Dental Health Care for Children Choose to be, Cavity

Dental Health Care for Children Choose to be, Cavity
The parents complete guide to
Dental Health Care for Children
from newborn to tween
Choose to be, Cavity Free!
OUR STORY............................................................................ page
INTRODUCTION................................................................. page
Advanced Prevention................................................. page
DENTAL WELLNESS....................................................... page
DENTAL ANATOMY PRIMER..................................... page
Primary teeth............................................................ page
Permanent teeth..................................................... page
The Tooth...................................................................... page
Tooth Numbering.................................................. page
DENTAL DISEASE PRIMER.......................................... page
Early Childhood Caries (ECC)......................... page
How teeth develop decay.................................. page
Periodontal Disease.............................................. page
Juvenile Periodontitis.......................................... page
PREVENTION........................................................................ page
Maintaining Good Oral Hygiene......................... page
Caring for your new baby.......................................... page
Age 1.................................................................................... page
Age 3................................................................................... page
Age 5................................................................................... page
Age 6.................................................................................. page
Age 10.................................................................................. page
Age 13.................................................................................. page
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Caring for teeth of a
special needs child ........................................................ page
A GUIDE TO HEALTHY TEETH................................. page
What is Plaque?................................................................ page
How do we control Plaque?.................................... page
Tips on Brushing............................................................. page
Flossing................................................................................... page
FLUORIDE.............................................................................. page
NUTRITION............................................................................ page
CANADA’S FOOD GUIDE................................................ page
Dental food facts............................................................. page
INFANT FEEDING.............................................................. page
TODDLER FEEDING......................................................... page
What to expect at Kids Dental office............. page
Preparing for the first office visit.................... page
Sealants: long lasting dental insurance....... page
DENTAL EMERGENCIES................................................ page
Prevention of oral injury........................................... page
ORTHODONTIC CARE.................................................... page
Orthodontic problems.............................................. page
Brushing......................................................................... page
Flossing............................................................................ page
T he Comple te Guide to Dental Health Care for C hildren
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OUR STORY
Choose to be Cavity Free.
Tooth decay is the most common childhood disease in
North America. It is six times more prevalent than
asthma. Presently 35 % of all three year olds, 48% of
all four year olds and about 75% of all teenagers
exhibit tooth decay. In Canada millions of school
hours are lost each year to dental related illness.
The fact that dental decay is an infectious,
transmissible, diet dependent disease is not widely known. Indeed children’s
teeth are at risk long before they have been exposed to their first piece of candy.
Parents incorrectly assume that children get cavities because of sloppy or
inconsistent brushing and flossing habits. To a degree this notion is true, but
what is not widely known is that tooth decay is a disease called caries that is
caused by a specific family of bacteria called S. mutans. This process begins with
the colonization of baby teeth by these bacteria, and their use of sugar in the
mouth to produce acids. These acids dissolve the enamel, by dissolving the
calcium in teeth. As these bacteria multiply they form a slimy yellowish film
called plaque, trapping even more enamel dissolving acid. Together these two
processes rob teeth of calcium and the cavity forming process begins.
Traditionally dentists have started to intervene at this stage when cavities had
already formed. Caries or tooth decay has been managed for years with a surgical
approach of filling cavities with little regard as to the specific germs that caused
them.
What if however we strived to eliminate the cause of this disease instead of
addressing its symptoms?
Newborns enter this world without any S. mutans in their mouths. However by
the age of 12-19 months 22-25% of them harbor the bacteria. The presence of
S. mutans at age 1 is the most effective predictor of caries by age 3.
T he Comple te Guide to Dental Health Care for C hildren
page 3
Studies have shown that mothers are more prone than fathers in infecting their
children with these cavity causing bacteria, typically before the age of three. This
occurs by the transferring of bacteria through saliva from mother to child. Kissing,
cuddling, shared cooking utensils, blowing on hot foods, the use of common
toothbrushes all can be involved in the dissemination of these harmful bacteria.
Once colonized with S. mutans, children will always be prone to tooth decay. It is an
old wives’ tale that certain children inherit “soft teeth” from a family member. What
they are really inheriting is cavity producing bugs. This also explains why some
children with decent brushing habits are still getting cavities.
Apart form the type of bacteria a child harbors, another very
important part of the tooth decay puzzle is diet. The amount,
acidity, and even more importantly-the frequency of
carbohydrates in the diet directly influence both the growth of
the bacterial colonies and the “enamel dissolving effect”.
Good nutrition is not only important at the local/oral level. Junk
food is known to promote higher incidences of obesity, diabetes,
attention deficit disorder, depression, cardiovascular disease and
even some cancers in children and adults. Junk food along with
fast food has supplanted healthy eating. Indeed the nutritional
crisis is so dire that authorities warn that if we don’t change our
dietary habits soon, one in three children born after the year 2000
will develop diabetes. Today many pediatricians are predicting
that our children will be sicker and have a shorter life expectancy
than us, their parents.
Today’s processed food may be long on energy but very short on its medicinal or
health promoting qualities. There is no substitute for real wholesome foods.
Our approach at Kids Dental may be different than what you are traditionally used to,
as it aims at promoting the principles of dental wellness through advanced
prevention and natural nutrition. Indeed the old adage “an ounce of prevention is
worth more than a pound of cure” has never been truer.
The Kids Dental approach to dental care was founded by Dr. Ernest Cholakis, a
recipient of Her Majesty’s Golden Jubilee Medal for his contributions to dentistry and
his community. He has de-emphasized the drill-fill approach for a “wellness” strategy
that focuses on advanced prevention and natural nutrition. As a dental student he
received the Preventive Dentistry Award for his work in dental wellness. In addition
his own life experience both professionally and personally with his dentist-wife and
four daughters, has served as his inspiration to not only develop a better way to
medically deal with dental disease but to instill a culture ordered around the higher
ideals and values of prevention and natural nutrition.
T he Comple te Guide to Dental Health Care for C hildren
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At Kids Dental, we work very hard to make a visit to the dentist as easy as possible
for you and your child. Our team of dental and health professionals deliver quality
service in a fun, energetic environment that is centred on the needs of younger
patients. While we're having a great time doing our work, we take our commitment
to helping "our kids" become cavity free very seriously. We take great pride in our
dental "home" and invite you to join us in celebrating a lifetime of smiles.
Leading the charge is: Dr. Carla Cohn, a general dentist, who restricts her practice
to children with an exceptional background in comprehensive care, Dr. German
Ramirez, DDS(Col.), Dip Pedo.(Mex.), MDSc(Aus), PhD(Aus) - Dentist - with a
specific area of interest in Pediatric Dentistry, Dr. Karina Gamboa, DDS(Mex.), Dip.
Pedo.(Mex.) - Dentist - with a specific area of interest in Pediatric Dentistry; Dr
Billy Wiltshire, an Orthodontist and world renowned academician and educator
and Ms Phyllis Reid-Jarvis, a dynamic Registered Dietitian.
Our whole team along with many other collaborators have
taken enormous pride in Kids Dental’s potential and derive
great personal satisfaction in extending their invitation of
“celebrating a lifetime of healthy smiles” for all children.
Our Dental Home
In order to accomplish our mission of happy, healthy, cavity
free children we have created a “dental home” for you and
your child. In a warm and welcoming setting, reminiscent of
a home than a dental clinic, we are striving to break down
the barriers sometimes associated with the traditional dental
visit.
Children who have a dental home are more likely to receive
appropriate preventive and routine care. The concept of the
“dental home” is derived from the American Academy of
Pediatrics’ concept of the “medical home.” This concept
states that the care of infants and children ideally should be
accessible, continuous, comprehensive, family centered,
coordinated, compassionate, and culturally effective.
The child’s first visit establishes the dental home. This provides the opportunity to
implement preventive health practices and reduces the child’s risk for preventable
oral disease.
T he Comple te Guide to Dental Health Care for C hildren
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A Kids Dental Home provides the following:
• An accurate risk assessment for oral diseases and conditions
• The utilization of Previstat-the most advanced individualized preventive
dental health program in accordance with accepted guidelines and
periodicity schedules for dental health
• Anticipatory guidance about growth and development issues (e.g., tooth
eruption; thumb, finger, or pacifier habits; feeding practices)
• A plan and resources for emergency dental trauma
• Information about proper care of the infant’s or child’s teeth and
soft tissues
• Information about proper nutrition and dietary practices utilizing our
in house registered dietitian Ms Phyllis Reid Jarvis.
• Collaboration with other dental specialists, such as oral pathologists,
orthodontists, endodontists and periodontists, within our
dental home when required.
Grinich Village
We want to engage your youngster in a wondrous and
magical journey of discovery. Children retain
information best when they are able to apply the
concepts they are taught through play. Through Grinich
Village, a unique health discovery center, we plan on
engaging your child’s imagination and have him/her
experience first hand the values of wellness. From
creating unique masterpieces on the art table to
discovering the nutritional value of foods at the market,
Grinich Village is an exciting and whole new way of
experiencing health education.
Together we are as Strong as our Strongest Link
Our goal is to be a trusted parenting resource – that is
why we offer a comprehensive guide as well as supportive
material for your use. We also want to be the place you
come back to when you have questions and concerns. For
example whether on the website at kidsdental.ca, or in a
Kids Dental Home Center we're committed to helping
parents find the information, support and encouragement
they need.
T he Comple te Guide to Dental Health Care for C hildren
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INTRODUCTION |
Chapter 1
First, by making the dental experience fun and
magical, children play to learn about their health.
This philosophical distinction is very important
because you and your child will be exposed to a very
creative and imaginative educational process that
believes that we can do much to enrich your child’s
development with regard to preventive health.
Providing age appropriate activities, books, crafts and
toys can help create a sense of learning and
accomplishment that reinforces a wellness lifestyle.
Second, our clinical model emphasizes caring and collaboration. We are an
interdisciplinary clinic of general dentists, pediatric dental specialists, orthodontists,
periodontists, hygienists, registered dietitian, dental assistants and administrators all
working together with you and your child in a single facility. The health care
advantages of networking together in a single facility are enormous because of the
immediate access to expertise, improved lines of communication, superior
efficiency, and the enhanced opportunity for learning, research and innovation.
Third, by implementing best practices from ground breaking research, that has
identified the tooth decay process (caries) as a chronic, contagious, transmissible
disease. Of the possible 400 different species of bacteria that naturally reside in our
mouth, only S. mutans and a few others secrete acids in sufficient quantities to
dissolve tooth structure to form cavities. These specific bacteria are usually passed
from the primary caregiver (usually mothers) to babies in the first three years of life.
Hence tooth decay patterns are consistent from generation to generation as infected
mothers contaminate their babies with S. mutans by kissing, cuddling and sharing
of eating utensils. In one study, researchers observed that 89 percent of children
infected with S. mutans by age two had developed tooth decay by age four. Early
screening for S. mutans can flag those children and mothers who are at heightened
risk of developing caries so that antibacterial and preventive medications can be
prescribed to diminish the risk. This revolutionary approach represents a
tremendous advancement in preventive dentistry.
Traditionally dentists have managed tooth decay with a surgical approach of
filling cavities with little regard to the specific germs that caused them. The Kids
Dental approach is different. It emphasizes a “medical” strategy that focuses on
prevention. It addresses for the first time that tooth decay is an infectious disease.
