General Topics

What is a Pediatric Dentist?

In the same way that pediatricians are trained to meet a child’s medical needs, our pediatric dental specialists are uniquely qualified to protect your child’s oral health using the most advanced techniques, and all in our delightfully friendly, open treatment area.

Pediatric dentists have an additional two to three years of training at university pediatric facilities in addition to four years of dental school and four years of college study. Some pediatric dentists (including all of ours) practice general dentistry before specializing, giving them a unique perspective. They learn how to deal with the behavioral aspects of children, how to make them feel comfortable, and how to make the experience pleasant. They also are trained and qualified to treat special needs patients.

Why are the Primary Teeth Important?

The first baby teeth, known as primary teeth, usually appear as early as 3-4 months of age, but really start to erupt through the gums between the ages of 6 months to one year of age. The timing of eruption varies (and which ones come out first varies), but all 20 primary teeth (baby teeth) will usually erupt by the age of three.

And those baby teeth are important-- even if you can’t see them and even if they eventually fall out and are replaced with permanent adult teeth, baby teeth are extremely important.

When a baby tooth is lost too early, the permanent teeth can drift into the empty space and make it difficult for other adult teeth to find room when it’s their turn to erupt. So, proper oral hygiene is important as soon as your baby is born. Establishing good oral habits early will go a long way, even beyond impressing the tooth fairy!

Tips on Handling Some Dental Emergencies

Knocked Out Teeth

Knocked out Baby Tooth- If a Baby Tooth has been knocked out, contact Chester County Dentistry for Children during business hours. This is not usually an emergency, and in most cases, no treatment is necessary.

Knocked Out Permanent Tooth— It is of the utmost importance for the patient to see the dentist as soon as possible when a tooth has been knocked out…Time and the handling of the tooth are critical factors in saving the tooth! If possible, find the tooth. Handle it by the crown, not by the root. You may rinse the tooth with water only. DO NOT clean with soap, scrub or handle the tooth unnecessarily. Inspect the tooth for fractures. If it is sound, try to reinsert it in the socket. Have the patient hold the tooth in place by biting on a gauze. If you cannot reinsert the tooth, transport the tooth in a cup containing the patient’s saliva or milk. If the patient is old enough, the tooth may also be carried in the patient’s mouth (beside the cheek).

If you are unable to do this, preserve the tooth by placing it in a Tooth Preservation Kit (Coaches at sporting events sometimes have these available), or place the tooth in the mouth next to the cheek, or place in milk or water with a bit of salt. After preserving the tooth, get your child to one of our dental offices as soon as possible, within 15-20 minutes is ideal. Good preservation of the tooth will keep it viable for up to an hour or more. If you have access to the Tooth Preservation Kit, the tooth will be viable for 24 hours.

(Encourage your child’s school to have these tooth preservation kits available at all sporting events.)

Your school’s athletic program should also be using mouth protectors. Mouth guards can either be custom fitted at one of our dental offices or may be store purchased.

Digital X-rays

Digital x-rays are used for the additional safety and accuracy they provide. Although traditional x-rays are relatively safe, digital x-rays use 80% to 90% less radiation than film x-rays and are preferred by most patients.

  • Digital x-rays use less radiation – The #1 reason for using digital x-rays is that they use much less radiation than film x-rays: 80% to 90% less! Although traditional x-rays are relatively safe, digital x-rays are much preferred for most patients who may well need x-rays on a regular basis throughout their lifetime.

  • Better quality pictures – Once a digital x-ray image is on the computer screen, it can not only be enlarged to better view the area of concern, but be instantly manipulated in other ways (contrast, color, and brightness) to effect a better diagnosis by changing the size, contrast, color, and brightness. The Digital pictures enable the dentist to see certain dental conditions more closely that could possibly be missed. Digital x-rays (a/k/a “radiographs”) detect much more than cavities. They are used to survey erupting teeth, diagnose bone diseases, evaluate the results of an injury, or plan orthodontic treatment. If the dentist discovers a problem early enough, preventive or interceptive orthodontic treatment can begin and the dental experience for the child is more comfortable for him and more affordable for you! The American Academy of Pediatric Dentistry recommends radiographs and examinations every six months for children with a high risk of tooth decay.

