• What is a Pediatric Dentist?
• Why are the Primary Teeth so Important?
• Eruption of Your Child's Teeth
• DENTAL EMERGENCIES
• Dental Radiographs (X-rays)
• What's the Best Toothpaste for my Child?
• Does Your Child Grind His Teeth at Night? (Bruxism)
• Thumb Sucking
• What is Pulp Therapy?
• What is the Best Time for Orthodontic Treatment?

• Perinatal & Infant Oral Health
• Your Child's First Dental Visit
• When Will My Baby Start Getting Teeth?
• Baby Bottle Tooth Decay (Early Childhood Caries)
• Sippy Cups

• Care of Your Child's Teeth
• Good Diet = Healthy Teeth

• Oral Hygiene Concepts
• How Do I Prevent Cavities?
• Seal Out Decay
• Fluoride
• Mouth Guards
• Xylitol - Reducing Cavities

• Most Current Science Concerning Cavities
• If Your Child Has a High Caries Rate
• Treatment Options/Behavior Management

• Tongue Piercing - Is it Really Cool?
• Tobacco - Bad News in Any Form

For more information concerning pediatric dentistry, please visit the website for the American Academy of Pediatric Dentistry.

Other helpful websites:

• American Dental Association
• American Academy of Pediatrics
• American Board Pediatric Dentistry
• U.S. National Library of Medicine
• Creighton University Dental School
• Kansas Mission of Mercy
• Proctor and Gamble School Dental Programs

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General Topics

What Is A Pediatric Dentist?

Pediatric dentists have an extra two to three years of specialized training after dental school, and are dedicated to the oral health of infants, children, teens and special needs patients. The very young, pre-teens, and teenagers all need different approaches in guiding their dental growth and development, dealing with their behavior and helping them avoid future dental problems. The pediatric dentist is best qualified to meet these needs.

Why Are The Primary Teeth 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.

Eruption Of Your Child's Teeth

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).

Dental Emergencies

Toothache: Clean the area of the affected tooth. Rinse the mouth thoroughly with warm water or use dental floss to dislodge any food that may be impacted. If the pain still exists, contact your pediatric dentist. Do not place aspirin or heat on the gum or on the aching tooth. If the face is swollen, apply cold compresses and contact Dr. Kittle immediately.

Cut or Bitten Tongue, Lip or Cheek: Apply ice to injured areas to help control swelling. If there is bleeding, apply firm but gentle pressure with a gauze or cloth. If bleeding cannot be controlled by simple pressure, call our office, a physician or visit the hospital emergency room.

Knocked Out Permanent Tooth: If possible, find the tooth. Handle it by the crown, not by the root. You may rinse the tooth with water only. DO NOT clean with soap, scrub or handle the tooth unnecessarily. Inspect the tooth for fractures. If it is sound and your child will allow it, 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 (beside the cheek). The patient must see a dentist IMMEDIATELY! Time is a critical factor in saving the tooth. Call our office during or after business hours.

Knocked Out Baby Tooth: Contact Dr. Kittle during business or after hours. This may or may not be an emergency. In many cases no treatment may be necessary, however, it is better to have each individual circumstance evaluated.

Chipped or Fractured Permanent Tooth: Contact Dr. Kittle immediately. Quick action can save the tooth, prevent infection and reduce the need for extensive dental treatment. Rinse the mouth with water and apply cold compresses to reduce swelling. If possible, locate and save any broken tooth fragments and bring them with you to our office.

Chipped or Fractured Baby Tooth: Contact Dr. Kittle.

Severe Blow to the Head: Take your child to the nearest hospital emergency room immediately.

Possible Broken or Fractured Jaw: Keep the jaw from moving and take your child to the nearest hospital emergency room.

Dental Radiographs (X-Rays)

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.

Radiographs detect much more than cavities. For example, radiographs may be needed to monitor growth, survey erupting teeth, diagnose bone diseases, evaluate the results of an injury, or plan orthodontic treatment. Radiographs 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 frequency of x-rays is based on a child’s past dental history and susceptibility to cavities. The American Academy of Pediatric Dentistry recommends radiographs and examinations every six months for children with a high risk of tooth decay. Panorex x-rays are taken based on the need to monitor changes associated with growth and development.

