Have a question about a dentist-related issue? Search this page for answers to some of the frequently asked questions our clients have. If you don't find your answer, please feel free to call the office or send us an email.

Pediatric dentistry is the specialty of dentistry that focuses on the oral health of young people. After completing a four-year dental degree program, pediatric dentists are required to undergo an additional two to three years of rigorous training. This special program combines study with hands-on experience to prepare pediatric dentists to meet the needs of children from infancy to adulthood and those with special health care needs.

The primary teeth serve a number of critical functions. They allow your child to chew properly, maintaining good nutrition. Primary teeth provide space for the permanent teeth, allowing the permanent teeth to erupt into the correct position. Additionally, primary teeth assist with the development of speech and appearance. A healthy smile can help children feel good about the way they look to others.

The primary teeth all begin formation in utero, usually between 14-19 weeks. At birth, all twenty primary teeth are already formed in the baby's jaws, hidden in bone and soft tissue until time to erupt in the mouth. There are also the beginning buds of some permanent teeth. Eruption of these primary teeth can begin as early as 4 months, with all twenty appearing by the age 3. Eruption begins with the central incisors, and is followed by the lateral incisors, first molars, canines, and second molars, with lower teeth erupting before the upper teeth. Around age 6, the first permanent teeth begin erupting, beginning with the molars and lower central incisors, and this process will continue throughout childhood and adolescence, ending at approximately age 21.

Toothache:	Clean the area around the tooth. Rinse the mouth with warm salt water and use dental floss to remove any trapped food between the teeth. If there is swelling, apply a cold compress to the outside of the face. Do not place aspirin or heat on the gums or tooth. Take acetaminophen or ibuprofen. If pain persists, contact Dr Karsten.
Knocked Out Permanent Tooth:	For primary (baby) teeth- Contact Dr. Karsten during normal business hours. Primary teeth are not usually re-implanted and this is usually not considered to be an emergency. For permanent teeth- Find the lost tooth, if possible. Handle the tooth only by the crown, never by the root. If tooth is dirty, rinse only with water-- DO NOT use soap or scrub the tooth. If possible, replace the tooth into the socket, and have the child hold the tooth in place by gently biting on a gauze pad or washcloth. If it is not possible to replace the tooth, place the tooth in a cup of milk or cool water. Go to the dentist immediately. Time is a critical factor in saving the tooth, and seeing a dentist within 30 minutes is best.
Chipped or Fractured Tooth:	For primary (baby) teeth- Contact Dr Karsten. For permanent teeth- Contact Dr. Karsten immediately. Gently cleanse the area around the break with cool water. Place a cold compress on the face in the area of the broken tooth to minimize swelling. If possible, save any broken tooth fragments and take them to the dentist.
Severe Blow to the Head:	Take your child to the nearest hospital emergency room immediately.
Possible Broken or Fractured Jaw:	Do not move the jaw. Stabilize the jaw by tying a towel, necktie, etc. over the top of the head. Take your child to the nearest hospital emergency room.

X-ray films detect much more than cavities. For example, X-rays may be needed to survey erupting teeth, diagnose bone diseases, evaluate the results of an injury, or plan orthodontic treatment. X-rays allow dentists to diagnose and treat conditions that cannot be detected during a clinical examination. If dental problems are found and treated early, dental care is more comfortable and affordable.

In general, children need X-rays more often than adults. Their mouths grow and change rapidly. They are more susceptible than adults to tooth decay. For children with a high risk of tooth decay, the American Academy of Pediatric Dentistry recommends X-ray examinations every six months to detect cavities developing between the teeth. Children with a low risk of tooth decay require X-rays less frequently. In general, pediatric dentist request X-rays approximately once each year.

Pediatric dentists are particularly careful to minimize the exposure of child patients to radiation. With contemporary safeguards, the amount of radiation received in a dental X-ray examination is extremely small. In fact, dental X-rays represent a far smaller risk than undetected and untreated dental problems. Lead body aprons and shields help protect your child. Today's equipment filters out unnecessary X-rays and restricts the X-ray beam to the area of interest. High-speed film, digital X-rays, and proper shielding assure that your child receives a minimal amount of radiation exposure.

* Copyright ©2010 by the American Academyof Pediatric Dentistry. All rights reserved.

Most dental decay is caused by plaque - a sticky, white film that is constantly forming on teeth. Therefore, proper brushing is one of the most important tasks for good oral health. Part of proper brushing is choosing the correct toothpaste for your child. Many types of toothpaste contain harsh abrasives, which can shred the enamel of your child's teeth. The ADA seal of approval found on the box assures that the toothpaste has been tested and is safe for use.

