Pediatric Dentistry & Orthodontics of Livermore

Baby teeth

Pediatric dentists care for children of all ages. From the first tooth to adolescence, they help your child develop a healthy smile until they are ready to move on to a general dentist. Pediatric dentists have had 2-3 years of special training to care for young children and adolescents.

Research has shown that mothers with poor oral health may be at a greater risk of passing cavity-causing bacteria to their children, and periodontal disease can increase the risk of preterm birth and low birth weight. The American Academy of Pediatric Dentistry (AAPD) recommends that all pregnant women continue to visit the dentist for checkups during pregnancy. 


To decrease the risk of spreading the bacteria, mothers should visit their dentist regularly, brush and floss daily, and maintain a healthy diet full of natural fiber, and reduce sugary foods. Additionally, increasing water intake and using fluoridated toothpaste helps prevent cavities and improves oral health.

The American Academy of Pediatric Dentistry (AAPD) recommends taking your child to their first dental appointment and establishing a dental home by the age of one or shortly after the first tooth erupts.

Your child’s first tooth will typically erupt between 6 and 12 months, although it is common to occur earlier. Usually, the two bottom front teeth – the central incisors – erupt first, followed by four upper front teeth – called the central and lateral incisors. Your child should have their first full set of teeth by their third birthday. 


Most children have 20 primary, or baby teeth. Typically, there are 10 upper teeth and 10 lower teeth. These 20 primary teeth are eventually replaced by 32 permanent teeth, 16 in the upper jaw and 16 in the lower jaw. 


The eruption of the permanent molars usually happens between ages 6 and 7. Therefore these teeth are often referred to as the “six-year molars”. These molars erupt behind the baby molars. Many children will have 28 of their permanent teeth by age 13. These teeth include eight incisors, eight premolars, eight molars, and four canines.


The last teeth to develop are the third molars, better known as “wisdom teeth”. These teeth generally begin to erupt between the ages of 17 and 21. Due to these teeth being located so far back in the mouth, they often are not needed for chewing and can be difficult to clean. It may be recommended that these teeth are removed to prevent any issues in the future.

Baby teeth are temporary; however, if a baby tooth is lost too soon it can lead to other teeth crowding the vacant spot. This can cause alignment issues when the permanent tooth begins to emerge and could cause crooked teeth and biting problems. Baby teeth are important to help with chewing and eating leading to proper nutrition.

One of the most common forms of early childhood caries is “baby bottle tooth decay,” which is caused by the continuous exposure of a baby’s teeth to sugary drinks. Baby bottle tooth decay primarily affects the upper front teeth, but other teeth may also be affected.


Early symptoms of baby bottle tooth decay are white spots on the surface of teeth or the gum line and tooth sensitivity. More severe symptoms can appear in advanced stages of baby bottle tooth decay and include: brown or black spots on teeth, bleeding or swollen gums, fever, and bad breath. If your child shows any of these symptoms, you need to see your pediatric dentist immediately to prevent further, more complicated problems from occurring.

1 – Don’t send your child to bed with a bottle of anything EXCEPT water.

2 – Clean your baby’s gums after each meal.

3 – Gently brush your child’s first tooth.

4 – Limit sugary drinks and food.

Dental Emergencies

If your child fractures or knocks out a tooth, you may store the tooth or fragments in a clean container of milk. If milk is not available, you may use the child’s saliva to store the tooth. Never use water to transport a broken or knocked-out tooth. You must visit the dentist immediately to prevent infection and other complications that are brought on by chipped or knocked-out teeth. If the tooth is knocked out, only touch the crown of the tooth and not the root. Your pediatric dentist will be able to repair your child’s tooth or fix it with a crown.

If your child experiences a cut on their tongue, cheek, or lip, bleeding can usually be stopped by applying clean gauze to the affected area. You can also apply ice to the area to help stop the bleed. If you cannot stop the bleeding, call your pediatric dentist, or visit the emergency room. If your child has an open oral wound, for a long time they can be susceptible to infection.

If your child has a toothache, then have them rinse their mouth with warm water to ease the pain. If the pain persists for more than 24 hours, contact your pediatric dentist. Persistent toothaches can indicate more serious problems that need to be observed by a dental professional.