We are particularly careful to minimize the exposure of our patients to radiation. With contemporary safeguards, the amount of radiation received in a dental X-ray examination is extremely small. The risk is negligible. In fact, the dental radiographs represent a far smaller risk than an undetected and untreated dental problem. Lead body aprons and shields will protect your child. All of our x-ray equipment is digital which filters out unnecessary x-rays and restricts the x-ray beam to the area of interest. Digital x-rays reduce radiation to only 1/5th that of the "old" conventional film x-rays.

What's The Best Toothpaste For My Child?

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 as shown on the box and tube. These toothpastes have undergone testing to insure they are safe to use. A toothpaste containing xylitol is especially beneficial.

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, use only a "pea size" amount of toothpaste.

Does Your Child Grind His Teeth At Night? (Bruxism)

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 the appliance becoming dislodged. The positive is obvious by preventing wear to the primary dentition.

The good news is most children outgrow bruxism. The grinding decreases 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.

Thumb Sucking/Digit Sucking/Pacifier Sucking

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 age of 3 or 4 can cause problems with the proper growth of the mouth and tooth alignment. The damage is based on how often, how long, and how hard the digit is sucked. 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 have completely ceased 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:

• Children often suck their thumbs when feeling insecure. Focus on correcting the cause of anxiety, instead of the thumb sucking.
• Reward children if they are old enough to understand when they refrain from sucking during difficult periods, such as when being separated from their parents.
• Dr. Kittle can encourage children to stop sucking and explain what could happen if they continue if you desire.
• 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. Dr. Kittle may recommend the use of a mouth appliance.
• Failure to stop thumb or pacifier habits can often result in the development of a crossbite or an openbite which will require future orthodontic treatment.

What Is Pulp Therapy?

The pulp of a tooth is the inner, central core of the tooth. The pulp contains nerves, blood vessels, connective tissue and reparative cells. The purpose of pulp therapy in Pediatric Dentistry is to maintain the vitality of the affected tooth (so the tooth is not lost). If pulp therapy cannot be performed and the tooth must be extracted, it is often necessary to place a spacer to hold the space for the developing permanent tooth.

Dental caries (cavities) and traumatic injury are the main reasons for a tooth to require pulp therapy. Pulp therapy is often referred to as a "nerve treatment", "children's root canal", "pulpectomy" or "pulpotomy". The two common forms of pulp therapy in children's teeth are the pulpotomy and pulpectomy.

A pulpotomy removes the diseased pulp tissue within the crown portion of the tooth. Next, an agent is placed to prevent bacterial growth and to calm the remaining nerve tissue. This is followed by a final restoration (usually a stainless steel crown).

A pulpectomy is required when the entire pulp is involved (into the root canal(s) of the tooth). During this treatment, the diseased pulp tissue is completely removed from both the crown and root. The canals are cleansed, disinfected and, in the case of primary teeth, filled with a resorbable material. Then, a final restoration is placed. A permanent tooth would be filled with a non-resorbing material.

What Is The Best Time For Orthodontic Treatment?

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, Dr. Kittle is 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. The most common appliance used in this age group is a palatal expander.

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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Early Infant Oral Care

Perinatal & Infant Oral Health

The American Academy of Pediatric Dentistry (AAPD) recommends that all pregnant women receive oral healthcare and counseling during pregnancy. Cavities are an INFECTIOUS DISEASE. Research has shown evidence that periodontal disease can increase the risk of preterm birth and low birth weight. Talk to your doctor or dentist about ways you can prevent periodontal disease during pregnancy.

Additionally, mothers with poor oral health are at a greater risk of passing the bacteria which causes cavities to their young children. Mother's should follow these simple steps to decrease the risk of spreading cavity-causing bacteria:

• Visit your dentist regularly.
• Brush and floss on a daily basis to reduce bacterial plaque.
• Proper diet, with the reduction of beverages and foods high in sugar & starch.
• Use a fluoridated toothpaste recommended by the ADA and rinse every night with an alocohol-free, over-the-counter mouth rinse with .05 % sodium fluoride in order to reduce plaque levels.
• Don't share utensils, cups or food which can cause the transmission of cavity-causing bacteria to your children.
• Use of xylitol chewing gum (4 pieces per day by the mother) can decrease a child’s caries rate.

