FAQ

CLEANING TEETH

How do I clean my baby’s teeth?

How do I choose a toothbrush?

How do I choose a toothpaste

How should I floss my child’s teeth?

Should my child brush before bed?

Is a manual or electric brush better?

Does my child have healthy gums?

NUTRITION AND DENTAL HEALTH

How does nutrition affect my child’s dental health?

Can snacking cause dental decay?

Can nursing or baby bottles cause decay?

DENTAL DEVELOPMENT

When do the primary teeth erupt?

When do the permanent teeth erupt?

What do I do about tooth eruption?

What should I do about thumb sucking?

FLUORIDE AND YOUR CHILD

Does fluoride prevent decay?

What is dental fluorosis?

What is water fluoridation?

CHILDREN’S DENTAL CARE

"What is a pediatric dentist?

When should I plan my child’s first dental visit?

What should I expect at my child’s first dental visit?

What are sealants?

What is the best option for tooth fillings?

Are dental x-rays safe?

What is nitrous oxide or laughing gas?

What is oral sedation?

What is pulp therapy for primary teeth?

When should I consider space maintainers?

DENTAL SAFETY

How do I prevent dental injuries?

Does a sports mouth guard protect my child’s teeth?

Is tongue piercing safe?

CLEANING TEETH

Q: How do I clean my baby’s teeth?

Young children are not able to clean their own teeth. As a parent, you must do it for them when they are very young and do it with them, as they get older. When your child can write (not print) his or her name, your child is then ready to do a good job brushing.

You should start cleaning your child's mouth even before your child has teeth. It gets both you and your child into the habit of keeping the mouth clean, and it gives baby (or primary) teeth a clean place to come into. The goal is to wipe all parts of the gums and teeth.

Here's how to do it:

Lie your baby in a comfortable place.

Make sure you can see into your baby's mouth.

Use a soft baby brush or wrap your finger in a clean, damp washcloth. Brush or wipe your baby's gums and teeth. Starting in the top and back of the mouth, use a gentle circling motion with the brush from the gums to the tooth surface. Move from the back to the front of the mouth with this gentle circling motion on each tooth and around to the other side. Then move to the bottom and repeat. Fluoride tooth paste is recommended once your child has teeth.

Q: How do I choose a toothbrush?

The best kind of brush is soft, with rounded bristles. It should be the right size for your child's mouth. The bristle head will fit comfortably behind the bottom front four teeth. You will need to buy a new toothbrush at least every 3 or 4 months.

Children can be hard on toothbrushes. If the bristles get bent or worn down, they will not do a good job, and may hurt your child's gums.

Q: How do I choose a toothpaste?

Make sure the toothpaste has fluoride. Check the box or tube for the symbol of the Canadian Dental Association. This symbol means the toothpaste has fluoride. Use only a bit of toothpaste and make sure your child spits it out.

Children under 3 years of age should have their teeth brushed by an adult. The use of fluoridated toothpaste is currently recommended in this age group due to increasing decay rates in children. The child's teeth should be brushed by an adult using a minimal amount of toothpaste, the size of a grain of rice. Children from 3 to 6 years of age should be assisted by an adult in brushing their teeth.

Q: How should I floss my child’s teeth?

Step 1

Take a piece of floss about as long as your child's arm. Wrap it around your middle fingers, leaving about 2 inches between the hands. Use your index fingers to guide the floss between the teeth.

Step 2

Slide the floss between the teeth and wrap it into a "C" shape. It should wrap around the base of the tooth, where the tooth meets the gum.

Step 3

Wipe the tooth from bottom to top 2 or 3 times or more, until it is squeaky clean.

Be sure you floss both sides of each tooth, and don't forget the backs of the last molars.

Move to a new part of the floss as you move from tooth to tooth.

Q: Should my child brush right before bed?

Yes. If you don't get rid of the germs (bacteria) and sugars that cause cavities, they have all night to do their dirty work. Plus, when your child is asleep, he or she does not produce as much spit (or saliva). Saliva helps keep the mouth clean. So brushing at bedtime is very important.

Q: Is a manual or electric brush better?

