When a baby tooth is lost too soon, the teeth next to it may tilt or drift into the empty space, affecting the growth of the permanent tooth. If left untreated, this condition may require extensive orthodontic treatment, since the permanent tooth may be crooked due to crowding. Space maintainers hold open the empty space left by the lost tooth. They steady the remaining teeth, preventing movement until the permanent tooth takes its natural position in the jaw. Space maintainers are appliances made of metal or plastic material. They are custom-made to fit your child’s mouth and are small and unobtrusive in appearance. Most children adjust easily to them after the first few days.

In children, dental infections are usually caused by deep caries or a history of trauma/injury. Untreated dental infections can lead to pain, abscess, and cellulitis. Consequently, children are prone to dehydration – especially if they are not eating well due to pain and malaise. Extracting infected tooth is important to control pain and prevent the spread of infection. Extraction may also be necessary for other reasons, such as crowding/spacing issues or over-retained baby tooth which blocks the eruption of the permanent tooth.

If your child needs an extraction, we take great care to ensure that he/she is relaxed and comfortable. During the extraction, your child should feel a little bit of pressure as the tooth is gently lifted out of the socket. While it is normal to experience a small amount of bleeding afterward, bleeding can be controlled by biting down firmly on a square gauze. Our experienced staff is here to explain post-care instructions with you in detail. We can also be reached at (408) 828-7075 should you have additional concerns after-hour.

The pulp of a tooth is the inner, central core of the tooth. The pulp contains nerves, blood vessels, connective tissue and reparative cells. The purpose of pulp therapy in pediatric dentistry is to save a decayed or infected tooth that might otherwise need to be extracted. Dental caries (cavities) and traumatic injury are the main indications for pulp therapy. Pulp therapy is often referred to as a nerve treatment, a “baby” root canal, or pulpotomy.

After pulp therapy, the baby tooth will still be functional, but weak and prone to fractures. To protect it from further injury, the tooth will require a full coverage stainless steel crown for maximum protection. The restored tooth, along with the stainless steel crown, will eventually be replaced by the permanent tooth.

Stainless steel crowns are the most common crowns used by pediatric dentists to restore primary (baby) teeth. They are customized to fit your child’s tooth and are extremely durable and easy to place. Your child may need a stainless steel crown if:

• A primary tooth has extensive decay on multiple surfaces
• A tooth has a very large filling and further decay is present
• The tooth is fractured, broken or cracked
• The tooth has had pulp therapy

Composite filling is a mixture of glass or quartz filler in a resin medium that produces a tooth-colored filling. Composite fillings are durable and resistant to fractures in small-to-mid size restorations that need to withstand moderate chewing pressure. Less tooth structure is removed, which may result in smaller fillings. Composites can also be “bonded” or adhesively held in a cavity, often allowing the dentist to make a more conservative repair to the tooth.

Composite resin filling materials tend to be more expensive and require longer treatment time. They are also subject to stain and discoloration over time.

Used by dentists for more than a century, dental amalgam is the most thoroughly researched and tested restorative material. It is durable, easy to use, highly resistant to wear and relatively inexpensive in comparison to other materials. For these reasons, it remains a valued treatment option for dentists and their patients.</span>

Dental amalgam is a stable alloy composed of elemental mercury, silver, tin, copper and other metallic elements. Though questions have arisen about the safety of dental amalgam due to its mercury content, studies and researches have shown dental amalgam to be a safe, reliable and effective restorative material. It continues to be endorsed by the National Institute of Health (NIH), U.S. Public Health Service, Center of Disease Control (CDC), Federal Drug Administration (FDA) and World Health Organization (WHO).

Amalgam fillings are less expensive than composite resin fillings, reduce the chances of recurrent caries (cavities that form under a previously existing filling), and are easier and faster to place in your child’s tooth. Because amalgam fillings can withstand very high chewing loads, they are particularly useful for restoring molars in the back of the mouth, where chewing load is greatest. They are also useful in areas where a cavity preparation is difficult to keep dry during the filling replacement, such as in deep fillings below the gum line.

Radiographs (X-rays) are a vital and necessary part of your child’s checkup. They allow our dentist to diagnose and treat health conditions that cannot be detected with the naked eye. Without them, certain dental conditions, such as the extent of cavities, presence of cysts, abscesses, progress of dental development, and future orthodontic concerns, may not be properly evaluated. Dental care is much more comfortable and affordable when problems are addressed and treated early.

