I’m a pediatric dentist. Here’s what I want parents to know about dental care during COVID-19.

By Dr. Richard Mungo, chair of pediatric dentistry at CHOC

At CHOC, we know you want to give your child the very best care every day, especially during these uncertain times.

Kids are kids, even during a pandemic. They may trip playing hopscotch and crack a tooth or cause harm to the soft tissues of the mouth, have a toothache that prevents them from eating, or develop a dental abscess.

Oral health is a vital component of overall health. Proper oral health ensures one’s ability to eat and maintain proper nutrition – essential to a growing child’s overall health and development.

Many families feel anxious about seeking dental care during a pandemic. But not taking care of emergency dental issues can cause a moderate problem to develop into something much more serious, if it’s not corrected in a safe and timely manner. Here’s a guide on what qualifies as a dental emergency, and how your dental office may look different during this time.

Is it safe to go to the dentist during COVID-19?

The majority of dental practices are open for emergency care during this time. Practices will make every effort to ensure the dental visit is safe and comfortable for the patient, parent and staff present.

Dental offices in California follow safety and infection prevention guidelines from the Centers for Disease Control, California Dental Board, the California Division of Occupational Safety and Health (Cal/OSHA) and the U.S. Food & Drug Administration. During the COVID-19 pandemic, practices have been given additional recommendations from the California Department of Public Health.

If you need to make an emergency trip to the dentist during COVID-19, you will likely notice some differences from your last standard cleaning, including:

Scheduling changes

Necessary appointments are booked in a more limited manner, to ensure office staff have sufficient time to thoroughly clean and disinfect treatment areas between each patient. Therefore, the number of available appointments will be lower per day than in the past.

No crowds in the reception room

Patients should call the office when they arrive to the parking lot and stay in their car until a staff member comes to escort them into the office. The toys and books that usually populate the reception area of a child-friendly office will also have been removed for the time being. Once you are in the office, you will be taken to the treatment area immediately, which has been thoroughly cleaned and disinfected.

Fewer people in the office

Only one parent or guardian may accompany a child to the appointment, unless more are needed to assist a child with special needs.

Health screening

A staff member should take your temperature and ask several screening questions related to recent illness before you enter the office. If you have a recent history of COVID-19 exposure you may not be allowed in the office.

More masks

Masks should be worn by dental office staff at all times. Dentists, dental assistants and receptionists will be wearing personal protective equipment, also known as PPE, which may also include gowns or jackets, plus face shields, hair coverings and eye protection. Parents or guardians accompanying a child to an emergency appointment must also wear a mask.

Strong suction

Strong suction will be used to keep aerosolization particles as minimized as possible.

What qualifies as a dental emergency?

There are a number of potential dental problems that qualify as an emergency. Parents should be mindful of pain; infection; trauma; broken teeth, braces, retainers or fillings causing pain; or anything else in the mouth so difficult that it prevents eating or sleeping.

Children may have trouble verbalizing their dental pain or even pointing to a specific area that hurts or feels uncomfortable. It can be difficult for parents to see in a little mouth without good lighting, which can be a challenge in identifying the source of the pain. In these cases, contact your child’s dentist and ask for the possibility of a telehealth visit. This can help determine if your child should come into the office for care, or if the problem can be solved with a pain reliever, antibiotic or change in diet.

Other forms of dental emergencies affect children with medical complications or treatment, such as undergoing chemotherapy, radiation therapy or bone marrow transplantation. In these cases, they cannot have any form of infection present in their body in order to continue those treatments. Cavities are bacterial infections, and other oral soft tissue infections can also challenge the safety and success of cancer therapy. Children with co-occurring conditions may experience worsened medical conditions due to oral infections or difficulties.

There are other time-sensitive cases, including infants born with craniofacial abnormalities such as cleft lip and palate that require pre-operative dental care before their first plastic surgery.

Catching up on cleanings

Biannual dental visits are extremely important with children, who are growing and developing rapidly. With teeth coming in and falling out, it’s important to monitor their dental health regularly and keep an eye on cavities.

Pediatric dental offices perform a caries risk assessment, which consists of a questionnaire, examination and plan assigned to each patient. It identifies those who are at high risk and those who are at low risk for dental disease such as cavities and soft tissue problems.

If your child has had healthy check-ups and is a low risk for any dental problems, one missed dental checkup is probably OK. Once dental offices open up more broadly, schedule your child’s missed cleaning as soon as possible.

