Pediatric Dentistry Q&A {Sponsored : Legacy Pediatric & Adolescent Dentistry}

Recently we polled you, our Cowtown Moms, for questions you would like answered by a pediatric dentist and as we at FWMB think Legacy Dentistry is one of the best in town, we were so pleased they would provide us with some answers and the opinions and practices of their office!

1. How important is dental insurance for children?

Dental insurance can be a benefit to families especially when it comes to preventative dental treatments such as cleanings and exams. A few things to keep in mind when looking for an insurance plan to fit your family:

  • Yearly cost of the insurance
  • What is the plan’s deductible?
  • Yearly limit or maximum they will pay per person. (some plans have a very low maximum)
  • Frequency they will pay for preventative procedures
  • Freedom to choose your own dentist

Be sure to read what you are signing up for. All insurance plans are not the same and they are not all equal.


2. When/what is the point when we should start asking our dentist for orthodontist referrals?

Our office begins evaluating for orthodontic needs from the first visit. We will refer for an orthodontic evaluation when we feel it is necessary regardless of age. We refer as early as 6-7 years old but like to wait until the permanent teeth are all coming in (generally 11-13 years old if possible). The timing of the referral is based on each individual child and their development.


3. What to do at home once a child has had dental work done, like tooth pulled, cavity, etc. Medicine? Comfort? What foods to avoid?

If the child has had local anesthetic (numb) we recommend they do not eat until the feeling has returned (about an hour to an hour and a half after the procedure). This will help avoid biting of the lip or tongue. Liquids and very soft foods should not be an issue. Generally children’s Tylenol or Motrin are sufficient for pain control. Children who have had teeth taken out should avoid drinking through straws.


4. How to talk to kids who are apprehensive about regular dental visits and care? My 5 year old is terrified even though she’s never had a bad experience.

Always be positive about the dentist and upcoming visits. There are good books and TV shows about the dentist that might be helpful. Role playing can also be beneficial. A pre visit walk through at the dental office can be fun and alleviate fear. Too much information at home can sometimes frighten a child. A parent can say “ask the dentist” and he or she will be happy to answer your questions. It is very rewarding to help a child become a dental patient with very little or no apprehension. Sometimes this comes with routine and knowledge of what to expect the next time around.


2013-04-02-Permanent-Teeth-Eruption-Schedule5. What are tips for transitioning from baby teeth to permanent teeth? What should parents know about losing baby teeth – when to expect it, is it better to let them fall out if they are loose or do you pull them?

Typically teeth begin to transition at about age 5-6 years old and will continue until about 11-13 years old. We generally only remove teeth if we feel it will aid the eruption of the permanent teeth or the primary (baby) teeth are over retained (you and your child cannot get them to come out). When the primary teeth get loose we suggest the child “wiggle” them. Most teeth are lost normally without the dentist’s help.


6. Do sippy cups really ruin kids’ mouths, jaw lines, etc? What cups should you use/avoid?

Sippy cups can act similarly to bottles and cause movement of the teeth if the habit is prolonged beyond the recommended time. A general rule is to use the bottle until 1 year of age and transition to a sippy cup until 2 years old and then transition to a regular cup. Cups with straws instead of nipples are better than sippy cups after 2. Sippy cups and bottles can also deposit liquid between the teeth and lip and start to cause the cavity process to begin. You should never put your child to bed with a bottle or sippy cup unless it only has water in it.


knee to knee7. What are some tips on how to get a reluctant 2 year old to brush?

Playing games is always fun. You can play the tooth brush game. Let your child brush your teeth then it is your turn to brush their teeth or let them have a turn brushing their teeth and then you get a turn. You can pick a song that your child likes such as the ABC’s or Twinkle, Twinkle Little Star and sing while you brush the teeth so they know you brush as long as the song is going on. There are also apps on the iPhone and iPad that are 2 minutes of brushing teeth that your child can watch while you brush their teeth. Try to be positive but it is very important in the end to brush their teeth regardless of if they want to do it. One way to position the child during brushing is called the knee to knee technique if there are 2 adults in your house. The child sits straddling one adult and then lays their head in the second adult’s lap. The second adult is the one who brushes the teeth. This gives better vision and control in brushing and is often how we do exams on young children in the dental office. Always talk about brushing in a positive way and try not to use brushing the teeth as a punishment.  Having fun and being consistent is the goal.


