Arcadia, CA Pediatric Dentists - Drs. Snaer, Snaer & Chen, Huntington Pediatric Dental Group

Establishing a pattern of separating eating and sleeping while your baby is small is very important. Feed the baby, then wipe off the gums with a gauze square. This separates eating from sleeping and gets the baby accustomed to mouth cleaning routines. Keeping the bottle out of the crib allows the baby to learn to sleep through the night at a younger age, and avoids a later struggle over taking away the bedtime bottle.

When will my baby get teeth?

Usually at about six months, but there is a huge variation between different babies. Some start erupting their teeth soon after they are born, and some are toothless until they are 18 months old. The order in which the teeth erupt is almost always the same. The lower teeth usually come in first.

How can I make teething easier for my baby?

Teething rings are important to help the teeth work through the gums. As soon as the teeth penetrate the gum tissue, the discomfort begins to go away. Try cooling the teething ring in the refrigerator. Give the baby Tylenol Drops when needed, but be sure to stay within the guidelines on the bottle. A surface anesthetic preparation like Ora-Gel for Teething may be useful at bedtime or when the baby seems particularly upset, but it washes away in a short time. Be sure to use it only according to the directions. There is no perfect solution, so just give extra love and this problem will solve itself. If the baby has a fever or actually seems sick, be sure to check with your pediatrician. An illness may be present along with the teething.

When should I start cleaning my baby's teeth?

As soon as they erupt through the gums. You can use a gauze square or a little terrycloth finger cover at first. Change to a baby size toothbrush as soon as possible because it cleans better between the teeth and at the gumline. Just use a dry brush with no toothpaste. Place the brush squarely against the tooth at the gumline and jiggle side to side. Don't let your toddler carry a toothbrush because of the danger of falling with it.

When should my baby first see a pediatric dentist?

The American Academy of Pediatrics recommends that one year of age is a good time to have a first exam. This lets the parent and dentist get an early start on a prevention program that will keep decay away and minimize other dental problems too. If you see any suspicious spots on your baby's teeth, particularly if the teeth came in early or the baby has been taking a bottle to bed, don't wait. Bring the baby any time you suspect a problem.

How does the pediatric dentist work with a toddler?

We keep the child secure by leaving it in the parent's lap. After a period of getting acquainted, we move into a knee-to-knee position with the parent who slowly leans the child's head back onto the dentist's knees. Many children accept this procedure happily, but even if there is a little fussing, the exam only takes about a minute. It is not usually necessary to do any tooth cleaning.

What is Early Childhood Caries (ECC)?

Dental caries is a disease of the teeth caused by bacteria. Certain types of bacteria will produce acid if the bacteria is feeding on sugars or fermentable carbohydrates. This acid will break down the mineral structure of the teeth, and the result is a cavity. ECC is defined as the presence of a cavity in a tooth in a child under six years of age. The most common cause of ECC is by taking a nap or night bottle with anything but water in it. Milk, formula, and juice can all cause tooth decay. When the baby is sleeping, its saliva is not washing across the teeth to protect them from decay acid. Nearly 100% of tooth decay in infants and toddlers is caused by the nighttime bottle, and ECC is the largest cause of surgical procedures for children between 12 and 36 months. This type of tooth decay advances very rapidly and can cause abscessed teeth in year old children.

Why don't all babies who take night bottle get decay?

Some babies do not have the type of bacteria needed to change the sugar in the bottle into decay acid. Both the sugar and the bacteria must be present for ECC. Your baby can receive the decay bacteria from the kisses or food tasting of a care giver, but there is no easy way for us to know this. So, we concentrate on avoiding the night bottle. Then, if the baby gets the decay bacteria there will still be no ECC.

Won't the baby teeth be lost before they cause a problem?

The last of the baby upper front teeth are usually not lost until 8 years old. The last of the baby molars stay until age 11.

How does the pediatric dentist repair ECC?