If your child is at high risk for dental problems, then some form of communication with their dentist should take place around the six-month interval. That could come in the form of a discussion between a parent or guardian with the dentist or clinical dental assistant over the phone. You can share photos with your child’s provider of any changes or areas of concern, or they could ask that you come into the office to address any concerns.

Practicing good oral hygiene at home

With stay-at-home orders in effect, many of us are spending more time at home than ever before. Sometimes, subtle changes in our diet take place that we are not necessarily aware of, and they can impact our dental health. If we’re snacking more and preparing more comfort foods, we should be mindful of sugar intake, and how that and sticky foods can harm our teeth and gums. Remind your children to practice proper teeth brushing. Here’s some tips and tricks for getting kids to brush their teeth.

When in doubt, call your dentist

Parents or guardians should feel comfortable seeking advice from their pediatric dentist’s office to determine whether or not their child needs immediate attention, or if can things safely be delayed until after the COVID-19 pandemic.

If your child’s dental condition is an emergency, call your dentist as soon as possible. Pediatric dental experts are also on call 24/7 at the Julia and George Argyros Emergency Department at CHOC Hospital.Now

How to Get Kids to Brush Their Teeth

February is Children’s Dental Health Month, and we are brushing up on tips for healthy teeth, and examining the causes of halitosis, or bad breath.

What is halitosis and how can you avoid it?

Some bacteria in the mouth are odor-producing, which can lead to halitosis (bad breath.) If you don’t floss and brush regularly, these bacteria can build up. Mouthwash is a temporary fix, but if you do choose to use one, opt for an antiseptic one, which kills the germs that cause bad breath. A plaque-reducing mouth wash should have a seal of approval from the American Dental Association. For small children use an alcohol-free mouthwash. Your dentist can provide specific recommendations.

What is the cause of bad breath if you are brushing twice per day? There can be many reasons, but you may not be brushing long enough, says Dr. Richard Mungo, chair of pediatric dentistry at CHOC. Each brushing should last for two minutes, but the average person only brushes for about 45 seconds, Mungo says. Try setting a timer for the full amount of time or using one of the many Apps that are available on the internet to help children brush longer and have fun. Using electric toothbrushes are another way to ensure a proper brushing, he says. Electric brushes can be more efficient and many are programmed to stay on for the required two minutes, assuring a good brushing of all surfaces.

how to get kids to brush their teeth
Dr. Richard Mungo, chair of pediatric dentistry at CHOC

If bad breath persists despite proper brushings and flossing and regular trips to the pediatric dentist, your child may have post nasal drip or other sinus problems, contributing to the halitosis. If there are cavities present or inflamed gums, these difficulties must be attended to. Consult your pediatric dentist or pediatrician who can determine if something else is causing the bad breath.

How to get kids to brush their teeth:

It can be tricky to get kids to brush and floss regularly, but building healthy oral hygiene habits early in life is important. Dr. Mungo offers tips to getting little ones on board with brushing and flossing:

  • Play your child’s favorite song while they are brushing to get them used to brushing for the full two minutes.
  • Be a good example. If your children see you brushing and flossing regularly, they are more likely to model your behavior.
  • Let children choose their own toothbrush and toothpaste, from choices recommended by your dentist.
  • Create a positive attitude towards going to the dentist. Your child’s first visit should be at age one, or when the first tooth erupts into the mouth. That first early visit will introduce you to proper oral health care, emergency services that are available and proper dietary concerns for your children. Children can often pick up on parents’ anxiety, so be a good actor when present with the child, so they can be comfortable and confident that going to the dentist is fun.

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Developing Healthy Dental Habits in Children with Special Needs

Helping your child develop a dental hygiene routine can be complicated if other medical conditions are present. Dental care is the most common unmet need among children with special needs, according to the American Academy of Pediatrics. In honor of Children’s Dental Health Month, Richard Mungo, D.D.S., a pediatric dentist and chair of pediatric dentistry at CHOC, offers tips on dental health to parents of children with special needs.

Mungo, Richard

“The most important thing for parents to remember is that dental health is an essential part of their child’s overall health,” Mungo says. “It’s not something extra. It’s an essential part of their overall wellbeing.”

Children with special needs can have a higher incidence of cavities and oral problems because it’s harder to brush their teeth, says Mungo. Cavities are bacterial infections that if left untreated could spread to other parts of the body that may already be compromised by preexisting conditions.

