Ask Dr. Jared

Is thumb sucking a problem?

Thumb sucking is a normal habit many children develop as a means of soothing themselves. They usually grow out of this habit, but if your child sucks their thumb vigorously or continues thumb sucking when they are older than four, then they may develop dental problems. We recommend using positive reinforcement techniques to help them stop thumb sucking. Call Mountainland Pediatric Dentistry today for suggestions.

How do I stop my child’s thumb or finger sucking?

Young children will suck on fingers or thumbs for comfort, usually when tired or stressed. They usually will not stop the habit until they are ready. People have tried many different things to force the issue, and generally without success. Nasty tasting or bitter medicine on a finger will not stop the sucking. Nor will nagging. In general, it is better to wait until your child starts to give up the habit by themselves – they may be embarrassed to suck in front of friends or at school. Once they begin to stop, you can start an intervention program.

Why is there space between my child’s baby teeth?

Gaps between a child’s baby teeth are good. Your baby’s mouth won’t grow much wider before the permanent teeth start to come in. It your child has good size gaps between the baby teeth, they have a chance to have the permanent teeth come in straight. Baby teeth that are close together may look nicer initially, but almost always mean that the permanent teeth will be quite crowded when they come in.

What is a frenum?

A frenum is a muscle attachment that attaches the cheek, lip, or tongue to the bony area around teeth. The easiest to see are the attachments found between the two front teeth and under the tongue.

Young children will ofter tear their frenum when they fall. A torn frenum can be frightening and bloody. They generally hear quickly, and most often don’t’ need stitches. If your child does fall, however, they should checked by a pediatric dentist. There may be other injuries that need to be addressed that are not as easily seen as the torn frenum.

The frenum will generally look larger in a baby than it will later on. Although some dentists suggest cutting the frenum at a young age, I prefer not to. In my experience, the frenum tend to get smaller with age. Gaps that seem prominent in baby teeth tend to close when the permanent teeth erupt. If the frenum does need to be cut, it should be done after the braces are on and the gap is closed already.

If the frenum is clipped at a young age, scar tissue may sometimes form in the place where the frenum was, and make it difficult or impossible to close the gap with braces. Another surgery is then sometime necessary to remove the scar tissue.

What are the white spots on my child’s teeth?

There are many different types of white spots that may form. They may be harmless, may mean that teeth have weaker than normal enamel, or may be early signs of cavities forming. The dentist should look at them to decide what they are.

What are the black lines on my child’s teeth?

The most common black lines on a child’s teeth form around the gums on the child’s lower front teeth. It can almost look like the line was drawn with a marker. These black lines are usually the result of iron containing vitamins or culinary water with too much iron. The lines are harmless and can usually be easily removed at the dentist’s office.

What kind of toothpaste should I be using for my children?

Children less than 12 months old, or up to 2 years old if taking a fluoride supplement may be brushed with “training” or “safe to swallow” toothpaste that doesn’t contain fluoride. You may also choose to brush with a wet toothbrush without toothpaste.

Children between 1 and 2 years who are not taking a fluoride supplement should use a dab of fluoride about the size of a lentil bean.

Children 2 and older should use a dab of toothpaste about the size of the tip of their pinky finger.

The brand or kind of toothpaste doesn’t matter as much to me. Additives may be irritating to children (for instance, Tartar Control toothpaste can sometime cause children to have lots of canker sores), so plain fluoride toothpaste is usually better. Sodium Fluoride (such as Crest Kids) starts working more quickly than MFP fluoride (such as plain Colgate)

Why do my child’s gums bleed when I brush?

Gums bleed when they are irritated by bacterial plaque. If the teeth have not been brushed properly and the plaque sits on the teeth for a few days, it starts to harden. The plaque will also irritate the gums. As a result, bleeding gums show where your child needs to brush better.

Brushing is the best way to cure the bleeding problem. The child should gently brush on the gums as well as the teeth(the toothbrush should be about ½ on the teeth and ½ on the teeth). Once the irritating plaque has been cleaned off for several days, the gums will bleed less and less. Healthy gums, or gums that do not bleed when they are gently brushed, often mean that cavities and gum disease will not progress in your child’s mouth.

