Download Well Baby Visit

****The following pages are an example of one offices Well Baby Packet.
This information can be printed and given to patients in a folder either
before their first visit with their child or at the first visit. It can be used as a
reference for parents to keep on hand when they have questions. Feel free to
alter it as you see fit or as new research presents itself.****
Growth and Development
Eruption sequences
Children all follow a fairly consistent sequence for tooth eruption. The exact
sequence will not be the same in every child, and there is no exact time when each
eruption will occur, but there are averages. The following chart shows these averages,
and the order of eruption.
(http://www.mypediatricdentist.com/babyteeth.html)
Again, children vary. If your child does not follow this exactly, don’t panic.
Your dentist and hygienist will watch the development of your child’s teeth at each visit,.
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Spacing
Why baby teeth fall out-- baby teeth almost always fall out because there is a
permanent tooth erupting below it. This tooth pushes out the baby tooth to replace it.
When this occurs naturally, the space vacated by the baby tooth is filled fairly quickly
by the adult tooth, and that open space is filled. If, for some reason, the baby tooth
comes out early (accident, decay, etc.) then it is very important that the space left by
that tooth is maintained for the adult tooth to move in to. If this space is not held
somehow, the teeth on each side of the space will collapse into that space. When the
permanent tooth is ready to come in, there will not be enough space for it to fit nicely
into the arch. The result is crowding and it may require extensive orthodontic
treatment to correct.
How we hold space-- when a baby tooth is lost early, we use special appliances
called space maintainers made of metal or plastic to hold that space open. The
appliances hold the empty space where the lost tooth used to be until the permanent
tooth is ready to replace it. Children usually adjust very quickly to the space
maintainers, and it requires only a little extra care by you and your child to keep
clean.
Teething
Teething is the process of the primary (baby) teeth pushing through the gums as
they erupt into a child’s mouth. It is a natural event that every baby goes through, and it
may be painful for your baby.
 When it will happen and what symptoms to expect--the average age for the first set
of teeth to begin to push through the gums is around 6 months, but there may be
variation around this time. Teething can cause irritability, increased saliva, and
possibly some low grade fevers. However, teething should not be used to explain any
and all illnesses that your baby experiences around this age. Symptoms other than
those mentioned above are not likely caused by teething, and more in depth medical
treatment may be needed. High fevers or pain from ear infections can often be
mistaken for teething pain, but are not related, and you should contact your primary
physician.
 Treatment--teething pain will vary from child to child. Babies tend to bring their
hands to their mouths during this time because pressure brings some relief from pain.
Accordingly, massaging your babies gums gently with a clean finger may bring relief.
Many babies like to chew on cool things like wet washcloths or terry cloths that have
been in the refrigerator, or even smooth hard objects. Just be sure that whatever you
use, it is not something the baby may choke on. Benzocaine numbing gels may be
used to reduce pain temporarily, but they also will leave the baby’s mouth feeling
numb. This feeling is objectionable to some babies, and they may dislike it worse
than the pain. The gels may be effective in stopping the pain, but the numbness will
wear off. There is a small risk of allergy to these products as well, and thus for most
situations these gels are not advisable.
Enamel Appearance
You may be wondering about the color of your baby’s teeth. Enamel is the outer
layer of our teeth. It is the hardest part of the tooth, and also the layer that provides some
of the color of the tooth. Your baby’s teeth do not have to be perfectly bright white in
order to be healthy, but are generally an off-white or ivory color. Discoloration from
these shades can be the result of many different things.
 Why there may be discoloration--the most common cause of a change in color is
lack of proper brushing or cleaning, leading to buildup of bacteria and plaque that
gathers stain from food and drinks. This can be solved by regular professional dental
cleanings, and improved home care. Other possible causes include tetracycline use
during pregnancy, injuries to the teeth, recurring high fever, or jaundice. There are
also a few rare conditions that can affect the structure of your baby’s teeth, and
subsequently present as discoloration of the enamel. If you notice any dramatic
discolorations in your child’s teeth, please make an appointment to have the change
evaluated by a dentist.
