What is a Pediatric Dentist?
Often called the pediatricians of dentistry, pediatric dentists specialize in providing the comprehensive preventive and therapeutic oral health care needs of children (infants through teenagers), including those with special needs (chronically ill, disabled or mentally challenged).
A pediatric dentist has two to three years of additional training after completing a four-year dental school curriculum. This program of study and hands-on experience emphasizes child psychology, growth and development. Pediatric dentists know how to examine and treat children — not always the most patient or cooperative of subjects — in ways that make them comfortable and safe. They use specially designed equipment in offices arranged, decorated and sized with children in mind.
Choosing a pediatric dentist as your child’s specialist helps ensure you are getting the latest and best treatments, care and resources to prevent, detect and treat all of your child’s dental/oral health needs throughout the various stages of development. For instance, during infancy, your pediatric dentist may focus on prevention and education. During adolescence — when appearance and self-image often take center stage — the emphasis may shift to restoring/correcting teeth and teaching preventive dental health care, which includes information on sealants, oral piercing, tobacco/drug use, and cosmetic and/or restorative options such as tooth bleaching, veneers for teeth and crowns. Dr. Kiang can work with pediatricians, other physicians and other dental specialists to ensure that your child is best served through a comprehensive team approach.
Pediatric Dental Care
Care provided by Dr. Kiang includes regular oral health exams (including caries risk assessment for infant and mother); preventive dental care (such as brushing and diet/nutrition recommendations); regular cleaning and fluoride treatments; and use of sealants to prevent cavities. Dr. Kiang also may:
- Provide mouth guards (to prevent sports injuries)
- Provide or recommend special preventive care to safeguard against problems, such as teething and gum disease
- Offer habit counseling (e.g., thumb sucking, pacifier use)
- Offer assessment and treatment for teeth straightening and improper bite in the young child (orthodontics)
- Repair tooth cavities and/or defects
- Diagnose oral conditions associated with diseases such as diabetes, congenital heart defects, asthma and attention-deficit/hyperactivity disorder
- Diagnose and treat dental developmental difficulties (e.g., root canals on adult teeth that have not fully formed)
- Provide management of gum diseases and conditions, such as pediatric periodontal disease, ulcers and tongue-tie (when the membrane that attaches the tongue to the floor of the mouth is shorter than normal. If tongue-tie interferes with breastfeeding, a Dr. Kiang can clip the membrane to release the tongue)
- Care for dental injuries (e.g., fractured or knocked-out teeth)
Is nitrous oxide (laughing gas) safe?
Yes. Nitrous oxide is a colorless and odorless gas which is inhaled through a rubber breathing mask that sits over the patient’s nose. It is often the perfect adjunct to other forms of pain relief and anxiety management, which is why is it commonly used in the dental office. When on nitrous oxide, the patient is still awake and responds normally to conversation. All vital signs remain stable and there is no significant risk of losing protective reflexes (like the ability to cough). The amount of nitrous oxide delivered to each patient can easily be adjusted by the dentist and can be quickly turned on and off. Once turned off, the patient is allowed to breathe 100% oxygen, and the nitrous oxide is flushed out of the patient’s lungs almost instantaneously.
What is so important about baby teeth anyway if they just end up falling out?
Yes, baby teeth do ultimately end up falling out, but they serve many important functions until they are lost. First and foremost, baby teeth are important for eating and chewing. In addition to making any smile a happy and beautiful one, baby teeth also help in speech development. Baby teeth reserve space for the developing permanent teeth growing below the surface and help guide them into the proper place for eruption. If baby teeth are lost before the permanent teeth are ready to erupt, the teeth that are already in the mouth can drift into a different spot and the permanent teeth that will eventually grow in can get off track and wind up in the wrong spot or stuck. This can lead to additional orthodontic work (often braces) later on for your child.
What type of toothpaste should my child be using when brushing his or her teeth?
There are so many types, flavors, and brands of toothpaste out there, it’s important to find one that your child actually likes. We encourage all patients to use toothpaste that has fluoride in it to help strengthen the enamel. Because we are expecting most young children to swallow the toothpaste, the amount of toothpaste you are using is actually the most important part. For children less than 2 years, we recommend just a “smear” of toothpaste, equal to the size of a grain of rice. For children 2-5 years, we recommend a “pea-sized” amount. Once children are able to spit at the sink, you can bump up the amount of toothpaste applied.
Should I be flossing my child’s teeth?