Your Child's First Dental Visit-Establishing A "Dental Home"

The American Academy of Pediatric Dentistry (AAPD), The American Academy of Pediatrics (AAP), and the American Dental Association (ADA), all recommend establishing a "Dental Home" for your child by one year of age. Children who have a dental home are more likely to receive appropriate preventive and routine oral health care.

You can make the first visit to the dentist enjoyable and positive. If old enough, your child should be informed of the visit and told that the dentist and their staff will explain all procedures and answer any questions. The less to-do concerning the visit, the better. See our coloring book which is a wonderful way to introduce your child to their first visit. Coloring book for a girl | Coloring book for a boy

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.

When Will My Baby Start Getting Teeth?

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 to appear are usually the lower front (anterior) teeth and they usually begin erupting between the age of 6-8 months.
See "Eruption of Your Child’s Teeth" for more details.

Baby Bottle Tooth Decay (Early Childhood Caries)

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 (especially apple) 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.

Sippy Cups

Sippy cups should be used as a training tool from the bottle to a cup and should be discontinued by the first birthday. They should not be used as a substitute for a pacifier. If your child uses a sippy cup throughout the day, fill the sippy cup with water only (except at mealtimes). By filling the sippy cup with liquids that contain sugar (including milk, fruit juice, sports drinks, etc.) and allowing a child to drink from it throughout the day, it soaks the child’s teeth in cavity causing solutions that allow the bacteria to damage the teeth.

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Prevention

Care Of Your Child's Teeth

Good Diet = Healthy Teeth

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. Encourage water between meals.

Oral Hygiene Concepts

"GOOD SNACKS - BAD SNACKS"
The physical state of carbohydrates and frequency of ingestion (how frequently they are eaten) contribute to the initiation and progression of caries. Carbohydrate-containing foods that are not in the mouth long have a low caries potential in comparison with those there a longer time.

FOODS CONTAINING STICKY SUGARS
Sugar-coated cereals, sugar-coated gum, granola bars
Dried fruits - raisins, dates and apricots
Fruit Rollups, Fruitchews, Fruit Skittles, Fruit Gummy Bears
Pastries, puddings, muffins, sweet rolls, pies
Cakes, doughnuts, cookies, marshmallows, candy bars, brownies
Hard candy, life savers, lollipops, peanut brittle, jelly beans
Fruits cooked in sugar and jams and jellies
Ice Cream
Vegetables glazed with sugar - candied sweet potatoes, Boston baked beans
Frosting, honey
Cough drops

FOODS CONTAINING SUGAR IN SOLUTION
Soft drinks, soda pop, instant drink mixes, store made smoothies
Boxed Juices, Sports Drinks
Milk, Milk Shakes, malts
Popsicles

THE FOLLOWING SUBSTITUTE FOODS FOR THOSE CONTAINING SUGAR ARE SUGGESTED FOR OLDER CHILDREN:
Peanuts, walnuts, pecans, almonds, and other types of nuts
Unbuttered popcorn, whole wheat biscuits, whole grain crackers, unsweetened cereals
Cuts of meats (unsweetened)
Cubes of cheese
Hard boiled eggs
Pizza, tacos, toast
Fresh fruits, salads
Fresh vegetables such as carrot sticks, celery sticks
Baked potatoes
Unsweetened fruit juices, freshly squeezed fruit juices, Yogurt
Sugarless chewing gum especially Orbit or Trident

**Opt for low-fat, low-sugar, low-salt, high fiber

How Do I Prevent Cavities?

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.

Older children, can brush their teeth by themselves when they have developed the skills and dexterity to do so, usually around the age of 8. They should brush their teeth at least twice a day, with a maximum time and effort at the night time brushing. Also, number of snacks containing sugar that you give your children should be monitored by the parent.

The American Academy of Pediatric Dentistry (AAPD) strongly recommends every child be seen initially between 6 and 12 months of age. Routine recare visits are generally every six months and will keep your child on a lifetime of good dental health.

Dr. Kittle 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.

