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FAQs about Home Pediatric Dental Care

How should I clean my child’s teeth?

We will demonstrate to you the best approach to cleaning your child’s teeth during your child’s visit. It is best that when brushing with a toothbrush, it is one that has a small head and soft bristles. It is best to floss any teeth that are in contact with one another to prevent cavities. Your child’s behavior may prevent you from putting forth your best effort. Once your child has accepted brushing, begin to introduce them to flossing.

We recommend that parents assist children with brushing until their hand dexterity matures. Often, this occurs for school-aged children that have begun writing. After you have given your child the responsibility of brushing, we recommend that you still check to see that it is being done effectively.

What is the difference between toddler/child’s toothpaste?

Toddler toothpastes may also be known as training toothpastes. These toothpastes typically do not contain fluoride and are completely safe for your child to swallow. Please read the label for the toothpaste you have purchased to be sure it is safe to swallow.

Most children’s toothpastes do contain fluoride. When a toothpaste contains fluoride, you want to be sure to use a pea size amount or enough to add a little color to the tips of the bristles on the toothbrush. If a young child receives too much fluoride whether it be from supplements, toothpastes, mouthwashes, or from processed foods, it can result in fluorosis. Fluorosis can cause discolored or malformed enamel of the permanent teeth, but is not the only reason your child may have discolored or malformed enamel.

When should my child begin using toothpaste and how much should they use?

According to, the sooner the better! Starting at birth, clean your child’s gums with a soft infant toothbrush or cloth and water. As soon as the teeth begin to appear, start brushing twice daily using fluoridated toothpaste and a soft, age-appropriate sized toothbrush. Use a “smear” of toothpaste to brush the teeth of a child up to 3 years of age. For the 3-6 year old, dispense a “pea-size” amount of toothpaste and perform or assist your child’s toothbrushing. We recommend the American Dental Association’s recommendations which you can find here.  Remember that young children do not have the ability to brush their teeth effectively.  Children should spit out and not swallow excess toothpaste after brushing.

How can I help my child with the teething stage?

While teething, you may find your child to be mildly irritable, have a low-grade elevation in temperature (not greater than 100°F), have increased salivation, a desire to chew on hard things, and a change in appetite. These behavior changes usually begin a few days before the tooth erupts and subside a few days after. The best treatment is time, but you can try rubbing or massaging the gums, having your child chew on a teething ring or a frozen washcloth, and use pain medication as necessary. Please do not place sweet liquids on a teething ring or pacifier. We do not recommend the use of homeopathic teething tablets.

When can I expect my child to get their first tooth?

Everyone has a different time table for teeth to come into the mouth so do not become concerned if your child’s teeth come in a little earlier or later. Typically, the lower front teeth will erupt around six months of age and a total of 20 teeth are usually in place by three years of age.

Your child will then begin losing teeth beginning around six years of age. There will be eight teeth lost over the next two to three years while at the same time getting the first permanent molars. Between ten and 13 years of age, your child will lose a dozen teeth (if all of the permanent teeth are present). During this time, the 12-year-old molars will come into the mouth. This leaves the wisdom teeth, if present, to come into the mouth in the later teen years and early 20s.

My child’s permanent teeth have come in, but the baby teeth have not come out. What should I do?

It is very common for children to have a permanent tooth enter into the mouth without a baby tooth falling out first. This is most common for the two lower center teeth, but can happen anywhere in the mouth. We will encourage you or your child to wiggle on the baby tooth to help get them out of the way of the permanent tooth. In the case of the lower front teeth, the tongue will help reposition the teeth if there is enough room available.

What causes tooth decay?

There are a host of factors that are responsible for cavities to develop. If the delicate balance between these factors is disturbed, a cavity is likely to result. These factors include: your child’s diet and frequency of eating/drinking, the type and amount of saliva, the amount and type of bacteria in the mouth, hygiene frequency and effectiveness, and genetics.

The best way to prevent cavities is to get started on a good home oral health program at a young age. Try to brush at least twice daily and floss once daily. Snacks should be nutritious. Try to limit snacks that are high in sugar and starches. When appropriate, begin to incorporate products containing fluoride. Consider sealants for your child’s teeth. Be sure to keep regular dental visits.

What is early childhood caries? (also known as nursing caries, baby bottle tooth decay, bottle rot, or bottle mouth)

Early childhood caries (ECC) can be the result of frequent nursing either from the bottle or breast. Breast milk does contain a higher percentage of sugar than cow’s milk. ECC will typically affect the four top front teeth first, followed by the first baby molars, then the canines, and the second baby molars. Last to be affected are the lower front teeth which are protected by the tongue and lip.

With frequent feeding/nursing, the tongue side of the top front teeth are continuously bathing in milk and acid produced by the bacteria. In the absence of good oral hygiene, the enamel on the tongue side of these teeth can begin to breakdown. When cavities are noticed on the lip side of the top front teeth, the cavities are usually at an advanced stage.

It will be best to avoid bottle and breast feeding in bed. Try to make sleeping and feeding two separate events. If feeding occurs close to bedtime or during the night, wipe the mouth out with a wet cloth. Try to give bottles at meal times and try to avoid using them as a pacifier. Try to avoid placing juice in the bottle. Children should be taught to drink from a cup around one year of age.

What is acid erosion?

When the teeth come in contact with acid, the enamel begins to lose some of its minerals (demineralization). Most of us have spit that can neutralize the acid and help remineralize the teeth. The process can be assisted by the use of fluoride.

The acids that come into contact with teeth are in some of the beverages that we drink, such as fruit juice, sports drinks, diet and regular sodas and energy drinks and then from the by-products of the bacteria fermenting the sugars in these and other foods and drinks.

Athletes, at times, may have heavy mouth breathing which will reduce the amount of spit available to neutralize the acids found in the beverages consumed to maintain hydration.

When consuming beverages known to have a low pH or high acid content and/or are high in sugars, you can reduce the chance of acid erosion of the teeth by rinsing with water, using a straw, not consuming sodas or juices at bedtime, and not brushing for at least two to three hours after consuming acidic beverages. Be sure to read food and beverage labels, practice good oral hygiene habits at home and see us regularly.

Why does my child have bad breath?

Bacteria are constantly breaking down proteins found in the mouth, airway, esophagus, and stomach. Some bacteria degrade sulfur containing amino acids producing volatile sulfur compounds, which smell like rotten eggs. Aromatic chemicals such as methyl mercaptan, hydrogen sulfide, and putrescine are absorbed from the bowel into the bloodstream and are then excreted through the lungs. Ninety percent of bad breath originates from the tongue but the list of possible causes is vast. Talk with us if you feel your child has bad breath.

What about fluoride?

Fluoride is a mineral that can be found naturally in our water or is added to our water to help strengthen the teeth and prevent or reverse early stages of cavity development. Water fluoridation is considered by the Center for Disease Control to be one of the top ten great public health achievements of the 20th century. It is the most cost effective way to protect people of all ages from cavities. Not all areas have fluoride in the water; please contact your water district for the most accurate information of whether your water has fluoride and how much is in the water.

Your child may benefit from fluoride supplements if you live in an area that does not have fluoride placed into the water supply and your child is not using a toothpaste, which contains fluoride. The amount of fluoride your child should receive is based on your child’s age. We can discuss with you the correct amount of fluoride for your child.

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