Does my child need to be taken to a pediatric dentist?
Pediatric dentists are specially trained to handle problems particular to children, such as dental developmental difficulties and root canals on adult teeth that have not fully formed. However, most children are treated by general dentists. A general dentist often has a relationship with the entire family and therefore has a great deal of family history knowledge, which may apply to your child. If you're having trouble deciding on the type of dentist to use for your child, ask your family dentist or your child's pediatrician for suggestions.

When should I take my child to the dentist?
The ideal time is six months after your child's first tooth erupts. This is the perfect time for the dentist to carefully examine the development of your child's mouth. Dental problems often start early, so the sooner the visit occurs, the better. Also, your dentist can provide or recommend special preventive care to safeguard against problems, such as baby bottle tooth decay, teething irritations, gum disease, and prolonged thumb-sucking.

How do I prepare my child and myself for the first visit?
Before the visit, ask the dentist what procedures will be performed so there are no surprises. Plan a course of action to manage your child's reaction to the visit. Some children may be non-cooperative. Talk to your child about what to expect and build excitement as well as understanding about the upcoming visit. Bring your child's medical records to help you complete the medical history forms before the appointment.

When will my child lose his/her baby teeth?
Children will begin losing their teeth at approximately age 4. They will usually lose their front teeth first. Children will continue to lose baby teeth until age 12 or 13 when all of the permanent teeth finally erupt.

Why is it important to fix baby teeth that have decay?
It is very important to maintain baby teeth because these teeth hold space for the future eruption of permanent teeth. If a baby tooth decays or is removed too early, the space necessary for the permanent tooth is lost and can only be regained through orthodontic treatment. Infected baby teeth also can cause permanent teeth to develop improperly, resulting in permanent enamel defects and weaker teeth.

What can I do to protect my child's oral health at home?
Clean your infant's gums with a clean, damp cloth. Ask your dentist if you may rub a tiny dab of toothpaste on the gums. As soon as the first teeth come in, begin brushing them with a small, soft-bristled toothbrush and a pea-sized dab of fluoride toothpaste. Help a young child brush at night, which is the most important time to brush, due to lower salivary flow and higher susceptibility to cavities and plaque. By approximately age 5, your child can learn to brush his or her teeth with proper parental instruction. The best way to teach a child how to brush is to lead by good example. Allowing your child to watch you brush your teeth teaches the importance of good oral hygiene.

Can tooth decay affect infants?
Yes! Tooth decay in infants and young children most often occurs in the upper front teeth, but also may affect other teeth. Parents may not realize that a baby's teeth can decay soon after they first appear. The decay may even enter the underlying bone structure, which can hurt development of the permanent teeth. This problem is frequently referred to as baby bottle tooth decay. This decay is caused by long-term exposure of a child's teeth to liquids containing sugars. When a child consumes a sugary liquid, acid attacks the teeth and gums and causes decay.

How can children prevent damage to their teeth?
At school, children should rinse their mouth with water after meals, leaving their teeth free of sugar and acid. At home, encourage children to drink tap or fountain water. Use a straw when drinking soda to keep sugar away from teeth. If you purchase bottled water, be sure that it is fluoridated. Remember, bottled juices are not a good alternative due to the high sugar content. Regular dental check-ups, combined with brushing with fluoride toothpaste also will help protect children's teeth.

How can I help my child prevent tooth decay?
Brushing teeth after meals, regular flossing and fluoride treatments are the best ways to prevent tooth decay. Children should also be supervised as they brush. A good rule of thumb is when children can dress themselves and tie their own shoes, then they are ready to brush unsupervised. Children should be supervised in proper flossing techniques until the age of 10. If you have any concerns about your child's dental health or want some tips on preventing tooth decay, ask your dentist.

When Should My Child First See a Dentist?
Your child's first visit to the dentist should happen before his or her first birthday. The general rule is six months after eruption of the first tooth. Taking your child to the dentist at a young age is the best way to prevent problems such as tooth decay, and can help parents learn how to clean their child's teeth and identify his or her fluoride needs. After all, decay can occur as soon as teeth appear. Bringing your child to the dentist early often leads to a lifetime of good oral care habits and acclimates your child to the dental office, thereby reducing anxiety and fear, which will make for plenty of stress-free visits in the future.

How do I prepare my child and myself for the visit?
Before the visit, ask the dentist about the procedures of the first appointment so there are no surprises. Plan a course of action for either reaction your child may exhibit – cooperative or non- cooperative. Very young children may be fussy and not sit still. Talk to your child about what to expect, and build excitement as well as understanding about the upcoming visit. Bring with you to the appointment any records of your child's complete medical history.

What will happen on the first visit?
Many first visits are nothing more than introductory icebreakers to acquaint your child with the dentist and the practice. If your child is frightened, uncomfortable or non-cooperative, a rescheduling may be necessary. Patience and calm on the part of the parent and reassuring communication with your child are very important in these instances. Short, successive visits are meant to build the child's trust in the dentist and the dental office, and can prove invaluable if your child needs to be treated later for any dental problem.

Child appointments should always be scheduled earlier in the day, when your child is alert and fresh. For children under 36 months, the parent may need to sit in the dental chair and hold the child during the examination. Or, parents may be asked to wait in the reception area so a relationship can be built between your child and the dentist.

If the child is compliant, the first session often lasts between 15 and 30 minutes and may include the following, depending on age:

• A gentle but thorough examination of the teeth, jaw, bite, gums and oral tissues to monitor growth and development and observe any problem areas
  
• If indicated, a gentle cleaning, which includes polishing teeth and removing any plaque, tartar buildup or stains
  
• X-rays
  
• A demonstration on proper home cleaning
  
• Assessment of the need for fluoride

The dentist should be able to answer any questions you have and try to make you and your child feel comfortable throughout the visit. The entire dental team should provide a relaxed, non-threatening environment for your child.

When should the next visit be?
Children, like adults, should see the dentist every six months. Some dentists may schedule interim visits for every three months when the child is very young to build up a comfort and confidence level or to treat a developing problem.

How do I find a good dentist for my child?
Many general dentists treat children. If yours does not, ask for a referral to a good dentist in your area. A word-of-mouth recommendation from a friend or family member can also yield the name of a quality dentist.

How can I protect my child's oral health at home?
Parents typically provide oral hygiene care until the child is old enough to take personal responsibility for the daily dental health routine of brushing and flossing. A proper regimen of preventive home care is important from the day your child is born.

• Clean your infant's gums with a clean, damp cloth after each feeding.
• As soon as the first teeth come in, begin brushing them with a small, soft-bristled toothbrush andwater. If you are considering using toothpaste before your child's second birthday, ask your dentist first.
  
• To avoid baby bottle tooth decay and teeth misalignment due to sucking, try to wean your child off of the breast and bottle by one year of age, and monitor excessive sucking of pacifiers, fingers and thumbs. Never give your child a bottle of milk, juice or sweetened liquid as a pacifier at naptime or bedtime.
  
• Help a young child brush at night, the most important time to brush, due to lower salivary flow and higher susceptibility to cavities. Perhaps let the child brush their teeth first to build self-confidence, then the parent can follow up to ensure that all plaque is removed. Usually by age 5 or so, the child can learn to brush his or her own teeth with proper parental instruction.
  
• The best way to teach a child how to brush is to lead by good example. Allowing your child to watch you brush your teeth teaches the importance of good oral hygiene.
  

Is My Child at Risk for Early Childhood Tooth Decay?
The average healthy adult visits the dentist twice a year. The average healthy 2-year-old has never been to the dentist. By kindergarten, 25 percent of children have never seen a dentist, yet dental decay is the single most common chronic childhood disease in America.

The culprit? A combination of misinformation about when a child should first visit the dentist, when a parent should start caring for a child's teeth and the frequent and long-term exposure of sugary liquids to a child's teeth.

A child should first visit the dentist six months after the eruption of the first tooth. During this first exam, the dentist can teach parents the best way to guard against early childhood tooth decay by wiping down the teeth with a damp cloth after every feeding and remind parents to limit sugary beverages.

Frequent and long-term exposure of a child's teeth to sugary liquids is commonly called baby bottle tooth decay. Most parents are aware of baby bottle tooth decay but may not know that the long-term and regular consumption of sugary liquids in a bottle or cup puts children's growing teeth at increased risk for decay.

"Unsweetened fruit juices, teas and water are always best for children to help promote oral and overall health," says Academy of General Dentistry spokesperson Cindi Sherwood, DDS.

Fruit juice causes tooth decay if children are allowed to hold a bottle, cup or box of juice in their mouth through the day.

"If left untreated, baby bottle tooth decay can result in pain and infection," says Dr. Sherwood. "Baby teeth are important because they hold the place for permanent teeth and help guide them into correct position. Severely decayed teeth may need to be extracted, which could effect the development of permanent teeth, speech and chewing."

Caring for children's teeth beginning in infancy promotes good oral health care habits for a lifetime and increases the chances of a child maintaining healthy permanent teeth.

Tips for parents to decrease the risk of early childhood tooth decay:

• Wean a child from the bottle or breast by age 1.
• Use spill-proof cups as a transitional step in the development of children, not a long-term solution.
• Don't allow children to use spill-proof cups throughout the day. Save spill-proof cups for snack and mealtimes
  when increased salivary activity helps clean teeth.
• Drink sugary beverages through a straw. The best spill-proof cups to protect against decay are those with collapsible rubber straws.
• Introduce oral health care habits early. Wipe baby's gums with a damp cloth after every feeding. Introduce brushing with a soft-bristle brush and water when the first tooth appears. Parents can add a pea-sized dab of fluoridated toothpaste to the toothbrush by age 2.

What is Baby Bottle Tooth Decay?
Baby bottle tooth decay is caused by the frequent and long-term exposure of a child's teeth to liquids containing sugars. Among these liquids are milk, formula, fruit juice, sodas and other sweetened drinks. The sugars in these liquids pool around the infant's teeth and gums, feeding the bacteria in plaque. Every time a child consumes a sugary liquid, acid produced by these bacteria attack the teeth and gums. After numerous attacks, tooth decay can begin.

The condition also is associated with breast-fed infants who have prolonged feeding habits or with children whose pacifiers are frequently dipped in honey, sugar or syrup. The sweet fluids left in the mouth while the infant is sleeping increase the chances of cavities.

Why should I be worried about baby bottle tooth decay?
Giving an infant a sugary drink at nap or nighttime is harmful because during sleep, the flow of saliva decreases, allowing the sugary liquids to linger on the child's teeth for an extended period of time. If left untreated, decay can result, which can cause pain and infection. Severely decayed teeth may need to be extracted. If teeth are infected or lost too early due to baby bottle tooth decay, your child may develop poor eating habits, speech problems, crooked teeth and damaged adult teeth. Healthy baby teeth will usually result in healthy permanent teeth.

