Dr. Marc Lazare takes great pride in shaping and creating smiles starting from 2 years of age. When children start young, they develop home care techniques and positive associations that last a lifetime. Your child’s first visit to the dentist should be fun and enjoyable, and result in their looking forward to the next visit.
In order to create a memorable visit, we utilize interactive homecare techniques; take the child on a tour of their mouth using our intraoral camera; make balloon animals, perform magic tricks and give out Kooky pens. We have kid friendly music, some of their favorite DVD’s, TV and Nitrous Oxide Sedation.
What can I do to prevent my baby from developing cavities?
Parents and caregivers should realize that a baby’s teeth are susceptible to developing cavities from the moment they appear in the mouth. As a result, oral care should begin soon after the baby is born, and their gums should be cleaned with a clean, damp cloth or wet gauze pad after each feeding. As early as 4 months or as late as 12 months of age, the upper and lower front teeth first begin to appear. You may begin brushing your child’s teeth the moment these teeth emerge.
Never let your baby or toddler fall asleep with a bottle, unless it contains only pure water and then only after the bottle is rinsed out well before being filled. A bottle containing milk, formula, fruit juices, etc., is likely to cause decay. A pacifier coated with a sugary substance is also likely to cause cavities. This condition is referred to as Baby Bottle Tooth Decay, or Nursing-Bottle Syndrome. The teeth most likely to be affected are the upper front teeth, but other teeth can become damaged as well. Dental sealants are an effective cavity preventing treatment.
Baby (Primary) Teeth Development Chart
|Upper Teeth||When tooth emerges||When tooth falls out|
|Central incisor||8 to 12 months||6 to 7 years|
|Lateral incisor||9 to 13 months||7 to 8 years|
|Canine (cuspid)||16 to 22 months||10 to 12 years|
|First molar||13 to 19 months||9 to 11 years|
|Second molar||25 to 33 months||10 to 12 years|
|Second molar||23 to 31 months||10 to 12 years|
|First molar||14 to 18 months||9 to 11 years|
|Canine (cuspid)||17 to 23 months||9 to 12 years|
|Lateral incisor||10 to 16 months||7 to 8 years|
|Central incisor||6 to 10 months||6 to 7 years|
A Pediatric Dentist (formerly Pedodontist) specializes in the oral health care needs of young people, including infants, children and adolescents. Pediatric Dentists have completed an additional 2-3 years of study and hands-on training after dental school, to prepare them to aid in the unique dental needs of their younger population. If your general dentist feels your child needs unusual procedures or might be difficult to treat, you may be referred to a pediatric dentist.
A baby’s first tooth will usually erupt into the mouth by around six months of age. Some infants will be early, and some may be a few months later. If your baby still has not displayed their first tooth by the time they are 1 year old, then you can bring your child to the dentist for an exam.
From day one you should be cleaning your baby’s gums, and tongue with a washcloth, rubber finger brush, or cloth finger tender (even though no teeth are present). Clean the gums at least twice each day — after breakfast and after the last feeding of the day. Even better — clean your baby’s gums and tongue after every feeding to keep your the breath fresh and to get them accustomed to this routine. Once the first tooth erupts, you should be cleaning these teeth, trading in your cloth wipe for an appropriate sized, soft toothbrush. In order to see the teeth more clearly when brushing, you may choose to have your child lay their head on your lap, or lay them down on a bed. Remember, only use toothpaste that does NOT contain fluoride at this time.
Baby teeth hold the space for the permanent teeth to begin coming in at about 6 years of age. Your baby’s teeth, gums and tongue are not only very important for eating, but aid in the growth pattern of your child’s jaws and adult teeth. Note that baby teeth are also a key component in the ability to learning and perfect speech. Of course, a full complement of baby teeth will contribute to having a good self-image as your child grows older.
If your child uses a pacifier, do not dip it in honey or anything that has sugar, as this can cause cavities. Do not put your child to bed with a bottle or sippy cup that contains milk, formula, fruit juices or soda, since these contain sugary substances that can cause cavities too. Plain water is the only acceptable fluid to give your child when they are going to nap or sleep.
