Dental Topics

Anxious about Bringing Your Child?
Many parents are concerned about the apprehension their children may have regarding a dental visit. Many of these parents have had less than pleasant experiences themselves and know the difficulty they have with dental treatment as a result.  Part of Dr. Tawadros’ philosophy of care is to create a community of patients and successive generations who are free of dental phobias.
Respect and communication opens the channels of trust between our staff and your child.  Through Dr. Tawadros’ education and experience, and by his example, we have become excellent communicators with children. We tell children what we are going to do in terms they understand, we show them how we will accomplish this goal, and then we do it. This method may seem to take more time, but Dr. Tawadros believes children should be allowed to ask questions about their care, and also need to be reassured that we are here to help. 
Our office environment goes a long way in reducing your child’s fears.  Children are encouraged to be themselves in our reception area with activities and books.  The colors and wild animal décor are soothing yet fun (there can be no mistaking our office for anything but a pediatric practice).  Our staff is very dedicated to the families in our practice, so getting to know your child and remembering what makes them special is fun for us.  More importantly, it is comforting to your son or daughter to know we value them as a person, not as a set of teeth! 
In some situations general anesthesia offers the best and safest method to deliver dental care without creating/reaffirming a patient’s fears. See GENERAL ANESTHESIA page. 
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Why See a Pediatric Dentist?
A pediatric dentist is a dentist who has more specialized training for two to three years upon completion of dental school.  This training is focused on dental health of children from infancy through the teenage years.  Infants, pre-teens, teens and adults have different risks, development patterns, recommended care, and behavior management techniques.  Your child is not simply a small adult, but an individual with continually changing physical and emotional needs. A pediatric dentist like Dr. Tawadros can help your family navigate through these fun but challenging stages in your child’s life.
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 Your Child’s First Dental Visit
The American Academy of Pediatric Dentistry (AAPD), recommends your child should visit the dentist by his/her 1st birthday. To prepare your child for his first visit, let them know they are coming and let them know we will answer all of their questions upon arrival.  We have found telling children “what will happen” prior to their visit causes their anxiety level to rise, no matter how kindly it is stated. 