T he Comple te Guide to Dental Health Care for C hildren
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Advanced Prevention
The Kids Dental way of treating dental disease represents
the inclusion of new strategies for more individualized
care. It is based upon a more contemporary understanding
that tooth decay is a chronic transmissible disease. Tooth
decay is a disease of imbalance between de-mineralization
and remineralization driven by acid producing bacteria in
plaque. We know that the main offender in the bacterial
world is a specific bacterium called streptococcus mutans
and that it’s spread from one generation to the next
through parent- child interactions. We have observed
that many children present with no cavities while others
show extensive decay (the sad end point of the
unchecked cavity forming process). The center of our
clinical philosophy is focusing on the full spectrum of the
dental disease process, not the end product of treating
holes in teeth.
To facilitate this goal we have developed Previstat® –
a risk assessment model that identifies a child’s
susceptibility to tooth decay and customizes a tailored
preventive program.
If your child is within one of the high risk groups listed
below it is imperative that Previstat (an aggressive
anticipatory guidance and intervention program) be
implemented as soon as possible. High risks groups
include:
•
•
•
•
•
•
Infants with special care needs
Infants with mothers with high tooth
decay rates
Infants with identifiable tooth decay, plaque,
demineralization and or staining
Infants who sleep with a bottle
Late order offspring
Infants with poor dietary habits
T he Comple te Guide to Dental Health Care for C hildren
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DENTAL WELLNESS |
Chapter 2
Dental wellness is a vital component of overall infant health. Kid’s
Dental is dedicated to the principle of lifelong dental health through
prevention and well being, showing that the right dental and nutritional
decisions can have a profound effect on a child’s life and future.
Key elements in promoting
dental wellness include:
• Education
• Fun
• Communication
• Early intervention
• Cavity risk assessment
• Anticipatory guidance
• Lifestyle commitment to
good nutrition
• Sugar load analysis
In spite of all our modern technological advances many children are still
affected by dental caries. Caries in baby teeth is the most common health
problem affecting young children today. Approximately 50% of children ages
2 through 9, have dental caries and 92% of children between the ages of 8 to
18 demonstrate moderate gum inflammation. Tens of thousands of school
days are lost each year as a result of dental disease and injuries.
The consumption of sugar keeps increasing with the average person now
consuming 155 pounds of sugar per year. Good nutrition is essential for both
general and dental health. Good eating habits and food preferences are
established early in childhood. Poor nutrition is the leading cause of obesity
which is reaching epidemic proportions with a correlating increase in the
incidence of juvenile diabetes and heart disease. Sadly most children crave
sugar and other junk food that they see in TV commercials. Various food
processing companies focus their advertising on children, who do not have
the critical skills to make an informed value judgement or understand the
companies’ profit motives.
T he Comple te Guide to Dental Health Care for C hildren
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At Kids Dental we recommend that a child’s first oral health
visit take place no later than 12 months of age, or shortly after
the eruption of the first baby teeth. This is an ideal time for our
team to evaluate your child’s oral, dental and nutritional
health, as well as to diagnose any problems which may exist.
During this first visit we will:
1. Inquire about your child’s medical history.
2. Learn about your child’s dietary and
feeding habits.
3. Assess the need for fluoride supplements.
4. Evaluate the child’s oral hygiene.
5. Examine the mouth for dental caries or
other problems.
6. Perform a caries risk assessment.
7. Implement age appropriate oral hygiene
techniques.
8. Introduce the concept of wellness as a
lifestyle choice.
9. Provide guidance for injury prevention.
10. Prepare to provide preventive, interceptive
or restorative services.
T he Comple te Guide to Dental Health Care for C hildren
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Examination of the infant 6 months after the first tooth erupts and
at no later than 12 months of age, allows our team to intervene before
oral health is compromised by deficient oral hygiene or improper
feeding habits.
During these first visits early signs of
childhood caries such as “white spot” lesions
at the necks and inside surfaces of the upper
front teeth can also be detected. These are
white, chalky areas on the front teeth, close
to the gum line. These decalcifications,
caused by acid producing bacteria, directly
precede irreversible loss of tooth structure.
Oral hygiene techniques may be modified
depending on your child’s age. For small
infants, the gums and teeth need to be
cleaned once or twice a day with a piece of
clean gauze. Infants should be introduced to
the toothbrush around the age of one. At
around 2 years a small pea-sized drop of
children’s toothpaste can be applied to the
toddler’s brush.
Brushing baby teeth can be quite challenging for new parents. Some
infants and toddlers may refuse to let parents brush their teeth. Games of
sharing the duties by taking turns with rewards often work. The initial
brushing attempts need only last a few seconds.
The good news is that our mission driven approach is easily
achievable. By providing a healthy diet, minimizing the consumption of
candies, cleaning your child’s teeth at least twice a day, and seeing us
regularly, your child can have a happy, healthy smile!
T he Comple te Guide to Dental Health Care for C hildren
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DENTAL ANATOMY PRIMER |
Chapter3
The Mouth
The more you understand about the mouth and your
child’s oral health the better you’ll be able to collaborate
with your dentist to achieve your mutual goals of
complete dental health and wholeness for your family.
The mouth serves as the first step of
the digestive process by cutting,
tearing and grinding food. The
mouth is the only part of the
digestive system with nerve endings
that respond to taste, pain, pressure
and temperature.
The tongue aids in swallowing and
talking. The small projections on the
tongue are called papillae. Some of
the papillae on the tongue serves as
taste buds.
hard palate
soft palate
tonsil
tonsil
tongue
papillae
T he Comple te Guide to Dental Health Care for C hildren
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Primary teeth
Usually girl’s teeth erupt
earlier than boy’s teeth and
lower erupt earlier than
corresponding upper teeth.
Central incisor
Lateral incisor
Cuspid
First molar
Second molar
UPPER
There are 20 primary teeth.
They erupt, starting with the
lower front teeth, around six
months of age. The last
primary teeth to erupt are the
second molars, which present
around 20-24 months of age.
Eruption
7 1/2 mo.
9 mo.
18 mo.
14 mo.
24 mo.
Central incisor
Shedding
7 1/2 yrs old
8 yrs old
11 1/2 yrs old
10 1/2 yrs old
10 1/2 yrs old
Lateral incisor
Cuspid
First molar
Second molar
LOWER
Primary teeth are important
to keep healthy and in place
because they are necessary to
maintain the space for the
permanent teeth that will be
replacing them.
Second molar
First molar
Cuspid
Lateral incisor
Central incisor
Central incisor
Lateral incisor
Cuspid
First molar
Second molar
Eruption
6 mo.
7 mo.
16 mo.
12 mo.
20 mo.
T he Comple te Guide to Dental Health Care for C hildren
Shedding
6 yrs old
7 yrs old
9 1/3 yrs old
10 yrs old
11 yrs old
page 13
Permanent teeth
The first permanent
teeth usually erupt
between six and eight
years of age.
Central incisor
Lateral incisor
Cuspid
First bicuspid
UPPER
Permanent teeth follow
the same basic
sequence of eruption as
primary teeth. Adults
have a total of 32 teeth,
including wisdom
teeth.
Eruption
7-8 yrs old
8-9 yrs old
11-12 yrs old
10-11 yrs old
Central incisor
Lateral incisor
Cuspid
First bicuspid
Second bicuspid
First molar
A primary tooth is lost
prior to the eruption of
each tooth except for
permanent molars.
These molars do not
replace any primary
teeth as they come in
further back in the
mouth than any
primary teeth.
Second molar
Third molar
Third molar
Second molar
LOWER
The permanent teeth
are meant to last a
lifetime.
Eruption
10-12 yrs old
6-7 yrs old
12-13 yrs old
17-21 yrs old
Second bicuspid
First molar
Second molar
Third molar
First molar
Second bicuspid
First bicuspid
Cuspid
Central incisor
Central incisor
Lateral incisor
Cuspid
First bicuspid
Lateral incisor
Eruption
6-7 yrs old
7-8 yrs old
9-10 yrs old
10-12 yrs old
second bicuspid
First molar
Second molar
Third molar
T he Comple te Guide to Dental Health Care for C hildren
Eruption
11-12 yrs old
6-7 yrs old
11-13 yrs old
17-21 yrs old
page 14
The Tooth
Crown: The portion of the tooth above
the gumline.
Dentin: Dentin is a bone like substance
that forms the substructure of the tooth.
Neck: The intersection between the
crown and root of the tooth.
Pulp: The pulp contains blood vessels,
nerves, and connective tissue. It is located
beneath the dentin and extends through
the root to the middle portion of the
crown.
Root: The portion of the tooth that
extends into the jaws. The root forms the
anchorage component of the tooth.
Enamel: Enamel forms the outer shell of
the tooth above the gumline. Enamel is
the hardest substance in the body, capable
of withstanding unbelievable forces. Hard
but brittle enamel does not heal like a
broken bone. Tremendous care should be
exercised in maintaining the health of this
tissue.
Cementum: Cementum forms the outer
coating of the root of the tooth. Its softer
more porous surface helps anchor the tooth
to the jaw bones.
Tooth Enamel
GUMS
Periodontal Ligament: The PDL consists
of connective tissue fibers that attach the
root to the alveolar socket. The built in
shock absorbing characteristics of this
tissue allow the tooth to withstand the
exceptional forces during biting and
chewing.
Alveolar Bone: The hard tissue that forms
the jaw bones.
Gingiva: Commonly referred to as the
gums. It covers the bone and hugs the
necks of the teeth.
Crown
Dentin
Gum
Root
Bone
Pulp
Root Canal
T he Comple te Guide to Dental Health Care for C hildren
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Incisors:
These single rooted teeth are the front teeth in the upper and lower jaws.
They are broad and flat with thin edges. These teeth are good for cutting.
Typically there are four upper and four lower incisors. The pair at the
center are called centrals and adjacent to them are the incisors called
laterals.
Canines:
Also called cuspids these single rooted teeth are
adjacent to the incisors and form the corners of
the arch. There are four canines. These
teeth are thick and like an ice pick
come to a point tearing and ripping
foods that may be tough.
Incisors
Premolars:
Adjacent to the canines in the
permanent dentition are two
premolars (also called
bicuspids) for a total of eight
teeth. These teeth are a cross
between canines and molars
in that they have two broad
points for tearing but also
present with a broader chewing
surface for chewing and grinding. Upper first
premolars typically present with two roots and
the second with one root. Lower premolars
typically present with one root.
Canines
Pre Molars
Molars
Molars:
Adjacent to the premolars are three molars for a total of twelve. The first
molar also called the six year molar presents at six years of age. The second
molar also called the twelve year molar presents at approximately twelve
years of age. Finally the third molar also called the wisdom tooth are the
last teeth in the mouth and present if there is enough room between
eighteen to twenty-one years of age. These multi-rooted teeth with broad
chewing surfaces are ideal for crushing, grinding and chewing foods.
T he Comple te Guide to Dental Health Care for C hildren
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Tooth Numbering
The International Numbering System is a standardized approach for referencing
particular teeth. In this system teeth that should be present are numbered according
to location and sequence. The first number corresponds to the quadrant location
with 1 representing the upper right, 2 the upper left, 3 representing the lower left
and 4 representing the lower right. The second number represents the sequence of
the teeth from front to back. Thus, 1 is the front central incisor, 2 the lateral
incisor, 3 the canine, 4 the first premolar, 5 the second premolar, 6 the first
molar, 7 the second molar and 8 the third molar. As an example tooth number 33
is the lower left canine and tooth number 15 is the upper right second premolar.
Quadrant 1
Right
Quadrant 2
Left
15
16
14
13 12 11
21 22
23
17
24
25
26
27
18
28
48
38
47
37
46
45
44 43
33
42 41 31 32
Quadrant 4
Right
T he Comple te Guide to Dental Health Care for C hildren
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35
36
Quadrant 3
Left
page 17
DENTAL DISEASE PRIMER |
Chapter 4
Caries
Caries or tooth decay can start at any age.
