DENTAL HEALTH

Children and Teens need their teeth for eating, talking, smiling and for the general growth and development of the upper and lower jaws. Taking care of those teeth from day one will lead to better dental health and better overall health.

frequently asked questions

Why does my child need checkups every six months?
How often should we change our toothbrush?
My child’s breath is awful! What can we do?
My child’s gums bleed when they brush or floss. Why?
What causes tooth decay (cavities)?
My children don’t eat much candy, but they are still getting cavities. Why?
Why are there stains on my child’s teeth?
My child has a tooth coming in and the baby tooth hasn’t not fallen out yet (double teeth).
My child gets sores in their mouth. What causes this?
My child’s gums are brown, is this unhealthy?
My 10 year old’s canine tooth is loose, I think it is a permanent tooth.
My child says their jaw hurts and it looks like the gum is growing over the back tooth!
My 3 year old’s front tooth never came in. Why?
My 3 year old has a funny looking tooth that looks like it is split in two. Why?
At what age can my child go to the orthodontist?
My child plays sports. How can I protect their teeth?
Does my smoking cigarettes affect my child’s teeth?
Is my teenager as susceptible to cavities?
My child knocked out a tooth, how do I know if it is a permanent or a baby tooth?
My 2 year old sucks their thumb/finger and I want them to stop!
My 5 year old grinds their teeth at night! We can hear it down the hall!
What is the bump above my child’s tooth?
When should I call the after hour emergency phone number?


Why does my child need checkups every six months?

It takes serious commitment to take care of our teeth. The enamel of children’s teeth is thinner than permanent teeth. Once bacteria invade a tooth (cavity) they can quickly multiply and spread throughout the whole tooth, or invade the nerve. Children can also get gingivitis (gum disease) just like adults. Bacteria accumulate around the gums and in between the teeth causing the gums to swell, turn red and bleed when brushed or flossed.

Our modern culture includes foods which are high in carbohydrates (sugars). Sucrose, fructose, high fructose corn syrup, molasses, etc. are all sugars added to many of our foods. Fast and processed foods are loaded with these sugars. Soda, as well as being high in sugar , also is high in acids like ascorbic and citric acid. Even sports drinks have lots of acids! These acids dissolve enamel and make it easier for bacteria to invade the teeth. Most box drinks, except those that say they are 100% juice are loaded with sugar. Box chocolate drinks have more sugar than soda!

Our dental team can help you and your child keep their smile healthy for a lifetime.


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How often should we change our toothbrush?

Tooth brushes should be changed at least every two months. Make sure you only use a soft tooth brush. Hard tooth brushes can damage the gums. Change the toothbrush more often if your child chews on the toothbrush, or if they have been ill. (You can also put the tooth brush through the dish washer if your child has been ill) If your tooth brush bristles are not standing straight up, they are not cleaning your teeth well.


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My child’s breath is awful! What can we do?

From Halitosis Update ADA Journal vol. 35 April 2007:
The causes of bad breath can be multiple and can shift over time. Ninety percent of the time the wet, warm, dark mouth is the source of the odor. The oral cavity is the ideal breeding ground for microorganisms, and most halitosis sufferers have a localized cause for the malodor. Saliva, chewing , drinking, throat clearing and coughing work to help keep the mouth healthy. Insults such as smoking, neglectful oral hygiene, and conditions (asthma medicines) that cause xerostomia (dry mouth) tip the balance to enable odor causing bacteria to take over, growing with a virulence.

Food impaction between the teeth can produce unpleasant odors. Diseased gingiva (gums) , film-coated teeth, palate, tonsils/adenoids, and sinuses, as well as ear infections, can also cause bad breath. The tongue is of special significance because its crevices are covered by a thin sticky wetness clear or whitish yellow. The tongue is covered with bacteria, shed cells and decayed cells– it is the primary host of odors of all sites in the human body. Tongue cleaning reduces odor, but must be performed daily because the bacteria grow back each day and sometimes as fast as 15 minutes. The back of the tongue is like a sponge for post nasal drip which then commingles with the tongues’ bacteria to increase the odor. Tongue cleaning can be done with the tooth brush, a dry gauze , a tongue scraper or the edge of a plastic spoon. When cleaning the tongue reach as far back as possible, almost to the point of gagging.

