If your child was given a local anesthetic for dental treatment, we recommend these instructions to our patients so your child will not have any problems. ​ 1. The feeling of numbness may be of concern to your child. Reassure him/her that their tooth is asleep and it will wake up by itself shortly. ​ 2. Be sure that the tongue, lip and cheek are not BITTEN, CHEWED OR PINCHED. ​ 3. Eating should be avoided until the numbness goes away. A popsicle is highly recommended immediately after the appointment, especially for younger children that are bothered by the numb feeling. ​ 4. Sometimes Tylenol may help prevent soreness in the site of the injection. Use your judgement or please call us if you have any questions. ​

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.

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.

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.

We have two types of crowns available at the Pediatric Dental Center of Frederick. NuSmile Zirconia Crowns - White natural color Zirconia is a special type of advanced bioceramic material offering patients an unmatched combination of esthetics, durability and safety. When you choose a zirconia crown for your child, it’s almost impossible to tell the difference between a natural healthy tooth and the crown. Advantages Zirconia crowns are the most natural looking crowns. Also, the have an exceptional strength, so they can last until permanent teeth come in. Most importantly, they almost never chip or crack, and will not discolor or wear. NuSmile Crowns (metal free) Stainless Steel Crowns - Silver color. When a baby tooth is extensively decayed and using other filling materials isn't likely to be successful, the American Academy of Pediatric Dentistry (AAPD) recommends restoring the tooth with a crown especially if the tooth has received pulpal therapy. After removing the decay, your dentist will fit and cement a prefabricated crown made of stainless steel over the tooth. Here are some advantages of stainless steel crowns: - Durable but inexpensive - Full coverage protection for the tooth - Very little sensitivity

Infants 0 - 10 Months Developmental Events: - First tooth erupts Interaction with Dentist: - First visit to the dentist by 1st birthday Home Oral Hygiene Routine: - After feedings, use wet washcloth to clean gums until first tooth erupts - Begin brushing once teeth appear - Avoid giving a bottle at bedtime, because it can cause tooth decay Children Ages 1 - 3 Years Developmental Events: - More baby teeth begin to erupt Interaction with Dentist: - Regular dental cleanings/checkups every six months Home Oral Hygiene Routine: - Parents brushes child’s teeth - Use only water in sippy cups - To ease teething pains, rub gums with finger, use a frozen teething ring or pain relief gels Children Ages 3 - 7 Years Developmental Events: - Begin losing baby teeth, permanent molars start to erupt Interaction with Dentist: - Regular dental visits every six months - Dentists may take first x-rays - Dentist may place sealants on teeth Home Oral Hygiene Routine: - Use a soft bristled toothbrush and pea-size dab of fluoride toothpaste Children Ages 7 - 12 Years Developmental Events: - Child lose all baby teeth - May get cavities in perm. teeth Interaction with Dentist: - Regular dental visits every six months - Dentist may suggest braces Home Oral Hygiene Routine: - Brush twice a day/floss once a day - Limit sugary or starchy foods Teenagers Ages 13 - 19 Years Developmental Events: - May need braces - May get cavities in perm. teeth Interaction with Dentist: - Regular dental visits every six months Home Oral Hygiene Routine: - Brush twice a day/floss once a day - Limit sugary or starchy foods - Avoid starting to smoke - Limit drinking soft drinks - Avoid oral piercings - Keep travel toothbrushes in backpacks

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. DO NOT place aspirin on the gum or on the aching tooth. If face is swollen apply cold compresses. Take the child to a dentist. ​ 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 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. The tooth may also be carried in the patient’s mouth. The patient must see a dentist IMMEDIATELY! Time is a critical factor in saving the tooth.

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 examination 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.

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).

Children should visit a Pediatric Dentist by their first birthday or 6 months after their first tooth erupts. ​ We encourage parents to accompany their children and be a part of the dental experience. Our dentist are trained to work with children and will help with their first experience. ​ We ask that you refrain from using words around your child that might cause unnecessary fear, such as needle, pull, drill, or hurt. The office makes a practice of using words that convey the same message, but are pleasant and non-frightening to the child. ​ We like to teach prevention and the importance of dental care so that your child has a beautiful smile that lasts a lifetime. It is our goal to make each and every visit to our office a fun one!

