General Topics

What Is A Pediatric Dentist?

Pediatric dentists are the pediatricians of dentistry. To become a pediatric dentist, a general dentist or family dentist returns to a university for an additional two to three years of advanced education and training relating specifically to children’s dental care. Training for the needs of children from birth through the late teenage years is included. Pediatric dentists offer comprehensive dental care for children that includes primary care, specialty care, and emergency care.

The American Board of Pediatric Dentistry (ABPD) is the only certifying board for the specialty of pediatric dentistry that is recognized by the American Dental Association. The vision of the ABPD is to achieve excellence in pediatric dentistry through certification of all pediatric dentists. The ABPD certifies pediatric dentists based on standards of excellence that lead to high quality oral health care for infants, children, adolescents, and patients with special health care needs. Certification by the ABPD provides assurance to the public that your dentist is a pediatric dentist and he or she has successfully completed accredited training and a voluntary examination process designed to continually validate the knowledge, skills, and experience requisite to the delivery of quality patient care. Your board certified pediatric dentist has voluntarily submitted himself or herself to this rigorous examination process.

In recent years, it has become a common practice for some family dentists, general dentists, and cosmetic dentists to advertise “Children’s Dental Care, Dentistry for Children, Children’s Dentistry, or Children’s Dentist.” Most of these dentists are not pediatric dentists. Instead, most of the dentists in this type of practice are family dentists or general dentists who may have taken some continuing education courses, but may have little to no more training in pediatric dentistry than someone right out of dental school. Also, many dentists do “see,” “welcome", or “accept” children into their practices, and other dentists may advertise heavily in the media that they “accept children of all ages” into their practices. Again, most of these dentists do not have comprehensive training in the care for the dental needs of children. You should feel comfortable discussing not only your child’s care with his or her dentist, but you should also feel free to discuss your dentist’s training, Board-certification status, and other qualifications for caring for your child. For something as important as the care of your child’s health, we would recommend that you avoid the gimmicks and advertising hype and seek care from a trained pediatric dentist.

Why Are The Primary Teeth Important?

It is very important to maintain the health of the primary teeth, which are also called baby teeth. Neglected cavities can and frequently do lead to problems which adversely affect developing permanent teeth. Primary teeth, or baby teeth, are important for (1) proper chewing and eating, (2) providing and maintaining space for the permanent teeth and guiding them into the correct position, and (3) permitting normal development of the jaw bones and muscles. Primary teeth also affect the development of speech and add to an attractive appearance. While the front 4 teeth last until 6-7 years of age, the back teeth (cuspids and molars) aren’t replaced until age 10-13.

How Often Should My Child Visit the Dentist?

Beginning by the first birthday, the American Dental Association (ADA) recommends visits to the dentist at least once every six months for a professional examination and cleaning. Flouride varnish may also be applied to your child's teeth. Regular dental visits are necessary for the maintenance of healthy gums and teeth. Your pediatric dentist may recommend more frequent visits, depending on the status of your child’s oral health.

Some dentists recommend having a child’s first dental examination appointment at the third birthday, the fifth or sixth birthday, or by the time they start school. Most all of these dentists have minimal training caring for children and are likely unaware of the basic standard recommendations for the dental care of children. If a dentist is unaware of standard pediatric dental health guidelines for care and recommends not having your child evaluated by the first birthday, then likely that dentist does not have adequate comprehensive training in dentistry for children.

Remember that your child’s orthodontist does not clean your child’s teeth and does not examine your child’s teeth during the course of orthodontic care. Also, the orthodontic appliances (braces) tend to trap food and cause your child to have difficulty cleaning their teeth. Dental decay and permanent scarring of your child’s teeth can easily occur during this time if good dietary habits, cleaning, and check-up schedules are not maintained. Therefore, your child will need to continue with regular six-month appointments with your pediatric dentist during this very important time.

Eruption Of Your Child's Teeth

Children’s teeth begin forming before birth. As early as 4 months, the first primary (or baby) teeth to erupt through the gums are the lower central incisors, followed closely by the upper central incisors. Although all 20 primary teeth usually appear by age 3, the pace and order of their eruption varies.

Permanent teeth begin appearing around age 6, starting with the first molars and lower central incisors. This process continues until approximately age 21.

Adults have 28 permanent teeth, or up to 32 including the third molars (or wisdom teeth).

Dental Emergencies

Pediatric Dentist in Roanoke, VA - Dental EmergenciesToothache: Clean the area of the affected tooth. Rinse the mouth thoroughly with warm water or use dental floss to dislodge any food that may be impacted. If the pain still exists, contact your child's dentist. Do not place aspirin or heat on the gum or on the aching tooth. If the face is swollen, apply cold compresses and contact your dentist immediately.

