When should I make my child’s first appointment at the dentist?

The American Academy of Pediatric Dentistry and the American Dental Association recommend that a child’s first visit to the dentist should be at one year old or 6 months after the first tooth erupts — whichever is sooner. The purpose of dental visits at this age is not only to check and ensure that your child is developing properly, but also to teach parents some of the most important things they can do to prevent their children from having cavities in the future. The most essential habits that will keep your children’s teeth healthy throughout their life begin at this age. It is imperative that you began cleaning your child’s teeth at this young age. Bottle feeding, sucking habits, fluoride, oral hygiene, and proper diet are among the issues that should be discussed at this visit. Furthermore, by the time your child is 2, he or she is already forming lasting memories that will stay with him/her for many years to come. We want to build a healthy relationship so that when your child is older, he/she will have no fear of the dental visit. In fact, the younger they are when they began, the less likely they are to have cavities later and the more comfortable they will be if they do.
If a child’s first visit is when he is 3 or 4, he’s had enough time to develop (or learn from others) fears of the unknown before ever having experienced it firsthand. To make matters worse, if he has cavities already on this first visit, he now has to be introduced not only to the fun aspects of going to the dentist, but also the experience of fillings too. All of this can become overwhelming for a young first-timer!

How can my child have cavities at such a young age?

Cavities are caused by the normal bacteria in the mouth and exposure to sugar over time. Teeth are susceptible to this bacteria and, therefore, to cavities immediately upon eruption into the mouth.

How can I prevent cavities at this age?

Keeping teeth clean is the key to cavity prevention at all ages. As soon as teeth are in the mouth they should be cleaned after feeding time and before sleep time. For infants a wet paper towel or a washcloth can be used. As children get older, a toothbrush becomes more appropriate at least twice per day and as soon as the teeth come close together, flossing is necessary. Age is not as important a factor in hygiene as is tooth location and development.

Should my child be taking fluoride supplements?

It is recommended that anyone who does not have fluoride in his tap water (which is most of New Jersey), should take fluoride supplements from the age of 6 months until the mid teenage years. The dosage changes along the way so be sure your dentist or pediatrician updates your prescriptions appropriately.

What are sealants?

Sealants are a protective coating that can be applied to the grooves of teeth to help prevent cavities. One of the most susceptible areas adolescents get cavities is the grooves of their adult molars when they first erupt (at about 6 years of age). These teeth have grooves on them that are often quite deep and collect plaque and food particles. Because, at this age, these teeth are far back, mouths are small, brushing habits are weak, and diets are high in sugar these grooves tend to develop cavities quickly. Sealants fill in these grooves and flatten them out to make cavities less likely.

Should I seal all of my child’s teeth? Why only the adult molars?

Baby teeth have shallower grooves which do not tend to get cavities as quickly as adult teeth. Cavities on baby teeth usually appear in between the teeth in areas that cannot be sealed. The best way to prevent cavities on baby molars is to brush and FLOSS!!! On certain rare occasions, when children are at extremely high risk for cavities on the grooves, Dr. Sey may recommend sealants on baby teeth.
The other adult teeth either do not have grooves (incisors and canines) and, therefore, cannot be sealed or are not so far back in the mouth (premolars) thereby putting them at lower risk for cavities. These teeth could be sealed, but are usually not unless specifically indicated.

How should I prepare my child for his dental visit?

The best thing for parents to tell children before going to the dentist is NOTHING! If your child is very young and going for a visit, they should have no idea what the dentist is…let them formulate their own ideas. If they’re older and going for the first time, they may ask more questions. Then you tell them as little as possible. “I don’t know, we’ll find out when we get there” is appropriate. If they don’t let you get away with that you can say, “I think he may brush your teeth” or “count your teeth.” Don’t give them more information than necessary. Our specialty here at Brick Pediatric Dentistry is to introduce children to what we do in a non-intimidating way that they can understand. Even though you are trying to help, saying things like “Don’t worry, it won’t hurt” or “I’ll get you a prize after” will only increase a child’s fear because now he thinks something bad is going to happen. Never underestimate your child’s intelligence; you don’t tell him that you’ll take him for ice cream if he’s good at the zoo! You also want to avoid being a liar…do not tell your child that ALL we are going to do is count them and nothing else. Then if we have to do something else, they will feel deceived.

