FAQs

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General Information for All Ages
What is dental caries?

Dental caries is an infectious disease process that causes tooth decay or “cavities.” If untreated, caries can lead to severe pain, local infection, tooth loss, and even serious systemic infections. Babies typically are inoculated or “catch” dental caries from their parents. For this reason, it is important that parents attend to their own dental needs, striving to have excellent dental hygiene and, therefore, helping to prevent problems with their children’s teeth.

Here is what is happening in your child’s mouth: Teeth, which are primarily made of minerals, are in a constant state of back-and-forth de-mineralization and re-mineralization. When your child eats and drinks, certain types of bacteria create acid from the foods and fluids left on the teeth. The acid de-mineralizes or weakens the tooth enamel. In healthy mouths, the time between meals allows, minerals from the saliva to become incorporated into the teeth, remineralizing the enamel and reversing the damage from the acid. In essence, the tooth heals itself. However, in unhealthy mouths, where there is an abundance of bacteria and a high incidence of juice, energy drink or snack consumption, the enamel never remineralizes and the tooth, instead of healing, develops decay. Therefore, the more parents can clean their children’s teeth, use appropriate amounts of fluoride and give the teeth time between food and drink consumption to recover, the better chance their teeth will have to win the battle for re-mineralization, be healthy, strong and caries free.

How does fluoride help teeth?

Fluoride is an element which works in the re-mineralization process, helping your teeth to create stronger tooth enamel. It is important to get the proper dose of fluoride, as too little or too much can be bad for the teeth.

In general, there is not as much need to supplement a child for fluoride today as there was a decade ago, because we now have many sources of fluoride. Besides toothpaste, other sources are fluoridated drinking water, like we have here in Charlotte, and processed foods produced with fluoridated water, such as juices and canned foods. Talk with your dentist about your child’s fluoride sources to make sure they are getting the correct amount.

About brushing and flossing…

Parents should brush the teeth of infants, toddlers, and preschoolers, and help school age children with brushing their teeth until the age of 7 or 8. As a rule, until a child can tie his own shoe, he will need assistance in brushing his teeth! The best times to brush are after breakfast and before bedtime. The best toothbrushes for children have soft round ended bristles that clean while being gentle on the gums. Along with brushing, parents should floss children’s teeth where any two teeth touch. Flossing removes the plaque between teeth, where toothbrushes can not reach.

When choosing a toothpaste brand for your child, the most important thing to look for is the American Dental Association (ADA) Seal of Acceptance to ensure the product’s safety and effectiveness. We always recommend using a small amount of toothpaste and suggest placing the paste across the width of the brush’s bristles instead of the length. By applying the paste in this manner, a consistent, pea-sized amount will be delivered to your child and the risk of ingestion, reduced. Regardless of the brand your child uses, always have them spit out the excess toothpaste if possible rather than swallowing it.

Do you accept insurance?

Yes, we will be happy to call your insurance company to obtain a detailed verification of your benefits. We realize that dealing with insurance companies can be time-consuming, confusing, and at times, stressful. We make every attempt to make this process as easy as possible for you. Please provide us with your coverage information prior to your scheduled appointment. This will make the verification process quicker.

What is the best toothpaste for my child?

When choosing toothpaste for your child the most important thing to look for is the American Dental Association (ADA) Seal of Acceptance to ensure the product’s safety and effectiveness. Use a small amount of toothpaste – about the size of a pencil eraser or a green pea. No matter what the brand your child uses, always have them spit out the toothpaste rather than swallowing it.

At what age should I take my child to the dentist for the first time?

The American Academy of Pediatric Dentistry (AAPD) and the American Association of Pediatrics (AAP) recommends that children see a dentist six months after the first tooth comes in, and definitely by their first birthday. It is important to have this first dental visit for several reasons:

  • Dental carries is the number one bacterial infection in children. For this reason, it is important to clean the teeth as soon as they erupt to disrupt the bacterial plaque development, and reduce the amount of bacteria in your child’s mouth
  • An early professional assessment of your child’s oral health condition helps you to better plan for his future care.
  • Early information about your child’s dental care can better prepare you to:
    • Clean your child’s teeth properly
    • Decide which foods help or hurt your child’s teeth
    • Take precautions to prevent dental trauma within your home
    • Take positive action if your child has a dental emergency
    • Understand the effects of oral habits such as thumb sucking and pacifier use

We believe this appointment is important, because being an informed parent is the best thing you can do for your child’s dental health and providing you with this information is the best thing we can do for you!