If your baby does not want to open their mouth, place your finger near their mouth, and they will slowly open as they think that you are trying to feed them. Even if your baby tries to bite down on your finger, be patient, keep trying, and they will soon open up again. Reach inside along the cheek till you get between the upper and lower gums, and your baby will then open more to allow you to wipe the gums in the very back. In the case that one or more ulcers are found in your baby’s mouth, just clean around the ulcer until they are healed (usually within one week). Get your child accustomed to cleaning his mouth regularly and going to bed with a clean mouth.
When will my child’s adult teeth grow in, and how do I care for them?
Spaces for the permanent teeth begin to appear at the age of four as the jaw, supporting bone structure and facial bones begin to grow. The first baby teeth to be lost are the two lower front teeth. These come out between 6-7 years of age and are very soon replaced with the two lower adult front teeth. At the same time, the six year molars are starting to grow in. From six to twelve, it is typical for your child to have a combination of both baby teeth and permanent teeth in their mouth. Below is a chart showing when to expect the emergence of all the adult teeth.
Adult (Permanent) Teeth Development Chart
|Upper Teeth||When tooth emerges|
|Central incisor||7 to 8 years|
|Lateral incisor||8 to 9 years|
|Canine (cuspid)||11 to 12 years|
|First premolar (first bicuspid)||10 to 11 years|
|Second premolar (second bicuspid)||10 to 12 years|
|First molar||6 to 7 years|
|Second molar||12 to 13 years|
|Third molar (wisdom teeth)||17 to 21 years|
|Third molar (wisdom tooth)||17 to 21 years|
|Second molar||11 to 13 years|
|First molar||6 to 7 years|
|Second premolar (second bicuspid)||11 to 12 years|
|First premolar (first bicuspid)||10 to 12 years|
|Canine (cuspid)||9 to 10 years|
|Lateral incisor||7 to 8 years|
|Central incisor||6 to 7 years|
How do I control my child’s drooling and teething pain?
Babies are very easily agitated by the teething process. Parents should try to distract their children with activities, and allow your child to chew on a clean, chilled, liquid-filled teething ring to relieve the discomfort and irritation. Drooling during this time is normal and expected. Just wipe your child’s mouth often to keep them clean and dry. Swollen gums are normal at this time, however if the gum turns blue or red, then bring your child to the dentist to evaluate. Additionally, teething should not cause fever. Since your baby is picking up anything and everything that has germs on it, and putting it in their mouth to chew on, it is possible that their fever is due to this spreading of illness, in which case parents should bring their child to their pediatrician.
I heard that sometimes a baby could be born with one or more teeth (natal teeth), if that happens what should I do?
Occasionally a baby may be born with teeth (natal teeth) or erupt through the gums within the first month of life (neonatal teeth). Their occurrence is about 1 in 30,000 and usually just the lower front baby teeth (posterior tooth eruption is extremely rare). These teeth are usually the normal baby lower front teeth erupting early. Due to this early eruption, the tooth will not be fully developed. If this should occur, leave them alone, unless they are very loose or causing traumatic ulcers, or causing any discomfort to the baby or mother during breast feeding, in which case you would have them removed. This is a non-traumatic procedure and painless to the infant. Because natal and neonatal teeth are usually normal baby teeth, a new baby tooth will not replace them once they are lost. The space is usually left alone until the adult teeth eventually grow into that area. Teeth that are stable after 4 months have a good prognosis, although they may be discolored and not as esthetic as the other teeth.
When should I first take my child to the dentist?
Parents should take their children to the dentist for their first check-up by the age of 2, unless your doctor recommends and earlier exam. Subsequently, they should go for regular dental check-ups every 6 to 12 months, so your child’s dentist can monitor their oral hygiene, diet and growth patterns. It is best if your child’s first experience occurs at a time before invasive dental work becomes necessary. A ride on the dental chair, magic tricks with “Mr. Thirsty” and visiting the toy chest should make your child’s visit pleasurable and non-threatening. The first visit should also include the counting of teeth while your child looks at what is happening in a hand held mirror. Remember, early dental check-up makes it easier to build a good rapport with your child to establish a foundation of trust and comfort for future visits.
