We are committed to providing the best dental care for all children regardless of their developmental or other special health care needs. Children with special health care needs are individuals who have a physical, developmental, mental, sensory, behavioural, cognitive, or emotional impairment or limiting condition that requires medical management, health care intervention and/or use of specialized services or programs.

If the individual is not capable of self care, it is essential that people who are in daily contact with the individual become engaged in the prevention of dental disease and other aspects of the individual's oral health care.

We are specifically trained to diagnose dental problems and treat these special patients in our practice. Our reward is forming life-long friendships with them and their care givers.

By establishing our office as their dental home, our special needs patients learn individualized preventive oral health practices which significantly reduce their risk of preventable dental/oral disease.

More complex oral care will be identified and referred to the appropriate dental specialist who also works with the special needs population. You can be assured our office will give your special needs child the attention and gentleness he/she requires for a positive and successful dental experience.

Children's hands and mouths are different than adults. They need to use toothbrushes designed for children. Both adults and children should use brushes with soft, rounded bristles for gentle cleaning. Change to a new brush about every three months.

Wipe infant's teeth gently with a moist, soft cloth or gauze square at least twice a day, especially before sleeping. As babies grow, use a child's extra soft toothbrush with a small, pea-sized dab of toothpaste. By age two or three begin to teach your child to brush. You will still need to brush where they miss.

When children are seven to eight years old they are usually able to brush on their own. Flossing can be more challenging and this skill develops around age nine.

Hold the brush at an angle (forth five degrees) towards teeth and gums. Move brush back and forth with short strokes, about a half tooth wide.

• Brush the inside and outside surfaces of each tooth, top and bottom.

• Hold the brush flat on top of the teeth and brush the chewing surfaces.

• Gently brush the tongue to remove debris.

• Floss between teeth daily.

When to Begin Brushing?

Once your child's teeth begin erupting, you can begin cleaning them by wiping them with a moist washcloth. As your child gets more teeth, you can begin to use a soft child's toothbrush. You should use just a pea-size amount of fluoride toothpaste or a non-fluoride toothpaste until your child is able to spit it out. Be sure to ask us about child-friendly flavoured toothpaste.

For most toddlers, getting them to brush their teeth can be quite a challenge.

Some suggestions for making tooth brushing less of a battle can include:

• Letting him brush your teeth at the same time
• Letting him pick out a few toothbrushes with his favorite characters and giving him a choice of which one he wants to use each time (This will give him some feeling of control over the situation.)
• Try an inexpensive battery-operated brush to add fun to the task.
• Let him brush his own teeth first. You will likely have to "help out."
• Use child-friendly flossing aids.
• Use a stepstool and mirror to help him be proud of his results.
• Have everyone brush their teeth at the same time.
• Continue to encourage healthy habits even if your child is resistant. You will be pleased with the long-term results.

To help him understand the importance of brushing, it can be sometimes fun and helpful to let him eat or drink something that will "stain" his teeth temporarily and then let him brush them clean.

It can also be a good idea to create a "tooth brushing routine" and stick to the same routine each day. Tooth brushing and flossing charts can motivate older children, although the ultimate motivation is a parent's joyful approval of a child who has clean teeth.

What causes tooth decay?

Several specific types of bacteria that live on the teeth cause decay. When sugar is consumed, the bacteria use the sugar and then manufacture acids that dissolve the teeth and cause an infection in the tooth. This infection is called decay.

What is infant tooth decay?

Now known as Early Childhood Caries (ECC) or Nursing Caries. Infant or early childhood tooth decay results when babies fall asleep with breast milk or milk, formula and juice from a bottle on their teeth. Babies are not able to clear the pooling liquid from their mouths.

Because the sugar in formula, milk or juice stays in contact with the teeth for a long time during the night or at naptime, the teeth can decay quickly.

Here are some tips to avoid Early Childhood Caries:

• Brush your baby's teeth at least twice a day.

• Put your child to bed with a bottle of plain water, not milk or juice.

• Stop nursing when your child is asleep and wipe the teeth with a clean washcloth.

• Try not to let your child walk around using a bottle or sippee cup of milk or juice as a pacifier.

• Start to teach your child to drink from a cup at about six months of age. Plan to stop using a bottle by twelve to fourteen months at the latest.

• Don't dip your child's pacifier in honey or sugar.

• Read, sing or rock your child to sleep as an alternative to continuous feeding.

Healthy school lunches are a very important part of the school day. Why not inspire your children to bring to school some fun and healthy lunches? Involve them with menu planning, shopping and preparing meals. Children who feel they have had a part in preparing their lunches will be more likely to eat them and less inclined to trade with their friends. Let them pick out five or six lunch items they really like and build on those. Offer a new food with a familiar one. Applaud adventurous eating. Cut foods in different ways (i.e. carrot sticks one day and carrot coins another). Allow your children to choose a special food from time to time. Teach them the difference between everyday foods and occasional foods. Rely less on processed, packaged foods and replace them with fresh foods whenever possible. In time, your children will start making healthy choices on their own. Remember most kids will skip foods that take a lot of effort to eat.

