Pediatric Dentist Dr. Jeffrey Heilig Dental Topics title

For more information concerning pediatric dentistry, please visit the website for the American Academy of Pediatric Dentistry.

General Topics

What Is A Pediatric Dentist?

The pediatric dentist has an extra two to three years of specialized training after dental school, and is dedicated to the oral health of children from infancy through the teenage years. The very young, pre-teens, and teenagers all need different approaches in dealing with their behavior, guiding their dental growth and development, and helping them avoid future dental problems. The pediatric dentist is best qualified to meet these needs.

Why Are The Primary Teeth Important?

It is very important to maintain the health of the primary teeth. Neglected cavities can and frequently do lead to problems which affect developing permanent teeth. Primary teeth, or baby teeth are important for (1) proper chewing and eating, (2) providing space for the permanent teeth and guiding them into the correct position, and (3) permitting normal development of the jaw bones and muscles. Primary teeth also affect the development of speech and add to an attractive appearance. While the front 4 teeth last until 6-7 years of age, the back teeth (cuspids and molars) aren’t replaced until age 10-13.

Eruption Of Your Child's Teeth

Children’s teeth begin forming before birth. As early as 4 months, the first primary (or baby) teeth to erupt through the gums are the lower central incisors, followed closely by the upper central incisors. Although all 20 primary teeth usually appear by age 3, the pace and order of their eruption varies.

Permanent teeth begin appearing around age 6, starting with the first molars and lower central incisors. This process continues until approximately age 21.

Adults have 28 permanent teeth, or up to 32 including the third molars (or wisdom teeth).

Interactive Tooth Eruption Guide

Pediatric Dentist - Look! My Tooth is Loose!Look! My Tooth is Loose!
(with 16"x22" poster and stickers)
By Patricia Brennan Dermuth
Illustrated by Mike Cressy

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Dental Emergencies

Pediatric Dentist - Dental EmergenciesToothache: Clean the area of the affected tooth. Rinse the mouth thoroughly with warm water or use dental floss to dislodge any food that may be impacted. If the pain still exists, contact your child's dentist. Do not place aspirin or heat on the gum or on the aching tooth. If the face is swollen, apply cold compresses and contact your dentist immediately.

Cut or Bitten Tongue, Lip or Cheek: Apply ice to injured areas to help control swelling. If there is bleeding, apply firm but gentle pressure with a gauze or cloth. If bleeding cannot be controlled by simple pressure, call a doctor or visit the hospital emergency room.

Knocked Out Permanent Tooth: If possible, find the tooth. Handle it by the crown, not by the root. You may rinse the tooth with water only. DO NOT clean with soap, scrub or handle the tooth unnecessarily. Inspect the tooth for fractures. If it is sound, try to reinsert it in the socket. Have the patient hold the tooth in place by biting on a gauze. If you cannot reinsert the tooth, transport the tooth in a cup containing the patient’s saliva or milk. If the patient is old enough, the tooth may also be carried in the patient’s mouth (beside the cheek). The patient must see a dentist IMMEDIATELY! Time is a critical factor in saving the tooth.

Knocked Out Baby Tooth: Contact your pediatric dentist during business hours. This is not usually an emergency, and in most cases, no treatment is necessary.

Chipped or Fractured Permanent Tooth: Contact your pediatric dentist immediately. Quick action can save the tooth, prevent infection and reduce the need for extensive dental treatment. Rinse the mouth with water and apply cold compresses to reduce swelling. If possible, locate and save any broken tooth fragments and bring them with you to the dentist.

Chipped or Fractured Baby Tooth: Contact your pediatric dentist.

Severe Blow to the Head: Take your child to the nearest hospital emergency room immediately.

Possible Broken or Fractured Jaw: Keep the jaw from moving and take your child to the nearest hospital emergency room.

The Wand - Computer controlled local anesthesia delivery systemNew technology: The Wand® STA

Computer controlled Local Anesthesia delivery system

The Wand® STA is another excellent example of our efforts to bring you the latest dental technology, and to help our patients have a more pleasant, positive visit to our office.

If it is necessary that your child requires a local anesthetic for their dental treatment, Dr. Heilig may utilize the The Wand® STA.

The Wand® STA doesn’t look or work like a traditional syringe. The Wand® STA utilizes a computer microprocessor to dispense the local anesthetic at a slow, optimal flow that minimizes the awareness that the injection is even being administered. A beeping sound lets the children think that they are participating in a computer game.