By doing early exams on toddlers we can find cavities when they are very small. Simple inexpensive measures like changing to water in the bottle, better brushing, hand curretting the decay and temporary cement fillings may be all that is needed. When severe cases require sedation, or general anesthesia by a board certified anesthesiologist, we have the qualifications and staff privileges to provide these services.

What should I know about tooth accidents?

If the tooth is still in the same position and is firm, it is usually OK, even if there is a small amount of blood around the gumline, or a small chip in the biting edge. The types of accidents most likely to cause tooth loss are those in which the tooth is moved, either backward or forward or up into the gum. Call your pediatric dentist about all accidents of the severe type and any minor accidents about which you are uneasy.

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THE TODDLER YEARS

What is the most important dental fact about this age group?

Recent studies indicate that there is a "window" period from about 18 to 26 months of age when children are most likely to get the bacteria that causes tooth decay. The most common source is the saliva of the mother or another caregiver.

How can I use this information to protect my toddler?

Use this 6 point program:

If your toddler has not yet given up the bottle, be sure that it contains only water at naps and bedtime. When the child is sleeping, the saliva does not wash over the teeth to give protection from decay acid.
Keep your own teeth decay free with good dental care and regular brushing and flossing to minimize the concentration of the decay bacteria in your saliva.
Brush your toddler's teeth twice a day in a thorough way.
Avoid fruit juice.
See your pediatric dentist for a first exam at one year of age, and for checkups on the schedule that the pediatric dentist prescribes.
Be aware of the fluoride content of the water that your child drinks. If it is below O.6mg/L, consider fluoridated bottled water or a fluoride supplement.

What about breastfeeding and decay?

Breast milk contains lactose so it can cause decay when children nurse during the night. Children who have erupted their teeth early and who nurse for many short periods or stay attached to the mother while they sleep are particularly at risk. If you are still nursing after your baby's teeth erupt, use these suggestions:

Try to reduce the amount of night nursing because this is when the decay occurs.
Keep your toddler's teeth very clean.
Ask your pediatric dentist if there are any white spots or lines that signal beginning decay. If no signs are present, ask for ninety day checkup interval while you are still nursing at night, and don't worry. If decay is starting, you may want to consider weaning.

What is the best way to brush my toddler's teeth?

Use a dry toothbrush. Don't even wet the toothbrush with water.
Don't use toothpaste until 2 years old. After 2, brush with a dry brush first, then add a half pea size squib of paste.
Put the child's head in your lap for comfort, security and good vision.
Use a small soft toothbrush with the bristles placed squarely against the teeth at the gumline. Use just enough pressure to cause a slight whitening of the gums. Jiggle the brush in a sideways direction. Follow the same path around the mouth each time to cover all the outside, inside and chewing surfaces.
It should take 1 to 1 1/2 minutes to brush a toddler's teeth.

What if my toddler won't let me brush?

We would rather insist on brushing than insist on fillings. Many toddlers resist. That's part of the joy of parenting. Sit down on the floor, put the toddler's head in your lap, and brush. For particularly athletic offspring this may be a two parent activity for a while, but don't give up!

What about fluoride supplements?

The Los Angeles metropolitan area is more complicated than most areas of the country because we get our water from so many different sources. The fluoride levels vary widely. Your pediatrician and your pediatric dentist know what the fluoride content is at your home address and will tell you if your toddler needs extra fluoride. You must be sure to tell the doctors if your child is substituting bottled water or if you are putting your tap water through a reverse osmosis (RO) filter.

If my toddler is off the bottle, is a dental exam still necessary?

Probably no decay will be found. The visit is still worthwhile to evaluate and improve your preventive program. Sometimes very small openings are found in apparently healthy teeth. Then sealants or temporary fillings can prevent decay problems.

How can the pediatric dentist work with a toddler?

When children are 35 months or younger we usually do their exams in the parent's lap. We sit in a knee-to-knee position so that the child can be leaned back onto the dentist's knees. This keeps the child connected to the parent for reassurance. Minor restorative procedures can also be done in this way.

