FAQ

Questions About Caring for Baby Teeth

Children should see a dentist by one year of age or when they have the eruption of their first tooth, whichever happens sooner. However, if you have concerns about your child’s teeth, you are welcome to bring them to Coastal Pediatric Dental & Anesthesia even earlier.

Education and prevention are the best ways to prevent dental disease. Just as your child needs a medical home, your child also needs a dental home. In addition, having easy, early dental visits help children to have good dental experiences -- instead of having a first memory of the dentist connected to their first toothache.

Before your child starts to have teeth, you can clean their mouth and gums with a soft, small infant brush or damp washcloth. Brushing should start when the first tooth erupts, using a small-headed, soft-bristle toothbrush and a “smear” of toothpaste. From the age of 2 until 5, a pea-sized amount of toothpaste should be used. Even though children want to brush their teeth themselves, parents should always “double check” and re-brush their children’s teeth as they don’t have the dexterity to brush the hard to reach places.

Yes and no. Breastfeeding itself does not cause cavities. However, lactose (milk sugar) may cause tooth decay. There are an increasing number of parents who have cited a study by Erickson (http://www.aapd.org/assets/1/25/Erickson-21-02.pdf) that showed that clean, extracted teeth placed in breast milk did not develop cavities and were similar to placing them in water. Additionally, children who breastfed longer had the same number of cavities as weaned children. We do know that milk is less cariogenic (cavity-causing) than juice or sugar water. We also know that human breast milk is less cariogenic than cow’s milk.

So now that we have the good news, what is the bad news? Well, the same breast milk study showed that with the addition of any sugar, the extracted teeth actually developed more cavities than teeth soaked in sugar water. Our kids aren’t petri dishes or lab animals, and they are going to breastfeed, eat and drink other things. When the sugar in these food or drinks mixes with breast milk in the biofilms, tooth decay ensues.


Questions About Dentistry

We all have millions of microbes or bacteria in our mouths. These bacteria, especially Streptococcus mutans (yes, the same family that causes strep throat), like to metabolize (eat) the sugars we consume. These bacteria create acid as a byproduct (much like we create bathroom waste after eating) that rots away at the hard layers of the tooth. After a single exposure to a small amount of sugar, bacteria can create enough harmful acid to rot away at the tooth for 30-40 minutes.

Unfortunately the outer layer of the tooth has no nerves and is highly mineralized. It is like an armor coating to the inside of the tooth. It is not until the cavity gets close to the pulp -- the innermost portion of the tooth that has its blood supply and nerve -- that you start to feel something. Teeth themselves only have one type of nerve, the A delta fiber, which feels only pain. This is why it is best to not wait for a toothache.

Bring your child to see the dentists at Coastal Pediatric Dental & Anesthesia. You may also rinse the area with warm salt water and give over-the-counter pain medications such as Tylenol and Motrin. We strongly discourage use of topical anesthetics such as Orajel or Orabase for toothaches due to concerns with methemoglobinemia.

If your child develops facial swelling, especially around the neck or below the eye, you need to see a dentist immediately. If the child has difficulty breathing or swallowing from the swelling, please go to the nearest emergency room.

Fluoride is an ion found naturally in certain parts of the country’s water sources. Dentists noticed that people living in these areas had far fewer cavities. Now fluoride is often added in very small amounts to the public water system, at a rate of 0.7 parts per million. Interestingly, Virginia’s natural water has far higher levels than that of many other US states (http://www.fluoridealert.org/wp-content/pesticides/levels/virginia.html). Fluoride strengthens and even remineralizes the outer layer of the tooth called enamel, making it more resistant to the acid that bacteria produce. Children today have 1/3 of the cavities that they had before fluoridation.

A sealant is a resin composite material that is flowed into the nooks and crannies of the tooth that is at risk for cavities. It keeps bacteria and acids from accumulating in those grooves, and makes the nooks and crannies smooth so they can be easier to clean. Sealants help prevent future cavities on high-risk tooth surfaces.

Yes and no. We use local anesthesia, which most people refer to as Novocaine. Novocaine hasn’t been used as a local anesthetic in dentistry for years because of its risk for allergies and side effects. Instead, we use newer and safer local anesthetics such as Lidocaine.

Primary teeth are temporary, but some of those primary teeth will not be replaced by the permanent teeth until your child is 12-13 years old. Primary teeth are important for speech, eating, and hold the space for their permanent successors. These issues are well understood, but there are still parents -- and even dentists -- who don’t understand the relationship between a healthy mouth and a healthy body. Chronic infections create inflammation that affects the entire body and may put children and adults at risk for other diseases. Even a mother’s poor dental health has been linked to low birth weight babies. Children experiencing dental pain may not be able to sleep at night or pay attention in school. Finally, untreated dental infections can create abscesses that can spread into the neck, chest, or brain, which can be fatal. Read more about dental treatment of baby teeth.

Primary (baby) teeth should not be put back into the tooth socket, as there is risk of damaging the developing permanent tooth. For a permanent tooth, hold the tooth by the crown and do your best not to touch the root surface. Place the tooth in milk or a commercially available tooth saver solution if readily available (many sports teams have it) and report immediately to the dentist.