Why do I have to fix cavities on baby teeth if they fall out?

Untreated cavities will continue to grow until they can communicate with the pulp of the tooth. This is the internal part of the tooth which contains nerves and vascular supply. If the bacteria which cause cavities enter this region of the tooth, the result is often a toothache which can become severe. Infection is also common if the cavity is allowed to grow so far. This infection can spread beyond the tooth, into other facial spaces or the blood stream. Remember, the teeth are in the mouth which is in the head which is the most important part of your body! Untreated dental infections can be very dangerous – even fatal!
Besides pain and infection (and the obvious result of comfort during chewing and eating), the baby teeth are place holders for the adult teeth. There are times when baby teeth may have to be extracted prematurely. In this event, the problem arises of remaining teeth shifting into the place where the extracted tooth used to be which then can create complicated orthodontic issues.
There is no better way to avoid all of these problems than to properly care for the baby teeth. Prevention of cavities is the top priority, but early treatment of cavities when they are detected is necessary to avoid their development into larger events.

How do you do fillings for young children? Can I come in the room with them?

The actual fillings themselves are very similar to fillings in adults. The main difference is in behavior management. When adults go to the dentist, whether they like it or not, they know it is important and they do what they have to do. Children are not so sophisticated — if they don’t want to do something, they’ll let you know it! The key is to try to make the experience pleasant or even, if at all possible, fun.
First, and most importantly, you must not let your fears or negative feelings transfer to your child. If you hate the dentist or are scared of the dentist, KEEP IT TO YOURFELF. If your child thinks you hate it, she’ll have the right to hate it too. Avoid words that scare your child. Trigger words like “pain,” “hurt,” “shot” are four letter words that are not allowed in our office. Everything must be presented in a positive, child-friendly manner. The word “needle” itself is enough to frighten your child…no child enjoys getting shots and just the thought of it is enough to make them run away. However, if it can be done in such a painless way that they don’t even know it happened, it’s not a bad thing. “Sleepy juice from a squirt gun” is a much easier procedure to anticipate…and it’s not so scary! If you lie to children, you will lose their trust, but you can play with semantics!
There are an infinite number of simple behavior management techniques that can be utilized to help get your child through the appointment with ease. Most of them are some form of communication, e.g., distraction, raising or lowering the voice, and positive reinforcement. Each individual responds to different forms of treatment so your dentist or hygienist may go through many tactics before finding something that works best for your child. You may hear Dr. Sey singing, telling jokes, counting, talking about school or cartoons, or simply explaining what he’s going to do next.
While it is universally agreed upon that most children behave better without their parents in the room, Dr. Sey feels it is important for the parents to have some involvement in the treatment. It is important to him that, at a minimum, the parents get to see how their children enjoy the visit and, therefore, won’t need to ask inappropriate questions later (e.g., “did it hurt?”). Parents are invited to join their children in the operating rooms while the work is being done, but we ask that they limit their interactions while we do our work. If a parent is becoming intrusive, we reserve the right to politely ask them to leave!
We try to make the visits here great experiences, however, we are not magicians. There are some children who do not respond positively any of our tricks. Usually these are very young children and those who have had negative experiences in the past. When this occurs we discuss the option of sedation techniques.

What is nitrous oxide?

Nitrous oxide (aka, laughing gas or sweet air) is an anti-anxiety gas that can be breathed in through a simple mask. It is, for all intents and purposes, a harmless medication which works fast and is extremely short lasting with relatively no side effects. It is a great tool for children because of its safety and efficacy. It helps alleviate anxiety in children who are cooperative but apprehensive. While nitrous is not necessary for many patients, Dr. Sey recommends it very often because he feels that if there is any way to safely make the experience even better, then why not? It is the lightest form of “sedation.” It essentially makes the patient feel a little bit “spacy” and ticklish. Because it makes children feel like they’re on a roller coaster, we always ask patients to be on an empty stomach for 2 hours prior to an appointment with nitrous. We try to avoid vomiting while we’re working inside the mouth!

