A pediatric dentist will train his entire staff to be kid friendly. They must be hands on with the children in order to be the most effective. They need to show how it is done rather than just talk about it. They are trained in helping them to feel relaxed and not so anxious about the visit. The doctor will examine the child's teeth, mouth and gums each time he comes in for a check up. He will also show your child all of the machines and the instruments first so your child does not freak out.

A pediatric dentist will often keep his schedule flexible so he can slip in any emergency as needed. They will also give free consultations for your first time visit. They accept many insurance plans. You must be sure to look for one who is a member of the AAPD, which is the American Academy of Pediatric Dentistry. He makes the commitment to care for your child until he reaches adulthood. He has a child friendly office and the staff all know how to deal with a fearful or uncooperative child.

veryday we see children that present with decay on their primary (baby) teeth, sometimes not just one but multiple teeth are involved. Sometimes the cavities are obvious and visible to the parents, and therefore the primary reason the parents made an appointment at our office, in other situations they are not, even to the doctor, especially if located in between the teeth with tight contacts. These such areas are only visible for inspection with radiographs. Sometimes in families with multiple children in which the older children never had any cavities and the younger one(s) has cavities, parents are perplexed at how this is possible.

It is also common to hear a parent say:

“Billy never eats any sugar, how can he have 6 cavities?”

“My dad had bad teeth and I have bad teeth, Billy must have inherited the same problem”.

Sometimes baby teeth suffer traumatic events that caused them to discolor, form an infection, and even cause swelling (abscess) and pain.

All of the above scenarios essentially lead to the same question when treatment is recommended: But aren’t they just baby teeth?

Yes, however the decision to treat or not is a multi-factorial one.

2. Permanent cuspids (replace baby canines) and bicuspids (replace 1^st and 2^nd baby molars) usually erupt between 10-13 years of age

*Usually meaning “on average” this is the pattern children follow; there are the outliers that will either get their baby teeth earlier or much later. This is the reason why treatment of baby teeth is multi-factorial and individualized. The size of the cavity, the daily diet (acidic vs basic), oral hygiene, tooth structure, enamel quality, salivary flow, and the number of years the tooth is to remain in the mouth, are among the factors used in determining if the tooth needs to be treated or left alone to exfoliate on its own.

“My other children never had cavities, how can Billy have four?”

It is common; in fact we see that happen quite frequently. There is variation in oral bacterial populations in every child’s oral cavity. Every child has a different set of bacteria and different levels of each; and every child has different salivary flow and quality. Every child may not always eat exactly the same thing even in the same family. In addition, we often hear about one of the children having a “sweet tooth” meaning that child may be eating more sweets not only in the form of candy or chocolate but also starchy snacks and sweet drinks.

Some non-dental factors to consider are that brushing habits may be different, vigilance of children may decrease as the number of children in a family increases, at times the older children may have the task of monitoring their younger sibling’s brushing, or children may be under the care of grandparents for the major part of the day and getting treated to more snacks than usual. Some children in a family were cared for at home while another child may have been cared for in a childcare center or pre-K school, causing a change in the diet and oral care of that child, in comparison to the other siblings.

Don’t most of us have a tongue tie and lip tie? Why has nobody said anything about it before?

These are two very common questions I get asked almost every day. There is a great deal of detail I could go into but I’ll reserve that for another blog. On this blog, I will keep it a simple explanation and open the door for further discussion. The answer to the first question is very simple, yes, most of us do have a tongue tie and lip tie(also known as frenulum). Should we have one? Is it normal?

Early in fetal development, when the left and right side of the face fuse together the cells at the midline should undergo auto disintegration to allow free movement of the tongue and lip. Something causes the incomplete auto disintegration to occur and it remains as a remnant tissue (congenital malformation).

In my practice, I examine every baby, child, and teenager during each exam visit for a tongue tie and lip tie assigning a classification to it. I also examine adults that seek me for this specific problem. I use the same classification Dr. Larry Kotlow uses. In my opinion, only a small percentage of the population does not have a tie and in my practice, I estimate this is less than 5%.

Tongue ties can contribute to different problems. Babies may experience problems breastfeeding, infants may experience feeding difficulties, children may have speech development challenges (r, s, t, d, l, sounds) and breathing disorders; teenagers may have experienced all the previously mentioned problems in addition to dental and jaws underdevelopment. Breathing problems may include mouth breathing, snoring, and sleep apnea. Adults may be experiencing all the above symptoms in addition to neck tension, headaches, TMJ problems, gagging, etc…

Some lip ties cause pseudo pockets above the top front teeth causing over-retention of foods and liquids exposing the teeth to sugars and starches for a longer period. This may lead to caries development. Per some speech therapists some very restrictive ties can interfere with “m”, “b”, and “p” sounds. In addition, thick, short, fibrous ties can lead to a larger than normal gap between the top front teeth. If your child needs braces due to crowding or other malocclusion problems, it is very likely the orthodontist will require the tissue be removed to prevent it from separating the front teeth.

Are X-rays (Radiographs) Truly Necessary?

This is a question our front desk team members gets asked often when scheduling a new patient appointment. It is difficult to answer “Yes” or “No” due to the fact that for new patients we do not have any information on file regarding their dental history, family history, dietary habits, oral hygiene status, dental age, and ultimately there’s no “caries risk” status on file. It is imperative to know that a definitive and complete diagnosis on a child’s oral status rests on a clinical and radiographic (X-ray) exam. Dental X-Rays play a vital role in determining the presence or absence of dental disease, supernumerary teeth, pathology, dental abnormalities (including benign and malignant tumors), and dental development. At Green Apple Pediatric Dentistry, we follow the standard of care and guidelines to determine when and how many radiographs need to be obtained.

I recently had a lovely couple present themselves, at another location I currently work at, with their child of almost four years of age, to get a a the previous office. The X-rays obtained not only showed several cavities but it also showed how advanced the decay was, calling for crowns on the teeth rather than just fillings.

Another example of the importance of X-rays was the presence of a child with the two front upper teeth erupting with a large gap between the teeth. The child had not had radiographs taken in a few years. The new radiographs showed the presence of a supernumerary (extra) tooth in between both front teeth to be the cause for such gap. In this case the child will need braces to help bring the teeth together. Early detection and extraction of such supernumerary tooth might have prevented this course of action.

As a pediatric dentist I have to agree that sometimes when the child is too young to cooperate, it is very difficult or impossible to obtain diagnostic X-rays and sometimes even when we try our best it is just not possible. However, when we cannot visualize the surfaces in between the teeth, and we have a young cooperative child, it is important to have X-rays as a piece of information to properly guide parents in the oral health status of their child and provide them with alerts when there is a cavity beginning to develop and most importantly, rule out any pathology present.

At Green Apple PediatricDentistry, we use digital fast speed sensors to obtain radiographs, meaning the X-ray exposure is very low. In addition, we use a protective apron to cover the child’s body including the neck area. If there are any fears or concerns about radiographs, we invite you to discuss those with us and trust that our intent is to take care of your child the best way possible.

A radiographic (X-ray) exam is highly important for new patients; how many are needed and how often at subsequent visits is determined once a child is established as a patient and a full comprehensive exam has been completed.