1. What is a Paediatric dentist?

A paediatric dentist is a specialist with 3 years additional training in treating children and who deals solely with the oral healthcare of children, from infancy through the teenage years.

2. When should my child’s first dental visit be?

Ideally, your child should see a Paediatric dentist at 12-15 months old, or as soon as the front teeth erupt. This will allow the dentist to carry out an examination to ensure the healthy development of teeth and their supporting soft tissues as well as providing advice on prevention. Parents also have the chance to discuss feeding practices, teething and habits such as the use of pacifiers or thumb-sucking.

An early intervention can help prevent more complex procedure later on. You may also want to see a Paediatric dentist early if your child has a medical condition that puts him/her at risk of having dental problems.

Finally, dental trauma is common in children between 2-4 years old as this is the time they start to walk and have no fear. If your child is more familiar with the dental environment, then should he or she need to make an emergency dental visit, they are less likely to be anxious or frightened.

3. How often should my child visit the dentist?

The common recommendation is every 6 months due to a child’s changing diet, habits and growth. However, your dentist may tailor your child’s visits according to their individual needs and risks.

4. From what age do children’s teeth need to be cleaned?

The simple answer is that teeth should be cleaned as soon as they first appear. Routine cleaning twice per day should involve cleaning only to teeth and the gums.

5. Can young children get tooth decay?

Dental problems can start at an early age. Due to the amount of refined and hidden sugars in our food, a recent publication by the British Society of Paediatric Dentistry stated that 40% of all 5-year-olds in the UK have experienced dental decay. This trend appears to be global, with one in 4 children in the US reported as having tooth decay by the age of 4 and 1 in 10 children experience tooth decay before they are two years old.

In very young children the most common cause of dental decay is caused by frequent use of bottles or on-demand breastfeeding. An early dental visit can identify these problems and hopefully avoid the need for future dental intervention.

Occasionally an illness or some systemic disturbance can affect the developing primary teeth, resulting in poor enamel formation on the teeth. These teeth can decay early and more easily. Therefore an early dental examination around one year of age helps identify these problems, where advice can be given to avoid future dental problems.

6. Does my child need x-rays?

There are many factors which determine if your child needs a dental x-ray. These could include; if the teeth are close together, if there is evidence of dental decay in the mouth or there have been filled teeth in the child’s’ mouth which puts the child in a high-risk category, the dentist may feel that the teeth cannot be examined thoroughly without an x-ray.

With the use of digital radiology, we are happy to say that the dose of radiation received by your child is minimal. We aim to minimise the number of x-rays taken, but it is advised that your child has two small x-rays for caries detection when there is no spacing between the back teeth, at approximately one-year intervals, depending upon individual circumstances.

7. Is fluoride bad for children?

Definitely not, provided it is given in the correct dosage. It is not recommended to give fluoride to children under the age of 6 months as their kidneys are still developing. Fluoridated toothpaste must be used after 6 months on any erupted teeth. Fluoride prevents tooth decay and plays an important role in helping your child keep a healthy smile for a lifetime. The correct amount to use can be easily calculated with the help of your dentist.

8. What are fluoride supplements?

Fluoride supplements can be taken in the form of drops or tablets which have a systemic effect, or a topical fluoride such as mouthwash and various fluoride toothpaste. Use of topical fluoride on a daily basis is recommended in patients at high risk of dental decay when they are able to spit out. Systemic fluoride may be prescribed for your child at a young age if they have had a history of cavities or are likely to develop cavities.

9. My child has a cavity in a baby tooth. Does it need to be filled?

Primary, or “baby,” teeth are important for many reasons. Not only do they help children speak clearly and chew naturally, they also maintain the space for when the permanent successor tooth erupts. Children start losing baby teeth from the age of 6 years, but the primary molars are not lost until 10-12 years of age. If a cavity is not filled, this can lead to pain, infection of the gums and jaws, impairment of general health and premature loss of teeth. This, in turn, can lead to space loss and perhaps create orthodontic problems in the future.

Failure to restore decayed teeth will allow the bacteria that cause tooth decay to multiply in areas of decay, eventually spreads to other teeth and even to the permanent teeth when they come into the mouth.

10. What type of filling should my child have?

The type of filling depends upon many factors such as the size and location of the cavity if the tooth is root treated and how long the tooth is expected to remain in the mouth before exfoliation. White fillings can be used when there is enough healthy tooth tissue to support the filling. In larger cavities and root treated primary molars, stainless steel crowns are recommended.

