Paediatric Dentists are dental child specialists who provide a comprehensive range of dental services from infancy to adolescence. Special needs children, anxious children and children with extensive treatment needs are referred to us.

Dr Tan Wee Kiat, Senior Consultant from the Department of Paediatric Dentistry, Dr Terry Teo and Dr Lai Wen Pui Bien​, Registrars from the Department of Restorative Dentistry, at National Dental Centre Singapore, give detailed answers to your questions.

Question by esim

I have difficulty in bringing my 6 year old boy to the neighbourhood dentist, he is always very scare of the cleaning tools sound and the dentist always have hard time in doing the cleaning. How can we coax/distract him? Are there special dental clinic which we can bring him to?

Answered by Dr Tan Wee Kiat Senior Consultant Paediatric Dentistry Unit Department of Restorative Dentistry National Dental Centre of Singapore

Children need to be trained on coping strategies to manage their anxiety. He could observe you undergoing the same procedure. He can wear headphones or play on his game boy while the treatment is going on.

Paediatric dentists are trained to manage anxious children, but bear in mind, repeated visits are needed to for desensitisation and behavioural modification.

Question by rsim

My young girl has gaps between front upper and lower teeth, I consulted the dentist what can be done to 'close' these gaps, was told braces is not the solution as it will not help to close the gaps and since the gaps space is minimal, it was suggested to leave it as it is. After eating, food always get stuck in-between her teeth gaps, are there any other treatment available?

Answered by Dr Tan Wee Kiat Senior Consultant Paediatric Dentistry Unit Department of Restorative Dentistry National Dental Centre of Singapore

This will depend on the age of the child, whether the gaps are in the permanent teeth or the milk teeth. If you need orthodontic opinion, then the best person is an orthodontist.

Question by rachel

At what age should we switch from children's toothpaste to adult/normal tootpaste for kids? Is there any difference besides the flavouring? Any long term harmful effects if children want to continue using the child toothpaste into their teenage years?

Thanks

Answered by Dr Tan Wee Kiat Senior Consultant Paediatric Dentistry Unit Department of Restorative Dentistry National Dental Centre (NDCS) Singapore

Current evidence show that children’s toothpaste contain too little fluoride to be effective in preventing decay. As a general rule, children should progress to a pea size amount of fluoride toothpaste the moment they can spit. Paediatric dentists balance the risk of fluoride ingestion vs cavity prevention in their toothpaste recommendation. You can choose to go to them if you want a customised preventive programme for your child

Question by elizabethlcs1988

Dear SDC, I got difficulties coaching my 15 mth plus boy to brush his teeth. He refuses to open his mouth whenever I wanna brush his teeth even though I put a mirror in front of him. He will scream and cry loudly whenever my mother-in-law and myself tried to force him to brush. I really dunno how to let him to have a gd brushing habit. Please advise. Thanks!

Answered by Dr Tan Wee Kiat Senior Consultant Paediatric Dentistry Unit Department of Restorative Dentistry National Dental Centre (NDCS) Singapore

Persevere in your attempts. Do not stress yourself out. Make it fun for your child. Brush together with him, reward him with stickers, have a brushing chart in the bathroom whereby he can stick it. Use your imagination! All this is good dental parenting, which can be fun if you know how.

Question by larkygal

Dear NDC specialist, I have several questions: 1)What are the fluoride limits for children? 2) When should we give fluorinated toothpastes for childen? 3) Also, is dental fluorosis reversible? 4) Lastly, how does xylitol help to promote good hygiene in children? Thanks for your time!

Answered by Dr Tan Wee Kiat Senior Consultant Paediatric Dentistry Unit Department of Restorative Dentistry National Dental Centre (NDCS)Singapore

The levels of fluoride we are exposed to in our water and food is within safe limits. Dental fluorosis is caused when children consume excessive fluoride over a long period of time, when their teeth are developing. It is not reversible but can be masked. In Singapore, we sometimes see the very mild type, which is not perceptible to the layman. Children should use a fluoridated toothpaste when they can spit.

Xylitol is a substitute sugar which has anti cavity properties by inhibiting oral bacteria. You may find more information on xylitol from this link

http://www.facebook.com/465398610158924/posts/512528928779225#!/notes/paediatric -dentistry-ndc/mom-asked-what-does-xylitol-in-baby-tooth-wipes-do/512528928779225

Question by soys

My son is now 10 years old. He has a missing front tooth and will need to put on braces eventually. When is the best time for him to have the braces on and what will be the cost involved? If he requires a dental implant, when can it be done?

