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Duke Oral Health

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Dental Care Tips


What is a pediatric dentist?

“Pediatric dentists are the pediatricians of dentistry,” according to the American Academy of Pediatric Dentistry (AAPD). Pediatric dentists complete 2-3 years of specialty training following dental school in order to focus on providing primary and specialty care for your children.

Dr. Keels has developed an office that is designed to fit your children’s needs from infancy through adolescence – including those children with special medical needs. More information from the

 AAPD: The Pediatric Dentist


What is preventive dentistry?

Preventive dentistry encompasses the proper practice of brushing and flossing, as well as the monitoring of fluoride levels, oral habits, and diet. With the cooperation of parent involvement and the use of needed sealants, orthodontics, and proper sports safety, your child will have a bright and healthy smile! For more information on specific dental procedures, please see our Common Dental Procedures below.


Why is preventive dentistry important?

Having a healthy smile is more attractive, which lends to building positive self-esteem in your child! However, having a healthy smile goes beyond the aesthetic. Children with healthy mouths are able to chew foods more easily and may be able to learn to speak more quickly and clearly. Also, by remaining disease-free in the mouth, children may increase their chances of better general health.


Here are some helpful topics in children’s dental care:

  • Dental Care for Your Baby/Toddler

    When should your baby first see the dentist?

    When your baby’s first tooth comes in is the ideal time to make your first trip to the dentist. The first tooth usually comes in around 6 months to 12 months of age. This visit is encouraged because children can develop decay very rapidly due to improper bottlefeeding and other factors. The earlier the dental visit, the earlier your child can start developing good dental habits.


    When should I first clean my baby’s teeth?

    The AAPD recommends starting from birth! Use a soft-bristled infant toothbrush and water on your baby’s gums. Even after small children develop teeth, they may not have the proper coordination to brush effectively. So, you may need to “take turns” with your child at brushing time – letting him/her brush and then finishing up yourself to cover all areas.


    The importance of your child’s baby teeth

    Your child’s baby teeth will eventually fall out and be replaced with permanent teeth; thus, it may not seem very important to take proper care of them. However, baby teeth set a path for permanent teeth to follow. By keeping baby teeth healthy and in place until they are naturally lost, they help save space in the mouth for the permanent teeth.


    This may help prevent permanent teeth from coming in crooked and the need for orthodontic appliances. Also, by keeping proper place in the mouth, baby teeth are involved in proper speech development and also allow your baby to chew appropriately! Finally, improper care of baby teeth may lead to bad habits that will continue to create problems in your child’s permanent teeth.


    Special Topics:


    Thumb, finger, or pacifier sucking


    Should I worry if my child sucks his/her thumb, finger, or pacifier?

    Thumb, finger, or pacifier sucking is completely normal for babies! Most children stop sucking by themselves around two to four years of age. However, if your child continues to suck on his/her thumb, finger, or other object for longer, there may be developmental delays in his/her upper front teeth. Also, prolonged sucking can lead to improper development of your child’s upper jaw, leading to further dental problems in the future.


    What can I do to stop a sucking habit?

    Dr. Keels will carefully monitor your child’s teeth development and sucking habits to identify potential problems. While most children will stop sucking habits by themselves, some children may need the help of their parents and the pediatric dentist. Our staff recommends positive, gentle reinforcement from the parent to help the child stop a sucking habit by his or herself. In the rare case that your child does not seem likely to give up a sucking habit, we can offer an orthodontic appliance that may be used to eventually curb this habit.


    Breast and Bottlefeeding


    There are many confusing guidelines of the benefits and disadvantages of breastfeeding and when to start and stop breastfeeding and formula-feeding.


    At our office, the dentists recommend that you breastfeed your child as long as you feel is necessary and comfortable. As your child sees Dr. Keels will regulate routine dental cleanings based on your child’s needs. Depending on your feeding schedule, you may need to increase the frequency of cleanings until your child grows older.

  • Dental Care for Teens

    Early and late adolescence is a time of development and challenge in a child’s life. During this time, children may begin to establish behaviors that set a pattern for the rest of their life in many areas, including nutrition and oral health. Below are a few tips compiled from both the AAPD and AAP regarding your teen’s healthy choices.