How should I prepare my child for their dental visits?
Tell your child that the dentist is there to help take care of his/her teeth. Read your child a fun children’s book about going to the dentist. Describe to your child the surroundings of a dental office and role play the job of a dentist. It may help to tell your child the date for dental visit in advance so that they can prepare for the visit and hopefully look forward to it. Remember, NEVER use the dentist as a threat for not taking care of their teeth, this will just instill a fear in them that will last well into the future. Speak positively about dental visits, and make it something to look forward to. It is important to establish a positive relationship between your child and the dentist by starling early and continuing to see the dentist for regular check-ups. And don’t forget to share this valuable knowledge with anyone else who may be helping to care for your child.
When does my child need fluoride and what is the right amount?
Fluoride is a mineral helps prevent tooth decay by strengthening the tooth’s enamel and making it more resistant to acids and harmful bacteria. Most municipal water supplies are fortified with fluoride (check with your local water authority to find out about yours). Some bottled water companies will fortify some of their water products with fluoride, so be sure to check the labels. If the fluoride content of your water supply has less than 0.3 parts per million, ask your child’s doctor whether you should give your child a fluoride supplement (the amount recommended for children from 6 months-3yrs old is 0.25 milligrams per day). Your doctor can prescribe fluoride in the form of drops that you can add to your baby’s bottle or food once per day, or they can be prescribed as part of your child’s vitamin.
The American Academy of Pediatrics doesn’t recommend fluoride supplements for babies under 6 months old. Your child will not get any fluoride from breast milk. If you live in an area with fluoridated water, your child will get fluoride from the water you use to make the formula. A little fluoride is good for your baby’s teeth, but too much of it can lead to a condition called fluorosis, which can cause white spots on your child’s adult teeth. It is recommended to wait until your child is old enough to spit out before giving your child fluoridated toothpaste, and even then you should let them use only a tiny (pea-sized) amount each time. This is because young children tend to swallow their toothpaste rather than spit it out and swallowing too much toothpaste over time can lead to fluorosis, or become toxic in large quantities.
|Age||Fluoride Ion Level in Drinking Water (ppm)*|
|<0.3 ppm||0.3-0.6 ppm||>0.6 ppm|
|6 months-3 years||0.25 mg/day**||None||None|
|3-6 years||0.50 mg/day||0.25 mg/day||None|
|6-16 years||1.0 mg/day||0.50 mg/day||None|
|* 1.0 ppm = 1 mg/liter** 2.2 mg sodium fluoride contains 1 mg fluoride ion.|
Can water filters reduce the benefits a fluoridated water system would otherwise offer to my children’s teeth?
Yes, some types of water treatment systems that are installed in one’s home can decrease the fluoride levels, thus potentially reducing the cavity-preventing effects of a water supply that has been optimally fluoridated. It has been documented that the reverse osmosis systems and distillation units remove significant amounts of fluoride. However, studies have also shown that water softeners do not cause a significant loss in fluoride levels. The concentration of fluoride found in your water will depend on the type and quality of the water filter you purchased, the current status of the filter and its age. For questions about the level of fluoride in your water supply or to arrange to have your filtered water tested, contact your local and state public health departments. Your dentist should also be contacted to determine if your children are candidates for fluoride supplementation, as it is available by prescription only. Those individuals who drink bottled water as their primary source of water may also be depriving themselves of the benefits of fluoride, as many brands fall short of the optimum levels of 0.7-1.2 ppm.
Is it better to use a manual toothbrush or an electric toothbrush for my child’s teeth?
An electric brush has a few advantages over a manual brush. First it generates more brush strokes per second; making it more effective for the amount of time it is being used. Keep in mind that while it is recommended to brush for 2 minutes, the average person only brushes for 30 seconds. With an electric brush it is easier to clean behind the back teeth. Many of these electric brushes have certain extra bells and whistles such as a digital timer so you know when 2 minutes are up, and an indicator light to show if you are pressing too hard. There is usually less trauma to the gums and teeth when brushing with an electric brush since many over-zealous manual toothbrush users bang into their gums with the wrong technique, or scrub too hard.
