Ask a Hygienist Archive

Welcome to Ask a Hygienist, a project developed by Kern County Children’s Dental Health Network for parents to answer questions about child dental hygiene care or the role of a dental hygienist.
Susan McCracken, RDHAP, has worked as a dental assistant for 10 years and as a dental hygienist for the last 8 years. She holds an AA degree in liberal arts from Taft College and an AS degree with a certificate in Dental Hygiene. Recently, Susan has earned a RDHAP license from West LA College. In addition to working for KCCDHN, Susan is also a part-time clinical instructor at Taft College.


Question #2: Are training or "sippy" cups bad for my child? What is an appropriate age to wean my child from the bottle?

A: It is recommended that a child begin to make the transition from a bottle to a cup as the first birthday approaches. It is important to remember that a training cup or "sippy" cup is meant to be used as a temporary tool to help teach your child to drink or sip from a cup rather than suck from a bottle. Some important considerations are what kind of training cup you choose, what you put into the cup, how frequently the child is allowed to sip from the cup, and if your child is allowed to carry the cup around (not good!).

Avoid the training cups with a "no spill" valve because the only way a child can get liquid from a cup with a valve is by sucking, which defeats the purpose. Instead, choose a cup with a snap-on or screw-on lid with a spout. A two-handled cup may be best, as your child learns to handle it.

Offer liquids containing sugar (this includes milk and juice drinks) only at mealtimes, understanding that little ones may need to eat more frequently throughout the day. Constant or at-will sipping on liquids (like milk or juice) can cause tooth decay, so offer milk or juice with food. (Saliva flow increases when chewing food which helps to neutralize acids in the mouth; and, saliva rinses food particles off the teeth). If your child gets thirsty between mealtimes, give him/her water in the cup.

Carrying the cup around is a bad idea because toddlers are unsteady on their feet. If the child should fall while drinking from the cup, he/she could injure his/her mouth and/or teeth.
Once your child learns how to sip, the training cup should be set aside and replaced with a regular cup.


Question #3: Hi, I have a 7-year old son who lost his first central incisor a month ago, and we do not see any signs of a new tooth coming in yet. Should we be worried about this? How long does it take for a new tooth to erupt once it has exfoliated (been lost)?

A: There are many reasons why your son my not have a new tooth coming in to replace the lost baby tooth. The only way to see what is going on is to take him in to a dentist and have an x-ray. There may not necessarily be anything wrong, and your son may just be slow to have his teeth erupt. Times vary and are difficult to predict. But to be sure, I would take him in to a dentist for an x-ray.


Question #4: My baby was born with two front teeth on his lower jaw. I thought these teeth were supposed to fall out early, but he is now 8 months old and he still has them. Should I be doing anything about this?

A: So called “milk teeth” are teeth that are present at birth (natal teeth), or they erupt through the gums wilthin the first month of life (neonatal teeth). The occurrence is rare and is hereditary. Some researchers think there may be a link to certain syndromes (other hereditary conditions), such as the Jadassohn-Lewandowsky syndrome, or the Ellis-Van Creceld syndrome, but this does not necessarily mean that your child has any other type of syndrome. It is merely recommended that the an infant with "milk" teeth be carefully evaluated. Here are some other interesting facts about "milk" teeth:

  • In addition to being painful to a nursing mom, the teeth may cause injuries to the baby as well. The infant may cut his tongue or lip accidentally. The dentist may be able to smooth the teeth or make a protective splint for the infant for protection.
  • Since the teeth erupt so early, the teeth usually have not developed roots. Therefore, the tooth/teeth may be loose. If the teeth are really loose, they may be pulled in an effort to keep the child from swallowing or breathing in the tooth/teeth. Periodic checks are recommended to ensure the teeth do not become loose enough to swallow or breath in.
  • Because milk teeth do not have roots and the crown (the part of the tooth that shows) may be lost early, the roots may develop later, and also may need to be removed later as well.
  • If the teeth are lost early and are in the front of the mouth, there are typically not problems. If they are in the back of the mouth, a space maintainer may need to be made by the dentist.
  • If the teeth are lost, no new baby teeth grow in to replace the “milk” teeth. Therefore, it is advisable to try to keep them, as long as they are not very loose.
  • Teeth that are not very loose, may grow firm on their own. Teeth that remain for four months or longer, usually have a good outcome, although they may be discolored or brown.
  • Don’t forget to keep these teeth clean! Clean them with a wet gauze after feedings until the infant is old enough to use a soft-bristled toothbrush.
  • Permanent teeth usually grow in normally and do not seem to be affected by the occurrence of natal or neonatal teeth.