What if a child under 3 years of age needs a lot of dental work?

It is often surprising how much cooperation we can get from very young children. But when the amount of work to be done is beyond a child's ability to cooperate, we have the qualifications and staff privileges to provide sedation, or general anesthesia by a board certified anesthesiologist.

How about thumb sucking and pacifiers?

There is not much we can do about thumb sucking before three years old that is both effective and kind. So we suggest just a low key effort to minimize the time spent sucking. Since the pacifier is not attached to the child, we can exert a little more control. After infancy, use the pacifier only for sleep and real distress. Don't automatically bring it to the store, to church, to the doctor. When the child can communicate, don't volunteer the pacifier at night until the child asks for it. The ideal time for the child to be weaned from the pacifier is from 12 to 15 months of age.

When my child bumps a tooth, how do I know if the dentist should look at it?

If a tooth is loose, moved out of its usual position, or is broken so that the nerve may be exposed, the pediatric dentist should examine the child. We do not reimplant baby teeth that are totally knocked out.

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THREE YEARS AND OLDER

What are the most important dental health concepts for this age group?

There are two. First, get regular dental checkups for your child. Even children with apparently clean teeth who don't seem to eat much sugar often develop small cavities. Since the "nerve" in baby teeth is only two millimeters from the outside surface, the decay has often reached this critical area by the time parents see the cavity. Regular checkups keep dental work simple for the children and inexpensive for their parents. The second important thing to remember is that six-year molars are permanent teeth. This fact is often overlooked because no baby teeth are lost when the six-year molars come through the gums. They are the first permanent teeth to erupt, the largest, and the most important of all the permanent teeth.

How often should my child have a dental checkup?

Six month checkups are best for most children, but if expense is a concern, talk to your pediatric dentist about designing a customized program. Less frequent checkups with increased parent home care can reduce your cost without sacrificing your child's dental health. In fact, such a program can actually improve your child's dental health.

What should I do about my child's sucking habit?

At three years of age most children have already given up their pacifiers, but thumb and finger habits continue longer. The first step is to evaluate whether the habit is causing a significant problem. If the change in tooth position or in the "bite" is small, there is no need to give much attention to the habit. But if there is a crossbite, anterior open bite, or protruding incisors, we should consider a strategy to end the habit. The most effective strategies are individually designed by the pediatric dentist-parent team.

My child doesn't want me to help with brushing. Is that OK?

To get the best combination of tooth cleanliness and child participation, we suggest that parents do the first part of each brushing session with a dry brush. It's better if you don't even put water on it. Put the child's head in your lap so you can really see well, and brush all the surfaces thoroughly. This will take about two minutes. Then encourage the child to finish the job by going to the sink and polishing the teeth with a pea sized dab of fluoride toothpaste.

When my child has an accident involving teeth, when do I need to call the dentist?

Since most children don't get their permanent upper front teeth until seven years of age, serious accidents in the 3-6 year age group are rare. But accidents to baby teeth should be evaluated by the pediatric dentist if teeth are moved out of position or are broken severely enough to expose the nerve. If you are in doubt, call your pediatric dentist.

Is there a coating that can be applied to my child's teeth to prevent decay?

Yes, these coatings are called pit and fissure sealants and they are very effective in preventing decay in the natural defects of the teeth, mostly on the chewing surfaces. Sealants cannot be used on the smooth surfaces of the teeth so they do not prevent decay between the teeth.

What about flossing?

If you want to buy the world's least expensive, most effective dental insurance, floss your child's teeth once each day. It works! If you absolutely cannot floss every day, aim for a minimum of three times a week.

What is a sensible policy about sugar and decay prevention?

