Pediatric Dentistry

Pediatric Dentists like Dr. O’Brien and Dr. Huynh have an extra two years of specialized training after dental school and are 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. Dr. O’Brien and Dr. Huynh are Renton & Kent’s local Pediatric Dental Specialists.

Begin daily brushing of your child’s teeth as soon as the child’s first tooth erupts (comes in). 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. Dr. O’Brien and Dr. Huynh and their team 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 should 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.

Dr. O’Brien and Dr. Huynh and their team will show your child the proper way to brush and floss and coach them at visits to their office.

Healthy eating habits lead to healthy teeth. Like the rest of the body, the teeth, bones and the soft tissues of the mouth need a well-balanced diet. Children should eat a variety of foods from the five major food groups. Most snacks that children eat can lead to cavity formation. The more frequently a child snacks, the greater the chance for tooth decay. How long food remains in the mouth also plays a role. For example, hard candy and breath mints stay in the mouth a long time, which cause longer acid attacks on tooth enamel. If your child must snack, choose nutritious foods such as vegetables, low-fat yogurt, and low-fat cheese which are healthier and better for children’s teeth.

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.

For older children, brush their teeth at least twice a day. Also, watch the number of snacks containing sugar that you give your children.

The American Academy of Pediatric Dentistry recommends twice yearly visits to the pediatric dentist beginning at your child’s second birthday. Routine visits to O’Brien Children’s Dentistry & Orthodontics will start your child on a lifetime of good dental health.

Dr. O’Brien or Dr. Huynh may also recommend protective sealants or home fluoride treatments for your child. Sealants can be applied to your child’s molars to prevent decay on hard to clean surfaces.

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. If your child won’t fall asleep without the bottle and its usual beverage, gradually dilute the bottle’s contents with water over a period of two to three weeks.

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.

Dr. O’Brien and Dr. Huynh each specialize in treating infant’s teeth problems like Baby Bottle Tooth Decay.

A child’s first set of teeth, called baby or primary teeth, serve several important functions in the developing child. Healthy baby teeth are important for speech development, aesthetics and the development of the child’s self image. They permit the child to maintain good nutrition as the teeth are essential to proper chewing. Baby teeth also guide the eruption and position of permanent teeth which in turn affects the growth and development of the entire lower face. This makes the prevention of dental decay in young children our primary concern.

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.

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.

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 28 permanent teeth, or up to 32 including the third molars (or wisdom teeth).

Dr. O’Brien and Dr. Huynh will closely monitor your child’s teeth eruptions during your child]s six month dental checkups.

If your child is having a dental emergency, call our office at 425-255-6008. If it is after office hours, please listen to our message for instructions.

Types of emergencies and what you can do before seeing Dr. O’Brien or Dr. Huynh include:

Toothache: Clean the area of the affected tooth thoroughly. Rinse the mouth vigorously with warm water or use dental floss to dislodge impacted food or debris. If the pain still exists, contact your child’s dentist. DO NOT place aspirin on the gum or on the aching tooth. If the face is swollen apply cold compresses and contact your dentist immediately.

Cut or Bitten Tongue, Lip or Cheek: Apply ice to bruised areas. If there is bleeding apply firm but gentle pressure with a gauze or cloth. If bleeding does not stop after 15 minutes or it cannot be controlled by simple pressure, take the child to hospital emergency room.

Knocked Out Permanent Tooth: Find the tooth. Handle the tooth by the crown, not the root portion. You may rinse the tooth but DO NOT clean or handle the tooth unnecessarily. Inspect the tooth for fractures. If it is sound, try to reinsert it in the socket. Have the patient hold the tooth in place by biting on a gauze. If you cannot reinsert the tooth, transport the tooth in a cup containing the patient’s saliva or milk. If the patient is old enough, the tooth may also be carried in the patient’s mouth. The patient must see Dr. O’Brien or Dr. Huynh IMMEDIATELY! Time is a critical factor in saving the tooth.

It is not recommended to reinsert a primary (baby) tooth.

This would be a child age five or below.

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 age of four years. Usually, children stop between the ages of two and four, with positive encouragement by parents. Peer pressure can also help many young 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 Dr. O’Brien and Dr. Huynh.

Dr. O’Brien and Dr. Huynh recommend several techniques for your child to quit 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 or distraction. Reward children when they refrain from sucking during common periods, such as bedtime.