Cut or Bitten Tongue, Lip or Cheek: Apply ice to injured areas to help control swelling. If there is bleeding, apply firm but gentle pressure with a gauze or cloth. If bleeding cannot be controlled by simple pressure, call a physician, dentist or visit the hospital emergency room.

Knocked Out Permanent Tooth: If possible, find the tooth. Handle it by the crown, not by the root. You may rinse the tooth with water only. DO NOT clean with soap, scrub or handle the tooth unnecessarily. Inspect the tooth for fractures. If it is sound, try to reinsert it in the socket. Have the patient hold the tooth in place by biting on a gauze. If you cannot reinsert the tooth, transport the tooth in a cup containing the patient’s saliva or milk. If the tooth is kept out of the mouth, please keep the tooth chilled and moist. If the patient is old enough, the tooth may also be carried in the patient’s mouth (beside the cheek). The patient must see a dentist IMMEDIATELY! Time is a critical factor in saving the tooth. Also, since this accident may have involved trauma to the head, contact your pediatrician to determine if care is indicated for possible head or neck injury and to be sure that your child’s recommended immunizations are up to date.

Knocked Out Baby Tooth: Contact your pediatric dentist. In most cases, following an examination, no treatment is necessary. It is important to examine the area to determine if other teeth or areas of the mouth have been injured. Also, since this accident may have involved trauma to the head, contact your pediatrician to determine if care is indicated for possible head or neck injury and to be sure that your child’s recommended immunizations are up to date.

Chipped or Fractured Permanent Tooth: Contact your pediatric dentist immediately. Quick action can save the tooth, prevent infection, and reduce the need for extensive dental treatment. Rinse the mouth with water and apply cold compresses to reduce swelling. If possible, locate and save any broken tooth fragments and bring them with you to the dentist. He may be able to bond them back in place.

Chipped or Fractured Baby Tooth: Contact your pediatric dentist.

Severe Blow to the Head: Take your child to the nearest hospital emergency room immediately.

Possible Broken or Fractured Jaw: Keep the jaw from moving and take your child to the nearest hospital emergency room.

Facial swelling associated with possible infected teeth or gums: Seek immediate medical attention.

Dental Radiographs (X-Rays)

Radiographs (X-Rays) are a vital and necessary part of your child’s dental diagnostic process. Without them, certain dental, oral, and facial conditions will not be detected.

Pediatric Dentist in Roanoke, VA - Dental Radiographs (X-Rays)

Radiographs detect much more than cavities. For example, radiographs may be needed to survey developing and erupting teeth and surrounding supportive structures, diagnose bone diseases, evaluate the results of an injury, or plan orthodontic treatment. Radiographs allow dentists to diagnose and treat health conditions that cannot be detected during a clinical examination. If dental problems are found and treated early, dental care is more comfortable for your child and more affordable for you.

The American Academy of Pediatric Dentistry recommends radiographs and examinations every six months for children with a high risk of tooth decay. On average, most pediatric dentists recommend radiographs approximately once a year. Approximately every 3-5 years, it is a good idea to obtain a complete set of radiographs, either a panoramic and bitewings or periapicals and bitewings.

Pediatric dentists are particularly careful to minimize the exposure of their patients to radiation. With contemporary safeguards, the amount of radiation received in a dental X-ray examination is extremely small. The risk is negligible. In fact, the dental radiographs represent a far smaller risk than an undetected and untreated dental problem. Lead body aprons and shields will protect your child. Today’s equipment filters out unnecessary x-rays and restricts the x-ray beam to the area of interest. Digital formats, high speed film, and proper shielding assure that your child receives a minimal amount of radiation exposure.


Bonding can be used to restore chipped, cracked, intrinsically discolored, or misaligned teeth as well as areas of dental decay by rebuilding the surface with an adhesive resin material. To place the bonded material, your pediatric dentist would remove decay, buff the surface of the tooth, and prepare the tooth surface with an etching solution. Then special resin materials are chosen in shades to resemble your child’s teeth. These materials are applied to your teeth and shaped to the desired contour. Finally, they are cured (hardened), bonding them in place. Final shaping and smoothing of the resin would then be completed. Bonding is one option to consider when restoring teeth or attempting to improve cosmetics.

What's The Best Toothpaste For My Child?