At First Smile Pediatric Dentistry, we take extra precaution in minimizing radiation exposure to our pediatric patients, parents and staff. Lead body aprons and shields offer physical protection while high-speed film and digital X-rays assure that children receive the minimal amount of radiation exposure. X-rays are only taken on an as needed basis to evaluate and monitor your child’s oral health. If your child has taken an X-ray at another office within 6 months, please request copies to be sent to our office to help reduce radiation exposure.

Sealants are an excellent way of protecting the chewing surfaces of your child’s teeth that have never had a filling and do not have decay. It is a white or sometimes clear material that is placed on the chewing surfaces of your child’s back teeth, the molar. It is typically applied on the permanent molar as it first appears, around age seven. Sealants protect your child’s teeth from decay by acting as a physical barrier and protecting enamel from plaque and acids. The purpose of the sealant is to smooth out the normal ridges and crevices of your child’s back teeth where plaque and bacteria accumulate.

Sealants fill up these grooves and allow food to slide off the tooth surface. Combined with fluoridated water and topical fluorides (mouth rinses & tooth-paste), sealants virtually eliminate decay on the chewing surfaces of your child’s teeth. The American Dental Association’s latest studies indicate that children who have had sealants applied to their teeth had a 6% cavity rate on the chewing surfaces of these teeth. Those children without sealants had a 59% cavity rate.

No “shots” are necessary when sealants are placed on your child’s tooth. To apply a sealant, the operator cleans each tooth then etches it with a mild acid wash to give the sealant a rougher enamel surface bond with. The plastic coating is then applied and cured with a special light. The procedure is quick and comfortable and takes only one visit. Your child will be able to eat right after the appointment.

Sealants are not a guarantee against decay. Sealants can only prevent decay on the chewing surface of your child’s tooth, not in the area between teeth. Sealants protect the chewing surfaces of your child’s back molars where decay occurs most often. It is very important that your child continues to brush and floss every. The integrity of a sealant depends on a child’s chewing, eating, and grinding habits. Typically, sealants are replaced after three to five years as the borders of the sealant may be weakened by this time. During your regular six month check-up, Dr. Kao will evaluate the condition of the sealants and reapply as necessary.

General anesthesia is sometimes recommended for children who are unable, by either age or behavior, to cooperate during dental treatment. As this may pose a threat to patient’s own safety, our practice utilizes a certified anesthesiologist (MD) to facilitate in this process. Once general anesthesia is recommended as a potential treatment option, an in-depth discussion between the parents and the pediatric dentist takes place to ensure proper understanding of the procedure and maximize optimal outcome.
• General anesthesia is a controlled state of unconsciousness that eliminates awareness, movement and
discomfort during dental treatment.
• It is very safe. A board certified anesthesiologist (MD) comes to the office and comfortably sedates your child
during the dental procedure.
• All dental work is completed during this single visit.
• If radiographs (X-rays) were not obtained at the initial exam due to fear or uncooperative behavior, they will be
obtained while your child is sleeping, possibly revealing new cavities which will be restored at the same time.
• Since your child is unconscious and pain medications are given during the procedure, your child will not have
any memory of the procedure or feelings of pain and discomfort.
• Unlike conscious oral sedation, where the dentist monitors both the patient’s vital signs and completes the
dental work, two doctors are on site during general anesthesia. The anesthesiologist brings his/her own
monitoring devices and focuses solely on monitoring patient’s vital signs. This allows the pediatric dentist to
fully dedicate his effort on the necessary procedure.
• Prior to your child’s appointment, he/she will be asked to refrain from drinking or eating any fluids and foods. It
is critical that you follow the instructions provided by the anesthesiologist. If your child develops a fever or is
sick on the day of the treatment, it may be necessary to reschedule the appointment to a later date.
• After the treatment, your child will be asked to rest in the comfort of our office until he/she is stable, alert, and
ready to leave. Since patients are often tired following general anesthesia, please allow your child to rest at
home with minimal activity until the next day.

Precautions are taken to protect your child during general anesthesia. Personnel with advanced training will monitor your child closely to prevent and manage complications. Please feel free to discuss the benefits and risks of general anesthesia when it is recommended for your child.

Most children respond well to the treatment described above. Some children, however, occasionally present with behavioral considerations that require more advanced techniques. Pediatric dentists, such as Dr. Kao, are specially trained and familiar with the use of protective stabilization, sedation, and general anesthesia to assist patients.

