Antioch, CA (California), Orthodontist Shelby J. Smith, DDS, MS Antioch, CA (California), Orthodontist Shelby J. Smith, DDS, MS
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Please note that on this web site, Dr. Shelby cannot comment on specific dental problems, diagnoses, fees, or treatment recommendations. Any questions you have will gladly be answered in our office setting.


  1. The Pediatric Dentist
  2. What's the difference between Baby Teeth and Permanent?
  3. Anatomy and Development of the Mouth and Teeth
  4. Regular Dental Visits
  5. X-ray Use and Safety
  6. Sealants
  7. Tooth-Colored Fillings
  8. The Anxious Child
  9. Nitrous Oxide/Oxygen
  10. Conscious Sedation
  11. General Anesthesia
  12. Thumb, Finger or Pacifier Habits
  13. Space Maintenance
  14. Diet and Snacking
  15. Preventive Dentistry
  16. Fluoride
  17. Dental Care for Your Special Child
  18. Dental Care for Your Baby
  19. Early Childhood Caries

With two different sets of teeth to worry about, children's dental needs are different than those of an adult. For this reason, pediatric dentistry exists. The parents of infants deal with teething, the threat of early childhood caries and, later, potential thumb-sucking and pacifier dependency issues that can threaten oral health. Older children, meanwhile, have to deal with losing baby teeth and preparing their mouths for possible orthodontic work later on.

And of course, all children should be learning preventative dental care—techniques such as daily brushing and flossing to prevent dental problems. Pediatric dentistry deals with all of these issues. Practitioners in this field, called pediatric dentists, undergo an extra three years of training to learn about children's growth, development and psychology. They also take behavior management classes, where they learn to deal with nervous or hard-to-handle young patients.

Pediatric dentistry includes:

Preventative care
This is the most important part of dental care. A pediatric dentist can ensure the child learns to brush and floss properly, greatly reducing the risk of dental problems throughout his or her lifetime. The dentist can also ensure the child and its parent understand how decay occurs, and how proper eating and hygiene habits can help prevent it. As the child grows older, the pediatric dentist keeps an eye out for future tooth alignment or bite problems, and suggests preventative measures to reduce more extensive and expensive orthodontic treatment later on.

As the baby teeth emerge between the ages of six months to three years, the baby can experience sore gums and other forms of discomfort. A pediatric dentist can advise the parent on how to handle and reduce the discomfort. He or she can also counsel the parent on proper cleaning techniques once the teeth erupt.

Early childhood caries
Often, well-meaning parents "treat" their babies to a bottle of juice or milk at bedtime. The sugars in these liquids gather around the infant's teeth and gums, feeding the bacteria that cause plaque. Prolonged and frequent exposure to these sugars can cause the baby's teeth to decay. Early decay can lead to a need for early extraction. To avoid this situation, bottles should be filled with water only. Ideally, bottles should not be given at nighttime and babies should be weaned off the bottle between the ages of twelve and fourteen months. A pediatric dentist can advise parents on how to prevent and treat early childhood caries.

This is a normal activity for infants and very young children that usually stops between the ages of two to four. However, if it continues even after the permanent teeth have begun to emerge, bite problems can occur. The upper teeth can lean towards the lip, or not come in properly. In these cases, pediatric dentists can recommend a mouth appliance to block the habit.

Interceptive orthodontic treatment
Bite and alignment problems can be most easily corrected while the jaw is still growing. The pediatric dentist can suggest appliances to stretch and shape a child's jaw and mouth to prepare for future orthodontic treatment once the permanent teeth have come in.

The chewing surfaces of the back teeth are full of crevices difficult for very young children to clean. Food trapped in these crevices can cause bacteria to collect, leading to cavities. Pediatric dentists can seal these crevices with resin to shut out food particles.
Pediatric dentists are excellent choices for children who are scared of dental visits. The pediatric dentist will use pictures, simple language and his or her extensive knowledge of child psychology to motivate young patients to care for their smiles from an early age.
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What’s the Difference Between Baby Teeth and Permanent?

