Dental Topics

Please click on a topic below:

Adolescent Dentistry News

Baby Bottle Tooth Decay (Early Childhood Caries)

Dental Emergencies

Dental Radiographs (X-Rays)

Diet and Cavity Prevention

Eruption Of Your Child’s Teeth


Mouth Guards


Teeth Grinding

Thumb Sucking

What Is A Pediatric Dentist?

When should my child get braces?

Why are baby teeth so Important?

Your Child’s First Dental Visit

Adolescent Dentistry News


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.

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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.

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.

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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.

Caries is an infectious disease. Several factors need to be combined to develop caries.

  1. teeth need to be present
  2. bacteria need to be present
  3. a substrate (food for the bacteria) needs to be present
  4. caries requires time to develop

These are the major factors involved in the caries process. The combination of the factors leads to disease, if one or more factors are missing disease may not develop.

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Dental Emergencies

Toothache: 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. The most serious toothaches are the ones that prevent kids from eating or wake them up at night. Pain that is spontaneous is usually not a good sign and signifies a likely infection.

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 dentist or visit the hospital emergency room. In many circumstances large lacerations need sutures. Although the mouth is a “dirty” place with lots of bacteria, they do heal very quickly.

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 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.

Knocked Out Baby Tooth: Contact your pediatric dentist during business hours. This is not usually an emergency, and in most cases, no treatment is necessary. If other teeth are suspect of injury see our dentist fairly soon.

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.

Chipped or Fractured Baby Tooth: Contact your pediatric dentist.

Severe Blow to the Head: Take your child to the nearest hospital emergency room immediately. A dental follow up exam can be done at a later date to examine possible dental trauma

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

If you have questions or concerns feel free to contact our office. If it is after hours feel free to contact our emergency number. Many dental problems perceived as dental emergencies are not true emergencies. We will be happy to consult with you over the phone and determine whether the problem warrants immediate care.

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Dental Radiographs (X-Rays)

Taking dental radiographs on children can be a challenge at times. The film sensors are not always easy for the kids to tolerate. We will evaluate each child and assess the need for dental radiographs and the frequency needed. We will work with kids on an individual basis to make taking radiographs as easy as possible.

Radiographs (X-Rays) are a vital and necessary part of your child’s dental diagnostic process. Without them, certain dental conditions can and will be missed.

Radiographs detect much more than cavities. For example, radiographs may be needed to survey erupting teeth, 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 request radiographs approximately once a year. Approximately every 3 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. In our office we use digital radiography which subjects your child to even a much smaller percentage of radiation exposure than conventional film based radiography. We are using the latest and greatest in dental technology to provide the safest experience for your child.

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Diet And Cavity Prevention


Healthy 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.


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.

For older children, brush their teeth at least twice a day. Also, watch the number of snacks containing sugar that you give your children.

With that being said I have parents ask me almost every day, “Why does he have cavities when I brush and floss his teeth two times a day?” My best answer to that is something that I feel strongly about. The biggest cause of caries in kids is FREQUENCY. How frequently is your child snacking, eating, drinking etc. is going to be the biggest cause of cavities even if your child is a good brusher and flosser. Provide good healthy snacks and wash them down with water or milk. Kids are growing so they need to snack to stay healthy, but chips, fruit snacks, high carb crackers, fruit juice and poptarts are going to make for a lot of cavities.

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. Small cavities can be diagnosed early and taken care of easily!

We may also recommend protective sealants or home fluoride treatments for your child. Sealants can be applied to your child’s molars to prevent decay on hard to clean surfaces.

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Eruption Of Your Child’s Teeth

The following is a general guide to when teeth erupt and exfoliate (fall out) My biggest advice here is to tell you not to worry if your child doesn’t fall within the normal eruption times. The eruption times vary greatly. For example, the first tooth should erupt around 6-10 months. I have seen several children at 16-18 months getting their first tooth. I have also seen kids with teeth at 3 to 4 months.
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, and many time by age 2, the pace and order of their eruption varies.

Natal teeth= teeth present at birth. Consult a Pediatric dentist soon. These teeth often times need to be taken out.

