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Infant and Toddler Dental Care


baby smile oral care


Oral care begins  at birth. In fact, while you’re still in the hospital you can begin looking after your baby’s oral health. After you give the bottle to or nurse the baby, go ahead and wipe his gums. This gets the baby used to having something in his mouth, and begins the process of preventative oral care. You can use a clean washcloth or any damp, clean cloth; it doesn’t matter what it is as long as it’s clean.

HOW TO DO IT:  When you’re cleaning your infant’s mouth, you’re going to go over the whole mouth. You’re going to go around the cheeks, the ridges where the teeth come in, everywhere that the milk has been, and you’re going to wipe the tongue as well. Then as those first teeth start to come in around six months, go ahead and pull out a toothbrush. It needs to be a really soft toothbrush, a smaller toothbrush than an adult size. You don’t need to use toothpaste at this time. You’re just trying to get off the little bit of the film left from the milk, rice cereal or whatever the baby is eating.



There are three things needed to cause cavities: sugar, bacteria, and teeth. When a baby is first born, the mouth is sterile. The longer we keep it sterile, the better we will be. We want to do all we can to avoid transmitting the bacteria from your mouth, from another baby’s mouth, or from grandparents’ mouth to the infant’s mouth.

The way infants most commonly get this bacteria is through this kind of transmission, whether it comes from parents cleaning the pacifier with their mouth and then giving it back to the baby, or, when they’re spoon-feeding the baby, taking the spoon and touching it to their tongue to test how hot the food is before putting it into the baby’s mouth. Even something as simple as Grandma and Grandpa wanting to smooch on their little grandbaby by kissing her on the mouth transfers bacteria from their mouth into the baby’s. All of a sudden this baby goes from having a sterile mouth to one with potentially cavity-causing bacteria. The longer you can avoid getting that bacteria into your baby’s mouth, the longer it is before we have to worry about cavities. We call it horizontal transmission or vertical transmission. Vertical transmission is right from the mouth of a parent, from Mom’s or Dad’s mouth to the baby’s mouth. Horizontal transmission comes from other people or grandparents. In the exam room, I counsel parents to look out for this kind of transmission, to try to avoid kissing the baby on or around the mouth, although I know it’s hard, because those cheeks are big and those babies are cute.

Why a Pediatric Dentist?

 little girl with toothbrushAs a specialist in pediatric dentistry and a parent myself, I understand the desire parents have for honest, thoughtful answers to questions about their child’s health care. We pore over books that outline our child’s developmental progress, medical issues, and emotional health—but I’m surprised daily at the dearth of information even the best informed parents seem to have about their children’s oral development and the important role that proper dental care plays in their overall health. It’s not that they’re not interested in the answers; it’s simply that, outside of the dentist’s office, they really have nowhere to turn for them. So many parents come in and ask me for answers to questions that should be common knowledge. They may have tried to do online research but still couldn’t find reliable data. I wrote a whole book on that based on my desire to provide that vital information.


The whole topic of baby teeth deserves more attention than it gets. A lot of people say, “These teeth are going to fall out anyway, so why should I take care of them or worry about them?” Childhood is when you’re establishing the habits for good oral health over your lifetime, habits that should be ingrained in the very beginning stages of life.


“Baby teeth are completely different than adult teeth. The enamel is thinner. The teeth obviously are not as mature. The anatomy of the teeth is different. The way that you treat a primary tooth is different from how you treat adult teeth.”

I start seeing patients at six months of age. Parents question why in the world I want to see infants when they don’t even have any teeth, but it’s not always about just the teeth. I’m concerned not only for their oral health care but for their overall health as well. When I’m seeing these infants, I’m talking to and educating the parents just as much as I am treating their children. I want to start seeing these patients early so that we can avoid any future problems by catching them before they become bigger issues, and I want to get the children used to the notion of the dentist. I urge parents to find somebody who specializes in pediatric dentistry.

Baby teeth are completely different than adult teeth. The enamel is thinner. The teeth obviously are not as mature. The anatomy of the teeth is different. The way that you treat a primary tooth is different from how you treat adult teeth.

Behavioral management is an art and a science. It’s not something you can just pick up by being a mother or father. As I went into to my residency, I was already a father of four children, and it was amazing to me how little I knew about how to take a patient—a baby or a child—who was upset or traumatized and turn the situation around just through effective behavioral management. Now, I occasionally get a child who has been traumatized in the previous dentist’s office and doesn’t even want to sit down. By the time they leave, they’re laughing; dental work is complete, and the child and parent had a great experience.