Pediatric Dentist in Roanoke, VA - Brushing TeethTooth brushing is one of the most important tasks for good oral health. Many toothpastes, and/or tooth polishes, however, can damage young smiles. They contain harsh abrasives, which can wear away young tooth enamel. When looking for a toothpaste for your child, make sure to pick one that is recommended by the American Dental Association as shown on the box and tube. These toothpastes have undergone testing to ensure they are safe to use.

Remember, children should spit out toothpaste after brushing to avoid consuming too much fluoride. If too much fluoride is ingested, a condition known as fluorosis can occur. To fight cavities in children, the American Dental Association’s (ADA) Council on Scientific Affairs (CSA) has updated its guidance to caregivers that they should brush their children’s teeth with fluoride toothpaste as soon as the first tooth comes in. This new guidance expands the use of fluoride toothpaste for young children.To help prevent children’s tooth decay, the CSA recommends that caregivers use a smear of fluoride toothpaste (or an amount about the size of a grain of rice) for children younger than 3 years old and a pea-size amount of fluoride toothpaste for children 3 to 6 years old.

Does Your Child Grind His Teeth At Night? (Bruxism)

Parents are often concerned about the nocturnal grinding of teeth (bruxism). Often, the first indication is the noise created by the child grinding on their teeth during sleep. Or, the parent may notice wear (teeth getting shorter) to the dentition. One theory as to the cause involves a psychological component. Stress due to a new environment, divorce, changes at school, etc. can influence a child to grind their teeth. Another theory relates to pressure in the inner ear at night. If there are pressure changes (like in an airplane during take-off and landing, when people are chewing gum, etc. to equalize pressure) the child will grind by moving his jaw to relieve this pressure.

The majority of cases of pediatric bruxism do not require any treatment. If excessive wear of the teeth (attrition) is present, then a mouth guard (night guard) may be indicated. The negatives to a mouth guard are the possibility of choking if the appliance becomes dislodged during sleep, and it may interfere with growth of the jaws. The positive is obvious by preventing wear to the primary dentition.

The good news is most children outgrow bruxism. The grinding decreases between the ages 6-9 and children tend to stop grinding between ages 9-12. If you suspect bruxism, discuss this with your pediatrician or pediatric dentist.

Thumb Sucking

Pediatric Dentist in Roanoke, VA - Thumb SuckingSucking is a natural reflex, and infants and young children may use thumbs, fingers, pacifiers and other objects on which to suck. It may make them feel secure and happy or provide a sense of security at difficult periods. Since thumb sucking is relaxing, it may induce sleep.

Thumb sucking that persists during or beyond the eruption of the permanent teeth can cause problems with the proper growth of the mouth and tooth alignment. How intensely a child sucks on fingers or thumbs will determine whether or not dental problems may result. Children who rest their thumbs passively in their mouths are less likely to have difficulty than those who vigorously suck their thumbs.

Children should cease thumb sucking by the time their permanent front teeth are ready to erupt. Usually, children stop between the ages of two and four. Peer pressure causes many school-aged children to stop.

Pacifiers are no substitute for thumb sucking. They can affect the teeth essentially the same way as sucking fingers and thumbs. However, use of the pacifier can be controlled and modified more easily than the thumb or finger habit. If you have concerns about thumb sucking or use of a pacifier, consult your pediatric dentist.

A few suggestions to help your child get through thumb sucking:

  • Children often suck their thumbs when feeling insecure. Focus on correcting the cause of anxiety, instead of the thumb sucking.
  • Children who are sucking for comfort may feel less of a need when their parents provide comfort.
  • Reward children when they refrain from sucking during difficult periods, such as when being separated from their parents.
  • Your pediatric dentist can encourage children to stop sucking and explain what could happen if they continue.
  • If these approaches don’t work, remind the children of their habit by bandaging the thumb or putting a sock on the hand at night. Your pediatric dentist may recommend the use of a mouth appliance.

What Is Pulp Therapy?

The pulp of a tooth is the inner, central core of the tooth. The pulp contains nerves, blood vessels, connective tissue and reparative cells. The purpose of pulp therapy in Pediatric Dentistry is to maintain the vitality of the affected tooth (so the tooth remains healthy, useful, and comfortable).

Dental caries (cavities) and traumatic injury are the main reasons for a tooth to require pulp therapy. Pulp therapy is often referred to as a "nerve treatment, children's root canal, pulpectomy or pulpotomy". Two common forms of pulp therapy in children's teeth are the pulpotomy and pulpectomy.

A pulpotomy removes 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 crown since the tooth likely will become brittle).

