Pediatric Dentists Answer Your Most Pressing Dental Concerns

Photo from hatchdentistry.com

You know the basics about caring for your child's teeth. But you probably still have questions, from toothpastes to use to dentistry specialists to seek and the need for braces.  

So we tapped pediatric dentists Fina Lopez D.M.D., and Mary Lee April Roxas-Cagatin, D.M.D., to give their expert advice on the following toothy situations:

I’m confused: When do I bring my child to a general dentist and what cases merit a visit to an orthodontist? I want to make sure I bring my child to the correct specialist.
Dr. Roxas-Cagatin: For any dental issue, general and pediatric dentists should see your child first. If we see that there is a problem with your child’s teeth alignment, that’s when we refer you to the orthodontist. We usually see signs of misalignment at the age of 10 to 12, when most permanent teeth are starting to grow out. General dentists can take X-rays and diagnostic casts so we can study the case first.

It’s better to bring your child to a pediatric dentist because we are trained to handle children. We introduce the instruments first (especially the dreaded drill) and brief the kids—we do all the pambobola! I can handle special children and those who need sedation during a procedure. Some general dentists may not be able to do that.

My child’s milk teeth are starting to erupt, and they’re sungki. Should I bring him to the dentist to have them corrected? Is there any form of correction we can do at home?
Dr. Lopez: Sungki teeth, as early as the milk teeth stage, are really a cause for concern. This is a definite sign that the child will have problems in the alignment of his teeth in the future. Ideally, the child’s milk teeth should have spaces in between. This is to give way for the larger permanent teeth that will come out later on. This is also the reason why we try to save the milk teeth from decay as much as we can. Losing a milk tooth too early can cause space loss for the permanent teeth, resulting in sungki teeth. Your child should definitely be monitored by a dentist (an orthodontist is even better). He will recommend appropriate interceptive procedures as your child gets older. This way, the eruption of your child’s teeth will be guided correctly.

When is the best time for my child to wear braces? Her teeth are a little crooked. If she does need braces, how do I help her with the adjustment?
Dr. Roxas-Cagatin: The time of eruption of permanent teeth varies per child, but most of them come out between ages 10 and 12. If you miss this window, don’t worry, because one can have braces any time. Earlier than that period, at around six to seven years old, we can give the child dental appliances he can wear at night to prevent the crookedness from worsening. This also allows the child to wear actual braces for a minimal amount of time, like for only a year instead of two years or more.

When your child does need braces, condition her mind. Some kids may find it hard to see the benefits beyond the initial pain and discomfort. Say that after some time, her teeth will become nicer, but for now, she will have to endure the pain and brush meticulously. For the first three days of having braces, she will have to be on a soft diet, and no sticky or caramelized food is allowed.

My six-year-old grinds his teeth during his sleep. His pediatrician says it’s stress-induced so we’re working on that, but is there something—anything—he could use to save his teeth from the damage that gnashing could bring?
Dr. Lopez: Teeth grinding or bruxism is one of the most common sleep disorders. Three out of 10 children grind their teeth. Thankfully, most outgrow it, but its cause is unknown. In children, teeth grinding may be a response to changes in the mouth, such as pain or erupting teeth. Stress is also a recognized cause of bruxism. A tired child or one who worries about school tests or arguing parents can experience enough stress to prompt teeth grinding. Relaxation techniques such as drinking a glass of milk before sleeping and listening to soft music can help calm a child and reduce stress. Hyperactive kids, those with certain conditions such as cerebral palsy or who are on certain medications, can develop bruxism.

Bruxism usually goes undetected with no adverse effects. But it can cause the wearing down and sensitivity of teeth or the chipping of their enamel. In extreme cases, it can cause severe pain and jaw problems. Wearing a mouth guard can help reduce further damage on the teeth.

When is the best time to introduce my child to the regular, mint toothpaste that we adults use? My daughter is five and still loves her tutti frutti kiddie toothpaste.
Dr. Roxas-Cagatin: That’s quite late already. Once the first tooth erupts at around six months of age, you should brush it with non-fluoridated toothpaste only because babies that young don’t know how to spit it out yet. When they already know how to spit, at around age two, you should slowly introduce them to regular toothpaste. Kiddie toothpastes only serve to jumpstart the habit of putting paste on the brush and not much else. But remember to put only a smear or a pea-sized amount of fluoridated toothpaste on your child’s toothbrush. During the weaning period, you can combine the regular toothpaste and the sweet toothpaste to help your child have a smoother transition.

I’ve been seeing tiny white dots on my four-year-old daughter’s teeth. What is it? Is it a cause for alarm?
Dr. Lopez: White dots are usually warning signs that the tooth is starting to decay. If they are chalky white, it means the tooth has lost its luster--some minerals have been lost. All efforts should be focused on bringing back lost minerals to the teeth. This is usually accomplished by taking in food that’s high in calcium and phosphate; by brushing teeth regularly with fluoridated toothpaste; by visiting your dentist; and by employing more aggressive preventive strategies to encourage the reversal of the impending tooth decay. On a non-alarming note, white dots that are smooth and shiny can also be disturbances on a developing tooth. Nevertheless, the presence of white dots definitely means it’s time for your daughter to pay a visit to the dentist soon!


Fina Lopez D.M.D., is a pediatric dentist whose practice is limited to infants, children, and special children. She is a fellow of the Philippine Pediatric Dental Society, Inc. and a pediatric dentistry specialist in Pediatric Dentistry Center Philippines, Oral Health Care Center Co., and Dentphix, Inc.

Mary Lee April Roxas-Cagatin, D.M.D., has hands-on training and experience ranging from pediatric to special needs dentistry, or treating children and patients with disabilities. Her affiliations include membership in the Philippine Dental Association and Philippine Association for Disability and Oral Health Inc., and Metro Dental

A version of this article originally appeared in the January/February 2011 and June 2013 issue of Smart Parenting Magazine. Minor edits were made by Smartparenting.com.ph editors. 

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