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Paul Lyle Glasser, D.D.S., P.C.

Pediatric  Dentistry

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 Patient Education


Early Orthodontics

It's never too early to keep an eye on your child's oral development.  Your pediatric dentist can identify malocclusion - crowded or crooked teeth or bite problems - and intervene early to guide the teeth as they emerge in the mouth.  Malocclusion is often inherited but can be caused by dental injuries, the early loss of primary teeth, or dental habits such as thumb sucking, fingernail biting, or lip biting.  Early orthodontic treatment can prevent more extensive treatment later.

Early orthodontics can indeed improve your child's smile, but the benefits are more than just for appearance.  Pediatric orthodontics can straighten teeth, guide erupting teeth into position, correct bite problems, and prevent the need for tooth extractions.  Straight teeth are easier to keep clean and less susceptible to tooth decay and gum disease.

It is imperative that your child maintains good oral hygiene during early orthodontic care.  The child must regularly brush and floss to keep the appliance and your child's health in top shape.  Removable appliances should be brushed each time the teeth are brushed.  Regular dental check-ups will continue to protect your child from tooth decay and gum disease.  Also, contact your pediatric dentist if the appliance breaks to keep orthodontic treatment on-time and on-track.

Your child can eat a normal diet except sticky foods (gum, hard candy, caramels, taffy) and hard foods (peanuts, ice, popcorn).  Some orthodontic appliances can alter speech, but most children adapt quickly and speak clearly within a day or two.  Generally, children can safely run, jump, swim, and play with an orthodontic appliance.  Check with your pediatric dentist for specific advice on your child's activities.

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Fluoride 

Fluoride encourages remineralization (a strengthening of weak areas on the tooth).  These areas are the beginning spots of cavity formation.  Fluoride is sometimes added in water and in dental products such s toothpaste, mouth rinses, varnish, and supplements.  Fluoride is documented to be safe and highly effective if used in the recommended quantities.  You only need to use small amounts of fluoride to get the maximum benefit.  It is important to keep toothpaste, gel, rinses and other supplements out of reach for your children and only allow them to use those products with your supervision. 

If the water where you live does not have enough fluoride, your pediatric dentist may prescribe fluoride supplements in the form of drops or pills.  These will be given to your child starting at about 6 months of age until they are 12 to 16 years old.  Only use these as directed because too much fluoride can stain spots on your child’s teeth.  You can also call your local water company to see if your water is being fluoridated.  If you are unsure that your water is fluoridated, you may bring a sample of the drinking water to our office for water analysis.  Please call our office or speak to our staff at your child’s next appointment for fluoride testing instructions. 

At each dental follow up appointment, we may provide your child with fluoride treatments, depending on the child’s age and overall risk for tooth decay.  Treatments are in the form of topical fluoride that comes in many forms.  Gels and foams can be placed in fluoride trays and applied after your child’s teeth have been thoroughly cleaned.  We may also use fluoride varnish.  The advantages of varnish are that it is easy and quick to apply, decreases the amount of fluoride digested, and continues to “soak” into the enamel for about 24 hours after its application.  Using varnish is useful for young patients and those children with special needs.

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Gingivitis 

A lot of parents may think that gingivitis and periodontal (gum) disease is only an adult problem.  However, gingivitis (the first stage of periodontal disease) is a common problem in children and adolescents.  The bacteria in plaque can release toxins around the gum and cause infection.  This makes the gum tissue swell, turn red and bleed easily.  Gingivitis is a serious health problem…it can even contribute to heart disease and stroke. 

We understand that maintaining a healthy mouth can be a challenge for kids, especially with an individual with a disability.  Or if an orthodontic appliance is worn, cleaning the teeth can be even more of a challenge.  Other conditions that make children more susceptible to periodontal disease include Type I Diabetes, Down syndrome, and Papillon-Lefevre syndrome. 

SIGNS AND SYMPTOMS 

Children and teens with gingivitis notice that their gums bleed during brushing and flossing.  You may also notice that their gums are receding and may have loose teeth.  In time, if left untreated, the bone supporting the teeth can be destroyed by gingivitis.  

