Healthy Mouth and a Healthier You

Children’s Dental Care: Ask the Dentist

Dentist Steven E. Roth, DMD, answers your additional questions about children’s dental care.

Question:

What is the recommended age for a child's first visit to the dentist? Does it have to be a pediatric dentist?

Answer:

In order to prevent dental problems, your child should see a pediatric dentist when the first tooth appears, or no later than his/her first birthday. This is the recommendation of the American Academy of Pediatric Dentistry. The purpose is to begin a thorough prevention program. Dental problems can begin early. A big concern is early childhood caries (formerly known as baby bottle tooth decay or nursing caries). Once a child’s diet includes anything besides breast milk, erupted teeth are at risk for decay. The earlier you start dental visits, the better the chance of preventing dental problems. Children with healthy teeth chew food easily and smile with confidence. Start your child now on a lifetime of good dental habits.

Question:

My daughter has an appointment for IV sedation this Tuesday. I want to know how long the procedure normally lasts.

Answer:

That would be a good question for you to ask the treating clinician, since we don’t know what the sedation is for. But I will add that it can take at least an hour for the sedation.

Question:

Do they make porcelain crowns for toddlers?

Answer:

Porcelain crowns are a fairly expensive. The more permanent procedure they require is not indicated for toddlers. There are quicker, more convenient procedures that can be performed in one visit for toddlers and children.

Question:

My little girl is 4 years old and was recently treated for a viral infection in her throat. After that, I noticed that her gums were very swollen and red, more so in the back by her molars. Is this normal? Is there a second set of molars that can come in?

Answer:

There are 6-year molars and 12-year molars that erupt within one year of the previous stated ages. Most likely, the sore throat and the swollen gums are all part of the viral infection. I suggest you see your family pediatric dentist.

Question:

My daughter is 18 months old. She was breastfed up until 4 months ago. She has a yellow discoloration on one of her front teeth. What caused this? Can it spread to other teeth?

Answer:

The yellow stain could be a number of things: an innocent stain, a cavity, a traumatic injury, or a genetic defect. Please take your child to the pediatric dentist for an examination.

Question:

My great-grandson is 3 1/2 years old and has no molars. He just visited the dentist who took an X-ray that shows no development of molars. He said it could be some sort of congenital disease and that his mom should check with the family doctor. What could this be? And what can be done?

Answer:

I would recommend that the child’s parent or caregiver take the child to see a pediatric dental specialist for an examination and diagnosis. There are many available treatments for patients that do not develop adult teeth. There are also children that develop their teeth much later than others. The bottom line is to see the appropriate specialist for care. 

Question:

My 6-year-old has a black discoloration on his gums that is sensitive to touch. The black doesn’t come off when brushing. What could this be?

Answer:

The possibilities include an infection, trauma, an erupting tooth, or normal pigmentation. Either way, I would strongly suggest a visit to the pediatric dentist for an evaluation of the problem. 

Question:

My 7-year-old has stains on his front teeth. Please advise a treatment for this.

Answer:

Staining can be caused by tetracycline, amalgam, iron, flourosis, and a myriad of other things. My best advice is to have the stain looked at by a pediatric dental specialist.

Question:

I brush my 3-year-old’s teeth daily and use fluoride when I do. But he is still getting tiny brown spots next to his gum line, and even has some missing enamel. I have called a dentist but don’t know what I’m doing wrong or what I could start doing differently.

Answer:

There are several enamel conditions that could be causing the problem. Or it could be intrinsic or extrinsic staining. I would recommend going to the pediatric dental specialist for an exact treatment plan.

Question:

My 5-year-old has a swollen spot on the top left side of his gums that’s red around the edges and white in the middle. What is it?

Answer:

There are many possibilities, such as an aphthous ulcer or canker sore, an abscess, or an erupting tooth. If your child is in any pain, I would recommend a trip to the pediatric dentist for an evaluation.

Question:

My son is almost 11, and most of his adult teeth are in. Can he use whitening toothpaste?