A Healthy Diet = Healthy Teeth

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 eating habits that begin in early childhood can go a long way to ensuring a lifetime of good oral health.

Good nutrition and a balanced diet will help your child grow up healthy. Whether your child is a toddler or a teen, you can take steps to improve nutrition and encourage smart eating habits.

Five of the best strategies are:

1. Have regular family meals. Kids who take part in regular family meals are more likely to eat fruits, vegetables and grains, less likely to snack on unhealthy foods, and less likely to smoke or drink alcohol. Allow your teens to invite a friend and keep mealtime calm and congenial with no lectures or arguing. Plan around a child who's at sports practice. Try setting aside time on the weekends such as Sunday brunch, when it may be more convenient to gather as a group.

2. Serve a variety of healthy foods and snacks. Younger kids will most likely eat what's available at home. Work fruits and vegetables into the daily routine. Other good snacks include yogurt, peanut butter and celery or whole-grain crackers and cheese. Serve lean meats and other good sources of protein such as eggs and nuts. Limit fat intake, fast food and other low nutrient snacks. On any given day, one third of toddlers eat no fruit, and french fries are the most commonly consumed vegetable. Instead of sugary drinks such as soda and fruit-flavored drinks, serve water and milk. The carbonation found in soda can actually erode tooth enamel. If they must drink soda, encourage them to use a straw which will help keep at least some of the carbonated beverage away from the teeth.

3. Be a role model by eating healthy yourself. Children will follow the lead of the adults they see every day. Send the right message. Providing your body with the right amounts of vitamins and minerals helps your teeth, gums and immune system stay strong and wards off infection, decay and disease.

4. Avoid battles over food. Establish a predictable schedule of meals and snacks. Don't force kids to clean their plates. Doing so teaches them to override feelings of fullness. Don't bribe or reward kids with food. Avoid using dessert as the prize for eating the meal. Don't use food as a way of showing love. Give hugs instead.

5. Involve children in the process. Talk to them about making choices and planning a balanced meal. At the store, help your child look at food labels to begin understanding nutritional values. Let them help in the kitchen with age-appropriate tasks. Don't forget to praise them for jobs well done. Let them help prepare school lunches.

Caries (cavities) are among the most prevalent health problems facing Indian infants, children and adolescents. Frequent ingestion of sugars and other carbohydrates (eg, junk food, juices and acidic beverages) and prolonged contact of these substances with teeth are risk factors in the development of caries. Nutritious conscious parents can prevent cavities for their children by limiting or eliminating apple juice or any other high sugar content juice from their children's diet. Children at high risk for cavities should restrict their liquid intake to water and milk.

Parents with sports-minded children should limit the use of sugar laden sports drinks. We recommend the use of electrolyte enhanced water.

Along with increasing caries risk, increased consumption of sugar-sweetened beverages and snack foods also has been linked to obesity.

When does the first tooth come in?

The first tooth usually comes in around 6 months of age. Most often it is a lower front tooth. Our experience, however, is that the tooth eruption timing of primary (milk) teeth is more variable than for permanent teeth. The front 8 teeth (4 on top and 4 on bottom) usually have come in by 9 months of age.

When should I start cleaning my baby's teeth?

The simple answer is that teeth should be cleaned as soon as they first appear. Parents should not limit the cleaning only to teeth. The gums also need to be cleaned.

Step 1: Prepare a piece of gauze, cotton or cloth and a glass of drinking water

Step 2: Wash your hands thoroughly with soap

Step 3: Wrap the gauze, cotton or cloth around your finger and damp it with water

Step 4: Gently put your finger inside your baby's mouth. Wipe the upper and then the lower gum pad once.

What is the best way to clean a baby's mouth?

Different methods have been recommended. The popular technique now-a-days is to use a clean, small gauze pad/ dry cloth can be used. The teeth and gums are firmly wiped to remove liquid and food debris. This is done before bedtime. Once the child has back teeth (molars), a small, soft toothbrush can be used to clean the grooves on the chewing surfaces of the molars.

When do you think my child should give up the bottle?

For those babies not being breast fed, there is general agreement that around one year of age is a good time to wean baby from the bottle. Paediatric dentists like to see children give up bottles as soon as possible. That is because they see an alarming number of toddlers with Nursing Bottle Decay. This type of decay, which begins on the front teeth, is only seen in toddlers. It results from prolonged use of a milk or sweetened liquid bottle that is put into bed with the baby.

