Click on a topic of interest for more information.

What is a Pediatric Dentist?
Taking Care of Your Teeth
Your Child's First Dental Visit
Routine Dental Care
Why are the Primary Teeth so Important?
Dental X-Rays
Care of your Child's Teeth
Good Diet = Healthy Teeth
How Do I Prevent Cavities
Sealing Out Tooth Decay
Baby Bottle Tooth Decay (Early Childhood Caries)
When will my Baby Start Getting Teeth?
Eruption of your Child's Teeth
Dental Emergencies
The Importance of Fluoride
What's the Best Toothpaste for my Child?
Does your Child Grind his Teeth at Night? (Bruxism)
Thumb Sucking
Tongue Piercing - Is it Really Cool?
Tobacco - Bad News in Any Form
What is the Best Time for Orthodontic Treatment?
Mouth Guards
Safety of Dental Unit Waterlines

The pediatric dentist has an extra two years of specialized training and is dedicated to the oral health of children from infancy through the teenage years. The very young, pre-teens, and teenagers all need different approaches in dealing with their behavior, guiding their dental growth and development, and helping them avoid future dental problems. The pediatric dentist is best qualified to meet these needs.
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Your child should floss or have their teeth flossed when their teeth are in contact with each other (usually after age 4). The back or molar area is the most important area to concentrate on.
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 Your Child’s First Dental Visit

Your child should visit the dentist by his/her 1^st birthday. You can make the first visit to the dentist enjoyable and positive. Your child should be informed of the visit and told that the dentist and his staff will explain all procedures and answer any questions. The less to-do concerning the visit, the better.

It is best if you refrain from using words around your child that might cause unnecessary fear, such as needle, pull, drill or hurt. Pediatric dental offices make a practice of using words that convey the same message, but are pleasant and non-frightening to the child.
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 Why Are The Primary Teeth So Important?

It is very important to maintain the health of the primary teeth. Neglected cavities can and frequently do lead to problems which affect developing permanent teeth. Primary teeth, or baby-teeth are important for (1) proper chewing and eating, (2) providing space for the permanent teeth and guiding them into the correct position, and (3) permitting normal development of the jaw bones and muscles. Primary teeth also affect the development of speech and add to an attractive appearance. While the front 4 teeth last until 6-7 years of age, the back teeth (cuspids and molars) aren’t replaced until age 10-13.
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Radiographs (X-Rays) are a vital and necessary part of your child’s dental diagnostic process. Without them, certain dental conditions can and will be missed.

X-Ray’s detect much more than cavities. For example, X-Rays may be needed to survey erupting teeth, diagnose bone diseases, evaluate the results of an injury, or plan orthodontic treatment. X-Rays allow dentists to diagnose and treat health conditions that cannot be detected during a clinical examination. If dental problems are found and treated early, dental care is more comfortable for your child and more affordable for you.

The American Academy of Pediatric Dentistry recommends X-rays and examinations every six months for children with a high risk of tooth decay. On average, most pediatric dentists request radiographs approximately once a year. Approximately every 3 years it is a good idea to obtain a complete set of radiographs, either a panoramic and bitewings or periapicals and bitewings.

Pediatric dentists are particularly careful to minimize the exposure of their patients to radiation. With contemporary safeguards, the amount of radiation received in a dental X-ray is extremely small. The risk is negligible. In fact, the dental X-rays represent a far smaller risk than an undetected and untreated dental problem. Lead body aprons and shields will protect your child. Today’s equipment filters out unnecessary X-rays and restricts the X-ray beam to the area of interest. High-speed film and proper shielding assure that your child receives a minimal amount of radiation exposure.
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Begin daily brushing as soon as the child’s first tooth erupts. A pea-size amount of fluoride toothpaste can be used after the child is old enough not to swallow it. By age 4 or 5, children should be able to brush their own teeth twice a day with supervision until about age seven to make sure they are doing a thorough job. However, each child is different. Your dentist can help you determine whether the child has the skill level to brush properly.

