Let’s Talk Teeth

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Kid-friendly care keeps teeth strong and children happy. Discover how pediatric dentists and orthodontists can benefit your child.

by Paula M. DeWitt

Growing up in the ’60s, a trip to the dentist was on par with eating broccoli: something you had to do, but definitely didn’t want to. My memories are of a grim-faced man poking around in my mouth. Ouch! His waiting room was unappealing and not at all kid-friendly. Back then, most dentists were general dentists and their offices were primarily arranged with adults in mind.

Times have changed. Over the years, large numbers of dentists have entered a field called pediatric dentistry. These practitioners deal exclusively with children, having acquired two additional years of training in pediatrics after dental school. “Pediatric dentists are to dentistry what pediatricians are to medicine,” says Buzz Alexander, D.D.S., of the Pediatric Dental Clinic in Franklin.

Not to say a general dentist isn’t a good choice for your child. If you have a relationship with a family dentist you like and trust, sticking with that person might be best for you. But if you don’t, consider a pediatric dentist.

Featuring bright, happy colors, toys and reading materials that children enjoy, pediatric dental offices are designed just for them. It’s not uncommon for kids to watch a Disney video while they have their teeth cleaned or play Pac Man games in the waiting room. The office staff works only with pint-size patients, so they have a special knack for dealing with them. This child-friendly approach can work wonders for children who are especially fearful or strong-willed, or for special-needs children.

 

THE FIRST DENTAL VISIT

Many pediatricians and general dentists recommend kids be seen for the first time at age 3 or 4. But pediatric dentists suggest children be seen as early as age 1 or 2. Alexander recommends a free “get acquainted” visit around age 1. Regular visits for cleaning and exams should start at age 2. However, if parents see anything unusual, like brown spots, which could indicate tooth decay, an office visit is needed. “Even at 14 or 16 months, a child could have a real problem.” Once dental visits are started, children should be seen every six months, he adds, “because kids’ teeth change rapidly. When they get cavities, the decay advances more rapidly than it does in adults.”

Once you make the first appointment, how should you prepare your child? A visit to the library or bookstore may help. There are many books and videos available dealing with visiting the dentist, like The Berenstain Bears Visit the Dentist or Barney Goes to the Dentist.

It’s important to explain, in a simple way, what will happen during the visit. “Don’t use the words ‘hurt, drill, or shots,’” notes David Lewellen, D.D.S., of David A. Lewellen Pediatric Dentistry in Madison and Brentwood Dental Pediatrics. Such words can cue fears in a child.

What if your child has cavities? Twenty years ago, silver fillings were preferred by dentists because they were far more durable than the more attractive tooth-colored fillings. But tooth-colored material is much sturdier today, says Lewellen, and a more frequent choice than it used to be. When preparing a tooth for filling, a shot of Novocaine into the gum numbs the mouth, but nitrous oxide, or laughing gas, is very safe and works well to alleviate fear.

 

EMPHASIZE PREVENTION

As soon as an infant begins getting teeth, usually around six months, they should be cleaned, even if it’s just with a wash cloth and some water. One of the most common problems in infants and toddlers is baby bottle mouth — decay caused by prolonged dependence on a bottle. “Children should be taken off the bottle by nine to 12 months,” says Alexander. “One of the worst things we see is apple juice in the bottle,” he adds, “because of all the sugar it contains. In terms of juices, it’s better to choose orange juice, white grape or V-8.” Sippy cups left for a child to drink continuously throughout the day can be a source of cavities as well.

If children are predisposed genetically to tooth decay, their permanent molars can be coated with a preventive sealant for about $40 per tooth. “This seals the grooves so food and bacteria won’t get in and cause cavities,” says Lewellen.

Brushing with plain water can suffice for older children who don’t like toothpaste, says Alexander. He adds that parents probably need to do some re-brushing. “I see very few kids under age 8 that can do a good job by themselves.” Teeth should be brushed twice a day, with greatest care given to the nighttime brushing. At 18 months, parents should begin flossing their children’s teeth once a day.

Be sure your child is getting fluoride, an important cavity fighter. Tap water in the Middle Tennessee area is fluoridated. Bottled and spring water don’t contain fluoride and some household water filtering systems remove it.

 

ACCIDENTS HAPPEN

Say your child takes a fall and cracks or knocks a tooth out. What should you do? Don’t panic, but do call the dentist’s office immediately. Most dentists try to work emergencies into their schedule, even if they’re very busy. They may not be able to do all of the work that day, but at least your child can get a temporary remedy, including pain relief. Dentists are always on call for emergency situations. If a permanent tooth is knocked out, it’s important to place it back in the socket within 30 minutes in order to save it.

Although a mouth guard is critical and usually required for contact sports, “most of the accidents I see are not from organized sports,” notes Lewellen. They’re just the result of ordinary play and “kids being kids.” Not surprisingly, accidents bring twice as many boys as girls into his office.

 

WHAT ABOUT BRACES?

The idea of braces can be a scary one for both parents and children, but for different reasons. Parents fear the cost; children, the embarrassment. But there’s good news. Today, many dental insurance plans pay for a portion of braces and innovations over the last 20 years have helped to make them more appealing.

Most children still get stainless steel, says orthodontist Harry Legan of the Vanderbilt Orthodontic Center, but they’re not nearly as clunky as they were in the past. Far less metal is used today and the elastic ligatures used on braces are available in a range of colors for a touch of style. Translucent braces are also available, made of a plastic close to tooth color, though not quite invisible. While it’s certainly an option today, Legan says these are not as efficient as metal because they tend to crumble and discolor. Truly invisible braces — placed inside the teeth — are “very inefficient,” he notes and are not recommended.

What would braces cost you? About $3,000 to $4,000 on average, says Legan. The average insurance plan will pick up about $1,500 of the tab. Typically, a child will be in braces for two years, with two initial appointments to fit them. After that, once-a-month check-ups are required.

Once braces come off, it’s common to wear a retainer for an additional two years. However, today some children continue to wear retainers on lower teeth for up to ten years, although not continuously. “The lower teeth are much more inclined to change position over a lifetime,” Legan notes.

How do you know if braces are needed? A parent may suspect a child needs braces for a variety of reasons, such as an overcrowded mouth, crooked or “buck” teeth, or problems in the fit between upper and lower jaw. The child should be examined by either a professional pediatric dentist or orthodontist. Many pediatric and family dentists affix braces, though some will refer you to an orthodontist — a dentist with an additional three years of specialized training fitting braces and other orthopedic appliances.

 

Typically, children get braces around age 12 or 13, once all of their permanent teeth have come in. But early intervention, called “interceptive orthodontics,” may occur as early as age 7. Interceptive orthodontics usually entails getting a partial set of braces at an early age to correct a specific, evident problem. Although this won’t usually alleviate the need for a full set of braces down the road, it can save money in the long run. Legan suggests parents get more than one opinion on whether interceptive orthodontics is right for their child.

While dentistry and orthodontistry pose very little risk to children, there is an increased risk of tooth decay for those who don’t keep their braces clean. Of course, braces or not, good hygiene is important in keeping teeth clean, healthy and cavity-free. Although prevention alone doesn’t assure a perfect mouth (genetics has a lot to do with it), it does go a long way.

Whether you opt for a family dentist or a pediatric dentist, don’t just look in the phone book, says Alexander. He suggests asking friends and relatives for recommendations of dentists they like. Pediatricians are another source for recommendations. Make sure that if you feel strongly about a particular issue — being with your child in the treatment room, for example — the dentist you choose agrees.

 

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