 White Spots--sometimes teeth have discolorations that are not darker, but actually
whiter than the rest of the tooth. Small white spots often develop on children’s baby
and adult teeth. These white spots are called fluorosis. Fluoride is found in most
cities water, as well as in many dental products. It is incorporated into teeth and
makes them stronger and more resistant to decay. It is a very important part of a
child’s dental health. Sometimes when teeth are developing, and fluoride is being
incorporated into teeth, it makes areas on the enamel a brighter shade of white.
Having these white spots does not mean the tooth is not healthy, but actually that it
has been reinforced with fluoride. More info on fluoride is available on a different
page in this packet. Occasionally, white spots on the teeth mean that the outer layer
of the tooth is weakened, or decalcified, as a result of attack by bacteria or acid. Your
dentist will be able to determine the difference between these two at regular visits,
and advise accordingly.
Fluoride
Fluoride is a naturally occurring mineral. It is most commonly found in water
sources, and even sometimes exists in water when it has not been added by humans. This
mineral is a great natural resource for our teeth. It has the ability to incorporate itself into
teeth and make them stronger. Fluoride makes teeth more resistant to the bacteria that
cause decay, and also the acid environment created by things such as soda pop. It can
even help to remineralize areas where acid attacks have already weakened the tooth. We
are confident that dramatic reductions in tooth decay in the past years are a result of
increased use of fluoride in water and through other means.
Research still shows that childhood caries (decay) is the most prevalent infectious
disease in children. Yes, tooth decay is an infectious disease. Tooth decay is caused by
an active bacterial infection in the mouth. Fluoride has proven to be one of the best
methods to fight this disease. Not by killing bacteria directly, but instead by making the
tooth more resistant to it.
Topical Fluoride
These forms usually have a fairly high concentration of fluoride, and like all
minerals, should not be ingested in large amounts. For that reason, it is important to not
swallow lots of these products, and to monitor young children when they use them.
 Fluoride toothpaste-- ages 3 through adult (under 3 should use non-fluoride to avoid
swallowing). Use a pea-sized amount, and brush and spit. There are many fluoride
toothpastes, so check the label, and find one your child likes.
 Mouthrinses-- brands such as ACT have fluoride added to the rinse, and are another
way to bathe the teeth in fluoride. It is important to spit it out when done. Most drug
stores carry multiple brand and generic versions of this.
 Professional gels, foams, or varnishes-- these products are applied by your dental
hygienist of dentist in the office. These are even more highly concentrated with
fluoride, and so not usually needed as often. Your dental team will use these as
needed.
Systemic Fluoride
This type of fluoride is ingested in the body where it is then incorporated in teeth
as they are forming. It also is useful because small amounts of fluoride will be present in
the saliva as it bathes the teeth.
 Fluoridated water-- most common method of receiving systemic fluoride. Most
cities and towns add small amounts of fluoride (.7-1.2 ppm) to their water supplies,
and it is then absorbed into the body.
 Supplements-- for use when fluoride levels in water are inadequate. These are
usually in the form of tablets, drops, or lozenges, and are provided by prescription
from your dentist. These require daily use as requested by the dentist.
A note on well water, filters, and bottled water: Well water may contain fluoride
already, but usually needs to be tested in order to figure out how much fluoride exists in
the water naturally. If it is low, supplements can be used to increase your child’s fluoride
levels. It is also important to note that most bottled water does not contain fluoride.
There are some that do, so check the label. Many water filters also remove fluoride from
water, so be sure to check the label, and buy one that does not.
Xylitol
Xylitol is a naturally occurring substance that tastes like sugar. It is found
naturally in many fruits and vegetables, and is even produced by our bodies during
normal metabolism. It is also extracted from birch trees, corncobs, and other natural
sources for use as a sweetener.
 Why it pertains to oral health—research has shown that Xylitol is not digested by
the bad bacteria in our mouths like they digest regular sugar. If they don’t have to
sugar to feast on, then they cannot function at a high level and cause decay. Xylitol is
also effective at changing our saliva from being acidic after meals and things like
soda pop, to a more beneficial basic (normal pH) level.