Children who are very young or have a high level of anxiety with the necessary treatment may require some level of sedation. Sedation is also helpful for children with special needs. There are many safe and effective medications available to help relax the child and promote a good environment for optimal and safe dental treatment.

Sedation dentistry is most helpful for:

• Infants
• Children requiring major treatment
• Children with high anxiety level
• Children with a history of traumatic dental experiences (sound and smell aversion)
• Children with a strong gag reflex
• Children who are medically compromised or have special needs

Sedation is endorsed by the American Dental Association and is an effective way to make many patients comfortable during their dental visit. Before using a sedative or anesthetic, it is important to tell your pediatric dentist about any medications or medical treatment your child is receiving.

Safety is our number one priority. Therefore, it is extremely important that children remain calm and still during dental treatment to avoid unexpected injury to themselves or members of the dental team. For children who are a little nervous or have never received dental procedures, nitrous oxide/oxygen for analgesia can be greatly beneficial in helping children relax.

• It is safe. Children remain awake, responsive, and breathe on their own without assistance.
• Much more oxygen is given than what we breathe in normal room air. This provides a wide margin of safety.
• Nitrous oxide/oxygen is usually breathed through a small mask placed over the nose.
• Dental treatment is more comfortable when children are relaxed.
• It is sometimes known as “laughing gas” because some patients become so comfortable and relaxed that they laugh.
• The pediatric dentists will often request that no food or drink be given to the child before treatment.
• A local anesthetic is usually given to numb the areas that are to be treated so that there is very little discomfort.
• Oxygen is usually given at the end of treatment to remove the effects of nitrous oxide gas.
• Once nitrous oxide is turned off, it only takes seconds for the gas to completely leave the body.

We do not use any form of physical restraint unless absolutely necessary for urgent situations (extractions or injuries sustained secondary to facial trauma). Our main goal is to always keep our patients comfortable to reinforce a positive experience. If your child is worried by the sight, sounds or sensations of dental treatment, he or she may respond more positively with the use of nitrous oxide/oxygen. On the other hand, for patients who may be anxious, fearful, too young to understand dental treatment, or unable to cooperate, additional supplement, such as an oral sedation medication, may help to facilitate a child’s dental treatment.

We invite parents to stay with their children during the initial examination, as well as any future visits. As a team, we can overcome apprehension, gain your child’s confidence, and provide the safest environment. We find that once we establish a certain comfort level, many children feel comfortable in coming to the treatment area by themselves. We also find on occasion that children do better by themselves if they require treatment. You know your child best – it is our goal to make his/her dental visit a great experience and we welcome your ideas and suggestions. For the safety and privacy of all patients, children without an appointment should remain in the reception room with a supervising adult. Our dental staff tailors behavior guidance and management techniques based on your child’s level of comfort with us. We use various techniques to establish positive communication and ensure a happy and comfortable environment.

• Tell-show-do: A verbal explanation of the dental procedure on an age appropriate level, followed by a
demonstration, then completion of procedure.
• Nonverbal communication: Reinforcement and guidance of behavior through appropriate physical contact,
posture, facial expressions and body language.
• Positive reinforcement: Awarding good behavior with verbal praise and rewards.
• Distraction: A technique that diverts the child’s attention from what he/she may perceive as unpleasant. It can
involve taking breaks throughout a procedure if needed.
• Voice control: Moderation of the voice to help direct your child and reinforce appropriate behavior.

Fluoride is a mineral that is naturally present in many foods and water. Routine use of a small amount of fluoride can help prevent tooth decay by strengthening the outside layer of the teeth. Fluoride also affects cavity-causing bacteria by discouraging acid attacks that break down the tooth.

Using fluoride for the prevention and control of decay is proven to be both safe and effective. However, excessive fluoride ingestion by preschool-aged children can lead to dental fluorosis, which is a chalky white to even brown discoloration of the permanent teeth.

Our pediatric dentist considers many factors before recommending fluoride supplement. Your child’s age, risk of developing dental decay and dietary sources of fluoride are all important considerations. We can help determine if your child is receiving – and not exceeding – the recommended amount. Please consult Dr. Kao at your visit with us.

