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Sucking is a natural reflex and thumb-sucking habits are common for young children. It may make them feel safe and happy, or provide a sense of security during periods of stress. Due to factors like frequency, duration, intensity and position, such a habit can adversely affect the position of the jaws and cause a malformed palate. As the child ages, the jaw bones continue to grow and change. If the child continues the habit as he or she approaches age 4, such undesirable changes become permanent. Therefore, it is important to break the habit by this age.

Most children will stop sucking on their own between the ages of 2 and 4. Peer pressure may also cause many school-aged children to quit sucking. In other instances, a reminder appliance may be needed to assist the child in quitting. If your child has not ceased a thumb- or finger-sucking habit by the time their permanent front teeth are ready to erupt, some appliance intervention may be recommended.
The dentists at Dentistry for Kids are happy to answer any questions you may have regarding thumb-sucking or pacifier use.

Tips on breaking thumb or finger habits:

• Choose the right time (low stress for the child)
• Motivate your child (use examples of older siblings, etc.)
• Positive reinforcement
• Do not acknowledge the habit, praise them when not sucking
• Use a reward system (ex:: calendar with stars followed by reward at the end of the week/month)
• Pacifiers

If you use a pacifier, use a clean one. Never dip a pacifier in sugar, honey, or juice before giving it to your baby. Prolonged use of pacifiers can harm the teeth just like prolonged thumb-sucking, but it often is easier to wean a child from a pacifier than a thumb habit.

Aim to have your child drink from a cup by their first birthday, and discourage frequent use of a training or sippy cup. Never allow a baby to take a bottle to bed at night or naptime. Bottles or cups used between meals should contain water and not juice, soda or milk.

PREGNANCY

During pregnancy, a woman’s hormone levels rise and gingivitis is common. Severe gum disease in the mother has been linked to babies with low birth weight and premature births. Additionally, baby teeth crowns develop in the fetus and chewing surfaces of the permanent molars begin to form during pregnancy. A balanced diet and use of prenatal vitamins help healthy teeth develop, while poor nutrition causes tooth decay.

Cavity-causing bacteria can be transmitted to an infant in utero, so it is important to reduce plaque and have decay-free teeth prior to the child’s birth.

If you are pregnant, be sure to visit your dentist regularly and have your teeth cleaned more often. At birth, bacteria may also be transmitted by a mother kissing her newborn. Your dentist may recommend the use of chlorhexidine mouth rinse or products containing xylitol.

INFANT CARE

To prepare your child for eventual tooth cleaning, we recommend cleaning your baby’s mouth with a clean, damp washcloth before he or she has teeth. Avoid putting your baby to bed with a bottle, sippy cup or while breastfeeding. This habit may cause cavities when your baby’s teeth grow in especially if milk, formula, juice or other sugary liquid is used. Only water should be put in a bottle or cup for your child if they cannot fall asleep without it. After breastfeeding your baby, wipe the gums with a damp washcloth as soon as he or she falls asleep and stops sucking. Sharing items such as spoons, pacifiers, toothbrushes and toys can spread cavity-causing germs between caregiver and baby and between babies.

It is normal for a baby to cry during tooth-brushing. Babies also cry when they are bathed, dressed or changed. Remain calm and methodical while continuing to clean your child’s teeth properly.

With time, he or she will appreciate your gentle attention to their teeth and will allow you to clean without protest.

BEGINNING BRUSHING

Once your child’s teeth begin erupting, you should begin wiping them with a moist washcloth.

Start a habit of brushing twice daily when the first tooth grows in. Use soft-bristled toothbrushes designed for babies with water or a very small amount of non-fluoridated toothpaste. Fluoride toothpaste may be used when your child can effectively spit. Consult your pediatrician or pediatric dentist about other sources of fluoride supplementation for your child.

You should use a pea-sized amount of a non-fluoride toothpaste until your child is able to spit it out.

For most toddlers, getting them to brush their teeth may be challenging.

Suggestions for making tooth-brushing easier include:

• Establish a tooth-brushing routine
• Let your child brush your teeth at the same time
• Let your child pick out a few toothbrushes with a favorite character, and then allow a choice of which one he or she wants to use each time (this will give your child some feeling of control over the situation)
• Allow your child to brush his or her own teeth first (and then you get a turn)
• Read some children’s books about tooth-brushing
• Have everyone in the household brush their teeth at the same time

ADOLESCENCE AND ORAL CARE

As children transition into adulthood, their dental needs change.

There is evidence which shows how periodontal disease may increase during adolescence due to lack of motivation to practice routine oral hygiene. Children who maintain good oral health habits up until their teen years are more likely to continue brushing and flossing than children who were not taught proper oral care.