Proper brushing removes plaque from the inner, outer and chewing surfaces. When teaching children to brush, place toothbrush at a 45 degree angle; start along gum line with a soft bristle brush in a gentle circular motion. Brush the outer surfaces of each tooth, upper and lower. Repeat the same method on the inside surfaces and chewing surfaces of all the teeth. Finish by brushing the tongue to help freshen breath and remove bacteria.

Flossing removes plaque between the teeth where a toothbrush can’t reach. Flossing should begin when any two teeth touch. You may wish to floss the child’s teeth until he or she can do it alone. Use about 18 inches of floss, winding most of it around the middle fingers of both hands. Hold the floss lightly between the thumbs and forefingers. Use a gentle, back-and-forth motion to guide the floss between the teeth. Curve the floss into a C-shape and slide it into the space between the gum and tooth until you feel resistance. Gently scrape the floss against the side of the tooth. Repeat this procedure on each tooth. Don’t forget the backs of the last four teeth.
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One of the most important factors associated with dental cavities is the diet. Children get primarily two types of cavities, those in-between the teeth and those on the grooves or biting surfaces.

Cavities in between the teeth are caused primarily by sweetened liquids such as juices, soda, chocolate milk, etc.. Children should be encouraged to drink water and/or plain milk. If your child drinks a sweetened liquid it is a good idea to alternate this drink with water and/or milk.

Cavities on the grooves or biting surfaces of the teeth are caused by sticky sweet foods such as Fruit Roll-Ups, Gummy Bears, Skittles, Starburst ,etc.. Foods such as raisins, although healthy, can cause dental cavities. Starches such as potato chips, pretzels, and crackers can also turn to sugar over time and therefore should be given with caution. These types of foods should be given in moderation and it is a good idea to tie them to meals as opposed to in-between meals.

Good oral hygiene removes bacteria and the left over food particles that combine to create cavities. For infants, use a wet gauze or clean washcloth to wipe the plaque from teeth and gums. Avoid putting your child to bed with a bottle filled with anything other than water. See "Baby Bottle Tooth Decay" for more information.

We use our back teeth to chew food. On their biting surface these teeth have deep, narrow and uneven grooves called pits and fissures. Bacteria grow in the pits and fissures, where saliva and toothbrush bristles cannot easily reach. In children, these grooves are highly susceptible to decay. Studies show that approximately 90 percent of new cavities form on the chewing surfaces of the back teeth. With dental sealants, decay can be significantly reduced.

Dentists and dental hygienists can place a safe, protective layer over these susceptible biting surfaces by covering them with a plastic resin called a dental sealant. Sealants have been accepted by the American Dental Association since 1976.

Here are some facts about sealants:

• Although fluoride is effective in the fight against decay, it works best on smooth tooth surfaces. Together, sealants and fluoride provide the strongest defense against tooth decay.

• An ideal time to apply sealants is soon after the primary and permanent molars erupt. Generally, primary molars appear between a child's second and third birthdays. The first permanent molars come in at about age six, and the second permanent molars around age twelve.

• Sealants do not require the use of dental anesthesia or a drill. Instead, the chewing surface is cleaned and prepared for the sealant. The sealant is brushed on and allowed to harden and "bond" to the tooth's surface.

• Fillings and sealants are not the same. Sealants keep teeth healthy by preventing cavities; fillings are placed in teeth that have already developed cavities. While preparing a tooth: for a filling may cause discomfort to the patient, sealant application is both rapid and painless.

• Extensive research and clinical studies have shown sealants to be safe and effective, and they are recommended for all children and teenagers-including those who receive fluoride daily. Sealants are also sometimes recommended for adults.

• Sealants complement good oral hygiene that includes brushing at least twice each day with fluoride toothpaste, flossing, snacking in moderation and regular dental checkups.

• Sealants last a long time. In one study, more than half the sealants were still in place after 10 years. Sealants are checked at each regular dental visit and can be easily replaced or repaired when necessary.

• Most insurance companies pay for dental sealants as a preventive measure, much the same way they do a professional fluoride treatment.