There have been multiple studies comparing the effectiveness of manual brushes as opposed to electric brushes.

Although not all electric brushes are the same, these studies conclude that in some cases, electric brushes are more efficient in controlling plaque than manual brushes. You can do a very good brushing with a regular manual brush, but the movements of an electric brush make the task easier and more effective, especially where teeth are crowded or there is limited manual dexterity.

Also, some electric brushes like Sonicare, that produce sonic vibrations that are difficult to mimic with a hand brush. Other electric brushes like Oral-B have small heads that help you access hard-to-reach areas of your mouth. This is very important when someone has orthodontic braces or a history of gum disease.

Q: Does my child have healthy gums?

Cavities are the main problem children have with their teeth. But children can get gum disease too, just like adults. It happens when the gums that hold our teeth in place get infected.

Daily brushing and flossing can stop gum disease. If your child's gums bleed, don't stop brushing. If the gums are always swollen, sore or bleeding, there may be a serious problem. You should take your child to the dentist.

NUTRITION AND DENTAL HEALTH

Q: How does nutrition affect my child’s dental health?

When your child eats or drinks sugars, the germs (bacteria) in your child's mouth mix with the sugars to make a mild acid. This acid attacks the hard outer layer of teeth (also called enamel). It can make holes (or cavities) in the teeth.

The damage that sugars do depends on how much sugar goes into the mouth and how long it stays in the mouth.

Any kind of sugar will mix with germs in the mouth. Natural sugars can have the same effect on teeth as white (or refined) sugar out of the bag! Many healthy foods contain natural sugars. Milk contains natural sugar.

If you put your child to bed with a bottle of milk, the milk stays in the mouth for a long time. This may cause cavities. Unsweetened fruit juice may have no added sugar, but fruit juice has natural sugars in it. If your child is always sipping juice between meals, the teeth are being coated in sugars over and over again.

Water is the best drink to have between meals. Starchy foods, like teething biscuits, break down to make sugars. If these kinds of food stay in your child's mouth long enough, they will make the acid that can cause cavities. Your job is to clean your child's teeth, not to stop your child from having milk, juice, bread or noodles. Your child needs these foods to stay healthy.

Read the labels of the packaged food you buy. By law, everything ingredient in packaged food is listed by weight. So if a sugar is listed first, you know that there is more sugar than anything else.

These are sugars you can look for on labels: corn sweeteners; corn syrup; dextrose; fructose; glucose; honey; maple syrup; molasses and sucrose.

Also, check to see if liquid medicines (such as cough syrup) have sugars. Ask your doctor or pharmacist to give you medicines that are sugar-free.

Q: Can snacking cause dental decay?

Growing children need and like snacks. Here are some smart ways to give snacks:

Limit the number of times a day your child eats or drinks sugars. If your child sips juice or pop while playing, he or she will have sugars in the mouth over and over again. Water is the best drink to have between meals.

Do not give your child sugar-rich foods that stay in the mouth for a long time like gum with sugar in it, suckers (or lollipops) and other hard candy. Stay away from soft, sticky sweets that get stuck in the mouth such as toffee, raisins and rolled-up fruit snacks or fruit leather.

Keep good snacks handy where your child can get them. Have carrot sticks or cheese cubes on the bottom shelf of the fridge. Children like small containers of a low sugar cereal (plain Cheerios), sliced vegetables, and small packs of nuts or seeds (provided they are safe for your child). Keep them in a low cupboard.

To keep your child from asking for sweets, do not buy them. If they are not in the house, you can't give them out. If you do serve sweets, limit them to meals. When your child is eating a meal, there is more saliva in the mouth. This helps to wash away the sugars.

Q: Can nursing or baby bottles cause decay?

Once your child has teeth, he is susceptible to tooth decay. Mother's milk, formula, cow's milk and fruit juice all contain sugars.

Babies may get early childhood tooth decay from going to bed with a bottle of milk, formula or juice. Unrestricted at-will breast-feeding at night may increase the risk of tooth decay, although the majority of breast-fed children do not experience this early childhood disease.

It can happen to children up to age four. Once your child has teeth, lift his or her lips once a month and check the teeth. Look for dull white spots or lines on the teeth. These may be on the necks of the teeth next to the gums. Dark teeth are also a sign of tooth decay.