Gradual weaning from the bottle seems to be more appropriate method. Reduction usually begins during the day when baby is able to drink from a cup. The last and most difficult bottle to be discontinued is the bottle before bedtime

What age should a child have the first dental check up?

Early examination procedures have been recommended strongly in the past decade to help reduce the number of infants and children who suffer from preventable tooth decay.

Ideally we like to see children have their first dental check up by their first birthday. Why? Seeing the child early gives the dentist the opportunity to examine the mouth and confirm normal oral development. Most importantly, the teeth can be examined for cleanliness. It gives the dentist the opportunity to provide advice on prevention and make the best care plan for your child. It also gives parents the chance to discuss feeding practices, teething and mouth habits.

Do you think it is O.K. to use a pacifier?

Sucking is a basic instinct of infants. Over the years there have been numerous debates as to the usefulness of pacifiers. The benefits attributed to them seem to outweigh any potential shortcomings for children. If it helps to comfort your baby then use the pacifier. Be certain to use pacifiers with a large flange that sits on the outside of the mouth and an oval shaped teat.

Could my child's temperature be from teething?

For years many thought that teething caused fever and general sickness. Teething has been blamed for many things! Research into the problems of teething has shown that some children become irritable, have increased drooling and sometimes a facial rash. Children, during this period, tend to put the all possible unclean things in their mouth to relieve the itching sensation in the gums; which may lead to diarrhea, infection, fever and even ear infections. However, for most children the effect of teething is teeth! It is a normal part of development. If your child has a high temperature that worries you, it is unlikely to be caused by teething and you should consult your pediatrician.

What do you recommend for teething?

Many remedies have been suggested over the years. There are non medical things that can help. Teething rings have been found to be helpful for some babies. The biting pressure seems to relieve some discomfort especially if the teething ring is chilled. We generally do not recommend pain relief medicines. The treatment can be managed by local measures. For example, special local anesthetic medicines are available to be placed on sore gum areas. Use the medicines intended for this purpose only.

Why do some children get tooth decay before they are two years old?

About 1 in 10 children experience tooth decay before they are two years old. The most common cause is when a baby is placed in the bed at night with a bottle of milk or sweetened liquid. The contents of the bottle cling to the teeth all night. Tooth decay begins! The same effect can occur with a sweetened pacifier. In circumstances, babies who are breast fed throughout the night over a long time are also at risk. The decay experienced by these toddlers has a typical pattern. It usually is evident near the gum line of the upper front teeth. Because of the age of these children, treatment becomes a major problem sometimes requiring general anesthesia. Parents need to be alert and keep the teeth healthy.

Occasionally when illness or some other disturbance affects growing teeth, the quality of the enamel (outer layer of tooth) is poor. These teeth can decay early and more easily. A dental examination around one year of age helps identify these problems.

What can be done about my child grinding teeth at night?

Some children grind their teeth at night. It is a habit called bruxism. It is not unusual in the early years. We know that this really worries parents but in our experience it rarely requires treatment. The grinding habit can be minor or a child can wear teeth severely. If the habit persists in later years and there is damage to the second teeth, some form of treatment may be indicated. Some suggestions for treatment have been minor tooth adjustments, the use of mouth splints, relaxation techniques and sedation at night.

Are baby teeth important?

For years, the importance of baby teeth was underrated. Once their importance was recognized, adult teeth improved! There are obvious reasons why baby teeth are important – chewing, speaking, and appearance. Baby teeth do more. They conserve the space in the jaws for permanent teeth. If baby teeth are removed ahead of their natural time to fall out, space for the second teeth may be lost.

Do injuries to the first teeth affect the second teeth?

Many children have unfortunate accidents and can damage their mouth and teeth. A wide range of injuries can occur. Sometimes the damages to the baby teeth are of little concern and sometime they are severe and teeth can be moved about or knocked out. The more serious injuries can cause damage to the permanent teeth that are still forming in the jaws. The amount and type of damage depends on the age of the child as this reflects the stage of development of the underlying permanent tooth. The amount of injury will not be seen until the second tooth comes into the mouth. It is advisable to consult pediatric dentist in case of injury involving mouth or teeth.

I am worried about my child's visit to get teeth filled, is there anything I can do to help?

We would all like the dental visit to be a good experience. Research tells us that anxious parents can pass their anxieties to their children. So, try and be relaxed and positive. Treat the visit as a routine part of life and health care. Extensive information on this website can be used to explain procedures. You may also ask friends and other family members about dental practices that are oriented toward children or about dentists who limit their practice to children. Other children in the dental office and a dental team who look forward to treating children can be a big help to the child.

By two years of age, are all the baby teeth present?

That is a hard question without a dental examination. The answer likely is no! Baby teeth begin to arrive around 6 months of age. By age two, 16 teeth usually are present and the last of the molars begin to appear, but they do not finish erupting until around 30 months. The upper molars are usually the last to come in.

