First time at the dentist?

As a parent, there are many things you should consider regarding your child’s dental health, and many questions that may arise. We’ve compiled the answers to those questions we get most frequently below as a quick reference guide.

San Antonio Children's Dentist
San Antonio Family Denistry


Why should my child see a pediatric dentist instead of a general dentist?

The specialty of Pediatric Dentistry requires an additional 2-3 years training beyond general dentistry in the unique aspects of oral health care of infants, children and adolescents. Pediatric Dentists are the Pediatricians of Dentistry! The specialty of Pediatric Dentistry is regulated by the AAPD, and certified pediatric dentists can be located through their website at

Will my child need braces?

Most children (up to 80%) develop crowding in the permanent dentition. Many parents become concerned about the possibility of crowding and need for braces at this time around ages 5-7. Permanent anterior teeth are larger than the baby teeth, and the size difference results in early anterior crowding in most children. However, early or interceptive treatment can prevent major crowding in most children. The great news is that we can help. We monitor tooth eruption and potential for crowding, and will make recommendations to allow permanent teeth to erupt with minimal crowding. Allowing permanent teeth to erupt in the proper sequence and in a near normal position will minimize the time in braces.

When should I bring in my child?

Along with the American Academy of Pediatric Dentistry (AAPD) we recommend that a child’s first dental visit be scheduled within 6 months of the eruption of the first tooth, and no later than their first birthday. These guidelines are very important for establishing a dental home and for getting the right habits in place early on. By learning about and decreasing risk factors that can eventually lead to cavities, we can stay on the preventive side of oral health. First visits help establish the dental office as a fin and positive experience, and allows children to get to know the doctor and staff. The result is a less anxious child who becomes more comfortable after enjoyable office visits. This is also an excellent opportunity for parental education and reinforcement of positive habits that will reduce cavity risk.

At Scuba Smiles, we are trained to see children very early, to identify risk factors, and to educate parents in preventive techniques. All combined we provide anticipatory guidance to ensure the brightest smile for your child’s future!

How can I prepare my child for their first visit?

There are many children’s books on first dental visits. Unfortunately, most story lines include either a filling, or an extraction which can be very frightening, so choose wisely if you want to use this method.

Parents are encouraged not to “make a big deal” out of the visit. Most children suspect something is up if huge rewards and promises are made before the appointment. More often that not this technique fails. In the child’s mind the thought process goes something like this: something terrible must be going to happen to me or my parents wouldn’t try to bribe me. Also, parents are encouraged to refrain from using words that could cause unnecessary fear or anxiety such as pain, blood, shot, drill, yank, pull, or needle. Such words will cause a negative emotional response in your child and make the appointment much more difficult. We are experienced in dealing with childhood anxiety and can explain treatment in a simple and non-threatening manner. Anxiety overrides common sense, so even the smallest thing can be blown way out of proportion. For young children anxiety and fear of the unknown is quite normal. Most warm up with repeated appointments and a gentle approach.

Parents, if you have concerns or want all the details, or if you personally have a fear of dentistry, it is best to ask to speak with one of our staff in private.

How safe are dental x-rays?

Routine dental intraoral x-rays produce exposure levels that would be equivalent to living in Denver, CO year-round. This is very little radiation! At Scuba Smiles, we follow guidelines for x-ray exposure developed by the American Academy of Pediatric Dentistry, which recommend exposure intervals based on cavity risk and are adjusted as the risk changes.

New technology dramatically decreases the amount of radiation that a child is exposed to during routine dental radiographs. In addition, the dental x-rays unit has a tube head that prevents much of the scatter by aligning the rays in a column, thus providing a very localized target area. And lastly, a lead apron is draped over the child to prevent scatter. While the risk is minimal, the benefits are great, as radiographs are invaluable for diagnosis in hidden areas between teeth, and under the gums.

What should I expect during the exam?

Dental exams for infants and very young children are best accomplished by having the parent hold the child while facing the doctor sitting knee to knee. The child will face the parent with their legs straddled around the parent’s waist. In this manner, the child’s head can be positioned in the dentist’s lap while the parent holds their child’s hands on their tummy. This allows good visualization for both the parent and the dentist. A similar technique can be used at home to hold the child for brushing and flossing.