A pulpectomy is required when the entire pulp is involved (into the root canal(s) of the tooth). During this treatment, the diseased pulp tissue is completely removed from both the crown and root. The canals of primary teeth are cleansed, disinfected and filled with a resorbable material. Then, a final restoration is placed. A permanent tooth would be filled with a non-resorbing material.

Filling Materials

Numerous materials are available for use for “filling” or restoring primary (baby) teeth and permanent teeth.

Amalgam restorations – These materials are often called silver fillings. These materials are metallic and have characteristics of metals: hard, fracture resistant, and wear resistant. Amalgam restorations typically are expected to outlast the tooth-colored plastic resin restoration materials, and their cost usually is substantially less that the cost of a resin restoration. These materials are easier and faster to use, therefore, young children with short attention spans may tolerate amalgam restorations better that resin restorations.

Resin restorations – These materials are often called tooth-colored or porcelain fillings. They are not porcelain, they are plastic, and they have the characteristics of plastics: softer, easily bent, more easily fractured, and less wear resistant than amalgam. These filling materials may not last as long as amalgam restorations for children, and they typically cost more than amalgam restorations. Frequently, these tooth-colored resins are utilized to restore front teeth for which cosmetics is a greater concern and strength is less of a concern. Since these materials are more technique-sensitive (the tooth must be kept perfectly clean and dry from start to finish) and may take longer to use to restore your child's tooth, children with short attention spans or who may be wiggly, may not tolerate their use as well as amalgam fillings. Again, these materials may not last as well as amalgam restorations, but if just a few short years are needed, then resins may work well for your child.

Stainless steel crown restorations – Crowns are often used when the cavities are very large, when the tooth has been fractured or when there is little remaining tooth structure for holding a filling in a tooth. With very small primary teeth, even if the cavity is not very large, crowns may be indicated because there may be insufficient remaining tooth structure to retain a filling in such a small tooth. Also, crowns are utilized following pulp therapy because these teeth become brittle and often fracture with normal eating if not adequately restored. These crowns are also available with cosmetic white coatings.

Tooth colored crowns - These are commonly used to restore front teeth when large areas of the tooth must be restored. There are several available cosmetic options to consider when restoring front (anterior) teeth with crowns. If the teeth can be kept clean and dry and there is sufficient space between the teeth, either Zirconia preformed crowns or bonded tooth-colored crowns can be used to restore anterior teeth. For teeth that cannot be kept clean and dry, stainless steel crowns with white veneered plastic facings are available for use to restore anterior teeth. Bonded tooth-colored resin filling material often can be utilized to restore anterior teeth if there is insufficient room for the preformed tooth-colored crowns. These same materials may also be available for use with the back (posterior) teeth. If you are considering these cosmetic options, please discuss this with your pediatric dentist so arrangements can be made for appropriate scheduling of your child’s appointment.

What Is The Best Time For Orthodontic Treatment?

Pediatric Dentist in Roanoke, VA - Orthodontic TreatmentDeveloping malocclusions, or bad bites, can be recognized as early as 2-3 years of age. Often, early steps can be taken to reduce the need for major orthodontic treatment at a later age.

Baby teeth are sized and shaped to reserve room for permanent teeth and to help guide the permanent teeth into place. Large cavities in baby teeth that cause the teeth to fracture or have holes in them may allow the baby teeth to shift, resulting in crowding of the permanent teeth or other malocclusion.

Premature loss of a primary (baby) tooth may cause the remaining teeth to shift, resulting in the loss of space for the permanent teeth to erupt. This can also adversely affect the way the teeth oppose one another (or fit together). Space maintainers may be utilized following the premature loss of a primary tooth or teeth in order to stabilize the remaining teeth and save room for the permanent teeth.

Stage I – Early Treatment: This period of treatment encompasses ages 2 to 6 years. At this young age, we are concerned with underdeveloped dental arches, the premature loss of primary teeth, and harmful habits such as finger or thumb sucking. Treatment initiated in this stage of development is often very successful and many times, though not always, can eliminate the need for future orthodontic/orthopedic treatment.

Stage II – Mixed Dentition: This period covers the ages of 6 to 12 years, with the eruption of the permanent incisor (front) teeth and 6 year molars. Treatment concerns deal with jaw malrelationships and dental realignment problems. This is an excellent stage to start treatment, when indicated, as your child’s hard and soft tissues are usually very responsive to orthodontic or orthopedic forces.

Stage III – Adolescent Dentition: This stage deals with the permanent teeth and the development of the final bite relationship.