Healthy eating habits lead to healthy teeth. Like the rest of the body, the teeth, bones and the soft tissues of the mouth need a well-balanced diet. A balanced diet is one that includes the following major food groups: fruits, vegetables, grains, meat, beans and milk. Most snacks that children eat can cause cavity formation. The more frequently a child snacks, the greater the chance for tooth decays. And the longer the food remains in the mouth, the higher the risk for the teeth to become weaker. Do not nurse a young child to sleep or put him to bed with a bottle of milk, formula, juice or sweetened liquid. Residual liquid in the mouth feeds bacteria that produce acids and attack the teeth while your child sleeps. Protect your child from severe tooth decay by putting him to bed with nothing more than a pacifier or bottle of water.

Simple tips for your child’s diet and dental health

1. Ask your pediatric dentist to help assess your child’s diet.
2. Shop smart! Do not routinely stock your pantry with sugary or starchy snacks. Reserve fun foods for special
occasions.
3. Limit frequency of snacks; choose nutritious snacks.
4. Provide a balanced diet.
5. Do not put young child to bed with a bottle of milk, formula or juice.
6. If your child chews gum or sips soda, choose those without sugar.

The American Academy of Pediatric Dentistry recommends a dental check-up at least twice a year for most children. Children with increased risk for tooth decay, unusual growth patterns or poor oral hygiene may require more frequent visits.

At First Smile Pediatric Dentistry, we believe that prevention is the foundation of good health. Though dental appointments can sometimes involve tooth decay treatment, it is not the only reason for a dental visit. During a routine visit, we will gently examine your child’s teeth, oral tissues and jaws. The teeth will be cleaned and polished, followed by the application of fluoride. Through our continual assessment, we may suggest additional fluoride use, dietary changes or sealants for ideal dental health. The pediatric dentist may identify orthodontic problems and suggest treatment to guide the teeth as they emerge in the mouth.

Much like your child’s annual visit to the pediatrician, regular dental visits allow for prevention and early detection of any oral diseases and can reduce major dental problems and expensive treatments in the future.

Four “ingredients” are necessary for cavity formation: a tooth, bacteria, sugar/other carbohydrates and time. To prevent tooth decay, it is very important for you to be mindful of when and what your child eats. Dietary habits that can increase the risk of cavities include:

• Excessive sugary foods, especially between meals
• Sugary drinks, including fruit juices, sports drinks, and flavored soy and cow’s milk, especially between meals
• Between meals snacks, especially starchy (cracker, chips, etc) and sugary (candy, cookies, dried fruit) foods

Best snacks include fresh fruits and vegetables, meats, cheeses, milk (unsweetened), and water. In addition to healthy eating habits, thorough daily brushing and flossing can keep bacteria from forming harmful colonies. Remember, dental decay is an infection of the tooth. Routine dental checkup can greatly reduce and prevent cavities and dental treatments.

Other Resources 

American Dental Association	American Academy of Pediatrics
American Academy of Pediatric Dentistry	California Dental Association
California Society of Pediatric Dentistry	Santa Clara County Dental Society
COVID-19 Confirmation Link

Sucking is normal for babies and young children. Thumb sucking habits are usually established by three months of age, with some children needing to “suckle” more than others. However, prolonged use of a pacifier or thumb can create a number of problems, such as an anterior open bite (front teeth do not meet), palatal changes and tongue protrusive posturing (tongue thrusting). Although these conditions can be corrected through orthodontics and/or surgical procedures in the future, early intervention is recommended. Pacifiers should be discontinued by 2-3 years of age. If your child has a thumb sucking habit, begin to encourage discontinuation at 4-6 years of age. Your pediatric dentist will work with you and your child to develop a positive reinforcement reward system to help lessen their dependency. If this approach isn’t successful, a thumb sucking or orthodontic habit appliance may be recommended. These appliances block the thumb or fingers from being inserted into the mouth. Treatment usually lasts 1-2 months with periodic visits to check on the child’s progress.

One serious form of decay among young children is baby bottle tooth decay. This condition is caused by frequent and long exposure of an infant’s teeth to sugar-containing liquids. 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 bacteria an opportunity to produce acids that attack the tooth enamel. If you must give the baby a bottle for bedtime comfort, it should only contain water. If your child won’t fall asleep without the bottle and its usual beverage, gradually dilute the bottle’s content with water over a period of two to three weeks. After each feeding, wipe the baby’s gums and teeth with a damp washcloth or gauze pad to remove plaque. The easiest way to do this is to sit down, place the child’s head in your lap or place the child on a changing table. Whatever position you use, be sure you can easily see into the child’s mouth.

