Close up portrait of cute girl brushing teeth.

Kids Care: Early Infant Oral Care

Dr. Eric Chu, Dr. Kitty Lam and their team makes sure that children of all ages feel safe and welcome. We provide a comfortable and caring environment and try to understand how best to respond to a child’s fear, anxiety or pain.  This is the foundation of our treatment approach.

Pleasant visits to the dental office promote trust and confidence in your child that will last a lifetime.  It is vital that your child gets the right advice at an early age.

For the very apprehensive children we offer oral sedation.

How Do I Prepare My Child For The Dentist?

We would like to make a few suggestions to prepare your youngster for the initial visit. First, present the visit as an exciting experience for yourself and for your child. Second, tell your child that we will “count”, “brush”, and “take pictures” of their teeth. By explaining the exam and the cleaning in these terms, your child will better understand the situation. Try to act relaxed and at ease. Your child will probably sense any anxiety on your part. Avoid negative phrases such as “hurt”, “drill”, “pull” and “shot”. This initial visit involves nothing uncomfortable and should be perceived by the child as non-threatening. It is our job to make this initial visit the most positive experience possible.

Your Baby’s First Appointment

We follow the American Academy of Pediatric Dentistry and American Dental Association recommendations to see children around their first birthday. This is especially important for your “first” child so we can educate you about normal growth and development, feeding and oral habits. At this visit, we will check your child’s oral cavity and provide you with oral hygiene instructions and answer any questions. This appointment gives you and your child the right start for years of positive dental care. Our goal for your child is a lifetime of strong healthy teeth for a beautiful smile.

Your Child’s First “Official” Visit

Around age 4 we have our First Official Appointment. We encourage you to make this appointment in the morning when your child is rested. You may want to leave siblings at home and make this a special time for your child. The appointment begins when our new patient coordinator greets you and your child in the reception area and escorts you to a special room where we can get to know you both. After reviewing your needs and questions, she will bring the doctor into the room to meet you. While the doctor and you are talking, the specially trained coordinator will take your child to get a toothbrush and begin the visit.

Before any procedures are started, we show and tell your child what we are going to do. We encourage their active participation in the visit by asking questions about their school or daycare, hobbies, friends or anything special they would like to share with us. Parents are encouraged to “sneak a peek” during the visit – seeing is believing! Mom and Dad are usually amazed how wonderful their children listen and behave during their dental visit. Occasionally, a child may cry during some part of the visit. This is normal behavior and usually the child will work their way through it with our compassionate coaxing.

We invite you to stay with your child during the initial examination. During future appointments, we suggest you allow your child to accompany our staff through the dental experience. This will help us establish a closer rapport with your child. Our purpose is to gain your child’s confidence and overcome any apprehension.  For the safety and privacy of all patients, other children who are not being treated should remain in the reception room with a supervising adult.


During teething it is important to use a soft bristled infant brush to brush the entire mouth in the morning and night to stimulate the gums — especially where teeth are breaking through the gingivae.

Teething Aids:
  • Vitamin A-rich vegetables
  • Vitamin D-rich eggs
  • Plenty of chilled foods, yogurt to relieve discomfort
  • Give lots of cool water daily
  • Chew on cold, raw carrot sticks
  • Use a teething ring that has been kept in the refrigerator

You may also use weak solutions of tea both internally and to gently pat on the teeth and gums with a soft cloth.

  • Chamomile
  • Red Raspberry
  • Peppermint
  • Fennel


Baby Bottle Tooth Decay (Early Childhood Caries)

One serious form of decay among young children is baby bottle tooth decay. This condition is caused by frequent and long exposure of an infant’s teeth to liquids that contain sugar. Among these liquids are milk (including breast milk), formula, fruit juices, and other sweetened drinks.

Putting a baby to bed for a nap or at night with a bottle other than water can cause serious and rapid tooth decay. Sweet liquids pool around the child’s teeth allowing bacteria create plaque and an opportunity to produce acids that erode tooth enamel. If you must give the baby a bottle as a comforter at bedtime, it should contain only water.  If your child won’t fall asleep without the bottle and its usual beverage, gradually dilute the bottle’s contents with water over a period of two to three weeks.