Adult Teeth Coming in Behind Baby Teeth

Baby Teeth - Pediatric Dentist in Roanoke, VAThis is a very common occurrence with children, usually the result of a lower, primary (baby) tooth not falling out when the permanent tooth is coming in. In most cases if the child starts wiggling the baby tooth, it will usually fall out on its own within two months. If it doesn't, then contact your pediatric dentist, where they can easily remove the tooth. The permanent tooth should then slide into the proper place.


Early Infant Oral Care

Perinatal & Infant Oral Health

Pediatric Dentist in Roanoke, VA - Perinatal & Infant Oral HealthThe American Academy of Pediatric Dentistry (AAPD) recommends that all pregnant women receive oral healthcare and counseling during pregnancy. Research has shown evidence that periodontal disease can increase the risk of preterm birth and low birth weight. Talk to your doctor or dentist about ways you can prevent periodontal disease during pregnancy.

Additionally, mothers with poor oral health may be at a greater risk of passing the bacteria which causes cavities to their young children. Mothers should follow these simple steps to decrease the risk of spreading cavity-causing bacteria:

  • Visit your dentist regularly.
  • Brush and floss on a daily basis to reduce bacterial plaque.
  • Proper diet, with the reduction of beverages and foods high in sugar & starch along with a reduction in snacking.
  • Use a fluoridated toothpaste recommended by the ADA and rinse every night with an alcohol-free, over-the-counter mouth rinse with .05 % sodium fluoride in order to reduce plaque levels.
  • Don't share utensils, cups or food which can cause the transmission of cavity-causing bacteria to your children.
  • A mother’s use of xylitol flavored chewing gum several times a day (3 to 8 grams daily) can reduce a child’s decay rate.

Your Child's First Dental Visit-Establishing A "Dental Home"

The following recognized authoritative organizations recommend that children have their first dental examination appointment within six months of the eruption of the first tooth, or by the first birthday, in order to establish a “Dental Home.”

  • The American Academy of Pediatric Dentistry
  • The American Academy of Pediatrics
  • The American Dental Association
  • The Academy of General Dentistry
  • The American Academy of Family Physicians
  • The American Dental Hygienists' Association
  • The National Institute of Dental and Craniofacial Research(NIDCR), one of the National Institutes of Health (NIH)
  • The National Maternal & Child Oral Health Resource Center
  • Most state Medicaid programs
  • Private dental insurance companies

For a variety of reasons, children who begin their preventive dental care at this stage of development and continue with ongoing recommended preventive care both at home and in the dental office are more likely to have better dental health and a positive and favorable outlook towards dental care throughout life.

The Dental Home is intended to provide a place other than the Emergency Room for parents.

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. Often, the less to-do concerning the visit, the better.

It may be 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.

When Will My Baby Start Getting Teeth?

Teething, the process of baby (primary) teeth coming through the gums into the mouth, is variable among individual babies. Some babies get their teeth early and some get them late. In general, the first baby teeth to appear are usually the lower front (anterior) teeth and they usually begin erupting between the age of 6-8 months.
See "Eruption of Your Child’s Teeth" for more details.

Baby Bottle Tooth Decay (Early Childhood Caries)

Pediatric Dentist in Roanoke, VA - Baby Bottle Tooth DecayThe American Academy of Pediatric Dentistry states, “The disease of early childhood caries (ECC) is the presence of 1 or more decayed (noncavitated or cavitated lesions), missing (due to caries), or filled tooth surfaces in any primary tooth in a child 71 months of age or younger. In children younger than 3 years of age, any sign of smooth-surface caries is indicative of severe early childhood caries (S-ECC). From ages 3 through 5, 1 or more cavitated, missing (due to caries), or filled smooth surfaces in primary maxillary anterior teeth or a decayed, missing, or filled score of ≥4 (age 3), ≥5 (age 4), or ≥6 (age 5) surfaces constitutes S-ECC.

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 or sippy cup containing liquid other than water can cause serious and rapid tooth decay. Sweet liquid pools around the child’s teeth, soaking them with sugary sweeteners, giving plague bacteria an opportunity to produce acids that attack and dissolve 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.

Sippy Cups

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. Remember that “juicy-juice” boxes and other single use spill-resistant juice containers are likely to contain liquids with a very high sugar content that can encourage tooth decay.


Care Of Your Child's Teeth

Remember that your child has more practice, training, and experience with printing, writing, and coloring than with brushing and flossing his or her teeth. Also, your child can see himself or herself as he or she prints, writes, and colors much better that they can see themselves brush their teeth. Therefore, remember that your child will not be able to brush their teeth as well as they print, write, and color. Usually, children’s brushing skills have not reached their full potential until they have been able to write cursively well for a couple years. Flossing may be more difficult than brushing for a young child. For the best decay prevention, parents should consider continuing to brush and floss for their children until the 10th to the 12th birthday.


