Q: How does a pediatric dentist help with dental anxiety?

A: Pediatric dentists have special training in helping anxious children feel secure during dental treatment. And, pediatric dental offices are designed for children. Staff members choose to work in a pediatric dental practice because they like kids. So, most children are calm, comfortable and confident in a pediatric dental office.

Q: How will a pediatric dentist help my child feel comfortable?

A: Pediatric dentists are trained in many methods to help children feel comfortable with dental treatment. For example, in the "Tell-Show-Do" technique, a pediatric dentist might name a dental instrument, demonstrate the instrument by using it to count your child's fingers, then apply the instrument in treatment.

The modeling technique pairs a timid child in dental treatment with a cooperative child of similar age. Coaching, distraction, and parent participation are other possibilities to give your child confidence in dentistry. But by far the most preferred technique is praise. Every child does something right during a dental visit, and pediatric dentists let children know that.

Q: Should I accompany my child into treatment?

A: Infants and some young children may feel more confident when parents stay close during treatment. With older children, doctor-child communication is often enhanced if parents remain in the reception room.

Q: What if a child misbehaves during treatment?

A: Occasionally a child's behavior during treatment requires assertive management to protect him or her from possible injury. Voice control (speaking calmly but firmly) usually takes care of it. Some children need gentle restraint of the arms or legs as well. Mild sedation, such as nitrous oxide/oxygen or a sedative, may benefit an anxious child. If a child is especially fearful or requires extensive treatment, other sedative techniques or general anesthesia may be recommended.

Q: What is conscious sedation?

A: Conscious sedation is a management technique that uses medications to assist the child to cope with fear and anxiety and cooperate with dental treatment. Medications and dosages should be selected that are unlikely to cause loss of consciousness in the patient.

Q: Who should be sedated?

A: Children who have a level of anxiety that prevents good coping skills or are very young and do not understand how to cope in a cooperative fashion for the delivery of dental care should be sedated. Conscious sedation is often helpful for some children who have special needs.

Q: Why utilize conscious sedation?

A: Conscious sedation aids in allowing a child to cope better with dental treatment. This can help prevent injury to the child from patient movement and promote a better environment for providing dental care

Q: What medications are used?

A: Many different medications can be used for conscious sedation. Your pediatric dentist will discuss different options for your child.

Q: Is sedation safe?

A: Sedation is safe when administered by a trained pediatric dentist who follows the sedation guidelines of the American Academy of Pediatric Dentistry. Your pediatric dentist will discuss sedation options and patient monitoring for the protection of your child.

Q: What special instructions should I follow before the sedation appointment?

A: In order to alleviate potential anxiety in your child, your pediatric dentist may recommend minimal discussion of the dental appointment with your child. Should your child become ill, contact your pediatric dentist to see if it is necessary to postpone the appointment. It is very important to follow the directions of your pediatric dentist regarding fasting from fluids and foods prior to the sedation appointment.

Q: What special instructions should I follow after the sedation appointment?

A: Your pediatric dentist will not discharge your child until the child is alert and ready to go. Children who have been sedated are usually requested to remain at home for the rest of the day with adult supervision. Your pediatric dentist will discuss specific post-sedation instructions with you, including appropriate diet, physical activity, and requested supervision.

An educational resource for parents and caretakers of children with special needs, this 12-minute videotape is excellent for viewing in dental and medical offices. Educational topics include the value of early dental care, prevention, and proper brushing, told heartwarmingly by three parents of children with disabilities. Developed in collaboration with several parent, community, and dental organizations.

Q: Do special children have special dental needs?

A: Most do. Some special children are very susceptible to tooth decay, gum disease or oral trauma. Others require medication or diet detrimental to dental health. Still other children have physical difficulty with effective dental habits at home. The good news is, dental disease is preventable. If dental care is started early and followed conscientiously, every child can enjoy a healthy smile.

Q: How can I prevent dental problems for my special child?

A: A first dental visit by the first birthday will start your child on a lifetime of good dental health. The pediatric dentist will take a full medical history, gently examine your child's teeth and gums, then plan preventive care designed for your child's needs.

Q: Will preventive dentistry benefit my child?

A: Yes! Your child will benefit from the preventive approach recommended for all children- effective brushing and flossing, moderate snacking, adequate fluoride. Home care takes just minutes a day and prevents needless dental problems. Regular professional cleanings and fluoride treatments are also very beneficial. Sealants can prevent tooth decay on the chewing surfaces of molars where four out of five cavities occur.

Q: Are pediatric dentists prepared to care for special children?

