Healthy Smiles. The Basics.

We all know our teeth are important, yet we often take them for granted. The following information give you the background you need to make smart decisions for your child and ensure he or she has a healthy, happy smile.


Getting Started Right — Infant Care

Importance of Primary Teeth

It is very important to maintain the health of the primary teeth.  Neglected cavities can and frequently do lead to problems which affect developing permanent teeth. Primary teeth, or baby teeth are important for proper chewing and eating, providing space for the permanent teeth and guiding them into the correct position, and permitting normal development of the jaw bones and muscles.  While the front 4 teeth last until 6-7 years of age, the back teeth (cuspids and molars) aren’t replaced until age 10-13.

Beginning Teeth Cleaning

Our rule is, the sooner, the better!  Starting at birth, clean your child's gums with an infant toothbrush and water.  Children up to age seven do not have the dexterity to brush their teeth effectively, so remember that it is the parent’s job and it should be done at least once a day at bedtime.  Unless it is advised by your child's pediatric dentist, do not use fluoridated toothpaste until age 2-3 since your child is probably not spitting yet.

Preventing Tooth Decay from a Bottle or Nursing

One serious form of decay among young children is baby bottle tooth decay. This condition is caused by frequent and long exposures of an infant’s teeth to liquids that contain sugar.  Among these liquids are milk (including breast milk), formula, fruit juice and other sweetened drinks.

Putting a baby to bed for a nap or at night with a bottle other than water can cause serious and rapid tooth decay.  Sweet liquid pools around the child’s teeth giving plaque bacteria an opportunity to produce acids that attack tooth enamel.  If you must give the baby a bottle as a comforter at bedtime, it should contain only water.

Encourage your child to drink from a cup as they approach their first birthday.  Children should not fall asleep with a bottle.  At-will nighttime breast-feeding should be avoided after the first primary (baby) teeth begin to erupt.  Drinking juice from a bottle should be avoided; it should be in a cup, and they should drink no more than 4oz per day.  Children should be weaned from the bottle at 12-14 months of age.

Thumb, Pacifier, and Finger Sucking

Sucking is perfectly normal for infants; most stop by age 2.  If your child does not, discourage it by age 3.  Prolonged thumb, pacifier, or finger sucking can create crowded, crooked teeth or bite problems.  Your dentist will be glad to suggest ways to tackle a prolonged thumb sucking habit.


From 6 months to age 3, your child may have sore gums as their teeth erupt. Many children like a clean teething ring, cool spoon or cold wet washcloth.  Some parents swear by a chilled teething ring; others may simply rub the baby's gums with a clean finger.


Habits for Life Toddlers & Children


Four things are necessary for cavities to form: 1) a tooth; 2) bacteria; 3) sugars or other carbohydrates; and 4) time.  At Missoula Pediatric Dentistry we will help you learn how to make teeth strong and keep bacteria from organizing into harmful colonies.  It is important to develop healthy eating habits, and understand the role that time plays in developing cavities.  Remember, dental decay is an infection of the tooth.


Use a toothbrush with soft bristles and a small strip of toothpaste.  When brushing teeth, move the brush in small circular motions to reach food particles that may be under the gum line.  Hold the toothbrush at an angle and brush slowly and carefully, covering all areas between teeth and the surface of each tooth.  It will take several minutes to thoroughly brush the teeth.  Brush the tongue and the roof of the mouth before rinsing.

Teeth should be brushed at least two times daily to avoid the accumulation of food particles and plaque.  If time permits, brushing after the noon meal is certainly encouraged for our patients.  As soon as the bristles start to wear down or fray, replace the toothbrush with a new one.

The following brushing schedule is optimal.


For areas between the teeth that a toothbrush can’t reach, dental floss must be used to remove food particles and plaque.  Dental floss is a thin thread of waxed nylon that is used to reach below the gum line and clean between teeth. It is very important to floss between the teeth every day.

We strongly recommend the flossing aids called floss picks as they make it much easier to floss the teeth.  In general, waxed floss seems to work the best and we highly recommend the Glide floss and flossing aids.

If using regular spooled floss, pull a small length of floss from the distributor.  Wrap the ends of the floss tightly around the middle finger on each hand. Guide the floss between all teeth to the gum line, pulling out any food particles or plaque.  Unwrap clean floss from around the fingers as you go, so the floss is used from beginning to end when finished.  Floss behind all back teeth as well.

Floss at night to make sure the teeth are squeaky clean before going to bed.  When first beginning to floss, the gums may bleed a little.  If the bleeding does not go away after the first few times, let a staff member know at your next appointment.


Children must have a balanced diet for their teeth and gum tissue around the teeth to develop properly.  Equally important, a diet high in certain kinds of carbohydrates, such as sugar and starches, may place your child at an extra risk of tooth decay.