If you see any signs, go to the dentist right away. Early childhood tooth decay must be treated quickly. If not, your child may have pain and infection.

If you give your child a bottle of milk, formula or juice at bedtime, stopping all at once will not be easy. Here are some tips:

Put plain water in the bottle.

If this is turned down, give your child a clean soother, a stuffed toy or a blanket.

If your child cries, do not give up.

Comfort him or her, and try again.

If this does not work, try watering down your child's bottle over a week or two, until there is only plain water left.

DENTAL DEVELOPMENT

Q: When do baby (primary) teeth erupt?

All twenty baby (or primary) teeth come in by the time your child is two or three years old.

If your child is getting his or her teeth and seems to be in pain, you can:

rub the gums with a clean finger

rub the gums with the back of a small, cool spoon

If your child is still unhappy, your dentist, pharmacist or doctor can suggest an over-the-counter medicine to ease the pain such as Tylenol or Advil.

Here's what you should not do:

Do not use the kind of painkiller that can be rubbed on your child's gums. Your child may swallow it.

Do not give your child teething biscuits. They may have sugar added or contain hidden sugars.

Do not ignore a fever. Getting new teeth does not make babies sick or give them a fever. If your child has a fever, check with your doctor.

Q: When do the permanent teeth erupt?

At age six or seven, the first adult (or permanent) teeth come in. They are known as the "first molars," or the "six-year molars."

They come in at the back of the mouth, behind the last baby (or primary) teeth. They do not replace any primary teeth.

Also at around age six, children start to lose their primary teeth. The roots slowly dissolve, and the tooth falls out. Children lose primary teeth until they are about 12 years old.

It's okay for children to wiggle their primary teeth if they are loose. But it's not okay to use force to pull out a tooth that's not ready to come out. When a tooth comes out at the right time, there will be very little bleeding.

Permanent teeth often look more yellow than primary teeth. This is normal. But it could also be caused by medicine your child took, by an accident that hurt a primary tooth, or by too much fluoride. Ask your dentist about this when you go for a dental exam.

Q: What do I do about a tooth eruption?

Even though they aren’t visible, children’s primary teeth begin forming before they are even born. At around the four month mark the primary teeth begin pushing through the gums. By the age of three, all 20 primary teeth have erupted.

Permanent teeth begin appearing around age 6, starting with the first molars and lower central incisors. This process continues until around age 21. Adults have 28 permanent teeth, or up to 32 including wisdom teeth.

Even before your baby’s first tooth erupts you can use a warm clean washcloth to gently swab the gums clean after every meal. When the first tooth erupts you can gently brush with a soft toothbrush. Current recommendations suggest that a rice grain sized amount of fluoride toothpaste be used twice a day starting with tooth eruption due to the increase in early decay seen in children. Emphasizing healthy dental habits at an early age contributes to better oral health in the future.

Q: What should I do about thumb sucking?

It is normal for babies to suck because it helps them relax.

By the time your child is two or three years of age, he or she has less need to suck. If your child still likes to suck, a soother is better than sucking a thumb. because you can control when and how your child uses a soother. You can't control a thumb going into the mouth.

Never put sugar, honey or corn syrup on a soother. They can cause cavities. It's best to get your child to stop sucking before permanent teeth come in, at about age five. If a child keeps sucking a soother or thumb after the permanent teeth have come in, it could cause problems with how the jaw and teeth grow.

FLUORIDE AND YOUR CHILD

Q: Does fluoride prevent dental decay?

Fluoride is a mineral found in soil, water and various foods. It has a positive effect on oral health by making teeth more resistant to decay. Fluoride can also prevent or even reverse tooth decay that has started.

Fluorides are used by communities as a public health measure to adjust the concentration of fluoride in drinking water to an optimum level (community water fluoridation); by individuals in the form of toothpastes, rinses, lozenges, chewable tablets, drops; and by the dental profession in the professional application of gels, foams and varnishes.

