A pediatric dentist completes four years of dental school and progress to two (sometimes three) years of specialty training to receive our degree. Every pediatric dental residency is required to train its students in eight areas: prevention, trauma, sedation/general anesthesia, growth/development and orthodontics, treating patients with special needs, oral pathology, and behavior management.

In order to prevent dental problems, your child should see a pediatric dentist when the first tooth appears, or no later than his/her first birthday. Of course, if there are any issues such as tooth decay or pain, please make an appointment with our office. Beginning dental care at an early age allows guidance for caring for your child's teeth and opportunities to address preventive issues that are important for healthy teeth and a pleasing smile. Early visits also help establish a positive relationship between the dentist and your child.

With each subsequent visit, your child will mature and confidence and trust will most likely increase. Usually after age 3, we will begin preventive care visits which include examination, cleaning, fluoride treatments, and appropriate radiographs.

The front eight teeth - called incisors - are lost between ages 6-8 followed by an eerie lull lasting a year or so. Suddenly, the back teeth start popping out like popcorn! The twelve baby teeth in the back - the cuspids and molars - are typically all gone by the time a child turns 14.

Before getting braces, it is important for the patient to already have good hygiene. Hygiene only worsens with braces.

Make sure all existing cavities are restored prior to braces placement. Orthodontists are dental specialists that place orthodontic hardware and appliances. Unless they work in the same office as the child’s dentist, they may not be aware of existing cavities. Orthodontists will see their patients every four to six weeks, but these visits do not replace the recommended six-month cleaning appointments. It is especially important for the braces patient to have regular cleanings and fluoride treatments during orthodontic treatment.

My recommendations:

What is IN the sippy cup is the most important thing!

Water is best for drinking throughout the day

Keep juices (including diluted juices), milk, and sodas to mealtimes or special occasions

Do NOT let your child go to nap or bedtime with a sippy cup

Use ANY sippy cup your child prefers, but do not allow him or her to carry it around throughout the day

Tooth grinding, or the fancy term: bruxism, is the involuntary, excessive grinding, clenching, or rubbing of the teeth during times that do not include eating.

Unfortunately, mouth guards are not typically recommended because they can be a potential choking hazard. If I am not seeing damage to the enamel, I do not recommend any treatment to stop bruxism. If I feel like it may be linked to a more serious condition, such as, obstructive sleep apnea, then I have the parents address it with the pediatrician to see if the patient needs to be evaluated by an Ear, Nose, and Throat physician. If I do see damage to the enamel, I try to dig a little deeper to evaluate the patient for gastric reflux. If the enamel attrition is severe, I may recommend placing crowns on the affected teeth.

Bruxism can be an indication of underlying medical issues, but in most cases, it tends to come and go throughout the year, and there is no need for treatment.

Orajel is a topical numbing agent that’s uses range from relieving pain from canker sores, tooth and gum pain, as well as for cold sores. The active ingredient in Orajel is 20% Benzocaine which is a topical local anesthetic (pain reliever). Some formulations also contain Menthol which is obtained from mint oils. Menthol increases blood flow to the area and provides at cooling sensation.

Benzocaine has been used for decades to relieve oral pain temporarily. Dentists most commonly use it to place on their patient’s oral tissue prior to an injection of numbing medicine. How does it work? Pain is caused by stimulation of specific types of nerve endings. Benzocaine stops the nerve from being stimulated temporarily by blocking the uptake of the molecule that stimulates the nerve.

Like any drug, we must be aware of its potential side effects, especially when we are talking about young children. It is generally safe and non-toxic when applied topically.

If I see a small child that has no cavities, and the parents are helping the child to brush at home, I do not insist the parents use fluoridated toothpaste. In fact, a lot of times, I will recommend brushing with water or non-fluoridated toothpaste in the morning and fluoridated toothpaste at nighttime to protect the child’s teeth while he sleeps. If the child has cavities or has dietary habits that increase his risk of getting cavities, then I do recommend fluoridated toothpaste for the morning and evening brushing. For example, if a child is older than one and is still waking up to eat through the night, the child would be at a higher risk for developing cavities than a child who is sleeping consistently through the night.

1. Stay Positive

2. Brush Your Child’s Teeth at Home

3. Use the Right Words

4. Read a Book

5. Do Not Make It a Big Deal

Dental fractures fall into categories as well: they can be complicated or uncomplicated. Uncomplicated fractures involve the enamel and/or dentin layers of the tooth, while the complicated fractures expose the nerve tissue of the tooth. The uncomplicated fractures can typically be restored with dental composite (filling material) or a crown. If it is a minor fracture, some times no treatment or smoothing the roughened enamel is all that is requried. When the nerve is involved, root canal therapy may be necessary or if it is a baby tooth, removal of the tooth may be the best option.

These are the questions you need to ask yourself when this happens:

Is my child okay?

What is involved? Is it the tooth, gums, lip, or a combination?

Does the tooth look different? Is it shorter? Is it longer? Is it broken? Is it pushed forward? Or backwards?

Is the tooth loose? Is there bleeding around the tooth?