Neonatal teeth= teeth present within the first month after birth. Consult a Pediatric Dentist.
Permanent teeth begin appearing around age 6, starting with the first molars and lower central incisors.

This process continues until approximately age 21. Consult a pediatric dentist around age 6 to have the first permanent molars sealed. These teeth often get cavities because they are hard to brush and difficult to reach for a 6 year old.

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

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Living here in Kootenai County our teeth do not have the luxury of getting a constant fluoride supplement through our water supply. It is important to discuss your individual plan for fluoridating your child’s teeth with your dentist so that an accurate assessment can be made as far as how much fluoride your child is receiving. If you do not have a fluoride supplementation for your child feel free to ask us to help you make those educated decisions for your child’s dental health

Fluoride is an element, which has been shown to be very beneficial to teeth. It aids in remineralization which strengthens areas which have broken down. 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.

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.
  • Place only a pea sized drop of children’s toothpaste on the brush when brushing.
  • 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).

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Mouth Guards

When 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, and should be used during any activity that could result in a blow to the face or mouth.

Mouth guards help prevent 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. One of the most common causes of TBIs (Traumatic Brain Injuries otherwise known as concussions) is from the crashing of teeth during a head injury. Children wearing mouth guards are much less likely to get a TBI during a sports injury.

The Academy of Sports Dentistry lists some 40 sports in which mouth protection would be advantageous: Acrobatics, baseball, basketball, bando, boxing, cycling, discus, equestrian sports, field hockey, football, gymnastics, handball, ice hockey, judo, karate, lacrosse, motocross, martial arts, parachuting, horseback riding, rugby, raquetball, skiing, soccer, squash, surfing, skate boarding, shot putt, sky diving, trampoline, tennis, volleyball, wrestling, weight lifting, and water polo. This calls for more education and motivation. Mandating rules are not the answer to the problem. Athletes should be wearing these protective devices as a result of their knowledge and concern for their own safety.
Advantages of Mouth Guards

  1. They prevent the tongue, lips and cheeks from being lacerated against the sharp edges of the maxillary teeth.4
  2. They lessen the risk of injury to the anterior maxillary teeth by about 90%.4
  3. They lessen the risk of damage to the posterior teeth of either jaw following a blow delivered to the inferior aspect of the mandible which causes traumatic closure of the mandible to occur. Such an impact can cause cusp fractures and tooth infractions.
  4. They lessen the risk of jaw fractures by absorbing the energy of a traumatic blow to the chin.
  5. They lessen the risk of concussion occurring subsequent to an impact to the mandible from either in front or below because full posterior translation of the condyles is prevented, reducing the level of force transmitted from the condyles to the base of the skull.

Ask Dr. Dance and his Staff about custom and store-bought mouth protectors

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A sealant is a clear or shaded plastic material 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.

Usually baby teeth are not sealed. They are occasionally sealed in children with a very high caries rate or children with very deep grooves and pits.

The most frequently sealed teeth are 6 year molars. 6 year molars are the permanent teeth that erupt around age 6 and are usually the first permanent teeth in a child’s mouth. They frequently get cavities because the teeth are difficult to brush when the jaws are still very small. They often remain partly covered by the gum tissue and trap food and bacteria which can cause cavities. We like to seal the 6 year molars just as soon as they are fully erupted to all them the best chance to remain cavity free.

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Teeth Grinding


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 is that of accommodation. With new teeth erupting and consistently changing the bite the kids play with these new teeth by grinding on them at night. Another 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. A final 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. On most children night guards are useless because they will not tolerate them and they simply spit them out soon after falling asleep. Also, a negative to a mouth guard are the possibility of choking if the appliance becomes dislodged during sleep or it may interfere with growth of the jaws. The positive is obvious by preventing wear to the primary dentition.

Just remember this…Bruxism or grinding is very common in children. It is not anything to worry about because your child is completely within the norm if he or she is grinding their teeth. Once the permanent teeth begin erupting grinding should subside. 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. Decisions will be made based on age and the ability to tolerate a mouth guard.