• Our office can provide you with more information about dental sealants.

• Form a protective layer over the cavity-prone biting surfaces of the back teeth

• Are applied rapidly and painlessly and are long lasting

• Together with fluoride and routine dental care provide maximum protection against cavities

• Are recommended for all children and even some adults

This information is based upon referenced material in the scientific monograph entitled "Dental Sealants, " produced by the Center for Dental Information, a national, non-profit organization that disseminates information about developments in dental science. Support for the Center is provided by an educational grant from Mars, Incorporated.
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One serious form of decay among young children is baby bottle tooth decay. This condition is caused by frequent and long exposures of an infant’s teeth to liquids that contain sugar. Among these liquids are milk (including breast milk), formula, fruit juice and other sweetened drinks.

Putting a baby to bed for a nap or at night with a bottle other than water can cause serious and rapid tooth decay. Sweet liquid pools around the child’s teeth giving plaque bacteria an opportunity to produce acids that attack tooth enamel. If you must give the baby a bottle as a comforter at bedtime, it should contain only water.

After each feeding, wipe the baby’s gums and teeth with a damp washcloth or gauze pad to remove plaque. The easiest way to do this is to sit down, place the child’s head in your lap or lay the child on a dressing table or the floor. Whatever position you use, be sure you can see into the child’s mouth easily.
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Teething, the process of baby (primary) teeth coming through the gums into the mouth, is variable among individual babies. Some babies get their teeth early and some get them late. In general the first baby teeth are usually the lower front (anterior) teeth and usually begin erupting between the age of 6-8 months. See "Eruption of Your Child’s Teeth" for more details.
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Children’s teeth begin forming before birth. As early as 4 months, the first primary (or 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.

The single most important factor in cavity prevention is daily exposure of the teeth to small quantities of fluoride.

Following are some basic facts about fluoride:

• Fluoride is good for the dental health of young and old alike. Once considered primarily a children's health issue, preventing cavities is now everyone's concern, because adults are living longer and keeping their teeth for a lifetime.

• Fluoride is stored in the mouth and is released when the teeth are "attacked" by plaque-generated acid. Plaque acid can cause demineralization, the loss of minerals from tooth enamel, and eventually lead to cavity formation. Fluoride working with saliva enhances remineralization, a process which rebuilds and reinforces tooth enamel.

• Fluoride is safe and present to some degree in all natural water. Water fluoridation is the process of adjusting the fluoride in drinking water to a therapeutic level to fight tooth decay.

• Fluoridated drinking water helps strengthen teeth in the formative stages by making the enamel more resistant to decay. After the teeth have developed, it also acts topically to help keep them cavity-free.

• If your home drinking water is not fluoridated, your child may benefit from the use of dietary fluoride supplements. Your dentist or pediatrician will determine whether to prescribe dietary fluoride supplements based on the child's age as well as the level of fluoride in your child's primary source of drinking water.

• Because many communities are adjusting the level of fluoride in the water supply, it is important to consult your dentist or pediatrician regarding the right balance of fluoride supplementation that your children may need to maintain good dental health.

• Fluoride toothpastes are recommended for people of all ages, whether the areas in which they live have fluoridated or fluoride-deficient drinking water.

• The best times to brush teeth are after breakfast and at bedtime. These times are followed by periods of low salivary flow and reduced "activity" in the mouth, allowing for improved fluoride retention. To ensure that you use an effective fluoride toothpaste, select one of the many brands bearing the seal of the American Dental Association.

• Even if you and your family drink fluoridated water and use fluoride toothpastes, topical fluoride solutions applied in our office or fluoride mouth rinses or gels used at home are often recommended for added cavity protection.

• Parents should make sure that their children do not swallow fluoridated dental products such as toothpastes and mouth rinses. Children should always use a child's size toothbrush with just a dab of toothpaste for each brushing. In addition, pre-schoolers should not use fluoride mouth rinses.