Answer:

Sensodyne is a toothpaste for patients with sensitive teeth who would like to whiten their teeth. The jury is out on what is an appropriate age to whiten teeth. Whitening toothpastes have polishing agents, in addition to the mild abrasives that help remove surface stains from teeth. Teeth that have surface stains are cleaned and whitened by whitening toothpastes. However, deeper stains won’t be affected. If your teeth have deeper, darker stains due to injury or certain medications, a more thorough brightening treatment, such as bleaching or microabrasion, will be required. If you choose to use whitening toothpaste, make sure the toothpaste contains fluoride as well as whitening agents. 

Question:

What is the term for a tooth growing out of the roof of a child’s mouth? Can this simply be pulled at the dentist’s, or is it best to have oral surgery? What types of problems could result?

Answer:

Sometimes teeth do not have enough room to erupt into the mouth and can be impacted in the palate. The best way to deal them it is to get treatment with an orthodontist and an oral surgeon to uncover the tooth and to guide eruption into the mouth. 

Question:

How do I know if my child has bottle rot?

Answer:

Bottle rot is indicated by dark stains around the teeth. But if you are concerned, see your local pediatric dentist as soon as possible. The risk of potentially devastating nursing-pattern dental decay exists for the breastfed child just as it does for the bottle-fed child. This kind of decay is caused by extended and repetitive feedings, with prolonged exposure of erupted teeth to fermentable carbohydrates.
Some General Recommendations
1. Infants should not be put to sleep with a bottle. Nocturnal breastfeeding should be avoided after the first primary tooth begins to erupt.
2. Parents are encouraged to transition infants into drinking from a cup as they approach their first birthday. Infants should be weaned from the bottle between 12 and 14 months of age.
3. Consumption of juices from a bottle should be avoided.
4. Oral hygiene measures should be implemented by the time of eruption of the first primary tooth.
5. An oral health consultation visit within six months of the eruption of the first tooth is recommended to educate parents and provide anticipatory guidance for prevention of dental disease.

Question:

My son is 8 years-old and recently lost his central incisors. He now complains that his new teeth are sensitive to hot and cold. Is it normal for a child's new teeth to be sensitive while they are growing in?

Answer:

It is definitely normal to have some sensitivity. But sensitivity can also be related to caries or tooth decay. So have your child’s dentist check his teeth.

Question:

My daughter is only 6 years old. She receives regular dental care, but her teeth are still in bad shape. We just came back from a visit, and the dentist suggested she have nine teeth taken out. I was horrified! If her teeth were so bad, why has she never complained about any toothaches?

Answer:

I would suggest that you speak to the dentist about this. Many diseases, like high blood pressure, have no symptoms. This is why we go to doctors for regular checkups. In some people tooth decay is painless until the nerve is infected.

Question:

Which toothpastes are good for a 2-year-old?

Answer:

It takes many years before children develop the fine motor coordination they need to do a good tooth brushing job. Some dentists advise that parents brush their children's teeth until the child can neatly write his or her own name. Other dentists suggest parents use their own judgment, but to consider between ages 6 and 8 as the time for kids to take on the job of keeping their teeth clean and healthy. General rule: A smear or pea sized drop of fluoridated toothpaste can be used when the child can spit effectively. 

Question:

My 7-year-old daughter's six new adult teeth are all coming in very yellow, even though her baby teeth were very white. Will the new teeth always remain this color? Or is it possible they will lighten up over time? Also, what causes this? Could it be caused by supplements I've given her since she was a baby (i.e. cod liver oil, fish oil, vitamins D & C, multi-vitamins, and elderberry liquid every now and then).

Answer:

When a child begins to lose their baby teeth and permanent teeth begin to erupt, the permanent teeth appear more yellow than the baby teeth. This is a natural occurrence because of the different makeup of baby teeth and permanent teeth. Baby teeth reflect light differently than adult teeth, making the adult teeth appear more yellow. When they are right next to each other, the difference in color is more dramatic. It is probably not the supplements, so go easy on yourself. Also check with your child’s pediatrician to see what they recommend about giving a 7-year-old these particular supplements.