Why is it important to have Continuing Care appointments every six months?

Visits to the dentist for continuing care will help keep your child’s gums and teeth healthy, and the exams allow for early discovery of problems. Early detection usually means an easier solution!

Why every six months?

Studies have shown that 6 months is the average time for plaque and tartar to form on the teeth and for tooth decay to be evident by a radiograph.
At each continuing care visit with your child, the pediatric dentist will:

  • Check his gums for inflammation, tooth mobility and pocketings;
  • Examine his mouth for indications of possible cancer, diabetes and vitamin deficiencies;
  • Examine his jaw joints for any irregularities in their form and function
  • Note any irregularities in his facial structure, bite, arch form, and teeth spacing.
  • Clean his teeth of plaque, tartar and stains
  • Apply appropriate fluoride to the teeth
  • Recommend dietary modifications if necessary
  • Show you and your child how to best clean their teeth at home
  • Encourage your child, if it is age appropriate, to practice good dental hygiene habits at home

We know that on average, we will only see your child 2x a year, so it is very important to us that you have the best information to care for your child’s teeth at home. If ever there are questions that you have related to home dental care, please NEVER hesitate to ask for our guidance. We care about your comfort with these tasks!

Food for healthy teeth — what’s good, what’s not?

In general, food that is good for your child’s body is good for his teeth. Foods rich in Vitamin D and calcium are especially important for strong teeth and bones.

Foods that are not good for your child’s teeth are those that create an acid environment in the mouth, stick in the crevices of the molars, or adhere to the teeth. These include the following:

  • Carbonated beverages, because the acid in the carbonation can cause damage to the teeth
  • Snack items like potato chips, candies and pretzels that stick in the biting surface of the back teeth (molars)
  • Sugary drinks like juices and energy drinks that pool in the gum pockets, causing tooth damage and decay at the gum lines and between the teeth

Not only is it important to be careful about what your child eats and drinks, but also when and how often they eat. Frequent or “at will” feeding of any carbohydrate, juice, milk, or snacks, can be damaging to the teeth because this allows less time for the mouth to create a non-acid environment where the teeth can re-mineralize and recover from any damage.

About X-rays / Dental Radiographs

Radiography is the use of X-rays to view unseen hard-to-see objects or areas is a necessary part of your child’s dental diagnostic process. Radiographs are needed to detect dental decay, survey erupting teeth, diagnose bone diseases, evaluate the results of an injury and plan orthodontic treatment. With contemporary safeguards, such as high-speed film, digital enhancement, equipment filtering, and proper shielding, the amount of radiation received in a dental X-ray examination is extremely low. Besides representing a standard for proper pediatric dental care, pediatric dentists use radiographs because they are much safer for your child than an undetected dental problem!

Is it a problem if my child grinds his teeth at night?

Teeth grinding, or bruxism, in children is not uncommon and is usually not related to stress, as it commonly is for adults. For children, bruxism is typically related to the anatomy of the immature jaw joint, and it typically ceases once the permanent teeth come in, or erupt, and the jaw joint matures.

What does it mean if my child’s teeth are sensitive to hot and cold?

It is not uncommon for children to express tooth sensitivity to hot and cold. The enamel of primary teeth is not as thick as that of permanent teeth. Some teeth, however, such as the 6 yr molars, can develop with “softer” enamel and, as a result, are more sensitive to temperature changes than other teeth. If this is an issue with your child, please discuss it with the dentist on your next visit.

Is there anything that can be done to make sure that my child’s teeth come in straight?

A complete evaluation of your child’s dental alignment, including space maintenance, arch development and eruption guidance, is part of each continuing care visit. Early treatments may be recommended and can be effective in allowing for the normal eruption of the permanent teeth.

What can you do to make my child more comfortable during dental treatments?

There is no getting around the fact that some dental treatments can cause discomfort. Our objective is to make your child as comfortable as we can while completing his dental rehabilitation. The options that we use for managing comfort are topical anesthetics, local anesthetics, nitrous oxide, and oral sedation with an anesthesiologist – also called “deep conscious sedation.” In some cases, we utilize the outpatient surgery center with Presbyterian Hospital and use general anesthesia. You will always have the opportunity to discuss the available options for your child with your dentist and dental team! Talk with the dentist to determine the best approach for comfort management during your child’s dental treatment.

Infant Ages 0-2 Years
Why are primary teeth so important – aren’t they going to fall out anyway?

