Pediatric Dental Series: PART 2 – parental advice!

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Today marks the second and final part of our pediatric dental series! We have the fabulous pediatric dentist, Dr. Erika Eaton, guesting on our blog this morning to answer our questions and give us all her tips and tricks for getting littles to brush and floss their teeth! If you missed last week’s post where Dr. Eaton answered all of our FAQs, you can access it here.

Now that Dr. Eaton has answered all of our burning questions, she is using today to give her favorite tips for parents to use to help maintain their child’s dental health. It seems like there’s so much to keep track of these days to keep our babes healthy and on the right track, but what I love about Dr. Eaton’s responses is that she makes it all seem so simple and easy to incorporate into your daily routine! Enjoy and please feel free to email me with any questions you may have!


  1. When should I stop bottle feeding?

Parents should be encouraged to have infants drink from a cup as they approach their first birthday. Infants should be weaned from the bottle at 12 to 14 months of age. Repetitive consumption of any liquid containing fermentable carbohydrates from a bottle or no-spill training cup should be avoided.

  1. How often should I change my child’s toothbrush?

Every 3 months. Unless you notice the bristles are splayed out, change at that time. Also, if your child is sick change their toothbrush after the sickness passes.

  1. What kind of toothpaste should my child use?

Starting with birth, clean your child’s gums with a soft toothbrush or cloth and water. Parents should use a tiny smear (very thin) of fluoride toothpaste to brush baby teeth twice daily as soon as they erupt and a soft, age-appropriate sized toothbrush. Once the child is 3 years old, the amount of toothpaste should be increased to a pea-size. Children should spit out and not swallow excess toothpaste. If the child cannot spit, wipe the toothpaste off with paper towel or cloth.

  1. Should I let him brush his own teeth or should I help?

You should always help. You should definitely encourage them to brush on their own, but they will not have the manual dexterity to brush properly on their own until anywhere from 6-12yrs, (every child is different, but if they can’t tie their shoes they most likely cannot brush properly). Even if the child insists on brushing themselves, you always need to go back and check/re-brush because they may not be reaching all surfaces of the teeth, doing it properly, or they might say they did even though they really didn’t. This is very common in the pre-teen years. (I recommend check/re-brush up to the age of 12).

  1. When should teeth first come in?

The first baby tooth should erupt between 3 and 9 months of age. As a general rule, use the rule of “4s”. By 7 months of age, 4 teeth should be present (all lower incisors). By 11 mos of age, 8 teeth should be present (upper and lower incisors). By 15 mos of age, 12 teeth should be present (all incisors and first molars). By 19 mos of age, 16 teeth should be present (incisors, first molars, and canines). By 23 mos of age, 20 teeth should be present (second molars).

This is just a guide. Do not worry if your child’s eruption pattern differs from this. This is what usually happens. If you have a question, always ask your dentist.

  1. When should teeth first start falling out?

The first primary tooth (baby tooth) usually falls out around 6 years of age. Usually, the first tooth lost is the lower central incisor. If you are worried that your child’s baby teeth aren’t falling out, you can request an x-ray from your dentist.

  1. What’s the difference between a pediatric dentist and a family dentist?

A pediatric dentist has gone to a residency program specifically for pediatric dentistry. It is typically a 2-3 year program following dental school. Pediatric dentists are the pediatricians of dentistry, and their practice is limited to treating only children (typically 18 years and under). A family dentist did not go to a pediatric residency. They may have completed another type of residency (like me, a general practice residency based in a Children’s Hospital; ours treats about 70% children which is rare for a GPR) without a specific specialty. A family dentist has not completed a pediatric residency, but that does not necessarily mean they aren’t qualified to treat children. If you visit a family dentist and they feel that something is out of their scope of knowledge, they will refer the child to a pediatric dentist.

  1. How do I make my child’s diet safe for his teeth? Are there certain foods/liquids I should be avoiding?

If children have poor diets, their teeth may not develop properly. Children need protein, vitamins and minerals, especially calcium and phosphorous, to build strong teeth and resist tooth decay and gum disease. Parents should select meals and snacks for dental health and for general health, providing sound nutrition. Snacks, served no more than three times a day, should contribute to the overall nutrition and development of the child. Some healthy snacks are cheese, vegetables, yogurt, and peanut butter. Sugars are essentially the same, whether natural or processed, to cavity-causing bacteria in the mouth. All types of sugars and the foods that contain them can contribute to tooth decay. In general, avoid all drinks and juices with sugar (orange juice, soda, grape juice, sweet tea). Between-meal snacks and extended exposures to foods and juice or other beverages containing fermentable carbohydrates should also be avoided. A child who licks a piece of candy every few minutes to make it last longer or slowly sips a sugared drink is at high risk for tooth decay. Long-lasting snacks create an acid attack on teeth for the entire time they are in the mouth. Cooked starches (fermentable carbohydrates) can lead to cavities just as sugars can. Some cooked starches as breads, crackers, pasta, and potato chips frequently take longer to clear the mouth than sugars. A food with sugar or starch is safer for teeth if it is eaten with a meal, not as a snack. If you cannot get to a toothbrush after your child has a meal or liquid containing sugar, you can wipe their teeth with a wet washcloth and/or have them drink or swish with water.

  1. Truth or myth. It’s bad for my child to fall asleep with a bottle.

Truth. Infants should not be put to sleep with a bottle containing fermentable carbohydrates. Repetitive consumption of any liquid containing fermentable carbohydrates from a bottle or no-spill training cup should be avoided. Early Childhood Caries (ECC) is commonly associated with poor feeding habits. For example, I routinely take 1-2 year olds to the operating room; typically the parents have allowed their children to sleep with the bottle every night; the result being severe decay on at least the anterior (front teeth). This is usually coupled with poor oral hygiene habits and the parents not being educated about proper dental hygiene for children.

  1. How do I know if my child is getting enough fluoride?

It depends on a variety of factors (water, diet, formula), but mostly on how much fluoride is in the water your child is drinking. Your dentist can look up the level of fluoride your child is getting based on what county you live in. If your child is not getting enough fluoride internally, the dentist can prescribe fluoride supplements.

  1. What should I do if my child has a toothache?

If your child is in pain, you can go ahead and give them Tylenol. Schedule a visit with your dentist as soon as possible. The emergency visit will usually entail an x-ray or x-rays and a limited exam (problem focused on the area that is bothering the child). Based on the child’s evaluation and source of pain, the dentist might decide to treat the toothache, (example 1: if the child has an abscessed tooth and swelling, that would be something that would require immediate treatment, example 2: child’s source of pain is an erupting tooth which would not require any immediate treatment, just palliative measures). Antibiotics and/or pain medication may be prescribed at the visit as needed based on the source of the toothache.

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xx – anna & emma grace