What type of toothbrush do you recommend?

Many types of toothbrushes are available in the market. Some manufacturers specialize in the development of children's toothbrushes. Rather offering a brand name, we would like you to think about what you want in a toothbrush for a child 2 -5 years old. Look for a brush with a short and bulky handle as this is easier for the young child to manage. Bristles should be soft to avoid injury.

How often do you recommend cleaning teeth?

One of the most important things about a tooth cleaning schedule is developing good habits. Brushing should be done at least twice daily – morning and at bedtime. Of course, if it is done more often that is good. Brushing teeth after meals or sweet snacks is very beneficial. Cleaning is best done by children and parents.

What can be done if my child doesn't like toothpaste?

In young children the most important thing is to remove the food debris from around the teeth and gums. To do this, toothpaste is not needed. Rather than argue with your child, brush with water. At layout toothpaste this benefit is lost. Toothpastes also neutralize acids in the mouth. And, of course, toothpastes help to have a pleasant breath. However, such fluoridated toothpastes should be used when the child is able to spit out and don't ingest the paste. Usually, child gains such ability around 3 years of age.

Why do my children's upper and lower front teeth do not contact each other?

This is typical of what dentists call an "open bite". This situation can be seen in younger children (2-5 years) and in some older ones too. There are several reasons that this may occur. One of the most common causes of an open bite is a habit. Sucking fingers or thumbs, placing the tongue between the teeth and holding objects between the teeth all are habits that can cause this problem. It also can be due to a growth problem but this is rare.

There are choices for dealing with open bites due to habits. The condition can be left without treatment. There are several ways that a habit can be eliminated. When this is done, very often the teeth move back into a better position without further treatment. Your Pediatric Dentist should be consulted if your child has any of these habits.

What do you suggest to get my child to stop sucking the thumb?

At 2 to 5 years age we are not too aggressive. We suggest that an occasional reminder to remove the finger is reasonable. Not too often, however. Be positive. Encourage and reward the child for not sucking. Praise the child for their grown up behaviour.

Parents sometimes want to tackle the habit problem too early. About half of the children who suck a digit, give the habit up spontaneously at about age three. Many of those who persist will drop the habit about age 6. Loose front teeth at that age and peer pressure will cause many children at this age to give up the habit. Nevertheless, it is advisable to get the child examined by a pediatric dentist.

What is the black stain on my child's teeth?

Black stain is a result of a combination of many things in the mouth related to saliva, bacteria and foods. Black stain on the surfaces of teeth is usually associated decay. Other kinds of stains also appear on the outside of teeth; brown and gray stains are the most common. These stains may indicate poor hygiene and under them early signs of tooth decay may be found.

Should children's first teeth be flossed?

Dental flossing cleans between the teeth in areas that the toothbrush cannot reach. For some children, it is important addition to the cleaning routine. Baby or first teeth tend to be spaced or non-spaced. If spaced, they do not require flossing as the toothbrush can reach the areas between teeth. If they are not spaced, children's first teeth can be flossed especially between the molars. At this age children cannot be expected to floss themselves. Parents need to help them. We suggest that you speak to your pediatric dentist for advice as to the need to floss.

Why do baby teeth need fillings?

When they have cavities (decay), baby teeth are filled. All the decayed parts of teeth are cleaned and fillings are placed to repair them until they fall out normally. If teeth are removed early, space may be lost in the dental arch.The end result is that the permanent teeth may become crowded in a mouth that might have had a good, straight set of teeth.

Another reason that baby teeth are filled is to prevent dental abscess and facial infection. Teeth left to decay can lead to unnecessary health problems.

A third reason that baby teeth are filled is to reduce the amount of bacteria (germs) in the mouth that cause tooth decay. These bacteria multiply in areas of decay. Eventually, the decay spreads to other teeth and even to the permanent teeth when they come into the mouth.

Why are my child's gums reds or bleed while brushing?

Bleeding gums are not healthy. There are many possible reasons for gums becoming red or bleed when brushing. The main reason relates to improper cleaning of the teeth. If the teeth are not straight, they may be more difficult to clean. The gums and teeth need to be brushed regularly at least twice daily. Dental flossing can help clear up the situation as the floss gets between the teeth and removes plaque from areas that the brush cannot reach. Parents and children can tell when the gums are getting healthier because the bleeding decreases and the gums become pink. Other causes are related to medical conditions. Some parents and children avoid brushing the gums because they bleed. This is a mistake. Consultation with the dentist is recommended.

Why do the gums bleed when brushing?

There are many possible reasons for gums bleeding when brushing. Most common cause is the plaque and bacteria accumulated over the teeth. Other causes are related to medical conditions.
Bleeding gums are not healthy. Some parents and children avoid brushing the gums because they bleed. This is a mistake. Consultation with the dentist is recommended.