What causes bad breath? What can I do about it?

Bad breath, or halitosis, is caused by the presence of excess bacteria in the mouth. The most common causes are infection in or around the teeth and infection in and around the gums. Gum infections can usually be cured with proper brushing. Tooth related infections need to be looked at by the dentist.

Bad breath can also be caused by large tonsils, drainage from sinus infections, and dirty tongues. The tongue can be brushed, but will often cause young children to gag. Tonsil infection and sinus drainage can be addressed by your child’s pediatrician.

What do I do if my child’s baby teeth won’t fall out?

Sometimes baby teeth are stubborn and do not want to come out. It is quite common to have the two bottom middle permanent teeth come in behind the baby teeth, which means you may see two rows of teeth. If the permanent teeth are visible and the baby teeth have come out, it is a good idea to have the dentist look at them. Baby teeth are generally very easy to extract, and not at all traumatic for your child.

Occasionally, a child will have pain around a tooth that is about to come out. If your child has more than a small amount of discomfort, and motrin or Tylenol does not relieve the pain, they should be checked by the dentist.

Why are my child’s teeth sensitive?

Sensitive teeth are teeth that feel excessive pain when your child eats certain foods. Cold foods or drinks most commonly cause the sensitivity. Sensitivity usually only lasts a few seconds, and then goes away by itself.

Sensitive teeth usually indicate cavities, although there may be other causes. If your child’s teeth are overly sensitive, it is a good idea to have the doctor look at the teeth. Permanent teeth also tend to be more sensitive when first coming in, and teeth will sometimes become more sensitive when a child’s hygiene improves dramatically. Sensitivity caused by cavities needs to be fixed, but sensitivity caused by other things usually resolves itself.

How do I prepare my child for the first visit to the dentist?

The first visit to the dentist is a big deal for both parents and children. It is important that parents discuss what will happen with their children, but you should focus entirely on positive aspects of the appointment. For instance, tell your child that the doctor will be looking at their teeth, brushing them, and possibly taking pictures of the teeth. More detailed information tends to confuse and frighten children. Rest assured that we will give your child detailed age-appropriate information every step away along the appointment.

It is also important for your child to realize that a trip to the dentist is not a punishment. Some parents will tell children repeatedly that you should “brush or you will get cavities” or “if you eat too much candy you will get cavities”. This often creates a dilemma for the child. Most children don’t know what a cavity is, but decide that it must be bad because the parents talk about it so often. That will often create unneeded anxiety and apprehension. It is better to tell the children that the dentist’s job is to make sure that everything is okay, and to make them feel better.

How do I prepare my child for a treatment appointment?

Most people experience some nervousness when thinking about having work done at the dentist. That is normal – I am not any different! As a result, I am very careful with your children. I will take time to explain everything that I will do – in an age appropriate and non-threatening way. I will be absolutely honest in answering any of your or your child’s questions. Honesty tends to allow you and your child to trust what is going to happen.

I also welcome parents into the treatment room. I am happy to show you how I interact with your child, and to teach parents about what and how I will be doing. If you would like, I am happy to have parents stand next to me and watch everything that I do.

As a result, there shouldn’t be any surprises for you or for your children at the appointment. You also don’t need to go into much detail when talking to your child about the appointment, since I will take care of that. Explain what your child should expect in positive, general terms. Avoid any negatives or words with negative connotations, such as “The shot is tiny, and will only hurt a little bit.” Most children will not have pain during the appointment, and parents should not suggest that they think that it might be painful.

What options are available for sedation?

There are two types of sedation – conscious and deep. Conscious sedation is usually given as a liquid that your child drinks. After drinking the medicine, the sedation takes between 15 minutes and 1 hour to start working, depending on the sedation. Under conscious sedation, your child will have no memory of the appointment, but will still usually be able to talk. This makes conscious sedation unpredictable. Some children, especially those who like to be in control, dislike the feeling that the sedation gives, and fight it. Although they have no memory of the event, they may cry, kick, and scream uncontrollably while the sedation is in effect. In my view, this makes conscious sedation less desirable. There is no way to predict which children will accept the feeling of sedation and relax into it, or which children will fight the sedation tooth and nail.

