One of our most common consults occurs when children around the age of 7 begin to lose their lower front teeth. Many of our parents become overly worried about this phenomenon. It is VERY NORMAL for permanent lower incisors (front teeth) to erupt behind their predecessors (baby teeth), however if a baby tooth is not loose by the time half of the permanent incisor has erupted, it may be necessary to pull it.

When a baby tooth changes color, it can mean many things. Baby teeth can and do normally change in color, particularly close to the time that they become loose; however, this change is minimal and should not be confused with a carious lesion (cavity). The best way to determine if your child has a stain or a true cavity is to take him or her to a pediatric dentist. Caries is an infectious disease; it progresses if left untreated, and usually is associated with pain (especially when the cavities are large). Teeth with cavities typically assume a darker (brown) discoloration; and depending on the extent, may exhibit loss of tooth structure. Teeth that have been previously 'bumped' may also change in color. Traumatized baby teeth can assume a yellow or a dark discoloration, which may or may not be associated with pain. Other less common causes of changes in color may be: fluorosis, food staining (particularly tea or colas), systemic disease (hepatitis), etc.

Crooked or crowded teeth are very common in the growing patient. Even patients that get braces may develop a minor degree of crooked (crowded) teeth, particularly in the front teeth of the jaws, as they grow old. The first step in determining the need for treatment is what we call an orthodontic consult. During this appointment, we may obtain special records and special x-rays of your child's jaw. This information will allow us to make a decision based on predicted growth patterns that your child may show later. In orthodontic terms, we refer to this as Early Treatment. Early Treatment refers to ANY orthodontic (braces) or orthopedic appliances (like Headgear) treatment that begins when the child is in primary dentition or in early mixed dentition (when the first permanent teeth begin to erupt). Early Treatment has been proven to be effective despite objections by some people in the orthodontic community. The American Academy of Pediatric Dentistry (AAPD) recognizes that early diagnosis and successful treatment of developing malocclusions can have both short-term and long-term benefits, while achieving the goal of occlusal harmony, function, and facial aesthetics.

How is that going to affect him or her?

Children require extraction of one or more primary teeth in certain situations. These situations may include extensive decay on their front teeth, and/or localized infection (for example an abscess or a gum boil).

Extractions are also necessary in cases of trauma, where the baby teeth have been pushed back, pushed forward, broken or simply knocked out.

Parents are obviously concerned of the aesthetic and functional effects (on speech, feeding, and breathing) of removing one or more front baby teeth.

There is good evidence that has shown NO long-term speech impediments on these cases. We also know from our professional experience that once the gums heal, children will be able to eat almost anything, since they can still bite-and-cut with the remaining teeth.

As far as aesthetics is concerned, your pediatric dentist can offer you information on fixed appliances that can replace the missing tooth/teeth, assuming your child meets the right criteria.

It is normal and even "ideal" for baby teeth to have spacing between each other.

Keep in mind that when permanent teeth erupt, their size will be considerably larger than that of baby teeth. As the baby teeth are lost, the erupting permanent tooth will quickly take advantage of this excess space.

Children who do not have spacing in their primary dentition can have a higher incidence of crowding (crooked teeth) in the permanent dentition.

Generally speaking, a soft bristled toothbrush is best. Whether you use a manual toothbrush or an electric, anything harder than soft, is too hard. Stiff bristles may give you that clean feeling, but they can also abrade your teeth and cause gum recession.

There is no such thing as the best toothpaste. We recommend ONLY products that have been ADA (American Dental Association) accepted or approved.The selection is usually made on a case-by-case basis, however the main consideration when selecting toothpaste is your child's age.This is due to the risk of fluorosis in younger children that swallow toothpaste during regular brushing. A child may face the condition called enamel fluorosis if he or she gets too much fluoride during the years of tooth development. Too much fluoride can result in defects in tooth enamel.