X-rays are valuable aids to help dentists diagnose and treat conditions that cannot be seen by looking in the mouth. X-rays can detect much more than cavities. X-Rays can show erupting teeth, diagnose bone diseases, measure the damage of an injury, or help with the planning of orthodontic treatment. If dental problems are found and treated early, dental care is more comfortable for your child and more affordable for you.


Dental X-Rays are very safe and the amount of radiation from dental X-Rays is very small. Today’s equipment filters out unnecessary x-rays and restricts the x-ray beam to the area of interest. Dental X-Rays are designed to limit the body’s exposure. Pediatric dentists are incredibly careful to minimize the exposure of their patients to radiation. Dental radiographs represent a far smaller risk than an undetected and untreated dental problem.

Orthodontic Treatment can be recognized as early as 2-3 years of age. Often, preventative steps can be taken to help reduce the need for major orthodontic treatment later on.

From ages 2 to 6, the main concern would be habits, such as finger or thumb sucking, underdeveloped dental arches, and early loss of primary teeth.

From ages 6 to 12, treatment options deal with jaw and dental alignment problems. This is a great time to start treatment, as your child’s hard and soft tissues are usually very responsive to orthodontic or orthopedic forces.

When adult teeth come in behind the baby teeth it is often called “Shark Teeth”. It is common and occurs as the result of a lower baby tooth not falling out when the permanent tooth is arriving. In most cases, the baby tooth will fall out on its own within a couple of months. If it does not fall out contact your pediatric dentist.

If your child shows signs of disturbed sleep including long pauses in breathing, tossing and turning in the bed, chronic mouth breathing during sleep, night sweats (owing to increased effort to breathe) this may be an indication of sleep apnea. This is far more common than parents realize and is mostly seen in children between 2 and 8 years old, although it can present itself at any age.


If your child is suffering from these symptoms, we can help determine underlying causes and may refer your child to an Ear, Nose, and Throat (ENT) doctor for further evaluation. While there is a possibility that affected children will “grow out of” their sleep disorders, the evidence is steadily growing that untreated pediatric sleep apnea can affect attention-deficit hyperactivity disorder, bed-wetting, sleep-walking, and even failure to thrive.

We use Nitrous oxide, sometimes called “laughing gas,” to help children become more comfortable during certain procedures. Nitrous oxide is a safe and effective sedative agent that is mixed with oxygen and inhaled through a small mask that fits over your nose to help you relax. It is not intended to put them to sleep but instead is designed to help them feel calm and comfortable. The effects of nitrous oxide are temporary and wear off soon after the mask is removed.


For treatments that may last longer or cause more discomfort, we will often recommend a mild oral sedative that your child can take before treatment. Every effort is made to ensure proper dosage and limit mild side effects if any.


More complex treatments may require deeper sedation to relieve both pain and anxiety. On occasion, general anesthesia through an IV may be used to cause a temporary loss of consciousness. Your child’s comfort and safety are especially important to us.

Yes. Silver diamine fluoride (SDF) is a liquid substance used to help prevent tooth cavities (or caries) from forming, growing, or spreading to other teeth. It can also help to arrest the cavities in young kids to hold off treatment until treatment can be done.


Bruxism is more commonly known as teeth-grinding, and a surprising number of children suffer from it – around 3 in 10. Teeth-grinding usually occurs while children are asleep, and it can become a dental problem if left unchecked. Regular teeth-grinding can wear down tooth enamel, reinforce improper bite patterns, and leave teeth more susceptible to cavities and decay.


Bruxism can cause headaches, earaches, facial pain, and bite and jaw problems.


If your child’s teeth-grinding is ongoing, then their dentist may prescribe a nightguard to protect their teeth and mouth. A nightguard helps ease the pain of tooth grinding and protects tooth enamel from being worn away.

Thumb sucking, finger sucking, and pacifier use are habits common in many children. Nearly one-third of all children suck on their thumbs, fingers, or pacifiers in their first year of life. Thumb sucking, finger sucking, and pacifier use can lead to many oral developmental issues that negatively affect the development of the mouth. These habits can cause problems with the proper alignment of teeth and can even affect the roof of the mouth.