Systemic Causes of Halitosis
Although rare, toxins in the blood caused by subsurface systemic diseases can contribute to mouth odors as the toxins are eliminated through the lungs. Hepatic, pulmonary, renal or metabolic disorders can cause oral malodor, as well as nerves, glandular disorders, gastric reflux, or other gastrointestinal disorders . Frequent sore throats can also be a symptoms of tonsils which may be impacted with sloughed cells, food , mucus and bacteria, causing odor. Your medical doctor would need consultation to rule out these possibilities.

Treatment and prevention
Mints and other candies provide temporary relief from halitosis, but then the sugar in the mints actually feeds the bacteria and can cause an increase in halitosis later! Mouth rinses with alcohol can also temporarily decrease malodor, but the alcohol dehydrates the mouth which causes the bacteria to grow further and cause more odor!

What Can Be Done?
Have your dentist make sure there are no cavities, and all restorations are in good repair. Your dentist can also check for any sores in the mouth. Have dental cleaning every six months. Plaque may be gathering between the teeth and under the gums which is the first stage of periodontal (gum) disease. Just like pet owners who have their carpets cleaned regularly, their houses smell less then those homes who do not have their carpets cleaned regularly. Patients who commit to have their teeth cleaned every six months often find this simple commitment helps keep oral malodors at bay.

Lastly, brush and floss together as a family. Your children are always watching and learning from you. If you don’t brush and floss regularly, neither will your children!


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My child’s gums bleed when they brush or floss. Why?

bleeding gums

Bleeding gums

If your child’s gums bleed when they brush their teeth, then they have not been brushing well or often enough. The teeth should be brushed after breakfast and after dinner, in other words every morning and evening. The teeth should be flossed every evening. Children (over age 5) and teens should brush 2 – 3 minutes. To gauge the correct time there are several aids: timers, electric toothbrushes with timers, or music. Children and teens can brush from the beginning to the end of a song.

The teeth and gums should be brushed. The tooth brush should be held where the teeth and gums meet and brush gently back and forth or in small circles making sure all teeth from the front to the back are brushed. Also, the “inside” should be brushed: along the roof of the mouth and next to the tongue.

Flossing can be done either before or after brushing, but I think more children remember if they floss first. The floss should go in between each tooth and under the gums. Once the floss is under the gums it should be moved back and forth. Lightly waxed floss is usually best for children and teens.

If the teeth and gums are brushed in this manner twice daily and flossed every evening the gums should stop bleeding within 2 weeks. If the gums do not stop bleeding, contact our office.


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What causes tooth decay (cavities)?

cavitiesThis is a very simplified version: We all have bacteria living in our mouths (as well as the rest of our body) . When we eat food, the bacteria eat as well. Since bacteria are simple animals, like humans, they pass gas (bad breath), and pee (acids). The acids soften tooth enamel and make it easier for the bacteria to move inside your tooth, therefore causing a cavity. If the cavity is not noticed early, the bacteria continue to soften the tooth and move further inside the tooth through enamel, dentin and then move into the pulp (nerve). The bacteria multiply during this entire process. If the bacteria reach the nerve and continue multiplying inside the nerve space, this is when severe pain can occur. If this pain is ignored , the bacteria can then spread into the soft tissue (gums or cheeks) and cause an abcess or cellulitis (cheek swelling).

Sometimes teeth with cavities that are not in the nerve can hurt also. Many times though, the pain is from food impacted (caught) in-between the teeth where the cavity has caused some of the tooth to break off and catch food. Flossing and brushing well, can alleviate the pain.

Tooth aches should never be ignored! Pain may be relieved temporarily, with flossing or pain medications, but the underlying cause of the pain needs to be determined.


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My children don’t eat much candy, but they are still getting cavities. Why?

In our modern society, candy is not the only source of sugar. Different types of sugar are hidden in most processed foods. Liquid sugars in the form of pouch or box drinks. Solid sugars are in cookies, crackers, cereals, breads, etc., etc. The trick is “all foods in moderation”.

Parents should set the example by having healthy food in the home and not storing “junk” foods or drinks. Parents should try to fix fresh vegetables and have fresh fruit for meals and encourage milk or 100% fruit juice. Limit soda to special occasions. Limit the amount of “white colored foods” , except cauliflower, these tend to be higher in sugar. Again, parents have to set the example: If you eat fresh, health foods and don’t buy many processed foods your child will learn to eat these also.