A: Absolutely. Pediatric dentists have two or more years of advanced training beyond dental school. Their education as specialists focuses on care for children with special needs. In addition, pediatric dental offices are designed to be physically accessible for special patients. Pediatric dentists, because of their expertise, are often the clinicians of choice for the dental care of adults with special needs as well.

Q: Will my child need special care during dental treatment?

A: Some children need more support than a gentle, caring manner to feel comfortable during dental treatment. Restraint or mild sedation may benefit your special child. If a child needs extensive treatment, the pediatric dentist may provide care at a local hospital. Your pediatric dentist has a comprehensive education in behavior management, sedation and anesthesia techniques. He or she will select a technique based on the specific health needs of your child, then discuss the benefits, limits and risks of that technique with you.

Q. When should my child first see a dentist?

A: "First visit by first birthday" sums it up. Your child should visit a pediatric dentist when the first tooth comes in, usually between six and twelve months of age. Early examination and preventive care will protect your child¡¯s smile now and in the future.

Q. Why so early? What dental problems could a baby have?

A: The most important reason is to begin a thorough prevention program. Dental problems can begin early. A big concern is Early Childhood Caries (also know as baby bottle tooth decay or nursing caries). Your child risks severe decay from using a bottle during naps or at night or when they nurse continuously from the breast.

The earlier the dental visit, the better the chance of preventing dental problems. Children with healthy teeth chew food easily, learn to speak clearly, and smile with confidence. Start your child now on a lifetime of good dental habits.

Q. How can I prevent tooth decay from a bottle or nursing?

A: Encourage your child to drink from a cup as they approach their first birthday. Children should not fall asleep with a bottle. At-will nighttime breast-feeding should be avoided after the first primary (baby) teeth begins to erupt. Drinking juice from a bottle should be avoided. When juice is offered, it should be in a cup.

Q. When should bottle-feeding be stopped?

A: Children should be weaned from the bottle at 12-14 months of age.

Q. Should I worry about thumb and finger sucking?

A: Thumb sucking is perfectly normal for infants; most stop by age 2. If your child does not, discourage it after age 4. Prolonged thumb sucking can create crowded, crooked teeth, or bite problems. Your pediatric dentist will be glad to suggest ways to address a prolonged thumb sucking habit.

Q. When should I start cleaning my baby¡¯s teeth?

A: The sooner the better! Starting at birth, clean your child¡¯s gums with a soft infant toothbrush and water. Remember that most small children do not have the dexterity to brush their teeth effectively. Unless it is advised by your child¡¯s pediatric dentist, do not use fluoridated toothpaste until age 2-3.

Q. Any advice on teething?

A: From six months to age 3, your child may have sore gums when teeth erupt. Many children like a clean teething ring, cool spoon, or cold wet washcloth. Some parents swear by a chilled ring; others simply rub the baby¡¯s gums with a clean finger.

Q: What is a healthy diet for my child?

A: A healthy diet is a balanced diet that naturally supplies all the nutrients your child needs to grow. And what's a balanced diet? One that includes the following major food groups every day: Fruits and Vegetables; Breads and Cereals; Milk and Dairy Products; Meat, Fish and Eggs.

Q: How does my child's diet affect her dental health?

A: She must have a balanced diet for her teeth to develop properly. She also needs 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 of tooth decay.

Q: How do I make my child's diet safe for his teeth?

A: First, be sure he has a balanced diet. Then, check how frequently he eats foods with sugar or starch in them. Foods with starch include breads, crackers, pasta and such snacks 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.

Sugar can be found in many processed foods, even some that do not taste sweet. For example, a peanut butter and jelly sandwich not only has sugar in the jelly, but may have sugar added to the peanut butter. Sugar is also added to such condiments as catsup and salad dressings.

Q: Should my child give up all foods with sugar or starch?

A: Certainly not! Many provide nutrients your child needs. You simply need to select and serve them wisely. A food with sugar or starch is safer for teeth if it's eaten with a meal, not as a snack. Sticky foods, such as dried fruit or toffee, are not easily washed away from the teeth by saliva, water or milk. So, they have more cavity-causing potential than foods more rapidly cleared from the teeth. Talk to your pediatric dentist about selecting and serving foods that protect your child's dental health.

Q: Does a balanced diet assure that my child is getting enough fluoride?

A: No. A balanced diet does not guarantee the proper amount of fluoride for the development and maintenance of your child's teeth. If you do not live in a fluoridated community or have an ideal amount of naturally occurring fluoride in your well water, your child needs a fluoride supplement during the years of tooth development. Your pediatric dentist can help assess how much supplemental fluoride your child needs, based upon the amount of fluoride in your drinking water and your child's age and weight.