  • Less “chair time” – There is no waiting for x-ray film to be developed in the office dark room and hung up to dry. Just like digital photography, the x-ray image is instantly available on our computer screen.

  • Better dental records – Again, just like digital photography, digital images can be enlarged for easier viewing, stored in computer files for easy access, transferred to another specialist, or easily compared between new and older images.

  • No hazardous waste disposal necessary – Digital dental x-rays use no chemicals to develop film and, therefore, no disposal problems for these harsh chemicals.

What’s the Best Toothpaste for My Child?

Parents should pick up a toothpaste that is recommended by the American Dental Association as shown on the box and tube. These toothpastes have undergone testing to insure they are safe to use.

Does Your Child Grind His Teeth at Night? (Known as Bruxism)

Bruxism is the grinding of teeth. It can be caused by stress, anxiety and sleep disorders as well as an abnormal bite or teeth that are missing or crooked. Symptoms include:

  • a) Dull headaches

  • b) Jaw soreness

  • c) Teeth that are painful or loose

  • d) Fractured teeth

“Sleep” Bruxism is the grinding of teeth while you are sleeping. The cause is unclear; but the American Dental Association studies indicate that a number of factors play a role in sleep bruxism, including but not limited to, genes, anxiety, sleep patterns, anatomy and use of some types of drugs. For a child, the stress or anxiety may be based on an event in a child’s life, i.e., parental separation or divorce, changing schools, moving away from friends, etc., all of which create an environment that can cause anxiety and stress. There is also the medical-based cause relating to pressure in the inner ear at night-time.

Parents may first be made aware of a child grinding his teeth by the noise it creates or they may notice the teeth wearing down. The latter can be addressed with a simple mouth guard fitted by the dentist and worn at night-time/nap-time. The good news is that most children outgrow bruxism. It normally occurs between ages 6-9 and is gone by ages 9-12.

Thumb Sucking

Thumb sucking, like the sucking of a pacifier, are habits that can be harmful for a child’s teeth if it is allowed for a prolonged period of time. It can sometimes be caused by the child feeling insecure. Focus on correcting the cause of the stress or anxiety instead of thumb sucking. After permanent teeth come in, sucking may cause problems with the proper growth of the mouth and alignment of the teeth. It can also cause changes in the roof of the mouth. Most children stop these habits on their own, but if they are still sucking their thumbs or fingers past the age of three, a mouth appliance may be recommended by the pediatric dentist.

What is Pulp Therapy?

The pulp of a tooth is the inner, central core of the tooth. It contains nerves, blood vessels, connective tissue and reparative cells. The purpose of pulp therapy in pediatric dentistry is to preserve the life of the affected tooth.

The two common forms of pulp therapy in children’s teeth are the pulpotomy and pulpectomy.

Pulpotomy is a procedure that removes diseased pulp tissue from the crown of the tooth and uses specialized dental agents to reduce further bacterial growth.

Pulpectomy (a/k/a Baby Root Canal), is a procedure that is necessary when decay enters the nerve of a tooth. When the infection has spread beyond the crown and extends into the tooth’s root, this procedure removes the diseased pulp tissue completely from the crown and root. The canals are cleansed, medicated and filled with a resorbable material.

When Does a Child Begin Orthodontic Treatment?

The American Academy of Pediatric Dentistry (AAPD) recommends that children be seen by a dentist within 6 months of eruption of the first tooth or 12 months of age, whichever comes first. It is also recommended that the proper age for a child’s first orthodontic consultation is no later than the age of seven. With regular visits, pediatric dentists monitor a child’s orthodontic needs and can do preventative interception earlier in a child’s oral growth to enable a less aggressive orthodontic process later.

Malocclusions, also known as “Bad bites”, can be recognized as early as 2-3 years old. Stage 1-Early Treatment, which is concerned with the underdeveloped dental arches, harmful habits such as finger or thumb sucking, or the premature loss of primary teeth, is often very successful and sometimes can eliminate the need for future orthodontic/orthopedic treatment.

Stage II-Mixed Dentition, covers ages 6-12 when the permanent incisor (front teeth) and 6 year molars erupt. It is concerned with jaw mal-relationships and dental realignment problems. It is an excellent stage to begin orthodontic treatment.