Why should I care about the baby teeth? They’re just going to fall out.
Primary teeth (or baby teeth) are important to your child’s present and future dental health. They encourage normal development of the jaw bones and muscles. They save space for the permanent teeth and guide them into position. Baby teeth play an important role in the development of speech and chewing. Some baby teeth don’t fall out until age 12 to 14!

Aren’t baby teeth the same as permanent teeth, just smaller?
No. Permanent teeth are different at the microscopic level, too. The enamel in baby teeth is thinner than in permanent teeth. That means that decay can progress more rapidly in baby teeth.

At what age can I expect my child’s teeth to begin to fall out?
At between six and ten months of age, most infants begin to get their "baby" teeth. The Central Incisors (front middle teeth) usually come in first, and then teeth begin appearing on either side and work their way back to the second molars. By the time a child has reached three years old, most of the "baby" teeth should be present. The process begins to repeat itself when the child is about seven years old. Generally, the incisors, both upper and lower, fall out between the ages of 5 and 8. The primary molars and canines are lost between the ages of 9 and 13. The Central Incisors fall out first and are replaced by permanent teeth. By the age of 21, most people have all of their permanent teeth.
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Anatomy and Development of the Mouth and Teeth

Children's teeth begin developing in the fetus. Good nutrition from the mother during pregnancy is important in the development of the teeth. The mother's diet should have adequate amounts of calcium, phosphorus, vitamin C, and vitamin D. Certain medications, such as tetracycline, should not be taken by the mother while she is pregnant as this can cause harm to the developing teeth of the embryo. There are four main stages of development of the tooth:
  • The first stage begins in the fetus at about 6 weeks of age. This is when the basic substance of the tooth forms.
  • Next, the hard tissue that surrounds the teeth is formed, around 3 to 4 months of gestation.
  • After the child is born, the next stage occurs when the tooth actually protrudes through the gum.
  • Finally, there is the loss of the primary "baby" teeth.

Parts of the tooth:
Each tooth has four main parts, including the following:

  • enamel - the outer layer of the tooth.
  • dentin - the inner layer and the main part of the tooth.
  • pulp - part of the inside of the tooth that contains the nerve.
  • root - the part of the tooth that secures it into the jaw.
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Regular Dental Visits

How often should a child see the dentist?
A dental check-up is recommended at least twice a year for most children. Some children need more visits due to increased risk of tooth decay, unusual growth patterns or poor oral care.

Why does my child have to go twice a year when they’ve never had a cavity?
Regular visits help your child stay cavity-free. Dental cleanings remove buildup on the teeth which may irritate the gums or cause decay. Fluoride treatments renew the fluoride content in the enamel, strengthening the teeth and preventing cavities.

We also provide ongoing assessment of changes in your child’s dental health which may include developing orthodontic problems.

What happens in a dental check-up?
First, we review your child’s medical and dental history. Next, we gently “count” your child’s teeth and examine the oral tissues and jaws. The teeth are cleaned and polished then given a fluoride bath.

Will X-rays be taken at every appointment?
No. Our office follows guidelines which recommend x-rays only when necessary to protect your child’s dental health. For example, to diagnose tooth decay or abnormalities or for orthodontic purposes.
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X-ray Use and Safety

How often should a child have x-rays?
Since every child is unique, the need for x-rays varies from child to child. They are taken only when they are likely to yield information that a visual exam cannot.

Why should they be taken even if my child has never had a cavity?
Because x-rays detect much more than cavities. The can detect problems with erupting teeth, diagnose bone diseases, evaluate the healing of an injury, or plan orthodontic treatment. They help us diagnose conditions that cannot be seen during a clinical examination. If we find and treat dental problems early, your care is more comfortable and affordable.

How safe are dental x-rays?
We are particularly careful to minimize the exposure of our child patients to radiation. With contemporary safeguards and because we use digital radiography, the amount of radiation received in a dental x-ray is extremely small. The risk is negligible. In fact, dental x-rays represent a far smaller risk than an undetected and untreated dental problem.