Q: My youngest isn't on solid foods yet. Do you have suggestions for her?

A: Don't nurse your daughter to sleep or put her to bed with a bottle of milk, formula, juice, or sweetened liquid. While she sleeps, any unswallowed liquid in the mouth supports bacteria that produce acids and attack the teeth. Protect your child from severe tooth decay by putting her to bed with nothing more than a pacifier or bottle of water.

Q: Any final advice?

A: Yes. Here are tips for your child's diet and dental health.

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

It's never too early to keep an eye on your child's oral development. Your pediatric dentist can identify malocclusion -- crowded or crooked teeth or bite problems -- and actively intervene to guide the teeth as they emerge in the mouth. Orthodontic treatment early can prevent more extensive treatment later.

Q: What causes crowded teeth and other orthodontic problems?

A: Malocclusion is often inherited. Orthodontic problems also are caused by dental injuries, the early loss of primary teeth or such habits a thumb sucking, fingernail biting, or lip biting. Your pediatric dentist can help your child avoid oral habits that may create orthodontic problems.

Q: Why is early orthodontic care important?

A: 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, even prevent the need for tooth extractions. Straight teeth are easier to keep clean and less susceptible to tooth decay and gum disease.

Q: What is early orthodontic treatment like?

A: Different orthodontic appliances work in different ways to benefit your child's dental health. Some are fixed; others are removable. Your pediatric dentist will explain which appliance is best for your child, what the treatment can do, and how long it will take.

Q: What care is recommended during orthodontic treatment?

A: As with any dental treatment, the more a child cooperates, the better the results. First, careful brushing and flossing keep the appliance and your child's health in top shape. (Removable appliances should be brushed each time the teeth are brushed.) Second, regular dental check-ups -- besides orthodontic appointments -- protect your child from tooth decay and gum disease. Third, prompt contact with your pediatric dentist when an appliance breaks will keep orthodontic treatment on-time and on-track.

Q: Can my child speak, eat, and play normally?

A: Your child can eat a normal diet except sticky foods (gum, caramels) and large, hard foods (peanuts, ice chips, popcorn). Some appliances alter speech, but most children adapt quickly and speak clearly within a day or two. Generally, children can safely run, jump, swim, and play with an orthodontic appliance. Check with your pediatric dentist for specific advise on your child's activities.

When your child needs urgent dental treatment, your pediatric dentist stands ready to help. Please keep the emergency number available and convenient.

Q: What should I do if my child's baby tooth is knocked out?

A: Contact your pediatric dentist as soon as possible.

Q: What should I do if my child's permanent tooth is knocked out?

A: Find the tooth and rinse it gently in cool water. (Do not scrub it or clean it with soap -- use just water!) If possible, replace the tooth in the socket and hold it there with clean gauze or a wash cloth. If you can't put the tooth back in the socket, place the tooth in a clean container with milk, saliva, or water. Get to the pediatric dental office immediately. (Call the emergency number if it's after hours.) The faster you act, the better your chances of saving the tooth.

Q: What if a tooth is chipped or fractured?

A: Contact your pediatric dentist immediately. Quick action can save the tooth, prevent infection and reduce the need for extensive dental treatment. Rinse the mouth with water and apply cold compresses to reduce swelling. If you can find the broken tooth fragment, bring it with you to the dentist.

Q: What about a severe blow to the head or jaw fracture?

A: Go immediately to the emergency room of your local hospital. A blow to the head can be life threatening.

Q: What if my child has a toothache?

A: Call your pediatric dentist and visit the office promptly. To comfort your child, rinse the mouth with water. Apply a cold compress or ice wrapped in a cloth. Do not put heat or aspirin on the sore area.

Q: Can dental injuries be prevented?

A: Absolutely! First, reduce oral injury in sports by wearing mouth guards. Second, always use a car seat for young children. Require seat belts for everyone else in the car. Third, child-proof your home to prevent falls, electrical injuries, and choking on small objects. Fourth, protect your child from unnecessary toothaches with regular dental visits and preventive care.

Q: What is enamel fluorosis?

A: A child may face the condition called enamel fluorosis if he or she gets too much fluoride during the years of tooth development. Too much fluoride can result in defects in tooth enamel.

Q: Why is enamel fluorosis a concern?

A: In severe cases of enamel fluorosis, the appearance of the teeth is marred by discoloration or brown markings. The enamel may be pitted, rough, and hard to clean. In mild cases of fluorosis, the tiny white specks or streaks are often unnoticeable.

Q: How does a child get enamel fluorosis?