Seal Out Decay

A sealant is a clear or shaded plastic material that is applied to the chewing surfaces (grooves) of the back teeth (premolars and molars), where four out of five cavities in children are found. This sealant acts as a barrier to food, plaque and acid, thus protecting the decay-prone areas of the teeth. Sealants are usually placed on the permanent molars, however, children with deep valleys and especially with high caries rates, are often recommended to have them placed on primary molars.

Before Sealant Applied

After Sealant Applied

Fluoride

Fluoride is naturally occurring element, which has been shown to be very beneficial to teeth, cutting cavitiy levels up to 40% in some studies. Fluoride can be topical (painted on by the dentist, in toothpaste or in fluoride rinses) or systemic (occurring in water and beveridges). Too little or too much fluoride can be detrimental to the teeth. Little or no fluoride will not strengthen the teeth to help them resist cavities. Excessive fluoride ingestion by preschool-aged children can lead to dental fluorosis, which is a chalky white to brown discoloration of the permanent teeth.

Some of these sources are:

• Too much fluoridated toothpaste at an early age.
• The inappropriate use of fluoride supplements.
• Hidden sources of fluoride in the child’s diet.

Two and three year olds may not be able to expectorate (spit out) fluoride-containing toothpaste when brushing. As a result, these youngsters may ingest an excessive amount of fluoride during tooth brushing. Toothpaste ingestion during this critical period of permanent tooth development is the greatest risk factor in the development of fluorosis.

Excessive and inappropriate intake of fluoride supplements may also contribute to fluorosis. Fluoride drops and tablets, as well as fluoride fortified vitamins should not be given to infants younger than six months of age. After that time, fluoride supplements should only be given to children after all of the sources of ingested fluoride have been accounted for and upon the recommendation of your pediatrician or pediatric dentist.

Certain foods contain high levels of fluoride, especially powdered concentrate infant formula, soy-based infant formula, infant dry cereals, creamed spinach, and infant chicken products. Please read the label or contact the manufacturer. Some beverages also contain high levels of fluoride, especially decaffeinated teas, white grape juices, and juice drinks manufactured in fluoridated cities.

Parents can take the following steps to decrease the risk of fluorosis in their children’s teeth:

• Use baby tooth cleanser on the toothbrush of the very young child.
• Place only a pea sized drop of children’s toothpaste on the brush when brushing.
• Account for all of the sources of ingested fluoride before requesting fluoride supplements from your child’s physician or pediatric dentist.
• Avoid giving any fluoride-containing supplements to infants until they are at least 6 months old.
• Obtain fluoride level test results for your drinking water before giving fluoride supplements to your child (check with local water utilities).

Despite the above cautions, however, fluoride remains one of the most effective means to reduce and prevent cavities. Fluoride toothpastes, topical fluoride and in some cases fluoride rinses should be used properly and consistently. Be sure to discuss what is appropriate for your child with us.

Mouth Guards

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 Dr. Kittle about custom and store-bought mouth protectors.

Xylitol - Reducing Cavities

The American Academy of Pediatric Dentistry (AAPD) recognizes the benefits of xylitol on the oral health of infants, children, adolescents, and persons with special health care needs.

The use of XYLITOL GUM by mothers (4 times per day) starting 3 months after delivery and until the child was 2 years old, has proven to reduce cavities up to 70% by the time the child was 5 years old.

Studies using xylitol as either a sugar substitute or a small dietary addition have demonstrated a dramatic reduction in new tooth decay, along with some reversal of existing dental caries. Xylitol provides additional protection that enhances all existing prevention methods. This xylitol effect is long-lasting and possibly permanent. Low decay rates persist even years after the trials have been completed.

Xylitol is widely distributed throughout nature in small amounts. Some of the best sources are fruits, berries, mushrooms, lettuce, hardwoods, and corn cobs. One cup of raspberries contains less than one gram of xylitol.

Studies suggest xylitol intake that consistently produces positive dental results requires the chewing of 1 piece of xylitol gum for 5 minutes, 4 times per day.

To find gum or other products containing xylitol, try visiting your local health food store or search the Internet to find products containing 100% xylitol.