Sugar plays a major role in causing decay, but unless your child is a diabetic, it is not practical to totally eliminate sweets from the diet. Our goal is to decrease the number of times a day that the decay bacteria receive sugar and start acid production. Also, sugar eaten with other foods causes less decay. Therefore, we suggest this simple policy: "No sugar between meals". This includes fruit juice and dried fruits like raisins. If your child is already getting decay, go one step further and eliminate sugar from lunch. This policy is meant to be a daily guideline, not a rigid rule that would prevent a child from having cake at a friend's birthday party.

How should I prepare my child for dental visits?

If your child has had toddler checkups it will not be necessary to do any additional preparation for checkups. If this is the first checkup, read a "first visit" book to your child at home. If your child needs dental work, we suggest that the less discussion at home, the better. Just the fact that the subject is discussed may signal the child that the parent has some apprehension. There is a certain appeal to the idea of telling the child everything, but our experience with children who have been "prepared" has taught us that this is not the best way for most children. Once the parent starts answering questions it's hard to stop. We suggest never saying "shot" or "hurt". The child knows about immunization shots and there is no way to convince him that an injection in the more flexible tissue of the mouth is easier. It is better to say, "You know how kind the dentist always is with you", than to say, "He won't hurt you". The "H word" hangs around in the child's near memory and increases the tendency to report that a variety of sensations "hurt". The best answer to many questions is, "I don't know, but the dentist will be very careful with you". We ask parents to remember that even we adults are apprehensive about some procedures that we totally understand. Of course the dentists and the staff explain each step as we work with a child, but our choice of words has been refined by experience and there is no time for the child to analyze the answer and create additional anxiety.

Do I need to give my child fluoride vitamins?

Only if the water your child usually drinks has less than O.6mg/L fluoride. You can determine this by calling your water company, your pediatrician, or your pediatric dentist. Bottled water for both home delivery and market sale comes in both fluoride and non-fluoride types. Reverse osmosis (RO) home filters and market water dispensing machines remove fluoride. If your home address changes, be sure to research the fluoride content of your new water supply, even if your water company does not change. Some water companies supply water from different sources to different service areas within their systems.

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PREVENTION

1. Clean Teeth

Reduce the number of bacteria that produce decay acid by:

Brushing: After breakfast and after dinner dry brush first, then brush with fluoride toothpaste.

Flossing: As close to every night as possible: never less than THREE times a week.

2. Sugar and Acid Control

Decay bacteria produce acid for 30 minutes every time sugar enters the mouth, and the "GOOD" bacteria have difficulty reproducing in that acid environment, so the percentage of "BAD" bacteria increases. Also, some drinks and treats are so high in acid that they dissolve enamel and advance decay without any help from decay bacteria. Acid is what tastes sour.

Avoid sugar and acid especially between meals.

Sugar-Containing Beverages: Fruit juice (even if it is diluted), Sport drinks like Gatorade, and soft drinks. The nutritional guidelines of the American Academy of Pediatrics recommend limiting juice to 4-6 ounces per day for children ages one to six years. Also, do not allow child to drink milk before falling asleep.

Sugar-Containing Food: Candy, cookies, sugar chewing gum, peanut butter and jelly; peanut butters that contain sugar like Jiffy, Skippy and Peter Pan (Laura Scudder's does not contain sugar) and dried fruits (raisins and fruit rollups). Acid-Containing Food and Beverages: Sour candy (Skittles to Warheads), sour mouth spray, soft drinks (sugar-free sodas also contain phosphoric and citric acid), lemonade, and chewable Vitamin C tablets. Never squeeze lemon wedges against front teeth. It's OK to eat an orange, but don't have an extended snack of orange wedges that stretches out the acid and sugar exposure time. Less common acid sources are unusually high consumption of catsup or dill pickles (both have high levels of acetic acid in the vinegar they contain.)

Cooked Starches: For most people, chips, pretzels and bread are not as much of a source of sugar and acid because, although the starch does hydrolyze, the resulting amount of sugar and decay acid is not as great as with a sugar food or drink. Still, for some people with a very high percentage of decay bacteria or for a child who continually snacks on cooked starch products, this can be the mystery source of decay.

