10 MOST COMMON QUESTIONS FOR A PEDIATRIC DENTIST
“Teeth are always in style.”
Dr. Suess
As a pediatric dentist, I spend a large part of my day in exams talking to patients and parents about oral and nutritional health. As I’ve been practicing over the last few years, I realized that I answer a lot of the same questions every day. The purpose of this blog post to answer some of them here. So if you’re a parent, read on! If you don’t have kids, maybe still read on just so you can have some fun facts in your back pocket for the next Zoom Happy Hour you’re on.
1. My child grinds their teeth. Is this normal?
The short answer is “It’s not uncommon.”
The longer answer is this: I get asked this question at least once per day. Children can start grinding their teeth as young as 18 months. It can continue up to age 6 and usually starts to subside once a child’s adult teeth come in. Children seem to be able to grind their teeth without having the jaw pain and tooth sensitivity that adults get. There have been research studies done on childhood teeth grinding without any definitive explanations for why it happens. Some of the hypotheses are that children who grind when they sleep do it as a way to breathe better, or due to large tonsil or adenoid size. Another explanation could be stress. A final explanation could be that it’s a type of sleep disturbance along with bed wetting, talking in your sleep, or sleep-walking. We also know that children with allergies or frequent ear infections seem to grind their teeth more. We aren’t exactly sure why but it could be a way to open their airways more.
If your child grinds their teeth, know that they will most likely grow out of it. As pediatric dentists, we don’t normally recommend night guards in children to prevent grinding because 1. Most children would not tolerate having something in their mouth at night 2. It’s a potential choking hazard for children 5 and under and 3. Besides some wear to teeth, it really doesn’t seem to affect teeth.
If your child continues to grind their teeth into adolescence, it might be worth talking to your dentist about.
2. How can I brush my child’s teeth if they don’t want to?
This is the second most common question I get every day. A lot of parents feel at a loss as to what to do with their two-year-old who has a full-on meltdown every time their teeth are brushed. The other thing I hear often is, “Oh, they brush their own teeth.”
First of all, I’d like to acknowledge that I understand how difficult it is to make your child do something that they don’t want to do. If you have a strong-willed three-year-old, some days it can feel exhausting to fight them on tooth brushing. But just like you as a parent know that your child has to sit in a car seat (even if they throw a tantrum) or get their diaper changed, (even if they throw a tantrum) it is the same with teeth brushing. I’m not exaggerating when I say that I have taken out more rotten and infected front teeth on two-year-olds than I can even count because parents didn’t think they needed to brush their kids’ teeth. Even at ages 1 and 2, your child can get big cavities on their teeth.
So how do you brush your wild toddler’s teeth?
A few methods to consider:
Brush their teeth in the bathtub. If your child’s nighttime routine includes a bath – some kids are more willing to have their teeth brushed in the bath. I’m not exactly sure why this is but I’ve tried it on several of my friends’ kids who normally don’t like to brush and it seems to work.
Sit your child on the sink so you can see their teeth as your brush them, and let them watch a show on YouTube as a treat. I recommend ones on toothbrushing like this or this one with Elmo.
Wrap your child in a towel and lay them on the floor or on the bed and brush their teeth with them laying down. That way, if they try to fight you on it, they are safely wrapped up, allowing you the freedom of doing a good job of brushing.
These are just a few suggestions, but the keys for quality tooth brushing are to be able to brush along your child’s gumline, which a lot of times is easiest to visualize if they are laying down or at eye level.
Wrapping a child in a towel and lying them down on a bed can help you to brush your child’s teeth more effectively by limiting their mobility.
3. Until what age should I brush my child’s teeth?
I recommend helping to brush your child’s teeth at least one time per day until they can tie their own shoelaces. Children may like to start brushing their teeth solo but that doesn’t mean they are capable of doing a good job. Most kids under four simply suck the toothpaste off and chew on the brush.
For young children, think about it like this: If you put your three-year-old in the bathtub and told them to wash – how good of a job would they do? Then apply that logic to toothbrushing.
If your child is older and learning to brush solo, make sure to inspect their teeth after brushing and look for any orange staining along their gum lines. Orange staining is what color plaque bacteria turn after food has been left along the gum lines for a few days and it means that your child needs to be brushing better (aka you need to be helping!)
orange staining on teeth is a sign of plaque that has been sitting on teeth for days.
