Why does my child need checkups every six months?
      It takes serious commitment to take care of our teeth. The enamel of children's teeth is thinner than permanent teeth. Once bacteria invade a tooth (cavity) they can quickly multiply and spread throughout the whole tooth, or invade the nerve.
      Children can also get gingivitis (gum disease) just like adults. Bacteria accumulate around the gums and in between the teeth causing the gums to swell, turn red and bleed when brushed or flossed.
      Our modern culture includes foods which are high in carbohydrates (sugars). Sucrose, fructose, high fructose corn syrup, molasses, etc. are all sugars added to many of our foods. Fast and processed foods are loaded with these sugars. Soda, as well as being high in sugar , also is high in acids like ascorbic and citric acid. Even sports drinks have lots of acids! These acids dissolve enamel and make it easier for bacteria to invade the teeth. Most box drinks, except those that say they are 100% juice are loaded with sugar. Box chocolate drinks have more sugar than soda!
      Our dental team can help you and your child keep their smile healthy for a lifetime.
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How often should we change our toothbrush?
      Tooth brushes should be changed at least every two months. Make sure you only use a soft tooth brush. Hard tooth brushes can damage the gums. Change the toothbrush more often if your child chews on the toothbrush, or if they have been ill. (You can also put the tooth brush through the dish washer if your child has been ill) If your tooth brush bristles are not standing straight up, they are not cleaning your teeth well.
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My child’s breath is awful! What can we do?
From Halitosis Update ADA Journal vol. 35 April 2007:
      The causes of bad breath can be multiple and can shift over time. Ninety percent of the time the wet, warm, dark mouth is the source of the odor. The oral cavity is the ideal breeding ground for microorganisms, and most halitosis sufferers have a localized cause for the malodor. Saliva, chewing , drinking, throat clearing and coughing work to help keep the mouth healthy. Insults such as smoking, neglectful oral hygiene, and conditions (asthma medicines) that cause xerostomia (dry mouth) tip the balance to enable odor causing bacteria to take over, growing with a virulence.
      Food impaction between the teeth can produce unpleasant odors. Diseased gingiva (gums) , film-coated teeth, palate, tonsils/adenoids, and sinuses, as well as ear infections, can also cause bad breath. The tongue is of special significance because its crevices are covered by a thin sticky wetness clear or whitish yellow. The tongue is covered with bacteria, shed cells and decayed cells-- it is the primary host of odors of all sites in the human body. Tongue cleaning reduces odor, but must be performed daily because the bacteria grow back each day and sometimes as fast as 15 minutes. The back of the tongue is like a sponge for post nasal drip which then commingles with the tongues’ bacteria to increase the odor. Tongue cleaning can be done with the tooth brush, a dry gauze , a tongue scraper or the edge of a plastic spoon. When cleaning the tongue reach as far back as possible, almost to the point of gagging.
      Systemic causes of halitosis- Although rare, toxins in the blood caused by subsurface systemic diseases can contribute to mouth odors as the toxins are eliminated through the lungs. Hepatic, pulmonary, renal or metabolic disorders can cause oral malodor, as well as nerves, glandular disorders, gastric reflux, or other gastrointestinal disorders . Frequent sore throats can also be a symptoms of tonsils which may be impacted with sloughed cells, food , mucus and bacteria, causing odor. Your medical doctor would need consultation to rule out these possibilities.