Our saliva buffers (neutralizes) acids produced by bacteria. The pH of our saliva must reach 5 for enamel to start softening. Some people have saliva with a high pH, such as 8 or 9. It is harder for these people to get cavities. Some people have saliva with a pH of 6. It is very easy for these people to get cavities.

The frequency of eating and snacking also influences the amount of cavities. If a child is constantly snacking or drinking juice or milk throughout the day or night their saliva does not have a chance to neutralize the acids produces by the bacteria. If your child must snack a lot, it is very important that these snacks not be processed sugary foods. Good snack choices are popcorn, cheese, peanut butter, nuts, fresh fruits, yogurt, veggies and dip, some dried fruits, and of course, water!


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Why are there stains on my child’s teeth?

Stains can be just on the surface of the tooth (extrinsic) or incorporated into the tooth (intrinsic). The latter is more rare. Stains on the surface of the teeth accumulate after the eruption of a tooth into the mouth. Newly erupted primary teeth may have a yellow membrane on them that will wear off in a few days. Newly erupted permanent teeth appear more yellow than their milky-white primary neighbors. This is their normal color. The permanent teeth are darker because they are denser so they can last a lifetime.

White color is not always good. Chalky white spots on permanent teeth can be a result of trauma to a primary tooth while the permanent tooth was developing in the jaw. Or, chalky white lines at the gum line or around orthodontic brackets can be a warning sign of beginning decay. Decay starts by removing minerals, especially calcium from the outer surface of the tooth. This softens and allows the acid from the bacteria in plaque to work more quickly. If oral hygiene (brushing and flossing) is started at this point, using a concentrated fluoride paste, and the teeth are kept meticulously clean, these areas can harden again by remineralizing. If the enamel turns brown, the enamel has been broken by the acid attack and the tooth may now need a filling.

If one or two teeth are dark, gray, pink, or yellow, this may be the result of that tooth having been hit accidentally. Your child should be seen soon thereafter for an x-ray picture of the tooth and a discussion about possible things that may happen to that tooth.

The rest of the stains below are all easily removed by a simple polishing done in the dental office.

Green or Orange Stain
Usually on the front teeth at the gum line. It is caused by color-producing (chromogenic) bacteria. Colonies of these orange or green bacteria usually mean that somebody is falling down on the job of cleaning the child’s teeth. It could also mean the child is a mouth breather.

Brown or Yellow Stain>
Very likely from antibiotics or colored chewable vitamins. The most common antibiotic to stain the surface of the teeth is Amoxicillin. A single dose may cause yellow to brown film to form on the teeth in some children. The stain may disappear partially or altogether once the prescription of antibiotics is finished. If is unattractive to you, the stain can be readily removed in the dental office.

Black Stain
Very often this stain is caused by chewable or liquid iron supplements, or even multiple vitamins with added iron. This stain polishes off easily. Some populations naturally form a black line on the teeth at the gum lines of all the teeth. It tends to be very tenacious, but can be removed in the dental office. Where these stains come from is unknown, but these children seem to have fewer cavities and seem to “grow out of” this black stain as they reach puberty.


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My child has a tooth coming in and the baby tooth hasn’t not fallen out yet (double teeth).

double teeth

Double teeth

This is very, very common!

The lower front teeth come in double in at least 50-75% of children. We do not need to extract (take out) the baby tooth unless it is the same height as the baby tooth and the baby tooth is not loose. When the baby tooth falls out, the permanent tooth will slowly (it may take months) move forward into its correct position.

If the top front teeth come in double we almost always need to help them out. Even my daughters teeth came in double!

 

 


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My child gets sores in their mouth. What causes this?

Sores in the mouth can be from many causes. Aphthus ulcers or “canker sores” (see left photo), recurrent cold sores (oral herpetic lesions), and traumatic injuries are some of the most common sores in healthy children.

mouth sores

Canker sore

The cause of canker sores is still a mystery, but scientists think they can be brought out by: braces, trauma, hard crunchy foods, cinnamon oils (in some candy and gums), and sodium laurel sulfate (found in many toothpastes).

Recurrent cold sores are caused by the oral herpes virus. They are contagious and can be spread by sharing foods, straws, kissing, etc. Recurrent cold sores will recur over your life time, thus the name. The sores can be brought out by trauma, and stress.

