We know you want the best care for your children’s teeth and you probably have a lot of questions about the timing, process, and some of the procedures. Here, we’ll answer some of our most frequently asked questions. If the answer to your most pressing question isn’t here, just click here and we’ll get back to you as soon as possible. We look forward to hearing from you.
Pediatric dentists are the pediatricians of dentistry. A pediatric dentist has two or three years of specialty training following dental school and limits his/her practice to treating children only. Pediatric dentists are primary specialty oral care providers for infants and children through adolescence, including those with special health needs.
A check-up every six months is recommended in order to prevent cavities and other dental problems. However, your pediatric dentist can tell you when and how often your child should visit the dentist based on their personal oral health.
“First visit by first birthday” is the recommendation from the American Dental Association and Dr. Chan. Your child should visit a pediatric dentist when the first tooth comes in, usually between six and twelve months of age. Early examination and preventive care will protect your child’s teeth and gums and help us detect any issues early on.
Dental problems can begin early and it’s important to begin healthy habits and a prevention program as soon as possible. A big concern is Early Childhood Caries (also known as baby bottle tooth decay or nursing caries). Your child risks severe decay from using a bottle during naps or throughout the night or when they nurse continuously from the breast. Children with healthy teeth chew food easily, learn to speak clearly, and smile with confidence.
The sooner the better, prepare your baby for brushing by cleaning his/her mouth, gums, and tongue with gauze or a clean washcloth.
For babies: Massage the gums with an infant finger brush or washcloth just prior to the eruption of the first primary tooth. This will prepare your baby for daily dental care and may help alleviate teething discomfort.
When the first tooth erupts: Use a soft-bristled toothbrush in a circular motion on all surfaces, especially along the gumline. This will remove plaque bacteria that can lead to decay. Any soft-bristled toothbrush with a small head, preferably one designed specifically for infants, should be used twice daily: in the morning and before bedtime. Remember that most small children do not have the dexterity to brush their teeth effectively on their own.
A good rule of thumb is to let them start brushing as soon as they can write their name in beautiful, cursive handwriting—usually between 6 and 7. By this time, they will then have the proper dexterity to hold the brush correctly and brush properly.
Between the age of 2-3 years old, it’s time to integrate fluoride toothpaste. You may use a small smear size amount of adult toothpaste or children’s toothpaste—though they may find the flavor of children’s toothpaste more appealing. Look for a fluoride toothpaste with the American Dental Association Seal. Just make sure children spit out and not swallow excess toothpaste after brushing.
Mouthwash is not meant to be swallowed and it may be difficult for children under six years of age to swish and spit. Children 6-12 should only use mouthwash under direct adult supervision. Please ask Dr. Chan for specific instructions.
Avoid putting anything other than water in their bedtime bottle. Bottles of milk and juice left in the baby’s mouth can cause a lot of decay and damage. At-will nighttime breast-feeding should also be avoided after the first primary (baby) teeth begin to erupt.
Yes! Primary, or “baby”, teeth are important for many reasons. Not only do they help children speak clearly and chew naturally, they also aid in forming a path that permanent teeth can follow when they are ready to erupt.
Thumb sucking is perfectly normal for infants; most stop by age 2. Thumb and pacifier sucking habits will generally only cause a problem if they go on for a very long period of time. Most children stop these habits on their own. If your child does not, discourage it after 4 years of age. Prolonged thumb sucking can create crowded, crooked teeth, or bite problems. Dr. Chan will be glad to suggest ways to address a prolonged thumb sucking habit.
From six months to age 3, your child may have sore gums when teeth erupt. Many children like a clean teething ring, cool spoon, or cold wet washcloth. Some parents swear by a chilled ring; others simply rub the baby’s gums with a clean finger.
Have the fluoride level of your child’s primary source of drinking water evaluated. If your child is not getting enough fluoride internally through water (especially if you filter your water with a reverse osmosis filtration system or if your child drinks bottled water without fluoride), then Dr. Chan may prescribe fluoride supplements. Let us help you determine the best fluoride supplementation regime for your child.
Excellent habits and routines. Parents should take their children to the pediatric dentist regularly, beginning with the eruption of the first tooth. Then, the pediatric dentist can recommend a specific program of brushing, flossing, and other treatments for parents to supervise and teach to their children. These home treatments, when added to regular dental visits and a balanced diet, will help give your child a lifetime of healthy habits.
A frenotomy or frenectomy is a procedure that consists of releasing the frenum under the tongue or upper lip to allow for better range of motion. Children may be born with a combination of conditions called a tongue-tie (ankyloglossia) and/or a lip-tie causing restrictions in movement that can cause difficulty with breastfeeding, and in some instances, other health problems like dental decay or spacing, speech and airway difficulties, and digestive issues. These issues can generally be corrected by a simple procedure done with our soft tissue laser.
A soft tissue laser does NOT cut, it is more a “vaporization” of tissue that occurs with light energy. The laser causes very little discomfort. There is almost no bleeding from the laser procedure. Lasers sterilize at touch and therefore have less risk of infection. Our laser stimulates bio-regeneration and healing. The result is beautiful tissue and less chance of relapse.
Tongue-tie (ankyloglossia), is the restriction of tongue movement where the tongue is adhered to the floor of the mouth. A tongue-tie is therefore caused by a frenum that is abnormally short or attached too close to the tip of the tongue.