A: By swallowing too much fluoride for the child's size and weight during the years of tooth development. This can happen in several different ways. First, a child may take more of a fluoride supplement than the amount prescribed. Second, the child may take a fluoride supplement when there is already an optimal amount of fluoride in the drinking water. Third, some children simply like the taste of fluoridated toothpaste. They may use too much toothpaste, then swallow it instead of spitting it out.

Q: How can enamel fluorosis be prevented?

A: Talk to your pediatric dentist as the first step. He or she can tell you how much fluoride is in your drinking water. (Your local water treatment plant is another source of this information.) If you drink well water or bottled water, your pediatric dentist can assist you in getting an analysis of its fluoride content. After you know how much fluoride your child receives, you and your pediatric dentist can decide together whether your child needs a fluoride supplement.

Watch your child's use of fluoridated toothpaste as the second step. 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.

Q: Should I just avoid fluorides for my child altogether?

A: No! Fluoride prevents tooth decay. It is an important part of helping your child keep a healthy smile for a lifetime. Getting enough -- but not too much -- fluoride can be easily accomplished with the help of your pediatric dentist.

Q: Can enamel fluorosis be treated?

A: Once fluoride is part of the tooth enamel, it can't be taken out. But the appearance of teeth affected by fluorosis can be greatly improved by a variety of treatments in esthetic dentistry. If your child suffers from severe enamel fluorosis, your pediatric dentist can tell you about dental techniques that enhance your child's smile and self-confidence.

Q: What is microabrasion?

A: In microabrasion, dentists carefully rub a compound on the teeth to remove superficial stains and discoloration.

Q: Why are my child's teeth discolored?

A: A number of conditions can cause discoloration of permanent teeth. For example, trauma to a baby tooth, an infection around a baby tooth, and high fevers or prolonged chronic illnesses during childhood can cause discolorations. Fluoride can also cause some white or brown discolorations of teeth when a child receives a high dose over a period of time.

Some teeth have a deeper, irreversible stain or discoloration, the result of trauma, root canal therapy or medications such as tetracycline. These deep stains are not improved by microabrasion.

Q: Will microabrasion work for my child?

A: The success of microabrasion depends on a number of factors, especially the type and extent of discoloration. So, it is difficult to predict when microabrasion will remove a discoloration completely from a tooth. Pediatric dentists have learned that brown or dark stains are removed readily in most cases. White discolorations are often improved; sometimes they are totally eliminated. Other times, white discolorations are very persistent and not removed completely with microabrasion.

Some teeth have a "speckled" appearance, showing a lot of white spots all over the tooth. These teeth may be improved with microabrasion. By removing the bright white spots, the teeth will have a slightly darker, but more even, natural color.

Q: What if microabrasion doesn't work?

A: Microabrasion is a safe, minimal treatment of discolored teeth. Attempting microabrasion does not eliminate any of the alternatives for treatment. Other treatments for discolored teeth are plastic or porcelain veneers or porcelain crowns. These options are less affordable and more extensive than microabrasion because they require some tooth preparation. So, it's wise to consider microabrasion as your first choice of treatment for discolored teeth.

Children smile when they are proud of their teeth. At school and at play, they feel more confident. Ask your pediatric dentist about esthetic dentistry to restore or enhance your child's smile.

Q: What causes discolored teeth?

A: There are many possible causes. Trauma to a tooth can cause discoloration. Severe illness during tooth development can discolor areas of teeth because of disruptions in tooth development. Additionally, an entire tooth might discolor if exposed to certain medicines or minerals during development. Lastly, poor oral hygiene, especially during orthodontic therapy, can lead to discolored areas on teeth as well.

Q: How do you restore a discolored tooth to its natural color?

A: Bleaching can be a good treatment choice. It requires no anesthetic and removes no tooth structure. One or more teeth can be bleached in a series of visits to your pediatric dentist. Or, your pediatric dentist may recommend a bleaching program at home under his or her guidance.

Q: How do you treat discolored spots on teeth?

A: A technique called microabrasion can improve the appearance of teeth with discolored areas. In this treatment, the pediatric dentist removes microscopic bits of discolored tooth enamel with an abrasive and a mild acid. Microabrasion is a conservative treatment, usually comfortable for the patient. It works best on surface discoloration.

Q: What about chipped or broken teeth?

A: Bonding tooth-colored plastic to the tooth or cementing tooth-colored veneers to affected teeth not only restores the appearance of discolored teeth, but restores the original shape of chipped or broken teeth as well. These techniques are less costly than crowns and generally can be done without a lot of tooth preparation. They restore the natural appearance of the tooth and therefore encourage a confident smile.

