FAQs

Pediatric dentistry is a specialty of dentistry, similar to the specialty of pediatrics within general medicine. Pediatric dentists receive two additional years of specialty training to provide oral health care and education for infancy through adolescence, as well as for children with special needs. Their specialized training includes emphasis on trauma, behavior management, infant oral health, interceptive orthodontics, sedation and hospital dentistry. Children benefit most from individualized approaches that are specific to their age and developmental stages. A pediatric dentist is best qualified to meet those unique needs.

After two years of specialty training, pediatric dentists dedicated to pursuing excellence in their field may voluntarily undergo a rigorous process to become certified by the American Board of Pediatric Dentistry (ABPD).

The ABPD requires that all members remain current in the latest developments in care, research, and technology. Once certified, in order to remain in good standing, additional continuing education in the field of pediatric dentistry above and beyond the minimum required to be a pediatric dentist must be undertaken on a yearly basis. Learn more at the American Board of Pediatric Dentistry

Dr. Mann is a Board Certified Pediatric Dentist!

Baby teeth do eventually fall out, but they also serve some very important functions while they are in:

• chewing and eating
• providing space for permanent teeth and guiding them into position
• allowing for proper jaw bone and muscle development
• for proper speech and having an attractive appearance

Children’s teeth begin forming before birth. Teething is variable among individual babies. Around six to ten months, the first lower center baby teeth usually make an appearance. Although all 20 baby teeth usually appear by age three, their pace and order of eruption may vary.

Permanent teeth begin appearing around age six, starting with the first molars and lower central incisors. This process continues until approximately 21 years of age, if there is space for the third molars (wisdom teeth) to erupt in.

The front teeth (incisors) are usually lost between six to eight years of age, and the back teeth (canines and molars) are not lost until ages nine to thirteen.

One form of serious tooth decay found in infants and toddlers is called “baby bottle tooth decay”. This is caused by frequent exposure to liquids that contain sugar, including milk, breast milk, formula, fruit juice and other sweetened drinks. If a young child is put to bed for a nap or at nighttime with any drink other than water, it can cause rapid and devastating tooth decay. The sweetened, sugary liquids can pool around the child’s teeth giving the bacteria in plaque the sugar they need to make acid and causes tooth decay. If feeding your baby at night, wipe the gums and teeth with a damp cloth, tooth wipe or toothbrush afterwards. During the day, for toddlers and older children using Sippy cups, offer water only between meals and save other drinks for meal and snack time.

Preventative dentistry is especially important for special needs children and adults. Unlike many of the health issues faced by patients with special needs, dental disease is preventable.

As a parent or caregiver, you may have concerns about your child’s ability to tolerate a dental visit. Please do not postpone dental care. Dr. Mann is always available to discuss any concerns you may have prior to meeting with you and your child. Dr. Mann and her team are highly experienced in caring for patients with special needs, and are happy to provide the extra care and TLC you and your child need to feel comfortable.

Some tips to help with oral care:

• http://specializedcare.com is an excellent resource with educational videos on caring for another person’s teeth, oral care kits and adaptive surround toothbrushes.
• If your child or adult you care for cannot be brushed with toothpaste, due to an inability to spit or gagging, brush with a fluoride rinse.
• Talk to Dr. Mann for more suggestions, she is happy to make individualized recommendations for your child or adult’s particular needs.

Once your child’s teeth start erupting, you can begin to clean them by wiping them with a wet washcloth, a tooth wipe or soft child’s toothbrush and a smear of fluoride free baby toothpaste.

Starting at age two or three, you can begin to teach your child to brush. You will still need to brush before or after their turn. Use one hand to draw the cheek away and the other to move the brush in circles or back and forth strokes at a 45 degree angle towards teeth and gums.

For ages 2 and up, a smear of fluoridated toothpaste is recommended. Once your child can spit out the excess paste, a pea sized amount of toothpaste may be used.

Children brush by themselves when they have the manual dexterity to tie their own shoelaces or write in cursive, usually around ages seven to eight years old. It is still best to supervise their brushing and help as needed. Brushing two times a day is recommended, once after breakfast, and again before bed.

To help your child learn where to brush, it can be fun to let them rinse with mouth rinse that will “stain” their teeth temporarily and then brush them clean, like Listerine Agent Cool Blue Tinting Rinse or Inspector Hector Plaque Detector.

For children over two years of age, begin to use a small smear of fluoridated toothpaste for your child, unless advised differently by Dr. Mann. Once your child is able to spit the toothpaste, use a pea-sized amount when helping your child brush.

If the sides of teeth are touching together, toothbrush bristles cannot reach between to clean. Any spots where teeth are touching should be flossed daily. Baby teeth usually begin to touch around age four, especially between the back molars. In the beginning, a parent will need to floss. As a child gets older, parents can supervise and allow their child to floss. This skill is usually mastered by middle school.