Watch your child's use of fluoridated toothpaste. A pea-sized amount on the brush is plenty for fluoride protection. Teach your child to spit out the toothpaste, not swallow it, after brushing. Consumption of fluoride toothpaste over a regular period of time or in too great a dose can lead to fluorosis, or defects in tooth enamel. If your child is too small or unable to spit toothpaste out, consider using non-fluoridated toothpaste or no toothpaste at all until they are able to spit the toothpaste out.

Bruxism is a condition in which children grind or clench their teeth while they sleep. Anxiety, frustration, and stress can trigger the condition in children. Treatment may be unnecessary as children generally outgrow bruxism. Between the ages of 6 and 9 children generally decrease the amount of time they spend grinding their teeth, with most stopping completely by age 12.

In a more severe case, the child may need to wear a mouth guard. The mouth guard is molded into the shape of the child's teeth and worn throughout the night. Although the guards can be effective, children may have difficulty adjusting to them, and they can become dislodged in sleep and become a choking hazard, or they can interfere with normal jaw growth and development. A child affected by bruxism should see a dentist on a regular basis for evaluation.

Sucking is a natural reflex among infants and children, though most children stop sucking on thumbs, pacifiers, or other objects on their own between ages 2 and 4. However, some children continue these habits over long periods of time. In these children, the upper front teeth may point towards the lip or not come in properly. The intensity of thumb sucking or sucking on pacifiers will determine the severity of dental problems. Resting the thumb or pacifier in the mouth will cause less severe problems than intense sucking.

Dr. Karsten will carefully watch the way your child's teeth erupt and jaws develop. Intervention may be recommended for children beyond 3 years of age to help prevent long-term problems. You can help your children break this habit by being positive and encouraging, praising them for not using the pacifier or sucking their thumb on occasions when they normally would. If such methods do not work, you can try placing a bandage or gauze around the thumb to make the child aware of their sucking habits. Your dentist can also help explain what will happen to the teeth and jaws if they do not stop.

The pulp is the inner central tissue of the teeth. It contains nerves, blood vessels, connective tissue and cells. Pulp therapy, also called a "baby root canal," is done to maintain the health of the affected tooth when severe cavities or an injury to the tooth has occurred. During a pulpotomy, the diseased pulp tissue within the crown is removed. Next, the dentist will place an antibacterial substance there to prevent bacterial growth. Finally, the dentist will replace the damaged enamel portion.

A pulpectomy is done when the entire pulp is involved. During this treatment, the entire pulp of the tooth will be removed from the crown and root. The root canal is then cleaned, disinfected and filled with material. After that, a final restoration is placed.

* Copyright ©2010 by the American Academyof Pediatric Dentistry. All rights reserved.

It's never too early to keep an eye on your child's oral development. Malocclusions - crowded or crooked teeth - can often be recognized as early as 2-3 years of age. Early orthodontic treatment can prevent more extensive treatment later. Early orthodontics can enhance your child's smile, but the benefits far surpass appearance. Pediatric orthodontics can straighten crooked teeth, guide erupting teeth into position, correct bite problems, and even prevent the need for tooth extractions.

There are generally three stages for orthodontic care. Stage 1 treats children between 2-6 years of age, treating conditions such as the effects of thumb sucking or the premature loss of primary teeth. During Stage 2, a pediatric dentist will work with children between 6 and 12 years old, as their permanent teeth begin to erupt. The tissues of the mouth are usually very responsive during this age range, making this an excellent time to begin orthodontic work. Stage 3 orthodontic work deals with the permanent teeth and the final bite relationship.

Teething, or the eruption of primary (baby) teeth, can vary among individual babies. Some begin as early as 4 months, though it generally begins between 6-8 months. Teething usually begins with the central incisors (front), and is followed by the laterals, molars, canines, and second molars, with lower teeth erupting before the upper teeth.

As soon as your child's primary (baby) teeth appear they are at risk for decay. In infants and toddlers, this is commonly referred to as Baby Bottle Tooth Decay. It is often found in the upper front teeth, though other teeth can also be affected. Baby Bottle Tooth Decay is caused by frequent and long exposure to liquids containing sugar, such as milk, breast milk, formula, juice, or other sweetened drinks.

The risk of Baby Bottle Tooth Decay can be lowered by wiping your baby's gums with a clean, damp gauze pad or washcloth after each feeding. Place only formula, milk or breast milk in bottles. Avoid filling the bottle with liquids such as sugar water, juice or soft drinks. Infants should finish their bedtime and naptime bottles before going to bed. If your child uses a pacifier, provide one that is clean - don't dip it in sugar or honey, or put it in your mouth before giving it to the child. Encourage children to drink from a cup by their first birthday and discourage frequent or prolonged use of a training (sippy) cup.