 Where you can find it—Xylitol is commonly found in chewing gum, candies,
toothpastes, rinses and breath mints/drops. These items are called sugar free, but are
still sweet because of the Xylitol. These products are great not only for your child,
but also for every adult. It has been shown that bad oral bacteria are initially
transmitted from parent to baby, so even adults should be interested in products that
have Xylitol in them. Chewing a piece of gum with Xylitol after a meal, snack, or
drink can really help your overall oral health without any of the bad side effects of
sugar.
Habits
Thumb sucking and Pacifiers
We know that most children will use a pacifier, suck their thumb, or both at some
point in their infancy or childhood. It is a newborn’s reflexive response to want to suck.
That is how they get nourishment, and it is comforting to them. It keeps them busy when
they are bored, and can get them to stop fussing if they are upset. It may help them sleep,
and relax them. There is some research showing that babies who suck their thumbs gain
confidence faster than those that don’t, don’t need to be held as much, etc. Toddlers use
it as a transition from clinging to their parents. No matter how you look at it, it is
considered a natural thing for babies to be interested in sucking their thumbs, or sucking
on a pacifier.
 Why it is of concern to oral health-- dental professionals generally agree that
intense or extended thumb and pacifier sucking can affect the shape of the mouth, and
alignment of the teeth. Generally, pacifiers are considered to be much less of a
problem than thumb sucking, but can still cause problems. As a child sucks on their
thumb or pacifier, they are creating pressure on the roof of their mouth, and if it is
prolonged, this can greatly affect the shape the mouth takes as it develops. The same
is true for the front teeth, especially the upper front teeth. If a child’s thumb is
constantly putting pressure on those teeth, they are likely to move forward and spread
apart. These are obviously both things that we would like to avoid.
 When to change these habits--it is not necessary to try to force a baby to stop
sucking their thumb from the first time they do it. As discussed above, this is a
natural reflex, and babies should be allowed the comfort of their thumb or pacifier.
Our concern begins when this habit continues on into later stages of childhood.
When a toddler who is 3 years old is still sucking their thumb consistently, it is time
to begin noticing the frequency of the habit, and determining how best to taper this
habit over the next few years. The age of 5 is considered the deadline for when
children should stop sucking their thumb altogether. This is time when adult teeth are
forming, and will soon erupt into the mouth, and is also a transition time for your
child emotionally. They will soon be at school and away from home, their cognitive
level will change, and they will be involved more with their peers.
 How to change these habits-- there are many different philosophies on what is the
best way to encourage a child to stop sucking their thumb, or relinquish their pacifier.
For some children it is as simple as putting a band aid on their thumb, or painting
something that tastes bad on the thumb or pacifier. It may work to cover the hand
with a sock. If the child is a little older, it may work to use a system of rewarding
them for days or nights when they do not initiate the habit. Some parents find
creating a weekly or monthly chart which the child can see and mark, and that shows
what there reward might be is an effective way of ceasing habits like this. No matter
how you do it, these can be hard habits to break. Many parents tell us it was a lot
easier to wean off the pacifier because they were able to simply throw it away.
Tooth Decay
An environment is created for tooth decay by four common culprits: sugar,
inadequate home care, acids, and destructive bacteria. Tooth decay occurs when
destructive bacteria that live on teeth ingest sugars from our diet and secrete acids as a
byproduct. When proper home and professional hygiene care are less than optimal, the
bacteria remain on teeth to turn sugar into acid which break down tooth enamel. After
the enamel has been compromised, the bacteria are able to destroy a baby tooth within
months.
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Sugar and acid- these things can come from many different sources. Soda pop,
bubble gum, cookies and candy are universally identifiable. Fruit juices, flavored
waters, and milk are other examples that offer similar, less obvious destructive
capability due to their sugar content. The sugar in these foods and drinks provides a
feast for destructive bacteria! Even though it contains no sugar, diet soda is also
detrimental because its acid level is close to that of battery acid. The bad bacteria in
the mouth love to have an acidic environment.
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Destructive bacteria- these are the bacteria which secrete more acid than other types
of oral bacteria. They also thrive on the sugar that passes through our mouth.
Destructive bugs enjoy hiding in grooves of teeth, near the gums that surround teeth,
and in between adjacent teeth. Unfortunately, these are the hardest areas to keep
clean. It should come as no surprise that decay occurs most frequently in these areas.