Dr. O’Brien and Dr. Huynh can encourage your child to stop sucking and explain what could happen if they continue. If these approaches don’t work, remind your child of their habit by bandaging the thumb or putting a sock on their hand at night. After other approaches have been tried, Dr. O’Brien or Dr. Huynh may recommend the use of a mouth appliance.

A couple books Dr. O’Brien and Dr. Huynh recommend for parents are:

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Harold’s Hideaway Thumb
by Harriet Sonnenschein
Jurg Obnzt (Illustrator), Jurg Obrist (Illustrator)

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David Decides About Thumbsucking: A Story for Children, a Guide for Parents 3rd Edition
by Susan P H. D. Heitler (Author), Susan M. Heitler (Author)

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. Dr. O’Brien and Dr. Huynh will monitor your child’s teeth and recommend orthodontic treatment when it is appropriate.

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.

Care of the Mouth after Local Anesthetic

Your child has had local anesthetic for their dental procedure:

• If the procedure was in the lower jaw… the tongue, teeth, lip and surrounding tissue will be numb or asleep.
• If the procedure was in the upper jaw… the teeth, lip and surrounding tissue will be numb or asleep.

Often, children do not understand the effects of local anesthesia, and may chew, scratch, suck, or play with the

numb lip, tongue, or cheek. These actions can cause minor irritations or they can be severe enough to cause swelling and abrasions to the tissue. Please monitor your child closely for approximately two hours following the appointment. It is often wise to keep your child on a liquid or soft diet until the anesthetic has worn off.

Please do not hesitate to call the office if there are any questions.

Care of the Mouth after Injury to the Mouth

Please keep the traumatized area as-clean-as possible. A soft wash cloth often works well during healing to aid the process.

Watch for darkening of traumatized teeth. This could be an indication of a dying nerve (pulp).

If the swelling should re-occur, our office needs to see the patient as-soon-as possible. Ice should be administered during the first 24 hours to keep the swelling to a minimum.

Watch for infection (gum boils) in the area of trauma. If infection is noticed – call the office so the patient can be seen as-soon-as possible.

Maintain a soft diet for two to three days, or until the child feels comfortable eating normally again.

Avoid sweets or foods that are extremely hot or cold.

If antibiotics or pain medicines are prescribed, be sure to follow the prescription as directed.

Please do not hesitate to call the office if there are any questions

Care of the Mouth after Extractions

Do not scratch , chew, suck, or rub the lips, tongue, or cheek while they feel numb or asleep. The child should be watched closely so he/she does not injure his/her lip, tongue, or cheek before the anesthesia wears off.

Do not rinse the mouth for several hours.

Do not spit excessively.

Do not drink a carbonated beverage (Coke, Sprite, etc.) for the remainder of the day.

Do not drink through a straw.

Keep fingers and tongue away from the extraction area.

Bleeding – Some bleeding is to be expected. If unusual or sustained bleeding occurs, place cotton gauze firmly over the extraction area and bite down or hold in place for fifteen minutes. This can also be accomplished with a tea bag. Repeat if necessary.

Maintain a soft diet for a day or two, or until the child feels comfortable eating normally again.

Avoid strenuous exercise or physical activity for several hours after the extraction.

Pain – For discomfort use Children’s Tylenol, Advil, or Motrin as directed for the age of the child. If a medicine was prescribed, then follow the directions on the bottle.

Please do not hesitate to contact the office if there are any questions.

Care of Sealants

By forming a thin covering over the pits and fissures, sealants keep out plaque and food, thus decreasing the risk of decay. Since, the covering is only over the biting surface of the tooth, areas on the side and between teeth cannot be coated with the sealant. Good oral hygiene and nutrition are still very important in preventing decay next to these sealants or in areas unable to be covered.

Your child should refrain from eating ice or hard candy, which tend to fracture the sealant. Regular dental appointments are recommended in order for your child’s dentist to be certain the sealants remain in place.

The American Dental Association recognizes that sealants can play an important role in the prevention of tooth decay. When properly applied and maintained, they can successfully protect the chewing surfaces of your child’s teeth. A total prevention program includes regular visits to the dentist, the use of fluoride, daily brushing and flossing, and limiting the number of times sugar-rich foods are eaten. If these measures are followed and sealants are used on the child’s teeth, the risk of decay can be reduced or may even be eliminated!