Boredom, anxiety, anger, hunger, or even sadness can all cause children to suck on their fingers for comfort. Children mostly suck on their fingers for comfort from an uncomfortable emotional state or stressful situation.


If your child hasn’t stopped sucking their fingers by age 5, then you must wean them from the habit so that they can develop a healthy young smile. By 5 years of age, your child’s mouth will be rapidly developing and thumb sucking, finger sucking, or pacifier use can interfere with that process.

While it can be common for children to breathe through their mouths on occasion (when they are congested, have a cold, or are involved in strenuous activities) breathing through the mouth all the time, including when you’re sleeping, can lead to problems.


If your child is suffering from these symptoms, we can help determine underlying causes and may refer your child to an Ear, Nose, and Throat (ENT) doctor for further evaluation. Mouth breathing in children can cause bad breath, crooked teeth, jaw alignment issues, and other orthodontic problems.


To prevent cavities, we suggest enjoying a mouth-healthy diet, full of fibrous fruits and vegetables. Drink more water, which prevents dry mouth and naturally cleans teeth. Brush twice a day for two minutes at a time, and floss daily. Visit your dentist every six months for routine checkups and preventative care.

It’s never too early to begin a healthy oral care routine. You should begin caring for your child’s gums long before their first tooth emerges, which is usually around the six-month mark of their life. Healthy gums are an important predictor of healthy teeth, and maintaining clean gums will help ensure that your child has healthy, cavity-free baby teeth.


You can clean your infant’s gums – or their first teeth – by simply using a cold, clean washcloth. Simply rinse a clean, soft washcloth with cool water and wring it out. After your child has finished eating or drinking a sugary drink, use the damp washcloth to gently wipe out their mouth. This will remove any sugar or acid that’s left by their food, and help prevent early cavities.


Once your child has a few more baby teeth – usually between 8 and 12 months – then you can graduate from a washcloth to a toothbrush designed for toddlers. There are a lot of toothbrushes designed for babies and toddlers from which to choose. Generally speaking, toothbrushes designed for babies have much softer bristles and a smaller head than those meant for older children.


Use only a smear of toothpaste – about the size of a grain of rice – to brush their teeth. When they’ve gotten older and have more teeth, use a pea-sized amount of toothpaste. Always be sure to rinse their mouth out with cool water after you’re done brushing, and try to keep them from swallowing any toothpaste.

Flossing is also important for baby teeth. Flossing helps remove the plaque and food that can become lodged between teeth. Be sure to floss your child’s teeth daily.

Children should eat a variety of foods including grains, fruits, protein, vegetables, and low-fat dairy, raw vegetables like carrots, celery, and bell pepper are excellent snacking alternatives to unhealthy chips and crackers. Starchy carbs like potato chips and crackers can stick to teeth and cause unhealthy buildup, which can lead to cavities. Fibrous vegetables like celery can clean your teeth as you eat them! That is also true of fibrous fruits like apples, strawberries, and kiwi. 

So, choose raw fruits and vegetables instead of chips, they are better for your overall health, and they won’t stick to your teeth like starchy carbs and sugars.

Dental sealants work to prevent cavities by sealing pits and fissures that naturally occur in molars. Sealants “seal off” the pit and fissure of your molars to prevent food and plaque from collecting and forming cavities.

Fluoride is considered to be nature’s cavity fighter. Fluoride is naturally found in all sources of water such as lakes, rivers, and even the ocean. Fluoride is added to most public water supplies, so the tap water in your home has fluoride added to it. Fluoride helps build tooth enamel which helps protect your teeth from tooth decay.


For more than half a century, the ADA has recommended using toothpaste containing fluoride to prevent cavities. Fluoridated toothpaste does an excellent job of cleaning teeth, but make sure that your child spits all of it out and rinses their mouth thoroughly after brushing since ingesting excessive fluoride can lead to a condition called fluorosis. Fluorosis is faint white lines on the teeth.

Xylitol has the sweet benefits of traditional sugar, but it does not have negative effects on teeth like sugar. The natural sugar alcohol, Xylitol, helps prevent cavities by inhibiting the growth of bacteria that causes cavities. You can find natural xylitol in some fruits and berries. Xylitol can most often be found in gums and mints.


