Thursday, June 20, 2013

Age When Children Should See a Dentist

There is much variability in the recommended age of when children should start visiting a dentist. There are many experts offering their opinions on this subject. Some of these experts are dentists, physicians, children's psychologist, early childhood experts and more. Their expert opinions range from newborn to the age of four. That's quite a range!

There are three main variables to consider.
  • Child Variability
  • Parent Variability
  • Dentist Variability
Teeth eruption times vary with each child. The first teeth may start to come in at 6-10 months of age. There is much variability in maturity levels as well. The more mature a child is, the easier the dental visit will be. Another consideration is the child's anxiety level. When the child isn't fearful, the appointments tend to be pleasant for them. This certainly isn't the case for the extremely fearful child.

Child with extreme apprehension of dentistry
Child with a positive dental attitude

The parents play a major role in shaping the child's first dental visit. If the parent has a positive view of dentistry, then the child will also more often than not have a positive experience. If the parent is highly dental phobic, then the parent will inadvertently transfer their fears onto their children. This can occur without the parent even uttering a word to their child. Children are highly intuitive. They can sense the emotions of others by mere observation.

The age at which my fellow dentists start seeing children varies greatly as well. We all have slightly different philosophies as to when we start seeing children in our offices. For me, age is not really that important. What is important for me is the child's level of cooperation. If they aren't fearful, then it's never a problem. When they are fearful, it makes it rather difficult to assess and treat any problems they may have. The single most important factor in my opinion is the parent's feelings about dentistry in general.

The sooner a child starts visiting a dentist, the better. If we can see them for a routine exam on their first visit, it makes future visits much simpler. If however the first visit is an emergency visit, it will almost certainly be a stressful event for the child and will therefore set them up to be dental phobic for their entire lives. Another reason why you should get them in sooner than later is that any potential treatment will be less expensive, less extensive and more predictable.

The American Academy of Pediatric Dentistry recommends that a child make their first visit when the first tooth comes in. Usually around six months of age. The bottom line is to get them in as soon as you can--preferably by their first birthday.

Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit

Thursday, June 13, 2013

Teeth Eruption Timeline


Mothers (and sometimes fathers) ask me frequently when their children's teeth should come in. Here is a chart that shows when certain teeth are expected to erupt and shed. These are only averages. Your child may be a little ahead or behind schedule. The chart (compliments of the American Dental Association) is rather straightforward and easy to read.

Primary Teeth Eruption Chart

Permanent Teeth Eruption Chart

Permanent Teeth Eruption Chart
If you notice that your child is lagging too far behind, have your dentist take a look to see why that may be the case.

Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit

Wednesday, June 5, 2013

Deep Cleaning VS Regular Cleaning

I've read a bit recently online about dental cleanings. Many people are angry with their dentists. Many believe that their dentists are trying to scam their patients into getting unnecessary services. Many are angry that some insurance companies don't pay for deep cleanings. Seeing many of these comments prompted me to write about the differences between routine cleanings and deeper cleanings.


Take a look at the chart above.

You'll notice a progression of severity as we move from left to right. The top row demonstrates deeper gum pockets (measured with a probe in millimeters). When these pockets exceed 3 mm, it becomes increasingly difficult to access the deeper areas with a toothbrush and floss. In advanced cases, the probing depths can be 10 or more millimeters. When this occurs, even if the tooth itself is healthy, it will still be lost since there are inadequate amounts of bone to anchor the tooth in place.

The second row demonstrates the visible condition of the mouth. As you can see, a healthy mouth is exemplified by gums that are pink (as opposed to red or even purple). In addition, the gums do not bleed readily and are not tender. On the other hand, unhealthy gums will bleed readily and are very tender. When gums are chronically irritated, a loss of the gums and bone progresses much more rapidly as the disease process worsens.

The radiographs (X-rays) in the third row demonstrates what happens to the bone as the progression of periodontitis advances.

When a patient comes in for a "cleaning", either a routine cleaning or a deeper cleaning is indicated.

Routine Cleaning

In many cases we can get away with a simple cleaning. When we have a situation where the teeth are not severely stained, do not have deep pocketing and do not have subgingival (below the gumline) calculus (tartar), then a simple routine cleaning is all that is required. In these cases, the cleaning is for the most part above the gumline.

Deep Cleaning

When we run into a mouth that has bone loss, deep pockets and tartar that goes below the gumline, then cleaning well below the gumline is indicated to prevent the progression of periodontitis and potential tooth loss.

If we simply clean above the gumline with a "routine cleaning", two potential problems arise. One is that the causative factors of periodontitis are not removed and the patient's condition will worsen. A second less commonly known issue is the development of a periodontal abscess. This occurs because the gums at the neck of the teeth may heal and close off the pocketing. The pocket is still there, but now we don't have access to the deeper areas. The bacterial flora changes from primarily aerobic bacteria to anaerobic. These bacteria are much more pathogenic (disease causing) and so instead of actually helping the patient, we actually make things much worse for our patient.


So, in essence, when a routine cleaning is performed in a mouth that requires a deep cleaning, we are actually creating bigger problems. If you doubt the recommendations of your dentist, it's okay to get a second opinion.

Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit