FAQ

When I started my social media platform in 2021, I had no idea just how great the need is for pediatric dentists in our country. I soon learned through thousands of messages and comments that many people lack access to a residency trained pediatric dentist in their area and often they don't even have a dentist in town willing to see children under age three (sometimes five!)

Over the next year I worked to create a course for those in need, called “Tantrum-Free Toothbrushing, Cavity Free Without the Tears”. It's for the families who want to learn how to take care of their child's mouth and do their very best at home until they're able to find a dentist who will see their child. I have it set at a minimum “pay-what-you-can” price to keep it permanently hosted on the website so that it's accessible to everyone. You can find it here and keep them cavity-free starting today!

The American Academy of Pediatric Dentistry (AAPD) recommends that a child establish a dental home within six months of his or her first tooth coming in or by the first birthday, whichever comes first. 

If you’re a parent, fellow dentist, or any other primary care provider and this sounds too young, please read more here about the basis for this recommendation. 

If you’re reading this and your child is over age one and hasn’t seen the dentist yet, or you’re a family medicine doctor who’s been telling parents to wait until the child is three years old being seeing the dentist, it’s okay! You’re here now and this is a safe place to ask questions and learn. Welcome!  Now spread the word to your friends and colleagues that the recommended age for the first dental visit one year.

Children generally follow a recall schedule similar to adults and are seen every six months. Baby teeth, however, have thinner enamel than adult teeth, which means cavities can progress more rapidly if left undiagnosed and untreated. If your child is at high risk for cavities,  your dentist may recommend that he or she be seen more often for check-ups and potentially for extra cleanings and topical fluoride applications. Your dentist may also recommend more frequent cleanings (e.g., every three months) if your child is in an orthodontic appliance such as braces because appliances also increase a child’s risk for plaque buildup and cavity development.

Both the American Academy of Pediatric Dentistry (AAPD) and the American Board of Pediatric Dentistry (ABPD) provide pages to help you locate one of their members in your area. 

Ask friends and community members as well, and then check out this post to learn more about what to look for on an office website or bio. 

Your goal is to help the child gain enough familiarity with a dental appointment to feel comfortable. If your dental office provides a YouTube video with a walk-through example of a dental visit, all the better. You could also watch a show (Daniel Tiger, Doc McStuffins, and Berenstain Bears all have dentistry-related episodes) or read a book beforehand about what to expect at the dentist. 

On the day of the appointment, be honest about where you’re going and don’t surprise the child. Limit the details you share and let the team and dentist explain what will happen and guide the child through the visit. Minimize your anxiety as much as possible. Parental anxiety as it relates to dentistry greatly influences the child’s perception of the dental appointment. 

It will help if you set realistic expectations and use positive guidance for the child about behavior before you arrive, e.g., “At the dentist, the hygienist will brush your teeth with a special toothbrush to clean them. It tickles! Then you will lay in mommy’s lap and let the dentist count your teeth.” Compare that to, “You will sit still, and you will not cry; otherwise, the dentist will give you a shot or pull out your tooth.” I cannot tell you how many times I’ve heard that final sentence uttered in the waiting room! You can guess how those visits went.

Many young children cry as a means of coping with stress in a new situation, so it is perfectly normal for a young child to express herself in this way during her first few visits to the dentist. Please don’t be embarrassed. Your child is not misbehaving; she’s just learning to cope with a new and unfamiliar experience. You and the dental team will be there to support her throughout the entire visit, and she will emerge proud of her ability to visit the dentist successfully. 

I have one final suggestion. It’s also a great idea to establish a reward before you arrive that the child will receive for completing the dental visit. It can be as simple as letting him know that he’ll receive a goody bag with a new toothbrush at the end of the appointment.

I’ll answer this for infants as that is the most frequent age group friends ask about regarding this question. As soon as the first tooth appears, it’s time to use a toothbrush. But how? Where? They’re so wiggly! I brushed my littles’ teeth on the changing table in the morning and in the bathtub at night. A high chair is also a great place once they’re sitting up. 

Brush twice daily with a grain-of-rice-sized amount of fluoridated toothpaste on a soft-bristled toothbrush with a small, preferably chewable/coated head. The two-minute rule is for a mouth full of teeth (20 baby teeth, 28ish adult teeth), so don’t feel like you have to brush those four new little teeth for two minutes. Just clean every surface (biting surface, tongue/palate side, cheek/lip side) from tip to the gumline. 

If any teeth are touching side by side, begin to introduce floss as well. A U-shaped toothpick flosser is excellent for reaching those tiny spaces. Mouthwash is not indicated until the child is about six years old and able to spit consistently. Avoid rinsing with water after brushing (this goes for you, too, grown-up)! Dentists recommend tiny amounts of toothpaste because we assume that the child will swallow most of it. Rinsing after brushing would wash off the fluoride, and we want to leave it on the teeth to work its cavity-fighting magic, especially overnight. Once the child turns two, you can increase the toothpaste amount to a green pea-size. For more information and tips about brushing for all ages, see here.

If a child can tolerate the vibration of an electric toothbrush and does not chew on the brush head, an electric toothbrush can be a great addition to the oral hygiene routine. The built-in timers help insure sufficient brush time to remove plaque from all tooth surfaces, and many of the brushes boast fun characters, lights, and tunes to make brushing more appealing. My kids were about two and a half years old when they could tolerate the “buzzy” toothbrush. My middle child was a bit more hesitant about it in general, so we used the electric toothbrush like a manual brush sans the “buzzy” for a solid six months before she decided she was ready to turn it on. 

Just because an electric toothbrush can be helpful, however, doesn’t mean that you must purchase one. Studies show that both manual toothbrushes and electric toothbrushes, when used correctly, are equally effective at cleaning the teeth. As long as you’re brushing all of the surfaces (biting, tongue/palate, and cheek/lip) from tip to gumline for two minutes (or as long as is necessary to clean every surface of every tooth in your child’s mouth), then you’re succeeding at brushing. When it comes to electric toothbrushes, do what works best for your budget and your child.

Children require assistance with bruising until about the age of seven. Years. I often tell my patients’ parents, half-joking, that until you can trust them to wash the fine china unsupervised, don’t trust them to brush their teeth unsupervised. An electric toothbrush is no substitute for a parent who checks that the child thoroughly cleaned all areas. I encourage parents to complete a final once-over with the brush after the child finishes until he demonstrates the ability to clean his teeth well on his own consistently. 

If parental assistance proves too difficult schedule-wise in the morning, at least ensure before bedtime that all surfaces of the teeth are clean by giving them a good “check” (and by check, I mean an adult completes a final, often abbreviated, brushing).

My three-year-old wants to do everything by herself, so if you’re receiving some push-back for the follow-up check, I empathize. “A” put up quite the fuss for a while about me brushing her teeth again after she’d finished, but I explained to her that grown-ups see sugar bugs better than kids, and it’s my job to make sure her teeth are squeaky clean. Eventually, she complied without complaint for the brush check, and it’s now an accepted part of the whole toothbrushing routine.

Many children go through phases of grinding their teeth, and it is generally no cause for concern. Although grinding can be associated with airway issues such as large tonsils, sleep apnea, and asthma, that is not typically the case. In my practice, I have found that children often grind during times of change to their bite, such as with the eruption of new teeth or after a recent growth spurt. Anxiety can also play a role in a child’s grinding intensity and frequency.

A dentist may grow concerned about grinding once permanent teeth enter the mouth if they begin to exhibit signs of wear. Additionally, if a child has an underlying condition such as acid reflux (GERD), even minor and infrequent grinding could result in significant wear to the teeth. GERD (what children often describe as “hot burps”) can be addressed with the child’s primary care provider to help minimize the impact of an accompanying grinding habit.

Generally, if a child stops a non-nutritive sucking habit (pacifier, thumb, lovey, etc.) by age three, the changes to the tooth positions are more likely to correct on their own as the child grows. The further beyond age three that the habit persists, and the closer to the time the permanent teeth enter the picture, the more likely permanent orthodontic problems will remain and require intervention to correct them. Examples of lingering orthodontic problems from a non-nutritive sucking habit include crowding, open bite, and crossbite. 

Studies demonstrate that a pacifier is protective against SIDS when used in the first year of life, so don’t be in a hurry to give that pacifier up until at least age one. Beyond age one, studies show that children who use a pacifier experience more frequent ear infections, so clean them regularly. If your child begins to suffer from repeat ear infections, consider cessation interventions to help break the habit. If you’re looking for tips and suggestions to help your child stop a non-nutritive sucking habit, you can check out this post.

If your child has established a dental home (see above about the importance of establishing a dental home by age one year), then contact your child’s dentist before you rush to urgent care, even if it’s after regular business hours. Exception being when other bodily systems are involved in the trauma; examples include but are not limited to: the child lost consciousness, vomited, broke a limb, or requires stitches. 

You can still call your dentist and let him or her know that the mouth was involved in an injury, especially if the injury involves a permanent tooth. Dentists have procedures in place for patients of record who experience a dental emergency after hours, and you should be able to reach someone from the office regardless of the hour of the day or night.

Generally, an abscess is not an emergency. Cavities are part of the chronic disease process of tooth decay, which means it takes many weeks to months before the infection impacts the tooth’s nerve. At such a time, the tooth may or may not become painful (most pediatric dental abscesses are not painful), the nerve may die, and the tooth may form an abscess. In the case of primary teeth, the infection remains localized to the tooth the majority of the time. The treatment of choice for an abscessed tooth is to remove it. The dentist can do this at the next available appointment during regular business hours.

A painless, uncomplicated abscess, whether bubble-like and filled with pus or flat with a draining fistula, does not require an antibiotic prescription. An antibiotic would do nothing for an uncomplicated abscess because the infection remains localized to the tooth and is not spreading systemically. An antibiotic could not reach the source of the infection (the bacteria inside the tooth) through the pulp (the blood supply of the tooth) because the tooth is no longer alive. Taking an antibiotic in this situation could contribute to the development of antibiotic-resistant bacteria and diminish healthy gut flora.