In any of these cases, it is a good idea to have your child seen by their dentist to have an exam and dental radiographs (X-ray) to make sure everything is okay and to get a baseline report to monitor the tooth in the future.

A cavity or dental caries is nothing more than a hole that has formed in the tooth by dissolving an area of the outer layer: enamel. Enamel is the second hardest compound on earth, second only to diamonds. A cavity can form when three things are present: a tooth, food and bacteria.

When food and plaque sit on teeth, the environment underneath the plaque is acidic, it can stay stuck to the enamel until we remove it from the teeth with a toothbrush or floss. In the acidic environment, the minerals that make enamel so strong, can get broken down and is unable to recover. At that time, a cavity will form.

Oral sedation is used in our office when a child is extremely fearful or uneasy and needs something to help them relax for the dental procedure. Our sedation technique is described as a conscious sedation in which the parent administers the sedation medicines in the office prior to the dental procedure. Nitrous oxide (laughing gas) is usually used to facilitate the conscious sedation. If your child will need sedation for the dental procedures, Dr. Milling will explain the details to you at the initial exam visit Patients are not sedated for the initial exam visit.

Tongue tie is when the tip of the tongue is attached to the floor of the mouth. There are varying degrees of tongue tie from minimal attachment to the full length of the tongue being attached to the floor of the mouth.

In infants, it can cause difficulty feeding/latching and for momma, it can cause nipple pain upon feeding.

If the parents say the child has colic or gastric reflux and is fussy, they are not typically a candidate for the surgical procedure to relieve the tongue. These issues are best brought up to the child’s pediatrician and once GI issues have been ruled out, they may be a candidate. If the parents say the child is having difficulty eating, is in a low weight class, or the mom is having pain on feeding, then the surgery may be helpful.

Fluorosis is a dental condition that occurs during the years that a tooth is developing. Excess fluoride is absorbed through the gut and can be stored in bones and teeth. It is noted clinically as white striations but can appear brown that may be attributed to dietary staining of the effected enamel. Severe fluorosis can present as pitted enamel. Microscopically, the enamel layer is more porous and thus, weaker in nature.

Fluorosis is more common in the southwestern United States due to its higher naturally occurring fluoride levels. Typically, fluorosis occurs from a long-term ingestion of excess fluoride and is not noticeable if a child has an acute fluoride toxicity event from eating a tube of toothpaste.

Silver Diamine Fluoride, known among dentists as SDF, is a liquid with a high concentration of fluoride that is applied to a cavity to prevent it from getting larger.

As costs increase and dental insurance benefits stay the same, it is becoming more and more of a struggle for parents to pay for their children’s dental needs. SDF may not be long term treatment, but if there is a need to defer treatment, it can be applied to the teeth to prevent the cavity from becoming larger. Typically, SDF needs to be applied every six months until the final treatment can be completed, or the tooth falls out. Some practitioners will place it once and follow up a week later to add another coat. Some practitioners will place the SDF and add some type of temporary restoration to further protect the tooth from breakdown.

The treatment of choice when your child has eaten a small to moderate amount of fluoridated toothpaste is to give your child a milk-based snack, i.e. a glass of milk or bowl of yogurt. The calcium in the milk binds the fluoride to make an inert salt (CaF2) that is excreted from the body.

In rare cases, a child can ingest a larger amount of fluoride than is safe to treat with milk or yogurt. Usually, when this occurs, a young child is involved. It does not take much toothpaste to cause a problem in a very small child. For this reason, it is extremely important to keep toothpaste out of reach of small children and behind childproofed drawers or cabinets. The symptoms that follow are nausea and vomiting that progresses to seizures and muscle spasms. It can potentially lead to death if left untreated. Poison Control will let you know if inducing vomiting is recommended. Once the child is admitted to the emergency room, activated charcoal may be given to help bind the fluoride and the child will be treated by physicians who will be monitoring the child’s vital signs until they have recovered.

The short answer to this question is fluoride is an ion that bonds to enamel and hardens its chemical structure.

Fluoride changes the structure of the tooth at a chemical level to make it stronger.

On average, the first tooth comes in around 6 months of age. Conveniently enough, this is the time that babies begin eating solid foods. The typical pattern is the front four teeth on top and bottom come in first, followed by the first molar. Next is the canines (the pointy teeth made popular by Dracula) and lastly, the second molars in the very back. The teeth continue to erupt until the child is 2-3 years old. There is a total of 20 primary (baby) teeth.

The teeth begin forming when the baby is only six weeks in utero! Children’s dental health starts with the mom’s (and dad’s) dental health. Research studies have shown when the primary caregiver has cavities, the child is more likely to get cavities. Dental cavities are a transmissible disease. A species of bacteria is directly linked to the formation of cavities… Streptococcus mutans if you are curious. How would one pass cavities from one person to the other? Blowing on your child’s hot food (guilty), drinking after one another (guilty), or sweet kisses (100% guilty). Give those kiddos kisses and don’t stop! But one way you can protect your child from getting cavities is to have any cavities you may have filled before your child is born.