“Localized aggressive periodontitis” can affect healthy young children.  It’s found in teens and young adults also.  This mainly affects the first molars and incisors.  It is characterized by the severe loss of alveolar bone and oddly, patients generally form very little plaque or calculus. 

“Generalized aggressive periodontitis” usually begins around puberty and involves the entire mouth.  It is marked by inflammation of the gums and heavy accumulation of plaque and calculus.  Eventually, it will cause the teeth to become loose. 

CAN ANYTHING BE DONE TO CORRECT GINGIVITIS? 

Yes!  The good news is that with improved home oral care and help from your pediatric dentist, gingivitis can be a reversible disease.  If your child or teen already has gingivitis, we will help both of you stop the disease process and maintain good oral health for the future. 

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How to Care for a Chewed Lip, Cheek, or Tongue 

After local anesthesia is used, your child may accidentally chew on his or her lip, cheek or tongue to the point of injury.  Once the initial bleeding stops, the area will likely turn whitish in color.  Do not be alarmed – this is normal and not a sign of infection.  Luckily, these areas of the mouth heal very quickly. 

  • If the area doesn’t stop bleeding in 30 minutes and/or the area of injury is significant, take your child to the local emergency room.
  • Apply an ice pack over the area during the first 3 days if there is swelling.  Place the ice pack on the area for 15 minutes and remove it for 15 minutes.  Repeat this process for 1 hour, 3 times a day.
  • Give your child Tylenol or Motrin over the counter as directed per the manufacturer’s label for pain.
  • Call us if the wound is not healing in 5-7 days or if it seems infected.
  • Signs of infection include continued swelling, drainage, and/or redness.

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How To Save a Permanent Tooth 

Certain trauma from falling or being hit in the mouth from flying objects while playing sports, can cause a permanent tooth to be knocked out or “avulsed”.  If this happens, sometimes the tooth can be saved by quick, careful action.  If the tooth is replaced in the first 30 minutes, it has a good chance of survival. 


First, if your child has any broken bones or other injuries, you should seek immediate medical attention at a hospital emergency room.  If the nature of the injury is only dental in nature, the most important thing to remember is to remain calm so you can find the tooth.   

Once you find it, do not hold the root and do not rinse off the tooth.  Hold the tooth by the crown (the big white part you normally see in the mouth) and try to re-insert it into the socket.  Try as best you can to position it like the neighboring tooth and hold the tooth in position with your finger or by your child biting on gauze.   

If it doesn’t go into the socket, do not try to force it.  Just place the tooth in a glass of milk or in a container with your child’s saliva covering the tooth and call our office.  An adult parent (NOT the child) can keep the tooth under the tongue until taken to the dentist.  You may use a “Save a Tooth” kit from your local pharmacy that has solutions and instructions to prolong the life of an avulsed tooth.  This kit should be bought ahead of time in case this type of emergency occurs with your child. 

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Nursing or "Baby Bottle" Decay 

Babies who go to bed with a bottle of milk, formula, or juice are more likely to develop tooth decay because the sugar in those liquids stays in contact with the teeth during the night.  Follow these simple steps to avoid this significant problem for your child: 

  • Avoid nursing children to sleep, nighttime feedings, or putting anything other than water in their bedtime bottle after his or her first tooth erupts.
  • Do not put your child to bed with a bottle of milk, juice, formula or sweetened liquid.
  • Stop nursing when your child falls asleep or stops sucking on the bottle.
  • Try not to let your child walk around using a bottle of milk, formula or juice as a pacifier.
  • Start teaching your child how to drink out of a cup at about 6 months of age.  Your goal is to stop letting your child use a bottle by 12 to 14 months at the very latest.
  • Do not dip your child’s pacifier into honey, sugar, sugar-filled drinks, or in your own saliva.  It is true that the same cavity-causing bacteria in your own mouth can easily be spread to your child’s mouth.