Answered by Dr Tan Wee Kiat Senior Consultant Paediatric Dentistry Unit Department of Restorative Dentistry National Dental Centre (NDCS)Singapore

I take it from your question you have already sought dental consultation somewhere. If not, you should consider bringing him to an orthodontist. Braces are usually put on when all the permanent teeth have erupted. Implants are usually done after the age of 18 years.

Question by mosmos

How often to get a dental checkup for a child below 3 year old?

Answered by Dr Tan Wee Kiat Senior Consultant Paediatric Dentistry Unit Department of Restorative Dentistry National Dental Centre (NDCS)Singapore

The first dental visit for your child should be at age 1 year, or shortly after the eruption of the first baby tooth.

Thereafter, the dentist will recommend a schedule of review visits based on caries risk and current condition of the mouth. This can vary between 4mo or 6mo.

http://www.ndc.com.sg/ForPatientsAndVisitors/ConditionsAndTreatments/Glossary /Pages/PaediatricDentistry-YourChild'sFirstVisittotheDentist.aspx

Question by octane

Which type of toothbrush is better for young children, manual or electric?

Answered by Dr Tan Wee Kiat Senior Consultant Paediatric Dentistry Unit Department of Restorative Dentistry National Dental Centre (NDCS)Singapore

Both are equally effective if used correctly. Both need to be supervised in young children. But that is not all, you should also floss for your child at least once a day.

Question by lawrencelim77

Hi My girl is turning 5 this year. She does not like to brush her teeth. 1) Any advice as to how to coax/persuade her? 2) From what age onwards should a child start brushing his/her teeth? And if it hurts eg they find the bristles too sharp, is it safe to delay starting the brushing regime? Then again able to delay till what age? 3) Around what age will the "child's teeth" or "milk teeth" fall off and be replaced by adolescent/adult teeth? Since there will be such replacement, does it mean that its ok for them to hurt their existing milk teeth eg fell down, knock and broke a tooth, since such teeth will eventually be replaced? Thank & Regards Lawrence Lim

Answered by Dr Tan Wee Kiat Senior Consultant Paediatric Dentistry Unit Department of Restorative Dentistry National Dental Centre (NDCS)Singapore

You should brush the child’s teeth the moment the first tooth erupts. 

Milk teeth are replaced gradually from the age of 6 – 12 yrs. We do not usually replace milk teeth ( like a denture in the case of adults) however, we may consider holding the space for the adult tooth, in selected cases.

Question by niqiy

My daughter just reached 3 years old and I would very much like to bring her to her first dentist visit. However considering that I have so much difficulty getting her to open her mouth to brush her teeth. I wonder how would paediatric dentists deal with such difficult cases. Need to drug her?

Answered by Dr Tan Wee Kiat Senior Consultant Paediatric Dentistry Unit Department of Restorative Dentistry National Dental Centre (NDCS)Singapore

Much as drugs are tempting, we only use this as a last resort, especially if it is just to examine the child. Most children will behave quite well provided they have not been pre-conditioned by adults to think of the dentist as a bogeyman.

Dental parenting i.e. guiding your child, being a good dental role model is an essential skill that many parents lack. You can start by priming your child for her visit eg reading stories of a visit to the dentist. There are many good books in the market on this. You can role play, patient/dentist and examine each other then you are truly on the road to being a good dental parent. Good Luck!

Question by krex78

Hi, my 4.5 yr old son recently went for his first dental visit and was found with a cavity in his tooth. The dentist said to cut down on sweet foods. While I'm aware that his grandparents have been feedhing him sweet snacks, e.g. chocolate, jelly, gummies, etc., I'm not able to limit or restrict his intake as I'm at work. Is there anything I can do to mitigate, e.g. train him to rinse his mouth after snacks? He's resistant to brushing his teeth in the day, and we can only do so for him at night. Tks.

Answered by Dr Tan Wee Kiat Senior Consultant Paediatric Dentistry Unit Department of Restorative Dentistry National Dental Centre (NDCS)Singapore

All this spells bad news for your son unless you take charge. Educate grandpa/ma. Snacks can be give once a day, maybe a jelly after dinner, but not throughout the day. Gummies and chocolate which stick to the teeth are cavity inducing, replace with low fat yogurt, sugar free candy, or cheese.