New Technology: AquaCut

Cavity Preparation System

AquaCut - Cavity Preparation System

Hydro Micro Abrasion is one of the most exciting and innovative advances in dentistry today and our office now offers this drill-less technology in the early treatment of dental cavities.

A microscopically fine powder is carried to the tooth by a stream of air and water, gently spraying away decay. In a simple sense, you could say it works like a precise miniature sandblaster.

It is now possible that your child may NOT have to experience the vibration and sounds of the dental handpiece.

Thanks to this new technology, Dr. Heilig can provide your child with attractive, tooth-colored fillings faster and easier than ever before.

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Dental Radiographs (X-Rays)

Dental X-ray Use and Safety

We are aware of the concerns that parents have for their children regarding the utilization of X-rays in dentistry and medicine. While the radiation dose from dental X-rays is low relative to medical X-rays, there are additional precautions that we take to keep the dose at a minimum while still providing the diagnostic information needed. Our office utilizes the principle of "As Low As Reasonably Achievable" when making recommendations as to why, when, and how to take dental radiographs.

Pediatric Dentist - Dental Radiographs (X-Rays)

Why are dental X-rays recommended?

Dental X-rays are taken because a radiographic exam can provide information that a visual exam cannot. For example, cavities often develop in-between teeth on the surfaces where teeth are flossed. If these cavities are initially diagnosed by a visual exam they are usually advanced and close to the nerve of the tooth. A radiographic exam could have provided for early detection and more conservative treatment.

Radiographic exams may be recommended following injuries to the teeth and also to evaluate the development and position of teeth prior to their eruption into the mouth.

Will dental X-rays be taken routinely?

No. The recommendation to take dental radiographs is a clinical determination based on current recommended guidelines and your child's individual needs. Some of the factors that are taken into account are your child's age, risk assessment for dental decay, previous treatment and stage of dental development.

How will my child be protected during a dental radiographic exam?

Body aprons and thyroid shields will be used to provide additional protection to your child. Our office also utilizes digital / computerized x-rays which enable us to reduce the amount of radiation exposure to your child.

Does Your Child Grind His Teeth At Night? (Bruxism)

Parents are often concerned about the nocturnal grinding of teeth (bruxism). Often, the first indication is the noise created by the child grinding on their teeth during sleep. Or, the parent may notice wear (teeth getting shorter) to the dentition. One theory as to the cause involves a psychological component. Stress due to a new environment, divorce, changes at school; etc. can influence a child to grind their teeth. Another theory relates to pressure in the inner ear at night. If there are pressure changes (like in an airplane during take-off and landing, when people are chewing gum, etc. to equalize pressure) the child will grind by moving his jaw to relieve this pressure.

The majority of cases of pediatric bruxism do not require any treatment. If excessive wear of the teeth (attrition) is present, then a mouth guard (night guard) may be indicated. The negatives to a mouth guard are the possibility of choking if the appliance becomes dislodged during sleep and it may interfere with growth of the jaws. The positive is obvious by preventing wear to the primary dentition.

The good news is most children outgrow bruxism. The grinding decreases between the ages 6-9 and children tend to stop grinding between ages 9-12. If you suspect bruxism, discuss this with your pediatrician or pediatric dentist.

Thumb Sucking

Pediatric Dentist - Thumb SuckingSucking is a natural reflex and infants and young children may use thumbs, fingers, pacifiers and other objects on which to suck. It may make them feel secure and happy, or provide a sense of security at difficult periods. Since thumb sucking is relaxing, it may induce sleep.

Thumb sucking that persists beyond the eruption of the permanent teeth can cause problems with the proper growth of the mouth and tooth alignment. How intensely a child sucks on fingers or thumbs will determine whether or not dental problems may result. Children who rest their thumbs passively in their mouths are less likely to have difficulty than those who vigorously suck their thumbs.

Children should cease thumb sucking by the time their permanent front teeth are ready to erupt. Usually, children stop between the ages of two and four. Peer pressure causes many school-aged children to stop.

Pacifiers are no substitute for thumb sucking. They can affect the teeth essentially the same way as sucking fingers and thumbs. However, use of the pacifier can be controlled and modified more easily than the thumb or finger habit. If you have concerns about thumb sucking or use of a pacifier, consult your pediatric dentist.

A few suggestions to help your child get through thumb sucking:

Pediatric Dentist - David Decides About Thumbsucking David Decides About Thumbsucking-A Story for Children, A Guide for Parents
by Susan Heitler PHD
Paula Singer (Photographer)

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What Is Pulp Therapy?