Care Of Your Child's Teeth

Good Diet = Healthy Teeth

Good Diet - Pediatric Dentistry in Roanoke and Vinton, VAHealthy eating habits lead to healthy teeth. Like the rest of the body, the teeth, bones and the soft tissues of the mouth need a well-balanced diet. Children should eat a variety of foods from the five major food groups. Most snacks that children eat can lead to cavity formation. The more frequently a child snacks, the greater the chance for tooth decay. How long food remains in the mouth also plays a role. For example, hard candy and breath mints stay in the mouth a long time, which cause longer acid attacks on tooth enamel. If your child must snack, choose nutritious foods such as vegetables, low-fat yogurt, and low-fat cheese, which are healthier and better for children’s teeth.

How Do I Prevent Cavities?

Good oral hygiene removes bacteria and the left over food particles that combine to create cavities. For infants, use a wet gauze or clean washcloth to wipe the plaque from teeth and gums. Avoid putting your child to bed with a bottle filled with anything other than water. See "Baby Bottle Tooth Decay" for more information.

For older children, brush their teeth at least twice a day and floss their teeth daily. Also, watch the number of snacks containing carbohydrates (sugars) that you give your children. Bacteria can only form cavities when they have food available. And each time we eat, the bacteria have access to foods and are actively forming acid the whole time we are eating and for an additional 20 to 30 minutes after we are finished eating. Therefore, each time there is even a little snack, there is about a half of an hour of decay activity.

The American Academy of Pediatric Dentistry recommends visits every six months to the pediatric dentist, beginning at your child’s first birthday. Routine visits will start your child on a lifetime of good dental health.

Your pediatric dentist may also recommend protective sealants, fluoride supplements, or diet modifications for your child. Sealants can be applied to your child’s molars or any other teeth with deep groves or pits to minimize decay on hard to clean surfaces.

Seal Out Decay

 Sealant therapy is a technique which may delay or reduce cavity formation in the grooves of teeth.

A sealant is a protective plastic coating that is applied to the chewing surfaces (grooves) of the back teeth  (premolars and molars), where four out of five cavities in children are found. This sealant acts as a barrier to food, plaque and acid, thus protecting the decay-prone areas of the teeth.

Since sealants are very thin layers of plastic that have been applied to the chewing surface of teeth, chewing of hard or sticky candy, ice, popcorn kernels, and any other hard or sticky materials should be avoided in order to prevent damage to the sealant.

Because sealants are extremely thin plastic coatings, keeping them intact and maintaining their effectiveness requires periodic checkups along with routine repair and reapplication. Also, since the sealant is only present over the crevices of the chewing surface of the teeth, excellent brushing and flossing is still required on a daily basis. Poorly applied, damaged, and poorly maintained sealants may bec associated with dental decay.

“Preventive Resin Restoration” therapy is a modification of the sealant technique. As with the sealant therapy, the surface of the tooth is cleaned prior to application of the bonded plastic coating. Unlike the sealant technique, in which the grooves and crevices are not completely cleaned and may remain contaminated with food, bacteria, and small areas of decay, with the “preventive resin restoration” technique, all of the grooves are completely cleaned and opened for access to the bonded “sealing” procedure. Not uncommonly, dental decay is found during this cleaning of the deeper crevices, leading to the need to restore, or fill, the tooth at that time. Often, the appearance of the surface of a sealant, a preventive resin restoration, and a small tooth-colored restoration is so similar that even your dentist may not be able to distinguish one from another.

Before Sealant Applied

After Sealant Applied


Fluoride is an element which has been shown to be beneficial to teeth. However, too little or too much fluoride can be detrimental to the teeth. Little or no fluoride will not strengthen the teeth to help them resist cavities. Excessive fluoride ingestion by preschool-aged children can lead to dental fluorosis, which is a chalky white to even brown discoloration of the permanent teeth. Many children often get more fluoride than their parents realize. Being aware of a child’s potential sources of fluoride can help parents prevent the possibility of dental fluorosis.

Some of these sources are:

  • Too much fluoridated toothpaste at an early age.
  • The inappropriate use of fluoride supplements.
  • Hidden sources of fluoride in the child’s diet.

Two and three year olds may not be able to expectorate (spit out) fluoride-containing toothpaste when brushing. As a result, these youngsters may ingest an excessive amount of fluoride during tooth brushing. Toothpaste ingestion during this critical period of permanent tooth development is the greatest risk factor in the development of fluorosis.

