Ask The Experts

“First visit by first birthday” sums it up. Your child should visit a pediatric dentist when the first tooth comes in, usually between 6 and 12 months of age. This visit will establish a dental home for your child. Early examination and preventive care will protect your child’s smile now and in the future.

The most important reason is to begin a thorough prevention program. Dental problems can begin early. A big concern is Early Childhood Caries (formerly known as baby bottle tooth decay or nursing caries). The earlier the dental visit, the better the chance of preventing dental problems.

It is very important that primary teeth are kept in place until they are lost naturally. These teeth serve a number of critical functions.

Primary teeth:

- Maintain good nutrition by permitting your child to chew properly.
- Are involved in speech development.
- Help the permanent teeth by saving space for them.

A healthy smile can help children feel good about the way they look to others.

Parents should take their children to the dentist regularly, beginning with the eruption of the first tooth. After completing a thorough oral examination and assessing your child’s risk for developing cavities, your pediatric dentist will design a personalized preventive program of home care for your child. This program will include brushing and flossing instructions, diet counseling and, if necessary, fluoride recommendations. By following these directions, you can help give your child a lifetime of healthy habits.

Q: For many children with “special needs” tooth brushing is a BIG hurdle and is very, very hard to do. Do you have any suggestions in that regard. In our home we have a toddler with special needs and the tooth brushing issue is a daily battle. - Liz, Orange County Mother

A: Thank you so much for your question. As pediatric dentists, we have had additional training and specialize in providing care for children with special needs as each child presents us the opportunity to develop a unique approach to their dental care. I would recommend that you establish a dental home for your child with a pediatric dentist, or a general dentist that is comfortable treating children with special needs. Once the oral exam is completed a detailed treatment plan can be established for your child. As you are aware, repetition and consistency are very important for all children and extremely helpful for them to establish a level of comfort over time with learning self help skills. Remember, No surprises! We have several patients with special needs in our practice, and we will sometimes have a patient come to the office every day for 10-15 minutes for a 1-2 week period just to feel comfortable with the office. Once they are more comfortable with the office then we can see them less frequently. At home, being consistent and persistent is important as well. The pediatric dentist/dentist will help in showing you how to perform a thorough brushing and flossing if necessary. Brushing like you mention can sometimes be extremely difficult. The pediatric dentist/dentist can provide more individualized and specific tips for proper positioning and good technique.

Many parents are surprised to hear that the American Association of Orthodontists recommends that children see an orthodontist for an orthodontic check up by age 7. “Why so young?” they ask. “When I was a kid, I didn’t see an orthodontist until I was 13!” Orthodontic treatment of the past most often included the removal of several teeth, the use of a headgear, and much longer treatment times. Newer technology now allows us to use patients’ early growth to help correct and more importantly, prevent orthodontic problems as the child’s permanent teeth begin to come in.

At age 7, most children have the perfect combination of permanent and primary teeth, and are in the middle of their jaw growth curve. This is the ideal time for the orthodontist to take measurements of the child’s face, jawbones and teeth in order to determine their facial growth patterns. The orthodontist can then determine whether the child will have room for their permanent teeth, and if the child has a harmful bite or harmful habits. If the orthodontist notices narrow growing jaws, impacted teeth, or an overbite that will necessitate extractions of headgear in the future, for example, he or she can now utilize orthopedic techniques to train the bones to grow correctly. Re-establishing the proper jaw size in this way makes extractions (teeth removal) and headgear virtually unnecessary. With this earlier intervention, treatment time in braces is now usually much shorter and more comfortable.

An orthodontist is a dentist who has completed an additional two to three years of specialized, accredited training in orthodontics. This training includes the study of facial growth and development, as well as the proper and safe way to move teeth and bones. Many dentists do offer their patients timely referrals to qualified orthodontists, but parents need not wait for that referral, as not all dentists are aware of this critical window of growth. Parents can quickly and easily assess their child’s need for an orthodontic checkup by simply looking for the following common signs:

- Lack of spacing between baby teeth
- Difficulty in chewing or biting
- Mouth breathing/snoring
- Finger or thumb sucking habits beyond age 5
- Speech difficulty
- Biting the cheek or roof of the mouth
- Protruding teeth or overbite
- Underbite
- Crossbite (when the top teeth fit inside the bottom teeth on either or both sides)
- Teeth that don’t meet in a normal matter, or don’t meet at all.

The need for an orthodontic checkup sometimes goes beyond the physical problems. Children who are teased as a result of their dental appearance often suffer from low self-esteem. Early intervention and treatment in these children often increases their self-confidence.

When a child comes to see me for their first orthodontic checkup, I always take time to talk to both the child and the parents, in order to address any questions and concerns they may have. I take measurements of the teeth and face, and then discuss my findings. If treatment is recommended, clear goals are presented. Many times, treatment is not warranted, and the child is scheduled for a growth recheck every six to 12 months.

With this earlier intervention, many cases that used to involve complicated orthodontic treatment, can now be treated in less time without teeth removal, surgery or headgear— now that is something to smile about! — Dr. Christopher Zachary

I started my graduate work in education, so teaching is my first love. When I became a parent myself and began working with postpartum moms (for 15 years) I realized that the primary support families need is understanding how to parent. Just because you were parented does not mean you automatically know how to parent!

I would say the number one concern is a toss up between toilet learning & tantrums. Most common frustration is not knowing what to do when their kids are being oppositional or when parents feel like their kids are not listening to them.

During a typical series we will cover; tantrums, toilet learning, sharing (or lack of it), sibling rivalry, listening, cooperation, public misbehavior, unsolicited parenting advice (family & friends), separation anxiety, new baby, pre-school, food/eating issues and more.