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Thumb Sucking

Sucking 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 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. As a parent you can take a pacifier away. It proves more difficult to take off a thumb. 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:

  • Instead of scolding children for thumb sucking, praise them when they are not.
  • 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 will 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.
  • The habit can be very difficult to break. Start early. It usually happens when the child decides to stop
  • 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. The appliance is an effective tool and many times necessary, but it is also a last resort in our office when other methods have been tried over and failed.

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What Is A Pediatric Dentist?

The pediatric dentist has an extra two to three years of specialized training after dental school, and is dedicated to the oral health of children from infancy through the teenage years. Dr. Dance went to the University of Washington School of Dentistry and then received his certificate in pediatric dentistry from Primary Children’s Medical Center in Salt Lake City, Utah. The very young infants, children, pre-teens, and teenagers all need different approaches in dealing with their behavior, guiding their dental growth and development, and helping them avoid future dental problems. The pediatric dentist is best qualified to meet these needs. The pediatric dentist is also trained in hospital dentistry, oral and IV sedation as well as behavior management skills to help make the child’s dental experience as safe and enjoyable as possible or necessary. Most people think to take their kids to a pediatrician for general health care, and from a dental prospective can also be very well served with a pediatric dentist.

Follow the FEET rule: A pediatric Dentist is Fast, Efficient, Effective, and has Tons of Fun!

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When Should My Child Get Braces?

A Pediatric dentist is trained in early intervention for orthodontics and can do a great deal to help prevent serious orthodontic problems that sometimes lead to surgery. As a pediatric dentist I can help direct families to a local orthodontist as necessitated by the child’s growth patterns and tooth eruption phases. There is much we can do in our office as well to provide interventional treatment for orthodontic problems. As Children grow they may tend toward a certain type of bite and treatment at a very early age can help correct and promote better growth patterns.

A child’s orthodontic problems may be derived from a skeletal, or underlying bone growth problem, or it may be a more simple crowding issue where the teeth are bigger than the space provided. Sometimes it is a combination of the two. These orthodontic problems can be recognized as early as 2-3 years of age. As diagnosed early, steps can be taken to decrease the severity of the treatment rendered later on in the child’s life.


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.


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. Your Child has not finished growing and bones have not fused.


This stage deals with the permanent teeth and the development of the final bite relationship. This is the most common stage for orthodontic needs and usually starts around ages 12 to 16. Our team can help you understand the pros and cons of orthodontic treatment and help you weigh out your decision making process of whether to pursue treatment or not.

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Why Are Baby Teeth So Important?


Many of my patients and parents ask me why primary teeth are so important and they also commonly use the phrase, “they are just baby teeth and will fall out anyway right?”

Well, I am here to say that yes, they will fall out anyway which is nice because we get in a sense a second chance with our teeth, BUT…

It is very important to maintain the health of the primary teeth. Neglected cavities can and frequently do lead to problems which affect developing permanent teeth. Primary teeth, or baby teeth are important for:

  1. proper chewing and eating
  2. providing space for the permanent teeth and guiding them into the correct position
  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.
  4. Neglecting primary teeth can lead to pain and infection which make for a terrible experience for the child.
  5. The habits that we form in our youth are often translated into habits in our adulthood and poor teeth in childhood have shown to make adult teeth more prone to cavities and subsequent problems.
  6. Caries is an INFECTION! That means that leaving one particular baby tooth untreated can subsequently “infect” another baby tooth or even worse, an adult tooth!

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Your Child’s First Dental Visit


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.

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

Establishing a dental home is critical even at an early age. Children are very “clumsy” as they are learning to walk and run and dental injuries are very common at the toddler age. By establishing a dental home you have a place to take your child in the event of an emergency.

Kids are also very susceptible to cavities. Many times a cavity can be cleaned out and filled without using dental anesthetic in our office if they are caught at an early stage before the cavity or hole makes its way through the enamel. This can be done on very young kids. However, if the cavity is discovered once it is too large then more complicated decisions need to be made. Can the child tolerate the procedure? Will sedation need to be used?

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.

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