Three months ago, when Jia was only about 4.5 months old, I was convinced she was teething. I couldn’t see any teeth yet, but noticed some hints of white beneath the gum and she was waking in the middle of the night (something I thought we were done with). She was letting out a high-pitched unfamiliar cry, was temporarily quieted with frozen teething rings, but still wouldn’t sleep. The only thing that would lull her back to sleep was nursing (I’d already weaned her from night feedings). Her pediatrician confirmed she was teething (Jia had a low grade temp, consistent with that of teething), but part of me suspected he only told me this to alleviate my anxiety about why she was all of a sudden not sleeping through the night.

Fast forward 2.5 months later, right before Jia’s 7 month birthday we finally saw two teeth sprout up from her bottom gums. OK, to tell you the truth, I was nursing her and felt her chomp down *OUCH* Only 2-3 weeks later, three more teeth on her upper gums started peeking through. My little Ji-A-Lantern was growing up and now I am faced with questions re: first dental appointment.

(Read below for tips from Alexandria Pediatric Dentistry.)

Recently, I had the privilege of talking with Family Dentist Warren Eng, DDS of Horseheads Dental, about general dental care for children. Though his patients range from age 4 and up, I wanted to get some advice as a parent of a recently toothy baby.

Overall Advice about Dental Appointments (from Horseheads Dental) for Children:

  • Family dentists will see children starting at around preschool age, but their willingness to work with the child can sometimes depend on the little ones’  personality. If the child is having a difficult time adjusting to being at the dentist, is throwing a fit, screaming, crying, etc. s/he may advise the parent to come back another time or try a different dentist.
  • Encourage parents to bring their children to the dentist as early as possible. Bring your little one along with you to your appointment, seat them in the chair with you. This will help to desensitize the environment. Bring them in and have your children interact with the staff and get used to the smells and surroundings. When they see mom doing well at their appointment, they won’t be as scared. Children model their parent’s positive behavior.
  • If a child needs to get a filling, even as a young child, make sure the parent doesn’t appear scared. Children will feed off of their parents’ demeanor, so if you are calm, the child will more likely stay calm. But, if you are anxious, your child can sense this and will feel anxious. (Similar to when your little one bumps her head, if you react worried, she will likely start to cry. If you smile and say “that was a little bump on your cute head!” then your child won’t think that it’s something to cry about.
  • Who’s the Boss? Some dentists prefer parents not to be with the child when they are old enough to sit alone in the dentist chair, because the dentist should be the boss. Other dentists prefer the parent coming in because that helps the child feel more comfortable.

Regarding Dental Care:

  • When the baby goes to bed, DO NOT give them a bottle with juice, milk, or formula! This leads to bottle syndrome. When they’re going to sleep, it’s (the liquid) bathing the teeth constantly with the sugar (yes, even breastmilk), which will cause decay. Dr. Eng says, “Sodas are extra bad because of not only sugar in the soda but also the acidic pH of the soda from the carbonation. Bacteria love acidic environments.”
  • If a child is seen at the dentist to have bottle syndrome, they will often refer the daily to a Pediatric Dentist that specializes in it, as the process to repair rotting teeth can be very extensive and painful, requiring a specialist’s approach.
  • If you want to ensure that a trip to the dentist is less traumatizing: Never start their early experiences at the dentist with needing fillings and tooth removal. This will negatively affect their ability to chew and eat. Nothing will traumatize children more about going to the dentist like needing stainless steel crowns, caps, and root canals. Fillings are difficult for baby teeth, because there is not a lot of tooth to work with, so often caps or crowns are placed.
  • Misconception: “They’ll (baby teeth) fall out anyway.” Children need healthy baby teeth in order to chew, eat, and to reserve the space for the grown-up/permanent teeth to fit properly.

I also visited Alexandria Pediatric Dentistry and met with Dr. Joseph Lopez, DMD MPH (pictured below with Jia) to ask specific questions and get some advice about what to expect, as a parent:

Don’t delay your first dental visit, to avoid visits involving extensive dental care, like tooth removal, fillings, anesthesia, etc.

Bringing your child in at an early age helps them “break in” the experience to help prevent them from being afraid of their surroundings.

