Daniel Seetin, DDS

If the extraction is because a baby tooth is over-retained and the tooth is not/was not infected, then he does not need antibiotics. However, some children have medical conditions, such as prosthetic heart valves and other internal prosthetic devices, which require taking antibiotics before most procedures, including cleanings. If your son does not have a medical condition like that, then no, he does not need antibiotics before or after the extraction.

Yes. I tell all of the parents of my patients to begin flossing their child's teeth as soon as the back teeth (baby molars) touch - this can be as early as 24-36 months. The MOST COMMON location for children to get cavities is between their teeth, in the "flossing spaces" because the brush can't reach there and the bacteria that cause cavities can live freely until they are flossed out. Especially with many kids diets today being full of snack foods such as crackers and chips (goldfish crackers, cheese-its, dry cereal) - any food that is "dry" and made of ground up bread/flour type ingredients - highly refined carbohydrates - can cause cavities just as fast as candy. Carbs = sugars to bacteria. Even the Organic crackers do the exact same. It's because dry or sticky (like dehydrated fruits) stick to our teeth, sticking the carbs/sugars to our teeth, giving the bacteria a stockpile of food that lasts them all day long. Carbs like noodles or whole bread don't stick to our teeth, and thus the bacteria don't have as much of a long term food source. So not all carbs are created equal! If your daughter has a healthy diet, eating mostly 3 meals a day, with healthy snacks not involving crackers/chips etc in between, and she drinks only water and milk, she's at lower risk for cavities than kids that eat crackers a lot and drink juices, etc. I tell all of my families they need to floss every day. For most - if they can floss at LEAST ONCE per day, doing their flossing at NIGHT is the most crucial time to floss. You don't want the bacteria "partying all night long."

Good question - and I have two follow up questions - how old is he and when is he going to lose the tooth - and you may not know the answer so I can help! It sounds like your son has a large cavity in his baby tooth - I am guessing it is a molar as that is more common and likely the case given your description. Depending on how old your son is, he might not naturally be supposed to lose that tooth for years to come. Kids lose their back molars mostly between 11-12 years old. If that tooth is only 1 year away from falling out, I might consider having it extracted - which would let the permanent tooth jump right in when it's only a year away. However, if the dentist recommended a "root canal" - it is likely he or she gave that recommendation in your son's best interest of trying to save the baby tooth until it falls out much later. If a baby tooth is removed or lost years before the permanent tooth is meant to come in, the other teeth next to the space left by the lost tooth can close into that space, to the point where there is not enough room for the permanent tooth to grow in later. This can lead to BIG consequences in terms of the need for braces and how long it might take to fix with braces down the road. Saving the tooth is very often the best for your child when possible, and is also often the most cost effective option in the long run when considering braces complications down the road. Also, many dentists often use the term "root canal" fairly loosely when it comes to kids. I actually prefer not even using the term because of what comes to mind for most adults who have experienced this in an adult tooth - it's actually a TOTALLY DIFFERENT PROCEDURE. For adults, a root canal involves a VERY long procedure that is cleaning everything to the very end of the tips of the roots of that tooth. In baby teeth, the most common procedure that likely your dentist MEANT is called a Pulpotomy. This is less invasive than a full "root canal" and involves cleaning only the upper portion of the potentially contaminated nerve tissue in the "chamber" of the nerve, down to where the nerve enters the roots. Then once it is cleaned out (and it is indeed determined the tooth can be saved and is not infected) a medicated filling is placed in the chamber, and a crown fitted over the top to seal off the tooth and "rebuild" the structure of the tooth lost due to the decay. Now that crown is likely (usually over 90% success rate) of staying in your son's mouth until the permanent tooth comes in, and it falls out like any other baby tooth. So the term "root canal" can make it sound a little "over the top," when really when I perform this procedure for kids, it adds only 5-8 minutes to my procedure, and they don't feel anything different than if they had only needed a small filling for a small cavity.

Absolutely! As a pediatric dentist, I recommend to my families that they begin flossing as soon as the back baby molars are touching together, which often times is as soon as they come in around 30 months old. Starting your son on a regular flossing routine now can pay dividends for a lifetime!