How can I prevent baby bottle tooth decay?
Never allow a child to fall asleep with a bottle containing milk, formula, juice or other sweetened liquids. Clean and massage the baby's gums to help establish healthy teeth and to aid in teething. Wrap a moistened gauze square or washcloth around the finger and gently massage the gums and gingival tissues. This should be done after every feeding.

Plaque removal activities should begin upon eruption of the first baby tooth. When brushing a child's teeth, use a soft toothbrush and water. If you are considering using toothpaste before your child's second birthday, ask your dentist first. Parents should first bring their child to the dentist when the child is between 6 and 12 months old.

Will changes in my child's diet help prevent baby bottle tooth decay?
A series of small changes over a period of time is usually easier and eventually leads to better oral health.

To incorporate these changes:

• Gradually dilute the bottle contents with water over a period of two to three weeks.
• Once that period is over, if you give a child a bottle, fill it with water or give the child a clean pacifier recommended by a dentist. The only safe liquid to put in a bottle to prevent baby bottle tooth decay is water.
• Decrease consumption of sugar, especially between meals. Children should be weaned from the bottle as soon as they can drink from a cup, usually by their first birthday, but the bottle should not be taken away too soon, since the sucking motion aids in the development of facial muscles, as well as the tongue.
  

Dental Sealants: Is My Child a Candidate?
By age 19, tooth decay affects nearly 70 percent of America's children, according to the Centers for Disease Control and Prevention (CDC). Left untreated, tooth decay, also known as cavities, may result in pain and infection.

One highly effective option to help prevent cavities is dental sealants – a thin plastic film painted on the chewing surface of teeth.

Dental sealants have been proven a safe and cost-efficient dental procedure for patients prone to cavities. Even health care task forces are recognizing the benefits of dental sealants, recommending school-based programs.

However, an article in the February 2006 issue of AGD Impact, the monthly newsmagazine of the Academy of General Dentistry (AGD), cites several reports that explain dental sealants are still underused, despite their advantages in averting tooth decay for an average of five to seven years.

"Studies show that many children are exceptional candidates for dental sealants.," says AGD spokesperson Mark Ritz, DDS, MAGD. "Parents should consider sealants as a preventive measure in their child's oral health and discuss this option with their dentist."

Surveys show the majority of all cavities occur in the narrow pits and grooves of a child's newly erupted teeth because food particles and bacteria are not easily cleaned out. A risk assessment by a dentist best determines if a child is a candidate for dental sealants.

Dental sealants act as a barrier to "seal-off" space between the tooth surface and any small food particles or bacteria that may otherwise cause a cavity in an "unsealed" tooth.

Paired with twice-daily brushing with a fluoridated toothpaste, a healthy diet and visiting the dentist twice a year to monitor the sealants' placement or bond on the tooth, properly applied dental sealants are 100-percent effective in preventing cavities.

"Remember that dental sealants do not protect against gum disease such as gingivitis, oral cancer or many common dental conditions," says Dr. Ritz. "Regular dental checkups are vital to monitor overall oral health."

Benefits of dental sealants:

• Paired with good oral health care, sealants are 100-percent effective against cavities in teeth that are sealed and properly maintained.
• Minimally invasive, safe and effective preventive procedure.
• Costs less than getting a cavity filled.

Take Care of Your Child's Smile for Life
With a baby, everything is a first, and that includes the first adorable smile. To ensure a lifetime of healthy smiles, the Academy of General Dentistry (AGD) recommends that your child's first trip to a dentist occurs six months after his or her first tooth erupts.

According to an article in the February 2006 issue of AGD Impact, the monthly newsmagazine of the AGD, this is the ideal time to visit, since it allows the dentist to examine the development of the child's mouth. Visiting sooner than later will also help identify any problems, such as baby bottle tooth decay or teething irritations.

Although pediatric dentists specialize in providing oral health care treatment for children, most children are treated by a general dentist, who is the primary dental care provider for patients of all ages and often has an established relationship with the entire family.

"Typically, the first baby tooth is lost between age 5 and 6, with children continuing to lose their baby teeth until age 12 or 13," says AGD spokesperson Cindy Bauer, DDS, MAGD. Many people are under the impression that, because these baby teeth will eventually fall out, there is no need to visit a dentist before that time.

Dr. Bauer explains, "It's important to fix decayed baby teeth so the surrounding teeth don't become infected. Cavities that are not fixed can lead to painful abscesses, early tooth loss, as well as the loss of spacing needed to be reserved for the incoming permanent teeth."

Parents can prepare themselves and their child for the first visit by asking the dentist about the procedures that will be performed and by bringing medical records. "Also, talk to your child about what to expect and build excitement, as well as understanding, about the upcoming visit," says Dr. Bauer.

At home, parents can clean an infant's gums with a clean, damp cloth, and teach older children brushing techniques. The best way to teach a child proper oral hygiene is to lead by good example, advises Dr. Bauer.

What may happen on the first visit?

• A gentle examination of the jaw, bite, gums and oral tissues
• A gentle cleaning, including polishing the teeth and removing any plaque, tartar build-up and stains
• Proper home cleaning will be demonstrated
• An assessment will be made of the need for fluoride

Fluoride Intake Important for Children

Parents should pay attention to the amount of fluoride their child receives. Too much fluoride can cause tooth discoloration, and too little fluoride can cause teeth to be more susceptible to cavities.

Bottled waters need to be on the list of items that parents must check before giving to their child. Some bottled waters have little or no fluoride at all.