Question #5: What is a dental hygienist?

A: A dental hygienist is a dental professional specializing in teaching oral health and also cleaning the teeth by removing plaque and calculus.


Question #6: My daughter, who is 3 years old, has decay in several of her baby teeth. When I grew up, our dentist told my mom not to worry about the decay in my baby teeth because they would fall out anyway. Now my daughter’s dentist tells me differently, that it is important to treat her decay. Which is correct and why?

A: Treating dental decay is important for several reasons:

  • Decayed teeth can cause pain and lead to infection. Painful teeth also make eating difficult, which can lead to poor nutrition. Pain affects the ability to concentrate and do well at school. By the way, toothaches are the number one reason children miss school.
  • Baby teeth are needed to hold the proper space for the permanent teeth. If baby teeth are taken out or lost from decay too soon, the permanent teeth may grow in out of place (crooked), and can also lead to abnormal cranial facial development. If the decay is left untreated, it can actually cause the erupting permanent teeth to grow in decayed as well. Also, if the teeth are badly decayed and discolored in front, the child may suffer from poor self-esteem. Early loss of baby teeth can also negatively affect speech development.
  • Sometimes a dentist will recommend that the decayed teeth are okay left untreated if he/she feels that the teeth will be exfoliating (lost) soon. Most children do not start losing their front teeth until the age of 5 or 6 years of age, and do not start losing their back teeth until 9-12 years of age.
  • If your child is only 3 years old and has visible decay, I strongly recommend that she be seen by a pedodontist (a dentist who specializes in treating children) for evaluation and possible treatment because depending on which teeth are decayed, they may be needed for years to come.

Question #7: At what age should I first take my child to the dentist?

A: Some dentists recommend that an infant be seen only for a visual screening at about 6 months, or upon the eruption of the first baby tooth. At this point they are just looking to see that everything is developing normally, and begin to familiarize the child with the dental office. Most local dentists would prefer to see the child for the first time at around age 3 years, unless there are brown spots on the teeth, obvious decay, or if the child complains of pain.


Question #8: When should I expect my baby to start getting teeth? When does my child start getting his permanent teeth? How long does it take for all his adult teeth to be in place?

A: Below is a chart of approximate ages of when teeth erupt. Remember that these ages represent a range and are not absolute!

teeth development:

Question #9: How can I prepare my child for a trip to the dentist?

A: The following are some helpful tips that can make the first visit to the dentist be a positive experience:
  • Schedule visits to the dentist/hygienist at a time when your child is likely to be well rested and cooperative.
  • Never mention the words "hurt" or "pain" around your child when discussing an oral health visit. Saying "it won't hurt" instills the idea that it might "hurt" into your child's thought process.
  • Do not discuss your own negative feelings or experiences within your child's hearing range.
  • Allow and encourage your child to discuss any fear he or she might have about oral health visits.
  • Read a fun book to your child about teeth, or a visit to the dentist, such as The Berenstain Bears Visit the Dentist.
  • Don't wait until your child is in pain or having something wrong. Begin taking your child to the dentist early--many recommend taking your child within 6 months of the eruption of the first tooth to within the first year of birth. Continue with dental visits every 6 months. Taking your child before there are dental issues establishes a routine that can be easy and fun!


Question #10: At what age should I begin to teach my child to brush or floss his own teeth?