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Current Science

The Most Current Science Concerning Cavities

CAVITIES are caused by a number of factors, to include:

1. bacteria
2. diet
3. improper/insufficient brushing and/or flossing
4. lack of proper amounts of fluoride

BACTERIA
All humans have bacteria in their mouths. Most bacteria are harmless, however, some bacteria cause cavities when not removed frequently and when the diet is high in carbohydrates (bread, crackers, pretzels) and/or sticky sugars and other substances that produce acids which attack the enamel of the teeth.

DIET
A diet high in sugars usually results in cavities. Sugars are in the usual things such as candy, sodas and fruit rollups, however, they are also in such things as breads, crackers, milk and fruit juices. How frequently the child eats or drinks the sugary substance IS THE KEY. Children should not be allowed to "graze", i.e. to eat or drink frequently. They should have three meals a day and one good snack in the morning and one in the afternoon. Frequent drinking, especially of milk and fruit drinks, sodas, or sweetened tea is often the reason cavity levels are increased. Water is the best for between meal thirst.

HYGIENE
Teeth should be brushed by an adult until the child reaches the age of approximately seven years old (the test is when they can write in longhand). Any teeth that touch each other should also be flossed by an adult until the same age. Brushing after every meal is a good idea, however, it is most important to brush well at night before bed. Fluoridated toothpastes are very important to use for the very, very young child. Infants, toddlers and young children should only have a "BB" sized amount of toothpaste.

OTHER FACTORS

1. NEVER put a child to bed or down for a nap with a bottle containing anything other than water. Ideally, do not use a bottle at sleep EVER.
2. Infectivity - young children usually acquire the cavity causing bacteria from the person who feeds them (usually their mother). They are most susceptible to acquiring the bacteria when they are 18 months to 36 months old. Do not share foods or drinks with the young child where saliva can be passed from one person to the child. Also, do not let the young child put his fingers in your mouth and then into his own mouth.
3. Fluoride has been shown to significantly reduce the number of cavities. Fluoride can be found in toothpastes, fluoride rinses and many water systems.
4. Water filters may remove fluoride.

If Your Child Has a High Caries Rate

Your child has been diagnosed by examination and x-rays with having many cavities. This may be a “first time” for your child or it may be a continuance from what has happened in the past. Nobody wants their child to have a lot of cavities. In addition to the multiple appointments and cost, it sets the child up for a LIFE LONG problem with cavities, UNLESS specific actions are taken. Recent evidence is also linking tooth and gum disease possibly to heart problems, premature labor, low birthrate babies, and diabetes.

The following are actions that can be taken by the parent(s)/guardian to decrease the number of cavities at future appointments: turn over this handout for more detailed explanations.

1. The PARENT MUST FLOSS all teeth that touch another adjacent tooth until the child is age 7 or 8. Any type of floss will work. Many parents like the Johnson and Johnson “Dino-flossers” or Oral B “Buzz Lightyear” flossers. Someone MUST continue to floss, every night, forever.
2. The PARENT MUST BRUSH all the teeth well before bed every night until the child is age 7 or 8. Use a toothpaste containing fluoride with the American Dental Association seal of approval. Tom’s of Main, Crest for Kids, Colgate for Kids are all excellent choices.
3. The DIET HAS TO CHANGE. Cavities do not form unless the child eats or drinks foods with a lot of sugar or a lot of carbohydrates that break down to sugars. READ labels – sugars to watch out for are: sucrose, lactose, fructose, dextrose, maltose, corn syrup, honey, high fructose, etc.

   *If you don’t want your child to have it, DON’T BUY IT!! Do not allow grazing – the ability of the child to snack whenever they want (“at will”), during the day or night, on anything other than water. Not juice, not milk, not Cheerios, not crackers, not bread, etc. Not in a bottle; not in a sippy cup, not out of a baggy.*