Decay-Safe Snacks: Carrot sticks, celery filled with cream cheese or sugar-free peanut butter, cheese, apples, jicama, nuts, milk (does not cause decay when child is awake and has normal saliva flow), fluoridated water with a thin slice of lemon or orange as a garnish (not to eat).

Xylitol Gum: Chewing gum (like Carefree Koolers) sweetened with this artificial sweetener is not only a sugar-free treat: the Xylitol actually interferes with the ability of the plaque to adhere to the teeth. Chew gum for five minutes three times a day.

3. Adequate Fluoride

When decay acid dissolves away small bits of tooth crystal, the body combines calcium in the saliva with fluoride to replace the dissolved bits with a fluoridated version of the crystal. These repair bits are thousands of times less soluble in decay acid than the original. This can only happen if there is fluoride available in the mouth. We can get the needed fluoride through:

Fluoride Drinking Water: Some local water companies provide tap water naturally high in fluoride. In other areas it is necessary to purchase bottled fluoridated water either at the market or by home delivery. To provide frequent small amounts of fluoride for tooth repair, use the fluoridated water for all drinking water, reconstituting orange juice, cooking vegetables, making soup and pancakes. Frequency is more important than then amount of water consumed. Ideal fluoride content is 0.8-1.0mg/L of fluoride except for water used to reconstitute powdered baby formula, which should not have fluoride content greater than 0.5mg/L.

Toothpaste: Use an American Dental Association approved toothpaste. Do not start toothpaste until two years of age because the fluoride concentration is high and young children swallow it. Use only a half-pea sized amount until the child spits effectively. Fluoride Rinse: For children with a decay threat or with braces the best approach is to brush and floss after dinner, then at bedtime rinse 15-30 seconds with ACT or

Fluorigard: Children 6-10 years who can spit out all the rinse can use this and should then rinse with water. Children 10-14 years should spit out all the rinse and rinse only lightly with water. Children 14 years and older should spit out all rinse and not rinse with water. This provides a mini fluoride treatment every night. These products are available at the pharmacy without prescription.

Professional Applications: Higher concentration treatment: provided in the dental office.

4. Regular Dental Visits

Six month checkups recommended for most children.

5. Sealants

Thin tooth-colored mineral-reinforced fluoride-containing coating that protects pits and grooves from invasion by bacteria that cause decay.

6. Advanced Prevention Program

For children with particularly severe decay problems a more aggressive program may include:

Chlorhexidene Antibacterial Rinse: Reduces plaque bacteria to rebalance the "GOOD" and "BAD" bacteria. This is only for older children and is available only by prescription.

Enhanced Use of Fluoride: Professionally applied fluoride varnish for longer retention; prescription strength fluoride toothpaste.

Measuring Bacteria in Saliva: This simple test allows a direct measurement of the number of decay producing bacteria in the mouth. Instead of measuring success of the prevention plan by the number of new cavities, this approach measures success by the reduction in the number of decay-producing bacteria in the mouth.

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TEETHING

When do baby teeth form?

The cells which form the hard structures of the teeth begin their work about half way through pregnancy. The crowns of the front teeth are completed at about 2 months of age, molars at about 11 months. The roots are still forming during tooth eruption and provide the force to push the teeth through the gums.

When will my baby's teeth erupt?

Usually at six months., but there is a huge variation. Some babies start getting teeth soon after they are born and some are toothless until they are 18 months old.

Is very early or very late tooth eruption a sign of any medical problem?

No. Some rare problems include late or early tooth eruption, but the other signs are more noticeable than the tooth eruption pattern.

What is the usual sequence of eruption?

The middle front teeth erupt first and eruption alternates between upper and lower with the lower usually coming in first. The pattern usually skips over the third tooth, the cuspid. After the first molar has erupted, the cuspid then erupts.

How can teething be made easier for my baby?