Early Infant Oral Care

Perinatal & Infant Oral Health

The American Academy of Pediatric Dentistry (AAPD) recommends that all pregnant women receive counseling and oral healthcare during pregnancy. Studies have shown that "periodontal disease can increase the risk of preterm birth and low birth-weight babies and is an important aspect of overall health for pregnant women, allowing them to enter delivery in optimal health. Additionally, mothers with poor oral health may be at greater risk of infecting their children with the bacteria that causes cavities, increasing their children’s caries (tooth decay) risk at an early age."

New AAPD Oral Health Guidelines for expectant mothers and infants:

  • Oral Health Education: Early intervention and counseling during the perinatal period from all health care providers including physicians, dentists, and nurses.

  • Caries Removal: Visit your dentist regularly to have your teeth cleaned by a hygienist.

  • Oral Hygiene: Brush and floss on a daily basis to reduce bacterial plaque which research has linked to preterm, low birth-weight babies.

  • Dietary Education for the Parents: Proper diet, with the reduction of beverages and foods high in sugar & starch.

  • Fluoride: Use a fluoridated toothpaste recommended by the ADA and rinsing every night with an alcohol-free, over-the-counter mouth rinse with .05 % sodium fluoride in order to reduce plaque levels.

  • Delay of Colonization: Educating parents, especially mothers, not to share utensils, cups or food which can cause the transmission of cavity-causing bacteria to your children.

  • Xylitol Gum: Use of xylitol chewing gum (4 pieces per day by the mother) can decrease a child’s caries rate.

Talk to your doctor or dentist about ways you can prevent periodontal disease during pregnancy.

Your Child’s First Dental Visit-Establishing A “Dental Home”

The “dental home” is the ongoing relationship between the dentist and the patient, inclusive of all aspects of oral health care delivered in a comprehensive, continuously accessible, coordinated, and family-centered way. The American Academy of Pediatrics (AAP), the American Dental Association (ADA), and the American Academy of Pediatric Dentistry (AAPD) all recommend establishing a “Dental Home” for your child by one year of age. Children who have a dental home are more likely to receive appropriate preventive and routine oral health care.

When Will my Baby Start Getting Teeth?

Twenty (20) primary (baby) teeth are already present in the jaws of the baby at birth and typically begin to appear when a baby is between 6 months and one-year old. They can come in one at a time or in multiples. Some babies get their teeth early and some get them late. Every child is different, but usually the first teeth that come in are located in the top and bottom front of a baby’s mouth. Additionally, when the primary teeth start breaking through the gum line (a/k/a “Teething”), the baby will feel discomfort, having sore or tender gums. To soothe the child, parents can rub the child’s gums with a clean finger, a small cool spoon or a wet gauze pad, or you can give the child a clean teething ring to chew on.

Baby Bottle Tooth Decay (a/k/a Early Childhood Caries)

Baby Bottle Tooth Decay is a condition that is caused by frequent and prolong exposure of the baby’s teeth to drinks that contain sugar. The bacteria plaque that is constantly forming on a baby’s gums and teeth mixes with the sugar from the drink in a bottle, producing acid and the perfect environment for tooth decay formation. So letting a baby fall asleep with a bottle full of breast milk, formula, juice or any sweet drink is like soaking those developing teeth in sugar. That wouldn’t be good for anyone’s teeth, especially your baby’s teeth, and it can result in baby bottle tooth decay. The bottom line—Water in a bottle, is the best liquid that can be given to a child at nap time or bed time.

Other Tips:

  • After each feeding, use a wet gauze or clean washcloth to wipe the plaque from teeth and gums;

  • Avoid putting your child to bed with a bottle filled with anything other than water.

  • Place only formula, milk or breast mild in bottles. Avoid filling the bottle with liquids such as sugar water, juice or soft drinks.

  • If your child uses a pacifier, provide one that is clean—don’t dip it in sugar or honey.

  • Try not to share saliva with the baby through common use of feeding spoons or licking pacifiers.

  • Encourage your child to drink from a cup by his/her first birthday.

  • Encourage healthy eating habits both at meals and snack-time.

  • Infants should finish their bedtime and nap time bottles before going to bed.

  • Routine visits to your pediatric dentist every six months, beginning at your child’s first birthday.