Question:

I have a 2 1/2-year-old who fell down the stairs a few weeks ago. I noticed that his gums above his right top teeth were bleeding, but not profusely, and it stopped shortly thereafter. However, a few days ago, I noticed that his right front tooth has started to turn gray. Some people have told me he will have to have it pulled. How will this affect his adult teeth coming in? Does he really have to have it pulled? If he doesn't, what could happen?

Answer:

Whenever a child experiences a traumatic mouth injury, get them to the dentist ASAP. Now that an injury is evident it is imperative to get there as soon as possible. 

Question:

I am concerned about my daughter’s teeth. She is almost 1, and she has white spots on and around the edges of her teeth. Should I be worried?

Answer:

Most of the time, white spots are not a problem. But 1 year of age is the perfect time to see the dentist for the first time!

Question:

I live in Germany and they do not put fluoride in the tap water. I have a 2-year-old and I am concerned about her not getting enough fluoride. What are the effects of low fluoride? How much should she get, and how do you recommend we get that amount?

Answer:

I would definitely speak to your pediatrician and pediatric dentist for specific advice on what and how much fluoride supplement to use. It is suggested that only children living in non-fluoridated areas use dietary fluoride supplements between the ages of 6 months to 16 years. Your physician or dentist can prescribe the correct dosage for your child, based on the previously mentioned factors. 

Question:

My son is a year old. The roof of his mouth is discolored. Is that normal? Should I take him to the doctor? What might it be? The color is white and light gray.

Answer:

Without examining the child myself, it is hard to say. But as a general rule, if something doesn’t look right, it is a good idea to see your pediatric dentist. An expert can rule out anything serious for you.

Question:

My son fell and one of his permanent front teeth fell out. At the emergency room, the tooth was put back in its socket. Should we expect a root canal in the future? The tooth did not crack.

Answer:

The accidental loss of an adult tooth is a grave event and very tricky to treat. Even the best techniques sometimes fail to permanently save the tooth. Bear in mind that there is a distinct possibility that your child may lose the tooth even if every precaution is taken. Root canal, gum surgery, and orthodontic care all may be necessary to ultimately save the tooth. And sometimes that may not work.

Question:

My 9-year-old daughter had a cleaning a month ago at school. The hygienist said she had two cavities. Because our dental insurance did not become effective for another two weeks, we held off on the appointment for the fillings. Now she has a large bubble on her gum above one of the teeth. Should I bring her to the hospital?

Answer:

The bubble can mean that there is an abscessed or infected nerve, gum, or foreign object inside the cavity. The child needs to be seen by a dentist immediately. Antibiotics or a baby root canal are possible treatments for the problem.

Question:

My daughter has two huge cavities in her bottom molars, one on each side. It will cost $800 to have a baby root canal performed and a silver cap placed. Do we really have to do this on her baby teeth?

Answer:

The simple answer is probably yes. The premature loss of a baby tooth can damage other teeth, alter the eruption patterns of the other teeth, and dramatically change any orthodontic intervention. So see the dentist and follow their recommendations.

Question:

My daughter just turned 1. The inside of her lip is connected to her gums between her two top front teeth. We noticed it when she fell the other day and it was bleeding. Is that normal, or is it something that we need to have looked at?

Answer:

As your daughter gets older this may change for the positive. I wouldn’t worry at this point, as long as her wound is healing well. Later on in life there is a simple procedure called a frenectomy that can easily resolve this situation.

Question:

I have two daughters that were born without permanent teeth and I am struggling to provide them with some form of teeth to eat with. I bought dentures for one of them, but she has developed an infection in her gums and then broke the dentures. My dental insurance will cover 50% of implants but only up to $1,500 a year. I am also worried that their bone structure isn’t sufficient enough to handle this procedure. One is 20 and the other is 16. Do you have any suggestions?

Answer:

Anodontia is a congenital abnormality where some or all of the teeth are missing, meaning the follicles needed to grow the teeth are completely absent. This is a difficult problem. My best advice is to see a pediatric dentist who can guide the prosthetic treatment and answer these questions. I would contact the local dental society for a referral.

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