During the examination, we will record your child’s medical and dental history, complete an oral examination, provide tooth charting and discuss any finding with you. Older cooperative children may also get a cleaning, and we may take diagnostic x-rays as part of the visit. It is important to keep first visits positive, to provide a good framework for future appointments. Sometimes this will require a series of shorter appointments to build trust, and gain confidence. If is best not to push children beyond their limits, because the negatives that result are hard to overcome, and make future appointments more difficult.

Is my child at risk for cavities?

As a parent, you never want your child to experience cavities, so prevention is the goal. Unfortunately, cavities are the most common chronic infection in childhood and up to 80% of children experience cavities prior to graduating from high school. Even with fluoride toothpaste, and fluoride in the municipal water supply, cavity rates in young children have increased in recent years. Why?

The answer is complex, but involves age at first dental visit, dietary habits, hygiene habits (brushing and flossing), family dental history, dental IQ, and genetics.

The American Academy of Pediatric Dentistry recommends that all children be seen routinely for dental examinations starting no later than their first birthday. There are definite risk factors for cavities that can be seen long before cavities occur. These risk factors can be identified and cavities prevented, but only if your child is seen early!

Pediatric dentists are trained in the process of primary preventions, which involves measures taken to ensure cavities do not begin in the first place.

If your child has moderate to high risk factors, cavities are in their future… just takes time. It is very important to take the advice of your child’s dental team in order to lower the known risk factors. This is the key to preventing cavities.  

Bringing your child to Scuba Smiles starting early, by age one, and at regular intervals is one of the best way to prevent cavities for your child, and ensure a healthy beautiful smile that will last a lifetime.

Baby Teeth

If my child gets a cavity on a baby tooth, should it still be fixed?

Yes!!! Pain and infection is very real even in baby teeth. No parent wants their child to have a toothache. The best prevention is to establish a dental home early, preferably by your child’s first birthday, so cavity risk is minimized. We will evaluate whether or not the child will be losing that baby tooth soon, and will develop a best course of action based on that.

Can thumb sucking be harmful to my child’s teeth?

Persistent and long term habits typically do cause problems. Non-nutritive sucking is normal during infancy. However sucking on a pacifier or thumb into toddlerhood and beyond can be problematic. Be sure to address any concerns when you bring your child in for a visit.

When does that last baby tooth fall out?

The last baby tooth that falls out is the last baby tooth that erupts into the primary dentition – the primary second molar. This tooth typically erupts before age three and is shed between 12-14 years of age. This means this tooth will need to last a lifetime as the permanent tooth that replaces it is sometimes congenitally missing (never forms or erupts). The importance of this tooth cannot be overlooked as it guides and holds the permanent first molar (6 year molar) in position. Severe space loss can occur when this tooth is lost early, as well as lead to extractions of permanent teeth later when braces are required. Ask us how we can help save these teeth for you child until they are due to be replaced.

When does the first permanent tooth erupt?

The first permanent tooth to erupt is typically the lower central incisor. However, the lower first permanent molar may erupt first in some children. This tooth erupts behind the last baby tooth in the ache. The age for this exchange is six, with girls typically following an earlier eruption schedule than boys.

How can I help my child through the teething stage?

Drooling and a desire to chew on any and everything are common during the teething period. Discomfort and sore gums are also common. Provide a clean, cold teething ring for your child to chew on. Gently rub and massage the gums with a soft cloth during cleaning. Additionally, your pharmacy will have numbing medications to rub on gums, but be sure to follow directions carefully.

Some children may develop stomach problems or run temperatures during the teething process. The break in the gum tissue allows bacteria and viruses to enter the body and cause secondary infections. Because your child’s immune system is not mature, these types of infectious exposures can actually help strengthen your child’s developing immune system and offer protection against future exposures. Be sure to visit your pediatrician if these symptoms are severe or persist longer than 24-36 hours.

Why are baby teeth important?