How Long Should My Child Drink From a Sippy Cup?

The American Academy of Pediatric Dentistry (AAPD) says that “Sippy Cups were created to help children transition from a bottle to drinking from a regular cup, but they’re too often used for convenience. Because sippy cups often prevent spills, they’re often used by children for long periods of time over months and years – rather than as a transitional drinking device, a purpose for which they were intended. Sippy cups should only contain water unless it’s mealtime. When kids sip for extended periods on sugared beverages, they’re exposed to a higher risk of decay.”

The Bottom Line

The Sippy Cup is a training tool to help children transition from a bottle to a cup. It shouldn’t be used for a long period of time – It is not a bottle and it’s not a pacifier.


What Kids Eat at Snack-Time Matters!!

No one underestimates the fact that a well-balanced diet starting early in life promotes a strong and healthy balance for both body and mind. Eating the proper food groups, creates the basis for a balanced diet; however, parents know that kids love snacks! But most snacks that children tend to eat are the culprits for causing cavity formation and tooth decay. The more frequently a child snacks…the sugar in snacks remains on the teeth. Plaque/bacteria (the sticky substance that is always forming on your teeth and gums) feeds on the sugar, making acid that eats the enamel on your teeth, resulting in tooth decay. The bottom line is that kids will be healthier, resulting in stronger and healthier teeth, if they eat nutritious foods during snack time, such as fruits, vegetables, low-fat yogurt and low-fat cheese.

How Do I Prevent Cavities?

The American Academy of Pediatric Dentistry recommends visits every six months to the pediatric dentist, beginning at your child’s first birthday.

The practicing of good oral health care lessens the chance for cavities forming. Combine that with the regular visits to the pediatric dentist and teeth cleanings by the hygienist, is a formula for dental success! For older children -- brushing at least two times a day for a minute on the top teeth and a minute on the bottom teeth, in addition to brushing the tongue, along with flossing one time a day, removes bacteria and the leftover food particles that combine to create cavities. For infants, use a wet gauze or clean washcloth to wipe the plaque from teeth and gums. Most importantly, parents should avoid putting a child to bed with a bottle filled with anything other than water.

Some other tips for preventing cavities include:

  • Limit frequency of meals and snacks.

  • Encourage brushing, flossing, and rinsing.

  • Watch what you drink.

  • Avoid sticky foods.

  • Make treats part of meals.

  • Choose nutritious snacks.

  • Routine visits to your pediatric dentist every six months, beginning at your child’s first birthday. The pediatric dentist may recommend protective sealants or home fluoride treatments for your child that can be applied to the molars to prevent tooth decay where it is hard to brush.

Dental Sealants

A sealant is a clear or shaded plastic material that is applied to the chewing surfaces (grooves) of the back teeth (premolars and molars). The sealant quickly bonds into the 4 depressions and grooves of the teeth, forming a protective shield over the enamel of each tooth. It protects the teeth from food, plaque and acid that cause tooth decay.


Fluoride is an element, which has been shown to be beneficial to teeth. However, too little or too much fluoride can be detrimental to the teeth. Little or no fluoride will not strengthen the teeth to help them resist cavities. Excessive fluoride ingestion by preschool-aged children can lead to dental fluorosis, which is a chalky white to even brown discoloration of the permanent teeth. Many children often get more fluoride than their parents realize. Being aware of a child’s potential sources of fluoride can help parents prevent the possibility of dental fluorosis.

Some of these sources are:

  • Too much fluoridated toothpaste at an early age.

  • The inappropriate use of fluoride supplements.

  • Hidden sources of fluoride in the child’s diet.

Two and three year olds may not be able to expectorate (spit out) fluoride-containing toothpaste when brushing. As a result, these youngsters may ingest an excessive amount of fluoride during tooth brushing. Toothpaste ingestion during this critical period of permanent tooth development is the greatest risk factor in the development of fluorosis.

Excessive and inappropriate intake of fluoride supplements may also contribute to fluorosis. Fluoride drops and tablets, as well as fluoride fortified vitamins should not be given to infants younger than six months of age. After that time, fluoride supplements should only be given to children after all of the sources of ingested fluoride have been accounted for and upon the recommendation of your pediatrician or pediatric dentist.