The American Academy of Pediatric Dentistry (AAPD) recognizes the benefits of xylitol for the oral health of infants, children, adolescents, and persons with special health care needs.

Did you know that sports drinks can contain more sugar than leading cola beverages, with as much as 19 grams of sugar per serving? The sugars increase the acidity in your mouth which attracts tooth enamel destroying bacteria and helps give bad oral bacteria the fuel it needs to create cavities.

Mouthguards – sometimes called mouth protectors – work by helping cushion a blow to the face, and minimizing the risk of broken teeth, or lacerating a lip, tongue, or cheek. Did you know that the CDC estimates that more than 3 million teeth are knocked out at youth sporting events? Mouthguards work to prevent tooth loss and other facial injuries. Mouthguards come in a variety of shapes, sizes, and are designed for multiple sports.


A frenectomy is the removal of connective tissue (called the frenum) from under the tongue (Lingual Frenectomy) or the upper gums (Maxillary Frenectomy). If your baby is having trouble with breastfeeding and “latching on” or your older child is experiencing certain speech, eating, or orthodontic problems, we may recommend frenectomy as an option. New technologies have made frenectomies a safe and convenient option for even very young children.

Babies who have difficulty achieving or maintaining proper latching with their mother’s breast may have a condition called Ankyloglossia, sometimes referred to as tongue-tie. Tongue-tie is usually related to a short, thick frenum, which limits the tongue’s capacity to move. Symptoms of a possible tongue-tie or lip-tie in a newborn are prolonged breastfeeding, difficulty latching onto the breast (causing sore nipples on the mother), and excessive gassiness. Many mothers are opting for a safe, fast healing frenectomy to help their babies establish a good seal while eating. Apart from breastfeeding difficulty, tongue ties can also impact speech and eating in children and adults. Patients often try to compensate for the lack of tongue mobility by changing their jaw position – resulting in other orthodontic issues.

Frenectomies can be an important part of orthodontic treatment when a long or short frenum is causing tooth or jaw displacement. In the case of a short lingual frenum, patients may push out the lower jaw to make eating or speaking easier – causing pain in the jaw or an underbite. In this case, a lingual frenectomy may be recommended to help ensure the success of orthodontic treatment. When treating a patient with a gap between their front teeth, the orthodontist may recommend a maxillary frenectomy after braces to prevent the teeth from spreading apart after treatment.

Baby teeth are temporary; however, if a baby tooth is lost too soon it can lead to other teeth crowding the vacant spot. This can cause alignment issues when the permanent tooth begins to emerge and could cause crooked teeth and biting problems. Baby teeth are important to help with chewing and eating, leading to proper nutrition.

An orthodontist receives special training to fix misaligned teeth. An orthodontist must first complete regular dental training and then has an extra four years of specialty training in orthodontics. If you have misalignment in your teeth and/or jaw, a dentist will refer you to an orthodontist.

As permanent teeth begin to replace baby (or primary) teeth, we recommend an orthodontic evaluation. This typically takes place by 7 years of age and the American Association of Orthodontists suggests that children receive an examination by an orthodontist no later than this age.

The orthodontist will look at your child’s teeth, face and jaws to determine proper growth and development. X-rays may be given if recent ones aren’t available or don’t provide the proper angels necessary for evaluation. We are specifically looking at tooth placement, bite and jaw alignment, and the overall development of the mouth and face. If a problem exists, or if one is developing, the orthodontist will advise you on treatment options.

Three common malocclusions (bite problems) are crossbite, crowding and impacted teeth.

Crossbite – A crossbite exists where the top teeth and bottom teeth do not come together or bite in the correct position. Instead, the upper teeth fit inside the lower teeth when the mouth is closed. If the back teeth are affected, the upper teeth sit inside of bottom teeth and this is referred to as a posterior crossbite. In an anterior crossbite, one or more top teeth sit behind the bottom teeth. This should not be confused with an underbite, where all of the top teeth are located behind the bottom teeth and the bottom jaw is pushed strongly forward.