Check how often your child eats foods with sugar or starch in them.  Foods with starch include breads, crackers, pasta and snacks such as pretzels and potato chips.  When looking for sugar in your child's diet, look beyond the sugar bowl and candy dish.  A variety of foods contain one or more types of sugar, and all types of sugars can promote dental decay.  Sugar can be found in many processed foods, even some which do not taste sweet.  Sticky foods, such as dried fruit or toffee, are not easily washed away from the teeth by saliva, water or milk.  They have more cavity-causing potential than foods more rapidly cleared from the teeth. A food with sugar or starch is safer for teeth if it's eaten with a meal, not as a snack.

If your child is not yet on solid foods, avoid nursing your child to sleep or putting them to bed with a bottle of milk, formula, juice, or sweetened liquid. While your child sleeps, any unswallowed liquid in the mouth supports bacteria that produce acids and attack the teeth. Protect your child from severe tooth decay by putting them to bed with nothing more than a pacifier or bottle of water.

In summary, here are tips for your child's diet and dental health:


Smart Choices — Adolescent Care


Fluoride is an element, which has been shown to be beneficial to teeth.  However, too little or too much fluoride can be detrimental to the teeth.  Because the water supply in Western Montana is not fluoridated, we recommend and prescribe supplements after an exam and review of habits and fluoride exposure.

You can provide your child with topical fluoride (fluoridated toothpaste, gels, rinses, and varnishes) to help slow or even stop the development of cavities, which are just beginning to form.

Orthodontic Treatment

Although only a few orthodontic problems need to be corrected in the primary or early mixed dentition, an early exam will allow a pediatric dentist to offer advice and guidance as to when the appropriate age to begin orthodontic treatment will be.

Stage I – Early Treatment:  This period of treatment encompasses ages 2 to 6 years.  At this young age, we are concerned with underdeveloped dental arches, the premature loss of primary teeth, and harmful habits such as finger or thumb sucking.  Treatment initiated in this stage of development is often very successful and many times, though not always, can eliminate the need for future orthodontic/orthopedic treatment.

Stage II – Mixed Dentition:  This period covers the ages of 6 to 12 years, with the eruption of the permanent incisor (front) teeth and 6-year molars.  Treatment concerns deal with jaw malrelationships and dental realignment problems.  This is an excellent stage to start treatment, when indicated, as your child’s hard and soft tissues are usually very responsive to orthodontic or orthopedic forces.

Stage III – Adolescent Dentition:  This stage deals with the permanent teeth and the development of the final bite relationship.

Mouth Guards

When a child begins to participate in recreational activities and organized sports, injuries can occur.  A properly fitted mouth guard, or mouth protector, is an important piece of athletic gear that can help protect your child’s smile, and should be used during any activity that could result in a blow to the face or mouth.

Mouth guards help prevent broken teeth, and injuries to the lips, tongue, face or jaw.  A properly fitted mouth guard will stay in place while your child is wearing it, making it easy for them to talk and breathe.

Ask your dentist about custom and store-bought mouth protectors.

Lip and Tongue Piercing

There are many risks involved with oral piercings including chipped or cracked teeth, blood clots, or blood poisoning.  Mouths contain millions of bacteria, and infection is a common complication of oral piercing.  Tongues can swell large enough to close off an airway!

Common symptoms after piercing include pain, swelling, infection, an increased flow of saliva and injuries to gum tissue. Difficult-to-control bleeding or nerve damage can result if a blood vessel or nerve bundle is in the path of the needle.

Follow the advice of the American Dental Association and give your mouth a break – skip the mouth jewelry.

Tobacco Use

Tobacco in any form can endanger your child’s health and cause incurable damage. Teach your child about the dangers of tobacco.

Smoking can have the following effects on your child's oral health:

Like cigarettes, smokeless tobacco products contain a variety of toxins associated with cancer. At least 28 cancer-causing chemicals have been identified in smokeless tobacco products. Smokeless tobacco is known to cause cancers of the mouth, lip, tongue, and pancreas. Users also may be at risk for cancer of the voice box, esophagus, colon and bladder, because they swallow some of the toxins in the juice created by using smokeless tobacco. Smokeless tobacco can irritate your gum tissue, causing periodontal disease. Sugar is often added to smokeless tobacco to enhance the flavor, increasing the risk for tooth decay. Smokeless tobacco also typically contains sand and grit, which often wears down the user's teeth.

If your child is a tobacco user you should watch for the following that could be early signs of oral cancer:

Because the early signs of oral cancer usually are not painful, people often ignore them. If it’s not caught in the early stages, oral cancer can require extensive, sometimes disfiguring, surgery. Even worse, it can kill.

Help your child avoid tobacco in any form. By doing so, they will avoid bringing cancer-causing chemicals in direct contact with their tongue, gums and cheek. For further information and support pertaining to tobacco use, visit: