Randall LaFrom, DDS COSMETIC AND GENERAL DENTISTRY (408) 996-8595 PH randy@club2000.com

PEDODONTICS - (The field of dentistry that deals with treatment of children's teeth.)

When we speak of pedodontics (or pediatric dentistry), we are referring to treating children (generally considered age 14 and under.) While children have special needs due to the additional concerns of orthodontics, space maintenance and dealing with the mixed dentition (having both "baby" and "adult" teeth), most dentists will treat kids. It is generally due to either a case being complex, or perhaps the child is a bit apprehensive about dental care, or doctors that we would decide to refer the child to a specialist. There are several things that an office can do to help eliminate the fears that children experience when visiting a dentist. Among these include, having the first visit be when the child is young and has no cavities. At this time, if the dentist can put the child in the chair (or in the mother's lap in the chair), then we can count their teeth and let them watch. (Often, we like to count their fingers first to allow them to see what we are doing and that it doesn't carry any stressful work.) Then after counting their teeth, we may put the air and water syringe in or near their mouth to show them how that works. We also introduce them to the overhead light and how it helps us see better. That is about it for their first visit. It's off to the "toy-chest" after that for a little reinforcement for their good behavior!

Special concerns for children's teeth: Baby Bottle Caries - Infants can get cavities just like older children and adults. In fact, if a child nurses with a bottle containing sugar in it, the acids can cause serious decay on the baby teeth. One way to prevent this is to not let your baby sit for long periods of time with sugar flavored drinks (juices, sodas, milk, etc.) in their bottle. Another way is to carefully brush your child's teeth after each bottle, or at least use a washcloth to clean them off. You can bring your child in for an exam as early as one year of age if you are concerned. Typically, however, we will see children for dental visits starting around three to three and a half years of age.. Fluorosis - When teeth are developing, systemic fluoride - through drinking water, tablets, or vitamins that contain fluoride, can all help strengthen the teeth and bones of a growing child. In addition, topical fluoride such as applied with a gel, in mouthrinses, and in toothpastes, has also been found to be beneficial for preventing cavities. These have been shown to reduce cavities 25-60% in various studies. Too much fluoride can cause discoloration of the teeth. You should monitor the amount of fluoride your child ingests when brushing their teeth daily and consult your physician about fluoride tablets, whether your community fluoride level is high enough to provide the benefit you are looking for. Sealants - Children's teeth have grooves in the tops of them and often those grooves end up getting decay during teh eruption process because they are difficult to clean. A common therapy to help prevent the bacteria and food getting into those grooves is by placing sealants into those grooves. This can also be done on adult teeth as well to prevent cavities. Since they fill in the deep part of the fissure on top of the tooth, they generally stay in the tooth well and offer protection for the tooth for years. Space Maintenance / Orthodontics - As children's teeth fall out, the adult teeth need to have that space to come in. Many orthodontic problem can be prevented with proper space maintenance. This is sometimes referred to as "Interceptive Orthodontics". By using "guided eruption" we can maintain a space for the permanent tooth to come in. Sometimes, "early extractions" are needed to prevent the adult teeth from growing in sideways or crowded, when the baby teeth don't fall out in time. Pevention of prolonged thumb sucking may have an effect on the permanent teeth causing an "overbite", or the teeth may protrude. We can create an appliance to help prevent this. If there is a large discrepancy between the upper and lower jaw size, then orthodontics and/or headgear may be indicated. Sealant needed in deep fissure. Excess fluoride showing fluorosis spots. Lower Appliance to maintain space for bicuspids. Photos used with permission: Creighton University Dental School

Special Dental tips for small infants and toddlers... Babies can start drinking out of a cup after about eight months, so if they can drink that way, it will lessen the amount of time they are sucking and letting milk, or sugary drinks sit on their teeth. As mentioned above, you can use a washcloth to wipe off infants teeth initially. Once they do begin to use toothbrushes, you only need a TINY bit of toothpaste, if any at all, to start off with their brushing routine. A cold teething ring can be good for babies to chew on to ease the discomfort of teeth coming in. (If they are still in a lot of discomfort, Acetaminophen will help most children.) It is interesting to note, that about the same time a child starts teething, their inborn immunity is starting to fade. As a result, often, they can develop a fever around the same time, causing them to become a little cranky. The children should be brought into the office before they are two years old, to help get them familiar with the environment. We can count their teeth and their fingers and then give them a toy, thereby letting them have a positive first experience with the dentist! As your child develops... You can expect that by age 3, they should have there first set of teeth complete in their mouth. You can expect the first permanent tooth to come popping in behind the last baby tooth sometime around age 6. Sometimes it's early and sometimes it late. There isn't much concern if it's within a 2 year window around the projected time. Around this same time frame, the lower front two teeth can start to get loose. This is because the roots of the baby teeth are dissolving and making room for the permanent front lower central incisors. As they get loose, they can take several weeks to fall out, even if they look a bit loose. Generally, it is fine to simply let the tooth come out on it's own time frame. If however, it appears that by keeping the baby tooth in longer might jeopardize the positioning of the permanent tooth, then we might consider assisting the tooth out to make room. Start your child off early with good oral hygiene habits (brushing and using floss)... Quick Answers to Common Questions of Parents About Their Children's Teeth: When do the first baby teeth come in? You can expect them around six months old. How many teeth do kids get? They typically get 20 "baby" teeth. When should I start brushing my child's teeth? If you can, start with a wet gauze as soon as they are born, wiping their teeth or gums to get them in the habit. What's the best way to teach them how to brush? Typically if they'll let you hold it in their mouth, that would be best, but a very close second is if you do it in your mouth and explain to them how you are getting all the surfaces inside, outside and top and bottom. Are their any foods I should keep away from my kids for dental reasons? Obviously limit sugary foods, but also be careful of starchy foods such as bread or even fruit, that make break down or contain sugar. Gummy candies and sodas last on the teeth for a while and should be limited as well. Milk is good because it contains calcium for the development of the children's teeth. When should a child come to see a dentist? Unless you spot trouble, typically late in the age two to age three range is good. Their first visit will hopefully be a simple one of counting teeth and squirting water in their mouth and showing them the dental chair. Is it worth it filling a child's tooth, it's going to fall out anyway? Children's teeth not only help them chew, but also, they act as space maintainers for the adult teeth. If a child looses a tooth early, there may not be room because of it, for the adult tooth to come in, because often they are larger than the baby teeth. We use a year or more as a guideline to fill a small cavity... if the tooth will be in for less than one year and it's a small cavity, then we might take a chance on it and let it go. We wouldn't want to leave in an abscessed tooth to create an infection for the child. Are sealants really worth it? The back teeth especially, have little pits and grooves in the teeth that are a serious problem for cleaning. The small bacteria can easily trap in there and cause problems. If a sealant is properly placed, then it could prevent a cavity from developing. While there isn't a guarantee that decay won't get in, there is a 70-80% track record for five years on teeth that are protected with sealants, that they won't get a cavity. This is significant, as we are seeing more and more children growing up without cavities in these very common areas for decay to occur. Note that not all teeth need sealants, especially if the top of the tooth is very flat or smooth and doesn't have the grooves that can contribute to the decay process starting. When should we be concerned about orthodontics for my child? As soon as the child has their first "permanent" molar, typically after 6 years old, is when orthodontists will consider putting some type of braces or beginning some type of treatment. If there is a skeletal discrepancy, and the jaws don't line up, then it's easier to use the growth of the child to gently guide the position of the teeth and jaws while the child is young and the bone is less dense, so it moves easier. Some dentists will wait until age 12 or 13 if the child doesn't have any major problems, to "fine-tune" the bite, and make sure the teeth align themselves well for maximal chewing function. What should I do if my child knocks out a tooth? If it's a baby tooth, we probably won't be doing much. In fact, because they have short roots, they may come out easily with a minor trauma. If the tooth is an adult tooth, then you can be more concerned. If the tooth is knocked out, sometimes, it can be replaced if the root hasn't fully formed and we can get it securely positioned within a few minutes. If it's a couple hours, the socket probably already has started to seal up and it is unlikely that we can reuse the tooth. It's always worth a try, however. Keep it in MILK to prevent it from being chemically drained or infected (milk has a similar pH level as that of saliva). Don't rinse the tooth off or scrub it. Leave the tissue on the tooth and let the dentist decide what needs to stay or come off. How important are wearing sports mouthguards? A well made mouth guard can handle an elbow or a head butt and prevent a serious injury to the teeth. A poorly fitted "boil and bite" guard may help with most trauma, but a solid whack will hit that guard against the teeth as well. A properly fitted guard will spread out the pressure amongst all the teeth and perhaps the palate or bony ridge and lessen the intensity. Any child that participates in wrestling, martial arts, hockey, football and basketball or other sports that contact, should consider getting a well-made mouth piece.

FUN SITES ON THE INTERNET FOR KIDS (For your convenience to find your way back, each link opens a new browser window, you can click on the upper box to close it.) Search Engines that Pre-screen children's sites: Ask Jeeves for Kids Disney GAMES ONLINE Infoplease (Kids Almanac) Yahooligans (Kids version of Yahoo!) ADA online - A fun site with online dental related games Children's Discovery Museum - A virtual tour of San Jose's hands-on museum for children. Colgate-Palmolive No Cavities Club - Join the Club and have fun! Connect Four - the online version of the game. Play against the computer. Cyberkids - Articles, links, entertainment and more. KidsHealth - Children's Health and Parenting Information. PBS Online - Good quality family programs - kids stuff. Santa Clara County Public Library - resource for kids. Tech Museum of Innovation - Innovations in biotechnology, robotics, space, and microelectronics.