A: You can begin to teach your child how to brush at around 2 or 3 years of age. However, you will need to monitor brushing and flossing until around age 8 or 9 years of age. He will then have the dexterity to do it alone. If there are spaces between the baby teeth, you do not need to begin flossing until the teeth touch, which begins usually, in the molar area. You should floss your child’s teeth until around 6 or 7 years of age, or when he can tie his own shoe laces. Then you should still monitor his technique and consistencey.


Question #11: What is the link between diet and decay?

A: Diet is important, but it should be understood that diet alone does not cause or prevent dental caries or decay. Also, it should be noted that the role of diet for proper tooth formation or development is a separate issue. Besides good nutrition, or eating the "right" foods, control of bacterial plaque in the mouth and strengthening of the tooth surface to resist decay is also essential. In other words, daily brushing and flossing to keep the mouth clean, and the use of the appropriate fluoride to keep the teeth strong, is also part of the solution to arresting tooth decay. There are, however, foods that contain the essential nutrients, called foundation or protective foods, which have been divided into five groups: the milk group, the meat group, the vegetable group, the fruit group, and the grain group. The food guide pyramid breaks down these foods into their perspective catagories and how many servings of each per day very nicely. More...


Question #12: I have an 8 month old daughter who has her two bottom front teeth and I noticed the backs of her teeth look grey. She was breast-fed for 7 months and is now on formula and I don't let her go to sleep with a bottle. I came across some information that said discoloration on the inside of the teeth may be due to trauma or medication. She hasn't fallen and she isn't on any medication. I don't know if this would have anything to do with it but she was born 3 weeks early. Any insight would be most appreciated.

A: It is difficult for me to say whether or not your daughter’s stains are "fixable," or what may have caused them. Grey stain is usually from amalgam (silver filling) staining, which she obviously cannot have since she has no fillings. Or, grey stain can be indicative of a tooth that is non-vital (the pulp has died), usually from trauma, like a fall, or if something has hit the tooth (like kids who play baseball and get hit in the face with a ball). Since I cannot see them, and I am not a dentist, I would again refer to your pediatrician as the person who can determine what should or could be done to improve the looks.

Some intrinsic (part of the tooth) stains can be removed with micro abrasion techniques. When stains are deep within the tooth structure, they can sometimes be removed with a burr (a drill) and then built up with composite resin (tooth-colored plastic filling.) Porcelain veneers or crowns can be made for adults, such as yourself, but not usually recommended until after age eighteen, especially if your child plays sports. Again, if the stains are just inside (tongue-side) of the teeth, it may not be necessary to do anything. As I stated earlier, your pedodontist or family dentist will best be able to give you a list of options that are relevant to you and your child.

Question #13: Should my child be taking vitamins with fluoride?

A: The water in Kern County is not fluoridated. Therefore, I would recommend fluoride supplements for most children. This should be discussed with your dentist or your child's doctor and individualized for your needs (for instance, age and weight of your child). Children from birth to 14 years of age will benefit the most from systemic fluoride. This is because your child is developing teeth during these ages, and the fluoride will then be in the bloodstream and will be available to be built into the enamel as the teeth develop. After age 14 and up (including adults), topical fluorides are recommended to delay or slow down the decay process. Topical fluorides are available in toothpaste, professional applications, and mouthrinses. Just make sure that your child is old enough to spit, before allowing him/her to use fluoridated toothpastes or rinses.


Question #14: What is a sealant and who should get them?

A: A sealant is a plastic material that is painlessly applied to the chewing surfaces of the back teeth--the molars and premolars. Most tooth decay begins on these chewing surfaces because they have many small grooves where germs and food can hide, and toothbrush bristles cannot reach to clean. This plastic resin bonds into these grooves and acts as a barrier to protect these surfaces from food, plaque, and acids. Prevention is better than treatment. Preventing decay by sealing out the bacteria and acids that contribute to caries/cavities is much easier and much less expensive that the trauma and cost of dental treatment, such as fillings, extractions, or crowns!

There are no shots or drilling when applying sealants! The tooth is first cleaned, a chemical etchant is applied, a liquid plastic material is painted on, and then "cured" (made hard) with a special light. It takes only minutes, and is easy for both the clinician and the patient! The hardest part about the entire procedure is keeping the tooth dry so that the sealant will stick.