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 maintain the vitality of the affected tooth (so the tooth is not lost).

Dental caries (cavities) and traumatic injury are the main reasons for a tooth to require pulp therapy. Pulp therapy is often referred to as a "nerve treatment", "children's root canal", "pulpectomy" or "pulpotomy". The two common forms of pulp therapy in children's teeth are the pulpotomy and pulpectomy.

A pulpotomy removes the diseased pulp tissue within the crown portion of the tooth. Next, an agent is placed to prevent bacterial growth and to calm the remaining nerve tissue. This is followed by a final restoration.

A pulpectomy is required when the entire pulp is involved (into the root canal(s) of the tooth). During this treatment, the diseased pulp tissue is completely removed from both the crown and root. The canals are cleansed, disinfected and, in the case of primary teeth, filled with a resorbable material. Then, a final restoration is placed. A permanent tooth would be filled with a non-resorbing material.

What Is The Best Time For Orthodontic Treatment?

Pediatric Dentist - Orthodontic TreatmentDeveloping malocclusions, or bad bites, can be recognized as early as 2-3 years of age. Often, early steps can be taken to reduce the need for major orthodontic treatment at a later age.

Stage I – Early Treatment: This period of treatment encompasses ages 2 to 6 years. At this young age, we are concerned with underdeveloped dental arches, the premature loss of primary teeth, and harmful habits such as finger or thumb sucking. Treatment initiated in this stage of development is often very successful and many times, though not always, can eliminate the need for future orthodontic/orthopedic treatment.

Stage II – Mixed Dentition: This period covers the ages of 6 to 12 years, with the eruption of the permanent incisor (front) teeth and 6 year molars. Treatment concerns deal with jaw malrelationships and dental realignment problems. This is an excellent stage to start treatment, when indicated, as your child’s hard and soft tissues are usually very responsive to orthodontic or orthopedic forces.

Stage III – Adolescent Dentition: This stage deals with the permanent teeth and the development of the final bite relationship.


Care Of Your Child's Teeth

Interactive Tooth Eruption Guide

Good Diet = Healthy Teeth

Good DietDietary choices affect oral health as well as general health and well being. Always choose snacks based upon nutritional value and limit between-meal snacking.

After 1 year of age, drinking between meals from sippy cups or bottles can be a risk factor since children may drink more frequently and for a longer duration.

Children that require long-term use of medications (often sweetened to improve the taste) are at a higher risk and therefore may benefit from early and more frequent dental exams and preventive treatment.

Making teeth more resistant to cavities

Brushing teeth twice daily (after breakfast and before bedtime) with a Fluoride Toothpaste has greater preventive benefits than brushing only once a day. When looking for a toothpaste for your child, Dr. Heilig recommends using one that is ADA Approved.

For young children, fluoride toothpaste should always be dispensed by the parent in order to prevent using an excessive amount that could be swallowed. Use a “smear” of toothpaste to brush the teeth of a child less than 2 years of age or if your child does not spit out properly. Use a “pea-size” amount if your child is older and is capable of spitting out their toothpaste.

While children should be encouraged to learn how to brush their teeth by themselves, they don’t always do an adequate job. So parents should still assist them with brushing at least until age 8.

While topical fluorides have been proven to reduce the incidence of dental cavities, there are other new products being developed that Dr. Heilig may also recommend based on your child’s risk for tooth decay.


Are you aware of the effectiveness of dental sealants in the prevention of tooth decay?

Regardless of how well teeth are cared for, it is difficult and sometimes impossible to effectively clean the tiny pits and fissures commonly found on the chewing surfaces of the back teeth.

However, sealants can be applied by Dr. Heilig to act as a barrier and protect these susceptible areas from the plaque and food which can cause tooth decay.

The permanent teeth that benefit most from sealants are the first or six-year molars, the second or twelve-year molars and the premolars.


Chewing surface of a molar before sealant is applied.

Deep pits and fissures make it difficult to remove bacteria from this tooth surface when brushing.


Chewing surface of a molar protected by a shaded sealant.

Bacteria are unable accumulate in the pits and fissures reducing the possibility of decay.

Dr. Heilig may use an advanced technology called HYDRO MICRO ABRASION to effectively remove the plaque that has accumulated in the deep pits and fissures of the tooth. The tooth is then re-examined to verify that decay does not exist. The sealant material is then flowed into the pits and fissures where it is bonded to the tooth.

Children are able to eat and drink immediately after the sealant appointment.

Although sealants can last for many years, periodic evaluations will determine when reapplication would be beneficial.

