Dental 101

Yes, just as you would visit a pediatrician for your child’s health needs, you would visit a pediatric dentist for their oral health needs. A pediatric dentist has completed at least four years in dental school and an additional two years of residency designed specifically around the growth and development of children. Pediatric dentists are dedicated to the oral health of children from infancy through the teen years.

After two years of specialty training, pediatric dentists dedicated to pursuing excellence in their field may voluntarily undergo a rigorous process to become certified by the American Board of Pediatric Dentistry (ABPD).

The ABPD requires that all members remain current in the latest developments in care, research, and technology. Once certified, in order to remain in good standing, additional continuing education in the field of pediatric dentistry above and beyond the minimum required to be a pediatric dentist must be undertaken on a yearly basis. Learn more at the American Board of Pediatric Dentistry.

Dr. Khoury is a Board Certified Pediatric Dentist!

According to the American Academy of Pediatric Dentistry, your child’s first visit to the dentist should happen before his or her first birthday. The general rule is six months after eruption of the first tooth. Taking your child to the dentist at a young age is the best way to prevent problems such as tooth decay.

While it is true that Primary Teeth, i.e. “Baby Teeth”, will fall out, what most do not realize is that the majority of the primary teeth will not shed before age 10-13. Therefore, it is extremely important to maintain the health of the primary teeth at an early age. Neglected cavities can, and do lead to problems that affect developing the permanent teeth.
Primary teeth are important for proper chewing and eating, development of speech, maintaining space for the permanent teeth, permitting normal development of the jaw bones and muscles, and of course self-esteem.

Children’s teeth begin developing in the womb. Your babies’ first teeth may begin to erupt as early as 4 months, and by and large, all 20 primary teeth have erupted by 3 yrs. of age, although pace and order of eruption varies.

Permanent teeth generally begin to appear around your child’s 6th birthday, and continue until their 21st birthday with the eruption of their wisdom teeth. This is why regular wellness visits are crucial for the health of your child’s permanent teeth.

Baby bottle decay, otherwise known as “bottle rot”, is a common finding amongst children who have frequent exposure to liquids and foods that can cause cavities, including milk, fruit juice, formula, and even breast milk. The sugars can create an acidic environment, and can cause decay to spread throughout the teeth. This is most commonly seen in the top four front teeth, and is often associated with children that are put to sleep with the bottle, or night nurse without brushing after.

It is important to wipe/brush your child’s teeth after consumption of milk or juice. If you must give the baby a bottle as a comforter at bedtime, it should contain only water. This can be achieved overtime by diluting the milk with water gradually.

Sippy cups should only be used as a transitional item, and should be only be used until your infant’s first birthday. Sippy cups should only be filled with water. If your child uses a sippy cup throughout the day, fill the sippy cup with water only, as drinks with sugar can promote tooth decay.

The most common theme in thumb sucking is it is a very natural, self-soothing reflex that happens in infants as a form of safety and comfort. Many children begin sucking their thumbs even in utero.  Many parents tend to oversee the potential problems it can cause since the child will use this method to fall to sleep. However, if the habit persists beyond the age of 2-3 years, there can be permanent damage to your child’s craniofacial development.

WHEN DOES THUMB SUCKING BECOME A REAL ISSUE?  

Evidence shows that children who cease the habit by roughly age 3-4 tend not to display any permanent skeletal effects, however this relies heavily in part to not only the duration, and frequency, but also the force of thumb sucking. For example, the child who is sucking their thumb aggressively, and audibly for hours on end, will have a very different skeletal outcome to those who are passively resting their thumb in their mouth right before bedtime. This is why consulting your pediatric dentist early on is crucial in preventing any permanent skeletal discrepancies like open bites or crossbites.

WHAT SHOULD YOU DO AS A PARENT?

We see a decline in thumb-sucking in school aged children due to the social implications surrounded by the habit. However, if your child is still sucking their thumb into age 5,6 + make sure you encourage your children in a positive manner. Children at this age must make a conscientious effort to drop the habit, and many times cannot be forced to change. Informing your child that their habit could cause permanent damage to their teeth and developing jaw, in conjunction with positive reinforcement charts often does the trick.

Please keep in mind that a child must be motivated to stop for any of the below strategies to work.

Keep it positive. It is difficult for a grown up to break a habit, and hard for a child too. Patience and understanding with positive praise when your child is not sucking is best.