After each feeding, wipe the baby’s gums and teeth with a clean damp washcloth or gauze pad to remove plaque. The easiest way to do this is to sit down, place the child’s head in your lap or lay the child on a dressing table or the floor. Whatever position you use, be sure you can see into the child’s mouth easily.


Why are The Primary Teeth so Important?

It is very important to maintain the health of the primary teeth. Neglected cavities can and frequently do lead to problems which affect developing permanent teeth. Primary teeth, or baby teeth, are important for (1) proper chewing and eating, (2) providing space for the permanent teeth and guiding them into the correct position, and (3) permitting normal development of the jaw bones and muscles. Primary teeth also affect the development of speech and add to an attractive appearance. While the 4 front teeth last until 6-7 years of age, the back teeth (cuspids and molars) aren’t replaced until age 10-13.

Innumerable studies and research have concluded on the importance of starting children early in their lives with good dental hygiene and oral care. According to research, the most common chronic childhood disease in America is tooth decay, affecting 50 percent of first graders and 80 percent of 17-year-olds. Early treatment prevents problems affecting a child’s health, well-being, self-image, and overall achievement.

The National Institute of Dental & Craniofacial Research estimates that children will miss 52 million hours of school each year due to oral health problems and about 12.5 million days of restricted activity every year from dental symptoms. Thus, there is such a significant loss in their academic performance.

Parents are responsible for ensuring their children practice good dental hygiene. Parents should introduce proper oral care early in a child’s life – starting in infancy.

Eruption of Your Child’s Teeth

Children’s teeth begin forming before birth. As early as 4 months, the first primary (or baby) teeth to erupt through the gums are the lower central incisors, followed closely by the upper central incisors. On average, all 20 primary teeth usually will have erupted by age 3, the pace and order of their eruption varies between individuals.

Permanent teeth begin to erupt around age 6, starting with the first molars and lower central incisors. This process continues until approximately age 21.

Adults have 28 permanent teeth, or up to 32 including the wisdom teeth.


Dental Radiographs (X-Rays)

Radiographs (X-Rays) are a vital and necessary part of your child’s dental diagnostic process. Without them, certain dental conditions can and will be missed.

Radiographs detect much more than cavities. For example, radiographs may be needed to survey erupting teeth, diagnose bone diseases, evaluate the results of an injury, or plan orthodontic treatment. Radiographs allow us to diagnose and treat health conditions that cannot be detected during a clinical examination. If dental problems are found and treated early, dental treatment is much less traumatic and more comfortable for your child and more affordable for you.

The American Academy of Pediatric Dentistry recommends radiographs and examinations every six months for children with a high risk of tooth decay. On average, most pediatric dentists request radiographs approximately once a year. Approximately every 3 years it is a good idea to obtain a complete set of radiographs, either a panoramic and bitewings or periapicals (x-rays that show the roots of the teeth) and bitewings.

With the advent of digital x-rays which minimize the exposure of their patients to radiation. With these contemporary safeguards, the amount of radiation received in a dental X-ray examination is extremely small. The risk is negligible. In fact, the dental radiographs represent a far smaller risk than an undetected and untreated dental problem. Lead body aprons and shields will protect your child. Today’s equipment filters out unnecessary x-rays and restricts the x-ray beam to the area of interest. Special and high tech digital x-rays sensors and proper shielding assure that your child receives a minimal amount of radiation exposure.


What’s the Best Toothpaste for my Child?

Remember, children should spit out toothpaste after brushing to avoid getting too much fluoride. If too much fluoride is ingested, a condition known as fluorosis can occur. If your child is too young or unable to spit out toothpaste, consider providing them with fluoride free toothpaste, using no toothpaste, or using only a “pea size” amount of toothpaste.

Many toothpastes, and/or tooth polishes, however, can damage young smiles. They contain harsh abrasives which can wear away young tooth enamel. When looking for toothpaste for your child make sure to pick one that is recommended by the American Dental Association. These toothpastes have undergone testing to insure they are safe to use.


Does Your Child Grind His /Her Teeth At Night? (Bruxism)

Parents are often concerned about the nocturnal grinding of teeth (bruxism). Often, the first indication is the noise created by the child grinding on their teeth during sleep. Or, the parent may notice wear (teeth getting shorter) to the dentition. One theory as to the cause involves a psychological component. Stress due to a new environment, divorce, changes at school; etc. can influence a child to grind their teeth

The majority of cases of pediatric bruxism do not require any treatment. If excessive wear of the teeth (attrition) is present, then a mouth guard (night guard) may be indicated. The negatives to a mouth guard are the possibility of choking if the appliance becomes dislodged during sleep and it may interfere with growth of the jaws. The positive is obvious by preventing wear to the primary dentition.