4. USE Anticavity Fluoride Rinse (“ACT” by Johnson and Johnson available everywhere {or the Equate brand at Walmart} or the Plaksmacker rinse on sale here). This should be used at night and only by those kids old enough to not swallow the rinse. Conventional wisdom is that all 6 years olds can use it, some 5 year olds and a few 4 year olds with supervision. Research shows this rinse cuts cavities between the teeth by about 40%.
5. USE the Chlorhexadine rinse (Peridex) for one week each month. It kills bacteria. If the child refuses to swish with it, or can’t swish, the rinse can be brushed on. This is a very critical part in preventing new cavities
6. Consider SEALANTS. Sealants are plastic coverings that are bonded on the teeth. They WEAR OFF with time (2-3 years). They MUST be replaced. They are very CHILD COOPERATION and operator ability dependant. They DO NOT protect between the teeth. Again, THEY WEAR OFF WITH TIME and have to be replaced, generally until about age 19. Sealants are usually placed on permanent molars. Sealants may be indicated for some primary teeth.
7. DRINK Fluoridated Water. Leavenworth, Lansing and Ft. Leavenworth all have fluoridated water. If you buy bottled water at the store, have it delivered, or have an in-home filter, your child is probably not getting the correct amount of fluoride. Fluoridated water cuts cavities by 30%-60% depending on the research. Call the company and ask how much fluoride is in the water or, we have a fluoride measuring kit that can be purchased here.
8. XYLITOL gum has been shown to make it harder for the bacteria to “grab onto” the tooth. To be effective, 4 pieces of xylitol gum have to be chewed daily. Gums with xylitol include Orbit and Trident for kids.

ULTIMATELY, whether your child gets a lot more cavities or stops getting cavities is MOSTLY UP TO THE PARENT/GUARDIAN. YOU will have to take an ACTIVE part in preventing new cavities. THE PARENT/GUARDIAN will have to do, or supervise, the brushing, the flossing, the rinsing, what is bought and what your child eats or drinks DAILY. The cavity bacteria will still be present. Only good oral hygiene, fluoride use, Chlorhexadine rinse and diet control can prevent more cavities from forming.

Treatment Options/Behavior Management

INTRODUCTION
Cooperation for a needed dental procedure is difficult or very difficult for some children, especially the very young, the very anxious or those with a history of difficult medical or dental procedures. The following are options available through our office to provide your child’s needed dental care in the safest possible manner while attempting to minimize negative dental experiences.

NO TREATMENT
Caries is a progressive disease. Decay can lead to the formation of an abscess, which can spread throughout the body and in the worst case, can cause death through meningitis, sepsis or bacterial routes. Less severe outcomes are early loss of teeth and subsequent orthodontic problems from shifting permanent teeth. Nutritional status of children with extensive dental decay has been shown to be compromised and these children are not as healthy as they could otherwise be.

FLUORIDE VARNISHES
Dental decay will be slowed down by good oral hygiene, minimizing sugar or sweets in the diet, and the application of a fluoride varnish periodically. This procedure is an interim treatment. It will not halt the spread of the decay.

RESTRAINT
The child may be held by the staff, parents, and/or a safety restraining device in an effort to restrict movement of the arms and legs, which could result in the child injuring themselves, if they were not restrained. For a small single filling or simple treatment need, the parent may wish to try this rather than sedating the child.

NITROUS OXIDE (LAUGHING GAS)
Nitrous Oxide works wonderfully for many children since it lowers anxiety and the gag reflex and increases the pain threshold. It is effective only if the child breathes through their nose! If they become upset and start crying or sobbing, it does not work. Nitrous Oxide is very safe. It disappears within several minutes after the gas is discontinued so when they are done there are few side effects. Nitrous Oxide will occasionally cause a child to vomit so it is important children do not eat 2 hours before its use. Mothers who are pregnant are not allowed in the treatment area because of implied risks to developing fetuses.

ORAL OR INTRAMUSCULAR SEDATION
Children with no compromising heart or lung problems are good candidates for oral or Intramuscular sedation if they are unable to cooperate, or too anxious to sit still for the more lengthy procedures. Sedation medications have a calming effect in about 70% of children. It is impossible to predict which children will respond favorably to sedation medications. Most children become relaxed but some may become combative and resist all treatment. Children who are sedated must be constantly monitored to insure that their breathing and heart are responding favorably to the medications. This requires intensive doctor time and we are limited in how many treatment slots we can dedicate to this. One parent MAY be allowed to remain with the child during treatment. Sometimes the sedation is not effective and the parents must decide whether to proceed or discontinue the procedure. The doctor may feel that the child is so disruptive in their reaction (even with sedation medication) that they cannot safely proceed. The procedure will be stopped and alternatives for treatment completion will need to be discussed. A sedation fee is charged which covers the many additional costs the practice incurs in offering this service to our patients and is not refundable if the sedation is terminated due to the parents or doctors concerns during the course of the visit. We take multiple precautions to include the use of sophisticated monitoring equipment to insure the safety of your child and minimize risks. Dr Kittle is our pediatric specialists and is certified in Pediatric Advanced Life Support. There are risks with Oral or Intramuscular Sedation which need to be considered by the parent and will be discussed in detail at the sedation appointment. Following directions and asking questions helps insure that we are working together to have a safe and good outcome for the child’s oral health needs. Two adults must accompany the child home after the procedure.

