Baby Teeth, The Tooth Fairy, and Other Topics in Pediatric Dentistry

Grinding teeth, braces or no braces, pacifiers & thumb-sucking, loose & injured baby teeth. These, and more, are all common concerns we receive from parents bringing their children to the dental office. In this blog, we’ll cover some of the top questions and issues surrounding kids teeth.

First, it’s important to know that children are dynamic, constantly-changing, constantly-growing human beings. If you consider the average dental visit to be once and every six months, then you can guarantee that a child under the age of 13 will present differently at each visit: Teeth will fall out, teeth will come in, their bite and tooth relationship will change. This fact further emphasizes the importance of routine care and check-ups to make sure that the child is headed in the right direction.

So topic number 1 is “When should I start bringing my child to the dentist, and why?” – The answer is the child should be brought to the dental office around the age of 1 year. At this initial visit, the main objectives will be education of the parent regarding diet (no sippy cups in bed, limit sugar intake frequency), a brief lap exam to evaluate for proper eruption sequence and absence of anomalies, possible application of fluoride depending on the case (primary teeth are most vulnerable to decay immediately after eruption because they have not fully finished calcifying), and last but not least – to try and establish POSITIVE experiences at the dental office for the child. The importance of this cannot be understated, as children who enjoy going to the dentist are much more likely to take care of their teeth.

Topic #2 – “My child really grinds his teeth at night. Sometimes it’s so loud I have trouble sleeping!” Most children have some type of grinding habit by the age of 12. Though there’s no experimental evidence to suggest why this happens, it’s generally believed to be related to the rapidly changing bite relationship between the teeth, as primary teeth and permanent teeth are making their way in and out of the child’s mouth. Primary teeth (or “baby teeth”), are also flatter and more square by nature, making them more conducive to grinding as well. The habit usually resolves itself by the time all of the baby teeth have exfoliated and all of the permanent teeth are in place (age 11-13). Night guards and other splints usually are not necessary or very beneficial due to the constantly-changing nature of a child’s tooth relationship: In other words, if we made a night guard for a 9 year old boy, it probably would not fit by the time he was 9.5 or 10 years old!

Topic #3 – “Will my child need braces?” Again, the answer to this question goes back to the importance of routine examination. The dentist and/or orthodontist will make this decision based on a wide variety of factors that need to be evaluated on a regular basis throughout the growth of the child: Before permanent teeth begin making their way into the mouth (age 1-6), the dentist will be evaluating proper growth, arch form, and spacing of the child’s mouth. If there is a skeletal or growth concern at this point, the dentist will refer the child to an orthodontist for proper treatment. As permanent teeth begin making their way in between ages 6-12, the dentist will use clinical exams and x-rays to (1) evaluate if all teeth are forming/developing or not (2) evaluate spacing to determine if there is adequate room for permanent teeth to come in (3) evaluate tooth relationship to determine if permanent teeth are in the correct spot, or if they need to be moved.

Topic #4 – “What about pacifiers and thumb-sucking habits?” Most children tend to have an oral fixation at a young age, where they enjoy placing pacifiers, thumbs, food, toys, and such into their mouth. It’s quite natural, but can be a concern regarding incoming teeth. If a child prolongs this habit to ages 4, 5, or even 6 years old – it will almost certainly affect the incoming permanent teeth, and result in what is called an “anterior open bite” – where the permanent front teeth are flared out and not touching – this is a very undesirable tooth relationship, both functionally and cosmetically. It’s important to get the child to stop using their pacifier or stop sucking their thumb before these critical ages (4-6) to prevent these problems, otherwise it will almost certainly require correction with orthodontic treatment.

Topic #5 – And quite possibly, one of the most common and complex topics: “What if my child knocks out or injures a tooth?” If a child experiences trauma to their mouth, it’s very important to get evaluated by a dentist as soon as possible. An Emergency Room visit will likely not be very helpful if it’s tooth-related, so be sure to call your dentist ASAP. Time is a very important factor depending on the child’s age, the tooth, and the injury involved. Some general guidelines to know: 1. If a child knocks out any tooth, always try to find the tooth and bring it with you. This will be a tremendous help during the diagnostic process. If it is a permanent tooth, store the tooth in cold milk or saline. Do not use tap water! Do not rinse or scrub the tooth! If you cannot get to a dentist within an hour, use tissue paper and try to replant the tooth yourself, then proceed to get to the dentist ASAP for evaluation and possible splinting of the tooth (the tooth with the best prognosis is the one that is replanted immediately!) 2. If you cannot find the tooth, be sure to tell the dentist. The tooth may be intruded from the trauma and will require an x-ray to make a decision. 3. If a baby tooth is knocked out, the dentist will not try to replace it. But the child should still be evaluated for other possible injuries to the jaw, lip, and face.

As you can see, there’s a lot more to baby teeth and pediatric dentistry than one would think! When in doubt, always consult with a dental professional. It is critical to establish great oral care in the early years of a child’s life to set the tone for the rest of their life. By the time they are 12 years old, most children will have all of their permanent teeth that are expected to last them 50 or more years! Thanks for reading, and be sure to get your child checked on routinely! We here at Rivertown Dental Care provide full family dentistry, from the infant to the grandma, and would love to see you and your family.

More information can be found at the American Academy of Pediatric Dentistry at http://www.aapd.org/policies/