Frequently Asked Questions

Q. What is a Paediatric Dentist?

A Paediatric Dentist is a dentist who has completed additional training specific to providing dental care for children. Dental training takes 5 years on average; Paediatric Dentists have completed 2 to 3 years full time additional training and qualification. This training includes behaviour guidance techniques, growth and development of the child, interceptive orthodontics and space management, dental care for special needs patients and dental management of the medically compromised child.

With this additional training and skill a Paediatric Dentist should be in the position to advise what the best plan is for your child. This should include how the treatment will be carried out, what can be expected in the future, what can be done in the surgery and at home to prevent similar problems from recurring in the future. The plan is modified to fit the needs of each individual child patient.

Q. When should I bring my child to the Dentist?

Sooner rather than later. I advise a visit before two years of age. This allows advice about tooth brushing, toothpaste, appropriate weaning, and use of soothers and thumb sucking. It also allows assessment of the developing dentition and identification of children at risk of early childhood caries. Examination at this age is usually carried out with the child patient sitting on the parent's knee. If the teeth and gums are healthy an annual visit will normally suffice until 5/6 years of age. By this age most children graduate to sitting in the dental chair for their visits.

Q. Will I be able to stay in the surgery during the dental visit?

In my practice I allow the parent and child to make this decision; most parents stay for all visits. If a parent does not wish to stay in the dental surgery, they can remain in the waiting room but are welcome to enter the surgery at any stage of the visit. Brothers and sisters are also welcome to come into the surgery. However if we anticipate a long visit or a visit that may upset younger siblings I will advise that they remain in the waiting room until the visit is completed.

Q. What will happen at the first visit?

The first visit to the dentist is very important. A pleasant introduction will help create the right attitude for future visits. We ask the parent to fill out a brief questionnaire prior to entering the dental surgery. This forms the basis for the opening discussion with the child, parent and dentist. Following choosing a suitable toothbrush and instructing the child and parent in brushing technique I will carry out an initial examination of the teeth and oral tissues. If additional information is required Dental X rays will be taken. A thorough cleaning follows where required, with the X rays viewed and discussed before the end of the visit.

A treatment plan and specific visit plan will be drawn up and explained with a costing included. I will also discuss the options for keeping the child happy with comprehensive pain control measures during the proposed treatment visits. If there is an emergency situation involving pain or discomfort this will be dealt with at the first visit. Non emergency treatments will be carried out at subsequent visits.

Q. Which toothbrush should I use for my child?

There are two types of brush - electric and manual. Both are equally good at removing plaque. All brushes should be soft in texture and small in size. The best way to measure the brush is to hold it up against your child's bottom four front teeth. Its length should not exceed the width of the bottom four front teeth.

Q. Which toothpaste should I use for my child?

Toothpaste use is age related:

All the major toothpaste brands are equally good. The most important advice is that you should only use a pea sized amount of paste from 2 years of age upwards. At the end of brushing I advise spitting out as much paste as possible.

Q. Who should be doing the brushing?

Again this is age related - up to 7 years of age children need assistance with brushing. I ask for a parent or care giver to brush for children twice per day until 7 years of age. If the child wants to do some brushing, this is fine after the adult has cleaned the teeth. From 7 years of age upwards the child can brush with supervision from a parent or caregiver.

Q. What about Flossing?

Floss allows you to clean between the teeth when they are tight together. Again flossing is age related and tooth related. Children do not have the skill to floss properly until about 10 years of age. So I ask the parents or caregivers to floss once per day for the child. Before going to bed, when there is usually more time, I advise flossing first and brushing second.

If the teeth are tight together then floss is needed. If there are spaces present, floss may not be needed as the brush will clean between the teeth. Waxed floss or unwaxed floss both work well.

Q. Can having a bottle cause decay?

It depends on what is in the bottle and when the bottle is used. Sweetened drinks are most likely to cause decay although milk or formula can also cause decay. If the bottle is used at night when in bed it can cause a particularly aggressive form of decay: early childhood caries. This happens because we do not have saliva produced at night, so whatever we drink stays in our mouth all night.

Top front teeth are most often affected by drinks at night. If the bedtime habit continues, eventually top back teeth and bottom back teeth will become decayed. Children who are breast fed on demand at night can also develop early childhood caries.