• Try to determine the underlying cause is and address it. Children tend to suck their thumbs when they are feeling insecure or bored.
• If pacifier use is the issue, try trimming the tip of the pacifier. This will deflate the pacifier and make it less appealing. Gradually trim off more and more until the child no longer wants the pacifier.
• A reward calendar where the child can track days they have avoided thumb sucking with marks or stickers. Agree on a motivating reward ahead of time and after 30 consecutive days, enjoy the reward. I
• Reminder finger polish, like Mavala, available at www.amazon.com, has a bitter taste which serves as a reminder not to place fingers or thumb in the mouth. Mavala is applied regularly 2-3 times a day on the nail and surrounding skin. This helps the child to become aware of their habit to help them to stop.
• Khoury and her team can encourage your child to stop sucking and explain why it is important to stop the habit too.

Suggestions for nighttime:

• Try placing a band-aid on the favorite finger or a sock or mitten gently taped at the base of the favored hand or an ace bandage gently wrapped around an elbow (which prevents the arm from bending at the elbow to get a thumb in). These can be tracked on a reward calendar for each night the child is able to keep it on and dry.

These suggestions are usually enough to successfully stop the habit. If it is not enough, Dr. Khoury can help with other strategies, such as fabricating a habit appliance.

Preventative dentistry is especially important for special needs children and adults. Unlike many of the health issues faced by patients with special needs, dental disease is preventable.

As a parent or caregiver, you may have concerns about your child’s ability to tolerate a dental visit. Please do not postpone dental care. Dr. Khoury is always available to discuss any concerns you may have prior to meeting with you and your child. Treatment is always a team effort, and the sooner we can collaborate the better the outcome. Dr. Khoury and her team are highly experienced in caring for patients with special needs, and are happy to provide the extra TLC you and your child need to feel comfortable.

Some tips to help with oral care:

• Specialized Care Co, Inc. is an excellent resource with educational videos on caring for another person’s teeth, oral care kits and adaptive surround toothbrushes.
• If your child or adult you care for cannot be brushed with toothpaste, due to an inability to spit or gagging, brush with a fluoride rinse.
• Talk to Dr. Khoury for more suggestions, she is happy to make individualized recommendations for your child or adult’s particular needs.

Proper oral hygiene removes bacteria and the left over food particles that combine to create cavities. For infants, use a wet gauze or clean washcloth to wipe the plaque from teeth and gums. Avoid putting your child to bed with a bottle filled with anything other than water.

For older children, brush their teeth at least twice a day, and introduce flossing before age three to ensure excellent oral hygiene. Also, watch the number of snacks containing sugar that you give your children.

The American Academy of Pediatric Dentistry recommends visits to the pediatric dentist every six months, beginning at your child’s first birthday. Routine visits will set up your child for a lifetime of good dental health.

Your pediatric dentist may also recommend protective sealants or home fluoride treatments for your child. Sealants can be applied to your child’s molars to prevent decay on hard to clean surfaces.

Once your child’s teeth start erupting, you can begin to clean them by wiping them with a wet washcloth, a tooth wipe or soft child’s toothbrush and a smear of fluoride free baby toothpaste.

Starting at age two or three, you can begin to teach your child to brush. You will still need to brush before or after their turn. Use one hand to draw the cheek away and the other to move the brush in circles or back and forth strokes at a 45 degree angle towards teeth and gums. It is often easiest to allow your child to lay down on your lap while brushing their teeth.

Children brush by themselves when they have the manual dexterity to tie their own shoelaces or write in cursive, usually around ages seven to eight years old. It is still best to supervise their brushing and help as needed. Brushing two times a day is recommended, once after breakfast, and again before bed.

Tooth Brushing should be performed twice a day, using a fluoride toothpaste approved by the American Dental Association. Due to the delicacy of young tooth enamel, toothpastes with harsh abrasives such as whitening toothpaste should be avoided until well into the teen years. It is recommended that for children younger than 3, you place a thin layer of toothpaste that barely covers the bristles like “butter on toast”. For children older than three who are better able to spit, a “pea-sized” amount may be utilized.

If the sides of teeth are touching together, toothbrush bristles cannot reach between to clean. Any spots where teeth are touching should be flossed daily. Baby teeth usually begin to touch around age three, especially between the back molars. Dr. Khoury recommends practicing your flossing techniques with your child as young as two years. In the beginning, a parent will need to floss. As a child gets older, parents can supervise and allow their child to floss. This skill is usually mastered by middle school.

Bacteria in plaque break down sugars to produce acid. If the acid is not removed, the tooth enamel weakens and then breaks down over time, forming a cavity. Brushing and flossing physically remove the sugars, plaque and acid from the teeth.