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Post-Op Instructions for Tooth Extractions 

  • After the extraction, replace the gauze as it becomes soggy and apply pressure by biting on it for 30 minutes.  Slight oozing and staining of saliva is normal for up to 2-3 days. 
  • Moderate bleeding can be controlled by biting on a tea bag wrapped in gauze and moistened slightly with water.  If HEAVY bleeding continues, call our office.
  • Make sure your child does not bite, scratch or pick at his or her lip, cheek and tongue while it is numb or “asleep”.  This numbness can last for about 2-3 hours.
  • After 24 hours, gently rinse the area with warm salt water after meals (1/2 teaspoon of salt per 1 cup of water). 
  • Brushing and flossing can be resumed within 24 hours.
  • Restrict diet to liquids for the first 3 hours, but avoid drinking out of a straw.  Then eat soft foods for the rest of the day.  Examples of soft foods are soup, Jello, yogurt, and eggs.  Your child should chew on the opposite side of the extracted tooth for the first 24 hours.
  • You can give your child Tylenol or Motrin every 4 hours as directed on the label for pain.
  • Apply ice packs to the face to reduce post-operative swelling for the first 3 days.  You can apply the pack for 15 minutes, alternately removing it for 15 minutes up to 1 hour, 3 times a day.
  • Call us if any questions or problems arise.  Notify us immediately if any of the following occur:
    • Vomiting occurs beyond 4 hours after the appointment
    • Temperature remains elevated beyond 24 hours or goes above 101°F
    • Any difficulty breathing
    • Excessive pain, not relieved by the prescribed medication
    • Excessive bleeding
    • Any other matter causing you concern

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Pulp Therapy 

The “pulp” of the tooth is the inner central core of the tooth.  It consists of blood vessels, nerves and connective tissue.  Cavities and injury are the main causes for a tooth to require “pulp therapy”.  Pulp therapy is used to maintain the vitality of the affected tooth so the tooth is not lost.  The two most common examples of pulp therapy are often referred to as “pulpectomy” or “pulpotomy”. 

A pulpectomy is required when the entire pulp is involved into the root canal of the tooth.  The diseased pulp tissue is completely removed from both the crown and the root.  The canals are then cleansed, disinfected and if in a primary tooth, filled with a material that resorbs.  Then a final restoration is placed.  A permanent tooth would be filled with a material that does not resorb. 

A pulpotomy removes the diseased pulp tissue in the crown portion of the tooth.  Then an agent is placed to prevent bacterial growth and to calm the remaining nerve tissue.  This is followed with a final restoration such as a stainless steel crown.

 

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Sealants 

According to national data, 78% of children in the United States have experienced tooth decay by the age of 17.  Believe it or not, as much as 90% of decay occurs in school age children!  The teeth that are at the highest risk are the permanent first and second molars where fluoride has its least protective effect on the pits and fissures of those teeth.  The American Dental Association and American Academy of Pediatric Dentistry recognize that sealants can play an important role in the prevention of tooth decay. 

ARE YOUR CHILD’S TEETH PROTECTED? – NOT WITHOUT SEALANTS! 

A dental sealant is a thin coating that is applied to the biting surfaces of the back teeth.  Sealants fill in the pits and fissures of those molars and premolars.  This helps keep food particles and plaque off of the deep grooves of the teeth.  Sealants form a smooth surface that is easy to clean.  However, the covering is only for the biting surface of the tooth – areas on the sides and between the teeth cannot be coated with sealants.  Therefore, good oral hygiene, flossing, and a good diet are still very important in preventing decay next to these sealants or areas unable to be covered. 

HOW ARE SEALANTS APPLIED? 

The application of sealants is very fast, easy and painless!  First, a solution is applied to the chewing surface of the tooth to prepare the enamel and help it to bond with the sealant material.  Next, the tooth is washed and dried.  Then, the sealant is applied using a tiny brush and then hardened with a visible blue light.  The sealants can last many years.  During every dental visit, our doctors and hygienists will check the condition of the sealant(s) and advise you if additional sealants are needed. 

HOW CAN I PROTECT MY CHILD’S SEALANTS? 

Your child should avoid chewing foods and candy that can fracture the sealant.  Do not allow your child to chew on ice or eat hard candy or very sticky foods.  Examples of foods to avoid are taffy, Now and Laters, and Jolly Ranchers.