A manual toothbrush can be very effective with the right technique, and conversely, an electric toothbrush can be virtually useless with the wrong technique. If using a manual brush, use small, vibratory strokes on a 45 degree angle so that the bristles get in the pockets between the teeth and gums. Avoid the up and down or circular motion, as that can just traumatize the gums. If you are using an electric brush, try to spend at least 2 full seconds on each tooth surface (inside, outside and top), making sure to angle the brush between the teeth and having the bristles go between the tooth and the gums. Spin brushes are just a watered down version of an electric brush that may attract the attention of your child with its various themed versions. Whether you use a manual brush or an electric, make sure you always change your brush or brush head every three months, or sooner if you just had a cold so you don’t re-infect yourself.
At what age should a child brush their teeth on their own?
This will depend on the child. While it is great to build up a child’s self-confidence and independence, children don’t usually develop the full coordination and understanding of what they are trying to accomplish until the age of 6 or 7. Even though they may want to do this all by themselves, it is recommended that the parent or guardian supervise, check, and when necessary, do additional brushing for their child at least up until the age of 10. Your toddler can have their toothbrush available to “pretend or play” tooth-brushing along with you. Cavities prevented during this time will save a lot of time, money and trauma in the future.
How often should I brush my child’s teeth, and at what times of the day?
It is recommended that everyone brush at least twice each day with a soft-bristled brush or electric brush. The first time should be in the morning, after breakfast, so your child’s teeth are clean before leaving for school. It defeats the purpose of brushing if you give your child their sugary vitamin after they brush, or give them their breakfast to nibble on the bus, because these substances will stay lodged in the top grooves of their molars and in between their teeth for hours to come, contributing to the formation of cavities. The most important time to brush is right before you go to sleep at night so that nothing is left on or in between your teeth when you are sleeping. The reason is that when you are awake, your saliva helps to bathe and rinse your teeth, but while asleep, you do not salivate that much, and your teeth is more susceptible to developing cavities from the debris left on them. Additionally, if you have the chance to brush after other meals or snacks, it would be advisable. And don’t forget to brush their teeth after they are given medicine, as the acids contained in medicines may break down the tooth enamel.
When should my child start flossing?
Parent-assisted dental flossing is recommended as soon as the teeth erupt next to each other. Independent flossing is recommended once children develop the dexterity to be able to do it on their own (often by six or seven years of age).
Which foods are bad for my child’s teeth?
Any food or snack that can become trapped within the pits and grooves of your child’s teeth or between their teeth can become harmful if not cleaned properly. Chewy candy (i.e. Taffies, caramels, jellybeans, and licorice) are among the biggest cavity culprits. However, you may be surprised to know that nuts, raisins and dried fruits can also cause a lot of damage, since they too get readily stuck in and around the teeth. The complex carbohydrates such as pretzels and potato chips get broken down into the same sugars that are found in cakes and cookies. Any food debris left on the tooth creates an acid attack in the mouth to break it down. The less likely the food is to dissolve or rinse away, the longer the acid attacks will be. Chocolate, which is full of sugar, is actually not as bad for your teeth as dried fruit and nuts, because chocolate dissolves quickly. However, you can prolong any acid attack by eating or drinking things slowly over a longer period of time.
Aside from the introduction of fluoride, dental sealants have become one of the biggest breakthroughs in terms of dental prevention. They are used to protect teeth from decay and are appropriate as soon as a posterior tooth erupts. The chewing surfaces of these back teeth have many pits and grooves that can trap food debris and cause cavities. Children and adults alike can benefit from dental sealants, which are a plastic resin that flows into the cleaned out grooves of the tooth, and hardened to make a more shallow, ice-skating like surface for which the food debris can be more readily brushed away. Sealants should be checked at your regular dental visits and redone periodically if wear or breakdown is evident.
What do I do if my toddler won’t let me brush their teeth?