Once your child's teeth have begun to erupt, brush them gently with a child's size toothbrush and water. This will remove plaque and bits of food that can harm erupting teeth. Brush your child's teeth until he or she is at least six years old. Encourage healthy eating habits that include a diet with plenty of vegetables, fruit and whole grains. Serve nutritious snacks and limit sweets to mealtimes. Ensure that your child has adequate exposure to fluoride. Discuss your child's fluoride needs with your dentist or pediatrician.

Daily brushing of your child's teeth should begin as soon as the first tooth erupts. Use a pea-sized amount of toothpaste. Once your child is able to spit the toothpaste out, begin using fluoridated toothpaste (search for the ADA seal of approval when choosing toothpaste). When your child is old enough to begin brushing independently, continue to monitor their brushing to ensure proper brushing techniques are being used and good habits are being formed. Generally, your child can begin brushing with supervision at about ages 4-5 and can continue without supervision around age 7. Each child is different - your dentist can help you to determine whether or not your child has the skill level to brush properly. Brush teeth twice daily, and don't forget to remember to brush the tongue to remove germs and helps freshen breath.

When teaching your child to brush, hold the toothbrush at a 45-degree angle against the gum line. Gently brush from where the tooth and gum meet to the chewing surface in short (about half-a-tooth-wide) strokes. Brushing too hard can cause receding gums, tooth sensitivity, and, over time, loose teeth. Use the same method to brush all outside and inside surfaces of your child's teeth. To clean the chewing surfaces of your child's teeth, use short sweeping strokes, tipping the bristles into the pits and crevices. To clean the inside surfaces of your child's top and bottom front teeth and gums, hold the brush almost vertical. With back and forth motions bring the front part of the brush over the teeth and gums. Using a forward-sweeping motion, gently brush your child's tongue to remove the decay-causing bacteria that exist in these places. Use an egg timer or play a favorite song while brushing your child's teeth to get used to brushing for a full 2 to 3 minutes. Some electronic toothbrushes have timers that let you know when 2 minutes are up.

To floss your child's teeth, sit with your child on your lap facing you. Take about 18 inches of dental floss and wrap one end around each of your middle fingers. Using your thumbs and index fingers as guides, gently slide the floss between two teeth, using a saw-like motion. Once at the gum line, pull both ends of the floss in the same direction to form a C shape against one tooth. Pull the floss tightly and move it up and down against one tooth. Pull the floss against the other tooth and repeat the motion. Repeat this for all of the teeth. Be sure to floss both sides of the teeth farthest back in the mouth.

A healthy diet is a balanced diet that naturally supplies all the nutrients your child needs to grow. A balanced diet is one that includes the following major food groups: fruits, vegetables, grains, meat and beans, and milk. These are the key groups according to the food pyramid. Your child must have a balanced diet for their teeth to develop properly. They also need a balanced diet for healthy gum tissue around the teeth. Equally important, a diet high in certain kinds of carbohydrates, such as sugar and starches, may place your child at extra risk for tooth decay.

To help keep your child's teeth healthy, be sure they have a balanced diet. Then, check how frequently they eat foods with sugar or starch in them. Foods with starch include breads, crackers, pasta and snacks such as pretzels and potato chips. When checking for sugar, look beyond the sugar bowl and candy dish. A variety of foods contain one or more types of sugar, and all types of sugars can promote dental decay. Fruits, a few vegetables, and most milk products have at least one type of sugar.

Ask your pediatric dentist to help you assess your child's diet. Shop smart! Do not routinely stock your pantry with sugary or starchy snacks. Buy "fun foods" just for special times. Limit the number of snack times; choose nutritious snacks. Provide a balanced diet, and save foods with sugar or starch for mealtimes. Don't put your young child to bed with a bottle of milk, formula, or juice. If your child chews gum or sips soda, choose those without sugar.

Proper oral hygiene means removing the bacteria and leftover food from teeth in order to prevent cavities. In infants, this means using a clean, wet washcloth or gauze to wipe the gums and teeth. Avoid putting your child to bed or down for a nap with a bottle filled with anything other than water. Brush your older child's teeth at least two times each day, and avoid giving them excess sugary snacks. Visit your pediatric dentist regularly for cleanings and check-ups. The American Academy of Pediatric Dentistry recommends a visit ever six months, beginning with your child's first birthday. Your pediatric dentist may recommend protective sealants or home fluoride treatments for addition protection.

A dental sealant creates a highly effective barrier against decay. Sealants are thin plastic coatings applied to the chewing surfaces of a child's permanent back cavities, where most cavities form. Sealants "seal out" food and plaque, and reduces the risk of decay. Applying a sealant is not painful and can be performed in one dental visit. Teeth are first cleaned, then conditioned and dried. Once the sealant is applied it flows into the grooves of the tooth, and is then hardened with a special light. Your child will be able to eat right after the appointment.