Introducing Children to the Dentist

Children with special needs may experience extra levels of anxiousness related to visiting the dentist. Mungo encourages parents to help in desensitizing patients to the new environment:

  • Bring a favorite toy, or an iPad and headphones to make your child feel comfortable and remind them of home
  • Schedule appointments at the part of the day when your child feels best.
  • In scheduling, attempt to have the same exam room and personnel available for each appointment to create a comfortable pattern and sense of routine

Finding the Right Pediatric Dentist

Your child’s pediatrician is a good source for recommendations on pediatric dentists who work with children with special needs, says Mungo. The pediatric dental staff can help you create a daily dental care routine that is specifically tailored to your child, including the right type of adaptive toothbrush that meets their needs.  Healthy Smiles of OC, in partnership with CHOC, is another resource. Funded in part by the Children and Families Commission of Orange County, Healthy Smiles is working with community pediatricians, pediatric dentists and schools to bring dental treatment, education and preventative care to the medically underserved community.

Flossing Tips for Your Little Ones

MP900321049[1]Bet you didn’t know it was National Children’s Dental Health Month? Check out these reminders on flossing to help your little ones keep a bright smile.

Brushing teeth properly and consistently helps to remove most dental plaque, however, brushing alone cannot remove plaque that is located in places that a toothbrush cannot reach, particularly in-between teeth. In addition to removing plaque, flossing also helps to remove debris that adheres to teeth and gums in-between teeth; polish tooth surfaces; and control bad breath. It should take place at least once a day for two to three minutes each time to be most effective.

Flossing should be started when your child is around 3 to 4 years of age, under the direction of your child’s dentist. Prior to this age, flossing is not necessary. Children usually need assistance with flossing until they are 8 to 10 years of age.

Your child’s dentist or other oral healthcare provider can provide a demonstration of any of the following flossing techniques. They include:

• spool method (also called the finger-wrap method)
Cut off a piece of floss that is approximately 18 to 20 inches in length. Lightly wrap each side of the piece of floss several times around each middle finger. Next, carefully maneuver the floss in-between the teeth with your index fingers and thumbs in an up and down, not side-to-side motion. It is best to bring the floss up and down making sure to go below the gumline, forming a “C” on the side of each tooth.

• loop method (also called the circle method)
Cut off a piece of floss that is approximately 18 inches long, and tie it securely in a circle. Next, place all of the fingers, except the thumb, within the loop. Then, use your index fingers to guide the floss through the lower teeth, and use your thumbs to guide the floss through the upper teeth, making sure to go below the gumline, forming a “C” on the side of each tooth.

Encourage your kids to floss on a regular basis. While it may be a little tricky at times, the health benefits are endless. Choose an appealing tooth floss your kids will enjoy. There are many varieties out there, including flavored or unflavored.

For more information on oral health, please visit the CHOC Health Library on choc.org, or click here:

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    Help Your Teen Practice Good Hygiene Habits

    Are good hygiene habits part of your teen’s back to school routine? Check out these easy reminders to help keep your teen happy and healthy, and continue these habits into adulthood.

    Understanding the body. If you’re talking about good teen hygiene, that also means talking about puberty. Have a casual and open conversation with your teen about the topic. Refer your teen to a good book or a reputable health web site on the subject, which may help with the conversation. If you’re having trouble talking about a particular issue, discuss it with your pediatrician who may have input on how to address the topic.

    Showering. Once puberty hits, daily showering becomes essential, especially after playing sports or sweating a lot. Recommend that your teen use a mild soap and to concentrate on the face, feet, underarms, groin, bottom, hands and fingernails. Also, discuss the pros and cons of daily hair washing. Some teens may want to wash their hair daily, especially if they have oily hair.

    Using deodorant. When puberty hits, your teen’s sweat glands become more active and the chemical composition of the sweat changes, causing it to smell stronger. When you or your teen begin to notice it, using deodorant or an antiperspirant should become part of her daily routine.

    Maintaining good oral health. Teens can get pretty lax about their teeth care. Be a good role model and show them the importance of brushing and flossing. Encourage your teen to brush all of her teeth thoroughly – not just the front ones! Ask your dentist if an antibacterial mouth rinse is right for her.

    Preventing acne. To help prevent the oil buildup that can lead to acne, encourage your teen to wash her face gently twice a day with warm water and a mild soap or cleanser. Encourage your teen to keep her hair away from her face and to wash it regularly to reduce oil. If your teen has acne, she may want to try a lotion or cream from the drugstore to help clear it up. Remind her not to pick, squeeze, or pop pimples.

    Sharing makeup. Talk to your teen about the serious problems that can come from sharing makeup, as well as brushes or other hair accessories. Cosmetic brushes and sponges, for instance, pick up bacteria from the skin that can then be passed on. Remind your teen to wash her hands before and after applying makeup.

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