• drinking fluoridated water daily

• using a fluoride toothpaste approved by the American Dental Association

• brushing teeth at least twice daily: after breakfast and before bed

In addition, our office may recommend one or more of the following:

• dietary fluoride supplements for your children if their primary source of drinking water is fluoride-deficient

• a fluoride mouth rinse or gel used at home after the age of five

• topical fluoride solutions applied to teeth in our office

This information is based upon the referenced material in the scientific monograph entitled "Fluoride: An Update for the Year 2000, " produced by the Center for Dental Information, a national, independent, non-profit organization which disseminates information about developments in dental science. Support for the Center is provided by an educational grant from Mars, Incorporated.
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Tooth brushing is one of the most important tasks for good oral health. Many toothpastes, and/or tooth polishes, however, can damage young smiles. They contain harsh abrasives which can wear away young tooth enamel. When looking for a toothpaste for your child make sure to pick one that is recommended by the American Dental Association. These toothpastes have undergone testing to insure they are safe to use.

Remember, children should spit out toothpaste after brushing to avoid getting too much fluoride. If too much fluoride is ingested, a condition known as fluorosis can occur. If your child is too young or unable to spit out toothpaste, consider providing them with a fluoride free toothpaste, using no toothpaste, or using only a "pea size" amount of toothpaste.
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Parents are often concerned about the nocturnal grinding of teeth (bruxism). Often, the first indication is the noise created by the child grinding on their teeth during sleep. Or, the parent may notice wear (teeth getting shorter) to the dentition. One theory as to the cause involves a psychological component. Stress due to a new environment, divorce, changes at school; etc. can influence a child to grind their teeth. Another theory relates to pressure in the inner ear at night. If there are pressure changes (like in an airplane during take-off and landing when people are chewing gum, etc. to equalize pressure) the child will grind by moving his jaw to relieve this pressure.

The majority of cases of pediatric bruxism do not require any treatment. If excessive wear of the teeth (attrition) is present, then a mouth guard (night guard) may be indicated. The negatives to a mouth guard are the possibility of choking if the appliance becomes dislodged during sleep and it may interfere with growth of the jaws. The positive is obvious by preventing wear to the primary dentition.

The good news is most children outgrow bruxism. The grinding gets less between the ages 6-9 and children tend to stop grinding between ages 9-12. If you suspect bruxism, discuss this with your pediatrician or pediatric dentist.
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Sucking is a natural reflex and infants and young children may use thumbs, fingers, pacifiers and other objects on which to suck. It may make them feel secure and happy or provide a sense of security at difficult periods. Since thumb sucking is relaxing, it may induce sleep.

Thumb sucking that persists beyond the eruption of the permanent teeth can cause problems with the proper growth of the mouth and tooth alignment. How intensely a child sucks on fingers or thumbs will determine whether or not dental problems may result. Children who rest their thumbs passively in their mouths are less likely to have difficulty than those who vigorously suck their thumbs.

Children should cease thumb sucking by the time their permanent front teeth are ready to erupt. Usually, children stop between the ages of two and four. Peer pressure causes many school-aged children to stop.

Pacifiers are no substitute for thumb sucking. They can affect the teeth essentially the same way as sucking fingers and thumbs. However, use of the pacifier can be controlled and modified more easily than the thumb or finger habit. If you have concerns about thumb sucking or use of a pacifier, consult your pediatric dentist.

A few suggestions to help your child get through thumb sucking:

• Instead of scolding children for thumb sucking, praise them when they are not.

• Children often suck their thumbs when feeling insecure. Focus on correcting the cause of anxiety, instead of the thumb sucking.

• Children who are sucking for comfort will feel less of a need when their parents provide comfort.

• Reward children when they refrain from sucking during difficult periods, such as when being separated from their parents.

• Your pediatric dentist can encourage children to stop sucking and explain what could happen if they continue.

• If these approaches don’t work, remind the children of their habit by bandaging the thumb or putting a sock on the hand at night. Your pediatric dentist may recommend the use of a mouth appliance.
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There are many risks involved with oral piercings including chipped or cracked teeth, blood clots, or blood poisoning. Your mouth contains millions of bacteria, and infection is a common complication of oral piercing. Your tongue could swell large enough to close off your airway!