8. By what age should we make our child’s first dental appointment and at what age do actual cleanings start?

The first dental visit is recommended by age 1. We perform an oral exam and review prevention. This helps to create good dental habits early. We usually do a toothbrush prophy(cleaning) and a fluoride application at this visit. We will clean the teeth whenever we see plaque or staining or by age 2-3 dependent on behavior.


9. How can we get our almost 5 year old to stop sucking his thumb?

Thumb sucking can be a difficult habit to break. It is best to start with encouragement first. Breaking this habit is nearly impossible until your child decides they are ready to stop the habit. Often going to school helps with breaking the habit. There is a book called David Decides that you can order to read with your child about making the decision to break the habit. Try a sticker chart if that motivates your child and when they get a certain amount of stickers they get a prize. It is also hard to try to stop the habit when your child is undergoing a big life change such as a new younger sibling or a move. Be positive with them about stopping the habit. Finally don’t be frustrated if the habit does not cease immediately and try not to frustrate your child as it can make the habit worse.


10. The dentist recently told me that my little one (age 1 year) has very little enamel on his 4 front teeth. They are almost clear and look awful. He said there’s nothing we can do except watch his diet and be very diligent about brushing until they fall out — hoping his permanent teeth are healthy underneath. I feel so helpless! Anything else I can do to strengthen his current teeth?

Once the enamel is fully formed, the best way to strengthen it is by good preventative measures. Maintaining excellent brushing habits is very important. Topical fluoride may also be of benefit to help strengthen the teeth. One reassuring thing to keep in mind is that if your child has thin enamel on the baby teeth, this does not necessarily mean that his permanent teeth will have thin enamel.


11. My daughter sucks her fingers (pointer and middle.) The dentist she goes to has never asked about sucking her thumb/fingers. Will this cause problems like thumb sucking does?

Sucking the fingers can cause similar changes to the position of the teeth like thumb sucking or prolonged pacifier use but it all depends on the amount of time, duration and intensity of the sucking. Sometimes the changes can be minimal and sometimes more severe.   At the next visit ask the dentist if there is any noticeable damage due to the habit.


12. Is it really necessary to have a cavity filled on a 3 year old? (It was able to be done without anesthesia, so it must have been really small)

The reason behind treating cavities when they are very small is that you can be less aggressive and sometimes even treat without local anesthesia (numbing). If it can be caught and treated while very small, it is an easier procedure on the child. As it gets larger, the longer and more difficult the procedure can become on the child. Cavities usually only progress once they are started.


13. If my baby’s dentist said not to worry about her severe tongue tie (she takes bottles fine) should I listen to him or get it fixed anyway?

Tongue ties are commonly seen in children. There are things that we generally look for when deciding whether or not to treat. Is the baby able to eat and are they gaining weight? Do they have full mobility of the tongue and can they stick the tongue out beyond the lip? A lot of tongue ties decrease as the child gets older and so it all depends on how severe the issue is and how aggressively you want to treat it because it may never cause problems. This is very dependent on the individual child.


Keep in mind that the answers given are our opinion of what we would do in our office. We invite you to visit our website to see answers to other frequently asked questions. If you have a question not here answered here or on the website, feel free to call our office at 817-731-6964 or submit a question through the website in the contact us section.


IMG_6877Dr. Dan Doss grew up in Kemp, Texas before making the move to Fort Worth to attend TCU. He attended dental school and a two-year residency in the specialty of Pediatric Dentistry at the University of Texas School of Dentistry in Houston. He has been married to Maureen (Mo) for 33 years and has two grown children, Michael and Kaydee and daughter in law Megan. He is excited to welcome his first granddaughter in March 2014. He enjoys reading, playing golf and spending time with family and friends.

Dr. Liz Gold grew up in Palestine, TX. She attended Texas A&M University where she graduated in 2006 and proceeded to continue her education at the University of Texas School of Dentistry in Houston where she completed both dental school and residency. She has 4 siblings and 3 in-laws and has recently become an aunt to Luke (22 months) and Emma (3 months). In her free time she enjoys traveling, running, Aggie football games and spending time with family and friends.

Dr. Doss and Dr. Gold practice at Legacy Pediatric & Adolescent Dentistry in Southwest Fort Worth. They are both Diplomats of the American Board of Pediatric Dentistry and members of the American Academy of Pediatric Dentistry as well as local, state and national dental societies.



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