Treatment and prevention
Mints and other candies provide temporary relief from halitosis, but then the sugar in the mints actually feeds the bacteria and can cause an increase in halitosis later! Mouth rinses with alcohol can also temporarily decrease malodor, but the alcohol dehydrates the mouth which causes the bacteria to grow further and cause more odor!
What can be done? Have your dentist make sure there are no cavities, and all restorations are in good repair. Your dentist can also check for any sores in the mouth. Have dental cleaning every six months. Plaque may be gathering between the teeth and under the gums which is the first stage of periodontal (gum) disease. Just like pet owners who have their carpets cleaned regularly, their houses smell less then those homes who do not have their carpets cleaned regularly. Patients who commit to have their teeth cleaned every six months often find this simple commitment helps keep oral malodors at bay.
Lastly, brush and floss together as a family. Your children are always watching and learning from you. If you don’t brush and floss regularly, neither will your children!
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My child’s gums bleed when they brush or floss.
      If your child’s gums bleed when they brush their teeth, then they have not been brushing well or often enough. The teeth should be brushed after breakfast and after dinner, in other words every morning and evening. The teeth should be flossed every evening. Children (over age 5) and teens should brush 2 - 3 minutes. To gage the correct time there are several aids: timers, electric toothbrushes with timers, or music. Children and teens can brush from the beginning to the end of a song.
      The teeth and gums should be brushed. The tooth brush should be held where the teeth and gums meet and brush gently back and forth or in small circles making sure all teeth from the front to the back are brushed. Also, the “inside” should be brushed: along the roof of the mouth and next to the tongue.
      Flossing can be done either before or after brushing, but I think more children remember if they floss first. The floss should go in between each tooth and under the gums. Once the floss is under the gums it should be moved back and forth. Lightly waxed floss is usually best for children and teens.
      If the teeth and gums are brushed in this manner twice daily and flossed every evening the gums should stop bleeding within 2 weeks. If the gums do not stop bleeding, contact our office.

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What causes tooth decay (cavities)?
      This is a very simplified version: We all have bacteria living in our mouths (as well as the rest of our body) . When we eat food, the bacteria eat as well. Since bacteria are simple animals, like humans, they pass gas (bad breath), and pee (acids). The acids soften tooth enamel and make it easier for the bacteria to move inside your tooth, therefore causing a cavity. If the cavity is not noticed early, the bacteria continue to soften the tooth and move further inside the tooth through enamel, dentin and then move into the pulp (nerve). The bacteria multiply during this entire process. If the bacteria reach the nerve and continue multiplying inside the nerve space, this is when severe pain can occur. If this pain is ignored , the bacteria can then spread into the soft tissue (gums or cheeks) and cause an abcess or cellulitis (cheek swelling).
      Sometimes teeth with cavities that are not in the nerve can hurt also. Many times though, the pain is from food impacted (caught) in-between the teeth where the cavity has caused some of the tooth to break off and catch food. Flossing and brushing well, can alleviate the pain.
      Tooth aches should never be ignored! Pain may be relieved temporarily, with flossing or pain medications, but the underlying cause of the pain needs to be determined.
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My children don’t eat much candy, but they are still getting cavities. Why?
      In our modern society, candy is not the only source of sugar. Different types of sugar are hidden in most processed foods. Liquid sugars in the form of pouch or box drinks. Solid sugars are in cookies, crackers, cereals, breads, etc., etc. The trick is “all foods in moderation”.
      Parents should set the example by having healthy food in the home and not storing “junk” foods or drinks. Parents should try to fix fresh vegetables and have fresh fruit for meals and encourage milk or 100% fruit juice. Limit soda to special occasions. Limit the amount of “white colored foods” , except cauliflower, these tend to be higher in sugar. Again, parents have to set the example: If you eat fresh, health foods and don’t buy many processed foods your child will learn to eat these also.
     Our saliva buffers (neutralizes) acids produced by bacteria. The ph of our saliva must reach 5 for enamel to start softening. Some people have saliva with a high ph, such as 8 or 9. It is harder for these people to get cavities. Some people have saliva with a ph of 6. It is very easy for these people to get cavities.
      The frequency of eating and snacking also influences the amount of cavities. If a child is constantly snacking or drinking juice or milk throughout the day or night their saliva does not have a chance to neutralize the acids produces by the bacteria. If your child must snack alot, it is very important that these snacks not be processed sugary foods. Good snack choices are popcorn, cheese, peanut butter, nuts, fresh fruits, yogurt, veggies and dip, some dried fruits, and of course, water!
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Why are there stains on my child’s teeth?
      Stains can be just on the surface of the tooth (extrinsic) or incorporated into the tooth (intrinsic). The latter is more rare. Stains on the surface of the teeth accumulate after the eruption of a tooth into the mouth. Newly erupted primary teeth may have a yellow membrane on them that will wear off in a few days. Newly erupted permanent teeth appear more yellow than their milky-white primary neighbors. This is their normal color. The permanent teeth are darker because they are denser so they can last a lifetime.
      White color is not always good. Chalky white spots on permanent teeth can be a result of trauma to a primary tooth while the permanent tooth was developing in the jaw. Or, chalky white lines at the gum line or around orthodontic brackets can be a warning sign of beginning decay. Decay starts by removing minerals, especially calcium from the outer surface of the tooth. This softens and allows the acid from the bacteria in plaque to work more quickly. If oral hygiene (brushing and flossing) is started at this point, using a concentrated fluoride paste, and the teeth are kept meticulously clean, these areas can harden again by remineralizing. If the enamel turns brown, the enamel has been broken by the acid attack and the tooth may now need a filling.
      If one or two teeth are dark, gray, pink, or yellow, this may be the result of that tooth having been hit accidentally. Your child should be seen soon thereafter for an x-ray picture of the tooth and a discussion about possible things that may happen to that tooth.
      The rest of the stains below are all easily removed by a simple polishing done in the dental office.

