Ask the pediatrician: Children’s dentist answers your questions about tooth care

Ask the pediatrician: Children’s dentist answers your questions about tooth care

This article was published in’s, Ask the Pediatrician column, on May 24, 2020.
Have questions about your children’s tooth care? A pediatric dentist answers some of the most common queries.
When COVID-19 closed dental offices, I found myself getting lots more questions about teeth.

So, I asked my friend and fellow McCaskey Red Tornado Dr. Aaron Miller to take over my column for a weekend and answer some commonly asked questions.

Welcome to a real cowboy, and one amazing advocate for kids, Dr. Miller.
Howdy, pardners, and welcome to tooth time at the LNP Corral!

When will my daughter get her first tooth?

kids-cowboys-pediatric-dentistry-lancaster-pa-Dr-Pia-FenimoreBetween 6 months and 3 years, your child will get 20 baby teeth.

Some children will not begin teething until 12 months.

Drooling is not necessarily a sign of teething, as the salivary glands naturally increase production around age 4 months to get the mouth ready for solid food.

The sequence is usually this: The two lower central incisors, the two upper central incisors, two lower and two upper lateral incisors. Then the first molars, canines and finally the second molars come in around 2 to 3 years of age.

Teething discomfort can affect each baby differently, and you may notice increased finger sucking, drooling and irritability.

Some parents have reported a low-grade fever.

Topical pain relievers should be avoided because they can be toxic to babies.

Chilled teething rings, or a gentle gum massage using a cold washcloth, can be helpful in relieving teething pain.

When will my son lose his teeth?

kids-cowboys-pediatric-dentistry-lancaster-pa-Ask-the-pediatrician03Baby teeth are lost in stages.

Here is an easy way to remember: From 6 to 8 we lose 8 and get 8. Then from 10 to 12, we lose 12 and get 12.

But let me explain. Usually, from ages 6 to 8, we will lose eight front teeth and get eight front teeth. Four uppers and four lowers — plus the first adult molars known as the six-year molars — arrive.

Then our teeth take a siesta for two years. From ages 10 to 12, children will lose 12 teeth and get in 12 teeth; plus, the second adult molars, known as the 12- year molars, make an entrance.

Help! I see a double row of teeth.

Ah yes, the famous “Shark Tooth Syndrome.” This occurs when the permanent lower incisors emerge (usually rotated) behind the primary incisors.

Fear not! This is a variation of normal.

The lower adult incisors develop in the jaw below and behind the baby incisors. They come up, move forward and push out the baby teeth with the help of the tongue pressure and voila! “Shark Tooth Syndrome” cured, usually.

A little ice cream on the gum and a little rotational force will help these ornery critters land in their rightful spot under the pillow, but they need to be loose first. Otherwise, you will have an angry baby shark.

Disclaimer: Some children may need additional dental help to have these removed.

My 4-year-old fell and hit his mouth on the sidewalk, what should I do?

Mouth injuries are scary and gross, but usually heal well. Keep calm, clean the injured area and apply pressure by using gauze or a washcloth.

This will slow the bleeding and help you better visualize the injury; something cold like a popsicle or ice cream, along with Motrin, will help ease their pain.

Next, make sure teeth are not displaced, mobile or out of the mouth. Displaced, mobile or knocked-out teeth are true dental emergencies and require immediate dental care.

If a tooth is knocked out (avulsed), find it, hold it by the crown, gently rinse the root with water and replace it into the socket (make sure the front of the tooth is in the front) and hold it there with gauze or a washcloth.

If you cannot do this, place the tooth in milk and take your child and his or her tooth to a dentist immediately.

Reimplantation within 30 minutes has a better chance for tooth survival.

Treatment for displaced or mobile baby teeth will depend on the age of the child and the degree of injury.

Best to contact your dentist for direction, but most of the time knocked-out baby teeth get placed under the pillow for the Tooth Fairy.

Fractured teeth that are sensitive to breathing or drinking should be seen by a dentist within 24 hours to reduce pain and the risk for future nerve injury.

My dentist has recommended X-rays for my child as part of their routine care, is this necessary and safe?

Dental radiographs are a safe and necessary part of a thorough dental examination. Did you know that two intraoral dental X-rays have 20 times less radiation than a chest X-ray?

Children are more susceptible to ionizing radiation, which is why dentists should follow the ALARA Principle (As Low As Reasonably Achievable) and Image Gently Campaign. These recommendations urge dental and medical providers to:

  • Select X-rays based on individual need and not just “routine.”
  • Use a thyroid collar or lead apron when possible.
  • Limit retakes.
  • Use the least radiation possible.

In dentistry for children, we use intraoral (the X-ray film is inside the mouth) and extraoral X-rays (the film is outside the mouth).

Intraoral X-rays are the most common and are usually taken between 12 and 24 months, depending on individual need.

Sometimes X-rays are taken more frequently for high-cavity-risk children and less frequently for low-cavity-risk children.

X-rays are used for the purpose of identifying cavities, extra teeth, missing teeth, injuries and pathology, and to ensure proper growth and development.

More X-ray information can be found from the American Academy of Pediatric Dentistry at

I hope this information is beneficial to your child’s dental health. If you have any further questions or concerns, please speak with your dentist.

Stay well, ride on and brush!

  • Aaron D. Miller, is a D.M.D. Diplomate with the American Board of Pediatric Dentistry. He practices dentistry at Kids Cowboy Dentistry in Lancaster.
  • Dr. Pia Fenimore, of Lancaster Pediatric Associates, answers questions about children’s health. You can submit questions at