4. What kind of toothpaste should we be using?
There are a lot of toothpaste companies that market “Infant Toothpaste” which does not have fluoride for use when your child is under the age of three. However, it is not necessary to use infant toothpaste if you are using the recommended dose of toothpaste. As stated in a previous blog post, for children under the age of 3, you can use a “smear” of regular toothpaste (about the size of a grain of rice). This is an adequate amount of toothpaste to brush all of your child’s teeth and also does not have enough fluoride to cause fluorosis.
5. Should we floss first, then brush or brush then floss?
I get excited when I hear parents ask this question because it means that they are really trying to optimize oral care for their children. My first answer to this question is “If you’re brushing and flossing every day – then I’m happy. The order is not that important.”
But scientifically speaking, it is best to floss first as it loosens any debris and food between the tooth when then you can brush away. If you’re using a mouth rinse, use that last in order to swish the last bits of food away and to optimize fresh breath.
Lastly, I have some good news. If your child has a lot of spacing in between their teeth, guess what? You don’t have to floss! Your toothbrush is sufficient.
6. Should we be taking getting fluoride from more than just our toothpaste?
“It depends.”
In Oregon, where I live, there are several parts of the state that aren’t fluoridated and some parts that are. The science on fluoride states that it is effective on reducing cavities and creating stronger enamel for teeth. The decision to use supplemental fluoride depends on a few things:
Even if a patient doesn’t live in a fluoridated area, it is possible that the patient is getting fluoride from other areas that are fluoridated. For example, here in Oregon, Portland does not have fluoridated water but the surrounding suburb, Beaverton does. If the child goes to daycare in Beaverton, then it is likely that they are getting fluoride throughout the day from water sources there. This is called the Halo Effect.
Does the patient have cavities? If the patient has minimal plaque, clean teeth and no cavities, but lives in an area that’s non-fluoridated, then they are considered to be a low risk for getting cavities. Therefore they may not need supplemental fluoridation. Ask your dentist if you are unsure!
7. Why do we need to do fillings on baby teeth if they’re just going to fall out?
Baby teeth do eventually fall out, but the timing of when is another matter. The average age for a baby molar to fall out is around 9 years old and your child can be as old as 12 or 13 before their last tooth falls out. For kids that are getting cavities in their molars at age 4 and 5, do you really want your child to have decay and infection in their mouth for 4-8 years before it falls out? I would hope not. Studies have also shown that infection and cavities in baby teeth can adversely impact grown up teeth as well. It can cause adult teeth to grow in the wrong place, to have discoloration, or to even get cavities in it before it even comes into the mouth.
This is an x-ray of a 9 year old patient who still has 11 baby teeth left.
The other reason to fix cavities in baby teeth is to lessen the bad bacteria that lives in your child’s mouth. Cavities are caused by three main factors 1. What you eat 2. How well/often you brush and floss 3. What type of naturally occurring bacteria live in your mouth?
We have all kinds of bacteria that live in our mouth. Some are “good,” meaning they help fight cavities and some are “bad,” meaning they create cavities. (I use quotation marks to label good and bad bacteria because it’s a simple way of explaining how cavities are caused.)
If you allow cavities to go untreated for months or even years, what starts to happen is the “bad” bacteria that causes cavities starts to grow stronger and stronger – which makes it more difficult for the “good bacteria” to make their home in our mouth. When we fix cavities, we upset the bacterial balance/load which greatly lowers the bad bacteria that causes cavities and allows the good bacteria to grow.
8. How do I get my child to stop sucking their thumb, fingers, pacifier?
This is a great question. For many children, sucking on a finger or pacifier is self-soothing. As a pediatric dentist, I recommend to start thinking about breaking your child’s non-nutritive sucking habits around age two-and-a- half. Sucking on the thumb, pacifier, or fingers can cause the upper front teeth to flare out, causing your child’s palate to narrow and cause problems with their bite later on. It can also cause your child’s permanent teeth to come in the wrong place.
What a typical mouth of a thumb-sucker can look like.