The sooner you start the better! Starting at birth, you can clean your child’s gums with a soft infant toothbrush or cloth and water. As soon as teeth begin to appear, start brushing twice daily using fluoridated toothpaste and a soft, age-appropriate sized toothbrush. For a child less than 2 years of age, use a “smear” of toothpaste during brushing. For children 2-5 years-old, dispense a “pea-size” amount of toothpaste and assist your child’s tooth brushing. Remember, young children do not have the ability to brush their teeth effectively without your help!

All teeth are important, whether they will fall out or not. If teeth are not cared for, they can decay, leading to cavities, significant pain, infection, and swelling. Studies have shown that children with dental disease do not perform as well in school due to pain, lack of sleep, and malnutrition. Untreated cavities of the baby teeth can and frequently do lead to problems that affect the development of permanent teeth. Baby teeth are important for

• proper chewing and eating
• development of permanent teeth
• development of the jaw bones and muscles
• speech development

The front 4 teeth typically start falling out at 6-7 years of age while the back teeth (cuspids and molars) are not replaced until age 10-13.

We feel very strongly that every child should visit the dentist at an early age, specifically, by his/her first birthday. Getting an early start in regular dental care is an important step in teaching your child healthy lifetime habits and preventing potential dental problems. It provides us with the opportunity to detect and manage early signs of oral diseases or abnormalities before they become difficult problems. Most importantly, it plants the seed for a positive relationship between your child and the dentist. The younger the child when first introduced to the dental office, the easier it is for him/her to develop an enthusiastic and com6ortable outlook. National organizations, including the American Academy of Pediatric Dentistry, American Academy of Peiatrics, andthe American Dental Association, also recommend that a child visits a dentist by age 1. When your baby is ready, we are here to give him/her the best chance for a lifetime of bright and healthy smile.

Children present a very unique set of physical and emotional traits when compared to adults. They are constantly growing and changing. They have different needs that require creative communication skills and unique behavioral management.

A pediatric dentist is specially trained to manage these differences, much like the way a pediatrician is trained after medical school to care for children. After completing dental school, pediatric dentists continue to train for an additional 2-3 years to learn all the unique needs of children and how best to manage them. Their expertise include behavioral management in young children, techniques in treating children with special health care needs, dental injury and trauma management, prevention of dental diseases starting at an early age and skills to provide children with a positive association with their dental care and visits.

Pleasant visits to the dental office help children establish trust and confidence that will last a lifetime. Our goal is to help all children feel good about visiting the dentist and teach them how to care for their teeth. From our special office design to our communication style, we are here to meet you and your child’s needs.

Some bleeding is expected after tooth removal and may occasionally occur after cavities have been fixed with fillings or silver crowns. If unusual or sustained bleeding occurs, place cotton gauze firmly over the bleeding area and bite down or hold in place for fifteen minutes. Repeat as necessary. When appropriate, this technique can also be accomplished with a tea bag. Tea has blood-clotting properties and has been used for many generations to treat excessive bleeding. Please call our office to discuss additional treatment options

This is a sign of an infected tooth or gums that requires treatment. Treatment options include the use of antibiotics to control the spread of infection and removal of the diseased tooth/teeth. Please call our office as soon as possible to discuss treatment options.

Tooth pain can be caused by many reasons and usually indicates an active disease that requires immediate attention. If left untreated, a toothache can progress to a severe infection that travels beyond the mouth, leading to significant swelling and illness.

* Chipped/Broken Tooth
Depending on the extent of injury, it can cause the tooth to be extremely sensitive and may occasionally result in nerve infection. This is a condition that should be discussed immediately with our doctor to determine the appropriate course of action.

* Knocked Out Permanent Tooth
This is a very serious emergency that requires IMMEDIATE treatment! Please call our office or go to the Emergency Room immediately.

* Knocked Out Baby Tooth
Unfortunately, there are no techniques to save a baby tooth once it has been knocked out. Do not attempt to replace it, as it may cause damages to the growth of your child’s permanent tooth. Call our office as soon as possible to discuss treatment options, such as a baby bridge.

* Cut or Bitten Cheek, Tongue, Lip, Gums
Apply pressure to stop or slow the bleeding. If the wound is severe or doesn’t stop bleeding, call our office or go to the Emergency Room immediately. Stitches may be necessary to stop the bleeding, prevent the spread of infection and allow for proper healing of the site.