See FIRST VISIT page
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 Why Are The Baby Teeth So Important?
It is very important to maintain the health of the primary teeth. We do not fix primary, or baby teeth, because we care so much for the baby teeth, but more from concern for the permanent teeth. Primary teeth are important for (1) providing space for the permanent teeth and guiding them into the correct position and (2) because cavities are an infection that left untreated will spread, so an infected baby tooth will infect permanent teeth as they come in.  So, in summary, we want the permanent teeth to come in as straight as possible, and as healthy as possible.
Primary teeth are also important for proper chewing and eating.  Studies show that after taking a child who has multiple areas of decay through dental treatment to a healthy state, most will advance in position on the height/weight growth chart.
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Why Do We Use Radiographs (X-Rays)?
Dental radiographs (X-Rays) are a vital and necessary part of properly diagnosing and preventing certain dental conditions. Without x-rays, those conditions can and will be missed.  Although bitewing radiographs are used to detect cavities forming between the teeth, they have other important functions.  For example, radiographs may be needed to survey erupting teeth, diagnose bone diseases, evaluate the results of an injury, or plan orthodontic treatment. Radiographs allow dentists to diagnose and treat health conditions that cannot be detected during a clinical examination.
Dr. Tawadros, as do most pediatric dentists, requests bitewing radiographs be taken once a year. The American Academy of Pediatric Dentistry recommends radiographs and examinations every six months for children with a high risk of tooth decay.  Approximately every 3 years it is a good idea to obtain a set of survey x-rays, either a panoramic or full-series of bitewings and periapicals.  Our office utilizes panoramic radiographs to monitor tooth eruption and development, and bone formation and development.  Again, without these radiographs, certain dental conditions can and will be missed.
It is a standard in the dental field, and bodies governing dental equipment and care to minimize the exposure of patients to radiation.  With contemporary safeguards, (lead aprons and filters, faster film speed) the amount of radiation received in a dental X-ray examination is very small, less than .01% of radiation the average person receives in one year. The risk is negligible in comparison to the benefit your child receives when untreated dental problems are detected with radiographs. When dental problems are found and treated early, dental care is more comfortable for your child and more affordable for you.
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How to Prevent Cavities
When we look for causes of tooth decay that we can control, we look at a child’s diet and oral hygiene. 
Accepted oral hygiene practices such as brushing twice a day and flossing at night are used to remove food and the bacteria that feeds on the food.  If left in our mouths, the bacteria will ingest the food that hasn’t been brushed/flossed away and the by-product is tooth decay. 
For infants, use a wet, clean cloth over your finger to wipe the plaque from teeth and gums.  Putting your infant or toddler to bed with a bottle filled with anything other than water, puts your child at high risk for cavities. See "Baby Bottle Tooth Decay" for more information.
Children and adults should brush teeth at least twice a day with a soft bristled toothbrush.  Flossing prior to bedtime is essential in preventing cavities from forming between teeth and also prevents bone loss and gingivitis.
By diet we refer to 1) what foods we eat and 2) how frequently we eat.  Watch the number of snacks other than water, fresh fruits and some cheeses that you give your children.  While good for your child, sports drinks, juice, soda, and milk are very dangerous for his/her teeth if sipped over an extended period of time.  Any drink other than water should be drunk all at one time (or throughout a meal). 
Regular visits to the dentist starting by age one (as recommended by the American Academy of Pediatric Dentistry) will give your child opportunity for a healthy dental future.
Sealants are a great way to prevent cavities on the chewing surfaces of your child’s permanent teeth. See Sealant Protection.
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Oral Hygiene Care for Your Child
Begin daily brushing as soon as the child’s first tooth erupts.  If your infant cannot tolerate a toothbrush a wet washcloth swabbed around the mouth will suffice. A pea size amount of fluoride toothpaste can be used after the child is old enough not to swallow it (typically around age 2-3).
By age 4 or 5, children should be able to brush their own teeth twice a day with supervision (meaning mom or dad gets a turn) until about age seven. However, each child is different. Dr. Tawadros and his hygienists can help you determine if your child has the hand-eye coordination to brush properly on their own.  Choosing an age appropriate sized toothbrush with soft bristles is important for all ages.
When teaching younger children to brush, simply make sure the toothbrush is half on the tooth, half on the gum line.  Brush back and forth along each tooth, front and back sides and chewing surfaces. Finish by brushing the tongue which harbors many cavity and odor-causing bacteria. As long as a soft bristled toothbrush is used, you cannot hurt your child by brushing their teeth.
When teaching older children to brush, place toothbrush at a 45 degree angle pointing towards the gum line and begin to brush in a gentle circular motion. Brush all surfaces (front, chewing, and tongue-side) thoroughly.  Finish by brushing the tongue which harbors many cavity and odor-causing bacteria.

Flossing removes food particles and plaque where no rinse or toothbrush bristles will reach. Floss between any two teeth that touch. You should floss your child’s teeth until he or she can do it alone. There are two methods of flossing that we employ. 1) Floss holders that have a large handle (one brand we use is Wild Flossers) and the floss already loaded are great for flossing your child’s teeth. 2) Use about 18 inches of floss, winding most of it around the middle fingers of both hands. Hold the floss between the thumbs and forefingers. In either scenario, use a gentle, see-saw motion to place the floss between the teeth. Gently slide the floss against the side of each abutting tooth.  Take care not to miss backside of the last four teeth.
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Does our Diet Really Matter?
Yes, but perhaps not in the way you think.  Children should, of course, eat a variety of foods from the five major food groups. You may not be aware, however, that most snacks that children eat can lead to cavity formation, not just candy. Pretzels, dry cereal, potato chips, and fruit snacks are often culprits in cavity formation.  If your child must snack, choose nutritious foods such as water, fresh fruits and vegetables, low-fat yogurt, and low-fat cheese which are healthier and better for children’s teeth.