Bacteria in plaque break down sugars to produce acid. If the acid is not removed, the tooth enamel weakens and then breaks down over time, forming a cavity. Brushing and flossing physically remove the sugars, plaque and acid from the teeth.

The good food choices for teeth are: cheeses, chicken or other meats, nuts, peanut butter and milk. These foods are thought to protect the tooth enamel by providing calcium and phosphorus to remineralize teeth.

Other good food choices for teeth are firm and crunchy foods like: apples, pears and vegetables. The high water content of these foods will dilute their natural sugars and stimulate saliva to wash away food particles. Popcorn is another good snack choice that is crunchy to clean teeth.

Acidic foods, such as citrus fruits, tomatoes and lemons, should be eaten as part of a larger meal to minimize their acids.

Everybody likes to have a sweet now and again. The key is choosing sweets that are tooth friendly and melt away. Melt away sweets, such as popsicles, ice cream, pudding or chocolate, are better choices than sticky treats, such as fruit roll-ups, lollipops and fruit snacks. A good test is if it would make your teeth stick together when you chew it, it should be a hardly ever or never treat.

Snacking or ‘grazing’ throughout the day can cause cavities, since constantly eating food leads to more sugars in the mouth and more frequent acid attacks. It is better to eat three meals a day with limited snacks than eating constantly throughout the day.

Sipping on a sugary drink or licking a hard candy slowly to make it last will create a longer lasting acid attack.

Be careful with starchy snacks such as pretzels, goldfish and potato chips, as starches break down into sugars too.

The best beverage choice between meals is water. Any other drinks are better to drink at meal or snack time. It takes your saliva 20 minutes to wash away sugars and acids. Slow sipping of beverages between meals, like a toddler drinking a Sippy cup of juice while playing, exposes teeth to constant sugar and can cause cavities. Limit consumption of sugary drinks, such as juice, soda, lemonade and tea with added sugar.

Exercise care with sports drinks. Due to their high sugar content and acids, sports drinks should be avoided and children may hydrate with water. If a sport drink is consumed, it should be consumed quickly and rinsed with water afterwards.

Fluoride helps stop the loss of minerals from tooth enamel (demineralization) and encourages strengthening of areas that are weakened (remineralization). Fluoride also affects the metabolism of the bacteria in plaque, discouraging acid attacks that break down the tooth. When permanent teeth are exposed to fluoride while forming, they make a harder enamel which is more resistant to acid attack then regular enamel.

If your area does not have fluoridated water and after considering other factors, Dr. Mann may recommend a fluoride supplement while your child’s permanent teeth are forming.

If you are unsure if your community’s water is fluoridated, we offer complimentary fluoride testing of your child’s drinking water. Just bring a 2-3 oz sample of water in a plastic container to your child’s first visit.

Dr. Mann may use x-rays to evaluate for cavities between the teeth, show unerupted, extra, or missing teeth, diagnose bone diseases, evaluate the results of an injury, survey the growth and development of erupting teeth, or to plan orthodontic treatment. X-rays can help to detect dental problems early, allowing for less extensive and expensive dental care.

Early detection of incipient enamel lesions (tiny in-between the teeth cavities) that would be invisible without x-rays, allows Dr. Mann to create an individualized home care plan that can stop or even reverse those small cavities when caught early. X-rays help Dr. Mann to be conservative in her care.

Extremely safe! Our office uses digital x-rays, which means the amount of exposure is very small. To help put it into perspective, according to the American Nuclear Society, the average dose per person from all radiation sources is about 620 mrems per year. Some typical sources of radiation from daily living are:

• 16 mrem/year = living in a state that borders the Gulf or Atlantic coasts
• 10 mrem/year = cooking with natural gas
• 7 mrem/year = living in a brick house instead of a wood one
• 5 mrem = flying in an airplane cross country flight
• 0.1 mrem = digital x-ray

Obviously, you would probably not move from New Jersey, refuse to fly on an airplane, stop living in a brick house and never cook with gas, because of the small amount of radiation you receive from those activities.

A digital dental x-ray exposure is 0.1 mrem. It is a 90% exposure reduction compared to the “old fashioned” dental x-rays. Dr. Mann’s practice only uses digital x-rays to minimize your child’s exposure to radiation. Lead body aprons and thyroid shields are used to further protect your child from exposure.

Source:

“Radiation Dose Chart.” American Nuclear Society. Updated 2012.

Children do much better when they know what to expect. We use the TELL SHOW DO method. We TELL your child about the procedure, in an age appropriate manner. Next we SHOW, which introduces the procedure in an exploratory way to examine the sound, smell, sight or sensations. Then we DO the treatment, carefully following each step as described.

Kid Friendly Term and Matching Instrument/Procedure

• Sleepy jelly = topical anesthetic
• Tooth pillow = bite block
• Sponge Bob nose/ Fighter pilot nose = nitrous oxide
• Tooth ring = clamp
• Raincoat = rubber dam
• Princess tooth/ Superhero tooth = crown
• Mr. Thirsty = suction
• Fairy light = curing light
• Tickle brush = prophy cup
• Whistle brush = high speed handpiece
• Bouncy brush = slow speed handpiece

We ask that you avoid using words that could create dental fear, such as “needle” or “shot”, “hurt” or “won’t hurt” and “don’t be afraid”.