Excessive and inappropriate intake of fluoride supplements may also contribute to fluorosis. Fluoride drops and tablets, as well as fluoride fortified vitamins, should not be given to infants younger than six months of age. After that time, fluoride supplements should only be given to children after all of the sources of ingested fluoride have been accounted for and upon the recommendation of your pediatrician or pediatric dentist. The fluoride concentration of your water supply should be determined prior to having a fluoride supplement prescribed for your child.

Certain foods contain high levels of fluoride, especially powdered concentrate infant formula, soy-based infant formula, infant dry cereals, creamed spinach, and infant chicken products. Please read the label or contact the manufacturer. Some beverages also contain high levels of fluoride, especially decaffeinated teas, white grape juices, and juice drinks manufactured in fluoridated cities.

Parents can take the following steps to decrease the risk of fluorosis in their children’s teeth:

  • Use baby tooth cleanser on the toothbrush of the very young child.
  • For children up to the third birthday, use a rice kernel sized amount of fluoridated toothpaste on the toothbrush when brushing your child’s teeth. From the third birthday until the sixth birthday, use a pea sized amount of toothpaste on the toothbrush when brushing your child’s teeth.
  • Account for all of the sources of ingested fluoride before requesting fluoride supplements from your child’s physician or pediatric dentist.
  • Avoid giving any fluoride-containing supplements to infants until they are at least 6 months old.
  • Obtain fluoride level test results for your drinking water before giving fluoride supplements to your child (check with local water utilities or have your water supply tested for fluoride).

Mouth Guards

Pediatric Dentist in Roanoke and Salem, VA - Mouth GuardsWhen a child begins to participate in recreational activities and organized sports, injuries can occur. A properly fitted mouth guard, or mouth protector, is an important piece of athletic gear that can help protect your child’s smile. Mouth guards typically should be worn during all activities for which protective gear is recommended, including riding a bicycle or scooter.

Mouth guards help prevent avulsed teeth, broken teeth and injuries to the lips, tongue, face or jaw. A properly fitted mouth guard will stay in place while your child is wearing it, making it easy for them to talk and breathe.

Ask your pediatric dentist about custom and store-bought mouth protectors.

Xylitol - Reducing Cavities

The American Academy of Pediatric Dentistry (AAPD) recognizes the benefits of xylitol on the oral health of infants, children, adolescents, and persons with special health care needs.

The use of XYLITOL GUM by mothers (3-7 times per day, 4 to 10 grams daily) starting 3 months after delivery and until the child was 2 years old, has proven to reduce cavities up to 70% by the time the child was 5 years old. Likewise, xylitol use by children (several times a day, 3 to 8 grams daily) in syrup form, gum, mints, lozenges, candies, and snack foods such as gummy bears has been shown to reduce cavities for up to 5 years after 1 to 3 ½ years of xylitol use.

Studies using xylitol as either a sugar substitute or a small dietary addition have demonstrated a dramatic reduction in new tooth decay, along with some reversal of existing dental caries. Xylitol provides additional protection that enhances all existing prevention methods. This xylitol effect is long-lasting and possibly permanent. Low decay rates persist even years after the trials have been completed.

Xylitol is widely distributed throughout nature in small amounts. Some of the best sources are fruits, berries, mushrooms, lettuce, hardwoods, and corn cobs. One cup of raspberries contains less than one gram of xylitol.

Studies suggest xylitol intake that consistently produces positive results ranged from 4-20 grams per day, divided into 3-7 consumption periods. Higher usage did not result in greater reduction and may lead to diminishing results. Similarly, consumption frequency of less than 3 times per day showed no effect.

To find gum or other products containing xylitol, try visiting your local health food store or search the Internet to find products containing 100% xylitol.

Beware of Sports Drinks

Sports Drinks - Pediatric Dentist in Roanoke and Cave Spring, VADue to the high sugar content and acids in sports drinks, they have erosive potential and the ability to dissolve even fluoride-rich enamel, which can lead to cavities.

To minimize dental problems, children should avoid sports drinks and hydrate with water before, during and after sports. Be sure to talk to your pediatric dentist before using sports drinks.

If sports drinks are consumed:

  • reduce the frequency and contact time
  • swallow immediately and do not swish them around the mouth
  • neutralize the effect of sports drinks by alternating sips of water with the drink
  • rinse mouthguards only in water
  • seek out dentally friendly sports drinks

Adolescent Dentistry

Pediatric Dentist in Roanoke, VA - Teens

Whitening (Bleaching)

Several options are available to make your child’s smile whiter and brighter: in-office bleaching, at-home bleaching, and whitening toothpastes. Ask your pediatric dentist which of these options may be best suited for your child.