Primary teeth, sometimes called “baby teeth,” are important to your child’s health and development and should be cared for just as you would for permanent teeth. Primary teeth serve critical functions as a child learns to eat and speak. They are important for the normal growth and development of the face. In addition, they maintain space on the dental arch and guide the eruption of the permanent teeth. While some primary teeth are typically replaced around age 6, the back teeth (molars) can remain in until age 12 or 13. Without proper care, these teeth can decay and possibly cause toothaches, gum disease, and serious health problems. For these reasons, primary teeth are significant and require good daily hygiene and regular professional attention, just like permanent teeth.

When will my baby start getting teeth?

The primary teeth are forming under the gums even before a child is born! While it is possible to have “natal teeth,” where the baby is born with teeth already in the mouth, the primary teeth normally start to come in between 4 – 6 months of age, with the lower, center, front teeth (central incisors) coming in first. Permanent teeth start to develop under the gums around age 3 and begin to erupt around age 6. Eventually your child will have up to 32 permanent teeth, including the 4 wisdom teeth.

Teething…

The vast majority of kids fly right through teeth eruptions with no problems, but teething can be difficult for some. When the back teeth are coming in, this can cause not only discomfort, but also fevers, blood blisters, and ear aches, which can simulate inner ear problems. To help your baby with teething, we recommend frozen bagels for them to chew on, so that the baby can gently work the gums to allow the teeth to erupt. You can also use Children’s Tylenol® or Motrin® to help your child be more comfortable. There are some topical analgesics, such as PM Orabase® that are also effective, but please do NOT apply aspirin directly to gums as this can cause severe burns of the tissue. If you have any questions about teething, please call us.

About bottles and nursing at bedtime…

It is important to know that nursing a baby to sleep or putting a baby to sleep with a bottle of milk or juice can be very bad for her teeth. When a baby sleeps, her saliva production is lessened, so the natural cleaning mechanism for the teeth is not at work. Without this saliva, your baby’s teeth becomes covered in the sugars from the milk or juice. These sugars feed the bad bacteria that are in the mouth, creating an acid environment that encourages tooth decay. For this reason, we recommend cleaning your baby’s teeth with water and a soft bristled brush or washcloth before putting her down to sleep and after night feedings. If you must give something in a bottle to help her go to sleep, use plain water or flavored water without sugar.

How should I clean my infant or toddler’s teeth?

Clean your infant’s or toddler’s teeth with water and a washcloth or child’s toothbrush with soft bristles. It is recommended not to use toothpaste until he is able to spit it out and not swallow it. This ability usually occurs around age three.

Do you do early orthodontic evaluations?

Pediatric dentists are specialists with children’s dental development. Your child’s complete dental condition, including potential orthopedic (concerning the positioning of facial bones) and orthodontic (concerning the positioning of the teeth) conditions will be evaluated at every continuing care visit. It can be helpful to know that it is not unusual and in fact it is normal.

Is it a problem if my child sucks his thumb or uses a pacifier?

Orthopedic change can result from a prolonged use of thumb sucking or pacifiers, however, this is typically not an issue until age 4 or 5. Sucking is a normal reflex for infants and, as you are probably aware, can soothe them. Children usually stop sucking their thumbs naturally as they get more active and begin to require both hands for their activities, like holding toys, climbing on furniture and coloring.

The potential for dental emergencies…

We don’t call them toddlers for nothing! The typical coffee table is the perfect height of the upper front teeth for many children and for that, we see many injuries to these teeth in this age group. Look at the layout of your furniture and think ahead about what could be a bad situation for your child. We strongly recommend precautionary measures, like installing bumpers or removing items with sharp corners, to save a lot of pain and trouble. Establish a Dental Home for your child now, before something happens, and put the emergency contact number in your speed dial and next to your home phone. If your child experiences any facial trauma, please remain calm and consult with his dentist, because in many of these situations, your assurance is important!

Tooth Eruption Chart

eruption
Download the following eruption charts (PDF files):
Primary Teeth Eruption Chart | Permanent Teeth Eruption Chart

Ages 2-5 Years
Why are primary teeth so important — aren’t they going to fall out anyway?

Primary teeth, sometimes called “baby teeth,” are important to your child’s health and development and should be cared for just as you would for permanent teeth. Primary teeth serve critical functions as a child learns to eat and speak. They are important for the normal growth and development of the face. In addition, they maintain space on the dental arch and guide the eruption of the permanent teeth. While some primary teeth are typically replaced around age 6, the back teeth (molars) can remain in until age 12 or 13. Without proper care, these teeth can decay and possibly cause toothaches, gum disease, and serious health problems. For these reasons, primary teeth are significant and require good daily hygiene and regular professional attention, just like permanent teeth.