 

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Space Maintainers 

When a baby tooth is lost too soon, the teeth beside it may tilt or drift into that empty space. Teeth in the other jaw may move up or down to fill the gap. As teeth beside the gap shift into the empty space, they create a lack of space in the jaw for the permanent teeth. When that happens, permanent teeth are crowded and can come in crooked. If left untreated, the condition may require extensive orthodontic treatment.

Space maintainers are used to prevent any drifting of teeth and loss of space in your child’s teeth.  They keep the remaining teeth in place until a permanent tooth is in that natural position.  Space maintainers are appliances made out of metal or plastic and are custom fit to your child’s mouth.  They are small and unobtrusive in appearance.  Using space maintainers is more affordable and easier on your child than having to move those teeth back in place with orthodontic treatment.  The appliance often feels different and may cause minor discomfort while biting for a few days following insertion, but this will improve over time. 

If your child has had a space maintainer placed, here are some helpful instructions to follow: 

  • Avoid sticky foods and sweets or chewing gum.
  • Maintain good oral hygiene, keeping the appliance clean by brushing twice daily.  Don’t forget to brush around the bands of the space maintainer.
  • Avoid “playing” with the space maintainer with the tongue or fingers.  This may loosen or even break the appliance.
  • Continue regular dental visits where the doctors and hygienists will check the space maintainer often.

 

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Tobacco Use 

Tobacco in ANY form, including cigarettes and chewing tobacco, can seriously harm your child’s health and cause irreversible and incurable damage.  Smokeless tobacco, known as chew or snuff, is sometimes used by teens who think that it is safer than cigarettes.  But studies show that chewing tobacco may be more addictive than cigarettes and also more difficult to quit. 

ATTENTION TEENS! – Did you know that ONE can of snuff per day delivers as much nicotine as 60 CIGARETTES??  In as little as 3-4 months, smokeless tobacco can cause periodontal disease and cause pre-cancerous lesions called “leukoplakia”. 

 

Tobacco also destroys your smile!  If you want a healthy, attractive smile, smoking cigarettes or chewing tobacco is definitely NOT an option –  

If your child is a tobacco user, you should watch for the following signs of oral cancer: 

  • A sore that will not heal
  • White or red leather-like patches on the lips and/or 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.
 

Some early signs of oral cancer are usually not painful, so it’s easy to ignore them.  If it’s not caught early, oral cancer can require extensive, sometimes disfiguring, surgery and can even kill.

 

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TONGUE PIERCING – Is it really cool? 

You may not be surprised anymore to see people with pierced tongues, lips, or cheeks.  But you may be surprised to know just how dangerous these piercings can be!  They can cause cracked or chipped teeth, blood clots, or even blood poisoning.  Remember that your mouth contains millions of bacteria and can cause infection in a piercing site.  Your tongue can even swell large enough to close off your airway! 


Common symptoms after piercing are altered eating habits, pain, swelling, infection, injured gum tissue, severe bleeding, or nerve damage. 

 

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Tooth Brushing 

For infants, parents can wipe the baby’s new teeth with a moist, soft cloth or gauze.  As babies grow, you can use a child’s toothbrush.  Children’s hands and mouths are different than adults.  They need to use toothbrushes designed for children with a small, rounded head and soft bristles.  Only use a pea-sized amount of fluoride toothpaste at the age of 2-3 when your child is able to spit it out.  They will need supervision and help brushing for several years because they don’t have the coordination to properly and completely brush their teeth until the age of 7 to 8.   

Their teeth need to be brushed at least twice a day, in the morning after breakfast and every night at bedtime.  After the nighttime brushing, do not allow your child to eat or drink anything except water.

                     

  • Angle the toothbrush at a 45-degree angle to the gums.
  • Brush with 3 circles on every surface of every tooth – top and bottom.
  • Hold the brush flat on top of the teeth and brush the chewing surfaces with short strokes – about a half tooth wide.
  • Gently brush the tongue after the teeth.
  • Replace your child’s toothbrush every 3 months and after any contagious illness, such as strep throat.

