Below are some of the most frequently asked questions patients have about dentistry and oral health issues.  If you have any other questions, or would like to schedule an appointment, we would love to hear from you.

Click on a question below to see the answer.

The American Academy of Pediatric Dentistry (AAPD) recommends that children visit the dentist for their first evaluation within 6 months after the first tooth erupts, or by 12 months of age. 

Early evaluation can prevent many problems and complications that might have been easily preventable.

Brushing and flossing help control the plaque and bacteria that cause dental disease.

Plaque is a film of food debris, bacteria, and saliva that sticks to the teeth and gums.  The bacteria in plaque convert certain food particles into acids that cause tooth decay.  Also, if plaque is not removed, it turns into calculus (tartar).  If plaque and calculus are not removed, they begin to destroy the gums and bone, causing periodontal (gum) disease.

Plaque formation and growth is continuous and can only be controlled by regular brushing, flossing, and the use of other dental aids.

Toothbrushing – Brush your child's teeth at least twice a day (especially before going to bed at night) with an ADA approved soft bristle brush and toothpaste.

  • Initially it's not extremely important to worry about the technique or method of brushing when your child is an infant or toddler.   A simple back and forth, scrubbing motion will usually suffice and won't harm the gums.
  • As the children get older, more attention can be paid to the recommendation to brush at a 45 degree angle to the gums, gently using a small, circular motion, ensuring that you always feel the bristles on the gums.
  • Brush the outer, inner, and biting surfaces of each tooth.
  • Use the tip of the brush head to clean the inside front teeth.
  • Brush the tongue to remove bacteria and freshen their breath.

Electric toothbrushes can also be recommended.  They are easy to use and can remove plaque efficiently.  Simply place the bristles of the electric brush on your gums and teeth (you can do several at a time) and gently move the brush up and down or side to side.

FlossingDaily flossing is the best way to clean between the teeth and under the gumline.  Flossing not only helps clean these spaces, it disrupts plaque colonies from building up, preventing damage to the gums, teeth, and bone.

  • Until you and your child get the hang of it, it's easiest to start by laying the child on a bed so that they are relaxed, and so that you can get good visual and physical access to their mouth.
  • Rather than floss at them, approach their mouth from behind their head (just like we do at the office).  This allows you to mimic the motion of flossing your own teeth, giving you a better feel and control of the flossing action.
  • Take 12-16 inches (30-40cm) of dental floss and wrap it around your middle fingers, leaving about 2 inches (5cm) of floss between the hands.
  • Using your thumbs and forefingers to guide the floss, gently insert the floss between teeth using a sawing motion.
  • Curve the floss into a “C” shape around each tooth and under the gumline.  Gently move the floss up and down, cleaning the side of each tooth.

Floss holders are recommended if you have difficulty using conventional floss.

Rinsing – It is important to rinse your mouth with water after brushing, and also after meals if you are unable to brush.  If you are using an over-the-counter product for rinsing, it’s a good idea to consult with your dentist or dental hygienist on its appropriateness for you.

It is recommended that your child have his or her teeth checked and cleaned at least twice a year, though the dentist or dental hygienist may recommend more frequent visits.

Regular dental exams and cleaning visits are essential in preventing dental problems and maintaining the health of your child's teeth and gums.  At these visits, their teeth are cleaned and checked for cavities.  Additionally, there are many other things that are checked and monitored to help detect, prevent, and maintain your dental health.  These include:

  • Medical history review: Knowing the status of any current medical conditions, new medications, and illnesses, gives us insight to your child's overall health and also their dental health.
  • Examination of diagnostic x-rays (radiographs): Essential for detection of decay, tumors, cysts, and bone loss.  X-rays also help determine tooth and root positions.
  • Oral cancer screening: Check the face, neck, lips, tongue, throat, tissues, and gums for any signs of oral cancer.
  • Gum disease evaluation: Check the gums and bone around the teeth for any signs of periodontal disease.
  • Examination of tooth decay: All tooth surfaces will be checked for decay with special dental instruments.
  • Examination of existing restorations: Check current fillings, crowns, etc.
  • Removal of calculus (tartar): Calculus is hardened plaque that has been left on the tooth for sometime and is now firmly attached to the tooth surface.  Calculus forms above and below the gum line, and can only be removed with special dental instruments.
  • Removal of plaque: Plaque is a sticky, almost invisible film that forms on the teeth.  It is a growing colony of living bacteria, food debris, and saliva.  The bacteria produce toxins (poisons) that inflame the gums.  This inflammation is the start of periodontal disease!
  • Teeth polishing: Removes stain and plaque that is not otherwise removed during toothbrushing and scaling.
  • Oral hygiene recommendations: Review and recommend oral hygiene aids as needed (electric dental toothbrushes, special cleaning aids, fluorides, rinses, etc.).
  • Review dietary habits: Your child's eating habits play a very important role in their dental health.

As you can see, a good dental exam and cleaning involves quite a lot more than just checking for cavities and polishing your child's teeth.  We are committed to providing your child with the best possible care, and to do so will require regular check-ups and cleanings.

Prior to the eruption of the first tooth, it's a good idea to get your baby used to oral cleanings by using a washcloth and wiping out the mouth after feedings.

Once the teeth start erupting, transition to an appropriately sized tooth brush.  Current recommendations call for the use of a small "dot" of children's toothpaste with fluoride up until about age 3.  At 3 years old, you can use a pea-sized amount of fluoride toothpaste

"Infant" or "Baby" or "Safe to Swallow" types of toothpaste with out fluoride are of no real benefit, and are not recommended for use.

Fluoride is very important in the fight against tooth decay.  Fluoride works in several ways and is available in several forms.

Fluoride is a naturally occuring mineral.  Fluoride is an ingredient and catalyst that promotes enamel re-mineralization (strengthening).  It also makes it more difficult for the bacteria that causes cavities to adhere or stick to the teeth.  Lastly, fluoride also interferes with that same bacteria's metabolism, rendering them less active.  Fluoride strengthens teeth, prevents cavities, reverses small cavities, and neutralizes bacteria.

Fluoride can be found in most toothpastes, in anticavity rinses and mouthwashes, in specially prescribed gels and pastes, and in the form of a supplement with or without a multivitamin.  In the dentists's office, fluoride can also be applied in the form of a foam, gel, or varnish.

Fluoride is present naturally public drinking water.  If it's present at a sufficient enough level, it will provide a significant anti-cavity effect.  Here in Hawaii, fluoride does occur naturally but not at a level high enough to provide that benefit.

Cavities or dental caries, is the result of loss of acid demineralization of tooth enamel or dentin.  This acid is produced by bacteria in the mouth.  The bacteria is dependent on fermentable carbohydrates as fuel.

Once the acid level reaches a certain strength in your mouth, the tooth begins to lose mineral.  After enough mineral has been lost, and after the tooth has been exposed to this environment enough times, a cavity will begin to form.

Things we can do to help prevent this acid demineralization are to limit the frequency of consumption, rinse your mouth with water after meals/snacks/drinks, and proper oral health care including brushing, flossing, and the use of fluoride.

Dental sealants are a very effective way to prevent cavities in the pit & groove (biting) surfaces of teeth.  Up to 80% of cavities occur in these surfaces of young teeth.  Sealants are a resin material that is micromechanically bonded to the susceptible surface of the tooth.  This process creates a protective layer that cuts off the cavity causing bacteria from their source of fuel.

 Sealants may need to be replaced over time, but can last up to 10 years. 

Over the years there has been some concern as to the safety of amalgam (silver) fillings.  An amalgam is a blend of copper, silver, tin and zinc, bound by elemental mercury.  When the mercury combines with the other components of the filling, it becomes an inactive substance that is safe.  Dentists have used this blended metal to fill teeth for more than 100 years.  The controversy is due to claims that the exposure to the vapor and minute particles from the mercury can cause a variety of health problems.

According to the American Dental Association (ADA), up to 76% of dentists use silver containing mercury to fill teeth.  The ADA also states that silver fillings are safe and that studies have failed to find any link between silver containing mercury and any medical disorder.

The general consensus is that amalgam (silver) fillings are safe.  Along with the ADA’s position, the Center for Disease Control (CDC), the World Health Organization, the FDA, and others support the use of silver fillings as safe, durable, and cost effective.  The U.S. Public Health Service says that the only reason not to use silver fillings is when a patient has an allergy to any component of this type of filling.  The ADA has had fewer than 100 reported incidents of an allergy to components of silver fillings, and this is out of countless millions of silver fillings over the decades.

Normally your child's teeth begin erupting at about 5-7 months of age.  There is some variation that naturally occurs, and they can begin earlier or later and still be considered normal.  The baby teeth continue to erupt sequentially and the process is usually complete by 3 years.

At the time of birth, the permanent teeth start developing and will usually begin erupting at about 6-7 years.  Again, there is some variation and they may start erupting as young at 5 and as late as 8 years.  Typically, if you child's baby teeth start coming in "early", so will the permanent teeth.  Not counting wisdom teeth, the usual permanent teeth continue to erupt and the process is usually complete around 12 years.

Recently it has been shown that there is some association with pacifier use and occurrence of ear infections.  However, researchers are still not clear as to how or why the association exists so this does not suggest that you should avoid pacifier use.  The important thing to remembe is to try and keep the pacifier as clean as possible and change it frequently if you baby does use one.