Q: Are there any limitations to bonding or veneers?

A: Yes, there are some limitations. Although the treatments are conservative, they require some loss of tooth enamel. Also, bonded teeth and veneers are simply not as strong as the original tooth structure. Nail biting, hard foods, and sports accidents can damage them. They must be maintained with good oral hygiene and regular dental visits.

Q: What about porcelain crowns?

A: Porcelain crowns give nice cosmetic results for discolored, chipped, or broken teeth. They do present two realities of which a parent should be aware. First, crowns are more costly than other treatments. Second, the dentist must remove a significant amount of tooth structure to place a crown. Therefore, porcelain crowns are seldom recommended for pediatric patients.

How does fluoride work?

When the element fluoride is used in small amounts on a routine basis it helps to prevent tooth decay. It encourages "remineralization," a strengthening of weak areas on the teeth. These spots are the beginning of cavity formation. Fluoride occurs naturally in water and in many different foods, as well as in dental products such as toothpaste, mouth rinses, gels, varnish and supplements. Fluoride is effective when combined with a healthy diet and good oral hygiene.

Will my child need fluoride supplements?

Children between the ages of six months and 16 years may require fluoride supplements. The pediatric dentist considers many different factors before recommending a fluoride supplement. Your child's age, risk of developing dental decay and the different liquids your child drinks are important considerations. Bottled, filtered and well waters vary in their fluoride amount, so a water analysis may be necessary to ensure your child is receiving the proper amount.

What type of toothpaste should my child use?

Your child should use toothpaste with fluoride and the American Dental Association Seal of Acceptance. Young children, especially pre-school aged children, should not swallow any toothpaste. Careful supervision and only a small pea-sized amount on the brush are recommended. If not monitored, children may easily swallow over four times the recommended daily amount of fluoride in toothpaste.

How safe is fluoride?

Fluoride is documented to be safe and highly effective. Research indicates water fluoridation, the most cost effective method, has decreased the decay rate by over 50 percent. Only small amounts of fluoride are necessary for the maximum benefit. Proper toothpaste amount must be supervised, and other forms of fluoride supplementations must be carefully monitored in order to prevent a potential overdose and unsightly spots on the developing permanent teeth. Do not leave toothpaste tubes where young children can reach them. The flavors that help encourage them to brush may also encourage them to eat toothpaste.

What is topical fluoride?

Topical fluoride comes in a number of different forms. Gels and foams are placed in fluoride trays and applied at the dental office after your child's teeth have been thoroughly cleaned. Fluoride varnish is one of the newer forms of topical fluoride applied at the dentist office. It has been documented to be safe and effective to fight dental decay through a long history of use in Europe.
The advantages of varnish are:
• Easily and quickly applied to the teeth.
• Decreases the potential amount of fluoride digested.
• Continues to "soak" fluoride into the enamel for approximately 24 hours after the original application.

This method is especially useful in young patients and those with special needs that may not tolerate fluoride trays comfortably.

Children who benefit the most from fluoride are those at highest risk for dental decay. Risk factors include a history of decay, high sucrose carbohydrate diet, orthodontic appliances and certain medical conditions such as dry mouth.

Q:What is general anesthesia?

A: General anesthesia is a management technique that uses medications to cause the child to become unconscious and asleep while receiving dental care. It is provided by a physician or dentist who has special training in anesthesia.

Q:Who should receive dental care with general anesthesia?

A: Children with severe anxiety and/or inability to cooperate are candidates for general anesthesia. These children may be young or have compromised health or special needs. They usually require extensive dental treatment and their anxiety cannot be controlled with conscious sedation techniques.

Q:Is general anesthesia safe?

A: Although there is some risk associated with general anesthesia, it is safe when administered by an appropriately trained individual in an appropriately equipped facility. Many precautions are taken to provide safety for the child during general anesthesia care. Patients are monitored closely during the general anesthesia procedure by personnel who are trained to manage complications. Your pediatric dentist will discuss the benefits and risks involved in general anesthesia and why it is recommended for your child.

Q:What special considerations are associated with the general anesthesia appointment?

A physical examination is required prior to general anesthesia for dental care. This physical examination provides information to ensure the safety of the general anesthesia procedure. Your pediatric dentist and/or your general anesthesia provider will advise you about evaluation appointments that are required.

Parents are instructed to report to the pediatric dentist any illness that occurs prior to the general anesthesia appointment. It may be necessary to reschedule the appointment. It is very important to follow instructions regarding preoperative fasting from fluids and foods.