Deep sedation is usually a better option. Deep sedation means your child will be unaware of any treatment that may be performed, and will be asleep enough to lie still for the entire appointment. Deep sedation should always be performed with a skilled nurse anesthetist or anesthesiologist who is comfortable and experienced working with young children. During a sedation appointment, no other appointments are scheduled, which allows everyone to concentrate on your child’s care. The anesthetist or anesthesiologist will remain with your child for the entire visit, and has the responsibility to monitor your child constantly.

Deep sedation may be performed in the office or in a surgical center. The sedation in the office is given with an injection while your child sits on your lap in the waiting room. Your child will fall asleep in 3-5 minutes, and will remember nothing from that point on. Sedation in the surgical center is given as your child breathes a gas from a mask that is placed over their nose and mouth. Surgical center sedation, or general anesthesia, takes effect in 15-30 seconds

What are the risks associated with sedation?

Everything we do has risk. There are risks associated with any drugs or medicine we take or give to our children. There are also risks associated with driving on the freeway, or flying in the airplane. I like to balance the risk of performing an action against the potential reward that can be accomplished by the action. For example, when you get in the car to drive to a dental appointment, there are risks associated with the action. There are people injured and killed on Utah roads every day. By driving in the car, we accept that we may be injured, but understand that the risk of that happening to us on any given day is very low. We also, usually unconsciously, balance the reward of driving. If we chose to walk instead of driving, we would have less chance to be in a harmful car accident, but it would take much longer to get where we needed to go.

I look at sedation in much the same way. There are risks associated with sedation, much as there are risks associated with taking any medicine. The risk that your child may die is present, but very small. In fact, your child is much more likely to die during the car trip to the office or surgical center than they are once they get there. The risks still need to be taken seriously. If your child is sick, or has eaten prior to the appointment, they will likely be rescheduled for another day. If your child has other health problems, such as asthma, the type of sedation may be modified.

I also like to balance the risk of sedation against the benefit of performing the treatment. Unrestored cavities usually carry a much greater risk of harm than the sedation. Cavities, if not treated, lead to pain, localized infection, and eventually life-threatening body wide infection. Large decay will also often lead to loss of teeth, which can affect how permanent teeth erupt.

In summary, the risks of sedation are usually far outweighed by the benefits. I will still discuss these with you in relation to your child, because your child may be different.

Why should my child’s baby teeth be fixed? Won’t they just fall out?

This is one of the most frequent questions that I am asked. Baby teeth will eventually fall out, though not as early as many people think. Front teeth will start to fall out at about age 6, but primary molars will not come out until your child is 11 or 12. If teeth are within a year or so of falling out, and the decay is reasonably small, I will often let the teeth fall out. If the cavities are large, or very actively growing, the teeth will usually cause pain and infection long before the teeth fall out.

Pain and infection will often lead to loss of baby teeth. Untreated loss of baby teeth leads to severe crowding of permanent teeth, and will often lead to loss of permanent teeth because there is not room for all of them to come in.

In short, cavities in baby teeth should usually be treated.

Should the fillings be silver or white? What is the difference?

Silver and white fillings are fundamentally different. Silver fillings are made from a combination (or amalgamation) of several metals. Mercury is one of these. The metal has some advantages. It can be placed when the tooth is not clean or dry, and is less like to wear down over time. However, it is more brittle. As a result, the silver filling needs to be a certain size for it not to break. That means that the hole, or cavity, in the tooth will often need to made larger that it was initially so that the filling material won’t break. The dark color of the filling also makes it more difficult to see problems that may be developing along the edge of the restoration. That means that I may not be able to see a new cavity developing around the filling as easily as I could with a white filling, and the new cavity may be larger when it is found.

Most white fillings are essentially plastic. The plastic bonds to the tooth more strongly, and is less brittle. This usually allows me to be more conservative when removing the decayed tooth. I can often remove only the rotten part of the tooth, and leave the rest essentially untouched. New cavities along the border of white restorations are more easily found that cavities along the border of silver restorations, which means that while white fillings may need to be patched more often, the new cavities are usually smaller because I can find them earlier.