Dental cavities increase in teens because of changes in dietary habits, lack of motivation for good oral hygiene habits, increased demands in school, work and social arenas and experimental drug use. These topics are discussed with the dental assistant and doctor according to individual need.

Young adults differ from children in their overall dental needs. Many of our adolescent patients have orthodontic appliances and are taught how to prevent cavities that can easily develop around the braces. Wisdom tooth removal is a big concern for this age group. The dentists at Dentistry for Kids can provide literature and ease the fears of oral surgery. Sealants are recommended when all the permanent teeth erupt to protect the chewing surfaces. Some teens require mouthguards for sports or more involved treatment considerations such as temporomandibular joint (TMJ) dysfunction.

These topics and more are addressed and planned for with our teen patients and their parents. We have found motivating teens to be knowledgeable about their own dental needs leads to long-term health of permanent teeth into adulthood.

TIPS FOR PARENTS

Early diagnosis is important for successful treatment of periodontal diseases. Therefore, it is important for children to receive a periodontal examination as part of their routine dental visits. Be aware if your child has an advanced form of periodontal disease, this may be an early sign of systemic disease. A general medical evaluation should be considered for children who exhibit severe periodontitis, especially if it appears resistant to therapy.

An important step in the fight against periodontal disease is to establish good oral health habits with your child early on. Begin brushing your child’s teeth with non-fluoridated toothpaste at 12 months old. When the space between your child’s teeth begins to close, it is important to begin flossing.

Serve as a good role model by practicing good oral healthcare yourself. Be sure to maintain regular cleaning and exam visits.

Schedule regular dental visits for family checkups, periodontal evaluations and cleanings.

Check your child’s mouth for the signs of periodontal disease, including bleeding gums, swollen and bright red gums, gums that are receding away from the teeth and bad breath.

If your child currently has poor oral health habits, work with your child to change these now. It’s much easier to modify these habits in a child than in an adult. Since your child models behavior after you, you should serve as a positive role model in your oral hygiene habits. A healthy smile, nice breath and strong teeth all contribute positively to a young person’s confidence and self-esteem.

What is gum disease and how can I prevent it?

While many people believe periodontal disease is an adult problem, studies indicate gingivitis (the first stage of periodontal disease) is nearly a universal problem among children and adolescents.

Advanced forms of periodontal disease are less common in children than adults, but can occur.

Chronic gingivitis is common in children. It can cause gum tissue to swell, redden and bleed easily. Gingivitis is preventable and treatable with routine brushing, flossing and professional dental care. If left untreated, gingivitis can develop into a more serious form of periodontal disease.

Localized aggressive periodontitis can affect otherwise healthy children. It is found in teenagers and young adults and mainly affects the first molars and incisors. It is characterized by severe loss of alveolar bone and, ironically, patients generally develop very little dental plaque or calculus.

Generalized aggressive periodontitis may begin around puberty and affect the entire mouth. It is marked by inflammation of the gums and heavy accumulation of plaque and calculus. Eventually it can cause the teeth to become loose.

Conditions which make children more susceptible to periodontal disease include:

• Type I diabetes
• Down Syndrome
• Papillon-Lefevre syndrome

What Causes Tooth Decay?

Several types of bacteria living on the teeth cause decay. The most common bacteria associated with dental decay are Mutans Streptococci. When sugar is consumed, the bacteria metabolize the sugar and produce acids which demineralize the teeth and cause infection/decay.

What is Early Childhood Caries or baby bottle tooth decay?

Early Childhood Caries or baby bottle tooth decay is a very serious condition in which a child’s primary teeth decay very early due to prolonged feeding with a bottle or from the breast. When the sugar in formula, milk and juice stays in contact with the teeth while the child sleeps, the teeth decay quickly, often seeming to erupt with decay.

How to prevent Early Childhood Caries:

• Put your child to bed with water, not milk or juice.
• Stop nursing when your child is asleep or has stopped feeding on the bottle/breast.
• Don’t substitute a bottle of milk or juice for a pacifier.
• Teach your child to drink from a cup at about 6 months of age. Plan to stop using a bottle by 12 to 14 months of age.
• Don’t dip your child’s pacifier in honey or sugar.

How to: Prevent cavities

Cavities are caused by a combination of:

1. Bacteria
2. High sugar consumption
3. Lack of oral hygiene

1) LIMITING BACTERIA PROLIFERATION ON THE TEETH

Each of us develops decay-causing bacteria as an infant. While we may limit the amount of bacteria present by brushing and flossing, complete elimination of bacteria is impossible. The remaining bacteria must be modified in order to reduce the risk of dental decay.

2) DIET MODIFICATION

We recommend a diet low in sugar and regular brushing. These two practices will prevent dental decay.