The required elements for decay are susceptible teeth, bacteria in the mouth,
and certain foods which contain sugar. The tooth decay process begins with a
soft, sticky layer of bacteria called plaque. Within the plaque matrix are
particular bacteria that metabolize the sugar and starches in the foods we eat
to produce acids. The plaque holds this acid against the teeth. Each time this
acid is produced it attacks the tooth enamel for about 20-30 minutes. These
chronic repeated attacks begin to break down the enamel to create a cavity. Once
this occurs, the cavity spreads inward to the center of the tooth called the pulp.
At this point an abscess can form at the end of the root that causes severe
pain. Treatment is needed to prevent further decay or this destructive process
will result in tooth loss. Warning signs of tooth decay are:
• A tooth sensitive to heat, cold or sweets
• Pain during chewing
• Swelling or drainage at or below the gum line
• A white spot on a tooth
• A dark spot on a tooth
• Persistent discomfort in the mouth or sinus
WHAT TO LOOK FOR:
Check for presence of tooth defects - a risk for decay
T he Comple te Guide to Dental Health Care for C hildren
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Early Childhood Caries (ECC)
• A severe rapidly developing form of tooth decay in infants and young children
• Can effect all teeth however classically found in the front incisors which erupt
first, at about 6 months, and are least protected by saliva
Formerly called:
• Baby bottle tooth decay
• Nursing caries
Severe ECC may lead to...
• Extreme pain
• Spread of infection
• High risk of dental decay and crooked
bite in adult teeth
• Difficulty chewing, poor nutrition,
below average weight
• Poor self-esteem, behavioral and
social interaction problems
• Extensive and costly dental treatment
• Speech development problems
• Lost school days and difficulty
learning
Pre-treatment
Post-treatment
T he Comple te Guide to Dental Health Care for C hildren
Post-treatment
page 19
How teeth develop decay
• Dental decay is the most
common chronic disease
of childhood
6% of 1 year old
22% of 2 year old
35% of 3 year old
48% of 4 year old
Bacteria + Food + Tooth = Decay
FOOD
BACTERIA
DECAY
T he Comple te Guide to Dental Health Care for C hildren
page 20
Periodontal Disease
Periodontal disease or gum disease is the leading
cause of tooth loss in the adult population.
Although most tooth loss from
periodontal disease occurs in adulthood,
early signs of the disease may be
witnessed in adolescents. Periodontal
disease attacks the gums, bone, and
other structures that hold the teeth in
the jaws. The toxins produced by
bacteria in plaque inflame the gums,
making them swollen and tender. Prone
to bleeding, the tissues worsen as the accumulating plaque colonizes on the
teeth and hardens into calculus (tartar) that collects under the gum line.
Calculus cannot be removed by brushing and flossing. Only scaling by the
hygienist or dentist can remove calculus. As plaque and calculus continue
to form, the gums become red, swollen, tender, and prone to bleeding. This
condition known as gingivitis can be reversed by thorough plaque removal
and regular periodontal maintenance by the hygienist.
In many cases untreated gingivitis can lead to a more severe condition
called periodontitis. Although gingivitis may progress to periodontitis it is
not clearly proven that periodontitis is always preceded by gingivitis. In the
most common form of destructive periodontal disease the gums pull away
from the teeth, forming pockets between the teeth and gums. These
crevices fill with bacteria, and become deeper. The gums, bone, and other
structures supporting the teeth are seriously compromised and the teeth
may pathologically drift and loosen. Surgery may be needed to save the
teeth or they may have to be extracted.
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Current research demonstrates that periodontal disease
is a widespread disease that may not necessarily progress
slowly and can eventually result in tooth loss.
Dental researchers now believe the content rather than the amount of plaque
may play a more important role in the development of the disease process. It
has only been in the past few years that researchers have been able to identify
the specific microorganisms in plaque associated with various forms of
periodontal disease. Other changes in thinking are that the disease is not
generalized or slowly progressive. A patient may have one or more active
sites, with the rest of the mouth showing no signs of periodontal disease. The
disease may also move in bursts of activity rather than progress at a continuous
pace. These new findings are challenging the profession to find new ways to
diagnose and treat periodontal disease.
Other factors that may contribute to the progression of periodontal disease
include smoking or chewing tobacco, metabolic diseases like diabetes,
hormonal changes ranging from puberty to pregnancy, harmful habits
presenting as clenching, mouth breathing and grinding, and finally growth
and development processes such as misaligned teeth and a bad bite.
Warning signs of gum disease include:
•
•
•
•
Gums that bleed on brushing and flossing
Red, swollen or tender gums
Gums that have receded from the tooth structure
Suppurative exudate (pus) discharging from
the gums
• Teeth that are loose or drifting
• Changes in the fit of the bite
• Persistent bad breath or a sour taste
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Juvenile Periodontitis
Juvenile Periodontitis is a rare form of periodontal disease
that affects adolescents and young adults.
Here the mouth appears healthy with little inflammation or discomfort.
Loose teeth are the first sign of trouble. X-rays will reveal that the vital
bone around molar teeth and upper incisors has been destroyed.
Treatment may include surgery and antibiotic therapy by the
Periodontist team member at Kids Dental.
MALOCCLUSION
Malocclusion refers to the irregular way teeth or jaws fit together. The causes of
malocclusion can be inherited or acquired. Tooth size, jaw size, cleft palate,
congenitally missing teeth, and other abnormalities are examples of inherited causes.
Acquired causes include premature loss of teeth, mouth breathing and other harmful
habits such as tongue thrusting and thumb sucking. If left untreated, malocclusion may
cause abnormal pressure on the teeth, resulting in uneven wear and/or periodontal
disease. Effective plaque removal is difficult to practice when the teeth are not in proper
alignment. Malocclusion can also lead to digestive disorders caused by improper
chewing. Speech, social and emotional problems may result if the malocclusion is not
corrected. The treatment of malocclusion is provided by the Orthodontist team member
at Kids Dental, a dentist who has additional training in this area of dentistry.
ORAL CANCER
The most common sites of oral cancer are the tongue, floor of the mouth, lips, soft palate
and tonsillar area. Since oral cancers vary widely in appearance, they are often difficult
to recognize. This is why it is important to have regular check-ups and perform monthly
self exams. The warning signs of oral cancerous lesions are:
•
•
•
•
•
•
Any swelling, lump or growth located in the head or neck area.
A sore that does not heal after two weeks
White or red patches in the mouth or on the lips
Repeated bleeding from the mouth or throat
Difficulty in swallowing or persistent hoarseness
In leukemia the symptoms are red swollen gums that are prone to bleeding
Early detection of oral cancer is critical. Regular screenings are performed at every
check-up appointment by the Dentist.
T he Comple te Guide to Dental Health Care for C hildren
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PREVENTION |
Chapter 5
Caring for your child’s teeth before birth
Eating Right
During the 9 months of pregnancy,
the baby depends entirely on the mother
for nourishment.
Teeth and bones require calcium, phosphorus and other vitamins
that can be obtained from the four food groups. Obtaining a
balanced diet throughout pregnancy will ensure the baby is
receiving essential nutrients for growth and development.
Expectant mothers should consult with their obstetrician or a
dietician to ensure that a healthy diet is maintained throughout
pregnancy.
Specifically diets should be analyzed to determine if the proper
amount of calcium, phosphorous and vitamins A, C, and D are
being ingested. Calcium and phosphorous are major mineral
components of teeth. Vitamins C and D aid in the absorption and
deposition of calcium and phosphorous. Vitamin A is required for
the differentiation and maintenance of the cells that form
enamel and dentin. Both vitamins A and C are needed for
healthy gingival tissues.
Folic acid - vitamin B9 contributes to a healthy pregnancy. Many
authorities advocate that mothers-in-waiting take 0.4mg of folic
each day, starting 3 to 4 months before pregnancy begins. The
current thinking believes that folic acid supplementation protects
the developing baby against various birth defects of the spine and brain, called neuraltube defects. The first four to six weeks is extremely important in helping to prevent
cleft palates and lips.
In conclusion be careful with vitamin, mineral and herb supplementation. Don’t self
medicate with large or unusual combinations because birth defects can result. Eat a
well balanced diet and take one multivitamin or a prenatal vitamin each day and
consult your obstetrician. At Kids Dental, prenatal counselling is an important
priority, because it improves the oral health of mother and child. Maternal diet,
self-care, and lifestyle can affect the offsprings oral health.
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Maintaining Good Oral Hygiene
Expectant mothers should keep
their regular dental schedule. Meticulous
oral hygiene will help to produce a
healthy and happy baby.
An important link has been found between
maternal gum disease and premature low birth
weight babies. For example, oral infections such
as periodontal disease can cause an increase in
the level of prostaglandin, a maternal hormone.
Prostaglandins are also a powerful hormone that
can be used to induce labor. Thus periodontal
disease in an expectant mother can cause an
increase in the level of prostaglandin and trigger
premature delivery.
Things That May Happen to
the Expectant Mother That
Affect the Baby's Teeth
A fever or virus or any sort of infection during
pregnancy could affect the quality and quantity
of tooth structure, that is forming in the fetus. The
natural balance of calcium and phosphorus in the
mother's bloodstream becomes distorted and can
interfere with tooth formation until the mother
becomes healthy again.
If a baby is born before term, there is a possibility that the child's teeth will be
affected. Full-term babies are found to have fewer cavities than preterm
babies. This is likely due the fact that the teeth are likely mineralizing just
around the time of birth and are most susceptible to decay.
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Caring for your new baby
What to do Before the Teeth Come in
One of the most important things to do
as a parent is to keep good oral hygiene
for their child and themselves.
Babies are not born with bacteria in their mouths. In fact, bacteria are
transferred to the baby by everyday contact such as cuddling, kissing,
feeding and playing. Therefore, parents should be very mindful to keep
excellent oral hygiene and reduce the number of microorganisms in their
own mouths.
Sucking Habits
It is totally normal for your baby to suck on a thumb, finger or pacifier. It is
a comforting and healthy habit that originated as a natural reflex in the
womb. Usually by the age of 4 to 5 years most children overcome this
habit, however in other instances they may not and this can lead to:
• Protruding upper front teeth
• Misalignment of the upper and lower jaws
• Malformation of the upper palate
Remember that the amount of damage relates to the frequency, intensity and duration
of the habit. Stress is often the underlying reason for continuance of this habit. When a
parent discovers why the child is sucking, a solution can often be formulated to address
it. When the stressor is eliminated the child is more open minded and cooperative in
giving up the habit.
Concerning the issue between the thumb versus pacifier debate, Kids Dental recommends
the pacifier. The pacifier habit is easier to break because parents can control the
timeline. In addition the pacifier is a good alternative to the comfort bottle of formula,
milk, or juice that parents give their babies at bedtime. Going to bed with a bottle is
definitely a bad idea as it can result in severe tooth decay.
In conclusion for children after the age of 6 that continue to suck it is important to note
that something may be bothering them. Identification of the stressor is the first step in
helping the child deal with the problem. Sucking helps children deal emotionally with
many complex issues and in many instances restoring a dental problem is easier than
addressing an injured psyche.
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Pacifier Tips
• Never dip the pacifier in anything sweet like honey.
• Never attach a pacifier to a cord, string or a ribbon for fear of strangulation.
• Never replace a bottle nipple for a pacifier.
