Child Dentistry & Fluoride

A child’s first regular dental visit is typically just after their third birthday, though the American Academy of Pediatric Dentistry recommends the first visit by the first birthday. Early examination and preventive care can help protect your child’s smile now and in the future.

Your Child’s First Visit

The first visit is usually short and involves very little treatment. A gentle examine of your child’s teeth and gums along with X-rays may be taken to reveal decay and check on the progress of your child’s permanent teeth under the gums.

A basic cleaning application of topical fluoride may be given to help protect the teeth against decay. We will make sure your child is receiving adequate fluoride at home and most important of all, we will review with you how to clean and care for your child’s teeth.

Parents/Guardians may be asked to sit in the dental chair and hold your child during the examination. You may also be asked to wait in the reception area during part of the visit so that a relationship can be built between your child and your dentist.

  • Examine your child’s mouth, teeth and gums.
  • Evaluate adverse habits like thumb sucking.
  • Check to see if your child needs fluoride.
  • Teach you about cleaning your child’s teeth and gums.
  • Suggest a schedule for regular dental visits.

Preventative Care

Tooth decay and children no longer have to go hand in hand and at the office of Dr. Hayes we are concerned with all aspects of preventive care.


We use the latest in dental sealant technology to protect your child’s teeth. Dental sealants are space-age plastics that are bonded to the chewing surfaces of decay-prone back teeth. This is just one of the ways we will set the foundation for your child’s lifetime of good oral health.

Silver Diamine Fluoride

In August 2014, SDF was cleared by the Food and Drug Administration (FDA) as a desensitizing agent, similar to fluoride varnish 20 years ago, to treat and prevent caries. It has been used outside the United States for this purpose for some time now and has been proven quite effective. Please review the link below to learn more.

  • More About Silver Diamine Fluoride

    What is SDF?
    Silver diamine fluoride (SDF) has been used extensively outside the United States for many years for caries control. 1 SDF is
    a colorless liquid containing silver particles and 38% (44,800 ppm) fluoride ion that at pH 10 is 25% silver, 8% ammonia,
    5% fluoride, and 62% water. This is referred to as 38% SDF.
    What is the strength of evidence for SDF?
    In clinical trials, SDF applied directly to the cavitated lesion outperformed fluoride varnish for the non-surgical arrest of
    caries in children and older adults. In addition, SDF demonstrated impressive caries prevention to adjoining teeth not
    receiving direct application of SDF. 1,2 At least eight published reports of randomized clinical trials consistently
    demonstrated very high rates of caries arrest. 3,4,5,6,7,8,9,10 Although a 2016 systematic review and meta-analysis of clinical
    trials in children concluded 38% SDF applied at least once per year effectively arrested more than 65% of active caries, 11
    there is no consensus for the number and frequency of applications for optimal caries control. 12 A critical summary of the
    systematic review, published in early 2017, called for more well-designed and well-conducted clinical trials comparing the
    effectiveness of SDF with no treatment or other caries management approaches in populations with varying caries risk,
    lesion severities, and other fluoride exposures. 12
    Does SDF have FDA Approval?
    In August 2014, SDF was cleared by the Food and Drug Administration (FDA) as a desensitizing
    agent, similar to fluoride varnish 20 years ago. 13 As of early 2017, there is only one SDF product on
    the U.S. market. The FDA granted the manufacturer “breakthrough therapy status,” facilitating
    clinical trials of SDF for caries arrest. It is used off-label for caries arrest.
    What are indications for SDF use?
    SDF arrests active carious lesions painlessly and without local anesthetic, as long as the teeth are
    asymptomatic, avoiding or delaying traditional surgical removal of caries. This intervention can be
    applied to teeth as soon as caries is detected. SDF is indicated in treating caries in people who are
    unable to access dental treatment or tolerate conventional dental care, including very young
    “precooperative” children, persons with intellectual/developmental disabilities, or older adults.
    What are contraindications for SDF therapy?
    No adverse events using silver compounds have been reported in more than 80 years of use in
    dentistry. 1,14 Silver allergy is the only known contraindication. 2 Teeth with evidence of pulpitis or
    pulpal necrosis are not appropriate for SDF treatment and require surgical treatment. Similarly,
    teeth with deep lesions where the carious dentin has been excavated are not candidates for SDF,
    due to the ammonia content and high pH, which may create a pulpal reaction.
    Are there other considerations for SDF therapy?
    The silver particles in SDF darken active dental caries and if touched, temporarily stain unprotected
    soft tissues, which may be a concern with patient/parent acceptance. It does not stain sound
    enamel. See the UCSF protocol (below) for additional information. Some individuals report a
    transient metallic taste after application of SDF. SDF will also permanently stain floors, clothing, and
    Are there recommended protocols?
    All providers applying SDF need appropriate training. In January 2016, for example, the University of
    California San Francisco (UCSF) School of Dentistry published a thorough clinical protocol for the use of SDF 14 (watch the application of SDF on YouTube). The American Academy of Pediatric Dentistry is currently conducting a review and, depending on the evidence, may include clinical guidelines (personal communication, Norman Tinanoff, University of Maryland, 3/1/2017).