Every time a child eats, an acid reaction occurs inside their mouth as the bacteria metabolize the sugar in the food. This reaction lasts approximately 20 minutes. During this time, the acid environment may destroy tooth structure, causing cavities. By reducing the number of times a child snacks, you reduce the number of exposures to this process and, therefore, reduce the risk for dental decay.

3) IMPROVING ORAL HYGIENE

Improving oral hygiene is critical to reducing the amount of time the cavity-causing bacteria stay on your child’s teeth. A proper oral hygiene routine involves brushing twice daily (including the tongue) and flossing once daily. You don’t have to wait until bedtime to brush and floss your child’s teeth, nighttime brushing and flossing should occur after the last snack or meal has been eaten.

The consistency of a person’s saliva also makes a difference in determining one’s risk for dental decay. Thinner saliva breaks up and washes away food more quickly. Thicker saliva allows food, sugar and bacteria to remain on the teeth for a prolonged period.

Tips for cavity prevention:

• Limit frequency of meals and snacks.
• Encourage brushing, flossing and rinsing.
• Watch what you drink (soda, juice and sports drinks contain sugar)
• Avoid sticky food.
• Make treats a part of meals, not a snack.
• Choose nutritious snacks.

A child’s primary teeth are important as they not only hold space for the developing permanent teeth but also are important for chewing, biting, speech and appearance.

4) FLUORIDE

Fluoride strengthens teeth and prevents tooth decay. If the water where you live does not contain enough fluoride, your doctor may prescribe fluoride supplements (fluoride drops or pills). Your child would take these pills or drops every night, beginning at about 6 months of age. Only give the prescribed amount of fluoride to your child because too much can cause spots to develop on permanent teeth.

A baby’s front four teeth on top and bottom are usually the first to erupt, generally at about 6 months of age.

The timing of tooth eruption varies as some children grow teeth early and others may not have teeth until shortly after their first birthday.

Most children have a full set of 20 primary teeth by the time they are 2 to 3 years of age. As your child grows, their jaws also grow, making room for permanent teeth which will begin to erupt at about 6 years of age. The oral tissues and erupting permanent teeth begin to absorb the primary teeth roots.

Most children will have the majority of their permanent teeth between the ages of 12 and 14. The remaining molars (wisdom teeth) erupt between the ages of 18 to 21 to form the complete set of 32 permanent teeth.

As teeth erupt, many children have tender gum tissue and irritability. Teething rings and gently massaging your child’s gum tissue with a cold cloth may be soothing.

Contrary to popular belief, a fever is not normally linked to tooth eruption. If your child has an unusually high fever you should contact their pediatrician.

Mouthguards are athletic mouth protectors made of soft plastic. They come in standard and custom fits to adapt comfortably to the upper teeth.

Mouthguards protect the teeth, lips, cheeks, tongue and jaw bone from possible sport injuries. They can also help protect a child from head and neck injuries, such as concussions. Most injuries occur to the mouth and head area when a child is not wearing a mouthguard.

A child should wear a mouthguard during any athletic activity in which there is risk of a head, face or neck injury. Such sports include hockey, soccer, karate, basketball, baseball, skating, skateboarding, and many more. Most oral injuries occur during basketball, baseball and soccer.

Choose a mouthguard your child feels is comfortable. If a mouthguard feels bulky or interferes with speech to a great degree, it’s probably not right for your child.

Mouthguards vary in comfort, protection as well as cost. The least expensive tend to be the least effective at preventing oral injuries. Dentistry for Kids provides customized mouthguards. They are more expensive than other mouthguards, but also more comfortable and shock absorbent.

When some children smile, they may show excessive gum tissue. This is called a gummy smile and may be due to a few different problems:

• Gum irritation and overgrowth from braces. This is more likely to happen if the teeth appear short before the braces are placed on the teeth. This problem results not from the quality of orthodontic care, but is a result of the pre-treatment gum and bone thickness.
• Altered passive eruption. The gum and bone normally recede as a part of the normal eruption of the teeth. When this normal recession doesn’t occur, the gums cover too much of the teeth and make them appear “too short”. The teeth are usually not “too short”. They are usually of normal size but are stuck under the gum tissue and bone.

Habits such as thumb-sucking or teeth-grinding (bruxism), excessive pressure and tooth wear can alter the appearance of the teeth. The problems might be corrected with orthodontics, surgical procedures or dental restorations such as crowns or veneers.

Skeletal developmental problems affect the growth of the jaws and the teeth. If orthodontic treatment begins between the ages of 7 and 9, jaw growth can often be controlled and the cosmetics improved.

Before treatment, it is critical to properly evaluate the problems and get an accurate diagnosis. Some cosmetic issues can be easily corrected while others, like skeletal problems, can be more difficult.