Conversations about pediatric dental care can begin before the baby’s even born. Here, we recap the topics to discuss,
according to the patient’s age
I have a deep passion for the dental industry and the
contribution each of us makes to our patients’ health and
well-being. That’s why I serve on public policy boards that
focus on children with special needs and their access to
care. I’m also committed to nurturing the next generation
of dentists, so I’ve been a professor at Children’s National Hospital in Washington, D.C., for seven years and am an
adjunct faculty member at MedStar Georgetown University Hospital with the Department of Pediatrics and the School
of Law and Equity. I did my undergraduate degree in cultural anthropology at Duke University,
which opened my eyes to how people from
other cultures interact with health care.
While earning my master’s in maternal
and child health, it became clear to me
that good health starts in the womb. I had
a “light bulb moment” when I realized that
pediatric dentistry would allow me to help
children begin a lifetime of positive oral
health habits and support those born with
certain risk factors.
Today, my scope of interest has expanded,
and I see oral health from a variety of
perspectives, including overall public health,
the cultural and nutritional environment of
our patients, and the developmental growth
and needs of the individual child sitting in
my chair. I also view it as a mother of two
Everything starts in the womb
The more I’ve learned and practiced, the
more it’s evident that pediatric dentistry is
about more than baby teeth. Children born
to mothers who have poor oral hygiene or
are in poor health may be at risk for a variety
of future general and oral health problems.
Moreover, while a child’s diet is responsible
for 95% of caries, some oral problems
have their root cause in utero. As dentists, we need to monitor these problems and
collaborate with our cohorts in the health
care community to manage their treatment.
You can draw a straight line between
the mother’s health and the future health,
growth and development of the child she is
carrying, because the baby’s teeth begin to
develop in utero at just six weeks.
How family dentists can help
Family dentists have an opportunity
to support both women of reproductive
age and expectant moms by making sure
they understand that their overall health—including their oral health—has a direct
impact on their baby’s teeth.
When the opportunity arises, dentists
can chat about everything from the
roles of nutrition and lifestyle to how
a lactation consultant can help a mom
through breastfeeding challenges. They
can provide guidance about teething and
let parents know that they can reach out
to a pediatric dentist, who has a wealth of
resources to offer.
It isn’t unusual for parents to ask their
family dentist about their worries. Dentists
are often the first people to hear about
teething, sleeping or feeding concerns, or
that teeth might be missing or are erupting
in an abnormal pattern. General dentists
also have first-mirror knowledge of the
parent’s dental history. Any time a general
dentist hears about teeth concerns with a
child or red flags in genetic history, it is an
opportunity to engage and refer the patient
to a pediatric dental specialist.
We are part of the larger health care community
General dentists have the opportunity
to remind those in their patient care teams
about the importance of oral health for
children and that the first dental visit
should take place at just 1 year of age. As dentists, working together to address
comprehensive family health concerns is
a required component of our job as part
of a larger medical community. We’re not
just the “teeth doctors”!
Questions about infants
One thing that’s unique about my
practice is my work in releasing tethered ties
through laser frenectomy. This procedure
is used to release a tongue or lip tie to help
children feed, speak and breathe more clearly
and cleanse their mouth better.
Because of the proven health benefits
of breastfeeding, frenectomy is, at times, a
necessary procedure for moms looking to
improve nursing for their newborn. This
has become a hot topic in the new mom
community, and families may look to their
general dentists for guidance and reassurance.
The important message to get across is that
this procedure should be explored as a team,
which may include a lactation consultant,
a pediatric dentist and possibly an infant
chiropractor or bodyworker.
In fact, any time families talk about
infants is a teaching moment! Most families
need guidance understanding the life cycle
of teeth, how the introduction of solids
increases the need to have an oral health
routine and how common dental trauma
is at such a young age, especially as young
children are learning to walk. I find that
most parents are receptive to this guidance
because parenting books often lack detailed
information about the topic of oral care.
Baby’s first visit to the dentist
Generally speaking, a child’s first dental
visit should be as close to age 1 as possible.
Exceptions to this rule include children born
with teeth or those born with craniofacial
abnormalities, who should be under a
pediatric dentist’s care earlier. At that first
appointment, I’m looking at the child’s oral
development and seeking information on a
range of topics from birth and family dental
history to sleep problems and respiratory
issues such as snoring.
Parents are often surprised by the amount
of time we spend talking about feeding,
swallowing, nutrition and their functional
relationship to oral health. In truth, the entire
conversation is geared toward identifying
risk areas and potential future concerns.
Let’s talk about kids and sugar
Toddlers, preschoolers and grade-school
children need to see a dentist every six months
to closely monitor their growth and development.
Our conversations in the treatment
room range from brushing and flossing to
feeding, nutrition and how to avoid sugar.