Discard pacifiers that demonstrate signs of wear or breakdown. Bulbs that are swollen,
cracked or sticky should be discarded. The pacifiers shield should be wider than the baby’s
mouth to prevent choking. Finally never leave a child unattended with a pacifier or let an
infant sleep with a pacifier.
Nursing and it's Effect on Baby Teeth
Nursing is a way of educating the baby's lips, cheeks, tongue and jaw to develop more
mature ways of handling fuel for the body.
Dental Medications and Breast-feeding
A nursing mother may be concerned about the effects of medications on her infant's
health. There may be risks to a baby's health when a mother takes certain medications
as most medications appear in the breast milk a few hours after taking them. It is
important for the nursing mother to discuss the risks and benefits of each medication with
the dentist or physician before using it.
The amount of medication appearing in breast milk depends on the drug's characteristics as
well as the characteristics of the mother's breast milk (i.e. rate at which milk is produced,
blood flow to the breast). A nursing infant will receive approximately 1% of the mother's
drug dose.
Some tips to follow to minimize the amount of medication in breast milk:
1. Try breast- feeding immediately before or shortly after taking the drug
2. Maximal doses of drugs appear in breast milk one to three hours after ingestion
The following dental medications are compatible with breast-feeding and are considered safe:
Acetaminophen
Amoxicillin
Acyclovir
Bupivicaine
Cefazolin
Clindamaycin
Codeine
Epinephrine
Erythromycin
Fentanyl
Fluoride
Ibuprofen
Levonordefrin
Lidocaine
Mepivicaine
T he Comple te Guide to Dental Health Care for C hildren
Morphine
Prednisone
Prilocaine
Streptomycin
Tetracycline
page 27
When do the First Teeth Appear?
The first teeth generally appear between
from 6 and 14 months.
Baby teeth will appear very white like shiny perfect
pearls. The first teeth to appear will either be the
lower or upper front teeth called the central incisors.
The next teeth to present, erupt right beside the
central incisors and are called the lateral incisors.
The eruption of teeth in your infant will vary and
may be 10 to 12 months from the average ranges and
still be normal. Every baby's teething schedule will
differ. Some children will get their teeth earlier while
others later. The chart on this page is an average
range of eruption of baby teeth. The significance of
early or late eruption may mean that those children
whose teeth erupt later will have a slightly higher
resistance to decay than those children whose teeth
erupt earlier. This is explained by the fact that
teeth that stay under the gums longer will pick up
the fluoride in the water supply as well as other
sources and become more resistant to decay.
The progression of eruption of your baby's teeth
should be monitored as your infant is growing. By the
time your child is 3 years of age, there may be certain
things you may want to consult with us about if there
are too few teeth in the baby's mouth. An
examination by the dentist will reveal if they are just
late coming in or if the child may have an inherited
condition. Yellowish-brown stained soft teeth are one
of the first signs of decay. These teeth should always
be saved as the baby teeth help to keep space for the
permanent teeth to erupt in.
Most babies will have 12 teeth by the time they are 18 months. By the time they
are 3, 20 teeth should have appeared. Any missing or extra teeth can lead to
Malocclusions and should be looked at by your baby's dentist. In fact, a baby's first
dental visit should begin 6 months after the eruption of the first tooth, or around
1 year of age.
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Cleaning and Caring for the Infant Teeth
A baby's mouth will form plaque from bacteria and food in the
mouth. Plaque is a film containing a sticky substance that coats the
teeth and sets the stage for decay and gum disease. Bacteria use food
to produce an acid that demineralizes the tooth to cause decay and
to harm the gums. Therefore regular cleaning of your infant's gums
and teeth helps to ensure a healthy and happy baby. Before teeth
erupt, clean your baby's mouth and gums with a soft cloth or infant
toothbrush. This helps to prepare your baby for the tooth cleaning that
is to come. Once your infant's teeth begin to erupt into the mouth
(as early as 4 months old), they should be cleaned twice a day,
preferably after breakfast and after their last meal in the evening.
Teething
Teething can vary in every infant depending on the age of eruption
of the primary teeth. Teething is often associated with daytime
restlessness, an increase in amount of finger sucking, an increase in
drooling and possibly some loss of appetite. The gums may appear
red before the emergence of the tooth and cause a temporarily
painful condition in the baby. However, this pain should subside
after a few days.
What can be done about pain
associated with teething?
1. A cleaned, chilled teething ring will help alleviate some of the
pain associated with teething.
2. A children's Tylenol elixir may help alleviate the pain and
inflammation.
Please note: Benzocaine ointment should not be used as it may cause
numbing of the throat and cause your baby to choke if too much is used.
Parents should always be suspicious during teething. If the baby
has symptoms of fever, nausea, congestion, don't assume the baby is
just teething. Check with your pediatrician for other possibilities.
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Caring for your child’s teeth from
babyhood through adolescence
Important Milestones in The Growth and Development
of Your Child's Teeth
Age 1
By the first birthday, the bottom and top front teeth have come in. The first primary
molars are about to appear and the crowns of the second primary molars have formed.
The biting surfaces of the first permanent molars are being formed and the first permanent
incisors are hardening. The jaw is increasing in size in both height and width as the
cartilage and bones are growing.
Age 3
By the child's 3rd birthday, almost all the primary teeth are present or accounted for.
The teeth should fit together at this stage which is the start of a developing occlusion or
bite. The crowns of the first permanent incisors are almost complete. The crowns of the
first permanent molars are complete. Mineralization of the premolar crowns are starting
and the permanent canines are about two-thirds complete. The roots of all the primary
teeth are complete.
Age 5
A lot is going on in your 5-year-old. Breakdown (resorption) of the roots of baby
incisors is taking place which allows the adult incisors to come in. When baby teeth
are ready to come out, they will at first feel loose and eventually fall out on their own.
The baby tooth will appear as if it did not have roots, however this is the process of
resorption taking place. The roots of the permanent first molars and permanent
incisors are beginning to mineralize at this time too. On occasion the adult teeth erupt
adjacent to the baby teeth and this may result in two rows of teeth. A consultation with
your dentist at this time is important to determine the status of the baby teeth.
Life Cycle of Primary and Permanent Teeth
Primary Teeth
Permanent Teeth
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Age 6
This is a time of great change. Growth in the skull and upper part of the face is
almost complete at this time. However, growth in the lower part of the face is just
beginning. It's at this time that your child will start to lose his or her "baby face."
Your first grader will have their first permanent molars making their way into the
mouth. Usually these teeth erupt without much fuss. The front baby teeth are
loose around this time allowing for the permanent incisors to grow through the
gums. The roots of the primary teeth continue to resorb and the crown of the
permanent canine is fully formed.
Age 10
Many changes have already taken place in your child's mouth. The permanent
incisors are by now fully into your child’s mouth and the primary molars are beginning
to loosen and fall out. The permanent molars are in position and the second
permanent molars are beginning to find their way into the mouth. The roots of the
baby canines are resorbing to make way for the permanent canines. The upper
canines are one of the last teeth to erupt into the mouth. These eye teeth help to
close the space between your child's upper front teeth.
Age 13
Your child is now 13 and has all of his or her permanent teeth in with the exception
of the last molars, often called the wisdom teeth. The bones and jaws are reaching
their adult dimensions and strength. There are 32 teeth in the mouth including the
wisdom teeth still under the gums.
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Caring for teeth of a special needs child
A healthy smile is important to a special needs child.
Starting early preventive care for your special needs
child is an important aspect of your child's health.
Dental disease is preventable and your child can benefit
from a collaborative approach between you, your child
and our team at Kids Dental. A first dental visit by
your child's first birthday is a good time to start
preventive dental care.
Children with special needs are very diverse in their
dental health. Some may have the same dental needs
as the rest of the population while others may have
disabilities or conditions that increase their risk for
various oral health problems.
One child may have a condition that interferes with
their ability to brush and floss effectively thus
increasing their risk of gum disease and tooth decay.
Another child may have health conditions that
require special medication or diet which may be destructive to their oral
health. Therefore, your child will benefit from early preventive care at our
office through effective brushing and flossing, adequate fluoride, sealants, good
nutrition and regular dental visits.
Home Care Tips for Your Child
1. Brush at least twice daily, the most important times being after breakfast
and before bed.
2. Floss once a day.
3. Use a small pea-size amount of toothpaste with fluoride to avoid fluorosis.
4. Encourage healthy snacks with positive reinforcement.
5. Use a toothbrush with soft bristles to avoid trauma.
6. Consider electrical toothbrushes when brushing effectively becomes
too difficult for your child.
T he Comple te Guide to Dental Health Care for C hildren
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A GUIDE TO HEALTHY TEETH |
Chapter 6
Prevention and wellness is key to keeping your child healthy
and cavity free. Practicing good oral hygiene from birth to adulthood is
one of the most important habits to develop.
Good habits promote healthy teeth, gums and
overall wellness. Daily preventive care incorporating
brushing and flossing will help prevent more difficult
problems that become more painful and expensive
for the child. An ounce of prevention is worth its
weight in gold.
Regular check-ups at Kids Dental are an important
component of preventive care. Here our team of
health care providers can provide your child with the
professional care they need. In between dental visits,
it is important to include the following home care
activities for your child preventive program.
1. Brushing thoroughly twice a day and especially before bedtime.
2. Flossing daily.
3. Eating a well balanced diet and limiting harmful snacks between meals.
4. Using Canadian Dental Association approved dental products
containing fluoride.
5. Rinsing with fluoridated mouthrinse as prescribed by the dentist for
patients with high caries risk.
6. Having professionally applied fluoride varnish for high caries risk dentitions.
7. Rinse with water or chew a xylitol chewing gum after eating when it’s not
possible to brush and floss.
To keep teeth and gums healthy, we must first understand what is the
cause of tooth decay. Seeing the whole picture allows us to control all
the factors involved in tooth decay and gum disease.
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What is Plaque?
Plaque is the culprit behind tooth decay.
Plaque is a sticky transparent film that coats
the teeth and is formed continuously, 24 hours a day.
How does plaque stick to teeth when we
have the action of the tongue, cheeks
and saliva in our mouth to wash away
plaque? Plaque is made up of millions
and millions of bacteria that secrete a
sticky substance called dextrans.
Bacterial dextrans are a type of "bacterial
glue" that helps bacteria adhere to the
teeth. Dextrans are so adherent to teeth
that rinsing with water will not eliminate
the plaque off our teeth. However, the
story doesn't stop there. Bacteria use
dextrans to help trap the food we eat to
use as reserve sources. When there is no food available, bacteria then digest some
of the dextrans to tie them over until the next meal is consumed. Plaque is thus a
combination of bacteria, dextrans and bits of food trapped within it.
Knowing all this we ask, what causes a cavity? When bacteria digest food they
produce an acid that is trapped in the plaque and is in continual contact with teeth.
The acid demineralizes the tooth and weakens the enamel crystals of the tooth. If
this is allowed to progress, eventually a cavity forms on the tooth.
Plaque not only causes cavities, it can lead to gum disease. Plaque is an irritant to
the gum tissue and when left undisturbed can lead to bleeding and irritated gums.
Plaque left undisturbed will invade the space between the tooth and the gum tissue
called the pocket. As the plaque creeps deeper into the pocket, it invades the
supporting structures around the tooth and causes inflammation, redness and
puffiness. If this situation is allowed to continue, the foundation around the tooth is
lost and eventually the tooth can fall out.
Plaque however is not all bad. Plaque has the ability to store fluoride in the form of
an acid soluble crystal. When acid is formed by bacteria, the acid will dissolve
the fluoride crystals and release fluoride where it is needed to prevent
demineralization and promote remineralization. Remember, teeth that have more
fluorapatite crystals in their structure are less soluble to acid demineralization.