How will my child be protected from x-ray exposure?
Lead body aprons and shields will protect your child. Today’s equipment filters out unnecessary x-rays and restricts the x-ray beam to the area of interest. Digital radiography and proper shielding assure that your child receives a minimal amount of radiation exposure.
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What are sealants?
Sealants protect the surfaces of teeth with grooves and pits, especially the chewing surfaces of back teeth where most cavities in children are found. Made of clear or shaded plastic, sealants are applied to the teeth to help keep them cavity-free.

How do sealants work?
Even if your child brushes and flosses carefully, it is difficult, sometimes impossible, to clean the tiny grooves and pits on certain teeth. Food and bacteria build up in these depressions, placing your child in danger of tooth decay. Sealants "seal out" food and plaque, thus reducing the risk of decay.

How long do sealants last?
Research shows that sealants can last for many years. So, your child will be protected throughout the most cavity-prone years. If your child has good oral hygiene and avoids biting hard objects, and isn’t a tooth grinder, sealants will last longer. We can easily replace or repair a lost or damaged sealant.

What is the treatment like?
The application of a sealant is quick and comfortable. It takes only one visit. We place a raincoat on the tooth to keep it dry, condition and dry the tooth, apply the sealant, then shine a small, bright light on it which allows the sealant to harden.

Which teeth should be sealed?
The teeth most at risk of decay, and therefore most in need of sealants, are the six-year and twelve-year molars. But any tooth with grooves or pits may benefit from the protection of sealants.

If my child has sealants, are brushing and flossing still important?
Absolutely! Sealants are only one step in the plan to keep your child cavity-free for a lifetime. Brushing, flossing, and regular dental visits are still essential to a bright, healthy smile.
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Tooth Colored Fillings

What are tooth-colored fillings?
Tooth-colored fillings are made from durable plastics called composite resins. Similar in color and texture to natural teeth, the fillings are less noticeable, and much more attractive, than other types of fillings.

What are the advantages of tooth-colored fillings?
Because composite resins are tooth-colored, they look more natural than other filling materials. Your child can smile, talk, and eat with confidence. In addition, tooth-colored fillings are compatible with dental sealants. A tooth can be filled and sealed at the same time to prevent further decay.

What are disadvantages?
First, tooth-colored fillings are not for every tooth. They work best in small restorations and low-stress areas. Second, without good hygiene, they may have recurrent decay more rapidly than silver fillings.

How do I decide if tooth-colored fillings are right for my child?
Talk to us. Together we will decide what type of filling is best for your child.

How do I care for a tooth-colored filling?
Take care of a tooth-colored filling the same way you take care of a silver filling: Brush, floss, and return for 6 month check-ups. Any filling will last longer with good oral hygiene. Dr. Shelby will regularly check the fillings for color change, leakage, or unusual wear and inform you of the need for repair or replacement.
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The Anxious Child

How does a pediatric dentist help with dental anxiety?
Pediatric dentists have special training in helping anxious children feel secure during dental treatment. And, pediatric dental offices are designed for children. Staff members choose to work in a pediatric dental practice because they like kids. So, most children are calm, comfortable and confident in a pediatric dental office.

How will a pediatric dentist help my child feel comfortable?
Pediatric dentists are trained in many methods to help children feel comfortable with dental treatment. For example, in the "Tell-Show-Do" technique, a pediatric dentist might name a dental instrument, demonstrate the instrument by using it to count your child's fingers, then apply the instrument in treatment.

The modeling technique pairs a timid child in dental treatment with a cooperative child of similar age. Coaching, distraction, and parent support are other possibilities to give your child confidence in dentistry. But by far the most preferred technique is praise. Every child does something right during a dental visit, and pediatric dentists let children know that.

Should I accompany my child into treatment?

Infants and very young children (2 and under) may feel more confident when parents stay close during treatment. With older children, doctor-child communication is enhanced if parents remain in the reception room.

What if a child misbehaves during treatment?
Occasionally a child's behavior during treatment requires assertive management to protect him or her from possible injury. Voice control (speaking calmly but firmly) usually takes care of it. Some children need gentle restraint of the arms or legs as well. Mild sedation, such as nitrous oxide/oxygen or a sedative, may benefit an anxious child. If a child is especially fearful or requires extensive treatment, other sedative techniques or general anesthesia may be recommended.
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Nitrous Oxide/Oxygen Sedation

Most children are calm, comfortable, and confident in a pediatric dental office. Because pediatric dentists specialize in treating children, they make children feel special. The office is especially designed for children. Staff members choose to work in a pediatric dental office because they like kids.

