth. It is not uncommon to have children who do not grow properly because they are unable to eat due to pain from the teeth.

Baby teeth are very different to permanent teeth and there are very different approaches to managing problems that occur with them. The main problem with not treating cavities in the baby teeth is that they tend to become very large very quickly. This can lead to bad toothache, often requiring complicated procedures to keep them in the mouth or extraction in the worst cases. A child suffering with severe toothache is distressing for both parents and the dental staff.

Generally the front baby teeth are lost between the ages of 5-8 years. It is not until around 10-11 years that the baby molar teeth fall out. Restoring baby teeth is important for your child to grow up with a healthy mouth, and pain free.

Tooth decay is a bacterial disease and treating the cavities will reduce the total numbers of decay causing bacteria in the mouth. This is important to help reduce the risk of bacteria passing directly to newly erupted permanent teeth (for example the 6 year old molars) and starting decay there.

As a pediatric dentist Dr Kylie understands that decay in the baby teeth puts your child at risk of decay in the future. To help reduce this management of the current decay is essential combined with a thorough preventive program.

Is it normal to have no teeth at 12 months of age?

When we talk about children developing or reaching milestones there is always a range of acceptable dates. Generally the front teeth start erupting between six and ten months of age, and the back teeth between 12 and 16 months. The full set of baby teeth are usually present in the mouth by 23-30 months. Of course there can be variations, often up to 6 months later than the average times. Your child’s dental development is not linked in any way to other developmental milestones. In most cases the teeth erupt in their own time.

In some rare situations the teeth may not erupt because something is blocking the path of eruption into the mouth or the teeth have not formed at all. If you are concerned you should take your child to see the dentist for a consultation. The dentist will look for signs of the teeth and advise a follow – up or xrays if your child is older.

Missing teeth tend to occur within families so if this is the case let your dentist know. If there are missing teeth, the dentist can advise you on appropriate management strategies.

The permanent teeth are erupting and the baby teeth haven’t fallen out! Is this normal?

This “double row” of teeth usually happens in the lower jaw. This is common in this area of the jaw as the permanent teeth have formed in this position and have erupted without causing the baby tooth root to dissolve. It is often seen where there is not a lot of space between the lower front teeth (they are crowded).

Dr Kylie will assess the situation for your child and determine if removal of baby teeth is necessary. Generally if there is enough space for the new permanent tooth the tongue will push the new permanent tooth forward into the right position once the baby tooth falls out. In some situations it is necessary for the dentist to remove a tooth or some teeth to help guide the newly erupting teeth.

When should I start cleaning my baby’s teeth?

It is important to understand that your child could get a cavity as soon as there is a tooth in the mouth! Therefore it is important that you start cleaning your infant’s teeth as soon as they appear. The easiest way to do this is the use a washer in the bath and rub the front teeth when they come through. This will remove any plaque that has developed there in between cleans.

As your child gets older the molar teeth will come through and you will need to be using a toothbrush at this time (12-18 months). Introduce the toothbrush as a toy in the bath initially and get your child used to the feel of it in the mouth. This can help when it is time to start using the toothbrush properly.

Why is a bottle at bed time a bad idea?

Our teeth are protected through the day by saliva in the mouth. Saliva is a comples mix of water, ions and other immune system elements that helps to preserve health in the mouth. Through the day it neutralizes acids that are created after we have a mouthful of something sweet. During sleep that saliva does not flow, and the acids that are created in the mouth are able to freely break down tooth structure as they are not being diluted by saliva.

If you would like to give your baby something at night make sure it is water. Water is the only neutral drink (it won’t dissolve tooth structure) and can be given freely. All other liquids can contribute to the breakdown of tooth structure. The best idea is to stop the bottle at night completely. This can be done by either taking the bottle away completely (with a few restless nights for the family) or gradually diluting the liquid in the bottle until it is just water (generally over a period of 10 – 14 days).

A bottle at bed time is one of the main causes of Early Childhood Caries (ECC). ECC was once called “bottle caries” but we now are aware that the bottle is not the only risk factor for ECC.

Why does one of my children have lots of decay but the other children have few cavities?

Tooth decay is a disease that is caused by bacteria and affects the teeth. Many factors contribute to each persons risk of tooth decay. Some of these factors are listed below:

  • Oral hygiene
  • Diet or frequency of sugar/acid intake
  • Number of decay causing bacteria your child has (usually passed from parent with risk occurring in families)
  • Amount of saliva – Quality of saliva (how well it buffers acids)
  • Quality of the tooth structure

As you can see there are many factors and these are but a few. It is possible for twins to have different risks of tooth decay even when they eat the same diet!

