FAMILY MATTERS: Pediatric dentist tells the tooth about children's oral health
A Q&A about kids' dental care
By Leslie Roman-Williams

Janine Randazzo, DMD, is a local dentist whose practice, Small Smiles of Richmond, LLC, is pediatric-based. She answers questions about children's tooth development and going to the dentist:

Janine Randazzo, DMD, practices at Small Smiles of Richmond, 5522 Chamberlayne Rd. in Richmond, VA. (804) 266-5040.

At what point should my child make his or her first visit to a dentist?
When they get their first tooth. We like to make sure things are progressing normally, and it is important to give parents oral health education that can help children avoid dental problems in the future. The sooner children visit the dentist, the more comfortable they become as they get older. And if any cavities do form, we can catch them at an early stage when they are relatively easy to fix.

How can I get my kids to brush and floss?
Try to get them toothpaste that they like the flavor of. Also, brush and floss with them. When they see you doing it, they are more likely to do it. There is a product on the market that looks like floss on a stick, and it is much easier for kids to use than traditional floss. There are also cartoon character battery-operated toothbrushes that are fun to use and cost under ten dollars.

Flossing is fun for children with this Crayola™ floss stick from G-U-M,® available at Target and CVS. Package of 30, $3.00.
How should I get them to overcome their fear of the dentist?
Children do not have an innate fear of the dentist. The fear usually comes from the unknown, or sometimes from well-meaning parents who use scary words or have a fear themselves that the kids pick up on. Helpful tips for parents are to obtain books about visiting the dentist. There are also videos that show what goes on in the dental office. Parents should not use words like "drill," "shots," "pinches," "it only hurts a little," etcetera. Let the dentist explain what he or she is going to do to the child. We have a whole other language that is child-friendly so kids can understand what to expect. For example, I told one child that when she comes back to see us, that we were going to "wash the bugs out of her teeth with the water gun." Her mom looked at me and said, "That's all you're going to do; you don't use drills anymore?" I smiled at the mom and whispered in her ear, "We don't call them drills here!"

What's new in dental techniques or care?
The electric toothbrushes with the cartoon characters are new. We're trying to get the kids to understand what we are doing, and to get them to enjoy visiting the dentist. Seeing the kids when their first tooth erupts (appears) is a relatively new recommendation rather than waiting until they get older and their teeth have already started to decay. The term for this is finding the kids "a dental home."

Dentists get "drilled"
By Jonathan Cox | Photographed By Darl Bickel

We put some Richmond-area dentists in the examination chair to find out which brands of toothpaste they themselves use - after each meal, of course, and in addition to daily flossing and twice-yearly visits to their own dentists - to keep the 'pearly' in their pearly whites.

The variety of responses did not quite stretch from ear to ear, as area dentists appear to be consistent in their personal use of well-known brands. Yet as long as you're brushing, with one of these toothpastes or any other, you're sure to bring smiles to dentists' faces. Here's how the responses squeezed out:

Any food or beverage tips?
Children should never be put to bed with a bottle. Milk can destroy the teeth very quickly if a child is left with a bottle overnight. Sugary snacks, soda, candy should all be avoided. Kids who carry around a "sippy cup" all day with juice in it also tend to have a higher rate of cavities. Juice or milk should be drunk with a meal, and water should be for all other times.

There was a story in the news recently about a Washington-area boy who died because of an infected tooth. Explain the medical process that led to this tragedy.
It is definitely a problem that has been taken for granted. The Surgeon General recently identified tooth decay as the most common childhood disease in America. He labeled it "a silent epidemic." We need to educate parents on the importance of good oral health.

The boy who died because of an infected tooth is a tragic example of the seriousness of dental disease. Dying from an infected tooth is relatively rare today, but it can still happen if an infected tooth is not treated in a timely manner, as this case demonstrates.

That young boy died of a brain infection that started from an infected tooth. What happens is that first a tooth gets a cavity. Cavities do not usually hurt and therefore are often ignored. People think if nothing hurts, then nothing's wrong.

Make your child's first dental appointment right after his or her first tooth appears.
This is why it is important for people to see a dentist every six months, so dentists can check for cavities and fix them before they progress. If a cavity is not treated, it gets larger. Eventually the cavity will enter the nerve space. Most of the time this is when people report having a toothache.

Bacteria and debris infect the nerve space and eventually leak out of the ends of the tooth, the roots, into the bone. Now you have a tunnel for bacteria to travel from the mouth to the bone. The bone starts to dissolve away and most of the time you will see a "bubble" on the gums called an abscess. An abscess is a draining tooth infection. This kind of infection is not usually life-threatening. However, sometimes the bacterium does not travel out of the bone; it travels deeper into the tissues and this is when things get dangerous.

An infection from a top tooth can spread into the deep tissues of the head, traveling through spaces in the skull along vessels and right up into the brain. Many antibiotics cannot pass the blood-brain barrier and that is what makes it difficult to treat. An infection from a bottom tooth can travel to the neck and the swelling can actually close the throat, causing a person to suffocate to death. Or the infection can travel down to the heart.

If the young boy in Washington had had that tooth extracted before the infection spread, he would not have died from it.