Certain foods contain high levels of fluoride, especially powdered concentrate infant formula, soy-based infant formula, infant dry cereals, creamed spinach, and infant chicken products. Please read the label or contact the manufacturer. Some beverages also contain high levels of fluoride, especially decaffeinated teas, white grape juices, and juice drinks manufactured in fluoridated cities.

Parents can take the following steps to decrease the risk of fluorosis in their children’s teeth:

  • Use baby tooth cleanser on the toothbrush of the very young child.

  • Place only a pea-sized drop of children’s toothpaste on the brush when brushing.

  • Account for all of the sources of ingested fluoride before requesting fluoride supplements from your child’s physician or pediatric dentist.

  • Avoid giving any fluoride-containing supplements to infants until they are at least 6 months old.

  • Obtain fluoride level test results for your drinking water before giving fluoride supplements to your child (check with local water utilities).

Protective Sportswear- Use of Mouthguards

When it comes to protecting your mouth, a mouth guard is an essential piece of athletic gear that should be part of your standard equipment from an early age. A properly fitted mouthguard, or mouth protector, is an important piece of athletic gear that can help protect your child’s smile, and should be used during any activity that could result in a blow to the face or mouth.

Additionally, mouthguards help prevent broken teeth, and injuries to the lips, tongue, face or jaw. A properly fitted mouth guard will stay in place while your child is wearing it, making it easy for them to talk and breathe.

Talk to your dentist or orthodontist about selecting a mouth guard that will provide the right protection as they can be custom-made or store-bought.

Adolescent Dentistry

Tongue Piercing – Is it really worth it?

Adults and teenagers in particular today, seem so casual when they speak about tongue piercings. It has gotten totally acceptable in society. The question you might ask yourself is— Did they take the time to research what happens or could happen during the process of piercing and in the long-term?

Tongue piercings or tongue splitting may look cool, but they can be dangerous to your health. Medically, your mouth contains millions of bacteria, and infection and swelling often occur with mouth piercings. Per the American Dental Association, “our mouth and tongue could swell so much in the process, that you close off your airway or you could possibly choke if part of the jewelry breaks off in your mouth. Furthermore, you could crack a tooth if you bite down too hard on the piercing, and repeated clicking of the jewelry against teeth can also cause damage. Oral piercing could also lead to more serious infections, like hepatitis or endocarditis. Piercing your tongue, lips, cheeks or uvula (the tiny tissue that hangs at the back of the throat,) it can interfere with speech, chewing or swallowing.”

With the possibility of infection, pain and swelling in addition to the damage to gums, teeth and fillings, it also may cause:

  • Hypersensitivity to metals. Allergic reactions at the pierced site are also possible.

  • Nerve damage. After a piercing, you may experience a numb tongue that is caused by nerve damage that is usually temporary, but can sometimes be permanent. The injured nerve may affect your sense of taste, or how you move your mouth. Damage to your tongue’s blood vessels can cause serious blood loss.

  • Excessive drooling. Your tongue piercing can increase saliva production.

  • Dental appointment difficulties. The jewelry can get in the way of dental care by blocking X-rays.

The bottom line—Don’t pierce on a whim! The piercing will be an added responsibility to your life, requiring constant attention and upkeep. Talk to your dentist for more information.

Tobacco Products - Cancer Anyone?

Smoking or Chewing Tobacco, is it worth it?? Parents need to discuss the dangers of tobacco with their children and teens so that they can think on their own when friends try to coerce them into trying it! Some teens who are involved in sports, think that the use of smokeless tobacco (a/k/a spit, dip, chew or snuff) is the norm when playing ball; other kids just think it’s cool! They think that it’s the safe alternative to smoking cigarettes. This is an unfortunate misconception. A statistic that should be promoted is that one can of snuff per day delivers as much nicotine as 60 cigarettes.

Teens need to know -- Tobacco products can cause bad breath, but that’s only the beginning. Other possible oral health impacts of smoking and all tobacco products include:

  • stained teeth and tongue

  • dulled sense of taste and smell

  • slow healing after a tooth extraction or other surgery

  • difficulties in correcting cosmetic dental problems

  • gum disease

  • oral cancer

And remember, there is no such thing as a healthy tobacco product!