What is conscious sedation and general anesthesia?

For those children who are not simply slightly apprehensive, but combative, special needs, or too young to understand, stronger sedation tactics can be employed. At Brick Pediatric Dentistry we do an oral sedation which is a medicine that your child can drink to make him feel much more relaxed. It does not make your child sleep. It is reserved for an extremely apprehensive or young child with a small amount of work to be done.
For combative children or those with more extensive work, general anesthesia may be more appropriate. This is done at the hospital under care of an anesthesiologist. All of the dental work is completed while the child is completely asleep thereby making it a much more pleasant experience for everyone and avoiding a child’s hatred and/or fear of the dentist for years to come.
All of the treatment options should be discussed with you on an individual basis by the doctor to determine what works best for you and your child.

Should I use a white or silver filling?

Both white (composite) and silver (amalgam) fillings have their advantages and disadvantages. For most situations, both are very good options; for some situations, one may be better than the other. Overall, it is a question of esthetics vs. cost. Composite is a more expensive filling material than amalgam. Amalgam contains mercury which many worry may cause mercury poisoning. At this time, scientific research has not proven a correlation between silver fillings and systemic problems. The FDA and ADA still recognize amalgam as an excellent and appropriate filling material and is considered by many to be the gold standard tried and true filling. At Brick Pediatric Dentistry, we offer both types of fillings and leave it to the parents to decide. Occasionally, Dr. Sey will recommend one over the other for specific reasons. Feel free to ask any questions before deciding which you prefer.

Why does my child need a silver cap?

Sometimes a tooth can be so broken down by decay that there is not enough tooth structure remaining to retain a traditional filling. Often this occurs in teeth that had to undergo a baby root canal (pulpotomy). When this happens, the best and strongest way to restore the tooth is to completely cover it with a stainless steel crown. This full coverage restoration holds the tooth together from the outside to prevent the tooth from fracture. It also prevents future cavities on the tooth by blocking off all surfaces of the tooth from the environment. You could often attempt to fix these teeth without a silver cap by simply placing a very large filling, but remember, baby teeth are very small and kids tend to put a lot of force on them with the things they eat. Over a period of time, these severely weakened teeth have a higher tendency to break. Plus, if they get another cavity later, they become even more fragile. While many parents do not like to see full silver teeth in their child’s mouth, it is a question of strength vs. esthetics.
Only back teeth are considered for silver caps. If front teeth require similar coverage, only white caps can be used for them. White caps, however, for back teeth have considerable drawbacks which make them poor options.

When should my child get braces?

Every child should have an orthodontic evaluation at about 7 years old. At each checkup, Dr. Sey, while not an orthodontist, will look at your child’s bite and determine whether or not it is necessary to begin treatment. In fact, it is not uncommon for Dr. Sey to begin mentioning bite issues from the earliest appointment. While it may not be time to treat yet, if certain predictions can be made, it never hurts to hear them!
There are certain orthodontic issues which require early intervention at about 7-8 years old. Otherwise, most orthodontic problems can wait until all the baby teeth are gone. Remember, there’s a big difference between who NEEDS braces and who WANTS braces! When the time is right, Dr. Sey will recommend you see an orthodontist for a full examination. That’s when you get to meet Dr. Tara (and can proceed to read ortho FAQs!)!

Does my insurance cover this work?

This is the hardest question there is! It would be great if insurance covered everything for everyone, but unfortunately it does not work that way. You have to call and specify your insurance and then MAYBE we can help determine what will and will not be covered. There can be so many factors that determine what is covered. Even within specific insurance plans, there are different clauses about specific procedures. The best way to figure it out is to submit to the insurance company a predetermination of what work needs to be done and they will reply with how much they cover. Believe it or not, even then things can turn out differently. While we never guarantee that we can tell you absolutely what your insurance will cover, we do vow to do our best to help figure it out, submit and collect. We work with most companies be they in-network or out-of-network and we try to work with you as much as possible to make treatment for your child feasible.

What time is it when you have to go to the dentist?

Tooth Hurty!!!!!