Usually patients are tired following general anesthesia. Your child will be discharged when alert and ready to depart. You will be instructed to let the child rest at home with minimal activity planned until the next day. Post-operative dietary recommendations will also be given.

Dental insurance plans differ by:

• services they cover
• amount they pay for dental procedures
• whether or not you can decide which dentist to see in order to get the most appropriate care in the most efficient manner.

Some dental insurance plans may limit your right to choose a dentist for your child, or your right to choose a pediatric dentist without first being referred by a general dentist, or your right to choose a pediatric dentist under any circumstance.

You have the right to choose a pediatric dentist for your child.

Your child will receive the most appropriate dental care when you make informed decisions with the dentist of your choice.

Pediatric dentists are primary care providers, as recognized by the American Dental Association.

Plans that require referral to a pediatric dentist only after an unsuccessful visit to a general dentist are not in your child's best interest.

When offered a choice of dental plans, know what services the plan does and doesn't cover before you enroll! Make sure you can select a pediatric dentist as your child's primary care provider.

Pediatric dentists are right for a child.

When you seek pediatric dental care for your child, you are making a wise decision.

Pediatric dentists are uniquely qualified by training and experience to provide the most appropriate, cost-effective dental care for children.

Pediatric dental care typically does not cost more than care provided by a general dentist.

Preventive dentistry can only occur if your child visits the dental office regularly. Some dental plans are designed to minimize coverage for regular examinations, topical fluoride treatments or dental sealants.

Parents have choices.

When you are unhappy with your dental plan, you have options.

Sometimes the dentist that is right for parents, brothers and sisters may not be the best choice for another child. When necessary, you can select a pediatric dentist outside your plan even though you may have to pay out-of-pocket expenses. The cost of this care is worthwhile in the long run.

You can find out if your employer offers less restrictive plans. Know your choices during your re-enrollment period.

If you are not happy with your dental plan, you should consider voicing your concerns to your employer.

If young patients must leave a pediatric dental practice, we understand.

When parents decide to change their child's dental provider, for any reason, pediatric dentists will assist in the transfer of records and make the transition as smooth as possible.

AND, if you switch to a more restrictive plan and are not satisfied, you are always welcome to return to your pediatric dentist.

Q: What are athletic mouth protectors?

A: Athletic mouth protectors, or mouth guards, are made of soft plastic. They are adapted to fit comfortably to the shape of the upper teeth.

Q: Why are mouth guards important?

A: Mouth guards hold top priority as sports equipment. They protect not just the teeth, but the lips, cheeks, and tongue. They help protect children from such head and neck injuries as concussions and jaw fractures. Increasingly, organized sports are requiring mouth guards to prevent injury to their athletes. Research shows that most oral injuries occur when athletes are not wearing mouth protection.

Q: When should my child wear a mouth guard?

A: Whenever he or she is in an activity with a risk of falls or of head contact with other players or equipment. This includes football, baseball, basketball, soccer, hockey, skateboarding, even gymnastics. We usually think of football and hockey as the most dangerous to the teeth, but nearly half of sports-related mouth injuries occur in basketball and baseball.

Q: How do I choose a mouth guard for my child?

A: Any mouth guard works better than no mouth guard. So, choose a mouth guard that your child can wear comfortably. If a mouth guard feels bulky or interferes with speech, it will be left in the locker room.

You can select from several options in mouth guards. First, preformed or "boil-to-fit" mouth guards are found in sports stores. Different types and brands vary in terms of comfort, protection, and cost. Second, customized mouth guards are provided through your pediatric dentist. They cost a bit more, but are more comfortable and more effective in preventing injuries. Your pediatric dentist can advise you on what type of mouth guard is best for your child.

Many children are calm, comfortable, and confident in a pediatric dental office. Because pediatric dentists specialize in treating children, they make children feel special. The office is especially designed for children. Staff members choose to work in a pediatric dental office because they like kids.

Sometimes, however, a child feels anxious during treatment. Your child may need more support than a gentle, caring manner to feel comfortable. Nitrous oxide/oxygen is a safe, effective technique to calm a child's fear of the dental visit.

Q: What is nitrous oxide/oxygen?

A: Nitrous oxide/oxygen is a blend of two gases, oxygen and nitrous oxide. When inhaled, it is absorbed by the body and has a calming effect. Normal breathing eliminates nitrous oxide/oxygen from the body.

Q: How will my child feel when breathing nitrous oxide/oxygen?

A: Your child will smell a sweet, pleasant aroma and experience a sense of well-being and relaxation. If your child is worried by the sights, sounds, or sensations of dental treatment, he or she may respond more positively with the use of nitrous oxide/oxygen.