I use white fillings almost exclusively for these reasons. The white color, although the most visible benefit of white restoration, is important to me, but not the most important.

Are silver fillings dangerous? White fillings?

Many people have worried about the safety of silver fillings. They worry that the mercury in the restoration will lead to health problems. As a result, the silver fillings have been heavily studied, and their safety evaluated. I know of no controlled studies linking the amount of mercury in silver fillings to health problems. You are actually much more likely to be exposed to mercury when eating seafood harvested from the ocean.

The mercury in the silver filling becomes volatile, or turned into particles that can be absorbed into your body when the filling is being placed or when it is being removed. Once a silver filling has been placed in your mouth, it is often safer to leave it there than expose the patient to the aerosol of the silver that is being removed. When silver fillings are placed or removed, care must be taken to suction as much of the dust and debris as possible.

Some dentists will suggest that all old silver restorations should be removed as a health benefit. I have two problems with this. First, the patient will be exposed to more mercury when the restorations are removed than they would if the restorations are left there. Secondly, the claims of health benefits when the silver fillings are removed have not been supported by current or past research.

I know that this is somewhat of a controversial topic. I welcome input and conversation. Please talk to me about this if you have concerns.

White restorations are more complex. They are a mixture of plastic, or resin, components and small glass particles. The most asked about ingredient in plastic is probably BPA. BPA, or Bisphenol A, is an estrogen analog, or a material that mimics estrogen in your body when consumed in large quantities. BPA is often found in commercial plastics.

There is no BPA in composite restorations, but there a BPA derivative called Bis-GMA is used. Bis-GMA has not been shown to cause any adverse health problems, but is still being studied.

What is a pulpotomy? Why is it necessary?

A pulpotomy is similar to root canal treatment for permanent teeth, although much less expensive, and generally not difficult or painful to have done. Pulpotomy (which literally means removal of infected pulp) means that infected tissue inside the tooth is removed, and antibiotic rinse or paste is applied to fight of future infection. Pulpotomies are necessary for primary (baby) teeth that have been severely traumatized or infected. Cavities are the most common type of infection.

If a tooth is infected with a large cavity, pulpotomies will often prolong the lifespan of the tooth. Infected teeth that are not restored, or that are restored without a pulpotomy, are much more likely to abscess, and much more likely to cause pain than a tooth that has the antibiotic treatment.

As an aside, once a pulpotomy has been performed, it is critical to seal the inside of the tooth against outside invasion of new bacteria. A recent study showed that a tooth that received a pulpotomy was six times more likely to survive when restored with a stainless steel crown that it was to survive when restored with a white or silver filling after the pulpotomy.

Why are crowns sometimes necessary for baby teeth?

Stainless steel crowns are ugly. No question. They are also the best restoration that a primary tooth may receive. They almost never get cavities again and rarely break or come off. Children with severe decay, and severe risk of new cavities, will sometimes have most or all of their teeth covered with crowns so that they cavities stop growing. This, however, doesn’t apply to most children.

In general, I would suggest a stainless steel crown for a primary molar that has multiple areas of decay on one tooth, decay that has destroyed ¾ or more of the tooth, of a primary tooth that had decay large enough to need a pulpotomy. I will also occasionally suggest a stainless steel crown covering for permanent teeth that are severely weakened by poor quality enamel.

Although I don’t like the look of the silver tooth, and most parents don’t either, most children are excited to receive the silver tooth. I would also suggest that parents avoid talking to children about crowns as if they were a punishment (“Your cavity was so big you had to get a crown!”). Please emphasize that needed treatment is only for their benefit.

Stainless Steel Crowns feel like normal teeth when your child is eating. Your child will almost always say that the crown feels better that the tooth did before it was restored.

The Crowns will fall out with the teeth that they are covering when the baby teeth fall out naturally.

Stainless Steel Crowns are much less expensive than permanent crowns. In fact, although a crown is more expensive than a white filling, it is less expensive that two. That means that it is less expensive to restore a tooth the first time with a crown that it is to try and get a white filling to work in a place where it may not, and then have to repair or replace the restoration.