In order to maintain optimal oral health for your child it is imperative that you focus on what they eat, and more importantly how often they eat it. Fluctuations to the pH of our mouths occur as soon as any food or liquids enter our mouth. It can take up to 20 minutes for our mouths to return to neutral pH. Therefore the more often your child is snacking or “grazing” the higher the risk of dental cavities.

Mouth-Healthy Foods and Drinks

The best food choices for the health of your mouth include cheeses, proteins such as chicken, and nuts. These foods are thought to protect tooth enamel by providing the calcium and phosphorus needed to remineralize teeth (a natural process by which minerals are redeposited in tooth enamel after being removed by acids).

Other food choices include firm/crunchy fruits, (for example, apples and pears,) and vegetables. These foods have a high water content, which dilutes the effects of the sugars they contain, and stimulate the flow of saliva (which helps protect against decay by washing away food particles and buffering acid). Acidic foods, such as citrus fruits, tomatoes, and lemons, should be eaten as part of a larger meal to minimize the acid from them.

Poor food choices include bananas, raisins, and other dried fruits, candy — lollipops, hard candies, and mints — cookies, cakes, pies, breads, muffins, potato chips, pretzels, and french fries. These foods contain large amounts of sugar and/or can stick to teeth, providing a fuel source for bacteria. Be mindful of Gummy Vitamins as well, as these often have sugars to improve tastes and can stick to teeth.

The best beverage choices include water (especially fluoridated water), and milk (in moderation). Limit your consumption of sugar-containing drinks (less than 4 oz. per day for young children), including soft drinks, juice, lemonade, and sports drinks or tea with added sugar. Also, avoid day-long sipping of sugar-containing drinks — day-long sipping exposes your teeth to constant sugar and, in turn, constant decay-causing acids.

Xylitol is a five carbon sugar found naturally amongst many fruits and vegetables as well as birch. It is a ‘tooth-friendly” natural sweetner found in many toothpastes, chewing gums, and candies.

It assists in the inhibition of certain strains of cavity-producing bacteria, and in effective doses can actually assist in remineralizing teeth, and keeping them from being attacked by plaque.

If your child is allowed treats, consider using treats sweetened with xylitol, such as Drjohns.com that can be found at your local health food stores. Additionally several toothpastes that are free of dyes or saccarines ustilize xylitol such as tanner’s tasty paste.

Fluoride is a natural element, and has been shown to be valuable to teeth in small, doses. However excessive fluoride ingestion by preschool-aged children can lead to dental fluorosis, which is a chalky white to even brown discoloration of the permanent teeth.

While topical fluoride in toothpaste can be beneficial in protecting teeth, children who live in water fluoridated communities, and are consuming fluoride-fortified foods or beverages, such as infant formulas, may be at an increased risk. One way for parents to be aware and to reduce the risk of fluorosis is to obtain fluoride level test results for your drinking water, and reading labels to foods or beverages your child regularly consumes.

Fluoride varnish can be beneficial during dental visits if there is evidence of a heightened risk for cavities. Feel free to ask one of our team members for more information.

Cavities are just one of the many issues that are often uncovered by radiographs. The eruption pathway of permanent teeth, the bone level, and the evaluation of trauma or pathology are just a few examples of what can be missed without proper radiographs. X-rays allow dentists to diagnose and treat health conditions that cannot be detected during a visual examination. If such dental issues are found and treated early, dental care is more comfortable for your child and more affordable for you.

The frequency of dental x-rays varies from child to child, however those with a high risk of tooth decay will typically require dental x rays every six months to a year.

Risks and benefits must always be weighed when discussing any kind of treatment. At The Brush Stop Dental, we are particularly careful to minimize the exposure of our patients to radiation, by utilizing the most advanced, digital x-rays units that emit the lowest possible amount of radiation in the industry (less than .05 millirems). With lead body aprons to shield your child’s body, equipment that effectively filters and reduces the amount of radiation received, and the high-speed film assures that your child receives negligible radiation.

In order to reference radiation exposure, it is important to define the units at which radiation is measured. A millirem is a unit of absorbed radiation dose.

