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Pediatric Health

It's Time to Smile!

All About Childhood Dental Health

February 01, 2011
At Dr. Carol McKown's office, everything is designed to put her pediatric dentistry patients at ease, from the Alice in Wonderland theme and the TVs with cartoons on, to the flavored gloves the staff wear (orange, grape or bubblegum) and the toy tower full of prizes for being a good patient.

"Everything is geared toward kids," Dr. McKown says. "I've had several parents say, 'Can you treat me, too? I'm really just a big kid.'"

Just as children need a pediatrician, several Indianapolis dentists specialize in pediatric dentistry.

"Pediatric dentistry is mostly about prevention," says Dr. McKown. "We learn how to treat the scared child, the apprehensive child."

A baby's first tooth usually appears around 6 months – though it can take longer or come early.

"Girls, in general, lose teeth and get teeth in faster than boys," Dr. Jennifer Satterfield-Siegal says. "My daughter started getting her teeth in at 4 months." Her daughter also lost her baby teeth early at 4, when the average is closer to age 6 – but a little early or late is nothing to be concerned about, she assures parents. "It's not a good thing, it's not a bad thing – it's just a thing," Dr. Satterfield-Siegal says.

If your baby is teething, she will be irritable, drooling more than normal and waking during the night and is completely normal, she says, but fever or diarrhea should warrant a doctor visit.

Dr. McKown says the first dentist visit should come around 1 year old. By this time, she says parents should start weaning their child off the bottle, as it can affect how teeth grow in.

While thumb-sucking might seem innocuous, Dr. McKown says it can distort teeth angles and the bite, conditions that could later require orthodontic correction.

"I want the child to stop the thumb by age 4," she says, adding that a pacifier doesn't deform the teeth the same way. "The thumb is a harder habit to stop than the pacifier."

Dr. Michelle Edwards recommends a rewards system and positive reinforcement for children aged 3 to 5, because negative stimulus isn't as effective until 5 or 6. An appliance that fits behind the upper teeth can fill the comfort space, making the action awkward and reminding kids not to do it.

Dr. McKown recommends helping children brush until age 7 when their fine motor skills are advanced enough to do a thorough job – usually, when they can write cursive or tie their own shoelaces.

"Girls' fine motor skills develop quicker and earlier," Dr. Edwards says. Until they can do a proper job themselves, teaching proper brushing and flossing technique is one of the most important things parents can do. "A lot of kids will want to do it themselves," says Dr. Erin Phillips, especially as toddlers begin to assert themselves in other areas.

For the child who doesn't want to brush their teeth, Dr. McKown advises making it a regular part of their day. "Routine is very important," she says. "It is something that you just need to do."

Turning it into a game or competition or singing a song can also help make it a positive experience, Dr. Phillps says. Brushing with parents can also be a bonding activity. Dr. Lauren Weddell recommends spin brushes and fun toothpaste flavors. And sometimes, parents just have to put their foot down.

"I tell parents all the time that this is the training period – either you train them or they train you," Dr. Satterfield-Siegal says, warning not to give into tantrums or pouting. "Don't give in. Be strong."

For snacks, Dr. Phillips recommends whole fruits and vegetables, cheeses and yogurt. If a child wants a sippy cup between meals or before bed, Dr. Edwards advises parents fill it with water, as juices, soft drinks, flavored waters and sports drinks can all cause tooth decay.

"So many children and adults are getting cavities because of drinks," Dr. Phillips says, warning that each teaspoon of most juices contains about three grams of sugar.

More detailed information can be found at the Indiana Dental Association site DrinksDestroyTeeth.com.

"The gummy vitamins have been causing a lot of cavities," Dr. Edwards adds, because they attach to the teeth, and get stuck between them, lengthening the exposure of sugar.

"Studies have shown it's not actually how much sugar, but how much exposure" that causes tooth decay, warns Dr. Weddell. So chugging a 2-liter of Mountain Dew in five minutes, while not Healthy, is less destructive than chewing sugary gum regularly, or sipping a glass of juice over an hour. Sugar-free gum, though, can help dislodge gunky foods without causing more damage, Dr. Phillips says.

Besides acids eroding teeth, when oral bacteria create their own acids when processing sugars. The more sugar exposure, the more acid produced, and the stronger it is, Dr. Weddell says. And processed foods have a lot of hidden – or not so hidden – sugars.

"Anything that has corn syrup listed as the first ingredient is probably not good for your teeth," Dr. Phillips warns. When a baby is born, they have no bacteria in their mouth, Dr. Phillips says, but they soon contract "good" bacteria from contact with their parents. This, in addition to dietary and oral hygiene habits, explains why the children of parents who have a lot of cavities are usually more prone to dental – their bacteria are less effective at combating tooth decay.

Another reason to start seeing a pediatric dentist early is that if the child sustains trauma – like a fall – the parents have a dentist they know and trust who is familiar with the child, and their medical records.

"It's nice to be able to call somebody you know," Dr. Satterfield-Siegal says.

While nursing is very soothing, it is important to wipe off the baby's teeth before they nap – not only are the sugars and acids coating the baby's teeth, the body produces less saliva while sleeping.

"When they sleep, their mouth is dry," Dr. Edwards says, so nothing washes those destructive elements away.

A cloth is acceptable until the molars come in, Dr. Edwards says, and flossing should begin whenever the teeth start touching. Soft-bristled baby toothbrushes are available for the first few months of brushing, Dr. Phillips says, and small amounts of fluoride toothpaste are acceptable when the baby is able to spit.

"The keys are starting early and consistency," Dr. Edwards says.

Dr. Edwards' own two-year-old isn't always thrilled with the routine, but like many medical professional parents, she practices what she preaches.

"By hook or by crook, she will get her teeth brushed, because it is what's best for her," Dr. Edwards says. "A lot of kids don't like to be put in their car seat, but you do it anyway, because it's good for them."

Like adults, many child patients have special needs that must be addressed to provide dental care.

"About 30 percent of my patients are disabled in some way," Dr. McKown says, including mental, physical and medical disabilities.

The biggest factors in treating these special patients is patience and attention to detail, Dr. McKown says – providing a bean bag chair for her cerbral palsy patient who can't sit in the usual chair, working with an autistic patient to make sure he or she is as comfortable as possible.

"It's really just taking more time," she says.

For children with cancer, she makes sure to check their white cell count at each visit; with diabetes, it's double-checking their insulin and that they eat before a visit. Dr. McKown also has to be careful about any medications her patients might be taking, as the anesthesia could interact with other drugs in the system.

Regardless of age or special needs, the importance of taking care of your child's teeth is just as important while they are young as it is when then are adults. So celebrate Childhood Dental Health Month by scheduling an appointment with your pediatric dentist today!

Allison Tyra is a graduate of Indiana University's School of Journalism. An Indianapolis native, she spends most of her time freelancing for various Midwest-based publications, watching too much Glee/Grey's Anatomy and giving into her cats' demands for attention.

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