Parents who say their children never eat
candy are always surprised when I remind
them that there may be hidden culprits that
contribute to caries, including acidic fruits
and granola bars, which may use honey
or another sugar substrate to bind them.
Because of the high sugar content, these
should be an occasional treat rather than
an everyday snack. Reading labels for both
nutritional content and tooth friendliness
is essential! Gummy vitamins are another
unexpected source of cavity-causing sugar.
They get stuck in teeth and cause problems.
General practice dentists can do their
part to reinforce good nutrition when they
speak with their adult patients. Sugar is a
problem at all ages and the benefits of good
nutrition helps grown-ups and kids alike.
Thumbs, fingers and pacifiers warrant
intense discussion in the pediatric dentist’s
office. The use of pacifiers for infants reduces
the risk of sudden infant death syndrome
(SIDS) in infants up to 6 months of age,
but prolonged use can create changes in the
mouth’s shape and cause misaligned teeth.
When it comes to finger sucking, things
can get a little trickier because you can’t take fingers away. It takes patience, and I have
several gentle tricks from finger ointments
In most cases, braces can reverse
alignment problems caused by sucking,
but heading off this issue prevents a
lifetime of malalignment. According to
the American Academy of Orthodontics,
evaluations for braces start when a child
is around 7 years old. For the most part,
treatment may not begin this early, but
the assessment allows parents to prepare
mentally and financially. It also gives the
child time with the pediatric dentist to
develop the brushing and flossing skills
they’ll need to keep braces clean.
Discussing dental trauma
One of the most challenging parts of
treating children is watching for neglect,
trauma or abuse. This is a vulnerable
population, and these patients can’t always
speak for themselves.
Toppling over while learning to walk or
ride a bike is a normal part of growing up
but can result in dental trauma. Even what
looks like a little bump on the chin can
make baby teeth smash into the unformed
adult teeth below, causing them to emerge
crooked in the years to come.
General dentists, pediatricians and
other health professionals should encourage
families to take their little ones to see a
pediatric dentist any time they have had
dental trauma. Any event forceful enough
to chip a baby tooth could also damage
the adult tooth nested beneath.
A holistic approach to care
A team approach is central to my
philosophy. Not long ago, I noticed a young
boy was grinding his teeth. Nighttime
mouthguards aren’t appropriate for children
this age because all their growth occurs
while they sleep.
I engaged the sleep specialist on my team
and we ruled out stress. Then we invited
the child’s pediatrician to collaborate. We
discovered he had a vitamin deficiency; the
boy was grinding because his teeth were
struggling to grow.
In fact, as the pandemic has deepened,
pediatric dentists across the country are
reporting an increase in stress-related behaviors
such as grinding and thumb-sucking.
Even the youngest children sense tension
in the adults around them.
Older children’s routines are disturbed.
They can’t see their friends and may be
worried Mom, Dad or their grandparents
will die. The family’s entire health care
team needs to be watchful for the signs
and symptoms of stress, depression and
Despite the pandemic, regular dental
appointments are vital to uncovering problems
as well as monitoring the development of
fast-growing mouths. During this time, I’ve
been a lot more lenient and do everything I
can to be flexible and make our families feel
safe. From video and telehealth appointments
to bringing snacks and coloring books to
families waiting in cars to a 15-point safety
protocol, we’ve taken pandemic precautions
to the max.
Caring for the big kids
Working with older children, tweens,
teens and young adults means finding ways
to share the same messages about brushing,
flossing and nutrition in a manner that
resonates so we can help them begin to take
care of themselves. I’ve discovered that a
follow-up text or even a daily call to young
people who refuse to brush can encourage
them to adopt good habits. So far, parents
have been happy to give permission.
My go-to tactic is to find out what
interests or worries them and use that
information to influence the decisions they
make about their health. It is incredibly
humbling when they trust me enough to
open up. I’ve had memorable conversations
with my teen patients about everything from
exam worries to a gender transition to how
difficult it is to try out for cheerleading.
I have a library of photos and brochures
to show young people the oral consequences
of recreational drugs, smoking and vaping.
Whenever I get the chance, I use all my
persuasive powers to dissuade them from
getting tongue and lip piercings.
By the time these young people age out
of pediatric care and into the hands of my
general dental colleagues, I’d like to believe
that they’ve learned the habits and skills they
need to take care of themselves.
I think the most important thing we
can all do as dentists is to be mindful of
how we communicate and reinforce advice
for good health with our patients and their
families. Building relationships, developing
trust and finding ways to influence and
motivate is the secret sauce needed to help
children grow up to enjoy the best health
I love my work and the opportunities I
have to shape health policy, teach pediatric
dentistry and influence my own families in
practice one tooth at a time. I’ve built a great
team around me. I feel genuinely honored
to be part of a national and international
“parent squad,” and I am optimistic that
I am influencing a generation of families
that know the mouth-body connection.