There are a few techniques you can pull out of your arsenal. The first is to have several different fun tooth brushes to choose from. When you go to brush their teeth with one of them, they will reach out and grab it from you. Then you pick up another brush and try to brush their teeth with that one knowing that they will now grab that brush from you with their other free hand. Now that both of their hands are occupied, you can go in with a third brush, preferably an electric one so you can get more accomplished in less time. Another technique is to say all the things you might see in there, recalling their meals and snacks that day as you brush (i.e. “I see a little pretzel there, let me get that away….oh look a piece of chicken, let me get that piece of cookie out…”, etc.). You can try brushing to music or while they are watching a show, or doing anything fun and creative. If all else fails, then try the two person technique where one person holds the legs down and the other straddles the head while pinning their straight arms along the side of their head. They will cry and scream, which is good because their mouths will now be wide open. Within several times of doing this they will start to realize that it is just easier to allow you to brush them without resistance, and they won’t remember this experience anyway.
My baby has white patches inside the mouth. What causes this?
It most likely could be caused by a common and harmless yeast infection known as thrush. Thrush looks like cottage cheese on the sides, roof, and sometimes the tongue of a baby’s mouth. Usually you will find it in babies 2 months and younger, but it can appear in older babies as well. What happens is that after your baby is born, antibiotics taken by you (if you’re breastfeeding) or your baby can trigger a case of thrush. These antibiotics kill off the “good” bacteria that can prevent a yeast imbalance. Often moms and babies pass the infection back and forth: Your baby can pass thrush on to you if you’re breastfeeding, resulting in a painful yeast infection on your nipples that would require a doctor’s treatment. And you can trigger a case of thrush in your baby if you’re breastfeeding and you develop a yeast infection on your nipples from taking antibiotics.
Does it really matter if my child has a cavity in their baby tooth; they will lose it soon anyway?
Yes, it does matter. Baby molars enter the mouth around the age of 2 years of age. If a cavity develops early on, that cavity is only going to keep growing down deeper towards the nerve. Since these baby molars aren’t lost until the age of 10-12 years of age, there is plenty of time for unnecessary, preventable damage to occur. As the cavity grows, the child may wind up needing a baby root canal or an extraction if an infection develops or if there not enough good tooth structure to utilize for a restoration. These baby teeth are fundamental to a child’s health and development, and they also maintain the space for the adult teeth to grow into.
What happens if a baby tooth comes out too early?
Baby teeth (dentists call them primary or deciduous teeth) aren’t just for chewing. Each one also acts as a guide for the permanent tooth that replaces it. If a primary tooth is lost too early, the permanent tooth loses its guide and can drift or erupt incorrectly into the mouth. Neighboring teeth also can move or tilt into the space, so the permanent tooth can’t come in. Primary teeth can be lost too early for several reasons: They can be knocked out in a fall or other accident; Extensive decay can require that a primary tooth be extracted; Primary teeth can be missing at birth; some diseases or conditions can contribute to early tooth loss. If your child loses a primary tooth before the permanent tooth is ready to come in, or if the permanent tooth is missing, your dentist may decide to use a space maintainer. The space maintainer keeps the space open until the permanent tooth comes in.
What are space maintainers, and are they really necessary?
Space maintainer are designed to maintain the open space left behind by the premature loss of a baby tooth, so that the adult tooth will be able to erupt into that space properly. Space maintainers can be made of steel and/or plastic, and can be made to be either removable or fixed in place. These devices can have an artificial tooth to fill in the space in more esthetic areas. Not every tooth that is lost requires a space maintainer. Usually if one of the four upper front teeth is lost early, the space will be maintained on its own until the permanent tooth comes in. Your dentist will periodically take an x-ray to follow the growth progress of the adult tooth. When it is ready to erupt, the space maintainer will then be removed.
What can be done to address the large space (diastema) between my child’s front teeth?
This gap or space, (aka diastema) most often occurs between the two upper front teeth. It is normal to have this diastema during some stages of dental development. The space eventually closes after the permanent canine teeth (eye teeth) erupt into the mouth. However, in some people, the space does not close. If that is the case orthodontic treatment may become necessary. If this gap is caused by an overly large frenum (thick gum tissue above and between your front teeth) then orthodontic treatment would not be effective here. In that case a frenectomy (removal of that tissue) would be indicated to allow the teeth to come together again. If the large space is due to undersized lateral incisors (the teeth next to the two front ones) then bonding, crowns or veneers may become indicated to help close the gaps.
