The most likely location for a cavity to develop in your child’s mouth is on the chewing surfaces of the back teeth. Run your tongue over this area in your mouth, and you will feel the reason why: These surfaces are not smooth, as other areas of your teeth are. Instead, they are filled with tiny grooves referred to as “pits and fissures,” which trap bacteria and food particles. The bristles on a toothbrush can’t always reach all the way into these dark, moist little crevices. This creates the perfect conditions for tooth decay.

What’s more, a child’s newly erupted permanent teeth are not as resistant to decay as adult teeth are. The hard enamel coating that protects the teeth changes as it ages to become stronger. Fluoride, which is found in toothpaste and some drinking water — and in treatments we use here at the dental office — can strengthen enamel, but, again, it’s hard to get fluoride into those pits and fissures on a regular basis. Fortunately, there is a good solution to this problem: dental sealants.

Dental sealants are invisible plastic resin coatings that smooth out the chewing surfaces of the back teeth, making them resistant to decay. A sealed tooth is far less likely to develop a cavity, require more expensive dental treatment later on, or, most importantly, cause your child pain.

How Sealants Are Placed

You can think of a sealant as a mini plastic filling, though please reassure your child that it doesn’t “count” as having a cavity filled. Because tooth enamel does not contain any nerves, placing a sealant is painless and does not routinely require numbing shots. First we will examine the tooth or teeth to be sealed, and if any minimal decay is found, it will be gently removed. The tooth will then be cleaned and dried. Then we will apply a solution that will slightly roughen or “etch” the surface, to make the sealing material adhere better. The tooth is then rinsed and dried again. The sealant is then painted on the tooth in liquid form and hardens in about a minute, sometimes with the help of a special curing light. That’s all there is to it!

A note about BPA: A 2012 study that received wide press coverage raised concerns that trace amounts of the chemical bisphenol-A (BPA) found in some (but not all) dental resins might contribute to behavioral problems in children. The study authors noted that while they had found an association, they had not actually proven that BPA in dental sealants causes these problems. In fact, BPA is far more prevalent in food and beverage packaging than in dental restorative materials. The American Academy of Pediatric Dentistry and the American Dental Association have since reaffirmed their support for the use of sealants. We would be happy to answer any questions you may have regarding this issue.

Taking Care of Sealants

Sealed teeth require the same conscientious dental hygiene as unsealed teeth. Your child should continue to brush and floss his or her teeth daily and visit us for regular professional cleanings. This will give us a chance to check for wear and tear on the sealants, which should last for up to 10 years. During this time, your child will benefit from a preventive treatment proven to reduce decay by more than 70 percent.

Your baby’s teeth will not be visible at birth. But believe it or not, they already exist beneath the gums. Children’s primary teeth begin forming at about the sixth week of pregnancy, and start mineralizing — building the bonelike inner tooth layer (called dentin) and the super-hard enamel layer that covers it — around the third or fourth month of pregnancy. So if you’re pregnant, it’s not too early to start thinking about how to make sure your child’s teeth are as healthy as possible!

Like everything else having to do with your baby’s physical development before birth, much depends on how well you take care of yourself. Developing teeth need certain nutrients to grow properly; if you don’t get them through your diet, your baby won’t receive them either. Likewise, you’ll have to watch your intake of substances that could harm your teeth in utero, such as certain antibiotics. Here’s a brief summary of what to seek and what to avoid.

Eat Right

Certain nutrients are particularly important for prenatal tooth development:

• Calcium, a mineral, is the main component of teeth. If there is not enough calcium coming from your diet to support fetal development, your body will actually take this mineral from your bones (but not your teeth) and use it to meet your developing baby’s needs. Good for your baby, not so good for you. The best sources of dietary calcium are dairy foods such as milk, cheese and yogurt. It can also be found in broccoli and kale.
• Phosphorous, another mineral, also accounts for the hardness of teeth. It is found in every one of the body’s cells, and also in many foods — especially high protein sources such as meat and milk, but also cereals. Of all the nutrients your baby’s teeth need, this is the easiest to get.
• Vitamin D helps the body absorb and retain calcium and phosphorous. Very few foods contain it naturally — oily fish like salmon and tuna are exceptions; that’s why it is added to milk and some other beverages and foods (check labels to find out which ones). It is also produced in the body naturally when skin is directly exposed to sunlight. Concerns about the negative effects of sun exposure may prevent you from getting all the vitamin D your body requires this way, so you may be advised to take a supplement.
• Protein is the most plentiful substance in your body after water. It is responsible for building, maintaining and replacing the body’s tissues. Interestingly, it is the action of a single protein that causes calcium-phosphate crystals to form tooth enamel rather than bone. All proteins are made of amino acids, but some amino acids cannot be manufactured by the body and must come from foods. Meats and dairy products are the most protein-rich. It is possible to get all the different proteins your body requires with a vegetarian diet, but you will need to pay closer attention to what combinations of foods will provide all the essential amino acids.

Seek Guidance on Dietary Supplementation & Medications

If you feel your diet is inadequate in some nutrients during your pregnancy, it’s best to seek professional medical advice on what supplements you may need. While it’s unlikely you will ever receive too much of any given nutrient from your diet, you can overdo certain vitamins and minerals in pill form (vitamin D and calcium, for example).