Crowding – Overcrowding of teeth is when there is not enough space in your mouth for your permanent teeth to grow in straight. This can cause misalignment of your bite and teeth.

Impacted Teeth – An impacted tooth is a tooth that does not fully erupt above the gums. This is typically caused by overcrowding, your jaw is too small for all of your teeth or the tooth is erupting in the wrong direction. Not all impacted teeth require oral surgery.

It’s important to remember that orthodontic treatment is a service and not a product. When you purchase orthodontic kits that allow you to perform orthodontic treatment at home, you’re taking on risks that your mouth and bone structure may not respond as anticipated. At home treatment does not begin with a comprehensive evaluation of your orthodontic condition. No x-rays are taken, overlying issues aren’t addressed, and a professional assessment isn’t made that may include more than one type of solution. Additionally, should problems arise during orthodontic treatment, it’s best to have a trained professional who can evaluate your progress and adjust the treatment plan as needed.

A palatal expander, often simply called an “expander” is an orthodontic appliance that fits over several of the top teeth and in the back of the mouth. Using a specialized key, the device is gradually widened to gently encourage more space in the jaw. After the proper placement is made, bones naturally gill the gap and solidify the expansion. Expanders can help with a number of childhood orthopedic problems including crowding, crossbite and impacted teeth (described in greater detail above). They are often required to begin correcting these problems before braces can be used.

We provide many different orthodontic treatment options which are personalized to the specific situation of each patient. There are times when several options may be available while some treatments may have only one. Each plan is based on the patient’s age, their activities, the underlying orthodontic issue being treated and other factors such as cost.

Metal Braces are the most common form of traditional orthodontic treatment, however today’s metal braces are smaller and more comfortable than they were in the past. Metal braces are made of high-grade stainless steel and bonded to the teeth. Wires slowly move teeth into alignment over time and frequent evaluations are made to determine proper movement. Patients can personalize their metal braces by choosing the color of their elastics (small rubber bands).

Ceramic Braces are similar in style and function to metal braces but use clear and translucent materials to make them less noticeable. Older teens and adults for whom Invisalign® isn’t an option, may want a less noticeable option and will often choose ceramic braces. It’s important to understand that ceramic braces are more fragile than traditional metal braces and require more care.
What are the benefits of treatment with Invisalign®?
Invisalign® treatment uses a series of virtually invisible, removable, and comfortable aligners that allow you to smile more during treatment as well as after. Every 2-3 weeks, patients move to a new set of aligners that help to gradually move teeth into their proper position. Invisalign clear aligners are made with 3D computer imaging technology and have been proven effective.

If a wire, bracket, or band breaks or becomes loose, you will need to take care of it as soon as possible. If the bracket is still attached to your wire, leave it in place and try not to touch it until your repair appointment. If a piece of your braces falls out, bring it with you to your repair appointment. If any part of your braces is causing you discomfort, you can cover them with a piece of dental wax until your appointment.

As braces move your teeth, you may experience minor soreness in your teeth or gums. This is normal! It means that your braces are working and moving your teeth. Most discomfort is very mild and should fade within a few days. To help ease discomfort, you can try using a warm salt water rinse or over the counter medicine such as Tylenol or Advil.

If you have a wire poking your gums, you can take a small amount of your dental wax and place it on the piece of wire that is poking you.

If a wire, bracket, or band breaks or becomes loose, you will need to take care of it as soon as possible. If the bracket is still attached to your wire, leave it in place and try not to touch it until your repair appointment. If a piece of your braces falls out, bring it with you to your repair appointment. If any part of your braces is causing you discomfort, you can cover them with a piece of dental wax until your appointment.

Flossing with braces will require a little more time than your normal flossing. Flossing is very important to make sure you get all food particles from around your brackets and in between your teeth. You may want to use a floss threader to help slide the floss between the wire and your teeth. We recommend you floss every night before bed.

There are several foods you will need to avoid during your orthodontic treatment. You will want to avoid hard foods such as candies, popcorn, nuts, ice, chips, corn on the cob, etc. Hard foods can break your brackets and wires as you bite down on their hard surfaces. You will also want to stay away from sticky foods such as gum, taffy, gummies. Sticky foods can pull your brackets away from your teeth.