By swallowing too much fluoride for the child's size and weight during the years of tooth development, a child can develop enamel fluorosis. This can happen in several different ways. First, a child may take more of a fluoride supplement than the amount prescribed.Second, the child may take a fluoride supplement when there is already an optimal amount of fluoride in the drinking water.Third, some children simply like the taste of fluoridated toothpaste. They may use too much toothpaste, and then swallow it instead of spitting it out.

This is the one of the most commonly asked questions that we get from our patient's parents. We try to minimize the discomfort of the injection by placing a gel that works as a local anesthetic and numbs the tissue were the injection will be administered. Profound local anesthesia is usually obtained five to ten minutes after the injection, depending on the area of the mouth where the anesthetic was placed. We always check to confirm that the area is numb before we begin to work. In cases of localized infection or trauma (like broken teeth), it is very difficult to obtain profound anesthesia. However, we do have other means of supplementing the anesthetic (like conjoined use of nitrous-oxide gas, medications, or conscious sedation). Younger children, particularly pre-schoolers, may interpret the feeling of numbness as pain, and therefore cry. Please follow the post-operative instructions that we give you, in order to minimize complications such as lip biting.

Why is my child's lip swollen and inflamed after having a filling done?

Children, especially the young ones, are at high risk of biting their lips or chewing on the inside part of their cheeks after they receive local anesthetic (a lidocaine shot). The affected area will be red, swollen and painful once the anesthetic wears off (like a canker sore). This usually happens because of their natural curiosity they try to feel the area or areas that are numb. For the first few days, place the patient on a soft, blend diet; avoid, hard, spicy, sour, or hot food because this could cause discomfort for the child. Fortunately, sores in the mouth tend to heal very quickly (3-5 days) with minimal if any scarring. Thus, it is important for parent(s) to remind the child not to bite or scratch his/her cheek/lip/tongue for the first two hours after the procedure.

I heard some children need to be strapped down for dental work, is that true?

Otherwise known as blanket wrap, or safety wrap, a papoose board is a safety tool that a dentist may use with the consent of the parents to help facilitate treatment. When a young child is too active and could not sit still enough for dental treatment, a papoose board physical restraint can be used to minimize the child's movement. Like a car seat that keeps the child secure and safe while riding in the car, the papoose board will secure and minimize the child's movement so that dental treatment can be delivered safely. If the parent(s) does not consent to the use of a papoose board, an alternative treatment approach is to put the child to sleep to have the needed treatment done.

Oral piercings can be bad for your health. Because your mouth contains millions of bacteria, infection is a common complication of oral piercing. Pain and swelling are other side effects of piercing. Your tongue (a popular piercing site in the mouth) could swell large enough to close off your airway. Piercings can also cause uncontrollable bleeding or nerve damage. The jewelry itself also presents some hazards. You can choke on any studs, barbells or hoops that come loose in your mouth, and contact with the jewelry can chip or crack your teeth.

What you eat affects the air you exhale. Certain foods, such as garlic and onions, contribute to objectionable breath odor. Once the food is absorbed into the bloodstream, it is transferred to the lungs, where it is expelled. The odors will continue until the body eliminates the food. People who diet may develop unpleasant breath from infrequent eating.

If you don't brush and floss daily, particles of food remain in the mouth, collecting bacteria, which can cause bad breath. Food that collects between the teeth, on the tongue and around the gums can rot, leaving an unpleasant odor.

Dry mouth occurs when the flow of saliva decreases. Saliva is necessary to cleanse the mouth and remove particles that may cause odor. Dry mouth may be caused by various medications, salivary gland problems or continuously breathing through the mouth.

Tobacco products cause bad breath, so if you use tobacco, ask your dentist for tips on kicking the habit.

Bad breath may also be the sign of a medical disorder, such as a local infection in the respiratory tract, chronic sinusitis, postnasal drip, chronic bronchitis, diabetes, gastrointestinal disturbance, liver or kidney ailment.