Eruption of Teeth

During this age, your child will get his final primary teeth as – the second molars generally erupt around age two years. He will then experience a lag time during which he will neither gain new teeth nor lose any teeth. Children typically begin to lose, or exfoliate, their first primary teeth around six years of age, but some children may begin this as early as four years. If you have any questions regarding your child’s tooth eruption or loss, please consult with his dentist.

Preventing cavities and controlling dental caries

Between the ages of 2 and 5, children tend to become more independent and we recommend that parents stay diligent at controlling their child’s nutrition, snacking habits, and oral hygiene. This is the age where children often increase their snacking and drinking of sugary liquids. It is no coincidence that we see a lot of tooth decay in children who drink a lot of fruit juice. Therefore, we highly recommend that juices be limited to twice a day consumption or the child be given plain water or flavored waters with no sugar.

Also at this age, children tend to want to do more things by themselves; however, we strongly recommend that a parent continue to help a child brush and floss his teeth until he is 7 or 8. A good rule of thumb is that if they can not tie his shoes, he can’t do an adequate job of brushing and flossing.

Is it a problem if my child sucks his thumb or uses a pacifier?

Thumb-sucking and pacifier use in children younger than 4 is not considered a problem. Children usually stop this habit between the ages of 2 and 4.

Children who suck their thumbs frequently or with great intensity after the age of 4 or 5 ARE at risk for dental or speech problems. Such problems include the improper growth of the jaws, misalignment of the teeth and shape of the dental arches. A child may also develop speech problems, including mispronouncing Ts and Ds, lisping, and tongue thrusting. Questions regarding oral habits are common, so please do not hesitate to ask yours!

If you are concerned about your child’s thumb sucking or pacifier habit, talk with the dentist about your child’s dental condition, and what you can do to help your child quit their habit. A good book about thumb sucking is David Decides About Thumbsucking: A Story for Children, A Guide for Parents, by Susan P H.D. Heitler.

Early orthodontic evaluation and treatment

The ages of 2 to 5 years often present opportunities to correct many orthopedic (concerns the positioning of the facial bones) discrepancies and to allow for normal function of the jaws. The goal of most intervention at this age is to create an environment that allows for normal eruption of the 6 year molars. Also, at this time, we can begin to assess crowding and develop strategies for managing the eruption of the permanent teeth.

The potential for dental emergencies

This is very active and adventurous time for most children. They are often climbing, jumping , and testing their limits. Please keep a watchful eye on them and help them to understand how to have fun while making good choices to avoid major injuries. We also recommend that you put our emergency number in your cell phone and next to your home phone. When you need it, you do not want to have to look for it! If your child experiences any facial trauma, please call the emergency number and consult with his dentist.

Ages 5-12 Years
About Orthodontics…

This is a time of transition from primary to permanent teeth and for reconfiguration of the jaw joint structures. We want to make sure that there are no cross bites or constriction of the dental arches that require an abnormal joint shift to bring the teeth together. We also want to assure normal eruption of the permanent molars, as they are important for the normal function of the joint.

At this time too, we want to assure proper alignment of the incisors, top and bottom, and correct alignment of the cuspids or “eye teeth.” (They can sometimes become impacted in the arch or look like fang teeth!) This is a time for rapid growth of the body and the face, and for that reason, it’s a good time to make any necessary changes in the development of the face. This is the age group of children who often receive head gears, for example, to correct overbites and underbites.

At Charlotte Pediatric Dentistry, we support the position of the American Association of Orthodontists that children receive a comprehensive orthodontic evaluation by age 7. The evaluation will include standard arch length measurements, registration of their bite and a panoramic radiograph study of their face. When appropriate, a consultation with the orthodontist, pediatric dentist and parents is scheduled to discuss any treatment recommendations.

Panoramic Radiograph

When your child’s first permanent molars erupt, we will suggest taking their first panoramic radiograph. This radiograph is critical for us to see the presence, or absence, of the permanent teeth as well as their shape and eruption pattern. We are also able to evaluate the development of the jaw joint (temperomandibular joint) and the presence of many pathological conditions that affect the jaws. This radiograph is critical to many decisions that we make concerning your child’s restorative and orthodontic care.

Preventing Cavities

We recommend that parents continue to teach and reinforce good nutrition, including healthy snacking habits and good oral hygiene with their child. We strongly recommend that a parent continue to help a child to brush and floss his teeth until he is 7 or 8. A good rule of thumb is that if he cannot tie his shoes, he can’t do an adequate job of brushing and flossing his teeth. Continue to schedule and keep regular continuing care appointments, or dental check-ups, for your child every 6 months.