The more frequently a child snacks, the greater their chances for tooth decay.  When we eat bacteria in our mouth feed on carbohydrates we chew.  The by-product of this is acid which attacks tooth enamel.  When we are done eating, the acidity returns to normal as our saliva washes the food and bacteria away.  If your child is snacking or “grazing” throughout the day instead of sitting down and eating a snack all at one time, the bacteria have more opportunities to feed and create acid.  The same goes for drinks as well.  While they are good for your child, sports drinks, juice, soda, and milk are very dangerous for his/her teeth if sipped over an extended period of time.  Any drink (other than water) should be drunk all at one time (or throughout a meal), not sipped.
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Sealant Protection
Sealants are thin protective plastic coatings that fill the grooves found on chewing surfaces of molars and premolars.  Sealants prevent food and bacteria from settling in those areas, which are the most decay-prone for permanent teeth.  Dr. Tawadros routinely recommends sealants for all permanent teeth behind the cuspids, or canines.  The procedure is very patient-friendly, and very effective.
Dr. Tawadros does not routinely recommend sealants for primary teeth because your child is just as likely to develop cavities in-between primary teeth as they are on the chewing surface. Therefore, it is not as cost effective to seal a primary tooth, but Dr. Tawadros will do so if parents make a special request or when taking a high-risk patient to the hospital for treatment under general anesthesia.
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Baby Bottle Tooth Decay (Early Childhood Caries)
A serious condition we see often in our practice is baby bottle tooth decay.  To a parent, the upper front teeth look as though they are chipped, turning dark, or sometimes broken to the gum line.  In more serious cases, discomfort, swelling, and fevers accompany these visual signs.
The cause of this pattern of decay is due to a child being put down to sleep with a bottle or sippy cup, hence the name: Baby Bottle Tooth Decay.  When a child falls asleep with a bottle, most often they have pulled in some of the liquid in the bottle without swallowing it all.  The sweet liquid pools around the child’s upper front teeth and there the bacteria feed and produce acids that attack the tooth’s enamel.  
If it comforts your child to fall asleep with a bottle, you may do so safely with water in the bottle.  If your child won't fall asleep without its usual beverage, gradually dilute the bottle's contents with water over a period of two to three weeks. 
If you can wipe your baby’s gums and teeth with a wet washcloth after they fall asleep (without waking them up too much), do so.
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Teeth Coming, Teeth Going..
There is a wide range of normal ages in which teeth can first begin to erupt into your child’s mouth. At anytime from 4 months to over 12 months can the first primary teeth come in.  The first teeth to erupt are the two lower central incisors, followed by the two upper central incisors.  Next, first molars, then canines, and lastly the second molars.  Most of the 20 primary teeth have usually erupted by age 3.
We do not become very concerned with the chronological age of eruption, however, we do take note if the order of eruption does not follow the usual pattern.
The age baby teeth are lost and permanent teeth begin appearing is between ages 5-7, beginning with the lower central incisors and the eruption of the first permanent molars which erupt behind all the 20 baby teeth. This process can continue up until age of 21.
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Dental Emergencies
Toothache: Clean the area of the affected tooth thoroughly. Rinse the mouth vigorously with warm water or use dental floss to dislodge any impacted food or debris. If the pain still exists, contact your child's dentist.  DO NOT place aspirin or an over the counter gel on the gum or on the aching tooth. If the face is swollen apply cold compresses and contact your dentist immediately.
Cut or Bitten Tongue, Lip or Cheek: Apply ice to bruised areas. If there is bleeding apply firm but gentle pressure with a gauze or cloth. If bleeding does not stop after 15 minutes or it cannot be controlled by simple pressure, take the child to hospital emergency room.
Knocked Out Tooth: Find the tooth. Handle the tooth by the crown, not the root portion. You may rinse the tooth but DO NOT clean or handle the tooth unnecessarily. Inspect the tooth for fractures. If it is sound, try to reinsert it in the socket. Have the patient hold the tooth in place by biting on a gauze. If you cannot reinsert the tooth, transport the tooth in a cup containing the patient’s saliva or water. If the patient is old and calm enough, the tooth may also be carried in the patient’s mouth. The patient must see a dentist IMMEDIATELY!  Time is a critical factor in saving the tooth.
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Fluoride
Fluoride is an element, which has been shown to be beneficial to teeth. However, too little or too much fluoride can be detrimental to the teeth. Little or no fluoride will not strengthen the teeth to help them resist cavities. Excessive fluoride ingestion by preschool-aged children can lead to dental fluorosis, which is a chalky white to even brown discoloration of the permanent teeth. Many children often get more fluoride than their parents realize. Being aware of a child’s potential sources of fluoride can help parents prevent the possibility of dental fluorosis.
Some of these sources are:

  • Swallowed fluoridated toothpaste .
  • Public water supply (drinking fountains, etc.).
  • Fluoride supplements.
  • Hidden sources of fluoride in the child’s diet (canned fruits and vegetables).

