BABY CARE

When should I begin brushing my baby’s teeth?
As soon as the first tooth is present, introduce a soft toothbrush with a small smear of fluoridated toothpaste. Make regular brushing a habit after each meal.

Can breast- or bottle-feeding cause cavities?
Letting your child fall asleep on the bottle or breast leaves the teeth exposed to sugars, which can do damage over time and lead to extensive dental work. If your child falls asleep during bottle- or breast-feeding, gently wipe the teeth with gauze or a clean washcloth. Avoid putting your child to bed with anything but water in the bottle (even “natural” juice has sugar).

When does teething usually begin, and what can I do to relieve teething discomfort?
Teething occurs most commonly between 4 and 10 months of age, beginning with eruption of the front teeth. Symptoms include irritability, restlessness, drooling, disturbed sleep, decreased eating and increased fluid intake. Diarrhea, fever and rash indicate systemic (entire body) involvement which should be monitored by a pediatrician.

To relieve discomfort, try using chewable objects (chilled teething rings can be especially soothing) and topical anesthetics. Fever should be treated with acetaminophen.

Teething in older children: It is not uncommon for children to experience teething discomfort when their 6-year molars erupt (come in) normally behind the 2-year molars. Topical anesthetics purchased from the drugstore may provide some relief.

Will pacifiers and thumb sucking affect my child’s teeth?
Extensive use of pacifiers (past age 2) and continued thumb sucking (beyond age 3) can lead to bite problems, known as “malocclusion.” As pediatric dentists, we can offer advice on working with your child to break these habits and/or correct any bite problems before they cause bite problems of the permanent teeth, necessitating orthodontic treatment (braces).

How often should my child brush his/her teeth?
Ideally, brushing should be done after every meal and at bedtime. To encourage brushing, make a fun “game” out of it. Let the child brush and then you do a follow-up brushing to ensure a complete job. Use only a pea-size dab of ADA-approved fluoridated toothpaste for children between ages 2 and 5.

VISITING THE DENTIST

When should my child first see a pediatric dentist?
American Academy of Pediatric Dentistry Guidelines recommend beginning check-ups after the first tooth is present or by age 1. Realistically, by 2 years old, your child should be visiting the dentist regularly (once every six months). It is important that your child be thoroughly examined to detect any problems that can be treated early or avoided completely. Don’t wait until all of the teeth are present; a lot can happen in three years. An early visit also increases the chances that your child’s first experience will be a simple examination, cleaning and fluoride treatment.

What is the benefit of bringing my child to a pediatric dentist?
As your pediatrician is specially trained and experienced in working with children, Dr. Loiben is specially trained to offer the most current and thorough treatment for your child. His additional years of pediatric specialty training following dental school provide:

  • The ability to treat the most apprehensive child and manage behavior effectively
  • Thorough knowledge of oral development and problems unique to children
  • Early detection of developing problems and successful intervention, which may prevent the future need for braces
  • Unique and innovative ways to restore decayed or broken teeth

Our office environment is especially comfortable and pleasant for children. Your child can actually look forward to regular visits, without fear or apprehension.

I brought my daughter to my general dentist and she wouldn’t even open her mouth. How do you get a 2-year-old to cooperative with you?
It can be done! Using a variety of techniques to actually involve your child in the procedures and eliminate fears of the unknown, Dr. Loiben knows the best ways to treat even the most apprehensive child. The minute you walk in the office you’ll notice a difference.

Why is it necessary to fill cavities in baby teeth when the teeth eventually fall out anyway?
Baby teeth are critical to a child’s development. Healthy primary teeth are needed for proper chewing, speech and appearance. They also save space in the jaws for the permanent teeth and guide them into their correct position.

My child’s front teeth are turning gray (or yellow). What could be the cause of this?
Trauma (a fall or blow to the mouth) may have caused damage to the teeth. This may have happened months ago and the breakdown of the internal tooth structure is now beginning to show. X-rays should be taken to determine the extent of the damage and if any treatment is needed.

PERMANENT TEETH

When should I expect to see permanent teeth coming in?
The first permanent molars should appear at 5 to 6 years of age, followed by the lower front incisors at six and a half, and the upper front teeth at 7. The remaining teeth follow up to age 12, excluding the wisdom teeth. These are averages, and your child’s development may vary.

When do wisdom teeth usually come in?
Eruption of wisdom teeth varies greatly and tends to happen in late high school or during college years. Often, the patient will experience discomfort as the teeth (especially the lowers) try to come into the mouth. It is not uncommon for these teeth to be trapped (“impacted”) and require surgical removal. A panoramic X-ray will reveal the course of action required. The intensity of discomfort can increase rapidly, so don’t hesitate to call us if such a situation is occurring.

What are sealants?
A sealant is a high-tech plastic material used to fill in grooves and depressions in the back teeth. Sealants can dramatically reduce the risk of decay from food and bacteria that accumulate in these teeth, even in children who have not yet had a cavity. They are easy and painless to apply. It is recommended that the first permanent molars (6-year molars) and later the second permanent molars (12-year molars) be sealed for three years until the teeth mature, to decrease their initial cavity susceptibility.

I noticed that my child’s new lower front teeth are coming in behind the baby teeth. What should I do with these “shark’s teeth”?
This is known as lingual (tongue side) eruption. If the baby tooth is loose then it will eventually fall out and the permanent tooth will drift forward into its proper alignment. If the baby tooth is not loose then it needs to be removed as soon as possible. This will stimulate the permanent tooth to drift forward into its desired position.

