Q&A Topics: Children’s Teeth and Concerns about Cavities, Fluoride and Injuries

with Dr. Katie Matthews, DMD, of Matthews Dental Associates

Q: When should I first bring my child to the dentist?A: I like to see children by their first birthday to establish a dental home. Think of it like a well-child visit with the pediatrician. The concept of a dental home is promoted by the American Association of Pediatric Dentistry (AAPD) and states that children who have a dental home are more likely to receive appropriate preventive and routine oral health care.

At this first visit, your child will receive an examination (usually on the parent or caregiver’s lap), a dental cleaning, and topical fluoride varnish is applied to the erupted teeth. We discuss the appropriate timing for discontinuing the bottle and pacifier, brushing your child’s teeth, and using fluoride. If there are any areas of concern, they can be addressed and treated early. After the first visit, most children are seen every six months for routine check-ups, cleanings, and fluoride treatments.
Q: My child was diagnosed with cavities in his baby teeth. Why do we need to treat them?A: Tooth decay is the single most common chronic childhood disease—five times more common than asthma, four times more common than early childhood obesity, and 20 times more common than diabetes. Left untreated, cavities in baby teeth can lead to discomfort, infection, hospitalizations, and problems with the developing permanent teeth. It is always best to treat cavities when they are small, before discomfort develops. If a baby tooth becomes infected (abscessed), it needs to be removed to protect the overall health of the child.

Cavities are transmissible and infectious. Start brushing your child’s teeth as soon as they erupt, take your child to a pediatric dentist by their first birthday, discontinue bottle feeding by age one, and never put your child to sleep with milk or juice. Continue to help your child brush and floss as they get older and see your pediatric dentist every six months.
Q: I’m concerned about using fluoride with my young children. What do you recommend?A: Start using toothpaste with fluoride as soon as you see that first little tooth erupt! The AAPD recommends a “smear” or “rice size” amount for children under three and a “pea size” for kids ages three to six. Introduce an over-the-counter fluoride rinse when your child is able to swish and spit. If you have a well or a community water system that is not fluoridated, discuss the use of supplemental fluoride with your pediatric dentist and pediatrician. See your pediatric dentist every six months for professionally applied topical fluoride treatments. Studies support that drinking fluoridated water and using toothpaste with fluoride are perhaps the most effective method in reducing and preventing cavities in children.
Q: What should I do if an injury knocks out my child’s tooth?A: If there are any other injuries or if your child loses consciousness, seek immediate medical attention. If there are no other injuries, try to calm your child and find the tooth for inspection. If bleeding cannot be controlled with pressure, seek medical attention; if you cannot find the tooth, it may actually be intruded into the gums. Call your pediatric dentist—your child will need a radiograph to confirm whether or not it was fully avulsed (knocked-out) or intruded into the gums. If you only find part of a tooth, the root may still be in the gums.

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Is it a baby tooth? Baby teeth are not replanted if they are avulsed. For avulsed permanent teeth, timing is critical! Immediate replantation is the best treatment. Call your pediatric dentist so they can meet you in the office or emergency room for treatment. Handle the tooth by the white crown, try not to touch the root. If the tooth is dirty, rinse very briefly (less than ten seconds) under cold water, and put the tooth back into the socket. Have your child bite on a towel to keep it in position. Meet your dentist for further treatment as soon as possible. If you are not able to replant the tooth immediately, place the tooth in milk or saliva— avoid water.
Q: My child was referred to a pediatric dentist for treatment. Why does she need to see a pediatric dentist?A: Many family and general dentists are very comfortable and successful treating children. A pediatric dentist completes a two- or three-year residency after dental school, specializing in the treatment of infants, children, adolescents, medically compromised children, and those with special needs. Particular emphasis is placed on not only the special care these patients require, but also on psychology, behavior guidance, sedation, and hospital dentistry. A nurturing, child-friendly environment can put both the child and parent at ease and lead to positive dental experiences. Many young children with cavities or infection can be treated in the office, while others may need to be sedated or treated in the hospital setting. A pediatric dentist can help guide your decision-making process to find the best fit for your family.
Dr. Katie Matthews received her DMD from Temple University School of Dentistry. She then completed a Residency Program in Pediatric Dentistry at Temple University, spending her final year as a Chief Resident of the Pediatric Dentistry program. Dr. Matthews has lectured on various topics, including the dental treatment of children with and without special needs. Dr. Matthews participates in, and lectures annually at, the Delaware State Dental Society’s Give Kids a Smile program. She has served as the Head Start Dental Home Initiative State Team Leader (DE).
Matthews Dental Associates
451 Hockessin Corner
Hockessin, DE 19707

Dr. Katie Matthews, DMD, of Matthews Dental Associates

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