If your child’s teeth are touching (meaning no gaps in between their teeth), then yes, you should be flossing. Flossing helps remove food debris, eliminates cavity-causing plaque, and helps protect gums from gingivitis and gum disease. We recommend trying both the hand-held flossers with the little plastic handles and traditional floss to see what works best in your hands.
My child grinds his teeth at night. It’s so bad, I can hear it from the other room. What do I do?
Don’t worry. Grinding is extremely common in children and has few negative effects on a growing child. The reasons why children grind varies from person to person. The good news is most children outgrow this grinding phase as they get more permanent teeth. If you’re extremely worried, talk to us about it at your next visit, and we will check to make sure there have been no detrimental effects that have occurred to your child’s teeth or jaw joint.
Why is fluoride important for my child’s teeth?
Fluoride is a naturally occurring element and has been shown to help to reduce cavities when used at the appropriate dose. When added to the drinking water, fluoride is the most beneficial and inexpensive way to reduce the occurrence of tooth decay across the entire population. Here in Sutton, the city drinking water is not fluoridated, so children need to receive fluoride from other sources. These sources include fluoride supplements prescribed by your Pediatrician or Pediatric Dentist, toothpaste, twice-per-year professional fluoride applications by your Pediatric Dentist, or even infant formula. We will help you calculate how much fluoride your child receives and will help provide the appropriate supplemental resources as necessary.
Fluoride is also beneficial in helping prevent the progression of small cavities, called “incipient lesions.” Cavities begin forming on the outside later of enamel and work their way internally until they reach the underlying dentin layer or the nerve of the tooth. Small cavities that are limited to the outer enamel layer can often be “watched” by the dentist and often don’t require fillings until they have spread to the underlying dentin layer. If fluoride is used in a methodical way, in combination with improved flossing and brushing, there is a chance that those small itty bitty cavities may never have to be treated with a filling at all! Now isn’t that music to everyone’s ears?
How often should my child be seen for cleanings and checkups?
We recommend that all children be seen every 6 months for dental cleanings and checkups by a Pediatric Dentist. With visits every 6 months, we can watch and monitor your child’s dental growth and development. These frequent visits also allow your child to become more and more comfortable and with our clinic and staff. This familiarity helps curb anxiety for both the parent and the child, as your child will see familiar faces each time they visit our office.
When will my child get her first baby tooth? When will she start losing baby teeth and growing permanent teeth?
The average age for an infant to get his or her first tooth is generally around 6 months. These teeth are usually the lower front two teeth. Once again, these bottom front baby teeth are also generally the first teeth that are lost. We usually expect to start seeing the eruption of permanent teeth around age 6-7, but this varies wildly with each patient.
How often do x-rays need to be taken on my child?
How often x-rays are taken depends on the individual needs of each patient. Because x-rays provide information that can’t be seen from a visual exam alone, they allow the dentist to track development as well as detect tooth decay. Generally speaking, we will attempt a child’s first x-rays around the age of 3-5 years when the back teeth touch. X-rays tell us when cavities are starting to form in between the teeth before we can see them on a visual exam, giving the Pediatric Dentist the opportunity to be one step ahead! X-rays are typically taken every 1-2 years, depending on your child’s previous cavity history
Sippy cups should be used as a training tool from the bottle to a cup and should be discontinued by the first birthday. If your child uses a sippy cup throughout the day, fill the sippy cup with water only (except at mealtimes). By filling the sippy cup with liquids that contain sugar (including milk, fruit juice, sports drinks, etc.) and allowing a child to drink from it throughout the day, it soaks the child’s teeth in cavity causing bacteria.
Baby Bottle Tooth Decay (Early Childhood Caries)
One serious form of decay among young children is baby bottle tooth decay. This condition is caused by frequent and long exposures of an infant’s teeth to liquids that contain sugar. Among these liquids are milk (including breast milk), formula, fruit juice and other sweetened drinks.
Putting a baby to bed for a nap or at night with a bottle other than water can cause serious and rapid tooth decay. Sweet liquid pools around the child’s teeth giving plaque bacteria an opportunity to produce acids that attack tooth enamel. If you must give the baby a bottle as a comforter at bedtime, it should contain only water. If your child won’t fall asleep without the bottle and its usual beverage, gradually dilute the bottle’s contents with water over a period of two to three weeks.
After each feeding, wipe the baby’s gums and teeth with a damp washcloth or gauze pad to remove plaque. The easiest way to do this is to sit down, place the child’s head in your lap or lay the child on a dressing table or the floor. Whatever position you use, be sure you can see into the child’s mouth easily.
What are dental sealants?