Canker sores can usually be differentiated from recurrent cold sores by their location. Canker sores usually occur on “moveable” oral tissues, like the tongue, cheeks, and the folds between the cheek and gums. Recurrent cold sores usually occur on the “non-movable” tissues, the gums and are usually very close to the teeth.

Sores from trauma usually are caused by an accident where the gums or other oral structures are injured. These sores are usually seen immediately. Canker sores or recurrent cold sores may not show for days after a trauma.


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My child’s gums are brown, is this unhealthy?

Brown gums are called physiologic pigmentation , and are normal. Children with brown or olive colored skin can have brown gums. This is completely normal. If gums are red, then you may have gingivitis or gum disease.


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My 10 year old’s canine tooth is loose, I think it is a permanent tooth.

Unless your child has had trauma to their mouth, the tooth is a baby tooth. Permanent teeth in children do not become loose without trauma.


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My child says their jaw hurts and it looks like the gum is growing over the back tooth!

molar photoAt approximately 6-7 years old children get their first set of permanent molars. The gum will recede (shrink) as the tooth comes in. Your child will get three sets of molars: at age 6-7, between ages 11-13, and wisdom teeth at age 14-21.

Anbesol, Children’s or Junior Tylenol, Motrin, warm water and salt rinses or Advil will help until the tooth is fully erupted (as long as your child is not allergic to these medications).

 

 

 


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My 3 year old’s front tooth never came in. Why?

Some children are missing teeth. Usually the problem is genetic (a parent or ancestor was missing teeth). When your child is able to cooperate, we will take an x-ray to determine if the permanent tooth is missing, also. If a permanent tooth is missing, your child can have a “fake” tooth made to replace the missing one, or have braces to move teeth around to close the space.


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My 3 year old has a funny looking tooth that looks like it is split in two. Why?

Sometimes primary teeth come in fused (glued) to the adjacent tooth. Sometimes primary teeth come in fused to an extra tooth. Sometimes a primary tooth will try to ‘split” into two! Terms we use for these teeth are fusion, gemination or twinning. An x-ray will determine which type of tooth your child has. These anomalies rarely occur in permanent teeth.


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At what age can my child go to the orthodontist?

There is not a definite age. It depends on how many permanent teeth your child has and what his/her dental problem is. Usually, the orthodontist will see your child when they have 8 permanent front teeth and 4 permanent back teeth. However, if your child has an under bite or severe crowding we will send them to the orthodontist earlier.


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My child plays sports how can I protect their teeth?

mouthguardsA custom fit mouth guard is best. These types of mouth guards fit snugly and do not flop around in the mouth. They are also thicker than store bought varieties. Your teen does not have to clench to hold them in place and they are able to talk. When teens have to clench on mouth guards to hold them in place, they are more likely to break bones in their face if they are hit. Mouth guards that fit correctly, allow the mouth to relax, so the likely hood of breaking facial bones decreases. The mouth guards can be made in almost any color or combination, even clear!


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Does my smoking cigarettes affect my child’s teeth?

Yes. Nicotine promotes the growth of the bacteria that cause cavities (strep mutans), so when mothers or fathers smoke and they kiss their children or share straws or utensils they pass the bacteria on to their child. So the lesson here is second hand smoke not only affects the lungs of children exposed to their parents’ smoking, it also affects the amount of cavities they may develop (March 12, 2007 JAMA).


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Is my teenager as susceptible to cavities?

Many parents and teens think they have “outgrown” cavities, but the teen years can actually see an increase in cavities.

Teens have busy, active lives, so they tend to choose food that is quickest, not what is healthiest. This may include lots of soda and fast food. Sports drinks include alot of acids (look at the nutritional label for citric, ascorbic, or phosphoric acid). These acids add to the acids produced by the bacteria and can cause an increase in cavities. If you saw the movie “Super Size Me”, then you know how much sugar is in fast food.

Brushing and flossing daily will help remove the sugars, and make the gums healthier. I know I am a broken record, but parents need to encourage their teens to eat dinner at home at the family table at least a few nights a week, so parents can provide healthy food choices.