Fluoride is a compound that contains fluorine, a natural element. Using small amounts of fluoride on a routine basis can help prevent tooth decay. Fluoride inhibits loss of minerals from tooth enamel and encourages remineralization (strengthening areas that are weakened and beginning to develop cavities). Fluoride also affects bacteria that cause cavities, discouraging acid attacks that break down the tooth. Risk for decay is reduced even more when fluoride is combined with a healthy diet and good oral hygiene.

However, excessive ingestion by pre-school aged children can lead to dental fluorosis, a chalky white, or in severe cases even a muddy brown, discoloration of the permanent teeth. Infant formulas contain different amounts of fluoride. Bottled, filtered and well waters also vary in the amount of fluoride they contain. Your pediatric dentist can help determine if your child is receiving -- and not exceeding -- the recommended amount.

To help prevent fluorosis, always dispense fluoridated toothpaste for your child at brushing. Make sure to use a pea-size amount of toothpaste, and encourage your child to spit out the toothpaste after brushing. If children are too young to spit out, consider using non-fluoridated toothpaste.

If your child is not getting enough fluoride, your pediatric dentist may recommend a fluoride supplement. The pediatric dentist considers many factors before recommending a fluoride supplement. Your child's age, risk of developing dental decay and dietary sources of fluoride are important considerations. Your pediatric dentist can help determine if your child is receiving -- and not exceeding -- the recommended amount.

A properly fitted soft mouth guard can protect your child's teeth, cheeks, lips, and gums. A mouth guard is recommended for any recreational activity that poses a risk of injury to your child's mouth, such as football, basketball, baseball, soccer, softball, hockey, skateboarding, boxing, martial arts, wrestling and extreme sports. When in doubt, ask your pediatric dentist.

The guard should be resilient, tear resistant, and comfortable. Make sure it fits properly and is easy to clean, along with not restricting breathing or speaking. Ask your pediatric dentist for more information about custom and store-bought mouth guards.

Xylitol is a naturally occurring sugar substitute found in the fibers of many fruits and vegetables, such as berries, oats, and mushrooms. Research shows that Xylitol has a plaque-reducing effect, and inhibits the bacteria that are significant contributors to tooth decay.

The American Academy of Pediatric Dentistry (AAPD) recognizes the benefits of Xylitol for the oral health of infants, children, adolescents, and persons with special health care needs. In fact, the use of Xylitol gum by parents (2-3 times per day starting 3 months after delivery and until the child was 2 years old) reduced the bacteria levels in children up to 6 years. At 5 years of age, those who had been using Xylitol in this way had a 70% reduction in cavities.

Studies using Xylitol as either a sugar substitute or a small dietary addition have demonstrated a dramatic reduction in new tooth decay, along with some reversal of existing dental caries. Xylitol provides additional protection that enhances all existing prevention methods. To find gum or other products containing Xylitol, try visiting your local health food store or search the Internet to find products containing 100% Xylitol. .

It is becoming more common to see people with facial piercing, but piercing of the tongue, lips, or cheeks can be very dangerous. According to the International Dental Society there is a risk of damage to the teeth, including chipped teeth and gum recession. Other complications include nerve damage, blood poisoning, blood clots, brain abscess, or infection. Your mouth contains millions of bacteria, and the piercing can become infected very easily. Complications from infection can include swelling and difficulties breathing, and paralysis of the tongue. Even after healing, the risk of infection never goes away. In many cases, a long-term wearer will have to remove their piercing due to a delayed infection. Take the advice of the American Dental Association- skip the oral piercing.

Tobacco in any form can jeopardize your child's health and cause incurable damage. Teach your child not to smoke or chew tobacco! The warnings you hear and read about are true. Besides lung and heart problems, tobacco can cause oral cancer. Of all cancers, 2.4 percent occur in the mouth and tobacco use has been estimated to account for over 90 percent of cancers of the oral cavity and pharynx.*

Many teenagers engage in the use of smokeless tobacco, also called chew or snuff, thinking that this is a safe alternative to cigarettes. This is an unfortunate misconception, as studies have shown that one can of snuff delivers as much nicotine as 60 cigarettes. In as little as three to four months, periodontal disease and pre-cancerous lesions can be caused by the use of smokeless tobacco.

Because the early signs of oral cancer usually are not painful, people often ignore them. If it's not caught in the early stages, oral cancer can require extensive, sometimes disfiguring, surgery. Even worse, it can kill.

If your child is using tobacco and you notice any changes in their mouth such as a sore that won't heal or white or red leather patches on the lips or under the tongue, contact your doctor immediately.