1. Green or orange stain- usually on the front teeth at the gum line. It is caused by color-producing (chromogenic) bacteria. Colonies of these orange or green bacteria usually mean that somebody is falling down on the job of cleaning the child’s teeth. It could also mean the child is a mouth breather.
2. Brown or yellow stain- very likely from antibiotics or colored chewable vitamins. The most common antibiotic to stain the surface of the teeth is Amoxicillin. A single dose may cause yellow to brown film to form on the teeth in some children. The stain may disappear partially or altogether once the prescription of antibiotics is finished. If is unattractive to you, the stain can be readily removed in the dental office.
3. Black stain- very often this stain is caused by chewable or liquid iron supplements, or even multiple vitamins with added iron. This stain polishes off easily. Some populations naturally form a black line on the teeth at the gum lines of all the teeth. It tends to be very tenacious, but can be removed in the dental office. Where these stains come from is unknown, but these children seem to have fewer cavities and seem to "grow out of" this black stain as they reach puberty.

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My child has a tooth coming in and the baby tooth hasn't not fallen out yet (Double teeth).
      This is very, very common! The lower front teeth come in double in at least 50-75% of children. We do not need to extract (take out) the baby tooth unless it is the same height as the baby tooth and the baby tooth is not loose. When the baby tooth falls out, the permanent tooth will slowly (it may take months) move forward into its correct position.
      Even my daughters teeth came in double!
      If the top front teeth come in double we almost always need to help them out.


Double Teeth (Click to view fullsize)

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My child gets sores in their mouth. What causes this?
      Sores in the mouth can be from many causes. Some of the most common are: Aphthus ulcers (canker sores), Recurrent cold sores (oral herpetic lesions), and traumatic injuries are some of the most common sores in healthy children.
      The cause of canker sores is still a mystery, but scientists think they can be brought out by: braces, trauma, hard crunchy foods, cinnamon oils (in some candy and gums), and sodium laurel sulfate (found in many toothpastes).
      Recurrent cold sores are caused by the oral herpes virus. They are contagious and can be spread by sharing foods, straws, kissing, etc. Recurrent cold sores will recur over your life time, thus the name. The sores can be brought out by trauma, and stress.
      Canker sores can usually be differentiated from recurrent cold sores by their location. Canker sores usually occur on “moveable” oral tissues, like the tongue, cheeks, and the folds between the cheek and gums. Recurrent cold sores usually occur on the “non-movable” tissues, the gums and are usually very close to the teeth.
      Sores from trauma usually are caused by an accident where the gums or other oral structures are injured. These sores are usually seen immediately. Canker sores or recurrent cold sores may not show for days after a trauma.