    Can SDF be used in addition to fluoride varnish, other professionally applied fluorides, or dental sealants?
    SDF is a new addition to professionally applied topical fluoride products available in the U.S. While there is little evidence
    in the literature to support additional efficacy, some practitioners apply fluoride varnish or fluoride in addition to SDF
    treatment, but not to the teeth already treated with SDF. For any patient with active caries, UCSF’s protocol includes
    replacement of fluoride varnish with the application of silver diamine fluoride to active lesions only. 14 Dental sealants are
    more effective than SDF for caries prevention in non-cavitated teeth. 15,16 Compared to SDF, the use of dental sealants is
    firmly supported for long term caries prevention by the quantity and quality of evidence available. 17
    Who can apply SDF?
    According to the rules and as governed by their state medical and/or dental practice acts, dentists, dental hygienists,
    physicians, nurses, and their assistants may be permitted to apply fluorides and SDF. Dental hygienists in most states
    whose Medicaid programs cover SDF application may be permitted to apply SDF under the same authorization or
    restrictions as other topical fluorides. 18

    1 Rosenblatt A, Stamford TC, Niederman R. Silver diamine fluoride: a caries “silver-fluoride bullet.” J Dent Res. 2009;88(2):116—125.
    2 Mei ML, Lo EC, Chu CH. Clinical use of silver diamine fluoride in dental treatment. Compend Contin Educ Dent. 2016;37(2):93—98.
    3 Yee RC, Holmgren C, Mulder J, Lama D, Walker D, Helderman W. Efficacy of silver diamine fluoride for arresting caries treatment. J Dent Res.
    4 Zhang W, McGrath C, Lo EC, Li JY. Silver diamine fluoride and education to prevent and arrest root caries among community-dwelling elders. Caries
    Res. 2013;47(4):284–290.
    5 Santos Dos VE, de Vasconcelos FMN, Ribeiro AG, Rosenblatt A. Paradigm shift in the effective treatment of caries in schoolchildren at risk. Int Dent J
    6 Chu CH, Lo ECM, Lin HC. Effectiveness of silver diamine fluoride and sodium fluoride varnish in arresting dentin caries in Chinese pre-school
    children. J Dent Res. 2002;81(11):767–770.
    7 Llodra JC, Rodriguez A, Ferrer B, Menardia V, Ramos T, Morato M. Efficacy of silver diamine fluoride for caries reduction in primary teeth and first
    permanent molars of schoolchildren: 36-month clinical trial. J Dent Res. 2005;84(8):721–724.
    8 Lo EC, Chu CH, Lin HC. A community-based caries control program for pre-school children using topical fluorides: 18-month results.
    J Dent Res. 2001; 80(12):2071–2074.
    9 Zhi QH, Lo EC, Lin HC. Randomized clinical trial on effectiveness of silver diamine fluoride and glass ionomer in arresting dentine caries in preschool
    children. J Dent. 2012;40(11):962–967.
    10 Li R, Lo EC, Liu BY, Wong MC, Chu CH. Randomized clinical trial on arresting dental root caries through silver diammine fluoride applications in
    community-dwelling elders. J Dent. 2016 Aug;51:15-20. doi: 10.1016/j.jdent.2016.05.005. Epub 2016 May 18.
    11 Gao SS, Zhang S, Mei ML, Lo EC, Chu CH. Caries remineralisation and arresting effect in children by professionally applied fluoride treatment – a
    systematic review. BMC Oral Health. 2016;16:12.
    12 Cheng LL. Limited evidence suggesting silver diamine fluoride may arrest dental caries in children J Am Dent Assoc. 148(2) Feb 2017.
    13 Wittach CM, Burkle CM, Lanier WL. Ten common questions (and their answers) about off-label drug use. Mayo Clin Proc. 2012;87(10):982—990.
    14 Horst JA, Ellenikiotis H, Milgrom PL. UCSF protocol for caries arrest using silver diamine fluoride: rationale, indications and consent. J Calif Dent
    Assoc. 2016;44(1):16-28.
    15 Liu BY, Lo ECM, Chu CH, Lin HC. Randomized trial on fluorides and sealants for fissure caries prevention. J Dent Res. 2012;91(8):753-758.
    16 Monse B, Heinrich-Weltzien R, Mulder J, Holmgren C, van Palenstein, Helderman WH. Caries preventive efficacy of silver diammine fluoride (SDF)
    and ART sealants in a school-based daily fluoride toothbrushing program in the Philippines. BMC Oral Health. 2012 Nov 21;12:52.
    17 Twetman S. The evidence base for professional and self-care prevention–caries, erosion and sensitivity. BMC Oral Health. 2015;15 Suppl 1:S4. doi:
    10.1186/1472-6831 15-S1-S4. Epub 2015 Sep 15.
    18 American Dental Hygienist’s Association. Dental Hygiene Practice Act Overview: Permitted Functions and Supervision Levels by State. Rev. Dec.
    2016. Accessed 5.3.2017.