It is important to understand that tooth decay is a disease and it needs to be managed. The management for one child may differ markedly from the needs of your other children. In time your child will grow up to understand how to manage their own dental health.

Does dummy sucking cause problems?

The suckling reflex is a natural instinct of infants. When very young sucking a dummy or pacifier may help to comfort your baby. It is thought that this relief may outweigh any negative factors in infants.If you would like your baby to have a dummy then select those with an oval shaped teat and a large flange that sits outside of the mouth. It is thought that this type of dummy is probably best for dental development.

If your baby continues with the dummy as a toddler (after 12 months of age) there are many changes that may be noted by the dentist. This is due to the force of the cheeks on the top jaw or rather the jaws “growing around” the dummy. The most common changes are:

  • Narrowing of the top jaw often causing a posterior cross bite
  • Increase in over jet or a more bucky appearance to the top teeth
  • Anterior open bite or failure of development in the front part of the upper jaw due to the presence of the dummy

To allow your child to grow without the influence of the dummy on the growth of the jaws, it is best to stop the habit as early as possible. One good way is to have the “dummy fairy” come and take the dummy away for the new babies, leaving a present. Try to have a time set (eg 1st birthday) when the dummy will be removed totally. There is usually only 1-2 nights of disrupted sleep before your child adapts to the change. In a very small percentage of cases your child may start finger or thumb sucking after the dummy is removed. It is not possible to predict for this. If this occurs then it is managed separately.

Is thumb sucking a problem?

Thumb sucking, like dummy sucking is a form of non-nutritive sucking. It frequently occurs in children up to the age of three or four. Quite often there is another associated habit (holding a toy or blanket, rubbing the nose, twirling the hair). The changes to the bite are similar to those found in dummy sucking.

As the permanent teeth start erupting into the mouth around 6 yrs of age, more significant changes may occur as the child is often growing more during this period.In a lot of cases peer group pressure at school is enough to break the habit, but for some children it can persist. Some good approaches to breaking the habit for 4yr olds and up include:

  • Reminders and rewards – Have a reward chart and allocate a stamp or sticker for each successful time allocation. You will probably need to work on breaking the habit in short periods of the day until it is finally broken. First try and focus on morning to lunch. Once this is broken then move on to lunch to dinner, and then finally dinner to bed.
  • Paint on remedies - There are foul tasting paints that can be applied to deter the sucking however, most children will learn to tolerate them.
  • Taping the finger or bandaging the arm - The child is sensing “pleasure” from the skin of the thumb rubbing on the roof of the mouth. Any barrier to this can help to break the habit. Sticking plaster wrapped around the finger may help. Similarly the elbow joint can be bandaged with a thick elastic bandage to prevent the arm from bending. This can be helpful at bedtime.
  • Orthodontic devices - For children who have already tried other methods to break the habit an orthodontic appliance may be the only option. These are generally bonded appliances that prevent the thumb contacting the skin on the roof of the mouth. This is usually worn for 3-6 months.

Remember it takes about 45 consecutive days to break a habit. That is going to require dedication on the behalf of the parent and the child. It is important that your child understands the need to stop the habit and that is why it is probably best to try aggressively to stop around 4 years of age.

Are there safe foods for teeth?

Diet is probably the major cause of tooth decay in children that I see in our practice. The thing to consider is how many times your child puts something in their mouth that is sweet or acidic. Yes, the frequency of exposure of the mouth to these things increases your childs risk of tooth decay. It is the number of mouthfuls not the total amount of sugar that is important. Consider sipping on a bottle full of juice over several hours compared with drinking the juice from a cup in one sitting. By limiting the intake of sweet or acidic drinks you are helping reduce the risk of tooth decay.

Before addressing safe foods for the teeth it is probably easier to show the food and drink that is worst for the teeth. Drinks probably account for the most tooth decay in our practice. Juice, cordial, sports drinks, flavoured waters and soft drinks are all equally damaging to your childs teeth. That is due to their high sugar and/or high acid content. Worse still they are often placed into convenience packaging encouraging “sipping or drinking” behaviours that then contribute to the risk of tooth decay.

Don’t be fooled by the words “natural” on products, that is used to simply sell the product and is no way a recommendation for health. Be aware of what you are feeding your children and try and limit the total amounts of sugars, including natural sugars. Different types of sugars that could be in foods include sucrose, dextrose, glucose, fructose, lactose and even honey. Limiting the frequency of these sugar containing foods and drinks will help to control your child’s risk of tooth decay. Fruit juice is not good for teeth or for your child. Fruit juice contains no fiber yet it is concentrated in sugars and calories and tends to fill children up without any nutritional benefits. Half a cup of juice can contain 23g of sugar.