When you go to a dentist, you get a cleaning, exam, and radiographs. The most common question parents ask the dentist is, “Does my child have any cavities?” That’s what most have come to expect from a dental visit. A dental visit should provide much more. The focus should be on the whole person and not just cavities. Of course, I look at that, but that’s just one tiny aspect of what a comprehensive exam should be.

A comprehensive exam should cover growth and development of the child. Pathology on both soft and hard tissues should be examined. The occlusion or bite should be discussed as well as any evidence of crossbite, attrition, and erosion. That being said, hopefully, if anything is seen that could potentially stem from something wrong systemically, advice can be given to the parent to go to a physician who specializes in that specific area. Problems regarding the TMJ (temporormandibular joint), skeletal and tooth related issues should also be covered.

Different types of x-rays may need to be taken in order to give the parents a more educated diagnosis on what is seen, such as malformations and missing teeth, and to allow us to observe overall development. Discussing what prevention methods would be beneficial is vital, in addition to discussing orthodontics, crowding, spacing issues, and periodontal issues.

Finally, trauma prevention, caries (cavities) risk and prevention, and diet should be discussed. There’s a lot more to proper dental care than just checking for cavities.

In a series of blog posts I’ll get down to the business of answering those questions—including some that may not have even occurred to you yet.

–Randy Hamilton III, DMD

Five Ways to Make Your Child’s First Dental Visit an Experience You Want to Remember


1) SEEK OUT A PEDIATRIC DENTIST. Pediatric dental offices are set up specifically to ensure that children have a great experience. Pediatric dentists have multiple years of additional training in treating children’s dental needs, their growth and development, the ability to observe pathology, special medical needs and syndromes, trauma, emergencies, and behavior management to make certain of a great experience. In addition, pediatric dentists are trained in different types of sedations for the timid, anxious, or extremely nervous child. We are in a new era of dentistry. There is no reason children should not have a fun, great experience at the dentist. Too many adults have grown up with a fear of the dentist that stems from too many bad experiences. A well-trained pediatric dentist can change that mindset. Remember, when a child has a great experience, the parents will have a great experience.


“when a child has a great experience, the parents will have a great experience”


2) FIND A DENTIST THAT ALLOWS PARENTS INTO THE HYGIENE AND TREATMENT ROOMS. Too many dentist offices state they do not allow parents in treatment rooms because they want to build a relationship of trust or because they want kids to get used to the idea of being on their own. The dentist tells the parent that the child will do better without the parent there. In some instances, I agree. However, the majority of the time, I find that the parents stay out of the way and allow the dentist to do his job. I don’t treat the child any differently based on whether or not Mom or Dad is in the room. In fact, I enjoy watching the parent see how well the child did and experience the visit with the child. I think some dentists are scared about what they will do in front of the parent if the child gets upset. Let’s face it, anything new can be scary. Children always feel more comfortable if Mom or Dad can be there. We all feel more comfortable if we have someone else with us when we are trying something new. That doesn’t apply solely to children; parents also feel more at ease because they can see what is going on and are able to be involved in the whole experience.


3) TAKE YOUR CHILD TO MEET THE DOCTOR AND STAFF AND TAKE A TOUR OF THE OFFICE BEFORE THE DENTAL VISIT. The day of the appointment holds a lot of anxiety; you can eliminate uncertainty on your child’s part by letting her meet the dentist and staff in advance, which will lower the anxiety level. Just knowing what the office looks like will also remove some of the fear of the unknown.


4) GIVE POSITIVE REINFORCEMENT. I cannot count how may times I have met children who are terrified of the dentist because Mom and Dad told them they hate the dentist or said they are afraid of the dentist. I even have parents who tell their child they will get a big shot if they are not good. Wow! That would scare me. Instead, let your children know that the dentist is fun. Tell them the office is full of TVs, aquariums, video games, or flat screens on the ceiling with kids’ movies playing (if it’s true of your dentist’s office, of course). Let your child know that this visit is special. Positive reinforcement goes a long way in helping your child have a great experience. If you want to go the extra mile, practice at home with your child, opening his mouth and pretending to count his teeth and then brushing his teeth as a hygienist might do.


5) BEGIN AND MAINTAIN GOOD ORAL HYGIENE HABITS AT HOME AND AT AN EARLY AGE. Brushing, flossing, and keeping your child familiar with good oral hygiene habits-along with a healthy diet-will also allow for a better visit to the dentist. When your children know they have been doing what they are supposed to do for their teeth at home, it makes for a very positive visit to the dentist. Contrary to popular belief, this is not the child’s responsibility, but rather the parent’s responsibility to ensure the child maintains good oral hygiene.