Dr Dan Howell Pediatric Dentistry (DDS, MS)

If your infant has any oral or dental condition that bothers you or appears to be out of the ordinary, then he/she should be seen regardless of age.  In unique situations we have seen children as early as their first week of life. This includes any problems with trauma to the teeth or mouth.

The American Academy of Pediatric Dentistry recommends that children receive an oral health risk assessment by six months of age, and that they establish a dental home by 12 months of age.  The reason for these recommendations is that some infants will develop cavities within months of the time that teeth erupt into the mouth.  Often these early cavities are caused by feeding and oral hygiene habits.  These early cavities may be avoided if the parents are counseled in these two areas as the first teeth are erupting.

We recommend that you come with your infant shortly after his/her first teeth have erupted. We will help you with home oral hygiene, diet, pacifier or finger habits, fluorides, toothpaste and injury prevention.  Both Mom and Dad are welcome at these appointments.  With professional guidance and demonstration, effective prevention can be stress free, easy and fun for the whole family.  Families who embrace early parental involvement in home dental care for their children can, very predictably, expect a lifetime with few, if any, dental problems.

If you have older children who are already patients in the practice, then you already have a "dental home. "  Additionally, you have been introduced to the home preventive dental care practices that we recommend.  Use the same techniques that you have already seen and heard for your newest edition.  If you are having any problems or concerns you are welcome to bring your infant along with your older children so that we can answer your questions.  If you have older children in the practice, are comfortable with your home preventive dental care routine, and don't have any questions or concerns about the oral/dental health of your infant, we recommend that your child come for a first dental visit at age three.

When you talk with your child about his/her first dental visit we recommend that you emphasize both honesty and a positive attitude.  Please do not talk to your child about any dental anxieties that you may have.  "The dentist will be very kind and gentle when he counts your teeth," and "Mommy will be with you all the time," are good places to start.  Answer all the questions that your child asks to the best of your ability without making a "big deal" out of the experience.  I have found that mothers are very good at predicting their child's behavior for his/her first dental visit.  Some children will feel more at ease if they know, in advance, every detail about the upcoming experience.  Others do better if they know nothing at all.   Remember, every child is an individual.  Prepare your child so that he/she has the best chance for a good experience.  We will use our training and experience along with the information that you give us to do the same.

Together we will review your child's health history, and then we will discuss what your main concern is about your child's teeth and oral health.  Dr. Dan will examine your child's head, neck, teeth and intra-oral soft tissues. The occlusion, or the way that the teeth are aligned and function together, will also be evaluated.  Radiographs or x-rays will be made only if they are needed to make an accurate and complete diagnosis of your child's dental health.  Dr. Dan will then discuss his findings from the examination and answer any questions that you have.  Also, your child's teeth will be cleaned and he/she will be given a topical fluoride treatment.

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Pediatric dentists are the pediatricians of dentistry.  After competing four years of dental school, the pediatric dentist goes on for an additional two to three years of specialty training.  Due to the specialty training, pediatric dental practices are dedicated to treating children from infancy through the teen years.  Children's physical, psychological and emotional growth and development are areas of expertise addressed in the specialty education.  Just as important as the specialized education involved in becoming a pediatric dentist, Dr. Dan and his staff treat children because they want to and because they enjoy it.

Sealants are tooth colored resins that are applied to the biting surfaces of posterior teeth in order to help keep them cavity free.  Sealants bond to the enamel and fill in the grooved and pitted surfaces of the tooth to prevent food particles and dental plaque from accumulating and causing cavities.  Fast and comfortable to apply, sealants are a valuable part of our preventive program.

Thumb and pacifier habits can cause changes in tooth alignment and to the way that the upper and lower jaws fit together.  Fortunately, these changes will usually reverse spontaneously if the habit is stopped before the front permanent teeth start to erupt (usually age 6 to 7).  Pacifier habits are often easier for your child to stop than thumb or finger habits.  If your child is having a problem with a thumb or pacifier habit beyond the age of 6 to 7, it should be evaluated on an individual basis.  We will help you find which of the many possible solutions would be best for your child.

Bruxism, or grinding the teeth together, is a common occurrence in children.  Bruxism often leads to the abnormal wearing away of the tooth structure which is called attrition.  Although bruxism has been studied extensively, we still do not know how to stop an individual from doing it.  An adult who bruxes and who also has significant attrition will often be advised to wear a "bite guard" appliance to control the damage to his teeth.

Treatment of bruxism in children who still have baby teeth (children usually have baby teeth up to age 12 to 13) poses some unique considerations and problems which can include: children have a tendency to either lose or not wear "bite guard" appliances; "bite guard" appliances don't fit well when baby teeth are getting loose, falling out, and being replaced by permanent teeth; "bite guard" appliances are expensive; and even though the baby teeth are being worn down due to the bruxing habit, they will be replaced by permanent teeth.  Also, many children stop their bruxing habit and the resultant attrition as they transition from baby teeth to permanent teeth.