The availability of fluorides from a variety of sources must be taken into account before embarking on a specific course of fluoride delivery. This is particularly important for children under the age of 6, where exposure to more fluoride than is required to simply prevent dental caries can cause dental fluorosis. Provided that the total daily intake of fluoride is carefully monitored, fluoride is considered to be a most important health measure in maintaining oral health.

There is no fluoride in the drinking water in the Niagara Region, including St Catharines, Niagara Falls, Welland and Port Colborne. Children should be seen by a pediatric dentist before age one to assess the risk of developing tooth decay and advise parents about an appropriate level of fluoride protection such as fluoride varnish, supplements and use of fluoride toothpaste.

Q: What is dental fluorosis?

Dental fluorosis is a change in the appearance of teeth. It is caused when higher than optimal amounts of fluoride are ingested in early childhood. In its mildest and most common form, it affects the look of the tooth with small white specks appearing on a child’s teeth. The Canadian Health Measures Survey 2007-2009 found that dental fluorosis is not an issue of concern for the vast majority of children (84%). Some children (16%) have mild forms of fluorosis that often go unnoticed by both the children and their parents.

Q: What is water fluoridation?

Water fluoridation is the process of adjusting the level of fluoride in a public drinking water supply to optimize the dental benefits of preventing tooth decay. Fluoride is added to public drinking water to protect all members of the community from tooth decay. Community water fluoridation is a safe and effective way of preventing tooth decay at a low cost. The Federal-Provincial-Territorial Committee on Drinking Water makes recommendations about the optimal level of fluoride in public drinking water to prevent tooth decay. The recommended level takes into account that Canadians receive fluoride from other sources such as food and beverages. An optimal level of water fluoridation is achieved by adjusting the level of fluoride in the water to achieve the right balance between the benefit of preventing tooth decay and the risk of developing dental fluorosis. With the exception of dental fluorosis, scientific studies have not found any credible link between water fluoridation and adverse health effects.

CHILDREN’S DENTAL CARE

Q: What is a pediatric dentist?

Pediatric dentists are the pediatricians of dentistry. A pediatric dentist has two to three years specialty training following dental school and limits his/her practice to treating children only. Pediatric dentists are oral health care providers for infants and children through adolescence, including those with special health needs.

Q: When should I plan my child’s first dental visit?

Your child’s first dental visit should be scheduled around their first birthday. The most important reasons for this visit is to provide guidelines for preventing early childhood caries by reviewing diet and fluoride recommendations. We will also familiarize your child with the dental office environment and help ease any anxiety associated with future visits. During this time the dentist can examine your child’s dental development and also address dental issues such as baby bottle decay. On this first visit, a gentle but thorough examination will be performed to monitor growth and development and address any problem areas.

Early examination provides your child with preventive dental care while establishing healthy dental habits at an early age. Ensure that your child’s future smile is a healthy, confident one.

Q: What should I expect at my child’s first dental visit?

The Canadian Dental Association recommends the assessment of infants, by a dentist, within 6 months of the eruption of the first tooth or by one year of age. The goal is to have your child visit the dentist before there is a problem with his or her teeth. This visit is needed to assess a child’s need for fluorides to protect against decay and provide important dietary information to prevent early childhood caries, the number one reason in Canada for children needing hospitalization and a general anaesthetic. In most cases, a dental exam every six to nine months, beginning around age two, will let your child's dentist catch small problems early.

Here are 3 reasons to take your child for dental exams:

You can find out if the cleaning you do at home is working.

Your dentist can find problems right away and fix them.

Your child can learn that going to the dentist helps prevent problems.

Your dentist may want to take X-rays. X-rays show decay between the teeth. They will also show if teeth are coming in the way they should. Your child's dentist may also talk to you about fluoride.

Once your child has permanent molars, your dentist may suggest sealing them to protect them from cavities. A sealant is a kind of plastic that is put on the chewing surface of the molars. The plastic seals the tooth and makes it less likely to trap food and germs.

When your child goes for a dental exam, your dentist can tell you if crooked or crowded teeth may cause problems. In many cases, crooked teeth straighten out as the child's jaw grows and the rest of the teeth come in.