Are white crowns available?

White faced stainless steel crowns are available for front and back baby teeth. I use these routinely for front teeth, but not for the molars. The molar white-faced crowns tend to break mush more easily than the front crowns do. I prefer not to have to repair or patch work if it is possible.

How do I prepare my child for sedation?

Carefully. When talking to your child, emphasize the positive results of the appointment (‘Your mouth will feel so much better!’).

Your child should not be sick for a few days before the appointment. A runny nose may be okay, but vomiting, diarrhea, productive coughing (coughing up stuff), or fever may mean that your child is too sick to safely be sedated. If you have a question, please don’t hesitate to call the office and ask. Once you arrive at the appointment, the nurse anesthetist or anesthesiologist will examine your child and talk to you about their health. If they feel that your child is not health enough for the appointment, they will ask us to reschedule. Please do not be disappointed! Our primary concern is your child’s safety. If we can make the sedation safer by letting your child get better, we will do so.

The night before the sedation, your child should get a good night’s sleep. They should eat a normal (not a really big) meal the night before. Once they are in bed, or after midnight at least, they should not eat or drink anything, even water. We try to have the appointments early in the morning, so when your gets up in the morning, you can often just hurry out of the house and “miss” breakfast. If your child does eat, even if is a very small amount, please let us know. We may need to reschedule the appointment, for your child’s safety.

What should my child expect after a treatment appointment?

Most children have few problems and little to no pain following a treatment appointment. They can expect a few strange and weird things, though.

The “numb” feeling of the anesthesia used bothers many children. Their lips and/or cheeks may be numb, although their tongue usually will not be. Children tend to play with numb lips and can injure themselves unintentionally. Please reassure your child that the feeling is okay, and that the feeling will return within a couple of hours.

Some children will interpret the numbness as pain. Be careful not to suggest to your child that the numb feeling should be painful (“Does your mouth hurt?”). Your child’s mouth should not be painful immediately following treatment.

Your child will also be bothered by the taste of the materials that have been used. We will usually offer them an otter pop to help with the taste. The teeth will start to taste normal in a few minutes.

Newly restored teeth feel different that the teeth did before. Holes in the teeth have been filled. Sensitive teeth tend to feel better. This is normal. The teeth may also fit together slightly differently than they did before. Fillings make the teeth feel slightly rough, although they should not feel sharp. Children will usually get used to the new teeth in a day or two. If they don’t, or something feels wrong, please come back to the office and let me look at it.

My child had a tooth extracted. What now?

Save the tooth for the Tooth Fairy!

Most baby teeth come out very easily. Expect numbness, as you would with a restoration. The gums around the tooth will be bleeding a little bit. We will give your child a piece of gauze to bit on, which slows the bleeding. We will also give you more gauze that you can take home and used as needed.

Sometimes children have a hard time swallowing their saliva when their mouth is numb. If they don’t swallow, they will drool. The saliva mixed with a little bit of blood can look messier than it really is. Most bleeding will stop within a few minutes. If it doesn’t, or if something feels wrong, please call or come back to the office.

If we extracted the tooth because it was ready to fall out, the permanent tooth is often going to come in quickly. If the tooth was extracted because it had a large cavity or was infected, a space maintaining appliance will usually be placed. The spacer should stay there until the permanent tooth can be seen coming in under it. I can usually take care of that at the routine check-ups.

Why are my child’s new permanent teeth so yellow?

Permanent teeth are almost always yellower that the baby teeth next to them. It is kind of an optical illusion, since the baby teeth are actually much whiter than the permanent teeth should be. Permanent teeth can be bleached to make them whiter, but I would suggest waiting until all of the permanent teeth are in. Bleaching front teeth before the back teeth come in will make it hard to match the color of the front and back teeth later.

My child’s loose tooth bothers them. What do I do about it?

It depends on how much it is bothering them. If the pain is mild, and your child only says something about it every once in a while, you can usually let the tooth come out by itself. If the pain is anything more, or if it is persistent, your child will usually feel better if I take the tooth out.