To avoid early childhood caries:

Q. How do some children have decay eating the same diet as decay free children?

Some children are more likely to get decay than others. This is most likely explained by the quality of their teeth. We inherit our tooth quality from our parents, some people inherit soft teeth. If this is the case they are more likely to get decay in both their primary/baby teeth and their permanent teeth. There is no test currently available to identify soft teeth, you only find out by experiencing decay. "Soft teeth" look the same as "normal teeth". To keep your child's teeth healthy in this situation, your child's diet needs to be low in sugar intake and your child's cleaning needs to be better than everybody else. From 6 years of age onwards using a daily fluoride rinse and sealing the permanent molars helps reduce the risk of further decay.

Q. What will happen with decayed primary teeth?

Primary/Baby/Milk teeth should be retained until they fall out naturally. If the cavities are small, the tooth can be restored with a tooth coloured filling. Larger cavities in primary back (molar) teeth can be restored with a stainless steel crown. This is a very durable restoration and lasts much better than a big filling. It looks like a tooth but is made of steel. Large cavities in primary front (incisor) teeth can be restored with strip crowns. These are white in colour and restore the appearance and function of decayed front teeth. In my practice I don't use Amalgam fillings; I use white fillings or stainless steel crowns.

If the primary teeth have infection or an abscess as a result of decay they should be treated to eliminate the infection. This can involve extracting the tooth, or carrying out root canal treatment and crown if the tooth is to be preserved. Leaving infected teeth runs the risk of damaging the developing permanent successor tooth. It also runs the risk of pain and swelling occurring in the future.

Q. Are baby teeth important?

Baby/Primary/Milk teeth serve a number of functions:

If the primary tooth is retained until it falls out naturally it will have served its purposes perfectly. If primary teeth become decayed, it is worthwhile treating the decay if the tooth is not due to be lost for 2 years. Primary front teeth are lost between 5 and 8 years, primary back teeth are lost between 9 and 12 years of age. Treating the decayed primary tooth also reduces the number of decay producing bacteria in the mouth; this reduces the risk of decay occurring in the permanent teeth.

Q. How can I prevent decay?

In order for decay to develop we need three factors to come together:

The sugar comes from the foods and drinks we consume. To prevent decay we should reduce how often we have sugar each day. If we must have a "treat" have it with our meals it does less harm. After we eat sugar, the bacteria in the mouth (plaque) use the sugar to produce energy; it also produces acid which dissolves part of the tooth. If this happens often enough a cavity will develops. Liquid sugars are popular with children; milk and water are more tooth friendly than juices or soft drinks.

The plaque we all have in our mouth plays a major role in decay; it produces the acid. Certain bacteria are very efficient at producing acid; if we consume sugars frequently and our cleaning is not good these acidogenic bacteria will thrive and multiply. This increases our risk of future decay. Brushing effectively twice per day with a fluoridated paste and flossing once per day reduces the number of harmful bacteria in our mouths. This reduces the risk of developing future decay. The susceptibility of our teeth to decay is genetically determined. We inherit tooth quality from our parents. If we have inherited soft teeth these teeth can be made more resistant to decay by a number of preventive strategies:

1. Optimal Exposure to Fluoride:

Fluoride promotes repair of acid damaged enamel by promoting remineralisation from saliva.

2. Fissure Sealing

Our back teeth have grooves and valleys (fissures) on the biting surfaces. These fissures retain plaque and food. 90% of decay in children occurs on these surfaces. The sealant is white in colour. It is applied as a liquid to the biting surface of the permanent molar teeth. A curing light then sets the sealant in place. The sealant works by preventing the plaque from sitting in the fissure 24/7.If some of the sealant is lost it can easily be replaced during check visits. Fissure sealants are placed on permanent molar teeth; they can also be applied to permanent premolars. If children have had decay in primary teeth, sealing primary molars will help reduce the risk of further decay.

Q. What is a Fissure Sealant?

A fissure sealant is a dental treatment applied to the valleys, groves and pits to prevent decay. It consists of a clear or white liquid which is painted onto the fissure before being set by a curing light. The sealant then stops plaque and food being in contact with the tooth 24/7.

Our back teeth (molars) are used for chewing food. They have a rough surface with many valleys, groves, and pits (fissures) that make them good at breaking up food. However these valleys and groves retain plaque and food particles placing the tooth at risk of decay. In Ireland 90% of all decay in children occurs on the fissured surfaces of permanent molars.

The application of the sealant is quick and comfortable. It takes one visit. It involves cleaning the tooth, conditioning the enamel before rinsing and drying the surface. The sealant is flowed onto the groves before being set. Your child will be able to eat right after the appointment.

Sealants need to be checked at review visits. If part of the sealant is lost it can be replaced at this visit. Sticky sweets can pull off fissure sealants so they should be avoided.

Sealants are made from the same material as white fillings. They are resin based. They have been used safely in Dentistry for children since 1975.