11. What are stainless steel crowns?

These are preformed crowns made of stainless steel, that are particularly useful in the restoration of grossly broken down teeth, primary molars that have undergone pulp therapy and primary or permanent molars that have developmentally poor quality enamel. Their life expectancy is far greater than any other restoration for primary posterior teeth in those circumstances, and they come close to the ideal of never having to be replaced prior to the primary tooth falling out naturally.

12. What are fissure sealants and how do they work?

Sealants are clear or coloured plastic coatings applied to the chewing surfaces of the back teeth, where decay occurs most often. The most common teeth sealed are the permanent molars which erupt at about 6 years of age. Tooth brushing alone often does not remove all the food and plaque from the grooves on the biting surface of the teeth and it has been reported that the first permanent molars are the most common teeth in adulthood to suffer from decay. Sealants work by filling in the grooved and pitted surfaces of the teeth, which are hard to clean, and prevent food particles from getting caught, possibly causing cavities. They are quick and comfortable to apply, and can effectively protect teeth for many years.

13. What are space maintainers?

A space maintainer is used to hold space for a permanent tooth where a baby tooth has been prematurely lost. If space is not maintained, teeth on either side of the missing tooth can drift into the space, this loss of space can prevent the permanent tooth from erupting. Generally, space maintainers are only required in early loss of primary molar in a crowded mouth. Losses of anterior primary teeth do not require space maintenance.

14. What is a mouth guard?

A mouth guard is made of soft plastic and fits comfortably to the shape of the upper teeth protecting the teeth, lips, cheeks and gums from sports-related injuries. Any mouth guard works better than no mouth guard, but a custom-fitted mouth guard is your child’s best protection against sports-related injuries.

15. What if my child sucks a thumb/pacifier?

Non-nutritive sucking habits, i.e. thumb or pacifier, are very common in children, with reported frequencies ranging from 40-95% below 12 months of age falling gradually with age. Most children have stopped by the age of 6.

Complications that could possibly arise from the habit include dental malocclusions such as narrowing of the upper jaw, callus formation on figures and thumb, irritant eczema and paronychia ( an infection where the nail meets the skin of the finger). It can also lead to an anterior open-bite, where there is a gap between the top and bottom incisors when the back teeth are together, and an increased overjet, where the upper front teeth protrude. This, in turn, can make the front teeth more accident-prone, more likely to be damaged or knocked out during a fall. It should be noted that anterior open bites and increased over-jets due solely to sucking habits usually self-correct if the habit stops before 6 years of age.

There is also the possibility of reduced social acceptance by peers, where thumb-suckers are regarded as less intelligent, happy, attractive, likeable, and less desirable as a playmate, and this has often been demonstrated in experimental studies of children of 7 years or older.

It is regarded by developmental psychologists as a normal phenomenon during the first two years of life, and so parents should not be concerned. At this stage the habit should not be discouraged, rather the parents need to make certain that their child is receiving an adequate amount and duration of nursing and feeding. If the habit persists between 3-4 years of age there may be underlying emotional stress such as boredom, tiredness, frustration or unhappiness, and parents need to minimise stress, provide a warm and caring emotional environment, and sufficient stimulation to prevent boredom. Threats or punishment for thumb sucking will not be helpful. If you find your child sucking while asleep, then gently remove the thumb, but almost certainly it will quickly find its way back into the mouth! Be relaxed, and accept the situation.

If the child is 6 years or older, the habit can be reduced or stopped altogether in many cases by simple behaviour modification exercises. Rather than criticising for the act of sucking, which can be interpreted as punishment, reward a period of not sucking with a hug, an appropriate treat, or allowing to watch a favourite TV programme. That reward is more effective when linked with a verbal explanation of why it is being given, and the period of non-sucking needs to be gradually extended before the reward is given, for true progress to be made.

Similarly, studies have shown great success when, while reading to the child at bedtime, or allowing to watch a favourite TV programme, as soon as the habit starts then the reading stops or the TV is switched off, only to be re-started straight away when the thumb comes out of the mouth. Again these were more effective when a verbal explanation was also given. Both of those approaches seemed to be more effective than painting bitter-tasting substances onto the thumb.

In older children who are unable to stop the thumb sucking without help, orthodontic thumb guards can be fitted to help break the habit.

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