Teething rings are important to help the teeth work through the gums. As soon as the teeth penetrate the gum tissue, the discomfort begins to go away. Try cooling the teething ring in the refrigerator. If you put it in the freezer compartment, don't give it to the baby immediately when you take it out because it is possible to get a "cold burn" on the sensitive mouth tissues. Ask your pediatrician's advice about whether to give Tylenol, and how much and how often to give it. A surface anesthetic preparation like Ora-Gel for Teething may be useful at bedtime or when the baby is particularly upset, but it washes away in a short time. Be sure to use it only according to the directions. There is no perfect solution, so just give extra love and the problem will solve itself.

Is it true that babies get sick in different ways from teething?

All kinds of problems from colds to rashes to diarrhea have been blamed on teething. The safest approach is to think of these problems as just accidentally occurring at the same time as teething. If your baby has a fever or actually seems sick, check with your pediatrician.

What are "eruption cysts"?

An eruption cyst is a soft bluish dome of gum tissue over an erupting tooth caused by a small blood vessel being broken and the fluid puffing up the gum. It is not really a cyst. Usually no treatment is needed, the teeth will penetrate the dome.

The Primary ("Baby") Teeth Eruption Chart

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FLUORIDE

How does fluoride help my child's teeth?

Fluoride is an important part of the crystalline structure of the tooth enamel because it makes the enamel less soluble to decay acids. The enamel can incorporate fluoride while the teeth are forming and also after they have erupted. This is why fluoride in several different forms can all be helpful.

How can my child get enough fluoride?

The most natural way to receive fluoride is to drink water that has fluoride in it. This fluoride is naturally present in many water supplies because the water contacts rocks with fluoride content. Fluoride content varies a great deal in our area, but we have a reference table that allows accurate identification of the fluoride level at your home. If the water supply is deficient in fluoride, the alternatives are bottled fluoride water and doctor-prescribed fluoride supplements.

What about fluoride toothpaste?

Fluoride toothpaste is a valuable anti-cavities agent, but even the special children's formulas contain 1.1 mg in a half inch strip of toothpaste. This means that if a small child uses a half strip morning and night, he/she has the opportunity to swallow up to eight times the amount of fluoride that a doctor would prescribe as a supplement. Since studies show that children under 5 years old swallow a high percentage of the toothpaste that enters their mouth, we suggest no toothpaste until age 2 years, a half pea-sized amount from 2-3 years, and a pea-sized amount from 3-6 years. Children should be taught to spit out the toothpaste, but young children swallow and then spit. Keep toothpaste out of the reach of young children; some children eat toothpaste as a treat.

What about fluoride rinses?

Like fluoride toothpaste, rinses have research-proven effectiveness, but children under six should not use even the children's formulas because we cannot be sure they will not swallow the rinse.

Why does the dentist give fluoride treatments?

Experienced personnel and professional equipment allow the application of a more concentrated form of fluoride than would be wise in the home setting.

Which bottled waters contain fluoride?

All major suppliers have fluoridated water for home delivery. Bottled water with fluoride is available at most markets. The most common brands are Sparkletts with Fluoride (1.0 mg/L), Dannon Fluoride to Go (1.0 mg/L), Beechnut Spring Water with Fluoride (0.8mg/L), and Gerber Baby Water (0.5 mg/L).

Do home filters remove fluoride?

Only reverse osmosis type filters remove fluoride. This type of filter contains membranes rather than cartridges. However, there are combination systems that contain cellulose and/or charcoal cartridges which pre-filter the water before it reaches the reverse osmosis membranes. Water softeners alone do not remove fluoride, but many water softening systems are combined with reverse osmosis filters which do remove fluoride.

Decision Tree for Fluoride Supplementation Chart

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Arcadia, CA Pediatric Dentists - Dr. Kevin Snaer, Dr. William Snaer, Dr. Toni Chen & Dr. Justin Shuffer ~ Huntington Pediatric Dental Group.

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