    Diet and Snacking

    With various extracurricular activities, teens may often be grabbing a bite to eat on their way from school to practice, tutoring, or another activity. Often the most convenient options – fast food and sodas – are the least healthy. Special attention to these pitfalls as well as an overconsumption of starches and sugars may be needed. Sugars can be found in most processed foods – even many that don’t seem sweet!


    Mouth Guards

    For many contact sports, such as football or soccer, your child’s coach may require the team to own their own mouth guards. Dr. Keels offers mouth guards that are made of soft plastic that fit around your child’s upper teeth.


    Teeth Grinding or Bruxism

    Many children exhibit signs of bruxism, or teeth grinding – which results in mild to severe wear of front and back teeth. While this is very common in young children with baby teeth, the habit usually stops after the eruption of all the permanent teeth around 12 years of age. If the habit continues, your child may develop tooth sensitivity in severe cases. Dr. Keels will monitor your child’s occlusal wear and may recommend a mouth guard at night if needed.



    Dr. Keels will check the progress of your child’s bite and jaw development with routine dental examinations. Often an early treatment assessment of your child’s teeth may prevent extensive orthodontic work in his/her future.


    There are often four signs that your child may need some orthodontic help in creating a healthy bite:


    Underbite – when your child’s lower jaw sticks out; in certain cases, with early intervention your child may be able to avoid jaw surgery to correct the misplacement of their jaws.


    Crossbite – when your child’s upper teeth and bottom teeth don’t seem to fit evenly when they bite. If you see this sign, you should see Dr. Keels to evaluate the necessity of an appliance that would correct this bite.


    Protrusive upper teeth – if your child seems to have large or protrusive front teeth, this may lead to potential hazards on the playground because these teeth are more prone to accidents. The use of partial braces and possible headgear may correct this problem.


    Crowding of teeth or a double row of teeth – initially, the removal of teeth may be necessary to create room in your child’s jaw.

  • Preventing Cavities



    Dr. Keels will recommend the use of special 3-headed toothbrushes or an electric toothbrush for special needs children. These special toothbrushes make it easier for your child to brush specifically tooth-to-tooth to further prevent cavities from forming.



    Dr. Keels recommends that children floss their baby teeth at least once a week. You only need to floss between baby teeth that touch, as saliva flow should prevent the accumulation of plaque between the gaps in your child’s teeth. Note that if you do not see any spaces in your child’s mouth, this may be a greater risk of cavities.

  • Common Dental Procedures

    Routine Dental Cleanings


    What happens during a routine dental checkup?

    During a dental visit, the dental assistant or hygienist will first review your child’s medical history with you. This is to ensure that Dr. Keels and our staff are updated on the general health of your child so that we may review any factors that may concern your child’s dental health. Then your child’s mouth will be examined for overall oral health and then his/her teeth will be cleaned to remove plaque, which can lead to cavities and gum disease. After the cleaning, fluoride will be applied to the teeth to help protect and strengthen the weak areas against decay.


    How often should my child get her teeth cleaned?

    For a healthy child, the AAPD recommends a visit to the pediatric dentist at least every six months to evaluate his/her oral health and development. However, if your child has certain special needs or is more predisposed to dental caries, the dentist may recommend more frequent visits so that no problems will be left untreated for too long.




    What does fluoride do?

    Cavities form when there is a weakening in the mineral composition of the enamel of your teeth. Fluoride promotes the remineralization of these weak spots, therefore helping prevent cavities.


    Where can I find fluoride?

    Fluoride occurs naturally in water. While city water is fluoridated to a specific standard level, well water may have varying levels of fluoride. Therefore, Dr. Keels may have your well water tested to see the level of fluoride present. Fluoride can also be found in many dental products such as toothpaste, mouth rinses, gels, foams, special bottled water, and other supplements.


    How do I know how much fluoride my child needs? Are there disadvantages to having too much fluoride?