If they do not straighten out, your child may have a bite problem (also known as malocclusion). This can cause problems with eating and with teeth cleaning. It can also affect your child's looks and make him or her feel out of place.

Your dentist can suggest ways to treat this, or refer your child to an orthodontist. An orthodontist is a dental specialist with 2 to 3 years of extra university training in this area.

The dentist says my child needs a filling in a baby tooth. Since the tooth is going to fall out, why bother?

Some primary (or baby) teeth will be in your child's mouth until age 12. The tooth that needs to be fixed may be one of those.

Broken teeth or teeth that are infected can hurt your child's health and the way your child feels about him or herself.

To do a filling, the dentist removes the decay and "fills" the hole with metal, plastic or other material. A filling can be a cheap and easy way to fix a problem that could be painful and cost more later because it stops decay from spreading deeper into the tooth.

If a filling is not done and decay spreads, the tooth may need to be pulled out. If this happens, your child may need a space maintainer to hold space for the permanent tooth.

When a baby (or primary) tooth is missing, the teeth on each side may move into the space. They can block the permanent tooth from coming in. To hold the space, your dentist may put a plastic or metal space maintainer on the teeth on each side of the space, to keep the teeth from moving in.

Q: What are sealants?

Sealants are thin layers of resin that are placed on the pits, fissures, and grooves of molars to prevent decay on these surfaces.

The majority of decay on back teeth starts in the grooves and pits of chewing surfaces, especially during the first few years after their eruption. Sealing these surfaces with composite resins prevents this kind of decay.

Sealants are one of the most effective methods of preventing decay on the surfaces where they are placed. Although it is still a possibility that decay may develop on surfaces in between teeth, sealants significantly reduce the overall chance of having cavities.

Q: What is the best option for tooth fillings?

When considering tooth fillings, one of the options available is composite fillings which are made from durable plastics that are similar in color to natural teeth. Because the composite fillings are tooth colored, they look more natural and are less noticeable than silver amalgam. It should be noted that amalgam is still a proven, safe and durable material although some authorities suggest limiting usage due to minute amounts of mercury in it.

Another benefit of tooth colored fillings is that they are compatible with sealants allowing your child’s dentist to create a smaller filling and seal other areas of the tooth. These fillings also bond to the tooth, which helps to add some strength back to the tooth after it has been filled.

Please note that when a cavity is large or a pulp treatment has been provided, a crown may be recommended to restore the tooth, as this is much stronger than a filling and may be available in both silver and white versions.

Q: Are dental x-rays safe?

There is very little risk in dental X-rays. Pediatric dentists are especially careful to limit the amount of radiation to which children are exposed. Lead aprons and high-speed film or digital sensors are used to ensure safety and minimize the amount of radiation.

Q: What is nitrous oxide or laughing gas?

Most children feel comfortable when visiting the dentist. Early exposure to the dentist helps younger patients to associate the dental office with feeling relaxed. Some children however, may become nervous when sitting in the dental chair and may need more than gentle care to feel comfortable for any treatment. Nitrous oxide is a safe sedative used to help your child relax during a dental visit and allows the doctor to effectively treat your child.

A fitted mask is placed over your child’s nose and as they breathe, the nitrous oxide is absorbed through the lungs. At the end of the treatment, the nitrous oxide is removed, the child will breathe oxygen and there will be no lingering effects upon leaving the office. Nitrous oxide provides a sense of contentment and relaxation as well as mild analgesia, or pain control, helping to provide a comfortable injection of local anaesthetic. The use of nitrous gas is very safe as it is rapidly absorbed, is reversible, and can be titrated easily to adjust the effect. Your child is fully conscious and keeps all of their natural reflexes.

Q: What is oral sedation?

Another alternative for helping nervous children relax at the dentist’s office is the use of sedation. When your child becomes so anxious that cooperating becomes difficult for them, sedation is an option. Sedation is a method in which oral medication, along with nitrous oxide, is used to help your child relax during the dental visit and allow the doctor to effectively treat your child. Sedation tends to produce feelings of drowsiness and relaxation but is not meant to make your child fall asleep. When administered according to the sedation guidelines of the American Academy of Pediatric Dentistry by a trained and experienced paediatric dentist, sedation is a safe, effective option. The Royal College of Dental Surgeons of Ontario inspect both the office and dentists who provide this service and will provide a certificate for Moderate Sedation that will be displayed in the office.