Does it matter that my child had a baby tooth removed?

Yes, it may be a problem later-on especially if back teeth are severely decayed or lost early. Baby or primary teeth are of a specific size and occupy a certain amount of space in the jaw. If baby tooth is removed, the nearby teeth may drift into the space that has been created by the lost tooth. This means there will be insufficient space in the future for the permanent tooth that will replace the lost tooth. The end result is that the way the teeth bite together may be affected.

What is a space maintainer?

A space maintainer is an appliance that reserves space in the jaw that is created when a baby tooth is lost prematurely. The design of a space maintainer depends upon the teeth missing, the teeth present and the child's tooth development.

When will my child start getting permanent teeth?
The arrival of permanent teeth occurs at 6 years +/- 6 months. With the exception of the wisdom teeth, the last of the permanent teeth come in around 12 years of age. Tooth eruption can be variable. Girls tend to get teeth earlier than boys. Variation has been observed. In our experience, it is not so much the timing that is important as the sequence of tooth eruption. When individual teeth are delayed, this could indicate local problems. A good reason to see your Pediatric Dentist regularly is to have development supervised.

What can be done for my child who is still sucking the thumb?

It is time to do something! Most experts think that by 6 years of age, when the second teeth start to come in, is the proper age to treat the habit. We like to see the habit discontinued because it can push the new teeth into poor alignment. Finger sucking encourages the upper teeth to protrude. It also can be associated with poor speech, social stresses and other habits. These habits are treated with psychologically based programs and/or mouth appliances. Correction of the habit is sometimes not easy. Consult your Pediatric Dentist.

Why does my child have two rows of teeth?

The common site for this occurrence is in the lower front tooth region. The appearance of two rows of teeth is due to the permanent teeth coming in behind the baby teeth. Your dentist should be consulted. An x-ray may be needed to determine how much of the root of the baby tooth remains. Sometimes the baby teeth need removal but in many cases they fall out after a few weeks.

If a child has bad baby teeth, will they have bad permanent teeth?

This does not have to be the case. To have dental decay we need teeth, germs in the mouth and sweet foods. If germs collect in large numbers and sweet foods are eaten regularly and allowed to remain in the mouth without being brushed away, we have a recipe for tooth decay. We have had many patients under our supervision that arrived with terrible baby teeth but did not get decay in their permanent teeth. It took a lifestyle change. Diet, proper mouth care, and regular dental visits are all important. So, bad permanent teeth do not have to follow bad baby teeth.

Why does my child have a large space between the new front teeth?

A large space sometimes is noticed when the two upper front teeth come in. The easy answer is that this is a normal part of jaw development. As more teeth arrive, the space tends to close. When canine teeth arrive near the teenage years, the space is usually closed. There can be other causes for space between front teeth and the area may need x-ray investigation by your dentist.

Why do children need sealants?

When teeth first come into the mouth they are more at risk for tooth decay. The most common teeth are the permanent molars. These molar teeth arrive about 6 years of age and often have deep grooves on the chewing surfaces. Tooth brushing cannot clean these grooves properly. As a result these new teeth will get decay. What the sealant does is stick to the tooth so that food cannot collect in the deep molar grooves. This prevents them from decaying!

Does my child need a mouthguard for sports?

Mouthguards help lessen injuries to mouth and teeth. They are used in many sports where there is a possibility of injury. Some of these are – football, netball, hockey, skateboarding and basketball. Mouthguards are best fitted from a mold of your child's teeth or they can be purchased commercially. The custom fitted mouthguard is a superior fit. This makes it easier for the child to talk wearing the appliance and it offers better protection. However, for a child in the 6 to 9 age bracket, teeth are constantly falling out and being replaced. It may be more practical for this age group to purchase the commercial guards. The more expensive fitted guards can be purchased when all the permanent teeth are in place. Note that mouthguards can be made for children wearing braces.

When do children begin to floss their own teeth?

Flossing teeth is difficult. Children acquire these abilities at different rates. Studies with 7 to 8 year olds have shown that many of the children do not have the ability to self-floss at this time. Consequently, at about 8 to 10 years of age we suggest that children can be introduced to self-flossing. Begin by learning to floss the front teeth. Then, when they can do this well, begin to floss in the back of the mouth. It is important not to have a child floss before they are ready. It frustrates them and then their cooperation will be lost. It is important to floss correctly. Your dental team can help you learn.

When will my child get braces?
Children vary in their development and so they will vary when they get braces. As well, the type of treatment being undertaken will determine when orthodontic treatment begins. Orthodontics may be undertaken early, when there are both primary and secondary teeth in the mouth. Sometimes it is all that is required or it could be the first part of a lengthy treatment. Commonly orthodontics begins later when the permanent teeth have come in and much of the facial development is nearly completed.