Sometimes, however, a child feels anxious during treatment. Your child may need more support than a gentle, caring manner to feel comfortable. Nitrous oxide/oxygen is a safe, effective technique to calm a child's fear of the dental visit.

What is nitrous oxide/oxygen?
Nitrous oxide/oxygen is a blend of two gases, oxygen and nitrous oxide. When inhaled, it is absorbed by the body and has a calming effect. Normal breathing eliminates nitrous oxide/oxygen from the body.

How will my child feel when breathing nitrous oxide/oxygen?
Your child will smell a sweet, pleasant aroma and experience a sense of well-being and relaxation. If your child is worried by the sights, sounds, or sensations of dental treatment, he or she may respond more positively with the use of nitrous oxide/oxygen.

How safe is nitrous oxide/oxygen?
Very safe. Nitrous oxide/oxygen is perhaps the safest sedative in dentistry. It is non addictive. It is mild, easily taken, then quickly eliminated by the body. Your child remains fully conscious, keeps all natural reflexes, when breathing nitrous oxide/oxygen.

Are there any special instructions for nitrous oxide/oxygen?
First, give your child little or no food before the dental visit. (Occasionally, nausea or vomiting occurs when a child has a full stomach.) Second, tell us about any respiratory condition that makes breathing through the nose difficult for your child. It may limit the effectiveness of nitrous oxide/oxygen. Third, tell us if your child is taking any medication on the day of the appointment.

Will nitrous oxide/oxygen work for all children?
Pediatric dentists know that all children are not alike! Every service is tailored to your child as an individual. Nitrous oxide/oxygen is not effective for some children, especially those who have severe anxiety, nasal congestion, extensive treatment needs, or discomfort wearing a nasal mask. Pediatric dentists have comprehensive specialty training and can offer other sedation methods that are right for your child.
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Conscious Sedation

What is conscious sedation?
Conscious sedation is a way of using medication to relax a child without the loss of consciousness.

Who should be sedated?
Children with severe anxiety and/or the inability to relax are candidates for sedation. Usually these children are young or have trouble managing their anxiety.

Why utilize conscious sedation?

Conscious sedation aids in calming a child so that she can accept dental treatment in a more relaxed state. This can help prevent injury to the patient and provide a better environment for providing dental care.

What medications are used?
Many different agents can be used for conscious sedation, from inhalation agents to medicines provided orally or by injection. We most commonly use oral Versed. However, none of these sedatives render the child unconscious. We will discuss sedation recommendations most appropriate for your child.

Is sedation safe?
Conscious sedation in appropriate dosages is extremely safe for healthy children. Because your child maintains consciousness along with their own airway and gag reflex, the chance of an untoward event happening is extremely small. Pediatric dentists are trained to administer, monitor and manage sedated patients. We will discuss sedation options and procedures with you.

What special instructions should I follow before the sedation appointment?
To alleviate potential anxiety we recommend minimal discussion of the dental appointment with the child. Should your child become ill, contact us ahead of time. It may be necessary to choose to arrange another appointment. It is important not to have a meal before a sedation appointment. We will inform you about food and fluid intake guidelines prior to the sedation appointment.

What special instructions should I follow after the sedation appointment?
Children who have been sedated are usually requested to return home for the remainder of the day with appropriate supervision. We will discuss specific post-sedation instructions with you, including appropriate diet, physical activity and requested supervision.
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General Anesthesia

What is general anesthesia?
General anesthesia provides a way of effectively completing dental care while a child is unconscious. It is administered under the care of a licensed Dentist Anesthesiologist here in our office.

Who should receive dental care with general anesthesia?
Children with severe anxiety and/or the inability to relax are candidates for general anesthesia. Usually these children are young or have compromised health and helping them control their anxiety is not possible using other methods.