"This is a problem when parents are giving their children only this 'designer' water from a bottle," says Academy of General Dentistry spokesperson Heidi Hausauer, DDS. "In my own practice, I've seen an 8-year-old girl come in with eight cavities. The fact that she's been drinking only non-fluoridated water could have been a contributing factor. Most of the tap water in this country is properly fluoridated, so it's best if the child receives most of the water straight from the faucet."

When introducing toothpaste, the Academy of General Dentistry recommends using a small pea-sized dab.

"Parents should be brushing their child's teeth with this amount until the child is 6 years old," says Dr. Hausauer. "Until this age, children don't have the dexterity to brush by themselves properly and they tend to swallow the toothpaste and ingest the fluoride, which can put them at risk for fluorosis (tooth discoloration)."

Monitor Infant's Fluoride Intake

If you add fluoridated water to your infant's baby formula, you may be putting your child at risk of developing dental fluorosis, a harmless cosmetic condition manifested by brown, mottled or discolored enamel.

Although fluoride – found naturally in all water and foods – is necessary to prevent tooth decay, in infants and children regular fluoride intake above optimal amounts can cause fluorosis in developing teeth. .

Though breast milk and most ready-to-feed formulas contain infant-safe fluoride levels, parents must be careful with concentrate formulas that require adding water. Community water or well sources often contain fluoride levels higher than 1.2 ppm, the highest amount proven to be beneficial in preventing tooth decay.

When formula concentrations need to be diluted, it is recommended parents use bottled water that is fluoride-free or low in fluoride water or tap water from a reverse osmosis home water filtration system, which removes most of the fluoride.

"If your child's teeth develop brown spots, visit your dentist to check for fluorosis," says Academy of General Dentistry spokesperson James Tennyson, DDS. "It also could signal tooth decay, in which case your child may be prescribed fluoride supplements."

"If you correct a fluorosis problem in your child's first primary teeth," says Dr. Tennyson. "Your child probably won't have a problem when the permanent teeth erupt at age 5 or 6."

Dr. Tennyson also recommends checking your water source's fluoride levels by collecting a fresh sample in a sterile container and taking it to your local health or water department. Or, your dentist may be able to test your sample if his office has a colorimeter, which can determine the concentration of fluoride by comparing the sample to a standard.

Tot Toothbrushes Promote Good Brushing Habits

Many parents don't know that children's teeth must be cleaned as soon as they start coming in. What they also may not know is that traditional toothbrushes may not be safe for toddlers to use themselves because they can be overinserted in the mouth or even swallowed.

Today, safer toddler toothbrushes are available that prevent the build-up of plaque and bacteria. Using toddler toothbrushes can help children establish good oral health habits at an early age.

A dental hygienist designed and introduced the first toddler toothbrush in 1993. It resembles an oblong-shaped teething toy, with one wide end for easy gripping and a narrow end with a small head of bristles. The shape prevents it from being overinserted in the mouth or swallowed, and some models have bumps around the gripping end on which infants can teeth.

Even before children's primary teeth come in, parents should start promoting oral health in infants by wiping the baby's mouth with a washcloth or gauze pad to prevent the build-up of plaque and bacteria.

It's never too early for parents to encourage their youngsters to start using toddler toothbrushes. "As soon as they're reaching and grabbing for things, they're ready for it," says Academy of General Dentistry spokesperson Bob Roesch, DDS, MAGD. "It familiarizes children with having a toothbrush in their mouths, and they like to mimic their parents."

"Parents need to be good role models," says Dr. Roesch. "They need to take good care of their own teeth and make dental care part of the daily routine for the whole family. Adults should supervise children while brushing. Adults also should help children have fun with oral care by singing songs to keep them brushing longer or making brushing a game by naming the individual teeth being cleaned."

Watch for "Preemie" Teeth

Even though they do not have any teeth yet, prematurely born babies can expect to have dental complications as they grow older.

About 6 percent of babies are born before their due date and below 7.2 pounds, and of these, up to 70 percent will have enamel hypoplasia when their teeth erupt, according to a 2000 study. Enamel hypoplasia causes teeth to appear brownish and less smooth, as well as to be softer and more prone to decay or chipping.

"You won't discover this until your child is about 6 months old, because that's about the time when the baby's first tooth would erupt," says Henry Finger, DDS, FAGD, past president and spokesperson of the Academy of General Dentistry. "Prematurely born children should see a dentist when their first tooth erupts to avoid any dental complications."

Children with the lowest birthweight and shortest gestational ages have the lowest rates of dental development, particularly before 6 years of age, according to the study. Children who are born prematurely can have delays in the eruption of their baby teeth and even their permanent teeth.

The front teeth are the first to erupt at 6 to 8 months, and the back teeth erupt between 18 and 24 months. Prematurely born children should visit the dentist regularly, even at this early stage, because they are more likely to be candidates for cavities than children born at term.

Tips on Finding Preventive Care for Children's Oral Health
More than 51 million school hours are lost each year due to dental-related illnesses. Despite these numbers, many children still do not visit the dentist. In addition, almost 50 percent of tooth decay remains untreated in low-income children, according to the Centers for Disease Control and Prevention (CDC).

"The need for dental care cannot be ignored. Dental diseases grow progressively worse without treatment, which influences overall health and may require increasingly costly care," says Academy of General Dentistry spokesperson Mark Ritz, DDS, MAGD. "However, most oral health problems can be prevented. Regular dental examinations, oral health education and primary disease prevention will dramatically reduce the burden of dental disease in most patients."