    Our doctors will monitor the development of your child’s teeth in order to prescribe the specific amount of fluoride that your child may need. In general, there is an acute balance between too little and too much fluoride. Fluoride is like sodium in the body, because too much is not good for you and too little is not good for you. Too little fluoride leaves your child’s teeth vulnerable to decay; while too much fluoride may damage developing teeth in your child leading to fluorosis. Fluorosis affects developing teeth by causing white spots to form on permanent teeth.


    Tooth Decay


    What are cavities?

    Tooth decay is a progressive disease that can start as soon as your child’s teeth come in! Bacteria that normally live in the mouth react with sugars from foods and drinks to create acid that slowly eats away at the enamel of your child’s teeth and can also damage sensitive gum tissue. With the loss of enamel, weak points in the teeth form. These weak areas become cavities– which left alone can lead to nerve damage or the necessary early extraction of your child’s tooth.


    What can be done about cavities?

    As soon as a cavity is identified, your pediatric dentist can repair the tooth using tooth-colored fillings. If the cavity is too deep, a stainless steel crown or extraction of the tooth may be needed. Effective brushing and flossing, the proper use of fluoride, and a balanced diet can help minimize the amount of decay to help your child have a happy, cavity-free smile!




    Why does my child need x-rays?

    The AAPD recommends x-ray examinations every six months for children with a high risk of cavities. Often x-rays can show weaknesses in the tooth structure (such as demineralization) that may not be visible with the naked eye. Children need x-rays more often than adults to stay current with developments in their teeth, since children grow and develop at a much more rapid rate.




    What are sealants?

    The naturally occurring pits and grooves on the chewing surfaces of teeth can often collect plaque. These grooves may be smaller than the width of a toothbrush bristle! While being so small, these cracks provide ample room for bacteria to grow rampant and are common areas for cavities to form. Sealants are applied to these surfaces to help prevent tooth decay.


    How long do sealants last?

    On average, sealants last for three years with the proper maintenance. At every dental check-up, the dentist will check that the sealants are intact. In order to prolong the life of your child’s sealants, avoid crunching and chewing on ice and hard candy (i.e. Jolly Ranchers, Lifesavers, etc.) or any similar foods.


    Tooth-colored fillings


    What are tooth colored fillings?

    Tooth-colored fillings are matched to the tint of your child’s natural white in front or back teeth where cosmetics are important. Fillings are used to repair decay and areas of fracture in the teeth.


    Stainless Steel Crowns


    What are stainless steel crowns and when are they used?

    In the case that decay has been left untreated, teeth may have extensive damage to the enamel as well as to the nerve. In such cases, tooth-colored fillings are not a viable option, and stainless steel crowns are fitted onto the baby teeth to prevent further damage until these teeth are naturally lost. It is recommended to avoid sticky candies (i.e. Skittles, Starburst, Gummies, etc.) as repeated chewing on these candies may loosen the cement that holds the crown on the tooth.


    What are the different types of stainless steel crowns?

    There are two different crowns: all silver crowns and crowns with a white veneer. The crowns with the white veneer are used in the front teeth where esthetics may be important. The white veneer is delicate and fragile, and may fracture easily. Therefore, chewing on toys and hard candy should be avoided to prevent chipping of the white veneer. The all silver crowns are used on the back molars.




    What is a pulpotomy and why would my child need one?

    Many caries may be so deep that they extend to the nerve, so the infected part of the nerve must be removed. The remaining healthy nerve will be left intact and medicated. The purpose of the pulpotomy is to extend the life of the baby tooth to avoid extraction of the tooth and a space maintainer until the eruption of the permanent tooth.




    When do teeth need to be extracted?

    Primary teeth are essential in maintaining the correct spacing in your child’s jaw for the permanent teeth. Therefore, extractions are done only as a last resort in the case of tooth decay. In other cases, extractions may be necessary in orthodontic care to help in the correction of crooked teeth.


    Space Maintainer


    What is a space maintainer?

    After a tooth is extracted, a space maintainer is used to help prevent teeth from either side of the extracted tooth from drifting into the space and causing a crooked smile. The space maintainer will be removed from your child’s mouth once his/her permanent tooth replacing the extracted tooth comes in.

  • Emergencies