Fluoride is an element, which has been shown to be beneficial to teeth. However, 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 even brown discoloration of the permanent teeth. Many children often get more fluoride than their parents realize. Being aware of a child’s potential sources of fluoride can help parents prevent the possibility of dental fluorosis. ​ 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. Blending the syrup, carbonation with the city water supply often makes soft drinks at fast food restaurants – so if fluoride is in the water – this is another source. Parents can take the following steps to decrease the risk of fluorosis in their children’s teeth: ​ - Use baby tooth cleanser on the toothbrush in 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 6 months old. ​ - Obtain fluoride level test results for your drinking water before giving fluoride supplements to your child (check with local water utilities).

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.

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 takeoff 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.

Educational information on gummy vitamins. Click on the linked PDF for more information.

Does Lupus affect oral health? Click the linked PDF below for more information on Lupus.

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.

What is Nitrous Oxide? You may know this gas as happy gas or laughing gas. It is a sweet smelling, colorless gas used to ease anxiety (often given at the dentist). ​ How will it help my child? Your child may be offered nitrous oxide gas while the pediatric dentist carries out a procedure such as restorative work. The gas helps to ease anxiety your child may feel, but usually does not make them fall fully asleep. When your child starts to breathe the nitrous oxide, they will feel relaxed within a couple of minutes. The gas will be continued until the procedure finishes and will wear off within 5 minutes when the gas is stopped. This means your child can quickly get back to their usual activities (playing, eating etc). ​ How will it be given? Nitrous oxide will be given by the doctor. Before it is given, your child will be assessed to make sure this is the best option. You may be asked to make sure your child stops eating and drinking for a certain time before they have the gas. This helps reduce the risk of vomiting, but most dental procedures on children are quick and do not require eating restrictions. You are welcome to stay while your child is having the gas. The gas will be given a few minutes before the procedure starts and will continue until it is finished. The gas may make your child feel "floaty", warm and tingly. When the nitrous oxide is stopped, your child will then be given oxygen through the mask to clear the gas from their lungs; this last stage in which only oxygen is given is very important. After your child has had the oxygen and is awake and alert they will be able to eat and drink normally. ​ Are there any risks? This gas is safe for use in children and there are no long-term side effects from occasional use. Young children may not like having a mask on their face. The doctor may need to hold the mask over your child’s face at first until the gas starts to work and your child relaxes. Other side effects may occur, but they are usually minor and get better quickly. Very rarely, some children feel sick or vomit during nitrous oxide sedation. The staff looking after your child will know how to manage these problems if they occur.

Can oral piercings affect my oral health? Click the PDF below to learn more.

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.

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.

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. When using perscription or over the counter medications for children, most have sugar and flavoring to make them more appealing. Make sure your child brushes their teeth and tounge after taking them so that the sugar does sit on the teeth. ​ The American Academy of Pediatric Dentistry recommends six month visits to the pediatric dentist beginning at your child’s first birthday. Routine visits will start your child on a lifetime of good dental health. Your pediatric dentist 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.

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.

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.

Children and adults with special health care needs need oral treatment like everyone else, but they benefit the most from seeing a dentist who specifically caters to these patients. Pediatric dentists have training and will work with patients, parents, and guardians with special need to make them comfortable.

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 ages of 6-8 months. See "Eruption of Your Child’s Teeth" for more details.

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. ​ Suggested reading on this subject: "Harold's Hideaway Thumb" by Harriet Sonnenschein and "David Decides About Thumbsucking - A Story for Children, a Guide for Parents" by Susan Heitler P H.D.

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 that 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 leukoplakia. ​ 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.

Some infant are born with their tongue or lips limited range of motion. With tongue-tie, an unusually short, thick or tight band of tissue (lingual frenulum) tethers the bottom of the togue's tip to the floor of the mouth, so it may interfere with breastfeeding. Someone who is tongue-tied might have difficulty sticking out his or her tongue. Tongue-tie can also affect the way a child eats, speaks and swallows. Sometimes a tongue tie may not cause problems, some cases it may require a simple procedure for correction. Signs that a procedure might need to be consider while breastfeeding might be: Painful or damaged nipples while breastfeeding Baby loses suction while feeding and cannot stay latched to the breast Baby quickly becomes tired when feeding. Baby has little or no weight gain Baby is noisy when eating/sucking Baby has excessive gas after eating Baby has reflux symptoms combined with some of the symptoms above

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, 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.