Why do some teeth grow behind another? What should be done when that happens?
Teeth are normally supposed to grow beneath the tooth it is replacing, as to slowly cause the roots of the baby teeth to be resorbed as the adult teeth grow in. As the roots are being resorbed, the baby teeth will start to loosen and come out on their own. On occasion, the adult teeth will grow in differently, usually towards the inside of the mouth when this happens. If the second set of teeth are growing inside of the teeth they are supposed to replace, then the first set would need to be removed by your dentist in order to create the space needed to allow for the adult tooth to grow into the right position. In most cases the tongue will naturally guide the tooth into the correct position. In some cases, when there is too much crowding, interceptive orthodontics may become necessary to help create the space necessary for the adult teeth that are growing in.
What are Peg laterals?
Peg Laterals are your top lateral incisors (the teeth on either side of your upper front teeth) which on occasion, can grow in peg shaped form. It is an anomaly that happens in about 5% of the population. Peg-shaped upper lateral incisors tend to be hereditary to some extent. It is often referred to as microdontia, which means teeth that are smaller than normal. Usually this condition is bilateral (occurring on both sides of the mouth). However, occasionally, an upper lateral incisor can be missing on one side and peg-shaped lateral present on the other side.
What should be done to treat a peg shaped tooth (Peg laterals)?
Individuals with Peg-shaped lateral incisors can have bonding, veneers or crowns placed over or around this smaller tooth to create the illusion of proper shape and proportion. Typically, it is recommended to do bonding until the patients jaw and teeth stop growing, and then place a more permanent restoration, such as a veneer or ceramic crown, once the growth has ceased.
How many people are born missing one or more of their adult teeth?
The failure of one or more teeth to develop (partial anodontia), is an anomaly that occurs in a small percentage of the population. The most common teeth to be congenitally missing are the third molars (wisdom teeth), lower second premolars, and the upper lateral incisors (in that order). In fact, there is about a 25% chance that someone will not develop one or more of their wisdom teeth. Additionally, the congenital absence of a baby tooth is not common. However, if this were to occur, it is most likely the upper lateral baby incisor that is missing. In these cases, when a baby tooth is not present, it becomes highly unlikely that its permanent replacement will develop as well.
How many people are born with extra teeth?
Extra teeth (referred to as supernumerary teeth), occur approximately 2% of the time in the adult set of teeth, and less than 1% in the child’s first set of teeth. Most of these extra teeth (about 90%) will occur in the upper arch of teeth (maxilla). Supernumerary teeth may also be referred to as polydontia or hyperdontia, with the most common type being the mesiodens (an extra tooth that tends to form between and just inside of the upper two front teeth. Most of the time, these extra teeth don’t even come through the gums, and they are discovered when taking an x-ray in that area. Other types of supernumerary teeth include the rare fourth molar (also referred to as paramolar or distomolar). Multiple supernumerary teeth are very rare in people that don’t have any syndrome or disease associated with it. It is more common to be missing certain teeth, than to develop extra teeth.
My dentist told me I have a double tooth. Why does this happen, and is there any way to make it appear more like a normal, single tooth?
A double tooth, or joined tooth occurs in one of a few ways.
- Fusion – where two separate teeth are attached together, sharing the dentin and enamel (the inner and outer layer of tooth structure) and often sharing the pulp chamber (where the nerves of the tooth are located) as well. The roots are separate.
- Gemination – is when you have what appears to be two teeth developing from a single tooth germ, sharing the pulp chamber and the root. When you count the teeth, it would still appear that you have the correct number of teeth, unlike fusion, where the count would be reduced.
- Concrescence – is different than germination in that the joining of tooth roots by cementum (the outer layer of the root) occurs after tooth formation is complete. This condition doesn’t have much clinical significance unless you need to have the tooth extracted. If this were to become necessary, careful examination of the x-rays would be very important.
There are ways to make a fused tooth appear to be more like a single tooth. This may involve some reshaping of the enamel, some bonding to add better anatomy, and sometimes the use of porcelain veneers to create the individualized appearance.