Ideally sealants are applied upon the eruption of the first permanent molars, usually at age 6 years, and upon the eruption the second permanent molars, usually at age 12 years. Although traditionally sealants are applied to children of these ages, they are effective preventative measures for adults as well, especially if your teeth have deep grooves, or if you are prone to decay.


Question #15: I am a parent of a 5 year old boy. He has his 6 year molars erupting and I took him to the dentist for a check-up. The dentist noticed his molars have yellow discolorations. He said that the enamel on his teeth (new 6 year molars) never fully formed and that's what the discoloration means. I am asking what contributes to a tooth erupting up discolored? I have heard that having high fevers as a young child can contribute. My son was only on antibiotics 2x in his life. What can I do to help protect his teeth? What preventive measures? Such as, sealants? Covering the tooth with what they use to fill in cavities? What are your thoughts?

A: Enamel that has not fully formed is called “enamel hypoplasia”. Incomplete or defective formation of enamel can cause an alteration in the form of the tooth, or it can cause discoloration (sometimes both). Several factors can cause the enamel to be incomplete:

1. Amelogenesis Imperfecta: (is a group of inherited conditions, having no associated systemic factors. Does anyone else in your family have discolored teeth? If so, he may have inherited them.)
2. Childhood illness with a fever (i.e. chicken pox, measles, scarlet fever)
3. Vitamin deficiency (especially A, C, or D)
4. Local infection of a primary tooth
5. Ingestion of too much fluoride
6. Congenital syphilis
7. Premature birth, or birth injury
8. Idiopathic factors (no real or known cause)
9. Trauma (such as a child falling and hitting his mouth/teeth during tooth development—usually this happens to front teeth)

The only antibiotic that I know of that causes discoloration of the teeth is tetracycline, which is no longer prescribed to pregnant or nursing mothers, or children for that very reason.
Is the discoloration in the fissures, or grooves on the top of the tooth? If so, a sealant would probably be recommended, and is a good idea anyway to protect the integrity of the tooth. Bacteria can seep down into these fissures or grooves and cause decay, since toothbrush bristles cannot get down into these grooves to thoroughly keep clean. If the enamel is incomplete, dentin may be exposed and the tooth would be softer in this area, also making it more prone to decay. However, if the discoloration is on the side of the tooth, a sealant may not “stick” if there is not a deep enough groove. Topical fluoride can remineralize the tooth to be more resistant from decay, but your dentist would be the best judge as to whether or not any treatment is necessary.

As far as protecting the teeth from discoloration, I would recommend keeping the teeth as clean as possible. Help him to brush for two minutes twice a day, once in the morning after breakfast, and once in the evening before bed. If brushing is not always possible, then at least have your child clear his mouth with water after eating. Limiting (or better yet, excluding) soda (especially colas) and iced tea (I have seen children drinking iced tea!) intake is also preventative. These are all things you can do to prevent “extrinsic” (caused from external or outside the teeth) stains or discoloration.

As far as “intrinsic” (caused from internal or within the tooth) discoloration or stains, the best thing you can do is to insure your child eats a healthy diet. As I stated earlier, eating healthy is very important, as vitamin or nutrient deficiencies can cause discoloration of the teeth. The other reasons listed above that cause teeth to erupt or to grow in with discolorations are not always something that can be controlled.

Applying a sealant or composite (white colored filling) to prevent staining or discoloration is not generally done. Usually, a composite, veneer, or crown, to cover moderate to severe discoloration is considered a cosmetic procedure, and is done to restore existing internal or external defects or discoloration. Hopefully, your child’s discoloration of teeth will be limited to the back of the mouth where the teeth are not visible, and will not require any cosmetic treatment. I hope I have answered all your questions! Thanks for your question.