When you know you’re pregnant (or if you may be pregnant), please share the news with us here at the dental office — along with any other medical professionals you see. That way, we won’t prescribe medication that should be avoided at this time. For example, if you need antibiotics to combat an infection, some are much safer for developing babies than others. Tetracycline, for example, can permanently stain teeth in utero. Fluoride supplementation at this time is not recommended either, as there are too many unanswered questions about its use during pregnancy.

Please feel free to talk to us about any concerns or questions you may have — especially at this important time in your life.

Your child’s little baby teeth have some big responsibilities. Until the adolescent years, they will not only help your youngster bite and chew (i.e., get proper nutrition) and speak correctly but also help guide the permanent teeth underneath them into proper position. In fact, a major function of baby teeth is to hold space for the adult teeth that will eventually push them out.

At least that’s how it’s supposed to work; sometimes, however, injury or disease can cause a baby tooth to be lost prematurely. When that happens, the permanent teeth that are coming in on either side can actually drift into the space that was reserved for another tooth. This can cause teeth to erupt out of position or to be blocked entirely, and it may result in crowded or crooked teeth.

Fortunately, if your child loses a tooth prematurely, there’s a dental appliance we can use to hold the space open for the permanent tooth that is meant to fill it. The device is, not surprisingly, called a “space maintainer” or a “space maintenance appliance.” Made of metal and/or plastic, space maintainers can be fixed (cemented) or removable, but either way their purpose is the same: to help your child develop the best bite possible and hopefully avoid the need for braces later on.

Fixed appliances are cemented onto adjacent teeth. They are made in many different designs: One consists of a band that goes around a tooth and then a wire loop that extends out from the band to hold the space; another features a loop attached to a stainless steel crown, which goes over a nearby tooth. In either case, the loop extends just to the point where it touches the next tooth. Fixed space maintainers are often preferred with younger children, because they are less easy to fidget with, break, or misplace than appliances that can be removed.

Removable appliances look like the type of retainer that is worn at the end of orthodontic treatment. It can have a false tooth on it, which is particularly useful when the lost tooth was visible in the mouth. Older children can usually handle the responsibility of wearing this appliance and caring for it properly.

Whether fixed or removable, your child’s space maintainer will be custom-made after we take impressions of his or her mouth. A child will wear a space maintainer until x-rays reveal that the tooth underneath is ready to erupt naturally. It is very important that anyone wearing a space maintainer keep up good oral hygiene at home and come in for regular professional dental cleanings.

Space maintainers are also useful when one or more permanent teeth are congenitally missing — in other words, they have never existed at all. In cases like this, which are not uncommon, permanent dental implant teeth are often recommended for adolescents or adults to replace a tooth they weren’t born with. But timing is very important with dental implants — they can’t be placed in a growing child. Therefore, we may use a space maintainer with a false tooth on it until jaw growth is complete and an implant can be appropriately placed. It’s a simple, non-invasive way we can avoid a malocclusion (bad bite) with some timely intervention.

Some children are just too fearful to receive necessary dental care. In that type of situation, we may recommend conscious sedation with nitrous oxide to help make your child’s experience of dental treatment stress-free.

Nitrous oxide, a colorless gas with a slightly sweet odor, has been used in medicine for about a century. It’s a safe and effective method of administering conscious sedation, which means that a child (or adult) will stay awake during the procedure, but feel completely relaxed — even happy. All bodily functions remain normal during the administration of nitrous oxide, and its effects wear off quickly afterwards.

How Is Nitrous Oxide Administered?

As a form of conscious sedation, nitrous oxide is inhaled through a small mask that fits comfortably over a child’s nose. The gas is mixed with oxygen as it is being delivered, and both gases are always kept at a level that is safe for the body. In just a few minutes, the patient may start to experience a floating sensation, and perhaps some tingling in the hands and feet. That’s a sign that the sedation is working. Once it has been verified that your child is calm and comfortable, and that the dose is correct, the dental procedure can begin.

Nitrous oxide itself isn’t a substitute for a local anesthetic in children or adults as it’s considered an anxiolytic, which means it makes anxiety disappear. However, for some pediatric procedures, a child receiving nitrous oxide may not need an anesthetic injection. Even if they do need a numbing shot, they won’t mind at all while under sedation with nitrous oxide. Yet they won’t be asleep — they’ll be able to speak, be aware of what’s going on, and they will remain in control during the procedure. In fact, the dose can be fine-tuned to just the level of sedation they need to make them comfortable yet alert.

When the procedure is over, the flow of nitrous oxide is decreased to zero, and the oxygen will be increased. After resting in the chair for a few minutes, the child will feel completely normal.

Who Can Benefit From Nitrous Oxide?

Any child whose anxiety would otherwise keep them out of the dental chair can benefit from conscious sedation with nitrous oxide. Before beginning treatment, we will take a complete medical history, including any medications your child is taking. We will make sure that your child is safe and comfortable. In fact, we sometimes create a fantasy of your child being an airplane pilot wearing their flight mask to encourage their imagination so that they have a good time during treatment. Afterwards, they will likely not remember a thing.