So, You're A Dentist?: Parents Q&A With Ridgefield Dentist

By Dr. Josephine Franzese, Ridgefield Dentist

Professional women blend work and home life without fantastic fanfare these days. So when Dr. Josephine Franzese, the mother of two young Ridgefielders, is learned as a dentist at a playgroup or at the playground, chances are a series of oral health questions will follow.

"When you're with your children and around their friends and their supporter's parents, the focus is on the play at hand, but it's common that moms – myself included – discuss health concerns,” Franzese said. “And when parents start talking about teeth and visits to the dentist, that's when questions come flying my way.”

Dr. Franzese has practiced in Ridgefield with Dana Jones & Friends since moving to town four years ago. 

Here’s a sampling of the well loved and now and again amusing questions, along with Dr. Franzese's answers:

When should my child's first teeth arrive?

There is a general guideline for the arrival of baby teeth (eruption) and loss (exfoliation), but like everything else related to your child's body, the guideline is just that: a guideline.  In general, the first teeth to erupt are the lower front teeth at about age 4-10 months, while the last to erupt are the upper 2^nd molars (way in the back) at about age 25-33 months. 

When do children start losing teeth?

Similar to the guidelines for the arrival of baby teeth, tooth loss follows a first-in first-out type of schedule.  So, the lower front teeth are the first to loosen, with the adult teeth erupting in their place at age 6-7 years. The first molars come in at about that time too, age 6-7 years, behind the last primary molar.  Middle childhood seems to be marked by many nighttime visits from the tooth fairy!

Can my child wiggle a loose tooth?

Provided we're dealing with a primary (baby) tooth that is destined to fall out, I say yes to this.  Selection a loosening tooth along with clean hands certainly speeds up the process for your child.  As with anything that is curious and different –children will play.  A loose tooth to them certainly feels like something that should be pulled.  If you've got a nervous child who is worried to lose the tooth, talk to her about the arrival of her "grown-up" teeth and how this tooth has to go out so the next can take its turn. Also, many children find momentary relief (enough to get a few excellent wiggles in) in the fleeting lack of feeling that a piece of ice applied to the gum around the wiggly tooth provides.  

What is the going rate paid by the tooth fairy for a tooth?

I've really been questioned this one a few times.  Contrary to well loved belief dentists don't speak with the tooth fairy, but I reckon the most I've ever heard reported from my younger patients is $10.00, with the usual being something like $1.00.  Now and again the tooth fairy "gets fancy" and leaves a dollar coin or a note with her compensation for the chat.  In a few instances I have heard of the tooth fairy leaving iTunes gift cards and such. I guess she is doing her best to stay present…especially with the older children!

When should my child first stay the dentist?

It is recommended by the American Academy of Pediatrics that you bring your child to the dentist around when her first tooth erupts so that you can discuss how to care for your child's new tooth and the subsequent teeth that will soon follow. Other topics for conversation may be healthy habits for oral hygiene, eating/bottle feeding/nursing, finger sucking, pacifier use, and teething. Getting into a healthy routine now will be beneficial for both you and your child later.

When should I take my child for his/her first dental cleaning?

Some children see our hygienists as early as age two-and-a-half, while most have had their first dental hygiene appointment closer to their third birthday. First and early exams are as extensive as the child permits at that moment. Your child will delight in tiresome out the huge cushy chair that moves up and down, brushing one of our animal puppet's teeth with the oversized toothbrush and showing us how he or she cleans teeth. I revel in the bewilderment through a child's eyes when we count teeth: "How do 20 teeth fit in that itty bitty mouth?!" We tailor these early cleaning and exam appointments to the comfort level of your child because making fun early experiences and building his confidence in the dentist is so very vital.

How do you get your infant/toddler to let you brush their teeth?

It really is all about access.  Try each nighttime (at bedtime) and morning (after breakfast)… just keep doing it, they'll get used to it – just like they do with cutting or filing nails.  Very few young children like having their teeth brushed, but you want to make that habit, the sense that this is routine.  The protests decrease with time – they know it is going to happen anyway. Try having the parent's turn first, and then it's your child's turn. 

Do I need to floss my child's teeth?