Is general anesthesia safe?
An experienced health care provider, specifically trained in delivering general anesthesia, is responsible for the general anesthesia delivery, monitoring and medical care of the child. Many precautions are taken to provide safety for the child during general anesthesia care in our office. Patients are monitored closely during the general anesthesia procedure by anesthesia personnel who are trained to manage complications. We will discuss the benefits and risks involved in general anesthesia and why it is recommended for your child's treatment.

What special considerations are associated with the general anesthesia appointment?
If your child has any sort of medical condition, a physical examination is usually required prior to a general anesthesia appointment to complete dental care. This physical examination provides information to ensure the safety of the general anesthesia procedure. The anesthesia office will advise you about any evaluation appointments that may be requested.

There are usually several recommendations for the day of the general anesthesia appointment. Minimal discussion about the appointment may reduce anxiety. It is important not to have a meal before general anesthesia. You will be informed about food and fluid intake guidelines prior to the appointment. If your child is sick, contact our office. It may be necessary to arrange another appointment.

Usually, children are tired following general anesthesia. You may wish to return home with minimal activity planned for your child until the next day. After that, you can usually return to a routine schedule.
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Thumb, Finger and Pacifier Habits

Why do children suck on fingers, pacifiers or other objects?
This type of sucking is completely normal for babies and young children. It provides security. For young babies, it's a way to make contact with and learn about the world. In fact, babies begin to suck on their fingers or thumbs even before they are born.

Are these habits bad for the teeth and jaws?
Most children stop sucking on thumbs, pacifiers or other objects on their own between two and four years of age. However, some children repeatedly suck on a finger, pacifier or other object over long periods of time. In these children, the upper front teeth may tip toward the lip or not come in properly and the back teeth and jaw can narrow (see photo).

When should I worry about a sucking habit?

We will carefully watch the way your child's teeth come in and jaws develop, keeping the sucking habit in mind at all times. For some children there is no reason to worry about a sucking habit until the permanent front teeth are ready to come in. For others, because of the duration, strength or frequency of the habit, we have to intervene early.

What can I do to stop my child's habit?
Most children stop sucking habits on their own, but some children need the help of their parents and their pediatric dentist. When your child is old enough to understand the possible results of a sucking habit, we can encourage your child to stop, as well as talk about what happens to the teeth if your child doesn't stop. This advice, coupled with support from parents, helps most children quit. If this approach doesn't work, we may recommend a mouth appliance that blocks sucking habits.

Are pacifiers a safer habit for the teeth than thumbs or fingers?
Thumb, finger and pacifier sucking all affect the teeth essentially the same way. However, a pacifier habit is often easier to break.
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Space Maintenance

What is a space maintainer?
Baby molar teeth, also known as primary molar teeth, hold needed space for permanent teeth that will come in later. When a baby molar tooth is lost, a space maintainer usually put between the remaining teeth to hold the space. Space maintainers are made of metal or plastic that are custom fit to your child's mouth. They are small and unobtrusive in appearance. Most children easily adjust to them after the first few days.

Why do children lose their baby teeth?

A baby tooth usually stays in until a permanent tooth underneath pushes it out and takes its place. Unfortunately, some children lose a baby tooth too soon. A tooth might be knocked out accidentally or removed because of dental disease. When a tooth is lost too early, we may recommend a space maintainer to prevent future space loss and dental problems.

Why all the fuss? Baby teeth fall out eventually on their own!
Baby teeth are important to your child's present and future dental health. They encourage normal development of the jaw bones and muscles. They save space for the permanent teeth and guide them into position. Remember: Some baby teeth are not replaced until a child is 12 or 14 years old.

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

How does a space maintainer help?
Space maintainers hold open the empty space left by a lost tooth. They steady the remaining teeth, preventing movement until the permanent tooth takes its natural position in the jaw. It's more affordable -- and easier on your child -- to keep teeth in normal positions with a space maintainer than to move them back in place with orthodontic treatment.