Question #16: My daughter is 7 yrs old and has not lost any teeth as yet. She has no tooth decay and has seen the dentist 12 months ago who said that her adult teeth should not be long to appear. She has been diagnosed with coeliac disease and I have read that this can impact the health of the teeth. Is this true? Her top teeth are very worn down (she did not have a dummy and has never sucked her thumb, she did not have a feeding bottle that she took to bed but the top front teeth are worn down not decayed, she does not seem to grind her teeth either). Should I be concerned about her lack of adult teeth at this age or should we wait a little longer?

A: Wow! Well, there are several questions that you have asked, and I shall answer them to the best of my ability; however, there are some missing pieces. For instance, when did your daughter begin eating cereals and/or foods containing gluten? When was your daughter diagnosed with Coeliac Disease (a.k.a. Celiac Disease)? Was she ingesting foods containing gluten for a period of time before being diagnosed? As you know, Coeliac Disease is an autoimmune disorder, and not just a "wheat" allergy. Her diet will have to be gluten-free for life!

Teeth begin developing around 3 months in utero and continue to develop until 20 years of age (wisdom teeth)! Depending on when wheat was introduced into her diet, the enamel may have been affected. Usually, the front teeth of a child with CD are normal, but there may be disturbances or abnormalities in the development of the canines and molars, because they are developing at a time when wheat is introduced (usually around 4-6 months). Also, because there is a mal-absorption of nutrients, such as calcium, vitamin D, phosphorous, vitamin C, and fluoride, teeth may have enamel hypoplasia (enamel is underdeveloped) which can cause tooth discoloration, and may also cause teeth to have a greater susceptibility to painful tooth decay. These deficiencies can also lead to osteoporosis which can affect the bones around her teeth. You may want to discuss this with her pediatrician.

Besides being deficient in calcium, a person with CD cannot absorb Vitamin B-12, folic acid, or iron, and may develop anemia. People with anemia may have recurring apthous ulcers (painful mouth sores), burning tongue (loss of papilla, tongue is smooth, shiny, and red), angular chelitis (dry, red, "cracks" at the corners of the mouth). Gums may have a lack of color and look pale. All of these oral problems disappear when the disease is controlled with a gluten-free diet.

Before the disease is controlled, children may be malnourished. This can cause their growth to be stunted and delay their development, which may be why your child has not yet lost any teeth. However, times vary as to when baby teeth fall out and sometimes children do not loose their baby teeth until 7 or 8 years of age. When did your daughter get her baby teeth? Was she on schedule or did they come in late? That may be an indicator of when she will be getting her permanent teeth. Also, many children get their 6-year molars (sometimes their first permanent teeth) before any of their primary front teeth fall out, or permanent front teeth erupt. Look in her mouth and count her teeth. Provided she has not lost any teeth, she should have ten on the bottom, and ten top teeth. If she has twelve, she has probably grown in her permanent 6-year molars, and you have not realized it yet.

This brings me to the next question regarding the wearing down of your daughter's baby teeth. I know you said you didn't think your daughter grinds her teeth, but perhaps she does it in her sleep, or maybe she just clenches. Children who grind/clench their teeth do so for a variety of reasons. She may have started grinding in response to the sensation of having teeth. However, permanent teeth are more sensitive to pain, and children who grind for this reason usually stop with the eruption of their permanent teeth. Or, the size and shape of her top teeth may not match her bottom teeth. If there is not a good "fit", teeth may wear down prematurely. This relationship of how the bottom and top teeth fit is called occlusion, and should be checked out by your dentist. Most problems associated with your child's occlusion can be corrected with braces, at an appropriate time.
You said that you had taken your child to her dentist 12 months ago, but do you know that it is recommended that everyone should have their teeth checked by their dentist and cleaned twice a year? That is the recommendation for healthy teeth! (More often if not healthy)! X-rays will show where the permanent teeth are, and how close they are to erupting. It will also show the health of the bones around the teeth. Therefore, I do recommend that she have her teeth checked by her dentist. You can also ask your dentist about her occlusion. If she continues to grind once her permanent teeth erupt, talk to your dentist about a night guard. Ask whether she may be a candidate for braces in the future. Although she does not have a history of dental decay with her baby teeth, discuss with your dentist the possible need for an at-home fluoride therapy for her permanent teeth.