I say yes, for the same goal with brushing – establishing a routine.  It's amusing, many babies and young toddlers will tolerate a kid's floss holder used to floss between those groundbreaking new pearly whites, more so than a 0-2 year-ancient-rated toothbrush. It feels cool to have the floss gliding between those modest teeth. Why floss a baby's teeth when they often have space between? Again, it's about desensitizing your child to the sensations of oral care.  Just be persistent despite the fuss and eventually you'll have children that want to take their turn with flosser and brush. 

What's the routine for Ella (her four-year ancient daughter)?

We start with Mom's or Dad's turn in the morning and evening before bed.  Since she's been excellent at spitting in the sink – this of course took practice – Ella uses a fluoridated children's toothpaste. After our turn, it's Ella's turn to brush on her own, spit, rinse and then we take turns flossing.  She's very pleased to do this, particularly when one of her parents or her brother are doing the same.  It is vital to model this excellent behavior.

What's the routine for Jack (her 17-month ancient son)?

For Jack we've been using just the brush with cold water.  We started with a wet washcloth before his first teeth came in and are just about to start on a non-fluoride (safe-to-swallow) child's toothpaste to add some interest to "the experience".  As with his older sister, after our turn, Jack gets to try to brush.  Jack is really not a fan of having his teeth brushed.  Justifiably those gums hurt. Each week, it seems, another tip of colorless tooth emerges from his reddened gums.  Still, we persist. He often cries in protest, but then we cradle him and the crying ironically gives us simpler access while his mouth is open wide. Try to brush very gently over those emerging teeth.  The massaging of the brush bristles is excellent, but don't shrubbery quick – be gentle.

What do you do if your child has an adult tooth knocked out playing a sport?

It is vital to replace the tooth immediately, for the best prognosis. You want to find the tooth immediately and not clean it off, or rub the tooth in any way. If there is dirt or waste on the tooth, pour some water on it, but do not attempt to shrubbery it clean.  This next step might surprise some: Insert the tooth back into the socket, gently supporting it, while you call your dentist to be seen as an emergency. If the tooth is out of the mouth longer than 5 minutes, place it in a storage solution and bring it and your child to the dentist.  Place it in one of the following (listed in order of preference): Viaspan, Hanks Balanced Salt Solution, cold milk, saliva, briny or water.  The first two fluids are often available in first aid kits maintained by coaches and teachers.  

Should my child wear a mouth guard for sports?

For many sports like football and lacrosse, mouth guards are required by the leagues our children play in, but I support the use of a mouth guard in each sport that bears the risk of contact to the head–so much so that our office makes custom mouth guards for patients of our practice for free.  For the child-sportsperson we present the mouth guard as just another piece of equipment that needs to be worn to protect their body, like shin guards, a helmet or an elbow pad.  In my office child-athletes delight in picking out the color of their guard from an array of options, including our most well loved, a two-tone guard made with Ridgefield's black and orange.

Should I give my child fluoride supplements?

This is a very well loved question because of the number of homes with well water in Ridgefield.  I don't routinely prescribe fluoride supplements but this is entirely a case-by-case analysis.  If a child is at high risk for decay and has a non-fluorinated water supply, then I may recommend the buck dose of fluoride supplement and recommend more frequent hygiene appointments and exams.   Most vital are the conversations that lead to the educating your child of excellent nutrition, and identifying the habits that are posing to be harmful to the teeth.  Again, getting your child into fantastic eating, drinking, and oral care habits now makes an extraordinary foundation for the rest of their lives.

At what age should my child see an orthodontist about braces?

This answer is best given by your child's current dentist. At your child's routine checkup appointments, your dentist is evaluating the teeth, the soft tissue, and doing a thorough head and neck exam.  When evaluating the teeth, the dentist looks at their development, their position, your child's bite, and questions about habits (tongue thrust, finger or pacifier sucking, mouth breathing, etc).   All of these observations factor into when and if you are recommended to consult with an orthodontist.

Quick TIPS:

• Establish routines
• Brush & floss regularly for all ages
• No milk for toddlers after brushing/before bed
• Limit sugary & sticky snacks (candy, raisins, pretzels, etc.) or pair them with a drink of water
• Boost healthy/crunchy snacks like nuts, carrots, raw vegetables and first fruit.
• Limit juices, avoid sodas, and follow with water when enjoying
• Stay your dentist early to get children comfortable with the process
• Question questions of your dentist, they like to help but beware, answers are long (see higher than J)

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