Will my child need permanent teeth removed if they get braces?
The decision to remove teeth will depend on the orthodontic diagnosis and treatment plan. There are different approaches to treatment. The decision on the need to remove teeth will be different for every child.

What is the best way to clean the mouth when wearing braces?
We realize that cleaning the mouth while wearing braces is not an easy thing to do. It takes more time and requires more effort. The person who puts the braces on should spend time instructing you what to do.
Three things can be suggested for home care. (1) Brushing may require a standard brush for regular cleaning and a special brush (small end-tufted brush) to clean around the hardware. (2) Special dental floss threaders which enable cleaning between teeth that cannot be done with wires in place. (3) Fluoride mouth rinse should be used daily because children wearing braces are more prone to tooth decay. Be very alert to having good hygiene and diet while wearing braces! Nothing is more disappointing to children, parents and clinicians than having to cope with gum problems and tooth decay when the braces are removed.

Why are my child's gums red or bleed while brushing?
Bleeding gums are not healthy. There are many possible reasons for gums becoming red or bleed when brushing. The main reason relates to improper cleaning of the teeth. If the teeth are not straight, they may be more difficult to clean. The gums and teeth need to be brushed regularly at least twice daily. Dental flossing can help clear up the situation as the floss gets between the teeth and removes plaque from areas that the brush cannot reach. Parents and children can tell when the gums are getting healthier because the bleeding decreases and the gums become pink.

Other causes are related to medical conditions. One special situation that should be mentioned is called pubertal gingivitis. This condition can persist even though the mouth appears well cleaned. It is due to the hormonal changes that occur in the body at puberty. We consider it a passing phase. The gums will eventually return to the healthy, pink colour. Consultation with the dentist is recommended.

Is it O.K. that my teenager uses mouthwash regularly?
Many teens start to use mouthwash regularly because they become more interested in their personal hygiene. The use of mouthwash should not be a substitute for regular, good toothbrushing. When using a mouthwash, it is good to use one with fluoride or proven anti plaque benefits. However, don't forget to brush the tongue as it can contribute to a stale mouth odour.

When do you get wisdom teeth?
This question usually is asked by older teens rather than parents. Wisdom teeth, or third molars, may come into the mouth as early as 16 years of age but usually they come in several years later.
The question is prompted by hearing stories about wisdom tooth problems. These problems often are due to inadequate space in the back of the mouth for these teeth. As a result they only partially come into the mouth. The gums around them tend to become infected causing pain and swelling. Under these conditions wisdom teeth are removed. If they need removal, we recommend that this be done early rather than waiting for years. Often the surgery is easier as the roots of the teeth are not fully formed.

Are mouth beads (rings) harmful in any way?
The current trend for young people to have facial jewellery can cause some dental damage. Tongue studs, for example, have contributed to breakage of back teeth. Lip rings can get caught in clothing or elsewhere and tearing of the lip can occur. The jewellery needs to be well-cleaned as it can be an area where infection begins. Whenever these items or tattoos are put into the mouth, they should be done under the cleanest possible conditions.

Know your teeth… The human have two sets of teeth. The teeth of the first set are called "Deciduous or Milk Teeth", Milk teeth are twenty in number Milk Teeth set contain 2 incisors 1 canine & 2 molars in each half of each jaw.

The permanent teeth are Thirty two in number permanent teeth set contain 2 incisors, 1 canine, 2 permolars & 3 molars (1 wisdom molar) in each half of each jaw.

Tooth Anatomy:

Tooth portion that project above the gum margin called as crown & portion that is embedded within bone beneath the gum is called as root. Structurally, tooth is composed of outermost toughest calcified covering known as enamel, Inner to that sensitive calcified layer present known as dentine. In centre tooth contain pulp. Pulp is made up of loose tissue containing blood vessels & nerves. It is life of tooth. All sensation whether of pain, hot or cold are all due to pulp damage.

 

Selecting the right toothbrush :

• Toothbrushes vary in design, size, length, hardness & arrangement of bristles.
• Wearing of enamel depend on brushing method of individual & abrasiveness of the toothpaste.
• Improper brushing can lead to painful recession (Downward shifting of gum) & triangular shaped defects in the neck areas of teeth.
• To maintain the effective cleansing, it is must to replace your toothbrush as soon as bristles begin to fray.
  Generally with regular use brushes wear in about 3 to 4 months of time.

Manual vs. Powered toothbrushes
Powered toothbrushes are recommended for;

• Individual lacking fine motor skills.
• Patients with orthodontic appliances.
• Small children, hospitalized or handicapped patients, person who need to have their teeth cleaned by someone else.
• Anybody who prefers can use powdered toothbrushes. Best results by using powered toothbrushes are obtained only when they are used in proper way. It can be valuable replacement for manual brush if used properly & regularly.However, when tooth brush cleaning ability is compared, it provides no superiority over manual tooth brushes.