What special care do space maintainers need?
We have four rules for space maintainer care. First, avoid sticky sweets or chewing gum. Second, don't tug or push on the space maintainer with your fingers or tongue. Third, keep it clean with conscientious brushing and flossing. Fourth, continue regular dental visits.
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Diet and Snacking

How does my child's diet affect her dental health?
She must have a balanced diet for her teeth to develop properly. She also needs a balanced diet for healthy gum tissue around the teeth. Equally important, a diet high in certain kinds of carbohydrates, such as sugar and starches, may place your child at extra risk of tooth decay.

How do I make my child's diet safe for his teeth?
First, be sure he has a balanced diet. Then, check how frequently he eats foods with sugar or starch in them. Foods with starch include breads, crackers, pasta and such snacks as pretzels and potato chips. When checking for sugar, 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. Fruits, a few vegetables and most milk products have at least one type of sugar.

Sugar can be found in many processed foods, even some that do not taste sweet. For example, a peanut butter and jelly sandwich not only has sugar in the jelly, but may have sugar added to the peanut butter. Sugar is also added to such condiments as catsup and salad dressings. Avoid sticky foods and those foods which tend to stay on and around the teeth (such as potato chips). Even “good” foods such as raisins can contribute to decay in this way.

Should my child give up all foods with sugar or starch?
Certainly not! Many provide nutrients your child needs. You simply need to select and serve them wisely. A food with sugar or starch is safer for teeth if it's eaten with a meal, not as a snack. Sticky foods, such as dried fruit or toffee, are not easily washed away from the teeth by saliva, water or milk. So, they have more cavity-causing potential than foods more rapidly cleared from the teeth.

Does a balanced diet assure that my child is getting enough fluoride?
No. A balanced diet does not guarantee the proper amount of fluoride for the development and maintenance of your child's teeth. If you do not live in a fluoridated community or have an ideal amount of naturally occurring fluoride in your well water, your child needs a fluoride supplement during the years of tooth development. We can help assess how much supplemental fluoride your child needs, based upon the amount of fluoride in your drinking water and your child's age and weight.

Any final advice?
Yes. Here are tips for your child's diet and dental health.
  1. Shop smart! Do not routinely stock your pantry with sugary, sticky or starchy snacks. Buy "fun foods" just for special times.
  2. Limit the number of snack times; choose nutritious snacks.
  3. Provide a balanced diet, and save foods with sugar or starch for mealtimes.
  4. Don't put your young child to bed with a bottle of milk, formula, or juice.
  5. If your child chews gum, choose those brands without sugar or even better, those with xylitol.
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Preventive Dentistry

What is preventive dentistry?
Preventive dentistry for children includes:
  • brushing
  • dental development
  • flossing
  • fluorides
  • oral habits
  • orthodontics
  • parent involvement
  • proper diet
  • sealants
  • sports safety

Why is preventive dentistry important?
Preventive dentistry means a healthy smile for your child. Children with healthy mouths chew more easily and gain more nutrients from the foods they eat. They learn to speak more quickly and clearly. They have a better chance of general health, because disease in the mouth can endanger the rest of the body. A healthy mouth is more attractive, giving children confidence in their appearance. Finally, preventive dentistry means less extensive, and less expensive, treatment for your child.

When should preventive dentistry start?
Preventive dentistry begins with the first tooth. Visit us when the first tooth comes in. You will learn how to protect your infant's dental health. The earlier the dental visit, the better the chance of preventing dental disease and helping your child belong to the cavity-free generation.

What role do parents play in prevention?
After evaluating your child's dental health, we will advise you on home care for your child. This includes brushing and flossing, diet monitoring, and if necessary, fluoride supplements. By following these recommendations, you can help give your child a lifetime of healthy habits.

How do pediatric dentists help prevent dental problems?
Tooth cleaning and polishing and fluoride treatments are all part of your child's prevention program. But there's much more. For example, we can apply sealants to protect your child from tooth decay, help you select a mouth guard to prevent sports injuries to the face and teeth, and provide early diagnosis and care of orthodontic problems. Dr. Shelby is uniquely trained to develop a combination of treatment plans to meet your child’s specific needs.
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  • Fluoride is safe and necessary, but only at appropriate levels.
  • Fluoride works two ways: Systemically, meaning it strengthens teeth internally, under the gums in the jawbone. Externally, fluoride strengthens tooth enamel on the surface of the teeth. Children between 6 months and age 16 should take in fluoride every day.
  • Water fluoridation is the safest and most cost-effective way to prevent tooth decay.
  • Two of the most common sources of fluoride are tap water and fluoridated toothpaste. Children under four often swallow some of their toothpaste when you’re brushing their teeth. Fluoride occurs naturally in some water, but in most major municipalities it is added to the water to help prevent tooth decay.