By the way, when I was a child, I had a tooth removed by tying it to a door handle with a piece of floss, and the having the door slammed. I don’t remember liking that very much. As a result, I am as gentle as I can be when removing teeth. I will always offer free Nitrous Oxide and local anesthesia. Most children, even the nervous ones, can’t tell when their tooth falls out.

Why are X-rays necessary?

X-rays, or Radiographs, allow me to examine parts of the teeth and mouth that cannot be seen by looking. I will look for cavities in between teeth, look for infections under and around the teeth, look for developing teeth and growth, and any other abnormailities.

I suggest taking X-rays at least every six months for young children. Children can often grow large cavities between teeth in just a few months. Examinations without X-rays are incomplete.

X-rays are also beneficial for very young children. I will usually not force the issue, though. If your child is able to cooperate for taking the pictures, I am happy to do so. If they cannot, and show any other signs of decay, I will take the pictures when your child is sedated. If the cannot take the X-rays, but show no signs of decay, we will not force the issue, and look again at the next check-up.

What is a cavity? How does it grow?

A cavity is literally a hole in the tooth. Cavities may be easily seen as a yellow/orange or brown/black spot on the front, side or top of your child’s tooth. They may also be hidden inside the tooth where it can only be seen with an X-ray. Cavities may be as small as the tip of a pin, or large enough that the tooth breaks into pieces. Cavities are usually not painful, although they may be. Small cavities tend to cause sensitivity, or short, sharp pain when eating cold, hot or very sweet food. Large cavities can cause spontaneous, life altering pain. The large cavity can hurt so much that sleep is impossible.

Bacteria in the mouth cause cavities. It is a disease. The bacteria eat some of the food that we chew, and then produce a waste byproduct. The waste, or plaque, is produced for 20-30 minutes every time food is consumed, regardless of the amount of food or drink eaten. As a result, the teeth will dissolve a little bit each time you eat. In between meals, the dissolved calcium from the teeth sits in the saliva, and can be absorbed back into the teeth, making them hard again.

Frequent consumption of food or drink is one of the biggest predictors of cavities. Children who graze, or are constantly eating are much more likely to grow cavities. Children who eat while going to bed, or while in bed, are also exposed to sugar for a long period of time

When is my child old enough to brush by itself?

Although every child is different, they will usually be ready to brush by themselves at about the time they learn to tie their shoes. If they are not trying very hard, sometimes much older children still need help.

What are the brown spots on my child’s teeth?

Brown spots are most often cavities, although cavities may also be yellow, orange, or black.

When should my child see an orthodontist?

Children should receive an orthodontic consultation when they turn seven-years-old. The orthodontist will check the development of their mouth and may recommend an early orthodontic treatment if problems are found. However, in most cases, children who need orthodontic care wear braces when all of their permanent teeth have erupted, usually when they are between 11 and 13 years in age.

How can I help my child brush their teeth?

Diligent families who have a regular tooth brushing routine usually have the best success at cleaning their child’s teeth. Make gentle back-and-forth strokes when brushing their teeth, and be sure to use a child-sized toothbrush. When your child develops enough manual dexterity to clean their own smiles, be sure to watch and guide them in this process.

When will my child’s baby teeth fall out?

Children typically start to lose their baby teeth when they are 6-7 years old, starting with the teeth in the front of their mouth. This process continues towards the back of the mouth and usually ends when the child is 11-13. If your child loses a tooth earlier than they should, then we may recommend placing a space maintainer in their mouth to prevent the other teeth from shifting into the spot (which can cause the permanent teeth to erupt crookedly).

Does my child need sedation?

Children who are very young, require extensive treatment, or have anxiety may benefit from sedation. Our safe sedation methods help kids to feel calm and comfortable during their appointments here, allowing our pediatric dentist in Lehi, Utah, to improve their oral health.

How often should my child visit the dentist?

Children should visit a dentist every six months for a routine cleaning and exam. These regular appointments help Dr. Jared Pearson make sure your child’s smile is growing correctly. Additionally, these appointments allow us to catch and treat dental problems while they are still small.

If you have any other questions about our services or how you can help your child keep their smile healthy, call us today!