By carefully checking the labeling at the supermarket you can avoid foods that are high in sugars. Look for plain crackers and give things like cheese and fresh vegetables as snacks between meals. Cheese at the end of snack time can help to neutralize the acids that naturally form in the mouth, helping to reduce the amount of damage that the acids can do to the teeth.

Make sure that water is the only convenience drink available to the child- do not put cordial, juice or any other substances in bottles or sippy cups. When giving juice make sure that it is diluted and only a very small amount in the cup. Ensure that it is taken with a meal as that will then be considered as part of the meal and one attack on the teeth (as compared with several sips over many hours).

Understand that you are teaching your child good habits to last their lifetime. Our bodies are made of water and therefore that should be our drink of choice. Teach your children what “treats” are and limit their intake accordingly.

When is my child old enough to brush alone?

Children are not able to brush their teeth adequately until they are around 8 years of age. Children younger than this struggle to get the brush at all of the correct angles to complete a thorough clean. Of course your invincible 2 year old thinks he/she can brush their own teeth, but can they write their name? No, of course not, and it is simple logic like this that will help you understand. Yes your son/daughter can do some tooth brushing but a grown needs to help to make sure it is done properly.

After initially using a washer in the bath to clean the teeth you can introduce a baby’s toothbrush. It should have soft bristles and a large handle to help your child use it.

We recommend that you then use age specific toothbrushes and these are made by different manufacturers. Do not let your child use an adult toothbrush when they are young as bigger does not mean better. Limit their choice to one designed for their age.

Allow your child some independence by allowing them to brush alone in the morning but make sure their is some assistance at night.

How do I brush my child’s teeth?

There are several different methods for brushing your child’s teeth but the easiest is to be behind the child with the child facing the same direction as you. For young children you may have them seated on your lap and then brushing the teeth is very much like brushing your own teeth. You may want to lie the child down on the couch with their head on your knee or do it on their bed. As the child gets taller they can stand in front of you on a stool/step, facing away from you again, and you brush the teeth.

Quite often toothbrushing is not the simple task we think it should be and toddlers voice their disapproval to the parents. This can be very difficult right before bed time. It is important that you make sure that the brushing is done. Your toddler is just trying to control the situation the only way they know how- by making a lot of noise. If you give in when this is happening the child will quickly learn that this is how to get out of things and the behaviour will be repeated time and again. It takes a lot more effort to be persistent but the negative behaviour will stop in the end. You cannot cause any damage to your child by ensuring tooth brushing is done properly every night.

In difficult cases it may be necessary for the dentist to show you techniques for two people to help with brushing or alternative strategies depending on your situation.

Which toothpaste is right for my child?

Generally children under 6 years of age are encouraged to use a smear of junior toothpaste with a low concentration of fluoride (400ppm) on the brush. These toothpastes were developed because young children tend to swallow the paste and in low concentrations a smear of this toothpaste is unlikely to cause mottling of the tooth enamel in the permanent teeth that is called fluorosis.

Once children reach 6 years of age it is usual to move to an adult strength toothpaste (1000ppm). Again only a smear of paste is needed.

After brushing encourage your children to spit out the excess paste but it is not necessary to rinse the mouth. The left over paste can be left in the mouth to soak back into weakened tooth structure, helping to stop any early cavities.

If your child does not like the taste or texture of toothpaste at least brush the teeth to remove the plaque. There are some new products available that are based on milk proteins and Dr Kylie may recommend these as an alternative for your child. “Tooth Mousse” comes in 2 varieties (without fluoride and with fluoride) and has a creamy feel in the mouth. Most children complain about the “hot or spicy” toothpaste and “Tooth Mousse” offers protective benefits that can outweigh regular toothpaste. Dr Kylie may recommend these products to you as an alternative after meeting your child and assessing their needs.

Is fluoride beneficial and should I be giving it to my child?

Yes we know that fluoride is beneficial to the oral health of your child. We also know no that the main benefits of fluoride (strengthening weakened tooth enamel) are from it contacting the tooth surface and not from swallowing it (a bit like putting moisturiser onto the skin).

Fluoride also has the capacity to reduce the effects of decay causing bacteria in the mouth.

The simplest ways to get fluoride to contact the tooth surface is to have it in water (it strengthens the teeth as it passes over it) or toothpastes and mouth rinses. The biggest problem is getting fluoride to contact the teeth of small children without them ingesting too much fluoride.