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My child knocked out a tooth, how do I know if it is a permanent or a baby tooth?

baby and permanent teeth

LEFT: Baby tooth (top), Permanent tooth with root (bottom) RIGHT: Permanent teeth

When a permanent tooth is knocked out it usually happens from a significant blow or fall to the face. The tooth will have a long root , about one inch. If your child’s permanent tooth is knocked out the chances of survival are best if the tooth is placed back into the socket at soon as possible (within one hour). If the tooth is dirty, it should be GENTLY rinsed in a cup of water. Do not rinse under a faucet because you may drop it down the drain. If you are not able to place the tooth back into the socket, then put it in a cup with the child/teens own saliva or keep the tooth in milk, just enough to cover it. Call our office right away so we can reposition the tooth and splint it in place. If it is after hours, our answering service will contact the doctor on call.

Baby teeth, even those with long roots cannot be placed back in the socket because the permanent tooth underneath may be damaged.


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My 2 year old sucks their thumb/finger and I want them to stop!

Sucking is a natural reflex and infants and young children may use thumbs, fingers, pacifiers and other objects on which to suck. It may make them feel secure and happy or provide a sense of security at difficult periods. Since thumb sucking is relaxing, it may induce sleep.

At 2 years old, children need the comfort their thumb provides. It is very difficult to stop a very young child from sucking their thumb. It is best at this time to ignore the habit as much as possible. Trying to force a two year old to stop sucking their thumb will be battle of wills, with you, the parent the loser! It is better to try to engage or distract your child when sucking, and take their thumb out of their mouth when they fall asleep.

When they are 4-5 years old, you can use a reward system. Reward your child when they do not suck, with a star, and when they get 10 stars they get a reward (e.g., toy, video, book). You can also limit the locations of thumb sucking to home only, or bed only. If your child is still sucking when the lower front teeth become loose, we can make a thumb sucking reminder appliance. These work best to help your child stop sucking his/her thumb.

Thumb sucking that persists beyond the eruption of the permanent teeth can cause problems with the proper growth of the mouth and tooth alignment. How intensely a child sucks on fingers or thumbs will determine whether or not dental problems may result. Children who rest their thumbs passively in their mouth are less likely to have difficulty than those who vigorously suck their thumbs.

Pacifiers are no substitute for thumb sucking. They can affect the teeth essentially the same way as sucking fingers and thumbs. However, use of the pacifier can be controlled and modified more easily than the thumb or finger habit.


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My 5 year old grinds their teeth at night! We can hear it down the hall!

As many as 80-90% of young children grind (brux) their teeth at night. Some children also grind during the day. There is no definitive cause for grinding, but several theories exist.

  1. Children with allergies and severely restricted airways grind as a means of relieving congestion, similar to yawning when going up in an airplane to relieve the congestion in your ears.
  2. Grinding may be part of a sleep disturbance during REM (active dream) sleep. Grinding can also be associated with bed wetting, sleep talking, drooling while sleeping and night time muscle cramping.
  3. The anatomy of the temperomandibular joint (TMJ) allows easy movement of the bottom jaw (mandible). These movements become harder to make as the TMJ matures with age.

Children usually grow out of this problem by age 10 without causing permanent damage. If the problem persists into the teens and the dentist recognizes signs of unusual wear to the permanent teeth, preventive measures can be taken to prevent future damage. Treatment may involve a plastic night guard for nighttime wear.

Remember, bruxism in young children does not always mean that damage is occurring or that dental problems will occur later in life.


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What is the bump above my child’s tooth?

abscessThe swelling is an abscess. In other words the bacteria that caused the cavity has now entered the inside of the tooth (nerve/pulp) and infected the tooth and gums. This tooth may need antibiotics and will need a pulpotomy (baby root canal) or extraction.

 

 

 

 

 


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When should I call the after hours emergency phone number?

(510) 589-3004
The after hour emergency answering service is for our current patients. Unfortunately, if your child has never been to our office we cannot accept your call after office hours.

It is very important to have your child with you when you call the emergency number. The doctor on call will most likely have questions to ask you about your child’s mouth.

Our most frequent after hour problem is trauma. If your child has a permanent tooth knocked out WE NEED TO SEE THEM WITHIN AN HOUR OF THE TRAUMA!! If you can put the tooth immediately back into the socket, then call us that would be best. Permanent teeth have long thick roots and do not get loose unless there is a blow to the mouth.

Other frequent after hour calls are for other trauma to the permanent teeth or trauma to baby teeth, swollen cheeks, and pain.

We always have a Pediatric Dentist on call.


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