Dental sealants protect the chewing surfaces of back teeth where most cavities in children are found. Made of a clear or shaded composite resin, sealants are painted onto the tiny grooves and depressions in the molars. By “sealing out” food and plaque, sealants reduce the risk of decay. They are quickly and painlessly applied to any baby teeth and permanent teeth that, in Dr. Kiang’s opinion, are likely to develop decay in the chewing surface. Sealants must be checked periodically and replaced or repaired when necessary, though they generally last for several years.
When should my child begin to brush his/her teeth?
Brushing should actually begin before children are capable of doing it themselves. A wet cloth or gauze effectively cleans gums and removes plaque after nursing and establishes a good habit early on. Gentle brushing with a soft bristle brush can begin with the eruption of the first tooth. Flossing, when most primary (baby) teeth are in.
At eight or nine, children can be expected to be able to adequately brush on their own, and by 11 or 12, they can be expected to floss on their own as well. The American Academy of Pediatric Dentistry says a good rule of thumb is…when children are accomplished enough in caring for their own needs that they can get up, bathe, dress themselves and comb their hair without your help – they are ready to accept full responsibility for their mouth-cleaning program!
Your Child's First Dental Visit - Establishing A "Dental Home"
The American Academy of Pediatrics (AAP), the American Dental Association (ADA), and the American Academy of Pediatric Dentistry (AAPD) all recommend establishing a “Dental Home” for your child by one year of age. Children who have a dental home are more likely to receive appropriate preventive and routine oral health care.
You can make the first visit to the dentist enjoyable and positive. If old enough, your child should be informed of the visit and told that the dentist and their staff will explain all procedures and answer any questions. The less to-do concerning the visit, the better.
It is best if you refrain from using words around your child that might cause unnecessary fear, such as needle, pull, drill or hurt. Pediatric dental offices make a practice of using words that convey the same message, but are pleasant and non-frightening to the child.
Regarding dental emergencies:
As a parent, it is not always easy to determine when a child needs immediate attention. If you have any questions, don’t hesitate to call our office. One of our doctors is on call 24 hours, 7 days per week to give advice over the phone or assist you in the office as needed. Our phone number is (508) 792-8500.
Dental pain can range from minor gum irritations to severe tooth infections. As a general rule, pain needs to be addressed quickly if it happens spontaneously, keeps your child awake at night, or doesn’t respond to pain relievers.
Cut or Bitten Tongue, Lip or Cheek:
You may apply cold compresses to injured areas to help control swelling and bleeding. If bleeding cannot be controlled by simple pressure, call our office or take your child to a hospital emergency room.
Knocked-Out PERMANENT Tooth:
Handle the tooth by the crown, not by the root.
Briefly rinse the tooth with water to remove dirt.
DO NOT clean the tooth with soap or handle it unnecessarily.
Inspect the tooth for fractures. If it appears whole, try to reinsert it into the socket. The tooth should displace the blood clot relatively easy. If excessive force is needed, do not continue to reinsert the tooth.
Have your child bite on gauze to hold the tooth in place.
If you cannot reinsert the tooth, transport the tooth in a cup containing MILK or your child’s SALIVA.
You should contact a dentist IMMEDIATELY! Time is a critical factor in determining the long-term outcome for the tooth.
Knocked-Out PRIMARY (Baby) Tooth:
DO NOT try to reinsert the tooth.
You may apply cold compresses to injured areas to help control swelling and bleeding.
Baby teeth are not reinserted because of the potential for damage to developing permanent tooth buds. Usually this type of injury does not need immediate follow-up.
Please do not hesitate to contact our office if you have any questions, or if your child sustained other injuries.
Chipped or Fractured PERMANENT Tooth:
Rinse the mouth with water and apply cold compresses to reduce swelling.
Locate any broken tooth fragments, place them in milk, and bring them with you to the dentist.
Contact our office as soon as possible.
Not all fractured permanent teeth need immediate attention; however, the outcome for a tooth with a complicated fracture can significantly improve with prompt treatment.
Chipped or Fractured PRIMARY (Baby) Tooth:
Usually this does not require immediate attention if the fracture only involves the outer shell of the tooth.
If a larger part of the tooth is fractured you should contact our office. We will help determine if your child should be seen immediately.
Small fractures of primary teeth are very common. This is particularly true when children are learning to walk.
Severe Blow to the Head:
Take your child to the nearest hospital emergency room immediately, especially if your child loses consciousness or experiences vomiting.
Possible Broken or Fractured Jaw:
Keep the jaw from moving and take your child to the nearest hospital emergency room.