Information for Parents

<Early Orthodontic Care> <Dental Care for Special Child> <Flouride> <General Anesthesia>
<Space Maintenance> <Tooth Colored Fillings> <Malocclusion>

Early Orthodontic Care

It's never too early to keep an eye on your child's oral development. Your pediatric dentist can identify malocclusion -- crowded or crooked teeth or bite problems -- and actively intervene to guide the teeth as they emerge in the mouth. Orthodontic treatment early can prevent more extensive treatment later.

Q: What causes crowded teeth and other orthodontic problems?

A: Malocclusion is often inherited. Orthodontic problems also are caused by dental injuries, the early loss of primary teeth or such habits a thumb sucking, fingernail biting, or lip biting. Your pediatric dentist can help your child avoid oral habits that may create orthodontic problems.

Q: Why is early orthodontic care important?

A: Early orthodontics can enhance your child's smile, but the benefits far surpass appearance. Pediatric orthodontics can straighten crooked teeth, guide erupting teeth into position, correct bite problems, even prevent the need for tooth extractions. Straight teeth are easier to keep clean and less susceptible to tooth decay and gum disease.

Q: What is early orthodontic treatment like?

A: Different orthodontic appliances work in different ways to benefit your child's dental health. Some are fixed; others are removable. Your pediatric dentist will explain which appliance is best for your child, what the treatment can do, and how long it will take.

Q: What care is recommended during orthodontic treatment?

A: As with any dental treatment, the more a child cooperates, the better the results. First, careful brushing and flossing keep the appliance and your child's health in top shape. (Removable appliances should be brushed each time the teeth are brushed.) Second, regular dental check-ups -- besides orthodontic appointments -- protect your child from tooth decay and gum disease. Third, prompt contact with your pediatric dentist when an appliance breaks will keep orthodontic treatment on-time and on-track.

Q: Can my child speak, eat, and play normally?

A: Your child can eat a normal diet except sticky foods (gum, caramels) and large, hard foods (peanuts, ice chips, popcorn). Some appliances alter speech, but most children adapt quickly and speak clearly within a day or two. Generally, children can safely run, jump, swim, and play with an orthodontic appliance. Check with your pediatric dentist for specific advise on your child's activities.

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Dental Care for Special Child

An educational resource for parents and caretakers of children with special needs, this 12-minute videotape is excellent for viewing in dental and medical offices. Educational topics include the value of early dental care, prevention, and proper brushing, told heartwarmingly by three parents of children with disabilities. Developed in collaboration with several parent, community, and dental organizations.

Q: Do special children have special dental needs?

A: Most do. Some special children are very susceptible to tooth decay, gum disease or oral trauma. Others require medication or diet detrimental to dental health. Still other children have physical difficulty with effective dental habits at home. The good news is, dental disease is preventable. If dental care is started early and followed conscientiously, every child can enjoy a healthy smile.

Q: How can I prevent dental problems for my special child?

A: A first dental visit by the first birthday will start your child on a lifetime of good dental health. The pediatric dentist will take a full medical history, gently examine your child's teeth and gums, then plan preventive care designed for your child's needs.

Q: Will preventive dentistry benefit my child?

A: Yes! Your child will benefit from the preventive approach recommended for all children- effective brushing and flossing, moderate snacking, adequate fluoride. Home care takes just minutes a day and prevents needless dental problems. Regular professional cleanings and fluoride treatments are also very beneficial. Sealants can prevent tooth decay on the chewing surfaces of molars where four out of five cavities occur.

Q: Are pediatric dentists prepared to care for special children?

A: Absolutely. Pediatric dentists have two or more years of advanced training beyond dental school. Their education as specialists focuses on care for children with special needs. In addition, pediatric dental offices are designed to be physically accessible for special patients. Pediatric dentists, because of their expertise, are often the clinicians of choice for the dental care of adults with special needs as well.

Q: Will my child need special care during dental treatment?

A: Some children need more support than a gentle, caring manner to feel comfortable during dental treatment. Restraint or mild sedation may benefit your special child. If a child needs extensive treatment, the pediatric dentist may provide care at a local hospital. Your pediatric dentist has a comprehensive education in behavior management, sedation and anesthesia techniques. He or she will select a technique based on the specific health needs of your child, then discuss the benefits, limits and risks of that technique with you.

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How does fluoride work?

When the element fluoride is used in small amounts on a routine basis it helps to prevent tooth decay. It encourages "remineralization," a strengthening of weak areas on the teeth. These spots are the beginning of cavity formation. Fluoride occurs naturally in water and in many different foods, as well as in dental products such as toothpaste, mouth rinses, gels, varnish and supplements. Fluoride is effective when combined with a healthy diet and good oral hygiene.

Will my child need fluoride supplements?