Regular examinations can seem expensive to people without dental insurance, and many children are without dental coverage. The Surgeon General's office reports that for every child without medical insurance there are 2.6 children lacking dental insurance. These resources are available to help the parents of children in need of dental care:

Federally sponsored programs
Medicaid is the largest source of funding for medical and health-related services for people with limited incomes. More than 40 million people have Medicaid coverage and about half are children. In order to be approved and receive the funding, certain eligibility requirements must be met. Go to http://cms.hhs.gov to look up eligibility requirements in each state.

State-assisted programs
A State Children's Health Insurance Program (SCHIP) is another option for uninsured children. SCHIP is a state-administered program, and each state sets its own guidelines regarding eligibility and services. Go to http://www.insurekidsnow.gov for a listing of SCHIP programs.

States also have dental clinics or other charitable programs set up to help children receive dental care at no cost or at a reduced fee. Search online at http://ask.hrsa.gov/pc. Some state dental societies will also list clinics or charities.

Dental schools
A dental-school clinic is another option for reduced fee treatment. Students perform the procedures, which helps reduce treatment costs. Experienced faculty members are on site throughout the process to evaluate the student's work. State dental societies should have a listing of dental schools in the area.

Pacifiers Have Negative and Positive Effects
It's one of the hardest habits to break and can require a great deal of persuasion: Parents often struggle with weaning their child off of a pacifier.

There is much debate regarding the use of pacifiers, but there is evidence to show that there are both pros and cons, according to a study in the January/February 2007 issue of General Dentistry, the Academy of General Dentistry's (AGD) clinical, peer-reviewed journal.

"Contrary to popular belief, there are some positive effects that result from sucking on pacifiers," says Jane Soxman, DDS, author of the study and Diplomate of the American Board of Pediatric Dentistry. "One is that they assist in reducing the incidence of sudden infant death syndrome (SIDS). Babies who are offered a pacifier do not sleep as deeply as those who sleep without a pacifier. Pacifier sucking makes it possible for the infant to be aroused from a deep sleep that could result in the stopping of breathing. Pacifiers also increase sucking satisfaction and provide a source of comfort to infants."

However, parents should be aware of the negative effects of pacifier sucking on an infant's oral health. "Children should stop using pacifiers by age 2," says AGD spokesperson Luke Matranga, DDS, MAGD, ABGD. "Up until the age of 2, any alignment problem with the teeth or the developing bone is usually corrected within a 6-month period after pacifier use is stopped. Prolonged pacifier use and thumb sucking can cause problems with the proper growth of the mouth, alignment of the teeth and changes in the shape of the roof of the mouth."

There is also an association between pacifier use and acute middle ear infections (otitis media).

"Continuous sucking on a pacifier can cause the auditory tubes to become abnormally open, which allows secretions from the throat to seep into the middle ear," explains AGD spokesperson Maria Smith, DDS. "Transmission of bacteria in secretions would lead to middle ear infections."

The bottom line is that if your child is continuously battling middle ear infections, you may have an alternative to surgery or antibiotics to stop this problem, says Dr. Smith, which would be to remove the pacifier.

Breaking the pacifier habit is not always easy, and there are several methods parents can use to stop it. Parents can dip the pacifier in white vinegar, making it distasteful; pierce the nipple of the pacifier with an ice pick or cut it shorter to reduce sucking satisfaction; leave it behind on a trip; or implement the "cold turkey" method.

Tips and recommendations:

• Pacifier use should be restricted to the time when the infant is falling asleep.
• Pacifiers can cause severe lacerations if the shield is held inside the lips.
• Look for a pacifier with ventilation holes in the shield, as they permit air passage. This is important if the pacifier accidentally becomes lodged in your child's throat.
• In order to prevent strangulation, do not place a cord around your child's neck to hold a pacifier. Look for pacifiers that have a ring.
• A symmetrical nipple permits the pacifier to remain in the correct sucking position.
  Dispose of the pacifier after use; it is not sanitary to keep it or give it away.

Stop Pacifying Preschoolers
If your child's heading to preschool this year and is still using a pacifier, now's the time to work with your child to drop the "binkey."

Thousands of parents rely on pacifiers to calm and soothe a fussy baby. For children under the age of 1, the continuous sucking action is normal and healthy.

However, if parents allow children to continue using a pacifier into toddler years, this action becomes habit instead of a natural instinct and can be detrimental to a child's oral health.

"Prolonged pacifier use can impede the natural development of teeth, the jaw and normal palate formation," says Academy of General Dentistry spokesperson Julie Ann Barna, DMD, MAGD. "For a child with several baby teeth, pacifier use can cause upper teeth to protrude and lower teeth to jut in."

In addition to moving and shifting teeth, studies show that pacifier users are more likely to suffer from acute middle ear infections. "Continuous sucking on a pacifier causes the auditory tubes to open abnormally, allowing secretions from the throat to seep into the middle ear," says Dr. Barna. "This makes the ears more susceptible to infection-causing bacteria."

Researchers have found no physiological reason why children should be allowed a pacifier past the age of 1, and report a trend that many prolonged pacifier users become prolonged thumb suckers after the pacifier is taken away, adding to a child's risk of damaging the natural position of the teeth.

For the health and proper development of your child, Dr. Barna agrees that parents should drop the pacifier by the child's first birthday and recommends "trading-in" the pacifier for "sippy cups," which promote the development of hand-eye coordination and help break the sucking habit.

Start the School Year Off With a Smile
Every child wants to look their best as they head back to school this fall. Parents help by scheduling haircuts and buying new outfits, but most overlook the simple steps to helping their child maintain one of their most visible features – their smile.