Brushing and flossing are definitely the best way to remove food, and most importantly plaque (bacterial buildup) from the surfaces and between the teeth. MOST 4 year olds put up a fight with brushing etc - it is part of growing up for them to want to test boundaries to see what they can "get away with." I encourage all my families to fight the battle of brushing. Toddlers can be very "stubborn," but if they know that no matter what they do or how much they fight that you are going to do it, they will stop fighting fairly quickly. If they know they can get away with it, they'll keep trying :) Ask your child's dentist for tips on different positions and ways you can hold your daughter that can help you manage her while you are brushing.

Yes, there are plenty of things to do! It also depends on if your son actually is calcium deficient or not. Just the act of not drinking cow's milk doesn't guarantee he is deficient in calcium. It's possible, theoretically, that a real calcium deficiency could have an impact on the strength of the developing enamel (outer layer of the teeth), but the good news is it probably wouldn't be severe unless the calcium deficiency were very severe. At 7 years old, many of your son's permanent teeth are still growing in his jaws, so maintaining good calcium can be beneficial to the teeth's development. WHAT TO DO: There are lots of other foods that you can incorporate into your son's diet (and/or providing him children's vitamins containing calcium) that would supplement his calcium intake to replace what's missing without drinking milk. Foods such as beans, almonds, collard greens, spinach, kale, and edamame (young soybeans like Japanese restaurants serve and can be found at Costco) all have a good amount of calcium in them. According to their nutritional facts, 1 cup of Silk almond milk has 45% Daily Value of calcium. Be aware, however, that Silk (and other non-dairy milks) often have a higher amount of sugar in them, so he should drink it with meals and not in between meals - in between meals we all should drink water only. Otherwise, a diet with more frequent exposure to sugars can increase the risk of cavities.

You should consider taking your daughter in to see a dentist - I would recommend a pediatric specialist - as soon as you have availability. Infants are recommended to see a dentist by age 12 months, and then every 6 months after that for checkups. Don't feel bad at all that she hasn't been in yet because most parents don't know! The dentist is not only checking for cavities (which amazingly enough can happen even at your daughter's age believe it or not!), but also the health of the other tissues, can give recommendations on diet and how to brush your daughter's teeth, and also is evaluating growth & development, and a bunch of things! Pediatric dentists are typically the most suited to see very young children as that is what they see all day every day, and their office and staff are specially designed and trained with kids in mind!

For most children with baby teeth only, it is not only common, but actually beneficial to have these spaces between their front teeth. Ideally, we like to see even spacing between the top four teeth and the bottom four teeth. If your daughter has no space between any teeth except for her two top front teeth, then this is mostly likely due to a thick/strong lip muscle attachment under the upper lip, which can keep a gap open when the permanent teeth come in. However, if the spaces are generally even between all four teeth top and bottom, consider yourself fortunate! These gaps allow for the MUCH larger permanent teeth to come into place without much if any crowding, and most often they close the gaps! Having even spacing at this age generally is a good sign that your child will have less problems that could require braces down the road. If your daughter has not yet seen a dentist, I recommend taking her to a pediatric dentist for an examination now - and they can tell you more about what to expect when her permanent teeth begin to come in, usually around 6 years old.

Yes, it is recommended to begin brushing the teeth twice daily (morning and night) as soon as the first teeth come in. There are a variety of products from toothbrushes for infants to bristled finger brushes that fit over your finger. I recommend a small brush designed for infants/toddlers. Begin brushing with just water on the bristles. As he gets older, at 12 months or so (he'll have about 12 teeth then) you can start using a fluoride free "baby toothpaste." Fluoride free toothpaste should be used rather than fluoride toothpaste (unless otherwise directed by your pediatric dentist) until your child has learned to spit (around 18mo-2yrs). Also, the American Academy of Pediatrics recommends taking your child to see a dentist by 12mo old. Pediatric Dentists have 2 years of specialized training specifically in treating children. You can go to http://www.aapd.org/ to find a pediatric dentist near you.