What about Bottled Water?
As more parents turn to bottled water for drinking and food preparation, pediatric dentists are concerned about whether children will get enough fluoride. Most bottled water brands do not contain the level of fluoride recommended by the AAPD, American Dental Association, American Academy of Pediatrics, American Medical Association, US Public Health Service, and the World Health Organization.

Pediatric dentists recommend that children who regularly drink bottled water, well water, or unfluoridated tap water get fluoride in some other way. Fluoride vitamins, drops, and tablets are good examples of fluoride supplements. Most bottled water brands process water by distilled- or reverse-osmosis systems that remove fluoride along with contaminants. Some types of bottled water add fluoride to the final product and are safe for children of all ages.

How about Filters?
If you want to keep fluoride in your tap water, try using a charcoal- or carbon-activated filtration pitcher (such as Brita) that offers better-tasting water without removing fluoride.

What is Fluorosis?
As important as fluoride is, it only works when used at the appropriate levels. Too much fluoride can cause a harmless discoloration of the teeth known as enamel fluorosis. Most cases of enamel fluorosis result from children taking fluoride supplements when their drinking water is optimally fluoridated. If there is enough fluoride in the child’s primary source of drinking water, we will seldom prescribe supplements.

It is impossible to know how much fluoride is in a child’s primary source of drinking water without having it tested. Ask your water company to test the fluoride level of your bottled water, tap water, or well water BEFORE supplements are prescribed.

ยท Pediatric dentists recommend scheduling a child’s first dental visit when the first tooth appears or no later than the first birthday to determine risk factors and evaluate fluoride needs before the child’s permanent teeth come in.
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Dental Care for Your Special Child

Do special children have special dental needs?
Most do. Some special children are very susceptible to tooth decay, gum disease or oral trauma. Others require medication or diet detrimental to   dental health. Still other children have physical difficulty with effective dental habits at home. The good news is, dental disease is preventable. If dental care is started early and followed conscientiously, every child can enjoy a healthy smile.

How can I prevent dental problems for my special child?
A first dental visit by the first birthday will start your child on a lifetime of good dental health. We will take a full medical history, gently examine your child's teeth and gums, then plan preventive care designed for your child's needs.

Will preventive dentistry benefit my child?
Yes! Your child will benefit from the preventive approach recommended for all children- effective brushing and flossing, moderate snacking, adequate fluoride. Home care takes just minutes a day and prevents needless dental problems. Regular professional cleanings and fluoride treatments are also very beneficial. Sealants can prevent tooth decay on the chewing surfaces of molars where four out of five cavities occur.

Are pediatric dentists prepared to care for special children?
Absolutely. Pediatric dentists have two or more years of advanced training beyond dental school. Their education as specialists focuses on care for children with special needs. Pediatric dentists, because of their expertise, are often the clinicians of choice for the dental care of adults with special needs as well.

Will my child need special care during dental treatment?

Some children need more support than a gentle, caring manner to feel comfortable during dental treatment. Restraint or mild sedation may benefit your special child. If a child needs extensive treatment, we may recommend they be treated under general anesthesia. Our doctor and staff have a comprehensive education in behavior management, sedation and anesthesia techniques. We will select a technique based on the specific health needs of your child, then discuss the benefits, limits and risks of that technique with you.
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Dental Care for Your Baby

When should my child first see a dentist?
"First visit by first birthday" sums it up. Your child should visit a pediatric dentist when the first tooth comes in, usually between six and twelve months of age. We may do nothing more than look around the mouth and give you some tips. However, early examination and preventive care will protect your child's smile now and in the future.