The good news is most children outgrow bruxism. The grinding gets less between the ages 6-9 and children tend to stop grinding between ages 9-12. If you suspect bruxism, discuss this with the dentist.


 Thumb Sucking

Sucking is a natural reflex and infants and young children may use thumbs, fingers, pacifiers and other objects on which to suck. It may make them feel secure and happy or provide a sense of security at difficult periods. Since thumb sucking is relaxing, it may induce sleep.

Thumb sucking that persists beyond the eruption of the permanent teeth can cause problems with the proper growth of the mouth and teeth alignment. How intensely a child sucks on fingers or thumbs will determine whether or not dental problems may result. Children who rest their thumbs passively in their mouths are less likely to have difficulty than those who vigorously suck their thumbs.

Children should cease thumb sucking by the time their permanent front teeth are ready to erupt. Usually, children stop between the ages of two and four. Peer pressure causes many school-aged children to stop.

Pacifiers should not substitute for thumb sucking. They can affect the teeth essentially the same way as sucking fingers and thumbs. However, use of the pacifier can be controlled and modified more easily than the thumb or finger habit. If you have concerns about thumb sucking or use of a pacifier, consult your dentist.

A few suggestions to help your child get through thumb sucking:

  • Instead of scolding children for thumb sucking, praise them when they are not.
  • Children often suck their thumbs when feeling insecure. Focus on correcting the cause of anxiety.
  • Children who are sucking for comfort will feel less of a need when their parents provide comfort.
  • Reward children when they refrain from sucking during difficult periods, such as when they are away   from their parents.
  • If these approaches don’t work, remind the children of their habit by bandaging the thumb or putting a sock on the hand at night. Your dentist may recommend the use of a mouth appliance.


What is Pulp Therapy (Baby Root Canal Treatment)?

The pulp of a tooth is the inner central core of the tooth.  The pulp contains nerves, blood vessels, connective tissue and reparative cells.  The purpose of pulp therapy (baby root canal)  in is to maintain the vitality of the affected tooth (so the tooth is not lost).

Dental caries (cavities) and traumatic injury are the main reasons for a tooth to require pulp therapy.  Pulp therapy is often referred to as a “nerve treatment”, “children’s root canal”, “pulpectomy” or “pulpotomy”.  The two common forms of pulp therapy in children’s teeth are the pulpotomy and pulpectomy.

A pulpotomy removes the diseased pulp tissue within the crown portion of the tooth.  Next, an agent is placed to prevent bacterial growth and to calm the remaining nerve tissue.  This is followed by a final restoration.

A pulpectomy is required when the entire pulp is involved (into the root canal(s) of the tooth).   During this treatment, the diseased pulp tissue is completely removed from both the crown and root.  The canals are cleansed, disinfected and in the case of primary teeth, filled with a resorbable material.  Then a final restoration is placed.  A permanent tooth would be filled with a non-resorbing material.


What is the Best Time for Orthodontic Treatment?

Developing malocclusions, or bad bites, can be recognized as early as 2-3 years of age. Often, early steps can be taken to reduce the need for major orthodontic treatment at a later age.

Stage I – Early Treatment: This period of treatment encompasses ages 2 to 6 years. At this young age, we are concerned with underdeveloped dental arches, the premature loss of primary teeth, and harmful habits such as finger or thumb sucking. Treatment initiated in this stage of development is often very successful and many times, though not always, can eliminate the need for future orthodontic/orthopedic treatment.

Stage II – Mixed Dentition: This period covers the ages of 6 to 12 years, with the eruption of the permanent incisor (front) teeth and 6 year molars. Treatment concerns deal with jaw malrelationships and dental realignment problems. This is an excellent stage to start treatment, when indicated, as your child’s hard and soft tissues are usually very responsive to orthodontic or orthopedic forces.

Stage III – Adolescent Dentition: This stage deals with the permanent teeth and the development of the final bite relationship.