That is why junior toothpastes were developed at 400ppm. There is no credible evidence that fluoride causes any major health problems. To the contrary the benefits of fluoride on oral health have been proven time and again. As acids wash over the tooth surface on a daily basis they rob this mineral rich layer of particles, which in time causes the enamel to become weakened and chalky. Fluoride applied in these areas can soak back in to the tooth structure and repair the damage of these acids. That is it’s main benefit.

Fluoride is a naturally occurring element and is in the soil and quite often in bore water. It is in high concentrations in certain foods naturally but we do not have fluoridated water here in Queensland. In most cases children using the correct toothpaste for their age, with a good diet they may not require additional sources of fluoride. In cases where there is a high risk of tooth decay (after being assessed by the dentist) additional fluoride supplements may be discussed.

In our practice we recommend the use of “Tooth Mousse” a dentist only prescribed topical paste that offers more repair and preventive capacity than toothpaste alone. We will recommend this for your child if we think it is necessary.

What are fissure sealants?

The most common site of tooth decay is in the grooves or fissures of the molar teeth. If there are deep grooves naturally present in your child’s teeth, food will pack there and the toothbrush will not be able to penetrate into this narrow area and clean out any of the debris. This then becomes a cavity and can progress to a large size if not detected and treated early.

The fissure sealant is usually a white adhesive material that fills any deep pits or grooves in the molar teeth, preventing the food packing and reducing your child’s risk of tooth decay.
When a sealant is placed properly (you need a very clean dry surface for it to stick), it helps reduce the chance of tooth decay occurring in these areas of the tooth that naturally would hold food. It is important that sealants are regularly checked and repaired if necessary. A leaking sealant is probably more dangerous that an unsealed surface because you can’t see what is happening underneath it. That is why the dentist needs to regularly check these fillings.

When should I start taking my child to the dentist?

The AAPD (Australasian Academy of Paediatric Dentistry) recommends that your child start seeing the dentist within 6 months of the eruption of the first tooth. This may seem early but it is very practical.

Paediatric dentists are focused on preventing dental disease in children and this can only be achieved by seeing your child early. The paediatric dentist assesses your child’s general health and development, the teeth that have erupted, the current diet and oral hygiene practices. Any modifications that are necessary to improve your child’s oral health will then be given to you. Your dentist will advise you how often your child will need to be followed up.

Do I need to floss my child’s teeth?

If your child has contacts between the teeth, typically the molar teeth then the answer is yes. The reason for this is that plaque forms on these smooth surfaces and they are protected from the toothbrush. The enamel in these areas is often very thin and is easily broken down by the plaque acids causing tooth decay.

There are different ways to floss your child’s teeth. You can use regular floss and this method may suit people who are good at using floss themselves. Dr Kylie can help to show you how to position your child to make this easier.

Another way is to use floss holders such as flossettes or other devices available at the supermarket or pharmacy. These are positioned and taken between the teeth and both surfaces in the contact point are carefully wiped to remove the plaque.

Children with closed contacts and crowding are more at risk of developing cavities due to the number of places that the teeth are touching. Regular flossing (nightly) as part of a good dental routine can help to reduce your child’s risk of cavities on these surfaces.

What is a paediatric dentist?

A paediatric dentist is a specialist dentist who is trained in the management of dental conditions in children from birth to adolescence. In Australia you must be registered as a specialist with the dental board and you need to have a basic dental degree and a suitable masters qualification. An extra three years of specialist training is completed following a basic dental degree. This training also includes the management of children with complicated medical conditions and part of the training is usually undertaken within a Children’s Hospital here in Australia.

A paediatric dentist is specially trained to understand your child’s special needs, assess their growth and development, diagnose and manage many different conditions affecting the oral cavity, manage trauma and provide interceptive orthodontic care when indicated. Paediatric dentists are very experienced in using behaviour management techniques, sedation and general anaesthesia for your treating your child.

A paediatric dentist understands what treatment will work for your child and the best way to carry it out for the benefit of all concerned. A paediatric dentist is specially trained to look at the “big picture” of your child’s oral health and give you an overall assessment. There are other people who might treat your child when you are at the dentist and they may include:

  • The dentist – a general dental practitioner has completed a dental degree usually 5 years long at a university level. There is no restriction on what they can do to help with managing your child
  • The hygienist/ therapist – your child may have seen the therapist at the school dentist or in private practice (they can be hired in private practice). A dental therapist has training of 2-3 years, mainly on procedures for the primary dentition. They are often used as the first person that your child may see in any given practice. There may be limits placed on the types of fillings that they are able to offer to you.

A paediatric dentist is able to offer you the most up to date options for the management of your child’s teeth. They are trained to provide the treatment that should last for the life of the tooth. The paediatric dentist has a wide knowledge base of conditions affecting your child and options for management.