Q: How safe is nitrous oxide/oxygen?

A: Very safe. Nitrous oxide/oxygen is perhaps the safest sedative in dentistry. It is nonaddictive. It is mild, easily taken, then quickly eliminated by the body. Your child remains fully conscious, keeps all natural reflexes, when breathing nitrous oxide/oxygen.

Q: Are there any special instructions for nitrous oxide/oxygen?

A: First, give your child little or no food before the dental visit. (Occasionally, nausea or vomiting occurs when a child has a full stomach.) Second, tell your pediatric dentist about any respiratory condition that makes breathing through the nose difficult for your child. It may limit the effectiveness of nitrous oxide/oxygen. Third, tell your pediatric dentist if your child is taking any medication on the day of the appointment.

Q: Will nitrous oxide/oxygen work for all children?

A: Pediatric dentists know that all children are not alike! Every service is tailored to your child as an individual. Nitrous oxide/oxygen is not effective for some children, especially those who have severe anxiety, nasal congestion, extensive treatment needs, or discomfort wearing a nasal mask. Pediatric dentists have comprehensive specialty training and can offer other sedation methods that are right for your child.

Q: What is preventive dentistry?

A: Preventive dentistry for children includes:

• brushing
• dental development
• flossing
• fluorides
• oral habits
• orthodontics
• parent involvement
• proper diet
• sealants
• sports safety

Your pediatric dentist practices preventive dentistry.

Q: Why is preventive dentistry important?

A: Preventive dentistry means a healthy smile for your child. Children with healthy mouths chew more easily and gain more nutrients from the foods they eat. They learn to speak more quickly and clearly. They have a better chance of general health, because disease in the mouth can endanger the rest of the body. A healthy mouth is more attractive, giving children confidence in their appearance. Finally, preventive dentistry means less extensive, and less expensive, treatment for your child.

Q: When should preventive dentistry start?

A: Preventive dentistry begins with the first tooth. Visit your pediatric dentist when the first tooth comes in. You will learn how to protect your infant's dental health. The earlier the dental visit, the better the chance of preventing dental disease and helping your child belong to the cavity-free generation.

Q: What role do parents play in prevention?

A: After evaluating your child's dental health, your pediatric dentist will design a personalized program of home care for your child. This program will include brushing and flossing instructions, diet counseling, and if necessary, fluoride recommendations. By following these directions, you can help give your child a lifetime of healthy habits.

Q: How do pediatric dentists help prevent dental problems?

A: Tooth cleaning and polishing and fluoride treatments are all part of your child's prevention program. But there's much more. For example, your pediatric dentist can apply sealants to protect your child from tooth decay, help you select a mouth guard to prevent sports injuries to the face and teeth, and provide early diagnosis and care of orthodontic problems. Your pediatric dentist is uniquely trained to develop a combination of office and home preventive care to insure your child a happy smile.

Q: How often should a child see the dentist?

A: The American Academy of Pediatric Dentistry recommends a dental check-up at least twice a year for most children. Some children need more frequent dental visits because of increased risk of tooth decay, unusual growth patterns or poor oral hygiene. Your pediatric dentist will let you know the best appointment schedule for your child.

Q: Why visit the dentist twice a year when my child has never had a cavity?

A: Regular dental visits help your child stay cavity-free. Teeth cleanings remove debris that build up on the teeth, irritate the gums and cause decay. Fluoride treatments renew the fluoride content in the enamel, strengthening teeth and preventing cavities. Hygiene instructions improve your child's brushing and flossing, leading to cleaner teeth and healthier gums.

Tooth decay isn't the only reason for a dental visit. Your pediatric dentist provides an ongoing assessment of changes in your child's oral health. For example, your child may need additional fluoride, dietary changes, or sealants for ideal dental health. The pediatric dentist may identify orthodontic problems and suggest treatment to guide the teeth as they emerge in the mouth.

Q: What happens in a dental check-up?

A: The pediatric dentist will review your child's medical and dental history. He or she will gently examine your child's teeth, oral tissues, and jaws. The teeth will be cleaned and polished, followed by the application of a fluoride solution.

Your pediatric dentist won't talk just to you about dental health, he or she will talk to your child with easily understandable words, pictures, and ideas. Your child will be motivated to take responsibility for healthy smile.

Q: Will X-rays be taken at every appointment?

A: No. Pediatric dentists, acting in accord with guidelines from the American Academy of Pediatric Dentistry, recommend X-rays only when necessary to protect your child's dental health.For example, X-rays maybe needed to diagnose tooth decay or abnormalities. Or, they may be required for orthodontic treatment. Your pediatric dentist will discuss the need for X-rays with you before any are taken.