Which toothpaste to use?

• Toothpaste aid in cleaning & polishing.
• Toothpaste contain abrasives such as aluminum oxides & silicon oxides, humectants, water detergent, flavoring & sweetening agents, therapeutic agents such as Fluoride coloring agents & preservatives.

Use of particular brand is totally depending on personal preference; however use of fluoridated tooth paste is must.

How many times should I brush?

Generally, everyone should brush twice a day. For children, brushing at night is helpful & needed.

Tooth brushing technique

• Use a soft nylon toothbrush with round ended bristles.
• Place the toothbrush with its bristles along the gumline at a 45 degree to long axis of the teeth. So the toothbrush is in contact with both tooth surface & gumline.
• With gentle to n fro rolling movements, brush the outer tooth surfaces of 2 to 3 teeth without dislodging the tips of the bristles. Apply 20 strokes in same position around the arch brush three teeth at a time.
• Similarly maintaining 45 degree angle brush using back, forth rolling motion along all the inner tooth surfaces.
• Tilt brush vertically behind the front teeth. Make several up & down strokes using the front half of the brush.
• Place the brush against the biting surface of the teeth. Gently do back & forth scrubbing motion. Brush the tongue from back to front to remove color producing bacteria or use tongue cleaner to clean tongue.
• Continue around the arch, brushing around three teeth at a time, then use the same method to brush the inner surfaces of the teeth. To help reach the inner surfaces of the front teeth, insert the brush vertically.

Flossing

To remove the plaque between your teeth, you need to do flossing at least once a day.

Flossing Technique :

• Floss should be long enough to hold securely; 14 to 18 inches is usually sufficient.
• Stretch the floss tightly between the thumb & fore fingers.
• Pull the floss tightly into a c shaped around the
  side of the tooth & slide it under the gumline.
• Clean the surface of tooth by using an up & down motion.

Mouth Rinsing

Generally proper brushing & flossing will loosen food particles & tooth plaque bacteria. These loosen particles can be easily removed by vigorous rinsing with water.

Repeated rinsing also results in a rapid lowering of sugar level in saliva, therefore, it is recommended that after having sugar rich food, one should rinse his or her mouth vigorously two or three times with as much water as possible to held in the mouth.(chlorhexidine mouth rinse)

Bad breath (Hallitosis)

The foul smell may have oral cause or might caused by extra oral factors. Some of oral contributing factors are retention of odoriferous food partical on or in between teeth, in cavities or on tongue, artificial dentures. Smokers breath & healing surgical or extraction wounds etc.
Tooth decay & gum diseases can cause foul smell because of accumulated food debris.
Extra-oral sources include respiratory tract infection such as bronchitis, pneumonia etc, or
Breath odor due to aromatic substances in blood stream. (Diabetic breath, alcoholic or uremic breath)

Infant Dental Care

Begin cleaning the baby's mouth with a clean damp washcloth. Avoid putting baby to bed with a bottle, sipper cup or while breastfeeding. This habit may cause cavities when your baby has teeth especially if milk, formula, juice or other sweetened liquid is used.

Pregnancy and Dental health

During pregnancy, a woman's hormone levels rise and gingivitis (inflammation of gums) is common. Serious gum disease in the mother has been linked to low birth-weight babies and premature births.

Begin cleaning the baby's mouth with a clean damp washcloth. Avoid putting baby to bed with a bottle, sipper cup or while breastfeeding. This habit may cause cavities when your baby has teeth especially if milk, formula, juice or other sweetened liquid is used. Only water should be put in a bottle or cup if your child cannot fall asleep without it. While your baby is breastfeeding, wipe the teeth with a damp washcloth as soon as he or she falls asleep and stops sucking. Sharing items such as spoons, pacifiers, toothbrushes and toys can spread cavity-causing germs between caregiver and baby and between babies themselves.

Start a habit of brushing twice a day when the first tooth comes in. Use soft-bristled toothbrushes designed for babies with water or a very small amount of non-fluoridated toothpaste. Fluoride containing toothpaste can be used when your child can spit. Consult your pediatrician or pediatric dentist about other sources of fluoride supplementation for your child.

It is normal for a baby to cry while tooth brushing. Babies also cry when they are bathed, dressed or changed. Be calm and methodical while continuing to give proper care to your child's teeth.

With time he/she will appreciate your gentle attention to his/her teeth and will allow you to clean without protest.

Why is this so important for baby teeth?

During pregnancy, a woman's hormone levels rise and gingivitis (inflammation of gums) is common. Serious gum disease in the mother has been linked to low birth-weight babies and premature births. Crowns of the baby teeth are developing and chewing surfaces of the permanent molars are beginning to form during pregnancy. A balanced diet and use of prenatal vitamins help to develop healthy teeth, while poor nutrition can be associated with tooth decay.