Studies show that one of the first things people notice about someone is their smile and that a good smile creates a positive self-image…something all parents wish for their children. "Back-to-school time is the perfect time to incorporate good oral health habits into a child's daily routine," says Academy of General Dentistry spokesperson Cindy Flanagan, DDS, FAGD. "The sooner you make them a priority, the sooner your child will benefit."

Schedule a back-to-school dental visit
Seeing a dentist twice a year during the school-age years is vital because this is a time of great change in the mouth, with kids losing baby teeth and getting in their permanent teeth. Tooth decay is still the most common chronic childhood disease and, left untreated, it can impair a child's ability to eat, speak, sleep and learn. However, studies show more than 60 percent of school-age children do not see a dentist annually. "Simple preventive checkups twice a year can head off childhood decay and help you and your child learn how to protect their teeth throughout the year," says Dr. Flanagan. To locate a dentist in your area, call 1.877.2X.A.YEAR (1.877.292.9327).

Establish daily brushing habits with your children
Children should brush at least twice a day. To encourage children to brush after every meal, let them pick out their own travel toothbrush and toothpaste to take to school. "There are many child-friendly products that help encourage younger children to brush," says Dr. Flanagan, "Make sure your child's toothpaste contains fluoride and the toothbrush is soft-bristled."

Make good nutrition a top priority
National studies show that only one in five school-age children eats the recommended five daily servings of fruits and vegetables – greatly increasing their risk of cavities. In addition, only one in five children meets even the minimum standards for calcium consumption. Take charge of your child's health this school year by packing healthy lunches.

"Don't forget after-school snacks," says Dr. Flanagan. "Many school children go straight to sporting practices after school and turn to sugary foods and drinks from a vending machine when they don't have any other option, which are disastrous to children's oral health." Bite-sized carrots, fruits, nuts and bottled water are much better after-school snack options and give children the fuel they need to excel in physical activity.

See a Baby Tooth? See a Dentist
Baby teeth are worth more than just a dollar under the pillow. Providing proper care and oral hygiene during a child's first year of life can mean a lifetime of good oral health.

Traditionally, parents have waited to bring their children to the dentist until primary teeth begin to appear. A 2002 consumer poll by the American Academy of Pediatric Dentistry shows that nearly 70 percent of parents wait until their children are 3 years old before taking them to the dentist. But a dental visit by age 1 – or within six months of the eruption of the first baby tooth – is crucial, says Academy of General Dentistry (AGD) spokesperson Cynthia E. Sherwood, DDS.

Dr. Sherwood says this early visit gives a dentist the opportunity to see potential problems such as early-childhood caries (also known as baby bottle tooth decay); educate the parent on proper oral hygiene for the child; and give the toddler a positive experience in a dental setting. This can do wonders in allaying fears and boosting the child's future attitude toward visiting the dentist, Dr. Sherwood says.

Education is the heart of the age-1 exam. "When we see a toddler, we primarily talk to the parents about growth, development, thumb sucking, bottle and breast feeding, oral hygiene and nutritional issues, use of fluoride and why baby teeth are important," Dr. Sherwood said.

During this first visit, the dentist usually will sit knee-to-knee with the parent, with the child nestled in the parent's lap, and the dentist will ask the parent to demonstrate how she or he brushes the child's teeth. Then, if parent and tot are comfortable, the dentist will turn the child around onto his or her lap, so the dentist can get a good look at the child's teeth and gums. This "pleasant, painless visit" should take no more than 15 minutes, Dr. Sherwood said.

"Sitting knee-to-knee with the parent, playing with the baby and talking with the parent, I can get a very good sense of the child's oral health care, and this position gives us a good opportunity to get a good look at the child's teeth," says Dr. Sherwood. "It's a great experience for everyone involved."

Toddler dos and don'ts:

DO:

• Take your child to the dentist within six months of the eruption of the first baby tooth, definitely by age 1.
  
• Follow your dentist's advice regarding nutrition, hygiene routine, fluoride and dental-visit schedule.
• Teach your child how to brush around age 3, and brush your teeth with your children to model good technique and spot problems.

DON'T:

• Think baby teeth don't matter "because they'll just fall out anyway."
• Allow children to have continual access to a bottle or "sippy cup" filled with anything other than water.
• Give your children the impression that visiting the dentist is unpleasant.

Keep Your Little Monster's Teeth Away From Harm This Halloween
More than 90 percent of children will go trick or treating this year and return home with bags full of sugary candy that can turn anyone's mouth into a nightmare. By taking a few preventive steps, however, your children can enjoy Halloween without harming their teeth.

Since sugar-free gum is one treat that actually helps prevent cavities, it is a smart choice to drop in Halloween bags this year. Parents can also give it to their children to help neutralize the effects of sugary snacks after eating. Chewing sugar-free gum containing the artificial sweeteners sorbitol and xylitol reduces cavities. The chewing motion stimulates the flow of saliva, which helps cleanse the teeth. Sweets are especially harmful, since damaging acids form in the mouth every time you eat a sugary snack and continue to affect the teeth for at least 20 minutes before they are neutralized. The sweetening agents in sugarless gum are effective in combating the bacteria in plaque and fighting the acid that eats away at enamel.

