Who needs a pediatric dentist? And when?

The Pediatric Insider

© 2013 Roy Benaroch, MD

Tanya asked, “Should I take my kids to a pediatric dentist?”

Maybe, maybe not. Children do need a dentist who’s sensitive and good with children—but that doesn’t necessarily mean it has to be a pediatric-only dentist (or “pediadontist”.) Many family dentists do a great job with everyone. I think it’s fine if parents take their kids to their own dentists, as long as the dentist is comfortable and good with children.

How can you tell? Ask. I think most dentists who prefer not to see children will tell you that, right up front. If your dentist says, “Well, we rarely see kids here” that tells you something. You should also look around the office and waiting room. If there are no kid-friendly toys or murals about, chances are children rarely go there. Do all the magazines feature Oprah, or are there little short chairs next to a sand table? Subtle clues abound.

There are some dental procedures that require specific child techniques or anesthesia, best done in a child-only practice. Your own dentist will refer you to a ped-dentist if that’s what you need. If you’re ever uncomfortable about anesthesia in an adult office, ask your dentist how often they do that. Or get a second opinion from a pediadontist.

According to the American Dental Association (ADA), children should have a dental home by age one. I’m not sure that’s always necessary or practical. The ped dentists near me recommend seeing children for a first visit at age 3 – 3 ½.

Whenever you decide to see a dentist, follow these tips to keep teeth clean and healthy starting young:

  • Never put a baby to bed or nap with a bottle.
  • Start brushing at age 1 with a soft brush and a tiny, rice-sized dab of fluoride-containing toothpaste.
  • Stop using baby bottles by 12 months of age—especially the one that leaves baby’s mouth full of milk at bedtime. After a last snack, brush teeth before bed.
  • Once complementary foods are added, babies should also drink water with meals. Water—not juice, not anything sweetened. Water. Ordinary, cheap, fluoridated tap water. Mmmmm.
  • Avoid sugary drinks, including juice, which is about as nutritious as soda.
  • Don’t let your child stroll around all day with a sippy cup.

If you haven’t been able to follow those steps, or have a strong family history of teeth problems, or you or your child’s doctor see problems with your child’s teeth, you ought to head to the dentist early—by age 1, as the ADA recommends. Whether it’s a ped-only or a general, family dentist is probably less important than overall good nutrition and dental habits.

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7 Comments on “Who needs a pediatric dentist? And when?”

  1. Rachel Says:

    Good advice – but why no mention of brushing teeth after nursing? I’m pretty sure breast milk contains sugars that could cause cavities, no?

    Also, I think the advice to give up bottles completely by one year of age but encourage nursing for as long as possible is kind of mean spirited. Breastfed babies get the comfort of nursing as long as they want but bottle babies (and their moms) are punished by having their bottles taken away so soon – or being made feel guilty if they don’t? A one year old is still a baby and still gets comfort from cuddling with mom or dad while drinking a bottle.

    Docs are always after the bottle feeders but nursing moms can do no wrong…


  2. Shannon Says:

    Our family dentist in Atlanta and now in Mobile have told us to not use fluoridated toothpaste until the child can adequately spit (for our first two was around 3-3.5 yr). I actually recently confirmed this with our new dentist because of an article published in Parents Magazine said to start earlier.


  3. Dr. Roy Says:

    I think there’s some differences of opinion on that issue, Shannon. The amount of fluoride in toothpaste is small. Though excessive ingested fluoride can cause the “scary sounding” dental fluorosis, in all but the most severe cases that condition actually strengthens the teeth, and you can barely even see the cosmetic result. So I think the worry is overblown.

    I rec starting with a fluoride-containing toothpaste at age 1, but only using a tiny amount– about the size of a grain of rice. That much isn’t going to cause mischief, even if it’s swallowed.


  4. Eric Rouah Says:

    Excellent Post. I am dentist in Toronto and Maple Ontario and really enjoyed your blog. Thanks so much for posting such an interesting read.

    Dentist Toronto
    Dentist Maple
    Dr Eric Rouah DMD


  5. Holly Z Says:

    We don’t use a pediadontist, but our family dentist is a man with a large family and a brood of children that he often refers to during a visit. It was important to us that our children’s dentist know what raising children is like and how dealing with kids and their anxieties can turn a frightening situation into a relaxing and enjoyable one.


  6. Holly P Says:

    We recently moved and the local water supply here contains no fluoride. Should I be concerned/do something about this? My son is 19 months old and we use toothpaste that does not contain fluoride, so maybe we will switch – do you think this is enough? Thanks.


  7. Dr. Roy Says:

    Holly, starting at 6 months of life children who are living in a household without fluoridated water should get a daily fluoride supplement. You can get the prescription from your pediatrician or dentist. In addition, use a tiny, single-grain-ofrice-sized blob of fluoride-containing toothpaste.


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