Dental x-rays are very safe. The amount of radiation exposure is similar to that amount you’d get while flying in a plane. At Coastal Pediatric Dental & Anesthesia, we have further reduced radiation exposure by using state-of-the-art digital sensors and the Nomad handheld x-ray unit. When our dentists recommend x-rays, it is because they have prescribed them for your child’s particular treatment needs or diagnosis. The risk of radiation is far less than the risk of not treating the suspected dental disease. For example, if your child were seen in the emergency room for a suspected broken arm, the surgeon would not treat it without an initial x-ray.


Questions About Our Dentists

A pediatric dentist is a dental specialist who has completed an additional 2-3 years of residency training after dental school. A pediatric dentist uses their additional skills in child psychology, behavior management, pediatric medicine and development, and expert knowledge in child growth and development to customize the dental treatments for your child. A family dentist or general dentist who sees children does not have this advanced training, nor do they limit their treatment to pediatric patients and patients with special healthcare needs.

A dentist anesthesiologist is a dentist with advanced hospital training in anesthesia. Dentist anesthesiologists spend 3 years training with medical anesthesiologists, providing anesthesia for both medical and dental cases. Our CODA (Commission on Dental Accreditation, a division of the ADA) and Graduate Medical Education approved residencies place an emphasis on treatment of pediatric patients and patients with special healthcare needs. In fact, we see more pediatric patients than our medical counterparts unless they pursue an additional pediatric fellowship.

A board-certified dentist is a dentist who has completed post-graduate residency training AND has also elected to take a written and verbal board examination after completing residency and practice.

Our mission drives everything we do. Dr. Kari and Dr. Jon wanted to bring the best of pediatric dentistry and anesthesia practice to Hampton Roads, with a focus on patient safety. We truly believe in Making Dentistry a Dream and making children smile.


Questions About Dental Hygiene

Flossing is the best way to clean in between the teeth, especially in permanent teeth or primary teeth without spaces in between them. Dentists have known for years that the studies are questionable. For example, one study suggested that flossing every other day was just as effective as daily flossing. The long-term effects of not flossing are not well studied. We recommend flossing for the benefits of cleaning places the toothbrush can’t reach and for preventing bad breath. It also helps keep your gums healthy in the long run by preventing periodontal (gum) disease. Good daily habits are important, and this routine just might keep you healthy decades later. (http://www.npr.org/sections/health-shots/2016/08/02/488378699/does-flossing-help-or-not-the-evidence-is-mixed-at-best)

A toothbrush is only as good as its operator. Brushing must last at least 2 minutes, cleaning all the hard-to-reach places in your mouth. We recommend using what works best for you and your children.

Halitosis or bad breath often comes from the oral cavity, tonsils, and pharynx (the part of the throat you can see when opening your mouth). One of the major causes is volatile sulfur compounds (VSCs). VSCs are produced as a byproduct of the bacteria in the mouth, much like the acid left by Streptococcus mutans. VSCs are responsible for the smell of rotten eggs, swamps, and barnyards. There are other disgusting sounding compounds that may contribute to bad breath, such as cadaverine, putrescine, and skatole. These compounds often originate from debris on the tongue and between the teeth. Brushing, flossing, and cleaning the tongue are the best ways to get rid of halitosis. If bad breath persists despite these practices, it might be a sign of other dental or medical problems.

This can be a sign of gingivitis, or the earliest signs of gum disease. Fortunately, gingivitis is reversible with good oral hygiene. Floss every day, and the bleeding will go away after 1-2 weeks. If it does not, make sure to see the dentist, as it may be a sign of other dental or medical problems.

Brushing should occur at least twice a day using a fluoride toothpaste. For young children up to the age of 2, use only a smear of toothpaste. For children ages 2-6, use a pea-sized amount. Once your child routinely spits out the toothpaste, then a normal ribbon of toothpaste is appropriate. One of the most important things in our opinion is to make sure teeth are brushed and flossed immediately before bedtime. Going to bed with clean teeth is an important habit, just as is getting around half a day’s sleep (https://sleepfoundation.org/excessivesleepiness/content/how-much-sleep-do-babies-and-kids-need). The key point here is that once the teeth are brushed, ideally only water will be consumed, or the teeth needs to be rebrushed.


Questions About Anesthesia / Sedation

Anesthesia and sedation both have risks. These should always be discussed as part of informed consent. At Coastal Pediatric Dental & Anesthesia, we emphasize patient safety and have an anesthesiologist on staff. In addition, our team of assistants AND nurses train rigorously for emergencies.

We invite you to come and take a look at our facility. We guarantee you have never seen a dental office like ours. We have followed NFPA life safety codes to meet the standards that an ambulatory surgery center follows for our two office-based ORs. Why? Because we believe no expense should be spared when it comes to anesthesia and sedation safety.

You do! Remember, at Coastal Pediatric Dental & Anesthesia we give you information to understand the alternatives to sedation and anesthesia. Our goal is not to have every dental procedure performed under sedation or anesthesia. However, when you need those services, we offer the highest standard of care for office-based ambulatory care. In fact, many patients are referred from other practices because they could not receive treatment in a more traditional dental setting.

Still have a question? Please ask us! It may even end up on the website if the question gets asked frequently enough.