Mouth guards for sports

We are very supportive of the use of mouth guards in any contact sports, including football, soccer, and hockey. Mouth guards not only protect the teeth, but can reduce concussions, brain injuries, and injuries to the joints. A mouth guard must be comfortable and not cumbersome, so that the child will use it. If you have trouble finding one to fit, we can make a custom one for your child.

Chewing gum

We encourage the use of sugarless gum to help prevent tooth decay! Sugarless gum can actually clean the biting surfaces of the molars and stimulate saliva production. This brings minerals to the surface and helps the teeth heal. Keep in mind that gum with sugar is very bad for the teeth.

Sealing out decay…

Sealants are used to protect the decay-prone areas of the back teeth, and are possibly the best preventive care measures that we can provide your child. Studies show that sealants can reduce caries in these permanent teeth by 70%. Sealants are easily applied and are quite durable, so ask the dentist if your child can benefit from sealants.

Ages 12-17 Years
Preventing Cavities…

We see a great frequency of dental caries in teenagers due to the availability of soft drinks and sports drinks in school. Sports drinks are good to use following athletics to replenish fluids, but regular and indiscriminate use bathes the teeth in sugar and acid and leads to decay. We recommend a switch to flavored waters or plain water to give the teeth a break from the sugar-producing acid and provide a chance for them to re-mineralize and heal (see the section on What is Dental Caries for more information on re-mineralization.)

Sealing Out Decay…

Sealants can be used to protect the decay-prone areas of the back teeth, and are possibly the best preventive care measures that we can provide. Studies show that sealants can reduce caries in these teeth by 70%. If a teenager has never had decay, we may not suggest sealing his teeth – particularly if he brushes and flosses well and has a healthy diet. However, if a teenager has had a history of cavities, it may be a reasonable recommendation. Sealing can be an effective preventive measure, but should be considered on a case-by-case basis.

Teeth Grinding…

Talk with the dentist if your teenager is grinding her teeth. At this age, teeth grinding can lead to jaw joint problems from the stress of overworking the jaw muscles. Often a custom made mouth guard allows the muscles to rest at night, reduces the pain, and protects the teeth and jaw joint.

Mouth Guards for Sports…

We are very supportive of the use of mouth guards in any contact sports, including football, soccer, and hockey. Mouth guards not only protect the teeth, but can reduce concussions and injuries to the jaw joints. A mouth guard must be comfortable and not cumbersome so that your teenager will use it. If you have trouble finding one that fits properly, we can make a custom guard for your teenager.

Chewing Gum…

We encourage the use of sugarless gum to help prevent tooth decay! Sugarless gum can clean the biting surfaces of the molars and stimulate saliva production. This action brings minerals to the surface and helps the teeth heal. Keep in mind that gum with sugar is very bad for the teeth.

Tobacco Use…

Most parents and teenagers are aware that smoking cigarettes is bad for their health, can damage their mouth and lungs, and stain their teeth. It is also important to note that smokeless tobacco is especially dangerous because the nicotine is absorbed directly through the gums. Studies show the incidence of cancer of the mouth increases as a direct result of its use. It is important to understand that tobacco in any form is very detrimental to oral health, and we strongly advise against its use.

Teeth Whitener…

Many teenagers are concerned with personal appearance and having healthy white teeth can boost their self esteem. While excellent oral hygiene and regular checkups are the best way to a beautiful smile, some teenagers may want to try whitening their teeth for extra dazzle. Over-the-counter teeth whitening products can be safe and effective, but consult with the dentist prior to using them to be sure. For a faster, safer and more effective result, we can provide cosmetic teeth whitening with custom trays. With this process, a chemical reaction occurs within the tooth to produce fast and stable results. Talk with the dentist if your teenager is interested in this process.

Bad Breath…

Many teenagers are concerned with bad breath. Our advice for this problem is to adequately brush your teeth and gums, palate and tongue, and floss every day. We have found that Crest Pro-Health™ toothpaste has been shown to be very effective in reducing bacteria and can improve the breath. Colgate Total™ toothpaste is another good option. We do not recommend that children or teenagers use alcohol-based mouth rinses.

It is important to note that if your teenager has allergies, asthma, or sinus infections, he will often have secondary halitosis that can’t be brushed or rinsed away. In these cases we recommend seeing your child’s doctor to address the primary cause.