Wisdom Teeth

Wisdom teeth, or third molars, are the final teeth to develop in the back of your child’s mouth. Most people have four wisdom teeth, which erupt during our late teens or early twenties.

Oftentimes, problems develop that require the removal of your child’s wisdom teeth. When the jaw isn’t large enough to accommodate them, they can become trapped or impacted. Wisdom teeth may grow sideways, emerge only part way from the gum, or remain trapped beneath the gum and bone. In most cases, it is recommended that impacted wisdom teeth are extracted (removed).

Wisdom tooth surgery is performed, usually under local anesthesia, in your dentist’s or oral surgeon’s office, an outpatient surgical facility, or a hospital.

Tongue Piercing - Is It Really Cool?

You might not be surprised anymore to see people with pierced tongues, lips or cheeks, but you might be surprised to know just how dangerous these piercings can be.

There are many risks involved with oral piercings, including chipped or cracked teeth, blood clots, blood poisoning, heart infections, brain abscess, nerve disorders (trigeminal neuralgia), receding gums or scar tissue. Your mouth contains millions of bacteria, and infection is a common complication of oral piercing. Your tongue could swell large enough to close off your airway!

Common symptoms after piercing include pain, swelling, infection, an increased flow of saliva and injuries to gum tissue. Difficult-to-control bleeding or nerve damage can result if a blood vessel or nerve bundle is in the path of the needle.

So follow the advice of the American Dental Association and give your mouth a break – skip the mouth jewelry.

Tobacco - Bad News In Any Form

Tobacco in any form can jeopardize your child’s health and cause incurable damage. Teach your child about the dangers of tobacco.

Smokeless tobacco, also called spit, chew, or snuff, is often used by teens who believe that it is a safe alternative to smoking cigarettes. This is an unfortunate misconception. Studies show that spit tobacco may be more addictive than smoking cigarettes and may be more difficult to quit. Teens who use it may be interested to know that one can of snuff per day delivers as much nicotine as 60 cigarettes. In as little as three to four months, smokeless tobacco use can cause periodontal disease and produce pre-cancerous lesions called leukoplakias. Also, smokeless tobacco products may contain a high level of sugar sweeteners which can lead to dental decay.

If your child is a tobacco user you should watch for the following that could be early signs of oral cancer:

  • A sore that won’t heal.
  • White or red leathery patches on the lips, and on or under the tongue.
  • Pain, tenderness or numbness anywhere in the mouth or lips.
  • Difficulty chewing, swallowing, speaking, or moving the jaw or tongue, or a change in the way the teeth fit together.

Because the early signs of oral cancer usually are not painful, people often ignore them. If it’s not caught in the early stages, oral cancer can require extensive, sometimes disfiguring, surgery. Even worse, it can kill.

Help your child avoid tobacco in any form. By doing so, they will avoid bringing cancer-causing chemicals in direct contact with their tongue, gums and cheek.

The American Academy of Pediatric Dentistry has reported that tobacco is a risk factor for 6 of the 8 leading causes of deaths in the world and kills up to one-half of its users. In the US, the Surgeon General’s report states that smoking is the single greatest avoidable cause of death. This report concludes that even in nonsmokers, secondhand smoke exposure causes disease and death.

Along with cardiovascular disease and numerous forms of cancer, significant health consequences for tobacco use include 440,000 deaths per year from smoking and an additional 50,000 deaths per year from secondhand smoke.

Secondhand exposure to tobacco smoke imposes other signifi­cant risks as well. Cardiovascular disease and lung cancer are increased by 25-30% in nonsmokers who inhale secondhand smoke. Infants and children who are exposed to smoke are at risk for sudden infant death syndrome (SIDS), acute respira­tory infections, middle ear infections, bronchitis, pneumonia, asthma, allergies, and infections during infancy. Dental decay in the primary dentition also is related to secondhand smoke exposure. Enamel hypoplasia in both the primary and permanent dentition also is seen in children exposed to cigarette smoke.

A new term, “thirdhand” smoke, has been proposed to describe the particulate residual toxins that settle in layers all over the home after a cigarette has been extinguished. These volatile compounds are deposited and “off gas” into the air over months. Since children inhabit these low-lying contaminated areas and because the dust ingestion rate in infants is more than twice that of an adult, they are even more susceptible to thirdhand smoke. Studies have shown that these children have associated cognitive deficits in addition to the other associated risks of secondhand smoke exposure.