Certain foods such as sweets and soda are easily linked to tooth decay, however all foods can promote tooth decay if eaten in excess. The key is to teach kids to eat in moderation and make sure that they take proper care of their teeth. "While healthy alternatives to candy, such as fruit and nuts, are great, these foods are sticky and can get caught in the pits and grooves of teeth, causing decay," says Academy of General Dentistry spokesperson Julie Barna, DMD, MAGD. "Reading nutrition labels and being sensible about the foods you and your children eat on a daily basis helps promote good oral and overall health."

Children should also brush three times a day for two minutes and rinse with a fluoridated mouthrinse.

How to Find a Kid-friendly Dentist
Although more parents know about the importance of age-1 dental visits, many parents may still wonder about what kind of dentist can provide care for their child.

According to Academy of General Dentistry spokesperson Cindy Bauer, DDS, MAGD, many general dentists treat children.

"Parents should seek out a dental office that provides a fun environment for children, so that they are excited about coming to the dentist's office."

For that reason, many dentists have made an effort to incorporate child-friendly design into their office environment. They provide entertainment – such as books, video games, television and movie access – for their patients.

To prepare the child for the visit, parents should ask the dentist about the procedures of the first appointment so there are no surprises. Plan a course of action for either reaction the child may exhibit – cooperative or non-cooperative. Very young children may be fussy and not sit still. Talk to the child about what to expect and build excitement, as well as understanding, about the upcoming visit. Bring to the appointment any records of the child's complete medical history.

Parents who feel their child is anxious about a dental visit should ask their dentist if they will schedule a pre-visit. Many dentists use pre-visits to alleviate any fear or anxiety by acclimating them to the office environment. The dentist will walk the child around the office, show them the tools, allow them to sit in the chair and even demonstrate on a family member to help them become comfortable.

Most importantly, parents should make sure their child regularly visits a dentist, reminds Dr. Bauer. "This will help them have better oral health for the rest of their lives."

How to keep your child from being anxious about the dentist:

• Talk to the dentist about the best way to communicate with your child about dental visits.
• Ask the dentist to take your child on a tour of the office and explain the equipment.
• Ask if the dentist will allow a relative to accompany the child in the treatment room.
• Avoid caffeine or sugary foods before a dental appointment.

How Do I Care for My Child's Baby Teeth?
Though you lose them early in life, your primary teeth, also called baby teeth, are essential in the development and placement of your permanent teeth. Primary teeth maintain the spaces where permanent teeth will erupt and help develop proper speech patterns that would otherwise be difficult; without maintenance of these spaces, crowding and misalignment can occur, resulting in more complicated treatment later. Baby teeth also are primers for teaching your child good oral care habits. It is important to take care of your child's primary teeth. Even though primary teeth last only a few years, decay, cavities and infection can take its toll and may require expensive treatment to repair.

When do baby teeth come in?
Your child's primary teeth generally make their appearance when he or she is 6 or 7 months old, though it can occur as early as birth. There are 20 primary teeth, followed by 32 permanent teeth that will eventually replace them. Your child should have all his or her primary teeth at age 3 and will keep them until age 5 or 6, when they begin to loosen and fall out. This process usually lasts until the child is 12 or 13. Primary teeth fall out because permanent teeth are pushing them, and by about age 14 children have 28 permanent teeth, plus four additional teeth, called wisdom teeth, that grow behind the permanent teeth in late adolescence.

What can relieve my child's discomfort during teething?
Between the ages of 6 months and 3 years, your child may experience sore gums and general oral discomfort as primary teeth erupt. While some lucky children experience no apparent discomfort during eruption, many others do. Signs that eruption is causing discomfort in your child include crankiness, lack of appetite, excessive drooling, restless behavior, pink or red cheeks, coughing, upset stomach and chewing or sucking of fingers and toys. There are ways you can bring your child relief. A cold, wet cloth for your baby to suck on can sooth gums. There are also teething accessories and toys your child can chew on to relieve discomfort. Thumb sucking also brings relief, however, dentists recommend this practice should cease upon the arrival of the first permanent teeth, so it does not interfere with the normal development of a child's oral cavity.

Should loose primary teeth be pulled?
Losing primary teeth before they are ready to fall out can affect the proper positioning of the permanent teeth. If a baby tooth is lost too early, other teeth may tip or fill in the vacant space, forcing permanent teeth to come in crooked. If a baby tooth is knocked out, see your dentist, who may recommend a space maintainer to reserve the gap until the permanent tooth comes in. In instances where a primary tooth is loose because of the emergence of a permanent tooth, have the child wiggle the tooth or eat something hard, such as an apple, to help it along. Once the shell of the tooth is disconnected from the root, the discomfort in extracting a loose primary tooth is minimal.

Early Dental Visits May Help Prevent Problems Down the Road
Many parents may not know their 1-year-olds are ready for their first dental checkup, but more and more dentists agree that the earlier children visit the dentist, the better.

The Academy of General Dentistry (AGD) and the American Dental Association (ADA) are just two of the organizations that recommend bringing children to the dentist six months after they get their first tooth, usually sometime between 1 year and 18 months of age.

"When teeth start to come in, we need to teach parents about nutrition and the growth and development of the child and their teeth," says AGD spokesperson Cynthia Sherwood, DDS.

While age-1 visits are recommended for all children, they could prove especially beneficial for children who drink liquids other than water. Acids and sugars in juices, formulas and breast milk can all lead to decay. Visiting the dentist at age 1 helps spot early signs of decay and cavities in baby teeth. It could also help put a major dent in childhood oral disease, which affects an estimated 2.5 million children nationwide and often results in lifelong problems that are painful, expensive and not just limited to the mouth.