Signs of systemic infection associated with an infected (and not necessarily abscessed) tooth, such as fever, facial swelling, or swelling inside the mouth or throat, indicate that a dental abscess qualifies as an emergency, and you should contact your dentist immediately. These cases often require systemic IV antibiotics and could require extraction of the tooth on an emergency basis, which for young children may necessitate seeing an oral surgery specialist and the use of sedation. If you suspect your child has a dental abscess that fits the emergent description, call your dental provider immediately. He or she will instruct you on the next steps unique to your location and situation. Check out this post for more information.

Yes. I believe the benefit of routine dental radiographs (x-rays) for children outweighs the risk associated with the small amount of ionizing radiation required to generate them. Dentists follow the ALARA principle regarding radiation exposure, which means they keep it “as low as reasonably achievable.” X-rays should always be ordered thoughtfully and based on a patient’s individual needs, and only if they provide valuable information necessary for proper diagnosis and treatment planning. Dentists treating children take additional precautions to decrease their radiation exposure, such as reducing the dose at the machine, taking digital x-rays, and using protective barriers like shields and lead plating. In the case of most children, routine dental x-rays fully align with the ALARA principle. 

Routine x-rays are essential for children because the enamel of baby teeth is thinner than that of adults, which means that a cavity can progress into the deeper part of a tooth much more quickly than in an adult. This potential for rapid progression is why the AAPD recommends that dentists prescribe dental x-rays at 6-12 month intervals for children at high risk for cavities and no greater than a 24-month interval for a child at low risk for cavities. 

For a more in-depth discussion of dental x-rays and radiation exposure, see this post. I also like this chart, which illustrates common ionizing radiation sources and their dose impact. It shows that the amount of ionizing radiation your child receives from his yearly bitewing x-rays is equivalent to the amount of radiation he receives from sunlight on any given day.

Like all chronic diseases, multiple factors contribute to the risk for and severity of tooth decay. These factors include diet, snacking frequency, topical fluoride exposure, hygiene practices, genetics, and caregiver disease experience. I discuss these factors in greater detail in this post, but suffice it to say that very few people and children, including my own children and me, are actually at low risk for cavities. Most of us are at moderate to high risk for cavities based on our dietary habits and hygiene practices alone.

It depends on his risk for cavities, which your child's pediatric dentist can evaluate with you. Many children are at moderate to high risk for cavities based on their diet and hygiene practices. Frequent low-dose topical fluoride exposure (such as from fluoridated water or toothpaste) reduces cavities. You read that right in the last sentence, the anti-cavity benefits of drinking fluoridated water primarily come from the topical fluoride effect rather than systemic because the dose in drinking water is so low. Higher-dose topical fluoride applied after routine dental visits also helps reduce cavities in children who are at higher risk for forming them. Low-level systemic fluoride exposure (such as from prescription supplements and to a lesser degree, fluoridated water) is most beneficial for young children at high risk for cavities whose permanent teeth are still forming. Incorporating fluoride into the enamel of the developing permanent teeth makes them more resistant to cavities life-long.

Many people in the U.S., even those who remove fluoride in their drinking water via reverse osmosis filtration systems, still receive some fluoride exposure via the “halo effect.” The halo effect occurs when beverages and foods are prepared in other communities that use fluoridated water, and then members of non-fluoridated households or communities consume them. Due to this halo effect, systemic fluoride supplementation is often limited to children at high risk for cavities and whose direct (e.g., well water) and indirect (e.g., city water at school) fluoride sources are infrequent and minimal. Today, many adults continue to benefit from their childhood exposure to fluoridated drinking water, which strengthened the enamel of their permanent teeth as they were forming and left them more resistant to future cavity formation.

Silver diamine fluoride (SDF) is not the same treatment as the topical fluoride varnish that your child receives at his or her routine checkups. Both types of fluoride are painted on the teeth, but silver diamine fluoride is a liquid, whereas fluoride varnish is a sticky substance. The most notable distinction between the two is SDF’s impact on a tooth’s color. 

SDF application results in a permanent color change to black in the areas where cavities exist. In contrast, fluoride varnish only temporarily changes the appearance of the teeth to whitish-yellow until the product washes away via saliva or brushing. The dentist can sometimes improve the dark coloring caused by SDF by covering it with white filling material, but the child must tolerate treatment in the office for this to occur. Often, SDF is chosen as a treatment modality because the child cannot cooperate for treatment in the office.

Although both products contain fluoride, they work in different ways. Fluoride varnish contains fluoride ions that strengthen tooth enamel, making it harder for the acid products of bacteria to dissolve it. Fluoride ions also work to stop bacterial growth by inhibiting enzymes that the bacteria need for growth. The fluoride portion of SDF works similarly. What sets SDF apart as a non-invasive treatment for active cavities is the ability of its silver component to kill cavity-causing bacteria. SDF also inhibits collagen breakdown in the deeper portion of the tooth called dentin and results in a solid mineral-rich surface on the arrested (no longer growing) cavity.

Most states participate in the CDC's website, from which you can search fluoride levels in the water supply by state and your area of residence. 

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