Pediatric Dentistry

When should I first bring my child to the dentist?

The American Academy of Pediatric Dentisty  suggests that a child first be seen by a dentist when the first baby tooth erupts, or by the age of one year.   At this visit, the parent holds the child on his or her knee while the dentist sits facing the parent knee to knee.  While the child will not yet have all of his or her baby teeth in place by the age of one, a visual inspection allows the dentist to assess for the beginning of early childhood decay (nursing bottle caries) and to council the parents on any obvious problems that appear to be developing.  It also creates a record for the child and the parents.
Most childhood falls that result in injuries to the teeth happen between the ages of  two and three, while the child is learning to coordinate his movements.  In an emergency, parents are very glad to have the telephone number of a sympathetic doctor who already knows their baby

Having said this, it is very rare to find a general dentist who will do an actual procedure, like a filling or an extraction on a child under the age of three.  If it is absolutely necessary to do a procedure on a very young child, the general dentist usually refers to a pedodontist (a children”t dentist) who can sedate him or her, or an oral surgeon who can “sleep” the child.

Fluoride and children

I have written an entire page on the advantages, disadvantages and controversy surrounding fluoride (along with a rather amusing letter from an antifluoridationist).  In general, fluoride is a well accepted fact of life in American dentistry.  We use it in toothpastes, mouth rinses, topical applications, for desensitizing teeth, remineralizing decay, and as a dietary supplement for children.

Topically applied fluoride creates a coating of decay resistant armor which lasts for several days on the surface of the teeth, and penetrates into decayed areas of teeth to help remineralize them.  (Fluoride binds with decayed tooth structure and encourages it to recombine with calcium in the saliva to begin the process of hardening the decay.)  We recommend it in all the toothpaste you buy so everyone in the family can enjoy this protection.

We also recommend that children under the age of 12 receive daily doses of fluoride in tablet form, or in the municipal water supply.  This form of fluoride is incorporated into the actual structure of the teeth that are developing at that time, and imparts some lifelong protection against decay.

One word of caution however.  Very young children often mistake the toothpaste placed on their toothbrushes for candy and will actually eat it.  The amount of fluoride in toothpaste vastly exceeds the amount recommended for internal consumption, and the child may get too much of a good thing.  Excess fluoride in the diet of children with developing teeth can cause fluorosis of the teeth.  This causes orange, brown and white spots in the enamel of the adult teeth which are forming at the time of the overdose.  We recommend that you supervise the use of fluoride containing toothpastes by young children, or that they use non fluoride containing toothpaste until they are old enough to understand that toothpaste is not candy.

When children come in for an exam and cleaning, it is routine for us to use a fluoride tray application which contains prescription strength fluoride for longer lasting protection, and in order to help stop decay already present.  Adults do not receive this service even though it would benefit them also. The reluctance of the profession to provide fluoride treatments to adults probably stems mostly from the perception by the general public that fluoride is only