Dental Emergencies

Toothache: Clean the area of the affected tooth. Rinse the mouth thoroughly with warm water or use dental floss to dislodge any food that may be impacted. If the pain still exists, contact the dental office. Do not place aspirin or heat on the gum or on the aching tooth. If the face is swollen apply cold compresses and contact the office immediately.

Cut or Bitten Tongue, Lip or Cheek: Apply ice to injured areas to help control swelling. If there is bleeding apply firm but gentle pressure with a clean gauze or cloth. If bleeding cannot be controlled by simple pressure, call a doctor or visit the hospital emergency room.

Knocked Out Permanent Tooth: If possible, find the tooth. Handle it by the crown, not by the root. You may rinse the tooth with water only. DO NOT clean with soap, scrub or handle the tooth unnecessarily. Inspect the tooth for fractures. If it is sound, try to reinsert it in the socket. Have the patient hold the tooth in place by biting on a clean gauze or towel. If you cannot reinsert the tooth, transport the tooth in a cup containing the patient’s saliva or milk. If the patient is old enough, the tooth may also be carried in the patient’s mouth (beside the cheek). The patient must see a dentist IMMEDIATELY!  Time is a critical factor in saving the tooth.

Knocked Out Baby Tooth:  Contact the dental during business hours.  This is not usually an emergency and in most cases no treatment is necessary.

Chipped or Fractured Permanent Tooth: Contact the dental office 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 possible, locate and save any broken tooth fragments and bring them with you to the dental office.

Chipped or Fractured Baby Tooth: Contact the dental office.

Severe Blow to the Head: Take your child to the nearest hospital emergency room immediately.

Possible Broken or Fractured Jaw: Keep the jaw from moving and take your child to the nearest hospital emergency room.


Adolescent Dentistry at Smiles @ Dental Group 

Dr. Eric Chu & Dr. Kitty Lam

Tongue Piercing – Is it Really Cool? You might not be surprised anymore to see people with pierced tongues, lips or cheeks, but you might be surprised to know just how dangerous these piercing can be.

There are many risks involved with oral piercing including chipped or cracked teeth, blood clots, blood poisoning, heart infections, brain abscess, nerve damage, receding gums or scar tissue.

Common symptoms after piercing include pain, swelling, infection, an increased flow of saliva, and injuries to gum tissue. Difficult-to-control bleeding or nerve damage can result if a blood vessel or nerve bundle is in the path of the needle.


Canker Sores
Canker sores (aka aphthous ulcers) are small sores inside the mouth that often recur. Generally lasting one or two weeks, the duration of canker sores can be reduced by the use of antimicrobial mouthwashes or topical agents. The canker sore has a white or gray base surrounded by a red border.

Body acid/alkaline balance is important. Add more cultured foods to your diet for prevention: yogurt, kefir, sauerkraut, etc. Avoid high arginine foods, such as coffee, peanut butter, nuts, seeds, corn, etc. Avoid red meats, caffeine, refined and fried foods, sugars, and sweet fruits.

Prevention wise eating a mineral-rich diet: plenty of salads, lots of raw and cooked vegetables, and whole grains. Baked potatoes and steamed broccoli are especially good. Drink a fresh carrot juice once a week. Tannins and bioflavonoid help, such as green tea. Other helpful hints: Get plenty of sleep and rest.

Our office can treat and resolve your canker sores permanently with the use of our dental laser- the Waterlase MD.


Tobacco – Bad News in Any Form

Tobacco in any form can jeopardize your child’s health and cause incurable damage. Teach your child about the dangers of tobacco.

Smokeless tobacco, also called spit, chew or snuff, is often used by teens who believe that it is a safe alternative to smoking cigarettes. This is an unfortunate misconception. Studies show that spit tobacco may be more addictive than smoking cigarettes and may be more difficult to quit. Teens who use it may be interested to know that one can of snuff per day delivers as much nicotine as 60 cigarettes. In as little as three to four months, smokeless tobacco use can cause periodontal disease and produce pre-cancerous lesions.

If your child is a tobacco user you should watch for the following that could be early signs of oral cancer:

  • A sore that won’t heal.
  • White or red leathery patches on the lips, and on or under the tongue.
  • Pain, tenderness or numbness anywhere in the mouth or lips.
  • Difficulty chewing, swallowing, speaking or moving the jaw or tongue; or a change in the way the teeth fit together.