"There's a common misconception that they're just baby teeth, and they aren't important," says Dr. Sherwood. "But really, it's about establishing good oral care habits."

The age-1 visit won't just involve the child – parents also participate, typically holding the child while the dentist takes a look inside the child's mouth. The dentist will then spend time discussing proper eating and tooth-care habits with parents to help head the child in the right direction, so future dental visits aren't so scary.

Cyclic Vomiting Syndrome: Recurring and Unexplained Episodes Destroy Teeth
Parents face many concerns when it comes to protecting their children. However, they may not be aware of a particular disorder that is more prevalent in children, cyclic vomiting syndrome (CVS).

According to a report in the November/December 2006 issue of General Dentistry, the Academy of General Dentistry's (AGD) clinical, peer-reviewed journal, CVS is characterized by a number of symptoms, the most evident being recurrent episodes of nausea and vomiting that are not caused by any specific disease and occur between periods of otherwise normal health.

The study's author, Eric T. Stoopler, DMD, says that the disorder generally lasts between two and six years and, fortunately, it commonly resolves during adolescence. With regard to oral health, CVS affects the mouth and teeth in similar ways to diseases associated with chronic vomiting, such as bulimia, and can cause tooth sensitivity and erosion, cavities, periodontal (gum) disease, dry mouth, salivary gland enlargement and trauma to the oral tissue.

So what can parents do? Dr. Stoopler advises parents to watch for anything unusual and to make sure both the child's pediatrician and dentist are informed. "If an otherwise healthy child develops chronic episodes of severe nausea and vomiting in conjunction with gastrointestinal, urologic or neurologic symptoms, parents should talk to their pediatrician. If your child's dentist thinks your child may have CVS, he or she will refer your child to a pediatrician for further evaluation."

What to look for:

• Nausea and/or vomiting not caused by any specific disease
• Extreme tiredness
• Headaches
• Sensitivity to sound or light
• Dizziness
• Ulcers or infections in the mouth
  

Children's Dental Visits: Parents, Prepare Yourselves
Children experience many firsts: first tooth, first words, first step, first birthday and first haircut. Parents want to be prepared for every step of their child's new life experiences, including dental visits. Only parents willing to model positive attitudes should accompany their child on a dental visit.

Parents averse to their own dental visits may transmit negative messages to children before, during and after a dental treatment. "Fearful parents can actually create a nervous and anxious child," says Jane Soxman, DDS, pediatric dentist and Diplomate of the American Board of Pediatric Dentistry. "Parents who are afraid of the dentist need to change their mindset."

Most children are not only comfortable but even curious during a first dental exam and cavity-filling procedures. However, a child may become problematic when the accompanying parent laces soothing messages with hints of fear or anxiety and relays incorrect assumptions about procedures.

"Because parents' interpretations and expectations towards dental visits can be quite different from the child's, parents need to be honest with themselves about their views of the dentist," says Dr. Soxman. "If a parent has severe dental anxieties, he or she needs to make every effort not to pass those fears to the child."

"Parents' presence is support enough for the child," added Dr. Soxman, who emphasizes the importance of parental presence for the first exam and until the age of 4, for restorative treatments.

Pretreatment meetings with a dentist provide directions and guidelines for the parent if he or she wishes to accompany their child during treatment. Parents learn how to provide moral support and to maintain a low, calm voice. Dr. Soxman suggests that the parent not "parrot" the dentist's requests but support the dentist as the authority figure during procedures. It is also important for the same parent to accompany the child during each sequential visit to fill any cavities.

"A parent's positive presence during early dental visits will empower a child to a lifetime of positive dental experiences," said Dr. Soxman.

Cavity Prevention Tips for Preschoolers
Providing proper care and oral hygiene during preschool years can mean a lifetime of good oral health, according to an article in the January/February 2005 issue of General Dentistry, the clinical, peer-reviewed journal of the Academy of General Dentistry (AGD).

Research shows that children who develop cavities in their baby teeth are more likely to develop cavities as an adult. So how can a parent determine if their child is at risk for cavities? It all begins with that first trip to the dentist.

The first dental visit should include an exam to determine if the child is at low, moderate or high risk for cavities and will help decide which oral hygiene program best suits them. Your dentist will be able to explain to you how often your child should be brushing, as well as provide flossing instructions for the child.

"Brushing should begin when the first tooth erupts," says lead author of the report, Jane Soxman, DDS. "Parents should be in charge of a child's brushing until the child is able to tie his or her shoes or write their own name clearly – usually 5 or 6 years of age."

Children whose parents are prone to cavities and tooth decay need to be extra careful.

"We know there's a genetic predisposition to tooth decay," says Dr. Soxman.

Children at high risk for cavities should be discouraged from eating starchy snacks such as crackers and chips. In fact, one good way to determine if a snack is good for a child is to check their teeth 20 minutes after consumption. If the teeth are still filled with food, the snack should be discontinued.

"Regardless of what food is eaten, regular efforts have to be made to clean the teeth before decay can begin," says AGD past president Tom Howley, DDS, MAGD. "This means things like brushing, flossing, rinsing after snacks and using non-sugary beverages in bottles or sippy cups."

"It is always good to schedule routine dental checkups and to limit your child's intake of sugary foods," says Dr. Soxman.

"Essentially all children are at risk for cavities to some extent or another," says Dr. Howley. "So the same basic principles apply – control of exposure of cavity-inducing food and thorough cleaning of the teeth. Even if decay is a low risk for an individual child, they can still develop gingivitis or other problems if home care is inadequate."