Rinsing does not prevent decay. There is no way around this. Reduce snacking, brush 2x a day with a fluoride toothpaste and regular dental visits is still the advice that holds true.

Question by elgasg66

My son aged 7 had a beautiful set of milk teeth. All the teeth are well aligned. However, as the milk teeth was replaced by the permanet teeth, noticed that some misalignment between the new teeth (lower set) & the 1 of the front teeth on the upper jaw is protruding out. Anything we could do on this? Also he has been grinding his teeth a lot during the night. Has this got anything to do with it? How do we reduce this grinding of teeth at night. Please advise. Thanks

Answered by Dr Terry Teo Registrar Paediatric Dentistry Clinical- Restorative Dentistry National Dental Centre Singapore

Very often, parents wonder why their children who had well-aligned baby teeth are now suffering from crooked permanent teeth. This is because "unsightly" spacing between the baby teeth actually provides more room for the permanent teeth to erupt properly. If your child's baby teeth had little space between them, that straight and neat appearance could actually have meant that the larger, wider permanent teeth now have less space to erupt properly, and hence appear crooked. This is a sign of impending crowding requiring braces later on. At 7, your son should already be in the school dental system and they will monitor him and refer him when ready.

Night grinding is caused by many factors, and much research is still being done to better understand the condition. Your child may or may not outgrow this habit, but generally treatment is undertaken when all permanent teeth are erupted. If your child is having headaches, jaw aches and poor concentration associated with this, a dental assessment at this stage would be beneficial as well.

Question by dr.candice.chan

Dear Doctor, I have a girl who has just turned 1 year old, and ever since she was born I have been religiously cleaning her mouth first with a towel, then an infant toothbrush with fluroide-free toothpaste after first teeth started to emerge. Fortunately, she loves her tooth brush would even attempt to do it by herself first before letting us help her. Currently she has 4 front teeth. Just a general question - when will it be appropriate for me to bring my child for her first dental check up? I am not sure if my child will be cooperative with the examination. Thank you very much.

Answered by Dr Terry Teo Registrar Paediatric Dentistry Clinical- Restorative Dentistry National Dental Centre Singapore

Well done for your diligence in caring for your daughter’s oral health! The American Academy of Paediatric Dentistry recommends that the first dental visit for your child be at age 1 year, or shortly after the eruption of the first baby tooth.

Now that your daughter has her 4 front teeth, it would be a perfect time to bring her for a check-up. Paediatric dentists specialise in examining and treating children from as young as birth, and there are various techniques and ways we employ to ensure a safe, thorough and fun examination for your child.

Question by cynlee2206

My 5 yo preschooler brushes her teeth 3 times a day. Is it necessary to bring her for a dental checkup at this age? Am concerned as she has classmates whose teeth have fallen off due to decay!

Answered by Dr Terry Teo Registrar Paediatric Dentistry Clinical- Restorative Dentistry National Dental Centre Singapore

According to latest recommendation, you are 4 years late in bringing your child for a check-up! But, better late than never. Besides good oral hygiene, other factors such as diet also have a crucial role in determining a child’s risk for developing tooth decay.

Thus, children who brush regularly may not necessarily be free from decay. This is especially so if they still fall asleep with a milk bottle or eat a lot of sweets. Please bring your daughter for a dental check-up. Do not wait for pain to occur before doing so.

Questions by chingmun

Dear Dr Tan,

My 2 year old daughter's teeth is such that the upper set is inside while the lower set is outside. I read somewhere that it's a Class III or Underbite condition. It's quite severe as what we can see is that she is not able to bite things off using her front teeth.

I would like to ask if we need to bring her to see a Paediatric Dentist soon, or wait till she's older? How do we kickstart the process for her? I don't want her to miss any opportunity in her growing-up years to adjust back the jaw/teeth.

In addition, I would think that this will be a long-drawn process. Is there any subsidized dental care for kids like her?

Thank you.

Answered by Dr Terry Teo Registrar Paediatric Dentistry Clinical- Restorative Dentistry National Dental Centre Singapore

It sounds like you are very concerned with how your daughter’s jaws are developing. At 2 years old, it is still too early to come to any conclusive diagnosis on what the pattern of her growth will be like in the future.