Two and three year olds may not be able to expectorate (spit out) fluoride-containing toothpaste when brushing. As a result, these youngsters may ingest an excessive amount of fluoride during tooth brushing. Toothpaste ingestion during this critical period of permanent tooth development is the greatest risk factor in the development of fluorosis.
Excessive and inappropriate intake of fluoride supplements may also contribute to fluorosis. Fluoride drops and tablets, as well as fluoride fortified vitamins should not be given to infants younger than six months of age. After that time, fluoride supplements should only be given to children after all of the sources of ingested fluoride have been accounted for and upon the recommendation of your pediatrician or pediatric dentist.
Parents can take the following steps to decrease the risk of fluorosis in their children’s teeth:

  • Use baby tooth cleanser on the toothbrush of the very young child.
  • Place only a pea sized drop of children’s toothpaste on the brush when brushing.
  • Account for all of the sources of ingested fluoride before requesting fluoride supplements from your child’s physician or pediatric dentist.
  • Avoid giving any fluoride-containing supplements to infants.
  • Obtain fluoride level test results for your drinking water before giving fluoride supplements to your child (check with local water utilities).

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“Mom my lip feels funny…”
If your child has had local anesthetic for their dental procedure: 

  • If the procedure was in the lower jaw... the tongue,  teeth,  lip and surrounding tissue will be numb or asleep.
  • If the procedure was in the upper jaw... the teeth,  lip and surrounding tissue will be numb or asleep.

Please monitor your child closely for approximately two hours following the appointment.  While the anesthetic is wearing off, there will be a tingling sensation that may last for up to twenty minutes.  While adults are familiar with this sensation, your child may perceive this as an ache.  Assure them it isn’t pain, but is waking up and will return to normal shortly.  It is sometimes wise to keep your child on a soft diet until the anesthetic has worn off if they received anesthetic in the lower jaw.
Often, children do not understand the effects of local anesthesia, and may chew, pinch, suck, or play with the numb lip, tongue, or cheek.  These actions can cause minor irritations or they can be severe enough to cause swelling and abrasions to the tissue.  If this happens, call our office immediately so we can instruct you on how to help your child heal more quickly. 

Please do not hesitate to call our office if there are any questions.
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Thumb Sucking/Pacifier Use
Sucking is a natural reflex and infants and young children may use thumbs, fingers, pacifiers and other objects on which to suck. It may make them feel secure and happy or provide a sense of security. Thumb sucking that persists can cause problems with the proper growth of the mouth and tooth alignment. Over time, a child’s thumb or finger acts as an orthopedic appliance and the upper jaw and front teeth form around it. Most children cease sucking their thumb around age 2-3. Peer pressure causes many school-aged children to stop.
Pacifiers should not be used as a substitute for thumb sucking. In fact, they can affect the teeth essentially the same way as sucking fingers and thumbs. However, use of the pacifier can be controlled and modified more easily than the thumb or finger habit. If you have concerns about thumb sucking or use of a pacifier, call our office to consult with Dr. Tawadros.
A few suggestions to help your child get through thumb sucking:

  • Instead of scolding children for thumb sucking, praise them when they are not.
  • Children often suck their thumbs when feeling insecure. Focus on correcting the cause of anxiety, instead of the thumb sucking.
  • Children who are sucking for comfort will feel less of a need when their parents provide comfort and encouragement vs. punishment for sucking.
  • Reward children when they refrain from sucking during difficult periods, such as when being separated from their parents.
  • Dr. Tawadros can encourage children to stop sucking and explain what could happen if they continue.
If these approaches don’t work, Dr. Tawadros may recommend the use of a mouth appliance.
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Mouth Guards
Spring and summer bring many patients with sports injuries into our office.  When a child begins to participate in just about any recreational activity or organized sport, injuries can occur. A properly fitted mouth guard is an important piece of athletic gear that can help protect your child’s smile, and should be used during any activity that could result in a blow to the face or mouth.  We very seldom see injuries from sports such as hockey, football, or boxing because they require the use of a mouth guard.  Baseball, basketball, soccer, bike riding are more frequent avenues to dental injury without a mouth guard. 
Mouth guards act as a shock absorber to help prevent broken teeth, a broken TMJ, broken jaw, injuries to the lips and tongue.  A properly fitted mouth guard will stay in place while your child is wearing it, making it easy for them to talk and breathe.  Almost all mouth guards work the same way…If you wear it, it will work. If you don’t wear it, it won’t work.  We can make you a custom made mouth guard that is more comfortable than the store-bought ones because it is tailored to your smile, however, it will also be more expensive than a store-bought version.  The most important thing to remember is to wear one!
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