With a gluten-free diet, your daughter should have a normal, healthy mouth, teeth, and life! Thanks for your questions!

Question #17: I have a child with an unusual tooth cutting through her gums. This tooth is erupting in the molar area of her mouth. She is also showing signs of eruption on her lower incisors. The eruption in the molar region is very unusual. Have you ever heard of this? Do you have any comments on why this could be happening?

A: You are correct in your observation that this is unusual. Teeth that are present at birth are called natal teeth (or tooth), whereas, teeth erupting within the first 30 after birth are called neonatal teeth. Sometimes, these teeth are commonly referred to as “milk” teeth. This is very rare and occurs 1 in every 2,000-3,000 births.

Natal teeth are hereditary, and some researchers think they may be associated with some syndromes (such as Ellis-Van Creveld syndrome, Hallermann-Streiff syndrome, Pierre Robin syndrome, or Soto’s syndrome). Most of the time, natal teeth occur as isolated incidents, and are not associated with a syndrome. However, it is recommended that the infant with natal teeth be carefully evaluated. Are there any other symptoms present? Is there any record of other family members being born with teeth? Or, having teeth within 30 days after birth?

Most questions regarding natal or neonatal teeth have been answered in one of my former questions from a parent and is still posted on my web page. (Click on “Visit answers to previous questions regarding:”, and then scroll down to question #5). Usually the “milk” teeth have no roots because they have developed so early. They may be loose and fall out. Or, the dentist may recommend that they be removed to prevent the child from swallowing or aspirating them.

Keep in mind that these are the child’s primary teeth, and if he/she loses them early, the child will not have these teeth until the permanent teeth erupt. In such cases, the dentist may wish to fashion a space maintainer to hold the required space for the permanent teeth. If the teeth seem solid, it is best to leave them alone, and roots may develop as the child grows.

Sometimes these teeth can be uncomfortable for both the mother and the infant. The infant may cut his tongue, upper gums, or lips accidentally. In these cases, the dentist may be able to smooth the teeth or make a protective splint for the infant for protection.

Question #18:  My 3 and a half year old daughter took a fall 2 weeks ago and hurt her teeth.  At first part of the gum above her front milk tooth was bruised but the tooth remained firmly in place.  His front tooth now shows a clear sign of discoloration which I think has been gradually building up since the day of the accident and is now quite visible.  What does this mean? How does this effect the remaining duration of the milk tooth and subsequently her permanent tooth?
 

A: The discoloration probably means that the nerve of the tooth has died, which can happen after trauma to the tooth from a bump, or fall.  Inside all of our teeth are chambers that have living blood vessels and nerves.  Trauma to the tooth can cause the tissue inside to become necrotic, or non-vital, which causes the discoloration.    Since it is now non-living, or non-vital, it can also become more brittle, and can crack or break easier.  It may also become infected (abscess), and can become quite painful.

Whenever there is trauma to the tooth, it is a good idea to have your dental professional take an x-ray of the tooth to make sure that no damage has been done to the permanent tooth.  When a tooth has been hit, as from a fall, the root of the primary tooth may have been forced against the developing tooth bud of the permanent tooth.  Without an x-ray, there is no way to tell whether the permanent tooth has had any damage or not, or the extent of the damage to either tooth.  

Your dental professional my want to "watch" it; that is, simply check it periodically for infection.  Or, if there has been some trauma to the permanent tooth, then extraction of the primary tooth may be advised.  The sooner you get her in, the better the dentist will be able to arrest or prevent permanent tooth damage.

Again, I am encouraging you to seek the advice of your dental professional.  Because your daughter is so young, I would recommend she see a pediatric dentist who specializes in treating young children.



For more information or if you have a question, please e-mail Susan McCracken, RDHAP.
Ask a Hygienist is a Kern County Children’s Dental Health Network informational program designed to provide general information on a variety of dental topics. All material appearing on the Ask a Hygienist page is provided for educational purposes only and is not intended to take the place of your personal dentist or health care provider. Should you or one of your family members have a dental problem, always consult your own dentist for diagnosis and treatment.


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