In light of the above considerations concerning bruxism and attrition, these problems are rarely treated in children.  There are unique situations; however, where treatment is needed when children still have baby teeth.  These unique situations require evaluation on an individual basis.  Adolescents (usually older than age 12 to 13) who have erupted all their permanent teeth and continue to brux to a degree that they cause significant wearing away of tooth structure need to be evaluated for a "bite guard" appliance.

We see many sports related injuries to the teeth.  We definitely recommend that your child use a soft plastic mouth protector while participating in sporting events.  Commercial mouth guards are effective if they are worn.  Unfortunately, the commercial mouth guards are not custom fit and are not as comfortable as those made in our office.  If your child will not wear the mouth guard from the sporting goods store, then you should consider one that is custom made in our office to protect his/her teeth from sports related injuries.

Dental treatment in the hospital with general anesthesia is one option that you, as a parent, may consider for your child.  The factors that you need to evaluate when making this decision are: health risks to your child associated with general anesthesia; expense of hospitalization or sedation for dental treatment; amount of treatment that your child needs; and whether the dental treatment can be completed safely in the traditional setting at the pediatric dentist's office.

The decision to have your child's dental treatment done in the hospital under general anesthesia is a very difficult one for most parents to make.  In order to make an informed decision, many parents have found it helpful to accompany their child to at least one treatment appointment in the traditional setting at the pediatric dentist's office.  This gives you, as a parent, the opportunity to be with your child and to evaluate your child's response to the treatment procedures.

Dr. Dan and his staff will use their training and expertise to help you and your child manage any anxieties that either of you have.  If, after observing your child's treatment in the traditional setting, you favor hospitalization for your child's dental treatment, we will be happy to help you find a facility that will meet your needs.  Dr. Dan does not put children in the hospital for dental treatment.

Baby bottle tooth decay is a pattern of rapid decay associated with prolonged bottle feeding or nursing.   Otherwise healthy milk or fruit juices can cause extensive decay when they are in contact with the teeth for extended periods of time.  This destructive process often occurs when a child goes to sleep while breast feeding or bottle feeding.  During sleep, the flow of saliva is reduced and the natural self cleansing action of the mouth is diminished.  Avoid nursing children to sleep or putting anything other than water in their bedtime bottle.  Encourage your child to drink from a cup near his/her first birthday. Your child should be weaned from the bottle at 12-14 months of age.

Dental cavities or dental caries is a disease process, not an isolated event.  This disease process is constantly ongoing in all people, both children and adults.  A six month old child with a single erupted tooth could potentially develop a cavity if enough disease causing factors are working against the disease protecting factors.  The process of developing a cavity is best visualized as a balance between the disease causing factors, or pathological factors, and the disease protecting factors.  Very simply stated, if the combined effect of the disease causing factors outweighs the combined effect of the disease protecting factors, then dental cavities will develop.

Cavity causing factors are:

• poor oral hygiene or failure to remove bacterial plaque from tooth surfaces regularly and effectively
• high frequency of ingestion of fermentable carbohydrates
• sucrose and all foods that contain sucrose
• acquisition of mutans streptococci in dental plaque at age two or younger
• decreased salivary flow
• genetics
• orthodontic appliances
• enamel hypoplasia

Cavity preventing factors are:

• early preventive dental visit (by age one)
• parent education in cavity prevention
• increased salivary flow
• genetics
• effective daily removal of bacterial plaque from all teeth
• fluoride in toothpaste, fluoride rinse, fluoridated drinking water
• systemic fluoride supplement (if drinking water is not fluoridated)
• chlorhexidine mouthrinse
• dental sealants
• xylitol gum and xylitol artificial sweetener

So we return to the question: "Why did my child get a cavity?"  A simple answer would provide you, as a parent, a simple solution to the problem.  Unfortunately, the formation of dental cavities is rarely a "simple" process.  All of the above mentioned positive and negative factors, plus others that we don't yet fully understand, combine to result in dental decay.

As a start, we will advise you in the following areas that we have found make the most difference for the most people in reducing or stopping the formation of new cavities:

• Get involved with helping your child remove the dental plaque form his/her teeth at least once daily.  We will demonstrate the techniques that we recommend and that we have found to be effective.
• Use fluoride supplements as we will discuss with you in the office.
• Attempt to change dietary habits that are potentially cavity causing.

We will be glad to explain these options in more detail next time you visit our office.

If your child is experiencing pain with a tooth, we will examine your child, determine the source of the pain, and discuss both the problem and the solution with you.  If it is safe for your child, the source of the pain will be treated the same day.  We save time in our schedule every day for emergencies.  This emergency time will be used to get your child out of pain.  Sometimes, due to swelling or dental abscesses, it is not safe to treat the source of the pain until your child has been medicated with antibiotics.  In this situation, we will give you a prescription for the swelling and the pain, and then schedule a time to treat the source of the pain.