    FLOSSING INSTRUCTIONS

  • Flossing removes plaque and food from between the teeth, where the toothbrush can’t reach – your child should have their teeth flossed daily!
  • You need to floss your child’s teeth until the age of 10 when their hand coordination has adequately developed.
  • Floss in between each tooth by “hugging” each tooth with the floss to prevent injuring the soft gum tissue.
  • Avoid forcing the floss straight down between the teeth to prevent injury.
  • Using a gentle pressure, work the floss in a “sawing” motion until it passes through where the teeth touch each other.
  • Always use a clean piece of floss.  There are handy floss holders you can find at area pharmacies that help you get the floss into the back of your child’s mouth easier.

 

For most toddlers, getting them to brush their teeth can be quite a challenge!  Here are some helpful hints that may make this less of a battle: 

  • Let your child pick out a toothbrush with his or her favorite cartoon character on it.
  • Read your child some children’s books about tooth brushing habits.
  • Let the child brush his or her own teeth first and then you will “help out”.
  • Show your child how you will brush their teeth using a doll or stuffed animal while you “brush” the toy’s teeth.
  • Have a routine where everyone brushes their teeth together – remember that YOU are your child’s best role model.  Stick to the same routine every day.
  • You can let your child rinse or chew products that will “stain” their teeth temporarily to show him or her the importance and fun of brushing the stain off.  Ask your pediatric dentist for these product suggestions.
  • Remain positive and try to make the experience fun.

 

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Tooth Eruption 

Your child’s first baby teeth to come in or “erupt” are usually the two bottom front teeth.  This occurs at about 6-8 months of age.  Then the 4 upper front teeth erupt, and then other teeth will erupt periodically.  Your child will continue to “teethe” or have new teeth erupt until about 2 ½ years of age.  At that point, your child should have all 20 teeth.  Between ages 5-6, the first permanent teeth will erupt.  Some permanent teeth will replace baby teeth and some do not – don’t worry if some teeth are a few months early or late. 

                        

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X-Rays or Radiographs 

Radiographs (x-rays) are a necessary part of your child’s dental diagnostic process to diagnose certain dental conditions.  X-rays detect more than just cavities – they can diagnose bone disease, evaluate injuries, and help in the planning of orthodontic treatment.  Some diseases cannot be discovered simply with a clinical exam.  Children generally need X-rays more often than adults because their mouths grow and change rapidly. They are also more susceptible to tooth decay than adults. The American Academy of Pediatric Dentistry recommends X-rays every six months for children with a high risk of tooth decay.  Children with a low risk of tooth decay require X-rays less frequently.  On average, pediatric dentists recommend X-rays about once a year, but every 3 years, it’s a good idea to obtain a complete set of X-rays. 

Pediatric dentists are very careful to minimize the exposure of radiation to the children.  The amount of radiation is actually very small in dental X-rays and the risk is negligible.  We use lead body apron shields to protect your child and our equipment uses digital radiographs to reduce radiation exposure and enhance diagnostic imaging.  We use small, lightweight, phosphor plates that are more flexible and comfortable than conventional analogue films.          

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PROTECTING YOUR CHILD’S TEETH DURING SPORTING EVENTS 

A properly fitted soft mouth guard can protect your child’s teeth, cheeks, lips, and gums.  A mouth guard is recommended for any recreational activity that poses a risk of injury to your child’s mouth. Sports that definitely should be considered for use of a mouth guard include (but not limited to):  football, gymnastics, basketball, baseball, soccer, softball, hockey, skateboarding, boxing, martial arts, wrestling and extreme sports. 

There are 3 types of mouth guards: 

  1. “Ready-Made” or “stock” guards
  2. “Boil-and-Bite” mouth formed guards
  3. Custom made mouth guards made by your dentist

If your child doesn’t have all of their permanent teeth, then a “boil-and-bite” mouth guard should work fine.  The guard should be resilient, tear resistant, and comfortable.  Make sure it fits properly and is easy to clean, along with not restricting breathing or speaking.  We will be happy to confirm that your child’s mouth guard is properly fitting at his/her next dental appointment if you bring it with you.

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