The good news is that most children stop without any additional help by age three. That’s why it’s a good idea to start encouraging them to stop around age two and a half. You can start by trying to restrict use to bed or naptime. Also, many children respond positively to hearing that “they are growing up to be a big kid, and big kids don’t suck their thumb/finger/pacifier.” An older brother, sister, or cousin can also help to encourage them as young children often look up to older siblings. But nagging them usually has the opposite effect so try to talk about it in a way that makes them want to stop.
If your child is older than three and you are starting to notice changes in their front teeth, you may want to step up the methods. First, I always recommend going with positive reinforcement. One idea could be to set up a chart for your child and reward them daily with stickers that they can place on the chart for every day they don’t suck their finger. At the end of a week, if they have enough stickers, they could earn enough stickers to pick out a prize at their favorite store. You can also praise them for not sucking their fingers, when they are not doing it or when you notice they catch themselves doing it.
Then there are what we call “reminder” techniques, such as placing a mitten on your childs’ hands at night, putting a bandaid on the fingers they normally use, or purchasing a brace for their thumb, or placing something that tastes bitter on their hand like Mavala. These methods can also help.
If your child is older than 5 and still has a sucking habit, then there are appliances that your friendly, neighborhood pediatric dentist can place for you. The one that I like to use that I have had very good results with is called a Blue Grass appliance. It’s glued onto your child’s back teeth and has a little ball that sits on the roof of your child’s mouth. The idea is the place makes it uncomfortable for a child’s finger to sit on the roof of their mouth, and the fact that the ball spins give your child something else to do instead of putting their finger in their mouth. Your child will most likely wear the appliance for 4-6 months, but they normally stop sucking within the first couple of days.
9. What are foods that cause cavities?
Great question. Most people probably feel like they know what causes cavities…
SUGAR!
And they’re right! But there are some sneaky things that can cause cavities that parents may not think about. Any of these things can be okay in moderation, but should not be used every day if you’d like to prevent cavities from forming.
Drinks: Soda, Juice, Gaterade, chocolate milk, even almond milk with vanilla. These all have a lot of sugar. The American Academy of Pediatrics recommends that children 2-6 only have 4oz of juice per day and that children under 2 get no juice. A lot of parents think they are avoiding all that sugar by watering down their child’s juice. This is a good idea, however, if your child is allowed to sip on watered down juice throughout the day, they are still getting sugar on their teeth. Teeth need time to recover from sugar. It’s a process called remineralization. They need a minimum of an hour between meals or drinks with sugar to re-mineralize. So the best course of action is to give your child some watered-down juice with a meal and then stick to water in-between.
Sticky foods: Foods that are both sugary and sticky like caramels, gummy bears, fruit leathers, etc. are the WORST thing your child can eat for causing cavities. This is because it’s a double-whammy. 1. These usually have a lot of sugar (even the ‘organic/natural’ fruit leathers still have a ton of sugar). 2. If a food is sticky then it will most likely get stuck on the little grooves and fissures in your child’s back teeth (their molars). It’s hard to brush these spots.
Sugary Foods that take a long time to dissolve. Anything that you have to suck on like lollipops, Jolly Ranchers, are also really bad for teeth because they keep the sugar circulating in the mouth for much longer.
Any other food that can get lodged in the grooves of your child’s teeth. Like goldfish or pretzels.
10. When should my child see an orthodontist to check if they need braces?
It depends.
Most orthodontists (the dentists who place braces) like to see kids around age 8 or 9 for evaluations. That doesn’t necessarily mean that your child is ready for braces at that age.
Most children are ready to get braces by the time they are 12 or 13, but sometimes orthodontists want to start earlier depending on what kind of bite your child has, how much crowding they have, or if it seems like your child’s upper jaw and lower jaw are not growing at the same rate.
Your child’s pediatric dentist has received special training in understanding the growth and development of a child’s mouth so they can help to let you know when it’s the best time for your child to see the orthodontist.
An example of teeth crowding that would benefit from braces (above). And an example of an underbite (below) that would benefit from getting braces earlier.
These are some of the most common questions that I get asked. Remember to have your child see their pediatric dentist every 6 months starting around age one! I hope this was helpful to answer some questions you may have whether you have kids or not. Keep brushing and flossing!