Destructive bacteria are also transmissible from care provider to child. So, it is not a
good idea to share your drinks or test bottles with children, as these destructive
bacteria can be passed on like the common cold.
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Appropriate oral hygiene- is important to keep destructive bacteria from resting on
teeth. Homecare instructions taught by a dentist or hygienist will help remove
bacteria on a consistent basis. Other preventative techniques such as sealants and
fluoride applications may be recommended to supplement good home care.
Following these practices will limit the destructive ability of the different causes of
decay.
The statement, “Everything in moderation” applies to tooth decay well. It takes about
20 minutes for destructive bacteria to ingest sugar and secrete acid on a tooth. If juice is
consumed with a meal, and a child’s homecare is optimal, tooth decay is not very likely
to start.
Alternatively, if juice is placed in a baby bottle or sippy cup and sipped over many
hours, it provides a constant feast for bacteria to digest sugar and spew acid on teeth!
The same is true allowing your child to snack constantly. Even with good homecare,
your child is more likely to develop tooth decay. This is why it is so important to never
allow your child to go to bed with a bottle with anything in it.
Oral Hygiene Instructions
Age Appropriate Home Care:
 0-6 months- wipe gums with a damp warm cloth at the end of each day before teeth
appear.
 6-28 months- once teeth begin to erupt into the mouth, brush your child’s teeth with a
soft bristled toothbrush using a pea-sized portion of non-fluoridated toothpaste, 1-2
times per day. Proper spitting habits should be encouraged to avoid swallowing
paste. Using non-fluoridated toothpaste is important until your child has developed
the ability to spit it out properly.
 28mo-Adult- help your child use a soft bristled toothbrush with pea-sized portion of
fluoridated toothpaste. Brush two times per day.
 Flossing- should begin when there are at least two neighboring teeth that touch each
other. Gently place floss between teeth, being careful not to snap floss into the gums.
Wrap the floss in a “C” shape around each tooth, and move up and down. Don’t
forget the back of the last tooth as well. Many retail stores carry specially designed
handles that can help you and your child if flossing becomes a struggle, but they are
generally not as good at removing plaque.
 Brushing- a soft bristled tooth brush is always recommended. Using a brush with
firmer bristles will not improve your ability to remove plaque. Age appropriate sizes
should be used as well. Your child should have a smaller brush for their smaller
mouth, and the brush can get bigger as they grow. Your hygienist will also give you
an appropriate sized brush at your visits to our office. Brushing should be done in
gentle, circular motions. It is important to make sure your child brushes the front,
back, and chewing surfaces of each tooth, and that the brush is also touching the
gums while brushing. Brushing a full set of teeth should take 2 minutes to do.
Electric toothbrushes are also available, and do an excellent job of cleaning teeth.
You may find an electric toothbrush is easier for your child, as they take a little less
dexterity. Parents should still help their child brush until the age of 6 or 7, or until
their dexterity is adequate to brush properly.
 Disclosing tablets or rinse- these tablets or rinses stain plaque on teeth. The particles
attach to the plaque that can be hard to see otherwise, and stain it dark pink. This is a
great method for showing your child why it is important to brush, and also the spots
that they are missing when they are brushing. The color stands out against teeth, and
your child can have something obvious to see how they are doing. It is great as a
motivator, and can be very rewarding for your child when they are able to remove all
the plaque. We use these tablets at visits to our office, but they are also good for
home care in between visits.
Sealants
Destructive bacteria hide in grooves and pits on the chewing surfaces of back
teeth. These areas are usually so small that toothbrush bristles cannot get in them to
clean. Sealants coat these grooves and pits to prevent decay from taking hold in these
high risk areas.
Sealants are made of clear material that bonds to tiny pores on the tooth surface.
They are usually only placed on adult teeth, and so will not be considered until about age
6. Placing sealants will not hurt and your child does not have to be numb for the
procedure. Not every child needs sealants. Each child is unique and your dentist will
determine if sealants will be beneficial for your child. They are made from safe materials
for your child, and can go a long ways towards prevented decay in the future.