Your child will know that you are there and you can support your child with touch, gentle foot rubs or hand holding. This allows us to communicate clearly with your child. Children will normally listen to their parents and may not hear our guidance.

These are ways that you can actively help make your child’s visit a success

While pacifier sucking can also cause the same problems as a thumb or finger, it is usually an easier habit to break. You can throw away a pacifier, the thumb, not so much.

Suggestions for stopping a pacifier habit are: a visit from the pacifier fairy, giving the pacifiers to someone with a new baby or bringing them into our office to put in the “binky bank”. What all of these choices have in common is going cold turkey. When you are ready to do it, go for it and don’t look back.

Suggestions for daytime:

• Keep it positive. It is difficult for a grown up to break a habit, and hard for a child too. Patience and understanding with positive praise when your child is not sucking is best.

Try to determine the underlying cause is and address that as children tend to suck their thumbs when they are feeling insecure or bored.

• Reading books, such as David Decides, Berenstain Bears and the Bad Habit or Thumb Love may help. These may be available at the library or Dr. Mann is happy to lend you one of her copies.
• A reward calendar where the child can track days they have avoided thumb sucking with marks or stickers. Agree on a motivating reward ahead of time and after 30 consecutive days, enjoy the reward. If the program isn’t succeeding after 2-3 months, tell your child that it seems as though you haven’t started at the best time for change and that you are stopping temporarily. Tell your child that the program will be started again on date that the child will recognize, like Valentine’s Day or Thanksgiving.
• Reminder finger polish, like Mavala, available at Amazon.com, has a bitter taste which serves as a reminder not to place fingers or thumb in the mouth. Mavala is applied regularly 2-3 times a day on the nail and surrounding skin. This helps the child to become aware of their habit to help them to stop.
• Dr. Mann and her team can encourage your child to stop sucking and explain why it is important to stop the habit too.

Suggestions for nighttime:

• Try placing a band aid on the favorite finger or a sock or mitten gently taped at the base of the favored hand or an ace bandage gently wrapped around an elbow (which prevents the arm from bending at the elbow to get a thumb in). These can be tracked on a reward calendar for each night the child is able to keep it on and dry.
• For something that cannot be removed, the ThumbGuard or FingerGuard are clear plastic cones with a hospital bracelet that a parent must cut with a scissor to remove in the morning.

These suggestions are usually enough to successfully stop the habit. If it is not enough, Dr. Mann can help with other strategies, such as fabricating a habit appliance.

Nope, that nails-on-the-blackboard sound is your child grinding their teeth. Good news is, as horrible as it sounds; it is something your child will likely outgrow.

It is very common in children under 7-8 years old. Many children will stop grinding once their first permanent molars erupt around age 6.

The cause of tooth grinding is not well known. Many children do this and this does not mean that they are stressed. Sometimes this is a natural expression of frustration until their vocabulary increases and they can verbally express their frustrations. Grinding may also come and go with seasonal changes for children who have seasonal allergies or chronic congestion. When congestion is present, children may grind their teeth to relieve inner ear pressure.

To help reduce congestion, parents can consider switching out down bedding products for foam substitutes which are less likely to harbor dust mites and fomites. Stuffed animals and other toys may be laundered to decrease allergens that cause congestion.

For grinding alone, usually little or no treatment is indicated. Dr. Mann will check for wear patterns on permanent teeth and recommend a mouth guard to protect the teeth from further wear if appropriate.

The next time your child falls asleep, check to see if they are breathing through their nose or through their mouth. Mouth breathing with snoring or grinding, may be indicators of sleep apnea.

Sleep apnea is a condition in which a person’s breathing repeatedly stops during sleep. It is more commonly seen in adults, but children may suffer from it as well.

It may be caused by an obstruction in the airway, such as enlarged adenoids and tonsils, or the size of the airway, muscle tone or nasal congestion.

A child who breathes through their mouth usually does not sleep well. This tiredness can affect energy levels, school performance, and can cause behavior and attention problems that may be misdiagnosed as attention-deficit hyperactivity disorder (ADHD). If sleep apnea goes untreated, dental health issues such as a long face, gummy smile, gingivitis, narrow palate and misaligned teeth may result as well.

Dr. Mann is trained to assess your child’s airway and will work with an ear-nose-throat (ENT), pediatric sleep specialist or orthodontist for corrective treatment. An overnight sleep study and/or an x-ray of the child’s head and neck to see whether the airway is too narrow or blocked, can help to further diagnose. If an airway obstruction is present, removing tonsils or other airway obstructions can help. Weight management, medicines to relieve nasal congestion, special appliances to expand the arches and positional therapy, may be helpful to open your child’s airway for proper rest, growth and development.