First of all, you deserve high praise for fighting the fight! Most toddlers fight with brushing, just like they can be very "determined" or "stubborn" in other aspects of the day. It can definitely be taxing on parents, so you deserve a lot of credit! Yes, it is important to brush your child's teeth twice per day. The bacteria in our mouths (they cause cavities by releasing acid onto our teeth after eating what we eat) never sleep, and cavities can creep up over time if bacteria are left on our teeth for long enough. Brushing morning and night breaks up the bacteria so they have to spend their time & energy working on rebuilding/regrowing rather than working on our teeth. Also, toddlers are in the stage of development where they are testing boundaries and seeing what they can get by acting different ways. If they believe they can get out of a task by putting up a fight - they will repeat that behavior. However, over time, if you are showing them consistently that regardless of their behavior that their teeth are going to get brushed, they tend to "give in" and begin to enjoy it as well. On the days she is more cooperative, let her participate and "help" with brushing, knowing that you will be the one to finish. If every once in a while you miss - those really rough mornings/nights - don't fret, one miss won't do it. It's what is happening the majority of the time (consistency) that counts. If you only brush once per day, that means bacteria has a full 24hrs of uninterrupted fun before they are broken up, and are more likely over time to cause cavities.

You should definitely take her to see a dentist immediately. Depending on her age, by 7 years old most kids have grown in their permanent teeth. Obviously an injury to the permanent teeth can have many more long term complications than baby teeth. But the baby teeth are also very important, and injuries to them if left unchecked can sometimes even effect the permanent teeth developing directly above them. Pediatric dentists are specially trained to work with kids of all ages, especially those with anxiety, and have advanced training in pediatric dental trauma. Consider taking her to a pediatric dentist immediately.

Don't worry! Braces will not cause any injury when being put on. They are "glued" on with a special adhesive - so they just one on to the front of each tooth - it's totally painless, and does not require any numbing. When people say braces "hurt," they are typically referring to the "tightness" that is felt when the thin wire is placed that joins all the braces together. The most "pain" you can have from braces can easily be handled with a little Tylenol or Ibuprofen.
In fact, if you take your age/weight appropriate dose of Ibuprofen about an hour before the appointment, it can definitely help with any of that initial tightness. Of course, new things on the front of your teeth can take some getting used to with your lips - that's the other part than can be uncomfortable for some at first - just because they rub a bit. But that's it - definitely not the end of the world. The reason for the tightness: Braces are meant to move teeth into a position that is straight. To move them, a wire is placed that puts light pressure so that the teeth move microscopic amounts on a daily basis. Your orthodontist will typically adjust or replace the wire with a new one about every 5-6 weeks so that the teeth continue moving toward the desired position.

Some young children with severe crowding can definitely benefit from "early intervention" with braces around age 7-9 - this depends on the orthodontist and whether enough permanent teeth are in. For most cases, orthodontists prefer to have all four of the back permanent "six year" molars fully grown in, as well as all four top and bottom front teeth. On average that is by about 8 years old. It never hurts to see an orthodontist for a consultation. Most orthodontists do their consultations for free - so look up a few around you and call to see what they offer. That way they can give you a clear idea of what to expect with braces and whether your child needs braces right away or can wait until all his permanent teeth come in (around 13 years old). Most of the time, understand that although he may get braces now to help prevent more complex orthodontic trouble down the road, kids that get the "Phase One" (what I called "early intervention" above) braces around age 8, will often need a second round of braces once all of the permanent teeth come in. However, this does not mean that everyone can just wait until 13. Some kids really need the early intervention.

The first baby teeth on average begin to fall out around 6-7 years old. However, many kids vary in age when they lose them - and it often mirrors when they got their first baby teeth as an infant. On average babies get their first teeth around 6 months old. Babies that get their very first teeth later, 7, 8, 9+ months, will tend to get their permanent teeth in later as well. If your daughter has seen a dentist and they have taken x-rays of the front teeth - which is often a routine diagnostic procedure about every 12 months, they may be able to tell you how close the permanent teeth are to growing in. If your daughter has not seen a dentist recently or ever, I would recommend taking her to a pediatric dentist soon for an evaluation.