Baby teeth are important as they serve as the foundation for, and guide the eruption of the permanent teeth. Yes, baby teeth will eventually fall out. In fact, every baby tooth is designed to fall out and be replaced with a permanent tooth. However, losing a baby tooth years before it is to be replaced will lead to costly long term corrections. Baby teeth erupt in a specific sequence, and they are replaced in a specific sequence. Early loss of a baby tooth will lead to undesired problems such as crowning, midline discrepancies, impactions, and ectopic eruptions. Untreated, or undiagnosed problems will usually present themselves about the time that all the permanent teeth should be erupted. Unfortunately, at a later stage, many problems cannot be fully corrected, and permanent teeth may have to be sacrificed to achieve a favorable result. The good news…all of these problems can be minimized or avoided with routine visits in our office.

At Home Care

When should I start flossing for my child?

The short answer is as soon as two adjacent teeth touch. Brushing will not clean between 2 teeth that touch, and over time the hidden area becomes susceptible to cavities. In our office, this is the most common area where we find cavities in baby teeth. X-rays are necessary to see in between the teeth to detect cavities in these hidden areas.

When should my child start brushing by themselves?

Parents of young children need to and should be brushing for their child at least twice a day. Young children do not have the dexterity of knowledge to brush correctly. It is okay for them to practice, but parents need to physically do the brushing each time! Brushing is more than wiggling the brush around in the mouth. Specifically, plaque must be removed for brushing to be effective. If plaque is poorly removed, your child is at a much higher risk for cavities. As an example, young children can scribble with a pen or pencil, and it take many years of practice for them to learn to write in cursive. The same is true for tooth brushing.

Should my child receive fluoride supplements?

Overexposure to systemic (ingested) fluoride results in fluorosis of the hard tissues including bone and enamel. Enamel has a high affinity for fluoride and too much will cause permanent discoloration during tooth formation and maturation. Remember, ingested fluoride is similar to air pressure in your car’s tires. Too little is not good and too much is disastrous. Topical effects, however are still beneficial so topical applications in toothpastes, mouth rinses, gels and varnished help strengthen already erupted teeth.

When should my child start using fluoride toothpaste?

In order to prevent unnecessary ingestion, fluoride toothpastes should be avoided until the child is able to hold and spit the water from the mouth without swallowing. This occurs anywhere from 2 1/2 to 3 1/2 years of age. We frequently instruct parents on the use of fluoride prior to this age and also apply fluoride varnish on high risk children, but this is done on an individual basis. Please schedule your child’s dental appointment now to determine if they would benefit from topical fluoride application

What can I do at home to help my child’s dental health?

Proper care at home is one of the most important preventive services that you can do on a daily basis to prevent cavities. Everyone has bacteria in their mouth capable of causing cavities. This bacteria produces plaque that is very acidic and if not constantly removed, the acidic plaque will cause cavities. Proper home care (brushing and flossing) are taught in our office, and reduce plaque levels below the levels that can cause cavities. It is critical to remove plaque and bacteria effectively everyday. Parents should brush their child’s teeth a minimum of twice daily and floss at least once daily. The night time brushing is critical because plaque levels increase during the day after meals, and we do not want to go to bed with all that acid on the teeth! We recommend that parents brush and floss for their child until the 3rd or 4th grade. Children can and need to practice, but their solo efforts often fall below the standard, leaving plague that will destroy enamel over time. Even children that brush three times a day can still be high risk due to  ineffective or substandard plaque removal. Proper prevention skills in brushing and flossing are reviewed and reinforced during periodic exams in our office. In fact, we grade each child’s oral hygiene, so we can track progress.

How does my child’s diet affect their dental care?

Let’s face it… the American diet causes cavities, as well as numerous other health problems. You only have to watch television for short time before you’re bombarded with food advertisements aimed at enticing your children. The cheapest form of sweetener (high fructose corn syrup) is added to virtually all packaged and processed pre-sweetened beverages and foods. It is extremely cariogenic (cavity causing). Diet drinks with artificial sweeteners are a big problem as well. These substances can be converted to acids in the dental plaque, as well as cause additional health concerns, so it is best to avoid them.