Q: How can I help my child enjoy good dental health?

A: The following steps will help your child be part of the cavity-free generation:

1. Beware of frequent snacking
2. Brush effectively twice a day with a fluoride toothpaste
3. Floss once a day
4. Have sealants applied when appropriate
5. Seek regular dental check-ups
6. Assure proper fluoride through drinking water, fluoride products or fluoride supplements

Q: What are sealants?

A: Sealants protect the grooved and pitted surfaces of the teeth, especially the chewing surfaces of back teeth where most cavities in children are found. Made of clear or shaded plastic, sealants are applied to the teeth to help keep them cavity-free.

Q: How do sealants work?

A: Even if your child brushes and flosses carefully, it is difficult - sometimes impossible -to clean the tiny grooves and pits on certain teeth. Food and bacteria build up in these crevices, placing your child in danger of tooth decay. Sealants "seal out" food and plaque, thus reducing the risk of decay.

Q: How long do sealants last?

A: Research shows that sealants can last for many years if properly cared for. So, your child will be protected throughout the most cavity-prone years. If your child has good oral hygiene and avoids biting hard objects, sealants will last longer. Your pediatric dentist will check the sealants during routine dental visits and can recommend reapplication or repair when necessary.

Q: What is the treatment like?

A: The application of a sealant is quick and comfortable. It takes only one visit. The tooth is first cleaned. It is then conditioned and dried. The sealant is then flowed onto the grooves of the tooth and allowed to harden or hardened with a special light. Your child will be able to eat right after the appointment.

Q: How much does it cost?

A: The treatment is very affordable, especially in view of the valuable decay protection it offers your child. Most dental insurance companies cover sealants. Some companies, however, have age and specific tooth limitations. Check with your benefits provider about your child¡¯s coverage and talk to your pediatric dentist about the exact cost of sealants for your child.

Q: Which teeth should be sealed?

A: The natural flow of saliva usually keeps the smooth surfaces of teeth clean but does not wash out the grooves and fissures. So, the teeth most at risk of decay?and therefore most in need of sealants - are the six-year and twelve-year molars. Many times the permanent premolars and primary molars will also benefit from sealant coverage. Any tooth, however, with grooves or pits may benefit from the protection of sealants. Talk to your pediatric dentist, as each child¡¯s situation is unique.

Q: If my child has sealants are brushing and flossing still important?

A: Absolutely! Sealants are only one step in the plan to keep your child cavity-free for a lifetime. Brushing, flossing, balanced nutrition, limited snacking, and regular dental visits are still essential to a bright, healthy smile.

Q: Why do children lose their baby teeth?

A: A baby tooth usually stays in until a permanent tooth underneath pushes it out and takes its place. Unfortunately, some children lose a baby tooth too soon. A tooth might be knocked out accidentally or removed because of dental disease. When a tooth is lost too early, your pediatric dentist may recommend a space maintainer to prevent future space loss and dental problems.

Q: Why all the fuss? Baby teeth fall out eventually on their own!

A: Baby teeth are important to your child's present and future dental health. They encourage normal development of the jaw bones and muscles. They save space for the permanent teeth and guide them into position. Remember: Some baby teeth are not replaced until a child is 12 or 14 years old.

Q: How does a lost baby tooth cause problems for permanent teeth?

A: If a baby tooth is lost too soon, the teeth beside it may tilt or drift into the empty space. Teeth in the other jaw may move up or down to fill the gap. When adjacent teeth shift into the empty space, they create a lack of space in the jaw for the permanent teeth. So, permanent teeth are crowded and come in crooked. If left untreated, the condition may require extensive orthodontic treatment.

Q: What are space maintainers?

A: Space maintainers are appliances made of metal or plastic that are custom fit to your child's mouth. They are small and unobtrusive in appearance. Most children easily adjust to them after the first few days.

Q: How does a space maintainer help?

A: Space maintainers hold open the empty space left by a lost tooth. They steady the remaining teeth, preventing movement until the permanent tooth takes its natural position in the jaw. It's more affordable -- and easier on your child -- to keep teeth in normal positions with a space maintainer than to move them back in place with orthodontic treatment.

Q: What special care do space maintainers need?

A: Pediatric dentists have four rules for space maintainer care. First, avoid sticky sweets or chewing gum. Second, don't tug or push on the space maintainer with your fingers or tongue. Third, keep it clean with conscientious brushing and flossing. Fourth, continue regular dental visits.