Tooth cavity causing bacteria can be transmitted to the fetus, so it is important to reduce plaque (tartar) and have teeth free of decay before the birth of a child.

If you are pregnant, be sure to visit your dentist regularly and have your teeth cleaned more often. At birth, bacteria may also be transmitted by a mother kissing her newborn child. Your dentist may recommend the use of chlorhexidine mouth rinse or products containing xylitol.

Most children who are old enough to understand what is going on (older than three) behave very well during their examination. You can assure your child before their visit that we will show them and tell them about everything we do before we do it. Children usually do quite well with this approach and can relax knowing that there will not be any unpleasant surprises.

Children who are extremely nervous, have special needs, or are too young to understand what is going on may cry. Please understand that this is their way of telling you that they would rather be somewhere else. For these children we may enlist your help during the exam. We want the experience to be positive for your child and we will do what needs to be done in a caring and efficient manner. If your child seems particularly anxious or non-compliant Dr. Shah will discuss with you numerous options for helping to manage this behavior for future appointments so that their experiences are as positive as possible.

We feel parental involvement is extremely important. Preparing your child for the first visit by playing pretend dentist and being positive about the dental experience is very helpful.

At the end of each appointment, parents are invited to reward their child with words of praise for a job well done. We enjoy establishing a trusting friendship with each child and their parents. We teach parents that it's fun to converse with their child using our gentle dental terminology.

We also help parents figure out what may be the cause of cavities for their child and give them many ideas for preventing dental decay.

Routine dental care, such as six-month cleaning and examination appointments, can also develop lasting friendships with our dental team. Children learn by watching their parents. Regular tooth brushing and flossing can be a fun family event.

Parents should not make a big deal out of the visit. One of the most important thing you can do for your child while preparing for their first dental visit is to make sure you are positive about the experience and don't impose any of your fears on them. We are experienced in dealing with children with anxiety and can explain treatment procedures in a positive and pleasant manner to avoid any anxious or negative feelings toward dentistry. Please understand that children look to their parents to help determine if a new situation is going to be OK or if they should worry. Saying something as simple as "don't worry" or "it won't hurt" introduces the concepts of "worry" and "hurt". Unfortunately, your child will not process the word "don't" and will only hear your concern and apprehension.

Explain to your child that he dentist is a friendly doctor that helps take care of teeth. We find that it is more positive and productive to explain to your child that they are going to see your "friend" the dentist.

• Don't use words like "needle" or "drill."
• On the day of the visit, say only, "We are going to my friend the dentist, and he cleans and counts teeth." If your child asks other questions, answer honestly that you don't know, "…but you can ask the dentist." Chances are that this is true since rarely do any two children require exactly the same treatment, and it is impossible to predict what your child will require until we meet.
• One should never allow your child to hear stories about experiences of others with dentists – good or bad!
• Do not offer treats or bribes of any kind for "being good"! Bribes tend to indicate to children that something unpleasant is about to happen, and that actually tends to create more apprehension. Think about it. You never have to bribe your child to go someplace nice, so why bribe your child to go to the dentist?
• One should not make promises as to what the dentist "will only do" or, "will not do". If some other treatment is necessary, then your child will feel that we have been deceitful.

We find that it is more positive and productive to explain to your child that they are going to see your "friend" the dentist. It is helpful to tell them that the dentist will count their teeth, brush their teeth with a special toothbrush, and take some pictures with a special camera. You can also let them know that we have stickers and prizes to give to all our "good helpers". This positive wording allows your child to be prepared and ready for a positive, fun dental visit.

If your child has any questions that you do not know how to answer, be honest and tell them "I don't know, we will have to ask your "friend", the dentist when we get there."

The first dental visit is the foundation of a growing relationship between our dental office and your child. We feel it is important that your child be allowed to become familiar with our office environment and staff as soon as their teeth start to appear.
At the new patient appointment Dr. Shah and staff will spend quality time getting to know you and your child. We teach your child to be comfortable with dentistry by explaining the procedures and demonstrating the equipment in a fun and imaginative way. The office visit will include a thorough oral examination, digital x-rays if required, a cleaning and fluoride application.
A complete review of your child's medical health and any special needs or concerns will be addressed. More complicated procedures, such as fillings, should be done at a later visit after your child has become familiar with the office. We conclude the first visit with an office tour.
We look forward to your visit and hope you and your child will have the dental experience of a lifetime.

AT WHAT AGE SHOULD MY CHILD FIRST VISIT THE DENTIST?
The time to start regular preventive dental care is when you child's first tooth appears- This usually occurs between six months and your child's first birthday. At this early visit, Dr. Shah has the opportunity to teach parents how to best PREVENT CAVITIES. Too often children visit the dentist at the age of three or four with large cavities that could have been prevented.