Aphthus ulcer (canker sore)on upper lip

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My child’s gums are brown, is this unhealthy?
      Brown gums are called physiologic pigmentation , and are normal. Children with brown or olive colored skin can have brown gums. This is completely normal. If gums are red, then you may have gingivitis or gum disease.
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My six year old/twelve year old says their jaw hurts and it looks like the gum is growing over the back tooth!
      At approximately 6-7 years old children get their first set of permanent molars. The gum will recede (shrink) as the tooth comes in. Your child will get three sets of molars: at age 6-7, between ages 11-13, and wisdom teeth at age 14-21.
      Anbesol, Children's or Junior Tylenol, Motrin, warm water and salt rinses or Advil will help until the tooth is fully erupted (as long as your child is not allergic to these medications).


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My 10 year old's canine tooth is loose, I think it is a permanent tooth.
      Unless your child has had trauma to their mouth, the tooth is a baby tooth. Permanent teeth in children do not become loose without trauma.
Tooth chart

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Eruption of your child’s teeth
      Children’s teeth begin forming before birth, in the second trimester. As early as 4 months, the first primary (baby) teeth to erupt through the gums are the lower central incisors, followed closely by the upper central incisors. Although all 20 primary teeth usually appear by age 3, the pace and order of their eruption varies.
      Permanent teeth begin appearing around age 6, starting with the first molars and lower central incisors. This process continues until approximately age 21. Adults have 32 teeth total including the wisdom teeth.


Tooth Eruption Chart (Click to view fullsize) OR
Click here to view chart as a PDF


Primary (baby) tooth, roots resorbed (Click to view fullsize)


Permanent tooth with full root (Click to view fullsize)


Permanent teeth in the center, primary teeth on each side(note: primary teeth are much smaller (Click to view fullsize)
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My 3 year olds front tooth never came in. Why?
      Some children are missing teeth. Usually the problem is genetic (a parent or ancestor was missing teeth). When your child is able to cooperate, we will take an x-ray to determine if the permanent tooth is missing, also. If a permanent tooth is missing, your child can have a "fake" tooth made to replace the missing one, or have braces to move teeth around to close the space.
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My 3 year old has a funny looking tooth that looks like it is split in two. Why?
      Sometimes primary teeth come in fused (glued) to the adjacent tooth. Sometimes primary teeth come in fused to an extra tooth. Sometimes a primary tooth will try to ‘split” into two! Terms we use for these teeth are fusion, gemination or twinning. An x-ray will determine which type of tooth your child has. These anomalies rarely occur in permanent teeth.
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At what age can my child go to the orthodontist?
      There is not a definite age. It depends on how many permanent teeth your child has and what his/her dental problem is. Usually, the orthodontist will see your child when they have 8 permanent front teeth and 4 permanent back teeth. However, if your child has an under bite or severe crowding we will send them to the orthodontist earlier.
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My child plays sports. How can I protect their teeth?
      A custom fit mouth guard is best. These types of mouth guards fit snugly and do not flop around in the mouth. They are also thicker than store bought varieties. Your teen does not have to clench to hold them in place and they are able to talk. When teens have to clench on mouth guards to hold them in place, they are more likely to break bones in their face if they are hit. Mouth guards that fit correctly, allow the mouth to relax, so the likely hood of breaking facial bones decreases. The mouth guards can be made in almost any color or combination , even clear!
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Teens and dental health
      Many parents and teens think they have “outgrown” cavities, but the teen years can actually see an increase in cavities. Teens have busy, active lives so they tend to choose food that is quickest, not what is healthiest. This may include lots of soda and fast food. Sports drinks include alot of acids : look at the nutritional label for citric, ascorbic, or phosphoric acid. These acids add to the acids produced by the bacteria and can cause an increase in cavities. If you saw the movie “Super Size Me”, then you know how much sugar is in fast food. Brushing and flossing daily will help remove the sugars, and make the gums healthier*. I know I am a broken record, but parents need to encourage their teens to eat dinner at home at the family table at least a few nights a week, so parents can provide healthy food choices.
     see the section on causes of dental decay
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Does my smoking cigarretts affect my child's' teeth?
      Yes. Nicotine promotes the growth of the bacteria that cause cavities (strep mutans), so when mothers or fathers smoke and they kiss their children or share straws or utensils they pass the bacteria on to their child. So the lesson here is second hand smoke not only affects the lungs of children exposed to their parents' smoking, it also affects the amount of cavities they may develop (March 12, 2007 JAMA).
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