“Ask the Doctor” questions are submitted anonymously via the PAMP discussion forum and have been edited for print. (Similar queries have been combined.) Dr. Quo’s remarks are meant to be generally educational and should not be construed as direct medical advice. If you are considering medical treatment of a condition, you should seek individual consultation with a Board Certified Professional such as Dr. Quo.

At what age should you try to stop your child’s thumb sucking? My child sucks her thumb when she is tired or bored and when sleeping. The suction created is so strong that I can’t even pry her thumb from her mouth when she is sleeping. This habit is impacting her front teeth and causing an overbite. I have tried applying bitter polish on her thumbnail and have used the thumb guard; neither has worked. What can I do to help her break this habit?

This is a very tricky question and not a very easy one to answer. All attempts to stop thumb sucking earlier than age 3 will be very difficult because your child will not understand why or how to stop. It is my belief that some children need their thumb to comfort themselves, and we do not want to deprive them of this ability.

When your child reaches an age when she can understand, usually around 3, begin to explain to her the importance of stopping this habit. If your child resists uncontrollably, then she may not be ready emotionally.

Start with little steps first. Try to have her only suck her thumb at bedtime or naptime. Try to avoid the “bored” thumb sucking because there is nothing else to do. Of course give her a lot of rewards, whether it be praise or something physical, like a prize when she accomplishes this first step. Then proceed gradually until the habit is only at nighttime—then eventually gone altogether.

We are looking for progress…however small it may be. Don’t forget to make a big deal of little successes. Remember to try to keep everything positive. Our ultimate goal is to try to have your child confident and proud of herself.

Do fillings and/or teeth sealants contain BPAs? If so, should we be concerned with this?

Most currently used sealants do not contain BPA.

What can I do to help relieve the pain when my child’s molars start coming out?

Teething pain is very common, but not all children exhibit discomfort. If your child has some discomfort, it is always best to give him or her something to chew on, whether it be a hard, rubbery teething ring, a cold wash cloth, or even a toothbrush to chew on. I prefer the toothbrush since it will accomplish both cleansing and pain relief. You can use anything that your child likes to relieve the pressure caused by the teeth erupting. If teething is still too painful, then you can use a little Tylenol or Motrin. Baby Orajel can relieve discomfort as well.

When should we take our baby to see the dentist for the first time? Are we supposed to brush the gums where teeth have not come out yet?

The American Academy of Pediatric Dentists recommends the first visit to the dentist at or around the age of 1. This first visit is all about education of the parent and how to prevent cavities. It is not necessary to brush or massage the gums, although this may help with teething. It is extremely important to brush or wipe the teeth clean as soon as they teeth erupt.

Are those dental X-rays for healthy toddlers and preschoolers with good diets, good brushing practices, and good diets really necessary? Are we putting our kids at risk unnecessarily by exposing them to extra radiation at such an early age? Their teeth are baby teeth and are going to fall out anyway in a few years.

The baby teeth will certainly fall out—it is more a matter of “how.” Ideally teeth will fall out normally between ages 6-8 for the incisors and ages 9-13 for the canines, 1st and 2nd primary molars. Sometimes, though, children lose teeth early because of cavities, infection, or abscess.

There are many factors associated with getting cavities, from genetics to diet, water intake with fluoride, oral hygiene with flossing—all of these factors and more can contribute to cavity formation. The dosage of x-rays is one very important method of detecting caries, or decay. Most offices use either digital x-rays or a faster speed of x-ray that diminishes the amount of radiation your child receives. There is more radiation flying in an airplane from LA to Boston than there is in a full-mouth set of x-rays for an adult, which usually includes 19 x-rays. The x-rays are important to prevent premature loss of teeth.

My child fell hard and bumped his mouth.  His mouth isn’t bleeding, but one of his baby teeth chipped and seemed to be displaced. What do I do about this kind of trauma? What should I look out for and under which circumstances would I come in to the dentist, or go to urgent care?

If the trauma is limited to the mouth, soft tissue and or teeth, the dentist should be your first choice. If the tooth in question is chipped or displaced, usually the proper line of treatment is to do nothing and let the body heal itself. The tooth will often appear mobile and will take 1-2 weeks to firm up. If the tooth in question is displaced so that it interferes with normal biting and chewing, then this will often lead to extracting the tooth. If the tooth is excessively mobile to where there is a risk of your child swallowing or aspirating the tooth into the lungs, then it needs to be extracted.

A traumatized baby tooth often turns a darker shade, which alone is not a bad thing. Look for two signs: pain or an abscess. If this does occur, then the body has begun to reject the tooth and it needs to be extracted.

When do children start with orthodonia nowadays? It seems that kids are wearing braces earlier than when we were kids. How do we know if we should be considering orthodonia for our kids? Will our pediatric dentist refer us if it’s needed?

Orthodontia should only be started early if your child exhibits a growth discrepancy—early meaning they are in mixed dentition with both adult and baby teeth. This can start as early as 7 or 8 years of age. Braces at this age are started because the orthodontist is planning for the future, so that adult teeth may not need to be extracted. Your pediatric dentist should advise you of the need for braces and should monitor the growth of your child’s jaws at each of their 6-month check ups.

My daughter is 7 and so far has lost 3 baby teeth. She has not had any cavities. Her dentist mentioned that we could put a sealant on her teeth. I remember reading a while back that it’s not really necessary for every child. I don’t remember having that procedure as a child. Incidentally, I never had any cavities until I was an adult. Can you give me more information on this?

Sealants are basically an insurance policy against getting cavities. It really depends on the anatomy of your child’s teeth. If there are a lot of pits and fissures in the teeth, then sealing teeth will help in preventing decay. Remember, the permanent teeth have to last a lifetime, and the location can be very difficult to clean. Even if your child has not had a cavity in the past, and her new teeth that came in are relatively groovy, then it may be inevitable that she may get small cavities somewhere on the biting surface of the tooth.

Dr. Brian Quo is a native of Ohio, born and raised in Cincinnati. He completed his undergraduate studies from The Ohio State University majoring in Finance. He relocated to the Bay Area in 1994 receiving his dental degree from the University of California at San Francisco. He continued with his education completing a residency in pediatrics from the University of Illinois at Chicago, while earning his masters’ degree in Oral Sciences. Since his return to the Bay Area, he has taught at UCSF while working around the Bay Area. He has published in Pediatric Dentistry and The Journal of Dentistry and is on staff at The Lucile Packard Children’s Hospital at Stanford in the Craniofacial Department. Dr. Quo is an active member of the American Dental Association, California Dental Association, Mid-Peninsula Dental Society, California Society of Pediatric Dentists, and the American Academy of Pediatric Dentists and an active member of the Palo Alto community for the past several years. Dr. Quo is married to Suzanne and they have two sons, Bennett and Brayden. He is an avid fan of all sports but especially loves baseball, football and soccer.

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