IV SEDATION (in office)
IV sedation is an option for a child who cannot cooperate for the dental procedure but whose dental treatment is not so extensive that it must be done in the operating room.

Your child’s sedation will be performed by an anesthesia professional trained specifically to provide sedation. They are focused solely on your child, and will not perform any other component of the dental procedure. To relax your child, they will receive initially a small amount of sedative agent by injection. Once relaxed, an IV will then be placed to provide continuous sedation throughout the procedure. Your child will be given continuous sedation through the IV. They will be comfortable and relaxed during the entire procedure. Your child’s heart and blood pressure will be continuously monitored by electrocardiogram (ECG) and blood pressure monitors. Oxygen is administered and levels are closely observed by the anesthesia professional. Your child will breathe normally during this entire procedure. The anesthesia professional will closely monitor your child to a safe recovery after the dental procedures are completed. Once stringent criteria have been met, your child will be discharged. Your child may show signs of drowsiness following the procedure and for the remainder of the day. This is completely normal and should not be a cause for concern. There are risks with IV Sedation which need to be considered by the parent and will be discussed in detail by the Anesthetist.

Space is limited to only the professionals working with your child/ this allows for the dental and anesthesia teams to focus entirely on your child. You may be present with the initial sedative is given, and will then be given regular updates on the progress of the procedure. Following the procedure, you may return to your child and be with them during the recovery process.

Your child is required to have nothing by mouth, including fluids, for at least eight (8) hours before the procedure. Depending on the scheduled time of the procedure, a strict diet may be instructed. If your child consumes any food or liquids prior to the appointment, he or she will not be able to receive sedation for the dental procedure. Two adults must accompany your child for this type of appointment.

OPERATING ROOM
Children who have dental caries which cannot be addressed in 1 or 2 sedation visits or by IV Sedation, and/or are unable to cooperate, are special needs patients, or are so disruptive that care cannot be safely rendered, are candidates for care in the hospital environment. General anesthesia is employed to put the child to sleep and all the dental care needs are completed in one visit. The child remembers nothing of the dental procedure and we can preserve the positive developing attitude toward good oral health and address serious dental health care needs in a timely and reasonably safe manner. There are risks with general anesthesia which need to be considered by the parent and will be discussed in detail by the Anesthesiologist. The risk of doing no treatment out of fear over general anesthesia generally outweigh the risks of the procedure. It is done on a regular basis by our office and we operate at two different hospitals. The parents have some choice in which of these facilities we utilize for their child. (Children’s Mercy Hospital-South (Kansas City) and St. John’s (Leavenworth)

RISKS
Every option has a risk. Doing nothing when severe dental caries have been identified can lead to significant and serious problems. Sedation modalities and the operating room are two options with greater risks than simple local anesthesia and treatment in the dental office, but they are not unreasonable treatment alternatives and should be considered by parents where the dental needs warrant such a recommendation.

OUTCOMES
Our goal is to provide your child with optimal dental care in the safest possible manner while minimizing negative dental experience.

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Adolescent Dentistry

Tongue Piercing - Is It Really Cool?

You might not be surprised anymore to see people with pierced tongues, lips or cheeks, but you might be surprised to know just how dangerous these piercings can be.

There are many risks involved with oral piercings, including chipped or cracked teeth, blood clots, blood poisoning, heart infections, brain abscess, nerve disorders (trigeminal neuralgia), receding gums or scar tissue. 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.

Tobacco - Bad News In Any Form

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 the lips, and on or under the tongue.
• Pain, tenderness or numbness anywhere in the mouth or lips.
• Difficulty chewing, swallowing, speaking or moving the jaw or tongue; or a change in the way the 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.