T he Comple te Guide to Dental Health Care for C hildren
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The first sign of a cavity is a white spot
on the surface of the tooth.
Sometimes these white spots can be remineralized and the decay will stop
progressing. However, if the white spot is continually exposed to acid attack by
bacteria, the tooth will continue to demineralize. As soon as the decay passes
the enamel in the tooth and reaches dentin, decay will progress rapidly and
form a hole in the tooth. If left alone without treatment, decay will eventually
reach the nerve centre and cause pain for the child. At this point, the tooth
will require more extensive treatment and perhaps even be lost.
How do we control Plaque?
Our main goal is to promote wellness for your
child. The best way to control plaque is
practice good oral hygiene. When bacteria
formation is disrupted at least once every 24
hours, bacteria cannot produce enough acid to
harm the teeth and gums. Brushing and flossing
are the best ways to control plaque in the
mouth, along with a healthy diet.
Babies and toddlers need help with brushing and
flossing until their fine motor skills are developed
enough for good oral hygiene practices.
Supervise your child's flossing until they are
10 years of age and their brushing until they
are 7 to 8 years of age.
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Tips on Brushing
~ Brush at least twice a day, in particular after breakfast and before bedtime.
During sleep, saliva in the mouth decreases, leaving the teeth more vulnerable
to tooth decay.
~ Brush with a soft or extra-soft bristled toothbrush.
~ Brush for at least 3 minutes. A timer is helpful to ensure each tooth is brushed.
~ Brush systematically and it will become second nature. Try to incorporate a
systematic route/method of brushing all the teeth. For example, brushing the
top teeth from left to right and then from the inside from right to left.
~ Change toothbrushes regularly. As soon as the bristles start to bend and flare,
it is time to change the toothbrush. We recommend a new toothbrush every
3 months.
~ Use a Canadian Dental Association approved toothpaste with fluoride.
HOW TO BRUSH
For younger children: Simply have your children scrub their
teeth in a back and forth motion on the inner, outer and chewing
surfaces.
For older children: We recommend the modified Bass brushing
technique.
1. Hold the toothbrush horizontally against your teeth with the
bristles directed 45 degrees towards the gumline.
2. Move the bristles of the toothbrush in circular motions with a
gentle motion for approximately 20 strokes.
3. Finally roll the bristles towards the biting surface of the tooth.
4. Repeat for each tooth until all the teeth are brushed.
5. To brush the inside of the front teeth, angle the brush
vertically and use the same circular roll motion.
6. To clean the biting surfaces of the teeth, hold the bristles of
the toothbrush on the biting surfaces and brush back and forth
until all the teeth are cleaned. Remember, these biting
surfaces often have deep pits and fissures on the chewing
surfaces that need to be cleaned effectively.
7. Rinse thoroughly with water to flush out any debris and food.
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How to Brush
Upper Outside Surfaces
Lower Outside Surfaces
Upper Inside Surfaces
Lower Inside Surfaces
Upper Chewing Surfaces
Lower Chewing Surfaces
Upper Front
Inside Surfaces
Lower Front
Inside Surfaces
T he Comple te Guide to Dental Health Care for C hildren
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Flossing
Flossing is the only way to clean between the teeth. Essentially think of
flossing as an “in-between toothbrush”. Even baby teeth need to be
flossed by parents. Baby molars often do not have space between them
that allows for a self cleansing action to take place. By the time the child is
10, flossing can be done independently or with little or no supervision.
Flossing Wands
These simple wish bone flossing aids are an easy introduction to daily flossing.
User friendly and easier to use than fingers, flossing wands are a great innovation.
How to Floss
1. Break off approximately 18 inches of floss and wind
one end of the floss around your middle finger.
2. Use a short segment of the floss and
hold the floss between your thumb
and index finger of both hands.
3. Guide the floss gently between the teeth and
see-saw through the contact.
4. Once it is through the contact, curve the floss in a
"C" shape and slide it along the tooth and
underneath the gumline. Slide the floss up and down
to scrape debris and plaque away from the tooth
surface. Then repeat this process against the
neighboring tooth.
5. Repeat this process until all surfaces between the
teeth are flossed.
T he Comple te Guide to Dental Health Care for C hildren
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FLUORIDE |
Chapter 7
Relevant Facts
Dental health through cavity prevention
in children is one of the forefront strategies
of Kids Dental.
Fluoride is one tool in the battle against dental
disease. Cavities should not be considered a fact
of life. Research has shown that fluoride reduces
cavities between 40 to 50 percent in baby teeth
and 50 to 60 percent in adult teeth.
There are numerous benefits of fluoride. When
added to community water supplies it is the single
most effective public health measure we have to
prevent tooth decay and improve oral health for
a lifetime.
All water contains some fluoride naturally, in amounts greater or lesser than that
needed to contribute to oral health benefits. Water fluoridation is the process of
adjusting the natural level of fluoride to the concentration necessary for protection
against tooth decay. Another way to receive fluoride is by using dental and home
care products such as varnishes, gels, toothpastes and mouth rinses. Both systemic
fluoride (fluoride that comes from eating foods and drinking liquids) and topical
fluoride (fluoride that is applied to the surfaces of the teeth) work together to keep
teeth strong.
Fluoride Varnishes: Innovation in
Prevention at Kids Dental
At Kids Dental the implementation of fluoride varnishes for higher risk patients at
intervals in-between regular dental visits represents a tremendous advancement in
prevention. Fluoride varnishes present several important clinical and practical
features compared to standard gels:
1. This innovative treatment has been shown in early research to reduce cavities
by more than fifty percent
2. Varnishes are quick and easy to apply;
3. Varnishes do not have the bitter taste of gels and can be readily applied in more
difficult cases, such as with young children or the handicapped;
4. The amount of fluoride ingested is small. Typically, plasma levels of fluoride
barely change after varnish application, but can increase significantly after gel
application.
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Fluoride: Easy does it
Water fluoridation is safe. Since the 1930’s literally
hundreds of carefully conducted scientific studies
have shown that water fluoridation, at concentrations
recommended for good oral health, has no harmful effects.
Parents should monitor their children’s tooth brushing
habits. Kids Dental encourages parents to take an active role
in their children’s oral health and one way to do so is to
supervise their brushing habits. Children should be told to
use only a small amount of toothpaste and not to swallow
toothpastes and mouth rinses.
Excessive levels of dietary fluoride result in an increased risk of
dental fluorosis that can be an esthetic problem. Dental
fluorosis is a hypoplasia or hypomineralization of the dental
enamel caused by the consumption of excessive amounts of
fluoride during the years of tooth calcification. Only a small percentage of children
experience this condition. Dental fluorosis is generally a mild condition unnoticeable to
most people. It is characterized by lacy white lines or specks in the teeth and is not harmful
to the patient’s health. What’s important to remember is that drinking optimally
fluoridated water will not cause dental fluorosis in children.
Sourcing your child’s fluoride
Parents need to establish the fluoride content of their children’s primary drinking
water source.
1. Your Home Tap Water: Get your water tested. In Winnipeg the communal
water is fluoridated at 1 part per million.
2. The School Drinking Supply: One third of a child’s days are spent at school.
3. Bottled Water: Only four percent of bottled water has had fluoride added to
it. Parents can check with manufacturers or the International Bottled Water
Association to determine the fluoride content.
4. Water Filters: Some home water filters remove fluoride. Devices that operate
by reverse osmosis can remove up to 95% of the fluoride from water, charcoal
or carbon based systems usually remove less fluoride.
5. Toothpaste: Children at the younger ages are very susceptible to swallowing
toothpaste. Therefore parents should supervise their preschooler’s
toothbrushing. Use a small amount of toothpaste and discourage your child
from swallowing toothpaste.
T he Comple te Guide to Dental Health Care for C hildren
page 40
NUTRITION |
Chapter 8
Advocating wellness is our primary mission,
and nothing is more sacred to us than good nutrition.
What our children will eat will affect them for the rest of their lives.
The old age “you are what you eat” is profoundly true. If this
sounds like grandstanding consider this: almost all cancers are
linked in some manner to nutrition. Links to heart disease, mental
prowess, allergies, fertility, immune function and yes bones and
teeth are all connected to the food our children will eat. With
our busy lives, full schedules, savvy advertising from food
processors (directed to our unsuspecting children) and the
associated peer pressure of today’s treat culture, its no small
wonder that the incidence of juvenile diabetes and obesity
continues to soar over time. The trend is not pretty!
One generation ago most of us ate three square meals a day. Today processed and fast food
sales have doubled over the past twenty years meaning that our children are eating more
and more chemicals. We have adopted a diet where children's’ food is a market
segment of its own, with imaginative animal shapes and exotic colors. Pizzas, hot
dogs, burgers, fruit roll ups, chips, cookies, chicken nuggets, candied yogurt and bright
colored ketchups are marketing exercises aimed to boost sales with little nutritional
value to offer. It is now estimated that fifty percent of us don’t eat a single portion of fruit
per day and less than twenty-five percent of us eat the daily recommendation of five
portions of fruit and vegetables.
From a dental perspective good nutrition is important but good nutrition
alone doesn’t guarantee healthy, cavity resistant teeth. Other factors
include regular hygiene care, the appropriate fluoride and sealants on
back molars.
Carbohydrates from fruit, starches and candies are consumed in the mouth by bacteria
which in turn produce acids that lead to tooth decay. Bacteria are not fussy; it is irrelevant
whether the carbohydrates come from sugars or starches, like bread and crackers.
So candies are not measurably worse than fruit or a glass of juice. In fact new data
suggest that crackers and cookies are more cariogenic (cavity producing) than say a
lollipop because the crumbs from cookies and crackers stay in the mouth longer. This
issue is described as retentiveness. Cooked starches stay longer in the mouth than
caramels and cola, because it take hours for these acid producing bacteria to break these
complex foodstuffs into their constituent sugars.
T he Comple te Guide to Dental Health Care for C hildren
page 41
Another factor is frequency, where
bacteria are quite active for up to thirty
minutes after eating-regardless of the
size of the meal or snack. So frequent
eating also leads to a higher incidence
of tooth decay. Practices like sipping on
a cola all day long or sucking on throat
lozenges can provoke prolonged
exposure to cavity producing acids.
Short-term consequences of junk nutrition
• Since 1970 the incidence of childhood obesity has doubled, with the greatest
increase in the past ten years.
• Sadly one in six teenagers shows significant early signs of heart disease.
• Increased incidence of learning difficulties.
Long-term consequences of junk nutrition
• The World Cancer Research Fund claims that between thirty to forty percent of
cancers may be caused by dietary factors.
• Sperm count on average is dropping 1.5% per year and experts are predicting a
mass infertility epidemic by the middle of the 21st century.
• Heart disease is present in some form in 20% of the children population.
• Osteoporosis studies indicate that carbonated drinks are robbing bones of calcium
and other minerals necessary to maintain bone mass. Today, school programs
substitute milk for cola as a portion of the sales goes towards school revenues.
• Besides processed and junk foods possessing little nutritive value they also
contain a tremendous number of chemicals linked to an equally high number of
illnesses and diseases. Many of these chemicals act as anti-nutrients that serve to
block the body’s ability to absorb the very elements children need to grow
healthy and strong.
General recommendations
• A balanced diet of fats, carbohydrates, proteins, vitamins, minerals, and trace
elements coupled with water and fiber ensures that our children will heal, grow and
develop at their optimal potential.
• Seek out a nutritionist for consultation and support.
• Read “Natural Health Care for Children” by Karen Sullivan M.D.