I can see that there is not enough space for my child’s permanent teeth to come in due to crowding. What should we do?
In some cases it is necessary to have the baby teeth removed to create space for the permanent teeth to erupt. This may eliminate the need for braces later, or simplify the orthodontic treatment.

Can you really tell at an early age whether or not my child will need braces?
There are early indicators, such as crowding of baby teeth and heredity. However, each child develops in their own individual way and situations may change. If orthodontics is indicated, it is usually started around 11 years of age depending upon your child’s stage of development. Early (Phase I) treatment may be indicated at 7 to 8 years old in some cases where severe crowding and/or substantial bite problems are present. It is never too early to have an examination and evaluation.

GENERAL CARE

Which common snacks should be avoided for good dental health?
In general, any foods that are high in sugar content and/or sticky can lead to decay.

Should I be giving my child fluoride supplements?
Most of the Chicago area’s water is fluoridated to the American Dental Association’s recommended level. The combination of fluoridated water, fluoridated toothpaste and fluoride applications during dental visits should provide adequate protection. Some suburbs don’t have fluoridated water because well water is utilized. You may call your village hall for this information. If your household only receives well water, then either a fluoride prescription needs to be administered daily up to age 13 or fluoridated bottled water is required.

What about fluoridated mouth rinses?
These should not be used before 6 years of age, because many younger children are unable to rinse without swallowing the liquid.

How often should my child visit the dentist?
Routine check-ups every six months coupled with good oral hygiene habits are essential to your child’s dental health. When children are in braces, it is recommended that they receive check-ups every four months to prevent build-up.

GENERAL ANESTHESIA (asleep)
Some pediatric dentists rely on drugs to sedate patients in order to perform dental procedures. Dr. Loiben is unique in that he uses no drugs other than a local anesthetic (novocaine).

In rare cases, nitrous oxide (“laughing gas”) is requested to calm an anxious child. Nitrous oxide is never to be used on extremely anxious patients; this only serves to increase their apprehension. Its use requires a nasal mask with tubing that restrains the child’s head onto the headrest. This removes the child’s sense of freedom and control, preventing them from sitting up to even take a drink of water. Nitrous oxide does not eliminate the need for an injection. Novocaine is still required to numb the treatment area. Some children become nauseous from nitrous oxide as well.

Other methods of sedation used by some pediatric dentists include oral drugs and injectable drugs. These require extensive monitoring by the dentist and many times have unpredictable results.

In cases where a patient is unable to cooperate for their treatment with local anesthetic and use of tried-and-true behavior-management techniques, general anesthesia is a viable and predictable alternative. We work with board-certified anesthesiologists (physicians) in our office so that comprehensive treatment can be completed in one visit while the child is asleep. Your child has no memory of the procedure or administration of the anesthesia. They fall asleep within 20 seconds by breathing through a small, clear nasal mask. Dr. Loiben’s complete attention is given to your child while the physician and his registered nurse administer and monitor the anesthesia.

Our schedule is blocked out during this time so that we may provide this special service to your child with Dr. Loiben’s uninterrupted attention. Your child is the sole focus of Dr. Loiben and his dental assistant as well as the anesthesiologist and his nurse.

At no time while under general anesthesia will a patient be unattended. A complete surgical suite is set up in our office including all emergency equipment and medications. You have the advantage of an operating room setting without the added expense and impersonal atmosphere of a hospital. You and your child are in the comfortable and familiar setting of our office.

WHAT CAN I EXPECT FOR MY CHILD’S DENTAL PROCEDURE?
Please do not convey your own dental apprehensions or experiences to your child! Parents often try to “prepare” their child with all good intentions, which usually results in increased anxiety and negative expectations. We want all visits to our office to be positive experiences for both you and your child. Please allow Dr. Loiben and our team to handle all explanations; we do this every day with great results. If your child is questioning you, just tell them that Dr. Ted will tell them everything they need to know.

FILLINGS
A filling is normally placed when there is decay in a tooth. Please do not try to get into any detail with your child to explain the procedure; simply tell them that Dr. Ted is going to wash their tooth. Dr. Loiben will speak with them during the visit and take them through in an easy-to-understand, nonthreatening manner.

In most cases we will use novocaine but we do not mention the word “shot”; we “squirt juice.” A desensitizing gel is gently applied to the gum with a Q-tip before the injection. We tell your child just what to expect, but again, in a nonthreatening way and without letting them see a needle. You may be surprised at how well it can go.

You will be given post-operative instructions regarding the filling, numbness and eating.

PULPOTOMY (nerve treatment)
A pulpotomy is the partial removal of a nerve. You may think of it as a “baby root canal,” but it is not as extensive as an adult root canal. From your child’s point of view, it is no different than a filling, except it may take a little longer. They will not feel any pain once properly anesthetized.

The pulpotomy allows a healthy environment for the developing permanent tooth and removes the source of infection in the baby tooth.

CROWN (CAP)
When the nerve has been removed from a baby tooth or when a cavity is especially large, a crown is placed over the remaining tooth structure. This is the strongest protection for the tooth. Unlike a crown for an adult tooth, this procedure is completed in one visit.

When the baby tooth is ready to naturally fall out, the crown will fall out right with the tooth in one piece. Think of the crown as a hat over the tooth.

PLEASE REMEMBER IN ALL CASES NOT TO DISCUSS NEEDLES AND SHOTS WITH YOUR CHILD. WE WILL TALK TO THEM THROUGHOUT THEIR VISIT TO OUR OFFICE.