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Optimal exposure to fluoride from both dietary and topical sources can significantly reduce your child’s risk for cavities. But the recommended amounts are age dependent. Many pre-school-aged children may get more fluoride than their parents realize and this can lead to dental fluorosis. Being aware of a child’s potential sources of fluoride can help parents prevent this from occurring.

Some recommendations are:

Mouth Guards

Pediatric Dentist - Mouth GuardsWhen a child begins to participate in recreational activities and organized sports, injuries can occur. A properly fitted mouth guard, or mouth protector, is an important piece of athletic gear that can help protect your child’s smile, and should be used during any activity that could result in a blow to the face or mouth.

Mouth guards help prevent broken teeth, and injuries to the lips, tongue, face or jaw. A properly fitted mouth guard will stay in place while your child is wearing it, making it easy for them to talk and breathe.

Ask your pediatric dentist about custom and store-bought mouth protectors.

Xylitol - Reducing Cavities

The American Academy of Pediatric Dentistry (AAPD) recognizes the benefits of xylitol on the oral health of infants, children, adolescents, and persons with special health care needs.

The use of XYLITOL GUM by mothers (2-3 times per day) starting 3 months after delivery and until the child was 2 years old, has proven to reduce cavities up to 70% by the time the child was 5 years old.

Studies using xylitol as either a sugar substitute or a small dietary addition have demonstrated a dramatic reduction in new tooth decay, along with some reversal of existing dental caries. Xylitol provides additional protection that enhances all existing prevention methods. This xylitol effect is long-lasting and possibly permanent. Low decay rates persist even years after the trials have been completed.

Xylitol is widely distributed throughout nature in small amounts. Some of the best sources are fruits, berries, mushrooms, lettuce, hardwoods, and corn cobs. One cup of raspberries contains less than one gram of xylitol.

Studies suggest xylitol intake that consistently produces positive results ranged from 4-20 grams per day, divided into 3-7 consumption periods. Higher results did not result in greater reduction and may lead to diminishing results. Similarly, consumption frequency of less than 3 times per day showed no effect.

To find gum or other products containing xylitol, try visiting your local health food store or search the Internet to find products containing 100% xylitol.

Beware of Sports Drinks

Sports DrinksDue to the high sugar content and acids in sports drinks, they have erosive potential and the ability to dissolve even fluoride-rich enamel, which can lead to cavities.

To minimize dental problems, children should avoid sports drinks and hydrate with water before, during and after sports.  Be sure to talk to your pediatric dentist before using sports drinks.

If sports drinks are consumed:

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Adolescent Dentistry

Pediatric Dentist - Teens

Tongue Piercing - Is It Really Cool?

You might not be surprised anymore to see people with pierced tongues, lips or cheeks, but you might be surprised to know just how dangerous these piercings can be.

There are many risks involved with oral piercings, including chipped or cracked teeth, blood clots, blood poisoning, heart infections, brain abscess, nerve disorders (trigeminal neuralgia), receding gums or scar tissue. Your mouth contains millions of bacteria, and infection is a common complication of oral piercing. Your tongue could swell large enough to close off your airway!

Common symptoms after piercing include pain, swelling, infection, an increased flow of saliva and injuries to gum tissue. Difficult-to-control bleeding or nerve damage can result if a blood vessel or nerve bundle is in the path of the needle.

So follow the advice of the American Dental Association and give your mouth a break – skip the mouth jewelry.

Tobacco - Bad News In Any Form

Tobacco in any form can jeopardize your child’s health and cause incurable damage. Teach your child about the dangers of tobacco.

Smokeless tobacco, also called spit, chew or snuff, is often used by teens who believe that it is a safe alternative to smoking cigarettes. This is an unfortunate misconception. Studies show that spit tobacco may be more addictive than smoking cigarettes and may be more difficult to quit. Teens who use it may be interested to know that one can of snuff per day delivers as much nicotine as 60 cigarettes. In as little as three to four months, smokeless tobacco use can cause periodontal disease and produce pre-cancerous lesions called leukoplakias.

If your child is a tobacco user you should watch for the following that could be early signs of oral cancer:

Because the early signs of oral cancer usually are not painful, people often ignore them. If it’s not caught in the early stages, oral cancer can require extensive, sometimes disfiguring, surgery. Even worse, it can kill.

Help your child avoid tobacco in any form. By doing so, they will avoid bringing cancer-causing chemicals in direct contact with their tongue, gums and cheek.

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Pediatric Dentist
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