IMG_2830Infant Dental Tips: Get toothbrushes that are made specifically for little ones with new teeth, such as the Mam First Tooth Brush for infants. Another option is to use a wet washcloth to gently rub the gums and teeth. Wiping down the surface around the gums and teeth, even before bed after a pre-bedtime feeding, will help to clean a yummy environment to bacteria to break down teeth. This will serve to wipe down the residue from breastmilk or formula, food or debris on their teeth and gums. The more teeth a baby has, the greater the enamel surface area for bacteria to latch on and eat away. This should be incorporated into the nighttime routine as soon as the first tooth comes through. The American Academy of Pediatric Dentistry recommends doing this at LEAST once a day and with a “tiny smear of fluoride toothpaste,” so Dr. Lopez recommends doing this twice a day: after a feeding and before bedtime.

Warning Signs to Visit the Dentist Earlier: Discolored (brownish) teeth, obvious pain or discomfort when chewing, preferring one side over another for chewing, dental trauma. If something doesn’t look “normal,” call the dentist.

What to Expect from the 1st Visit: Medical history intake (allergies, eating habits, who takes care of the dental routine at home, how often teeth are cleaned). This appointment is usually more of a conversation to strategize how to take properly care for baby’s teeth and overall oral health.

If the baby (or child) will allow, the dentist will then do a visual inspection. He will gently clean the existing teeth, check ones coming in, feel around the bone structures. This helps the dentist to see if the baby is meeting their age-appropriate dental milestones.

Dr. Lopez usually performs a parent/dentist knee-to-knee exam with baby lying on his/her back on parent’s legs, or by performing the exam with baby in mom or dad’s lap. These methods make sure baby doesn’t feel she’s there all by herself. Bring toys or blankets that help baby feel comfortable.

X-Rays are not typically taken on routine exams. Dr. Lopez (like most pediatric dentists) try to limit exposure of children to radiation by taking X-Rays in the event of oral trauma. Child-sized protective lead aprons should be available at all pediatric dentist offices.IMG_2833

Usual/Expected Pattern of Teething: Lower front teeth erupt first (almost 100% of the time), then some upper teeth, lower, upper, etc.  When baby teeth are replaced with permanent teeth, they fall out and follow this similar sequence. According to Dr. Lopez, baby teeth start peeking through for “early erupters” at around 5-6 months up until the last teeth coming through at around 2.5 to 3 years old (10 upper and 10 lower), with 12 remaining molars coming in later.  Girls usually erupt new teeth earlier than boys.

Recommended Schedule for Dental Visits: Make sure the have your child see the dentist by their 1st birthday. Like adults, children should see the dentist every 6 months unless there is something else going on where you are encouraged to come in right away or more frequently.

Why a Pediatric Dentist vs. a Family Dentist? Pediatric dentists have extra training for primary (routine) and specialized care for infants and children up to adolescents. Little teeth are different from big teeth! Plus, pediatric dentists go into this specialty because they love seeing kids smile!

Teething Discomfort: In July 2014, the AAPD issued a statement on the FDA’s Lidocaine Alert warning AGAINST the use of lidocaine, even at 2%, for infants and children with teething pain. The AAPD President, Dr. Edward Moody Jr. recommends to address teething discomforts by non-medicinal alternatives. Just an FYI, Baby Orajel has 7.5% benzocaine. The reason for this warning is due to its numbing effect (as an anesthetic) that can impair swallowing and the cough/choking reflex.  AAPD statement found here.

Dr. Lopez suggests baby ibuprofen (if age appropriate, per your pediatrician) or tylenol but really recommends frozen relief: teething rings, wet frozen wash cloths, teething toys, etc. I also mentioned to Dr. Lopez how we’d used Hyland’s Teething Tablets for Jia and he said his sister swears by them, so I felt like he wasn’t against the use of these…

His Main Message to Parents: Bring them in early! Don’t wait!

I hope this post helped some of you, I definitely learned a lot. To you nursing mamas out there, if your toothy kiddo bites you, you can try what I did and yell out “ouch!” each time and see if that works. Jia startled when I yelled and stopped biting after 3 days (haha)…

Thanks to Drs. Eng and Lopez! To Dr. Lopez, Jia will be coming by for her first visit soon enough! NoVa moms, go see Dr. Lopez at Alexandria Pediatric Dentistry, kids and babies love him and his office is so cheerful bright and happy (and super clean)! Pictured above is Jia with Dr. Lopez, wearing a hot pink Tutu part of a Breast Cancer Awareness challenge on Facebook. He likes to keep communication with his patients and families through his Facebook page and blog

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