T he Comple te Guide to Dental Health Care for C hildren
page 42
Eating
Well with
Canada’s
Food Guide
Recommended Number of Food Guide Servings per Day
Children
Age in Years
2-3
Sex
4-8
Teens
9-13
Girls and Boys
Adults
14-18
19-50
Females
Males
Females
51+
Males
Females
Males
Vegetables
and Fruit
4
5
6
7
8
7-8 8-10 7
7
Grain
Products
3
4
6
6
7
6-7
8
6
7
Milk and
Alternatives
2
2
3-4 3-4 3-4
2
2
3
3
Meat and
Alternatives
1
1
1-2
2
3
2
3
2
3
The chart above shows how many Food Guide Servings you
need from each of the four food groups every day.
Having the amount and type of food recommended and
following the tips in Canada’s Food Guide will help:
• Meet your needs for vitamins, minerals and other nutrients.
• Reduce your risk of obesity, type 2 diabetes, heart disease,
certain types of cancer and osteoporosis.
• Contribute to your overall health and vitality.
T he Comple te Guide to Dental Health Care for C hildren
page 44
What is One Food Guide Serving?
Look at the examples below.
Fresh, frozen or canned vegetables
125 mL (1⁄2 cup)
Bread
1 slice (35 g)
Bagel
1
⁄2 bagel (45 g)
Milk or powdered
milk (reconstituted)
250 mL (1 cup)
Leafy vegetables
Cooked: 125 mL (1⁄2 cup)
Raw: 250 mL (1 cup)
Fresh, frozen or
canned fruits
1 fruit or 125 mL (1⁄2 cup)
Cooked rice,
Flat breads
1
⁄2 pita or 1⁄2 tortilla (35 g) bulgur or quinoa
125 mL (1⁄2 cup)
Canned milk
(evaporated)
125 mL (1⁄2 cup)
Cooked fish, shellfish,
Cooked legumes
poultry, lean meat
175 mL (3⁄4 cup)
75 g (2 1⁄2 oz.)/125 mL (1⁄2 cup)
Fortified soy
beverage
250 mL (1 cup)
Cereal
Cold: 30 g
Hot: 175 mL (3⁄4 cup)
Yogurt
175 g
(3⁄4 cup)
Tofu
150 g or
175 mL (3⁄4 cup)
Eggs
2 eggs
100% Juice
125 mL (1⁄2 cup)
Kefir
175 g
(3⁄4 cup)
Cheese
50 g (1 1⁄2 oz.)
Peanut or nut butters
30 mL (2 Tbsp)
Oils and Fats
• Include a small amount – 30 to 45 mL (2 to 3 Tbsp) – of unsaturated fat
each day. This includes oil used for cooking, salad dressings, margarine
and mayonnaise.
• Use vegetable oils such as canola, olive and soybean.
• Choose soft margarines that are low in saturated and trans fats.
• Limit butter, hard margarine, lard and shortening.
T he Comple te Guide to Dental Health Care for C hildren
Cooked pasta
or couscous
125 mL (1⁄2 cup)
page 45
Shelled nuts
and seeds
60 mL (1⁄4 cup)
Eat well and be active today and every day!
The benefits of eating well and being active include:
Take a step today…
• Better overall health.
• Lower risk of disease.
• A healthy body weight.
Have breakfast every day. It may help
control your hunger later in the day.
Walk wherever you can – get off the
bus early, use the stairs.
Benefit from eating vegetables and fruit
at all meals and as snacks.
Spend less time being inactive such as
watching TV or playing computer games.
Request nutrition
information about
menu items when
eating out to help
you make healthier
choices.
Enjoy eating with
family and friends!
Take time to eat and
savour every bite!
• Feeling and looking better.
• More energy.
• Stronger muscles and bones.
Be active
To be active every day is a step towards better health and a healthy body weight.
Canada’s Physical Activity Guide recommends building 30 to 60 minutes of
moderate physical activity into daily life for adults and at least 90 minutes a day for
children and youth. You don’t have to do it all at once. Add it up in periods of at
least 10 minutes at a time for adults and five minutes at a time for children and youth.
Start slowly and build up.
Eat well
Another important step towards better health and a healthy body weight is to follow
Canada’s Food Guide by:
• Eating the recommended amount and type of food each day.
• Limiting foods and beverages high in calories, fat, sugar or salt (sodium) such as cakes and
pastries, chocolate and candies, cookies and granola bars, doughnuts and muffins, ice cream
and frozen desserts, french fries, potato chips, nachos and other salty snacks, alcohol, fruit
flavoured drinks, soft drinks, sports and energy drinks, and sweetened hot or cold drinks.
Read the label
• Compare the Nutrition Facts table on food
labels to choose products that contain less
fat, saturated fat, trans fat, sugar
and sodium.
• Keep in mind that the calories and
nutrients listed are for the amount of
food found at the top of the Nutrition
Facts table.
Limit trans fat
When a Nutrition Facts table is not available, ask
for nutrition information to choose foods lower in
trans and saturated fats.
Nutrition Facts
Per 0 mL (0 g)
Amount
% Daily Value
Calories 0
Fat 0 g
Saturates 0 g
+ Trans 0 g
Cholesterol 0 mg
Sodium 0 mg
Carbohydrate 0 g
Fibre 0 g
Sugars 0 g
Protein 0 g
Vitamin A 0 %
Calcium
0%
0%
0%
0%
0%
0%
Vitamin C
Iron
0%
0%
For more information, interactive
tools, or additional copies visit
Canada’s Food Guide on-line at:
www.healthcanada.gc.ca/foodguide
or contact:
Publications
Health Canada
Ottawa, Ontario K1A 0K9
E-Mail: publications@hc-sc.gc.ca
Tel.: 1-866-225-0709
Fax: (613) 941-5366
TTY: 1-800-267-1245
Également disponible en français sous le titre :
Bien manger avec le Guide alimentaire canadien
This publication can be made available on
request on diskette, large print, audio-cassette
and braille.
© Her Majesty the Queen in Right of Canada, represented by the Minister of Health Canada, 2007. This publication may be reproduced without permission.
No changes permitted. HC Pub.: 4651 Cat.: H164-38/1-2007E ISBN: 0-662-44467-1
Make each Food Guide Serving count…
wherever you are – at home, at school, at work or when eating out!
Eat at least one dark green and one orange vegetable each day.
• Go for dark green vegetables such as broccoli, romaine lettuce and spinach.
• Go for orange vegetables such as carrots, sweet potatoes and winter squash.
Choose vegetables and fruit prepared with little or no added fat, sugar or salt.
• Enjoy vegetables steamed, baked or stir-fried instead of deep-fried.
Have vegetables and fruit more often than juice.
Make at least half of your grain products whole grain each day.
• Eat a variety of whole grains such as barley, brown rice, oats, quinoa and wild rice.
• Enjoy whole grain breads, oatmeal or whole wheat pasta.
Choose grain products that are lower in fat, sugar or salt.
• Compare the Nutrition Facts table on labels to make wise choices.
• Enjoy the true taste of grain products. When adding sauces or spreads, use small amounts.
Drink skim, 1%, or 2% milk each day.
• Have 500 mL (2 cups) of milk every day for adequate vitamin D.
• Drink fortified soy beverages if you do not drink milk.
Select lower fat milk alternatives.
• Compare the Nutrition Facts table on yogurts or cheeses to make wise choices.
Have meat alternatives such as beans, lentils and tofu often.
Eat at least two Food Guide Servings of fish each week.*
• Choose fish such as char, herring, mackerel, salmon, sardines and trout.
Select lean meat and alternatives prepared with little or no added fat or salt.
• Trim the visible fat from meats. Remove the skin on poultry.
• Use cooking methods such as roasting, baking or poaching that require little or no added fat.
• If you eat luncheon meats, sausages or prepackaged meats, choose those lower in salt (sodium) and fat.
Enjoy a variety
of foods from
the four
food groups.
Satisfy your
thirst with water!
Drink water regularly. It’s a
calorie-free way to quench
your thirst. Drink more water
in hot weather or when you
are very active.
* Health Canada provides advice for limiting exposure to mercury from certain types of fish. Refer to www.healthcanada.gc.ca for the latest information.
T he Comple te Guide to Dental Health Care for C hildren
page 47
Advice for different ages and stages…
Children
Women of childbearing age
Men and women over 50
Following Canada’s Food Guide helps
children grow and thrive.
All women who could become pregnant
and those who are pregnant or
breastfeeding need a multivitamin
containing folic acid every day.
Pregnant women need to ensure that
their multivitamin also contains iron.
A health care professional can help you
find the multivitamin that’s right for you.
The need for vitamin D increases after
the age of 50.
Young children have small appetites and
need calories for growth and
development.
• Serve small nutritious meals and snacks
each day.
• Do not restrict nutritious foods because
of their fat content. Offer a variety of
foods from the four food groups.
• Most of all... be a good role model.
In addition to following Canada’s Food
Guide, everyone over the age of 50 should
take a daily vitamin D supplement of
10 μg (400 IU).
Pregnant and breastfeeding women need
more calories. Include an extra 2 to 3
Food Guide Servings
each day.
Here are two
examples:
• Have fruit and yogurt
for a snack, or
• Have an extra
slice of toast at
breakfast and an
extra glass of milk
at supper.
How do I count Food Guide Servings in a meal?
Here is an example:
Vegetable and beef stir-fry with rice, a glass of milk and an apple for dessert
250 mL (1 cup) mixed broccoli, = 2 Vegetables and Fruit Food Guide Servings
carrot and sweet red pepper
75 g (2 1⁄2 oz.) lean beef = 1 Meat and Alternatives Food Guide Serving
250 mL (1 cup) brown rice = 2 Grain Products Food Guide Servings
5 mL (1 tsp) canola oil = part of your Oils and Fats intake for the day
250 mL (1 cup) 1% milk = 1 Milk and Alternatives Food Guide Serving
1 apple = 1 Vegetables and Fruit Food Guide Serving
A balanced diet is an important part of
maintaining your child’s healthy teeth and gums.
Good eating habits and food preferences are
established in childhood.
Poor nutrition can eventually lead to poor health, obesity,
tooth decay, and periodontal disease. Additionally when and
how often a child eats may also adversely affect their teeth.
Bacteria in the mouth metabolize carbohydrates and simple
sugars from the left over food debris and form acid, which
decays teeth. It takes approximately 20 minutes for saliva to wash
away this damaging acid, and so if your child is frequently
snacking there will be a acidic environment for the teeth.
Carbohydrates, which are ultimately broken down to simple
sugars may come in many hidden forms. Potato chips and
pretzels for example are as cavity as lollipops.
Hang Time
The longer food can hang onto the surface of a tooth the greater the
likelihood of forming cavities.
Foods like granola bars. Potato chips, pretzels, salted and peanut butter
crackers, and cookies are the hang time champs. First runner up are figs,
jelly beans, doughnuts and raisins. Followed by white bread, caramels and
cream filled pastries.
T he Comple te Guide to Dental Health Care for C hildren
page 49
Dental food facts
• Your child’s dental health depends less on what they eat and more on how often they
eat it. Overall well being however requires a well balanced diet.
• Most foods contain sugars or starches that enable bacteria in dental plaque to produce
acids. These acids demineralize tooth structure which leads to cavities.
• High Carbohydrate-Cavity Causing Foods
•Crème-filled sandwich cookies
•Dried figs or granola bars
•Jelly beans
•Oatmeal or peanut butter cookies
•Plain doughnuts
•Potato chips and pretzels
•Puffed oat cereal
•Raisins
• To the cavity causing bacteria in the mouth, sugars are all the same, whether natural
or processed the same. Therefore all types of sugars and the foods that contain them
can play a role in tooth decay.