Children between the ages of six months and 16 years may require fluoride supplements. The pediatric dentist considers many different factors before recommending a fluoride supplement. Your child's age, risk of developing dental decay and the different liquids your child drinks are important considerations. Bottled, filtered and well waters vary in their fluoride amount, so a water analysis may be necessary to ensure your child is receiving the proper amount.

What type of toothpaste should my child use?

Your child should use toothpaste with fluoride and the American Dental Association Seal of Acceptance . Young children, especially pre-school aged children, should not swallow any toothpaste. Careful supervision and only a small pea-sized amount on the brush are recommended. If not monitored, children may easily swallow over four times the recommended daily amount of fluoride in toothpaste.

How safe is fluoride?

Fluoride is documented to be safe and highly effective. Research indicates water fluoridation, the most cost effective method, has decreased the decay rate by over 50 percent. Only small amounts of fluoride are necessary for the maximum benefit. Proper toothpaste amount must be supervised, and other forms of fluoride supplementations must be carefully monitored in order to prevent a potential overdose and unsightly spots on the developing permanent teeth. Do not leave toothpaste tubes where young children can reach them. The flavors that help encourage them to brush may also encourage them to eat toothpaste.

What is topical fluoride?

Topical fluoride comes in a number of different forms. Gels and foams are placed in fluoride trays and applied at the dental office after your child's teeth have been thoroughly cleaned. Fluoride varnish is one of the newer forms of topical fluoride applied at the dentist office. It has been documented to be safe and effective to fight dental decay through a long history of use in Europe.
The advantages of varnish are:

  • Easily and quickly applied to the teeth.
  • Decreases the potential amount of fluoride digested.
  • Continues to "soak" fluoride into the enamel for approximately 24 hours after the original application.

This method is especially useful in young patients and those with special needs that may not toleratefluoride trays comfortably.

Children who benefit the most from fluoride are those at highest risk for dental decay. Riskfactors include a history of decay, high sucrose carbohydrate diet, orthodontic appliances andcertain medical conditions such as dry mouth.

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General Anesthesia

Q:What is general anesthesia?

A: General anesthesia is a management technique that uses medications to cause the child to become unconscious and asleep while receiving dental care. It is provided by a physician or dentist who has special training in anesthesia.

Q:Who should receive dental care with general anesthesia?

A: Children with severe anxiety and/or inability to cooperate are candidates for general anesthesia. These children may be young or have compromised health or special needs. They usually require extensive dental treatment and their anxiety cannot be controlled with conscious sedation techniques.

Q:Is general anesthesia safe?

A: Although there is some risk associated with general anesthesia, it is safe when administered by an appropriately trained individual in an appropriately equipped facility. Many precautions are taken to provide safety for the child during general anesthesia care. Patients are monitored closely during the general anesthesia procedure by personnel who are trained to manage complications. Your pediatric dentist will discuss the benefits and risks involved in general anesthesia and why it is recommended for your child.

Q:What special considerations are associated with the general anesthesia appointment?

A physical examination is required prior to general anesthesia for dental care. This physical examination provides information to ensure the safety of the general anesthesia procedure. Your pediatric dentist and/or your general anesthesia provider will advise you about evaluation appointments that are required.

Parents are instructed to report to the pediatric dentist any illness that occurs prior to the general anesthesia appointment. It may be necessary to reschedule the appointment. It is very important to follow instructions regarding preoperative fasting from fluids and foods.

Usually patients are tired following general anesthesia. Your child will be discharged when alert and ready to depart. You will be instructed to let the child rest at home with minimal activity planned until the next day. Post-operative dietary recommendations will also be given.

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Space Maintenance

Q: Why do children lose their baby teeth?

A: A baby tooth usually stays in until a permanent tooth underneath pushes it out and takes its place. Unfortunately, some children lose a baby tooth too soon. A tooth might be knocked out accidentally or removed because of dental disease. When a tooth is lost too early, your pediatric dentist may recommend a space maintainer to prevent future space loss and dental problems.

Q: Why all the fuss? Baby teeth fall out eventually on their own!

A: Baby teeth are important to your child's present and future dental health. They encourage normal development of the jaw bones and muscles. They save space for the permanent teeth and guide them into position. Remember: Some baby teeth are not replaced until a child is 12 or 14 years old.

Q: How does a lost baby tooth cause problems for permanent teeth?

A: If a baby tooth is lost too soon, the teeth beside it may tilt or drift into the empty space. Teeth in the other jaw may move up or down to fill the gap. When adjacent teeth shift into the empty space, they create a lack of space in the jaw for the permanent teeth. So, permanent teeth are crowded and come in crooked. If left untreated, the condition may require extensive orthodontic treatment.

Q: What are space maintainers?

A: Space maintainers are appliances made of metal or plastic that are custom fit to your child's mouth. They are small and unobtrusive in appearance. Most children easily adjust to them after the first few days.