When flossing, try to stay against the tooth. Plaque does not stick to your gums; it sticks to your teeth. Slide the floss down the side of the tooth until you have just reached below the gum surface.

You do not need to put pressure on the gums. Simply slide the floss below the gums surface and curve the floss to cup the side of the tooth to clean as much tooth structure as possible. Before pulling the floss back through the teeth, do the same thing to the tooth next to it. Then repeat between each tooth.

Flossing, in my mind, is one of the most misunderstood aspects about oral health care. We’ve heard it our whole lives. Flossing is good for your teeth and gum health. But what does it really do? It clears plaque and food debris from between our teeth and from under our gums.

Research shows that cavities form more frequently between the teeth than on the biting and smooth surfaces of the teeth. It also shows that cavity rates are highest in younger populations than older. For these reasons, I will always be vigilant about educating my patients and their parents about flossing. Cavities, for the most part, are preventable and implementing flossing will help tremendously!

I encourage parents to use a warm washcloth to wipe the teeth and gums. I also encourage them to get a yellow banana rubber brush so the child gets used to the feel. These banana toothbrushes are great teethers and trainers, but they are not the best for really cleaning teeth. As the child gets more used the this, you can attempt a baby toothbrush with no toothpaste or with just a little dab. This can help your child get adjusted to the sensation.

You should start brushing your child’s teeth when the first tooth erupts with an appropriately sized soft bristled toothbrush and a smear of fluoridated toothpaste twice a day, before bedtime and after the morning meal.

The purpose for brushing your teeth is to remove the plaque from the teeth. What is plaque? 70% of plaque is bacteria and the remaining 30% are sugars and proteins that help bacteria stick to your teeth. The next question is: What does plaque do to my teeth? We all have bacteria in our mouths whether we clean our teeth or not. Every time we eat or drink, the bacteria eat and drink. When we eat, our body breaks down the food, keeps the nutrients and gets rid of the waste. Bacteria are the same, but oral bacteria’s waste is in the form of acid. This acid attacks our enamel (outer layer of the tooth) and makes our teeth susceptible to cavities (a hole created by the acid attack).

It is very important to maintain the health of primary teeth (baby teeth). Neglected cavities can cause pain and infection, and it can also lead to problems which affect the developing permanent teeth. Primary teeth are important for (1) proper chewing and eating, (2) providing space for permanent teeth and guiding them into position, and (3) permitting normal development of the jaw bones and muscles.

Radiographs (x-rays) are a necessary part of your child's dental diagnostic process. Without them, certain cavities will be missed. They also help survey developing teeth, evaluate results of an injury, or plan for orthodontic treatment. If dental problems are found and treated early, dental care is more comfortable for your child, and more affordable for you. On average, our office will request bitewing radiographs approximately once a year and panoramic radiographs every 3-5 years. In children with a high risk of tooth decay, we will recommend radiographs and examinations every six months. 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 restricts the beam to the area of interest.

Clean the area around the sore tooth thoroughly. Rinse the mouth with warm salt water or use dental floss to dislodge impacted food or debris. DO NOT place aspirin on the gum or on the aching tooth. If the face is swollen or the pain still persists, contact our office as soon as possible.

A sealant is a clear or shaded plastic material that is applied to the chewing surfaces (grooves) for the back teeth (premolars and molars), where most cavities in children can form. This sealant acts as a barrier to food, plaque, and acid, thus protecting the decay-prone areas of the teeth. However, cavities between the teeth are not protected by sealants. As long as there is no cavity in the tooth, sealants will be recommended for all children. If your child has a cavity, a filling is placed after the cavity is removed. The filling is tooth colored (white). In a primary tooth, if a cavity is too large to restore with a filling, a crown may be recommend or the tooth may need to come out. If the cavity is too large and has involved the nerve of the tooth, then the nerve will be removed (pulpotomy) along with the cavity, and a crown will be placed. A crown can either be tooth colored or stainless steel. For front teeth, white crowns are routinely used for esthetics. For back teeth, stainless steel crowns are used for their durability and longevity. The purpose of the crown is to help provide structure for the tooth, to help maintain space for permanent teeth to erupt properly, and to help protect the remaining tooth.

Apply ice to bruised areas. If there is bleeding, apply firm pressure with a clean gauze or cloth. If bleeding does not stop after 15 minutes or it cannot be controlled by simple pressure, take the child to the emergency room. If the child chews their lip, tongue or cheek area after completion of dental treatment,an antibiotic may be necessary. Please call our office.

Rinse debris from injured area with warm water. Place cold compresses over the face in the area of injury. Placement of Vaseline over the area of the broken tooth will aid in decreasing sensitivity. Locate and save any broken tooth fragments in milk.

Whenever he or she is in an activity with a risk of falls or of head contact with other players or equipment. This includes football, baseball, basketball, soccer, hockey, skateboarding, even gymnastics. We usually think of football and hockey as the most dangerous to the teeth, but nearly half of sports-related mouth injuries occur in basketball and baseball. Dr. Milling will recommend the best mouth guard for your child.