• Cooked starches can lead to cavities just as sugars can. In fact crackers, cookies,
pretzels and potato chips take longer to clear the mouth than sugars do. So the risk to
decay is greater.
• The bacteria levels in the mouth can’t discern the difference in the amount of sugar
in food. For example a sip of a cola can start the same mega acid attack as eating a
whole apple pie.
• A food with sugar or starch is safer for teeth if it is eaten with a meal, not as a snack.
• Snacks served no more than three or four times a day should contribute to the overall
nutrition of the child. Healthy snack foods include; cheese, vegetables, fruit and yogurt.
• A child that sips on apple juice all day long or continuously sucks on a rock candy every
few minutes to keep it longer runs a higher risk of developing tooth decay.
• Serve cheese for lunch or as a snack. Cheddar, Monterey Jack and Swiss, triggers the flow
of saliva that helps wash foods particles away from teeth.
• Pack milk or water instead of juice or soda.
• Chewing sugarless gum can help reduce the risk of cavities and interferes with the
metabolism of acid producing bacteria. Gum helps dislodge some of the food stuck in
your child’s teeth, but it also increases saliva which helps buffer the acids in your
child’s mouth. The ingredient “xylitol” in sugarless chewing gum also interferes with
the metabolism of acid producing bacteria.
T he Comple te Guide to Dental Health Care for C hildren
page 50
Here are some helpful hints to minimize the
effects of high carbohydrate foods.
Give your child healthy snack foods such as fresh fruits,
vegetables and cheeses.
Buy foods that are sugar-free or unsweetened.
Serve sugary or starchy foods with meals instead of as a snack.
Avoid sticky foods unless your child can have their teeth brushed
soon after eating.
Make sure your child’s teeth are brushed after snacks or at a minimum
they should rinse their mouth with water a few times.
Encourage your child to chose xylitol-sweetened or sugar-free gum.
Do not give your child a bottle with any juice or milk at bedtime.
Only water should be given.
Five Point Preventive Plan
All things being equal if your child brushes regularly and gets sufficient fluoride,
there’s nothing wrong with snaking sensibly. Even if it includes the occasional
candy! Especially if your child follows our five point preventive plan of:
1. Effectively brushing at least twice daily and flossing once daily
2. Sufficient fluoride
3. Receiving sealants on most permanent teeth
4. Seeing us at Kids Dental regularly
5. Having a healthy diet
T he Comple te Guide to Dental Health Care for C hildren
page 51
INFANT FEEDING
In terms of preventing dental decay here are some tips
concerning infant feeding:
• Breast feeding is recommended until age one
• Otherwise always hold the infant when bottle feeding
• No propping of bottle
• Only formula or breast milk in bottle
• From breast to cup
Bed time alternatives to bottles:
• Stuffed toy
• Blanket
• Clean pacifier
• Rocking
• Back rub
• Read or sing
• Remember crying is normal, after a few nights your baby will
sleep peacefully
If your child is having a lot of difficulty giving up the bottle filled with juice
or milk at bedtime try to:
• Slowly replace the juice or milk with water adding more water to the
juice or milk each time. Eventually, this way, your child will becomes
used to a bottle with only water.
TODDLER FEEDING
Liquids
• Ideally sugar free drinks
• No “liquid grazing” - sippy cups can contribute to “liquid grazing”. If a
child is thirsty dispense water. Try to keep juice and milk to a normal
cup so that your children are not walking around with it all afternoon.
• Milk or water between meals
• Sugars in fruit juice cause cavities
• Limit fruit juice to meal times
Solid foods
• Limit number of times eating and snacking
• Regular meals, no “grazing”. Be careful of sippy cups which can
contribute to “liquid grazing” Avoid juice or milk in these cups, it
promotes periodic drinking all day long.
• Sugar free snacks like cheddar cheese
T he Comple te Guide to Dental Health Care for C hildren
page 52
What to expect at Kids Dental office
The first visit is usually a short one. Our aim is to
give your child a chance to get to know the dentist
and the clinic in a friendly and non-threatening manner.
During this visit our dental team will do the following:
• Examine your child’s teeth for decay
• Examine your child’s gums and soft tissue for disease
or problems
• Evaluate the way your child’s teeth fit together,
“the bite”.
• Identify any potential problems or
deleterious habits.
• Show you and your child how to properly clean
his or her teeth at home.
• Answer your questions or concerns.
We do not usually do a cleaning on your child’s first
visit, since we want this visit to be as easy and fun as
possible for your child. If your child is very mature or
around the age of three or four at the time of their first
visit, we may recommend a cleaning and fluoride
application. This prophylaxis is an important treatment
that serves to reinforce the importance of home care as well as remove
plaque and tartar from teeth. At age one a lap-top exam is preferred. In the
later years it would be best for the child to sit independently as this
enhances the communication between the dentist and the child, without
the child looking to the parent for encouragement or security. Our dentists
are experts at handling all types of young patients in a friendly and
understanding way.
A parent or legal guardian must accompany the child for this first visit, since
this person will be asked to fill out medical and dental health forms. The
parent should also bring a list of any medications the child may be taking
and be prepared to discuss any behavioral or health issues. This information
is important because it helps us to treat and manage your child in a safe and
effective manner.
T he Comple te Guide to Dental Health Care for C hildren
page 53
Preparing for the first office visit
It is important to us and to your child
that the first visit be a positive one.
We recommend that your child make their first visit at 12 months of age.
At this visit our clinical team will count your child’s teeth and take a quick
peek inside the mouth to assess his or her overall state of oral health and to
pinpoint any problems early. The entire procedure may only take one or
two minutes depending on the behavior of your child. The main goal is to
have a fun and easy visit with your child and to introduce them to our
dental clinic and children's play village.
The best predictor of a child’s behavior in the dental chair is the parent’s
level of anxiety. In most cases, if the parent is nervous, the child is going to
feel the same way. Here are a few tips to help your child’s first dental visit
go smoothly:
• Tell your child about the visit, but don’t go into details.
• Let the dentist answer the questions about dental tools and
procedures since we often have kid friendly terms for all of our tools.
We will explain things in a non-threatening, easy to understand
manner.
• Never tell your child that something may hurt.
• Don’t tell your child about your own unpleasant experiences.
• Try not to promise your child a reward for going to the dentist.
• Remember that young children are often fearful. Some are afraid of
being separated from their parents, others from the unknown, and
some are just shy. We treat many children in our office and have
many ways of helping an anxious or fearful child learn to understand
and cope with their dental visits.
• Explain to your child that the dentist is there to help them with the
very important job of keeping their teeth and gums healthy.
T he Comple te Guide to Dental Health Care for C hildren
page 54
SEALANTS |
Chapter 10
Sealants:
long lasting dental insurance
Four out of five cavities in children under 12 occur
on the biting surfaces of the back teeth.
The teeth most at risk of decay are the six year molars and twelve year
molars. The biting surfaces of these molars erupt into the mouth often with
deep grooves and pits. Even if your child brushes his or her teeth, it is almost
impossible for him or her to clean the deep hills and valleys on the back
teeth. These teeth are at greatest risk of decay when they first erupt into the
mouth. Sealants are placed on these teeth to seal out food and plaque thus
reducing the risk of decay. One might say, why is this so important?
The 6-year molars are considered the most important teeth in your child's
mouth. Once they erupt into the mouth, they act as foundations for the
dental arch and its development. They also aid in keeping the other teeth
in their positions.
A dental sealant is a clear or white plastic coating that is painted onto the
biting surfaces of the back teeth. Sealants are applied in a liquid state and
harden and bond to teeth in only a few seconds.
Sealants should be a part of your child's preventive dental care, along with
brushing and flossing, use of fluoride, good nutrition and regular dental
check-ups.
T he Comple te Guide to Dental Health Care for C hildren
page 55
Sealants for children
Brushing and flossing help prevent cavities. So does and
regular dental visits. But one of the best ways to keep
your child cavity-free is to have sealants applied to his or
her back teeth or molars. Not only are sealants very
effective, they also cost a lot less than filling cavities.
A sealant is a clear or tinted plastic coating that is brushed onto
the chewing surfaces of the back teeth, the area where most
cavities form. Look in the mirror at your own molars. As you can
see, there are many grooves and crevices (also called pits and
fissures) that food can get stuck in. In fact, some crevices can be
so deep that the bristles of a toothbrush aren't small enough to
reach into them to remove food that has lodged there. These pits
and fissures provide the perfect environment for bacteria to grow
and cavities to form. Sealants prevent this from happening. They
cover the grooves and crevices so that there is no way for food to
get into them.
Applying sealant is a quick, painless procedure that can be done
during a routine dental visit. No injections are needed. However,
it is very important that the child sit still during the treatment so
the tooth or teeth being worked on stay dry. First, the dentist
cleans the tooth to remove any food or debris in and around the
teeth and makes sure they are completely dry so that the sealant
can stick. The sealant is applied in liquid form and flows over and
into the pits and fissures. The sealant usually hardens (sets)
within 20 to 60 seconds or is set with a special light.
Kids Dental recommend that sealants be applied to each
permanent molar as soon as possible. This may be when the tooth
is only partially erupted. It depends on how accessible the tooth is
and whether the dentist will be able to keep it dry during the
application process. The child must be able to cooperate and sit
still during the treatment. Sealants also should be applied to
second molars when they erupt, usually when the child is about
12 years old. If your child is at high risk for cavities, your dentist
may decide to seal your child's bicuspids as well. Dentists
normally don't suggest sealants for primary (baby) teeth.
However, they can be beneficial for some children.
T he Comple te Guide to Dental Health Care for C hildren
Studies show that
sealants can last a
long time, often as
long as 10 years. But
they are plastic and
don't last forever. The
dentist will check the
sealants during your
child's routine checkups. Sealants that are
worn or gone can be
replaced. Although it
is rare, sealants can
cause problems in
children who are
allergic to plastics
or components of
plastics.
Remember, sealants
work well, but they
can't keep your child
cavity-free without
some help. Good oral
care at home is still
very important.
page 56
DENTAL EMERGENCIES |
Chapter 11
Dental emergencies occur when you least expect them.
When a dental emergency occurs, the most important aspect
of handling the emergency is to have your child
brought to our office as soon as possible.
Oral ulcers
Protective ointments and gels such as Zilactin and Orajel may provide
symptomatic relief of pain for your child. These products can be purchased at the
local pharmacy. The most helpful treatment for aphthous ulcers is application of
Kenalog in Orabase ointment which is applied to the ulcers four times daily.
If your child is consistently presents with aphthous ulcers, a diary of when the
ulcers occur and what possible items and events triggering the aphthous ulcers may
be helpful. It is best to avoid trauma inside the mouth and avoid abrasive food
such as hard pretzels and potato chips. Your child should avoid allergenic foods
such as nuts, chocolate, and acidic foods that may trigger an aphthous ulcer event.
Toothache
Have your child rinse their mouth vigorously with warm
water to flush out debris. Use dental floss to remove any
food trapped between the teeth. If your child requires an
analgesic, have them take either Children's Tylenol or
Children's Advil. Do not apply the medication to the
tooth or sore area.
Knocked out permanent tooth
If the tooth is dirty rinse it gently in cool running water.
Don’t scrub it. Gently replace the tooth in its socket and
hold it in place. If this doesn’t work, put in a container of
cool water. GO IMMEDIATELY (within 30 minutes if
possible) to the dentist, who may be able to reimplant
the tooth. After hour emergency appointments are
available by contacting our emergency answering service.