Q: How does a space maintainer help?

A: Space maintainers hold open the empty space left by a lost tooth. They steady the remaining teeth, preventing movement until the permanent tooth takes its natural position in the jaw. It's more affordable -- and easier on your child -- to keep teeth in normal positions with a space maintainer than to move them back in place with orthodontic treatment.

Q: What special care do space maintainers need?

A: Pediatric dentists have four rules for space maintainer care. First, avoid sticky sweets or chewing gum. Second, don't tug or push on the space maintainer with your fingers or tongue. Third, keep it clean with conscientious brushing and flossing. Fourth, continue regular dental visits.

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Tooth-Colored Fillings

Q: What are tooth-colored fillings?

A: Tooth-colored fillings are made from durable plastics called composite resins. Similar in color and texture to natural teeth, the fillings are less noticeable, and much more attractive, than other types of fillings.

Q: What are the advantages of tooth-colored fillings?

A: Because composite resins are tooth-colored, they look more natural than other filling materials. Your child can smile, talk, and eat with confidence. In addition, tooth-colored fillings are compatible with dental sealants. A tooth can be filled and sealed at the same time to prevent further decay.

Q: What are disadvantages?

A: First, tooth-colored fillings are not for every tooth. They work best in small restorations and low-stress areas. For example, your pediatric dentist may not recommend a tooth-colored filling for a large cavity or for the chewing surface of a back tooth. Second, tooth-colored fillings may cost a bit more than silver fillings because they take longer to place.

Q: How do I decide if tooth-colored fillings are right for my child?

A: Talk to your pediatric dentist. Together you will decide what type of filling is best for your child.

Q: How do I care for a tooth-colored filling?

A: Take care of a tooth-colored filling the same way you take care of a silver filling: Brush, floss, and visit your dentist. Any filling will last longer with good oral hygiene. Your pediatric dentist will regularly check the fillings for color change, leakage, or unusual wear and inform you of the need for repair or replacement.

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Malocclusion is the improper positioning of the teeth and jaws. It is a variation of normal growth and development which can affect the bite, the ability to clean teeth properly, gum tissue health, jaw growth, speech development and appearance.

Q: What causes malocclusion?

Both heredity and environmental factors can play a role in developing malocclusions. The shape and size of the face, jaws and teeth are determined mostly by inheritance. Environmental factors can also have a large impact and these are the types of problems which the pediatric dentist is well trained to manage.

Q: How long does it take to treat a malocclusion?

Every child is unique and must be treated individually. The pediatric dentist will provide an estimate of the length of time required prior to initiating treatment. In complex malocclusions the treatment may be divided into several phases which are scheduled to coincide with the child's particular pattern of growth and development.

Q: Is it necessary to remove healthy teeth to correct a malocclusion?

Carefully controlled removal of selected primary teeth may be necessary to guide the permanent teeth into proper position. This procedure requires frequent monitoring over a period of time and usually in combination with the use of some type of appliance. The removal of permanent teeth depends specifically upon the circumstances for that particular child. There are some malocclusions which cannot be treated successfully without removing permanent teeth and there are other situations where permanent teeth should definitely not be removed. This is a decision which must be made very carefully after thoroughly evaluating all of the diagnostic materials available for that patient.

Q: What information does the pediatric dentist need to evaluate a developing malocclusion?

The complexity of each child's individual problem will dictate the extent of examination and diagnostic procedures. Following a thorough clinical examination with a review of past medical and dental history, impressions of the teeth are taken from which plaster models are made. These study models provide a baseline reference of the current relationship of the teeth and jaws and also provide a method to monitor the progress of any treatment. Photographs of the face and teeth also provide a record of the child's facial appearance prior to treatment. Several types of X-rays may be needed to properly diagnose a developing malocclusion. Most commonly used are a panoramic X-ray, which shows all the upper and lower teeth in biting position as well as any teeth still developing within the jaws, and a lateral X-ray of the entire head, known as a cephalometric X-ray which shows the relationship of the teeth and jaws to the face and skull.

Q: What types of appliances are used to correct malocclusion?

There are two basic types of tooth movement appliances, removable and fixed. Removable appliances are made of wires and plastic and can be removed from the mouth by the patient. Some fit the upper and lower teeth at the same time. Their success is totally dependent on the patient's compliance in wearing the appliance exactly as instructed by the pediatric dentist. An advantage of removable appliances is that they are easy to keep clean. Fixed appliances are what we know as "braces." Because this type of appliance is attached directly to the teeth, there is better control of tooth movement. However, cooperation from the patient in maintaining scrupulous oral hygiene while wearing fixed appliances is essential in preventing cavities in areas where food collects easily around these appliances.

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Content courtesy of American Academy of Pediatric Dentistry.