- Inability to open mouth widely affects speech and eating habits
- Inability to speak clearly when talking fast/loud/soft
- Clicking jaws
- Pain in jaws
- Protrusion of the lower jaws, inferior prognathism
- Effects on social situations, kissing, licking ice cream
- Dental health- a tendency to have inflamed gums, and increased need for periodontal surgery
- Tongue tie in the elderly often makes it difficult to keep a denture in place
- To help make breastfeeding more successful
- To help relieve the pain of breastfeeding and regain healthy nipples and breasts
- To stimulate milk production by adequate stimulation
- To help achieve satisfactory bonding between a mother and her baby
- To ensure adequate feeding and growth of the baby
- To avoid serious long term issues with palatal development, tooth spacing, dental caries, speech impairments, social stigma
Normal tongue function is important for multiple reasons. Among the many benefits, normal tongue function will allow a baby to latch adequately and breastfeed efficiently, promote normal speech development, make it possible for a child to self-cleanse the mouth during eating, allow adequate swallowing patterns, allow for proper growth and development, and it makes fun little things like eating ice cream, kissing or sticking your tongue out to catch snowflakes possible.
Lip-tie is the restriction of upper lip movement where the upper lip is adhered to the upper gums.
- Spacing between the permanent maxillary central incisors, a large gap can form called a diastema
- Difficulties with brushing and flossing
- Increased risk of dental decay
- Repeated trauma to the maxillary frenum because it is so low and prominent
- Pain with breastfeeding
- Inability to adequately flange the maxillary lip upward during breastfeeding, affecting an infant’s latch and ability to create a good seal
Many mothers are often told, or mistakenly assume, that if they cannot successfully breastfeed, there is something wrong with them. In fact, this is not true. Tongue-tie (ankyloglossia) and/or a lip-tie may be the problem.
Tongue-ties are normally straight forward to diagnose and fairly easy to treat: the tongue is heart shaped when the baby cries; there is an obviously tight frenulum underneath that runs from the floor of the mouth to an area close to the tip of the tongue. Tongue-ties can vary in severity and can include what we call “posterior tongue-tie” which is a lot more difficult to diagnose and recognize. The frenulum looks like it is non-existent so the first instinct is to believe that tongue-tie cannot be the issue. The tongue looks squared off with the floor of the mouth webbing/tenting the tongue. The edges of the tongue will form a cup when crying as it is unable to elevate. The tongue cannot move side to side but instead twists side to side. The tongue struggles to extend out of the mouth while it’s open but is absolutely incapable of “sticking out” when wide open, which is the ideal position for breastfeeding.
Mothers who try to breastfeed their tongue-tied baby suffer tremendously, both mentally and physically. Not only does she have to re-latch the baby multiple times during a feed and deal with feedings that last sometimes hours, she also experiences damaged nipples, cracks, bruises, and pain during feeds. Her risks of breast infection increases and her milk supply can be greatly reduced due to the lack of stimulation from an inefficient latch.
The babies may be losing weight, get sleepy during feeds (as they work much harder than other babies to stay latched), and become extremely gassy and irritable making the parent’s experience even more frustrating. Lip-tied babies end up with blisters on their lips from trying so hard to stay latched. Babies tend to feed a lot more often because their inefficiency results in less intake of milk so hunger kicks in faster.
A laser frenectomy may be the answer to a better breastfeeding experience for you and your baby.
Breastfeeding immediately after the procedure is fine as breast milk contains amazing healing properties and the simple act of breastfeeding will reassure and soothe the baby.
It is possible that latching will be a struggle at first since we are using a small amount of anesthetic to complete the procedure. The numbness will wear off about 30-45 minutes after the procedure. Do not be alarmed if latching is difficult at first.
Posterior tongue-ties may require a few weeks of practice before seeing the benefits of the frenectomy. We recommend to be thorough with the prescribed post treatment exercises and to work with the lactation consultant and possibly a bodyworker (cranial sacral therapist, pediatric chiropractor, etc.) to increase the chances of success.
Post procedure stretches are key to getting an optimum result. The mouth tends to heal so quickly that it may prematurely reattach. This is especially true if you have two wound surfaces in the mouth in close proximity, so it is important to keep the surfaces stretched open, apart from one another.
Most importantly—stay relaxed, smiling, and positive. Be playful and show your baby or child that not everything is going to be painful. The exercises are not meant to be forceful or prolonged. Stretching exercises with quick and precise movements are best. A small amount of spotting or bleeding is common while doing the exercises, especially in the first few days.
The lip is the easier of the 2 sites to stretch and if you are doing both lip and tongue, start with the lip.
Place your finger under the lip and move it up as high as it will go, until you feel resistance. Then, gently sweep from side to side for several seconds. Remember, the goal is to open the opposing surfaces of the lip and gum so they cannot stick together.
Insert both index fingers into the mouth and dive under the tongue and pick up the posterior part of the tongue and lift towards the roof of the baby’s mouth. The tongue needs three separate stretching motions:
- Once you are under the tongue, pick up the posterior part of the tongue as high as it will go towards the palate. Hold it there for 3 seconds, relax, and do it again. The goal is to completely unfold the diamond so that you can visualize the entire diamond. The fold of the diamond across the middle is the first place it will reattach.
- Place your finger in the middle of the diamond and do a gentle circular stretch for several seconds to dilate or open up the diamond.
- Turn your finger sideways and do a rolling pin motion to try and keep the diamond as deep as possible. Start at the fold “center” of the diamond and move to either side of the diamond top and bottom to loosen up the muscles of the tongue and floor of the mouth.
You may use non-numbing teething gel like Hyland’s Teething Gel, Orajel Naturals (No Benzocaine), Tylenol, Ibruprofen (if 6 months of age or older) or other homeopathic measures to help with discomfort. Starting a few days after the procedure, the wound(s) will look gooey white and/or yellow in appearance. This is a completely normal inflammatory response. The body’s natural way to make a band-aid.