If you must use an artificial sweetener, Xylitol is the best because it does not promote tooth decay! Unfortunately, it is more expensive so most manufactures chose not to use it. Trident gum contains Xylitol, so it is a good choice for those who chew gum. Fruit juice is another form of sugar that promotes cavities because the bacteria in the mouth can convert the fruit sugar to acid. Parents mistakenly think that if it is 100% pure fruit juice it must be good. Be mindful of how often you offer it to your child or you could increase their cavity risk.

It is obvious that juice, soda, milk, and sports drinks can cause cavities. Sweetened beverages tend to be especially problematic because these are routinely started in a child’s life, and cavities develop before parents realize there is a problem, or before they receive preventive counseling. As a general guideline, we recommend limiting the frequency of sweetened beverages and enjoying them with meals, and drinking RO or purified water between meals.
Problems arise when the frequency of cavity causing foods override our preventive efforts (brushing and flossing). Remember, when it comes to cavities, frequency is more critical that quantity. Even good brushers and flossers will develop cavities when the consumption of cavity causing food is high! The acid wins the battle, and the tooth loses.

When should I start brushing?

You should start oral cleaning at birth by wiping the gums pads with a soft cloth or finger brush. This should occur after each feeding. By the time the first tooth erupts, and enamel appears, a soft bristle brush can be added. At this stage, a non-fluoride toothpaste is recommended. Fluoride toothpaste is added as the child matures. The key is to start a consistent routine to keep the teeth and gums free of cavity causing plaque bacteria. In general, parents should be cleaning their child’s mouth a minimum of twice daily. Some children, especially those at high risk for cavities will require more frequent brushing. But remember that good home care can be undone by a bad diet, full of sweetened beverages and foods.
Be sure to ask one of our staff how to clean your infant’s mouth, even before teeth. At Scuba Smiles we can show you how to position your baby to ensure that oral care is effective and efficient.


What are some common types of dental injuries?

  • Crown Fractures: Involve fractures of the enamel and/or dentin. These may involve exposure of the nerve (pulp).
  • Root Fractures: A fracture of the root portion of the tooth below the gum line.
  • Concussion Injuries: Trauma that arises when a tooth is hit or bumped, although the tooth does not get loose. Many of these type of injuries require long term follow-up as the damage from the injury can slowly progress.
  • Subluxation Injuries: Trauma that occurs when a tooth is injured that makes the tooth loose, but without displacement.
  • Intrusion Injuries: The tooth is pushed up into the socket and may be completely buried.
  • Extrusion Injuries: The tooth is partially pulled out of the socket. These type of injuries require splinting
  • Avulsions: The tooth is completely knocked out of the socket. These injuries may require replacement and splinting.

What if I have an after-hours emergency?

After hours, we will only see patients of record that currently established in our office. Current patients have been in for regular examinations and cleanings within the last 12 months, thus we have a current medical and dental history that is up to date. If your child is not established in our office, or we have not seen them recently, please take them to the ER. We can see them during regular business hours and get them established in our practice.

What should I do if my child knocks out a tooth?

Primary (Baby Teeth)

If it is a baby tooth, transport it with child to the office. Baby teeth are not re-implanted due to risk of damage to the permanent tooth bud. However, sometimes a portion of the body tooth root remains and will need to be removed.

Permanent (Adult Teeth)

Permanent teeth need to be reimplanted quickly, preferably within the first 30 minutes of the accident. An avulsed (knocked out) teeth should only be handled by the crown (enamel). Do not touch the root portion. If dirty, gently rinse. Place the tooth back into the socket, if possible, or have the child hold the tooth in their cheek. The next best option is to place the tooth in a cup of the child’s spit (saliva), followed by placing the tooth in a cup of milk. If milk is not available then keep the tooth hydrated in plain water. Bring the tooth with you to the appointment.

What do I do if my child has a dental emergency?

We see many types of injuries that involve the mouth and teeth. If these occur during normal office hours, we will do our best to work you into our schedule in a timely manner. Some children will need to be seen in the Emergency Room prior to the dental office, loss of consciousness, dizziness, altered alertness, balance, hearing or visual difficulties are present, as these conditions require immediate medical attention.

San Antonio Family Denistry
Fish, San Antonio Orthodontics

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(210) 899-1099

a pediatric dental experience

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