Basics of Pediatric Dentistry

Prior to Conception

Dental Health: Expectant mothers should make sure their personal health is optimal because periodontal (gum) disease may lead to low birth weight babies. The infant will become colonized with the oral flora (bacteria causing gum disease and dental decay) from their primary care givers, mostly the mother, which could predispose the child to increased caries (decay or cavities).

Birth to 6 Months

Oral Hygiene: Parents should use a wet washcloth to massage gum pads.

Teeth: Natal vs. neonatal. Natal teeth are present at birth. Neonatal teeth erupt within 30 days of life. 90% of the time these teeth are part of the normal complement of the child's primary teeth and not "extra teeth."

6 Months to 24 Months

Oral Hygiene: Parents should clean the first 8 teeth with a special infant brush or a wet washcloth. When the molars erupt, parents should start using a toothbrush to clean the chewing surfaces. A fluoride containing toothpaste should not be used, in my opinion, until the child can spit effectively a, at about 2-3 years old. Swallowing fluoride containing toothpaste may lead to Fluorosis (excess fluoride that leads to discolored/stained enamel). You, as a parent cannot be sure how much fluoride the child is swallowing. We often see permanent upper front middle teeth (central incisors) with permanent changes to the surface that appear mottled, whitish or brownish. At 2-3 years old the crowns of these permanent teeth are already formed in the jaws and you can start using fluoride containing toothpastes again.

First Dental Visit: This should take place by the child's first birthday. We will do a simple lap appointment with one of the parents to get the child use to the dental environment and also discuss risk factors that the child may deal with in the future such as transferring of bacteria from the mother to the child and proper care/nutrition.

Feeding Practices: Child should be weaned from the bottle or breast by 12 months of age. Do not put the child to bed with a bottle filled with milk (water is the best if you have to!). Once the child transitions to a cup, prolonged "sipping" behavior of juices, milk, sodas also leads to increased risk for caries.

Teeth: There are 20 primary "baby" teeth. Approximate eruption times to guide parents:

Tooth	Nickname	Average Eruption Time
Central Incisor	"front tooth"	6 months
Lateral Incisor	"teeth next to front teeth"	8 months
Canine	"eye tooth"	18 months
First Molar	"first year molar"	12 months
Second Molar	"second year molar"	24 months

* Variations of 6 months either way are within normal limits

24 Months to 6 Years

Oral Hygiene: Tooth brushing should take place at least two times daily with parental assistance. Once the child can spit everything out (no swallowing of fluoride!). No more than a "pea-size" amount of fluoridated toothpaste should be used. If you can no longer see between the teeth, then floss.

Dental Visits: Twice yearly visits unless we recommend otherwise.

Feeding Practices: Avoid frequent sugary snacks and "sipping" of juices, milk sodas to reduce the risk for caries. Sippy cups should contain water once they leave the home. Quantity of sugar containing liquids isn't as important as the frequency of the sugar products. The mouth becomes more acidic because bacteria use sugar produces to live and produce acids that decay and dissolve the teeth.

Trauma: A very common accident is a child falling as they learn to stand and walk. If a baby tooth is knocked loose, it should be repositioned ASAP. If a baby tooth is knocked completely out-do not replant it. For any injured baby tooth, immediate dental care should be sought.

6 Years to 12 Years

Oral Hygiene: Children should begin to master tooth brushing and flossing without assistance. Children should brush their teeth twice a day using fluoridated toothpaste.

Dental Visits: Medical practitioners insure that the child is being followed by a dentist regularly. Make sure the 6 year and 12 year molars have been evaluated and sealed if necessary. Sealants are a plastic covering that protects the grooves of the back teeth.

Feeding Practices: Avoid frequent sugary snacks, sodas and sports drinks to reduce caries risk.

Trauma: Common in this age range secondary to activity with bikes, balls, bats, running etc.
Facts:

Boys are twice the risk of girls
Front teeth positioned out farther than the bottom teeth "bucked teeth", are at greater risk of breaking/chipping
If a permanent tooth is knocked loose- it should be repositioned ASAP. Please call us immediately!
If a permanent tooth is knocked completely out (avulsed)-replant the tooth ASAP back into the socket. If unable to place tooth into the socket, then place the tooth in cool milk to keep the tooth-root cells alive.
For any injured baby tooth, immediate dental care should be sought.

Teeth: The transition from primary (baby) dentition >> mixed dentition >> permanent (adult) dentition (teeth). There are 32 permanent teeth. The following is an approximate permanent tooth eruption pattern. The sequence of eruption is more important than the timing. We usually take an x-ray called a panorex at about 7 years old to check where all the permanent teeth are.

Tooth	Nickname	Average Eruption Time
Central Incisors	"front tooth"	6-8 years
Lateral Incisors	"teeth next to front teeth"	7-8 years
Canines	"eye tooth"	9-12 years
Premolars	"teeth behind eye teeth"	10-12 years
First Molars	"six year molar"	6 years
Second Molars	"twelve year molars"	12 years
Third Molars	"wisdom teeth"	17-25 years

* variation up to 24 months is considered within normal limits

COMMON PEDIATRIC ORAL PATHOLOGY

Primary Acute Herpetic Gingivostomatitis: This is the first exposure to HSV-1, most likely transmitted by a primary care giver. Unlike recurring herpes infections in adults that usually appear on the attached gingiva and lips, the initial H5V-1 infection in a child presents with multiple vesicles, malaise, high fever and pain. The virus will run its course and palliative care is common treatment.

Eruption Cyst: When a tooth erupts it may cause a small bruise with a swelling that looks purplish-blue. Once a tooth breaks through the gingiva the bruise will spontaneously resolve.

Double Row of Teeth: When the permanent teeth erupt they appear behind the baby teeth-without the baby teeth falling out. This usually means the teeth erupting are bigger than the jaw space available. A dental consult is needed to determine of the baby teeth need to be extracted to create the needed space.

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