T he Comple te Guide to Dental Health Care for C hildren
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A baby tooth is knocked out
Rinse your child's mouth with water and apply a cold
compress to reduce swelling. The best treatment is to
spend time comforting your child and to call the
office immediately. At the office, we will take a
thorough history and exam to ensure no other injury
has been sustained elsewhere to your child.
* Do not attempt to reimplant a baby tooth as this
may damage the permanent tooth below.
Bitten tongue or lip
Apply direct pressure to the bleeding area with a
clean cloth. If there is swelling, apply cold
compresses. If the bleeding does not stop, take your
child immediately to a hospital emergency room.
Broken or chipped tooth
Immediately contact the office and bring your child to the office.
Immediate action can prevent infection and reduce the need for
extensive dental treatment. Gently clean the debris from the injured
area with warm water. Attempt to save the tooth fragment and bring it
with you to the office. Use cold compresses to minimize swelling.
Emergencies can be prevented. The following are a few tips we
suggest to reduce the chance of an dental emergency:
1. Keep regular dental visits and preventive care to protect your
child from unnecessary toothaches.
2. Encourage your child to wear comfortable mouth guards
during sports.
3. Child proof your home to prevent falls, electrical injuries and
choking on small objects. A significant number of injuries occur
in children under 3 as they are just learning to walk and develop
their coordination.
T he Comple te Guide to Dental Health Care for C hildren
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Prevention of oral injury
Eighty percent of all fractured teeth occur in children, with the upper front
teeth being most often involved. Injuries are the most frequent causes of
mouth trauma. Biking, baseball, and skateboarding are the three main causes
of tooth injuries. Home injuries, such as tripping over objects on the floor,
stairway or ground, and not using handrails on stairways, cause many oral
injuries. A large number of injuries happen on school playgrounds.
Safety Rules
Children need to prevent oral injuries. By learning and practicing common safety
rules, children can prevent injuries to themselves and their teeth. Some of these
rules are listed below.
1. Always wear a properly fitted helmet and mouthguard in vigorous games and
contact sports.
2. Remember to wear a catcher’s mask when receiving pitched balls.
3. Keep your skateboard under control; don’t push or shove another skateboarder.
4. Don’t push or trip other skaters, or “hitch” a ride.
5. Use the ladder to climb out of a pool.
6. Don’t run alongside the pool or push playmates into it.
7. Don’t hit, push, or throw things at people as they drink from a container
or fountain.
8. Be prepared for sudden stops in a vehicle; always use your seat belt.
9. Never climb a wet tree or fence; the footing may be slippery.
10. Always use your handlebars when riding your bike. Be extra careful when
riding in rainy weather; wet roads and leaves are dangerous.
11. Never trip or push another playmate.
12. Watch out for trees, stumps, and other objects in your path when walking
or running.
13. Climb with an experienced person and be sure to test firmness of rocks and
footing.
14. Remain seated in a swing and don't jump from or walk under a moving swing
15. Watch out for trees and other things in your path when sledding.
T he Comple te Guide to Dental Health Care for C hildren
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Mouthguards
Many experts recommend that mouthguards or mouth protectors be worn during any
recreational sport. Mouthguards help prevent injury to the protect against head and
neck injuries by cushioning blows that might otherwise cause concussions or lead to jaw
fractures. Some of the sports for which mouthguards are recommended include:
Acrobatics
Baseball
Basketball
Bicycling
Boxing
Discus
Field Hockey
Football
Gymnastics
Handball
Ice Hockey
Lacrosse
Martial Arts
Racquetball
Rugby
Shotputting
Skateboarding
Skiing
Skydiving
Soccer
Squash
Surfing
Volleyball
Water Polo
Weightlifting
Wrestling
Mouthguards cover only the upper teeth because they are the most frequently injured.
Covering lower teeth may create additional bulk, diminishing comfort and fit while
providing little extra protection. Mouthguards should be resilient, thin enough for easy
breathing, tear-resistant, and comfortable. They should also fit properly, be durable, easy
to clean, and not difficult to speak with. Rinsing the mouthguard with cold water or
mouthrinse before using it will help increase its comfort in the mouth.
There are three types of mouthguards. Although the three types provide protection,
they differ in comfort, fit, and cost. The three types are:
1.
Stock mouthguard - the stock mouthguard is ready-made and can be found at most
sporting goods and department stores. It is commonly constructed of rubber or a
polyvinyl material. Little can be done to adjust the fit of a stock mouthguard. It is
often bulky and uncomfortable. The jaws must be closed to hold the mouthguard in
place. Good for a developing dentition.
2. Mouth-formed mouthguard - the mouth-formed guard is a plasticized acrylic gel or
thermoplastic material conformed to the contours of the individual’s teeth. Good for
a developing dentition.
3. Custom-made mouthguard - the custom-made mouthguard is individually designed
and constructed by a dentist. It is constructed over a plaster replica of the
individual’s teeth and is more expensive. It offers exceptionally good fit, comfort,
and overall quality. Ideal for a permanent dentition.
A strap is often fastened to any of these mouthguards, protecting against loss and
allowing the mouthguard to be removed or suspended from other face gear when the
individual is not in play. Mouthguards can last a long time if they are cared for properly.
The mouthguard should be rinsed under tap water after each use and allowed to dry
before storing.
T he Comple te Guide to Dental Health Care for C hildren
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Dental first aid
If an oral injury should occur despite using safety precautions and mouthguards,
prompt attention is necessary. Try to clean dirt or debris from the injured area
with warm water. Place cold compresses on the face next to the injured area to
minimize swelling. Then, see your dentist at Kids Dental immediately. Loss of
primary teeth due to accidents may not cause concern to some parents because
they feel those teeth will soon be replaced by permanent teeth. However, the
absence of these teeth may affect the child’s speech, appearance, and ability to
eat properly. Injury to or premature loss of primary or permanent teeth should
be checked by your dentist.
A dental first-aid kit is necessary to apply proper dental first aid. Items needed
in the dental first aid kit or as as part of a general first-aid kit are as follows:
Cotton swabs - Stops bleeding; cleans injury
Tea bags - Stops bleeding by pressing a wet tea bag on bleeding injury
(tannic acid in tea stops bleeding)
Dental floss - Removes objects from between teeth
Interdental cleaner - Removes objects wedged between teeth
or toothpicks
Sterile gauze squares - Cleans injury or used as compress
Tweezers - Removes objects between teeth
Dental wax - Stops irritation to cheeks or gums by placing the dental wax
(or paraffin) over a chipped tooth or a protruding wire from orthodontic
bands
Ice pack - Helps reduce swelling of an injury
Handkerchief - Immobilizes broken jaw
Milk - Stores a knocked-out tooth, if unable to place immediately
back in socket or store under the tongue
Medications - Consult school nurse and/or school’s medication policy
T he Comple te Guide to Dental Health Care for C hildren
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ORTHODONTIC CARE |
Chapter 12
What is orthodontics?
Orthodontics is that specialty branch of dentistry
dealing with crooked or malaligned teeth and jaws.
Straight teeth are important for a nice smile which in
turn is important for esthetics and good looks as well as
psychological confidence and social acceptability. Correct
jaw positioning as well as well positioned teeth are together
important for mastication (chewing), digestion, speech and
good looks, in other words physiological and psychological
health. Straight teeth are also easier to keep clean and this
enhances the health of the gums and of the oral cavity in
general.
Crooked teeth
Crooked teeth and jaws and unbalanced facial problems
could be caused by heredity(genes), environmental
factors(air pollution causing altered breathing patterns;
nutrition etc.) and habits (thumb sucking). This exemplifies
the importance of a balanced diet, healthy lifestyle and absence of deleterious
habits in stimulating normal growth and development of the teeth and jaws.
However, most dental and skeletal malocclusion, being of genetic origin, are
not preventable and may present as buck teeth, crooked teeth, missing teeth,
teeth of the incorrect size and/or shape, additional or extra teeth, incorrectly
positioned jaws, larger or smaller than normal jaws, cleft palate etc.
Orthodontic problems
Orthodontic problems could manifest at any age, but normally most problems
are diagnosable between 6 and 14 years of age. Many problems, such as single
tooth crossbites could be treated as young as 7 or 8 years of age. Many problems
should be treated while the child is actively growing, between 8 and 16 years of
age. Males on average mature about 2 years later than females and may
continue active growth into the 16th year. Growth modification or growth
stimulation(orthopedics) of the jaws must be accomplished while the patient is
growing and the active growth period in females ends at about 12 years of age
and 14 years in males.
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Orthodontic problems
During orthopedics the patient may be required to wear a
nightbrace(headgear) or activating appliance (functional appliance)
at night during sleeping hours.
Sometimes it is beneficial to undertake treatment in 2 phases, starting with
an early or first phase of treatment which normally last about 1 year. Once
all the baby teeth have fallen out and all the adult teeth have erupted,
orthodontic treatment of both arches can be undertaken. Full-fixed
orthodontic appliances or braces are normally placed on the teeth to
straighten them. Braces are normally worn for about 2 years with the
patient coming into the office every 4 to 6 weeks for adjustments. After
orthodontic treatment is finished, a retention appliance (retainer) often
needs to be worn to keep the teeth straight. In certain instances, the jaws
are so malpositioned, that orthogathic surgery or jaw surgery in
combination with braces is required to correct the malocclusion.
Braces
Bracket
Brace
Sometimes at the end of treatment, the dentist needs to
build-up some teeth with an aesthetic tooth, coloured
resin or filling material or some other prosthodontic
prosthesis to restore it. This is part of those difficult
cases requiring multidisiplinary treatment.
Put steady pressure on your teeth, guiding them into
place. Brackets are cemented to the teeth. They have
grooves that hold the archwires.
Retainer
A retainer holds your teeth in their new positions while
bone grows in to hold them steady. You may wear a
positioner first, to move your teeth each slightly and put
the finishing touch on your new smile. Make sure your
child wears their retainer as many hours as the
orthodontist suggests. Brush the retainer with toothpaste
once a day. When your children are eating, keep them
safely in its case.
T he Comple te Guide to Dental Health Care for C hildren
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Brushing
Make sure you brush your teeth right after every meal
and before you go to bed. Use a fluoride toothpaste to
help fight cavities. Your orthodontist may also prescribe
a fluoride mouth rinse to help prevent cavities.
Follow this brushing method with braces:
Start by brushing the outside of
each tooth at least 10 times.
Brush the inside surface of each
tooth at least 10 times, too.
Then brush where your gums
and teeth meet, using a rolling
motion.
Brush the chewing surfaces of your
teeth last, and rinse with water.
T he Comple te Guide to Dental Health Care for C hildren
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Flossing
Brushing alone won’t keep your teeth clean - flossing can help.
A floss threader, available from your orthodontist helps you
floss with braces on. Floss once a day, like this:
#1
#2
Thread floss through the
threader and slip it up behind
your archwire.
Pull the floss between two
teeth and up under your
gum margins.
T he Comple te Guide to Dental Health Care for C hildren
page 65
Choose to be,
Cavity Free !
Kids Dental™ is a place that celebrates family,
fun and well being.
Our mission is dedicated to the principle of lifelong dental health through prevention, showing that the
right dental and nutritional decisions can have a profound effect on a child’s life and future.
Please visit our website at: www.kidsdental.ca for wonderful parent resources, updates and support. It’s
also a place for your kids and you to explore educational games and Kids Dental materials.
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Tuxedo Park Shopping Centre
128-2025 Corydon Avenue
Winnipeg, MB
Canada
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