However, we can obtain some clues such as finding out about habits which may affect jaw development (ie thumb-sucking), and by examining the teeth and jaws of other members of the family. You are thus right to say that early examination and monitoring is the key to future planning and treatment success. She would benefit from a check-up now, with a thorough orthodontic assessment when she is older.

Question by changmaylian

Dear Doctor Tan,

I am rather perturbed that my 17 month old baby girl has only 3 teeth to date; 2 lower central incisors and 1 upper central incisor. She is on solids but her milk intake is poor. She does not take to milk (we failed to wean her from breastmilk to formula milk and we have tried all brands, including goat and soy milk). On average she consumes only 300ml of milk a day; far below an average toddler's intake. We have tried all means to introduce milk but all attempts failed. On advice of our PD, we have introduced cheese since she was 8 months old. She is my second child; and my first child's teeth came in on schedule. Should we be overly alarm? Please help.

Thank you very much.

Yours sincerely,
Maria

Answered by Dr Terry Teo Registrar Paediatric Dentistry Clinical- Restorative Dentistry National Dental Centre Singapore

Delayed eruption of primary teeth is common in infants, with large variations in eruption timings even among siblings. Generally, the first lower teeth erupt at about 6 months, but it is not rare for this to be delayed up to 18 months. It sounds like her teeth are now just erupting, thus we expect all her primary teeth to be out by 3 years of age. At 17months, milk (whether breast or formula ) alone cannot give all the nutritional requirements for growth. Hence the need to progress to a balanced diet of solid food. Having done so, a child may require less milk, or milk in other forms eg yoghurt, cheese.

Your PD is the best person to advise you on the dietary aspect of this. However, on-demand breast-feeding at 18 months places your daughter at high risk of dental decay, since her first teeth are already present. To prevent this, only give the milk to her at fixed timings through a sippy cup, and brush her teeth before bed-time after her last feed. Do not let her suckle through the night.

Question by wpchua

my daughter 7 sevens old, her bottom 2 front teeth had dropped and these two adult teeth had grown not straight, in an inverted 'V' shaped, should any correction be done now?

Answered by Dr. Lai Wen Pui, Bien Registrar Clinical-Restorative Dentistry Paediatric Dentistry National Dental Centre Singapore

Before the adult permanent teeth erupt, they present as tooth germs inside the jaw. The position of these tooth germs determines the position of the newly grown teeth. While the teeth may appear “crooked” at first, they may be slowly “moved” into position by the lower lip and the tongue as the teeth erupt more. This stage is transitional, and is commonly known as the “ugly duckling stage”.

Depending on the availability of space, the teeth may end up being well-aligned if there is enough space, and may end up “crooked” if the space is insufficient. No correction of alignment is usually needed at this stage.

An orthodontic consultation in the future may be advised if crowding persists or if there is a “bite” problem.

Question by snehal

Dear Doctor Tan,

Hi, My 2 yrs old kid din't allow us to brush his teeth neither he like to do it himself and after many trial if he get ready also sometimes(a day or two in a week)he refuse to do it with toothpaste,just want the brush plain. will this habit harms his tooth from now itself and if it continues whether this can effect his later coming permanent teeths also.please guide me what to do. Thanks

Answered by Dr. Lai Wen Pui, Bien Registrar Clinical-Restorative Dentistry Paediatric Dentistry National Dental Centre Singapore

Good job for the toothbrushing attempts! Toothbrushing is a learned habit. It is difficult for young children because they have not yet established the routine and rationale of toothbrushing.

That is why, as parents, you need to help them cultivate this lifelong habit. Make toothbrushing a daily fun activity for the whole family. Set specific timings for toothbrushing. Give rewards. Keep trying! Take charge and establish a routine for your child. Persevere in your attempts! If you give up, you will have to train your child all over again the next time.

Question by christopher_lim

Hi, My 5-yr old daughter is having a permanent teeth coming in behind the baby teeth, central incisor. The permanent teeth just coming out and the baby tooth is slightly loose. Should we bring her to a dentist to have the baby tooth extracted? Thanks for your kind advice! ..thanks Christopher L.

Answered by Dr. Lai Wen Pui, Bien Registrar Clinical-Restorative Dentistry Paediatric Dentistry National Dental Centre Singapore

For most of the time, baby teeth will shed without problem and extraction is not needed. Only a small number of cases require intervention to prevent malposition of the permanent teeth.

Ref: S13