Why so early? What dental problems could a baby have?
The most important reason is a practical prevention program. Dental problems can begin early. A big concern is nursing or early childhood caries. Your baby risks severe decay when he or she nurses continuously from the breast or from a bottle of milk, formula, or juice during naps or at night.

Another concern is gum disease. Recent studies show nearly half of all children aged two and three have at least mild inflammation of gum tissues. The earlier the dental visit, the better the chance of preventing dental problems. Children with healthy teeth usually chew food easily, learn to speak clearly, and smile with confidence. Start your child now on a lifetime of good dental habits.

How can I prevent tooth decay from nursing or a bottle?
Don't nurse your child to sleep or put your baby to bed with a bottle of milk, formula, juice, or sweetened liquid. This can result in Early childhood caries. Use only water in the bottle, or give your baby a pacifier. Check with your pediatric dentist to make sure your child is getting enough fluoride for decay protection. Lastly, learn how to brush and floss your child's teeth.

When should bottle or breast feeding be stopped?
To assure good dental health, infants should be weaned from a bottle or nursing at one year of age.

Should I worry about thumb or finger sucking?
Thumb sucking is perfectly normal for infants: most stop by age two. If your child doesn't, discourage it after age four. Prolonged thumb sucking can create crowded, crooked teeth or bite problems. We will be glad to suggest ways to address a prolonged thumb-sucking habit.

When should I start cleaning my baby's teeth?
The sooner the better! Starting at birth, clean your baby's gums with a clean damp wash cloth. Use a tiny dab of fluoride toothpaste if your pediatric dentist advises fluoride protection. Later, brush your child's teeth with fluoride toothpaste and small, soft-bristled toothbrush. Remember that most small children do not have the dexterity to brush their teeth effectively.

Any advice on teething?
From six months to age three, your child may have sore gums when teeth erupt. Many babies like a clean teething ring, cool spoon or cold wet wash cloth. Some parents swear by a chilled teething ring: others simply rub the baby's gums with a clean finger.
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Early Childhood Caries

Early childhood cariesis a devastating dental disease that can rapidly destroy the teeth of an infant or young child. The upper front teeth are the most susceptible to damage, but other teeth may also  be affected. This condition is difficult to treat and extremely costly, both financially and emotionally. The repercussions will last for years to follow.

What causes early childhood caries?
Early childhood caries is caused by sugar containing liquids like milk, formula, breast milk, fruit juice, sodas, and other sweetened drinks. The sugars in these liquids feed the bacterial plaque. As the child sleeps, the rinsing action of the saliva decreases and allows for the plaque acids to concentrate on the teeth. Shortly after, tooth decay can occur, resulting in what is called early childhood caries. By the time the decay is noticed, it may be too late to save the child's teeth and in more severe cases, can result in life threatening infections. In such young children, the options for treatment are limited and usually require the child to be sedated or put to sleep with general anesthesia.

How serious is early childhood caries?
Besides being painful and disfiguring, your child’s teeth could be lost as early as one year. Painful, disfigured or missing teeth can also contribute to:
  • Eating problems
  • Speech problems
  • Social problems
  • Permanent teeth Problems

How can I prevent early childhood caries?
You can prevent this from happening to your child's teeth by knowing how to protect them.
  • Begin brushing your child's teeth as soon as the first tooth erupts.
  • Flossing should begin when all primary teeth have erupted, usually by age 2 or 2 1/2.
  • Do not allow your child to sleep with a bottle containing a sweetened liquid.
  • If your child refuses to fall asleep without a bottle, simply fill it with water and nothing else. (They may cry for a night or two but think of the options if their teeth decay.)
  • Have the first dental checkup when your child is around twelve months old.

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The office of Dr. Shelby Smith provides pediatric dentistry and orthodontics for infants, kids, and teens in Antioch, CA (California). Dr. Smith and her team are dedicated to creating a positive dental and orthodontic experience for you and your child.Contact our practice to schedule an appointment.

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Orthodontist and Children's Dentist Shelby J. Smith, DDS, MS, 2213 Buchanan Rd, Suite 112
Antioch, CA 94509 (925) 755-5115

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