Common symptoms after piercing include pain, swelling, infection, an increased flow of saliva and injuries to gum tissue. Difficult-to-control bleeding or nerve damage can result if a blood vessel or nerve bundle is in the path of the needle.

So follow the advice of the American Dental Association and give your mouth a break – skip the mouth jewelry.
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Tobacco in any form can jeopardize your child’s health and cause incurable damage. Teach your child about the dangers of tobacco.

Smokeless tobacco, also called spit, chew or snuff, is often used by teens who believe that it is a safe alternative to smoking cigarettes. This is an unfortunate misconception. Studies show that spit tobacco may be more addictive than smoking cigarettes and may be more difficult to quit. Teens who use it may be interested to know that one can of snuff per day delivers as much nicotine as 60 cigarettes. In as little as three to four months, smokeless tobacco use can cause periodontal disease and produce pre-cancerous lesions called leukoplakias.

If your child is a tobacco user you should watch for the following that could be early signs of oral cancer:

• A sore that won’t heal

• White or red leathery patches on your lips, and on or under your tongue

• Pain, tenderness or numbness anywhere in the mouth or lips

• Difficulty chewing, swallowing, speaking or moving your jaw or tongue; or a change in the way your teeth fit together

Because the early signs of oral cancer usually are not painful, people often ignore them. If it’s not caught in the early stages, oral cancer can require extensive, sometimes disfiguring, surgery. Even worse, it can kill.

Help your child avoid tobacco in any form. By doing so, they will avoid bringing cancer-causing chemicals in direct contact with their tongue, gums and cheek.
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Developing malocclusions, or bad bites, can be recognized as early as 2-3 years of age. Often, early steps can be taken to reduce the need for major orthodontic treatment at a later age.

Stage I – Early Treatment: This period of treatment encompasses ages 2 to 6 years. At this young age, we are concerned with underdeveloped dental arches, the premature loss of primary teeth, and harmful habits such as finger or thumb sucking. Treatment initiated in this stage of development is often very successful and many times, though not always, can eliminate the need for future orthodontic/orthopedic treatment.

Stage II – Mixed Dentition: This period covers the ages of 6 to 12 years, with the eruption of the permanent incisor (front) teeth and 6 year molars. Treatment concerns deal with jaw malrelationships and dental realignment problems. This is an excellent stage to start treatment, when indicated, as your child’s hard and soft tissues are usually very responsive to orthodontic or orthopedic forces.

Stage III – Adolescent Dentition: This stage deals with the permanent teeth and the development of the final bite relationship.
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When a child begins to participate in recreational activities and organized sports, injuries can occur. A properly fitted mouth guard, or mouth protector, is an important piece of athletic gear that can help protect your child’s smile, and should be used during any activity that could result in a blow to the face or mouth.

Mouth guards help prevent broken teeth, and injuries to the lips, tongue, face or jaw. A properly fitted mouth guard will stay in place while your child is wearing it, making it easy for them to talk and breathe.

Ask your pediatric dentist about custom and store-bought mouth protectors.
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The safety and health of our patients is our main concern. This office was designed and built using the latest technology in all areas of sterilization.

ALL of our dental units are equipped with a self-contained water system from the manufacturer. We use pure distilled water, which is filled daily and all of our waterlines are drained at the end of the day.  We do not use municipal water which may contain bacteria and we do not allow water to remain in any of our waterlines when the units are not in use. Furthermore, on a periodic basis all waterlines are disinfected using recommended disinfection solutions.

ALL of our dental units are also equipped with anti-retraction valves which do allow any water to retract into the dental units, thereby never allowing for cross-contamination between our patients.

Of course, ALL of our instruments are sterilized and we use the latest technology to abide, and in some cases go beyond, the recommendations for infection control from the CDC and the American Dental Association.

Dr. Ramos, Dr. Russo, Dr. Siegel and our entire staff are very happy to explain and demonstrate all of the safety measures our office employs to ensure the safety of your child. Please feel free to ask us.
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