Most of the time cavities are due to a diet high in sugary foods and a lack of brushing. Limiting sugar intake and brushing regularly, of course, can help prevent unnecessary cavities.

The longer it takes your child to chew their food and the longer the residue stays on their teeth, the greater the chances of getting cavities. Be sure to follow these simple tips:

  • Limit frequency of meals and snacks.
  • Encourage brushing, flossing and rinsing.
  • Watch what your child drinks.
  • Avoid giving your child sticky foods.
  • Make treats part of meals.
  • Choose nutritious snacks.

Frequently Asked Questions

  • How will my child's teeth develop?

    The first baby teeth that come into the mouth are the two bottom front teeth. You will notice this when your baby is about 6-8 months old. Next to follow will be the 4 upper front teeth and the remainder of your baby’s teeth will appear periodically. They will usually appear in pairs along the sides of the jaw until the child is about 2 1/2 years old.

    At around 2 1/2 years old your child should have all 20 teeth. Between the ages of 5 and 6 the first permanent teeth will begin to erupt. Some of the permanent teeth replace baby teeth and some don’t. Don’t worry if some teeth are a few months early or late as all children are different.

  • Are baby teeth really that important?

    Baby teeth are important as they not only hold space for permanent teeth but they are important to chewing, biting, speech and appearance. For this reason it is important to maintain a healthy diet and daily hygiene.

  • What should I tell my child about the first dental visit?

    We are asked this question many times. We suggest you prepare your child the same way you would before their first haircut or trip to the shoe store. Your child’s reaction to his first visit to the dentist may surprise you, here are some “First Visit” tips:

    • Take your child for a “preview” of the office.
    • Read books with them about going to the dentist.
    • Review with them what the dentist will be doing at the time of the first visit.
    • Speak positively about your own dental experiences.

  • How can I prevent cavities?

    Watch your child’s diet to eliminate high levels of fermentable carbohydrates (sugars), encourage a daily routine of dental care, never allow your child to go to bed with anything other than water, start cleaning your child’s mouth from their very first meal.

  • Should I worry about thumb sucking or pacifier?

    Thumb sucking or a pacifier habit are normal for infants and young children. The habit should be discouraged by the age of four in order to reduce the risk of bite problems or crowded teeth.

  • Should my child be using fluoride toothpaste?

    If your child is unable to spit, fluoridated toothpaste should be avoided and a gum cleanser or non-fluoridated toothpaste should be substituted.

  • We have well water at home. Do we need fluoride drops?

    That depends. Some well water has fluoride in it and the water should be tested for fluoride content prior to receiving fluoride supplements for your child. Additionally, if your child does not drink the well water and receives adequate fluoride levels from the beverages they consume, they may not need fluoride supplementation.

  • What are the risks of too much fluoride?

    When a child receives too much fluoride (either through swallowing excessive amounts of toothpaste/fluoride rinse or ingesting prescription fluoride when drinking water contains fluoride) the enamel is weakened in the developing teeth still under the gums in the bone.

    These teeth may be rough, pitted, discolored and weak. These teeth are at high risk of developing cavities and need to be treated very carefully. Fluoride is an important part of caring for teeth. It needs to be carefully regulated in your child’s environment to promote a healthy smile.

  • How do I protect their teeth during sports?

    Mouthguards are the best way to protect your child’s teeth during sport events. Several types of mouthguards exist and your dentist can discuss which mouthguard would suit your child best.

  • What if a permanent tooth is knocked out?

    Try to find the tooth. Gently pick it up by the crown (try not to touch the root). Rinse it with plain water (no soap or cleanser), do not dry it. Place it back in your child’s mouth either in the socket or in between the cheek and gum. Cover it gently with gauze or paper towel to prevent swallowing of the tooth.

    If unable to place it back in the mouth, put it in a container with milk, saliva or plain water. Call your dentist immediately for care. The sooner the tooth can be treated, the higher the chance it can be saved.

  • How safe are dental xrays for my child?

    There is very little risk in dental xrays. This office uses a digital system that greatly reduces the amount of radiation exposure your child receives with each xray. Living in a brick house or taking a trans-coastal flight exposes your child to higher levels of radiation than the average set of dental xrays. Children tend to need xrays more often than adults since their mouths change more rapidly.