Pediatric Dentistry

Fluoride Treatment

Fluoride is a naturally occurring mineral that is essential for proper tooth development and the prevention of tooth decay. Tooth decay is still a significant problem in many communities throughout the United States, but it is far less prevalent than it used to be as a result of fluoridation of public water supplies. This is why the major associations of pediatric dentists and dentists support water fluoridation to the current recommended levels of 0.70 parts per million (ppm). This is also why the federal Centers for Disease Control and Prevention (CDC) has called fluoridated water one of the most significant health achievements of the 20th century. Though, not everyone has access to fluoridated water. This is one reason why fluoride supplements are often recommended for children without access to fluoridated water. Since it is possible for children to get too much fluoride, it is best to seek professional advice on the use of any fluoride containing product.

How Fluoride Helps

The protective outer layer of teeth, called enamel, is often subject to attacks from acids. These can come directly from acidic foods and beverages, such as sodas and citrus fruits, or sometimes through the decay causing bacteria already in the mouth that create acid from sugar. These bacteria congregate in dental plaque on teeth and feed on sugar that is not cleansed from the mouth. As these bacteria metabolize (breaking down) sugar they produce acids that can eat through tooth enamel. This is how cavities are formed in teeth. When fluoride is present, it becomes part of the crystalline structure of tooth enamel. This hardens the tooth and makes it more resistant to acid attack. Fluoride can even help repair small cavities developing in the enamel.

Delivering Fluoride to Teeth

Fluoride ingested by children in drinking water or supplements can be taken up by their developing permanent teeth. Once a tooth has erupted, it can be strengthened by fluoride exposure to the enamel surface. Using a fluoride-containing toothpaste is one way to make sure your children’s teeth receive helpful fluoride exposure daily. We recommend using only a grain of rice sized amount for children ages 2-6 and just a tiny smear for kids under two. Fluoride should not be used on children younger than six months. A very beneficial way to deliver fluoride to the teeth is with topical fluoride applications painted right onto your child’s teeth and allowed to sit for a few minutes for maximum effectiveness.

How Much Is Too Much?

Teeth that are over-exposed to fluoride as they are forming beneath the gum line can develop a condition called enamel fluorosis. Enamel fluorosis is characterized by a streaked or mottled appearance of the tooth. Mild fluorosis takes the form of white spots that are hard to see. In more severe cases the discoloration can be darker, with a pitted texture. The condition is not harmful, but may eventually require cosmetic dental treatment. Tooth decay, on the other hand, is harmful to your child’s health and can also be quite painful in severe cases.

The risk for fluorosis ends by the time a child is about 9 years old and all the permanent teeth have fully formed. Since fluoride use is cumulative, all the sources your child comes in contact with, including powdered infant formula mixed with fluoridated tap water, need to be evaluated. While caution is advised, it would be a mistake to forgo the benefits that this important mineral can bring to your children’s teeth and overall health.

Sealants

The most likely location for a cavity to develop in a child’s mouth is on the chewing surfaces of the back teeth. These surfaces are not as smooth as the other areas of your teeth are. Instead, they are filled with tiny grooves referred to as “pits and fissures,” which trap bacteria and food particles. The bristles on a toothbrush can’t always reach all the way into these little crevices. This creates the perfect conditions for tooth decay.

When a child’s permanent teeth first erupts, the teeth are not as resistant to decay as an adult’s teeth are. The hard enamel coating that protects the teeth changes as it ages to become stronger. The fluoride found in toothpaste, in some drinking water, and in treatments provided at the dental office can strengthen enamel on teeth. However, it is hard to get fluoride into those deep pits and fissures on a regular basis. Fortunately, there is a good solution to this problem: dental sealants.

Dental sealants are resin coatings that smooth out the chewing surfaces of the back teeth, making them resistant to decay. A sealed tooth is far less likely to develop a cavity, require more expensive dental treatment later on, or cause your child pain.

How Sealants Are Placed

You can think of a sealant as a mini plastic filling. Tooth enamel does not contain any nerves so placing a sealant is painless and does not routinely require numbing shots. First, the tooth or teeth to be sealed are examined so that if any decay is found it can be gently removed. The tooth will then be cleaned and dried. Then a solution that will slightly roughen or “etch” the surface is applied to make the sealing material adhere to the tooth better. The tooth is then rinsed and dried again. The sealant is then painted on the tooth in liquid form and is hardened with the help of a special curing light.

Taking Care of Sealants

Sealed teeth require the same conscientious dental hygiene as unsealed teeth. Your child should continue to brush and floss his or her teeth daily and have regular professional cleanings. Checking for wear and tear on the sealants is important, though they should last for up to 10 years. During this time, your child will benefit from a preventive treatment proven to reduce decay by more than 70 percent.

Space Maintenance

Children’s little baby teeth have some big responsibilities. Until their adolescent years, they will not only help youngsters bite, chew, and speak correctly, but also help guide the permanent teeth underneath them into the proper position. In fact, a major function of baby teeth is to hold space for the adult teeth that will eventually push them out.

Sometimes, injury or disease can cause a baby tooth to be lost prematurely. When that happens, the permanent teeth that are coming in on either side can actually drift into the space that was reserved for another tooth. This can cause teeth to erupt out of position or to be blocked entirely. This can result in crowded or crooked teeth.

Fortunately, if your child loses a tooth prematurely, there is a dental appliance that can be used to hold the space open for the permanent tooth that is meant to fill it. The device is called a “space maintainer” or a “space maintenance appliance.” Made of metal and/or plastic, space maintainers can be fixed (cemented) or removable. Either way, the purpose of the space maintainer is to help children develop the best bite possible and hopefully avoid the need for braces later on.

A child will wear a space maintainer until x-rays reveal that the tooth underneath is ready to erupt naturally. It is very important that anyone wearing a space maintainer keep up good oral hygiene at home and have regular professional dental cleanings.

Space maintainers are also useful when one or more permanent teeth are congenitally missing, in other words, they have never existed at all. In these cases, placement of a dental implant is often recommended as the child reaches adulthood since dental implants can’t be placed in a growing child. Therefore, it is very important to use a space maintainer with a false tooth on it until jaw growth is complete and an implant can be appropriately placed. It’s a simple, non-invasive way we can avoid a malocclusion or bad bite with some timely intervention.