Q: What is pulp therapy on baby teeth?

The pulp of a tooth is the inner, central core of the tooth and contains blood vessels and nerves. Dental caries (cavities) and trauma to the tooth are the primary reasons for children to undergo pulp therapy. Your child may need pulp therapy if they have the following symptoms.

Large cavities coming close to the tooth pulp

Tooth pain or sensitivity to biting or temperature

A broken tooth

The main purpose of pulp therapy is to save the tooth. Primary teeth are needed for chewing and speaking and serve as space savers for permanent teeth. Without the primary teeth to guide them, existing nearby teeth can crowd in, causing permanent teeth to grow in crooked or tilted. The two forms of pulp therapy for children’s teeth are pulpotomy or pulpectomy.

A pulpotomy will maintain and protect existing healthy pulp by removing the diseased pulp tissue within the crown portion of the tooth. Next, an agent is placed to prevent bacterial growth and to calm the remaining nerve tissue. This is followed by a final restoration, usually a stainless steel crown.

A pulpectomy is required when the entire pulp is diseased deep into the root portion of the tooth). During this treatment, the diseased pulp tissue is completely removed from all parts of the tooth. The canals are cleansed and filled with a special material designed to keep the remaining tooth structure healthy. A crown is placed on the tooth to prevent fractures.

If the pulp is severely damaged, your doctor may recommend removing the tooth entirely and may recommend a space maintainers to maintain normal jaw development.

Q: What are space maintainers?

Primary teeth stay in place until a permanent tooth pushes it out, taking it’s place in the mouth. Some children lose their primary teeth too early due to accidents or dental disease. When this is the case, a space maintainer may be recommended by your dentist to prevent space loss and future dental problems. It is important to remember that some teeth are not replaced until a child is 12 to 14 years old.

Space maintainers are appliances custom fit to your child’s mouth. and most children adjust to them quickly. With empty space or gaps, the teeth beside the gap may tilt or shift into the empty space. When adjacent teeth shift into the empty space, they create crowding in the permanent teeth. If left untreated, the condition may require future orthodontic treatment. Space maintainers hold open the empty space left by a lost tooth. They steady the remaining teeth, preventing movement until the permanent tooth takes its natural position. It is more affordable to keep teeth in their normal positions with a space maintainer than to move them back in place with orthodontic treatment.

DENTAL SAFETY

Q: How do I prevent dental injuries?

Always use infant car seats and seat belts when you drive.

Babies will chew on almost anything. Keep them away from hard things that could crack their teeth. Never let them walk with objects in their mouth

Children fall a lot when they are learning to walk. Teeth can break, crack, get knocked out or become loose. Move furniture with sharp corners or hard edges or place bumpers on those areas. See your dentist if this happens.

Q: Does a Sports Mouth Guard really protect my child?

Mouth protectors are soft plastic appliances that shape themselves to the upper teeth and are important sports equipment. Not only do they protect the teeth but they also protect the lips, cheeks, and tongue and can protect your child from serious head injuries such as concussions and jaw fractures. If your child is involved in a physical activity in which their head is in contact with other players or equipment then consider getting a mouth guard for your child today.

Q: Is Tongue Piercing safe?

Body piercing has become a popular form of body modification in today’s society. Tongue piercings are one particular procedure with high risks. Despite their popularity, it is important to know the associated risk factors with the piercing process.

There are many health risks involved with oral piercings including chipped or cracked teeth, blood clots, blood poisoning, receding gums or scar tissue. Your mouth is home to millions of bacteria that can easily promote infection in an oral piercing. Your tongue could swell large enough to close off your airway, can affect your speech and can even be a danger if swallowed.

Common symptoms after piercing include pain, swelling, infection, an increased flow of saliva and damage to gum tissue. Difficult-to-control bleeding or nerve damage can result if a blood vessel or nerve is cut by the piercing needle. Even without complications, healing takes four to six weeks.

Take the advice of the American Dental Association and just avoid oral piercings