A person would get this amount of radiation from:

• three days living in Atlanta
• About seven hours in certain areas of Brazil
• If you live at high elevations, like Denver, Colorado, you are naturally exposed to about 50-70 more millirems per year than living in, say, Seattle, Washington (sea level).
• Being next to the Rocky Mountains will net you exposure to about 40 extra millirems per year, due to the uranium in the soil.
• Every U.S. coast to coast round trip flight will expose you to about 10 extra millirems per trip.
• On average, a person living in the United States will naturally be exposed to somewhere around 360 millirems (36,500 bananas) of radiation per year, with the vast majority of that (300 millirems or so) coming from the sun, soil, rocks, and other natural sources.
• If you sat about 1 inch away from your tv-set, you’d receive about .5 millirems per hour.

Parents are welcome to accompany their child for treatment visits. If you choose to be present, we suggest the following In Office Parent Guidelines:

Children do much better when they know what to expect. We use the TELL SHOW DO method. We TELL your child about the procedure, in an age appropriate manner. Next we SHOW, which introduces the procedure in an exploratory way to examine the sound, smell, sight or sensations. Then we DO the treatment, carefully following each step as described.

Kid Friendly Term and Matching Instrument/Procedure

• Jelly = topical anesthetic
• Tooth pillow = bite block
• Astronaut nose/ elephant nose = nitrous oxide
• Sleepy Juice= Anesthetic
• Princess tooth/ Superhero tooth = crown
• Mr. Thirsty/ straw = suction
• Sugar Bug = Cavity
• Flash light = curing light
• Tickle brush = prophy cup
• Whistle brush = high speed handpiece
• Bouncy brush = slow speed handpiece

We ask that you avoid using words that could generate fear, such as “needle” or “shot”, “hurt” or “won’t hurt” and “don’t be afraid”.

We welcome parents to be near during treatment; however, it is important that Dr. Khoury and her team are given the chance to establish a closer rapport with your child. Our purpose is to gain your child’s confidence and overcome apprehension. For many children, the voice of a parent will always be the one they choose to hear. Thus, we kindly ask for your help by being a quiet observer in the room and allowing your child to focus their attention on Dr. Khoury and her team. To support this, we ask that you remain behind the dental chair out of direct view. We have provided seating directly behind every operatory so that you may be present, and ensure your child’s safety, while allowing us to create a trusting bond with your child. For the safety and privacy of all patients, other children who are not being treated must remain in the reception room with a supervising adult.

These are ways that you can actively help make your child’s visit a success.

Developing malocclusions, or bad bites, can be recognized as early as 2-3 years of age. Often, early steps can be taken to reduce the need for major orthodontic treatment at a later age. Many minor issues can be treated as young as 5 years of age; however, for more extensive treatment, we follow the recommendations of the American Association of Orthodontics, that children should be evaluated for full comprehensive orthodontics by age 7.

Once a child begins to participate in recreational activities and organized sports, injuries can occur. A properly fitted mouth guard, or mouth protector, is an important piece of athletic gear that can help protect your child’s developing jaw and smile, and should be used during any activity that could result in a blow to the face or mouth.

Mouth guards assist in the prevention of broken teeth, and injuries to the lips, tongue, face or jaw. A properly fitted mouth guard will stay in place while your child is wearing it, making it easy for them to talk and breathe.

Ask Dr. Khoury about how we can help make a custom mouth protector for pre-teen/teen.

If your child is seemingly tired throughout the day, displays bags or dark under-eye circles, frequently experience nasal congestion, breaths through their mouth, or wakes up multiple times in the middle of the night, they may be suffering from sleep apnea. The next time your child falls asleep, observe to see if they are breathing through their nose or through their mouth. Mouth breathing with snoring or grinding, may be indicators of sleep apnea.

Sleep apnea is a condition in which a person’s breathing repeatedly stops during sleep. It is more commonly seen in adults, but children suffer from it as well.

It may be caused by an obstruction in the airway, such as enlarged adenoids and tonsils, or the size of the airway, or tongue muscle tone or nasal congestion. Left untreated in children, it can hinder growth and development, and can cause detrimental damage to the heart, brain and other organs.

A child who breathes through their mouth usually does not sleep well. This tiredness can affect energy levels, school performance, and can cause behavior and attention problems that may be misdiagnosed. If sleep apnea goes untreated, dental health issues such as a long face, gummy smile, gingivitis, narrow palate, crossbites and misaligned teeth may result as well.

Dr. Khoury is trained to assess your child’s airway and will work with an ear-nose-throat doctor (ENT), pediatric sleep specialist or orthodontist for corrective treatment. An overnight sleep study and/or an x-ray of the child’s head and neck to see whether the airway is too narrow or blocked, may be indicated to further diagnose. If an airway obstruction is present, removing tonsils or other airway obstructions can help. Weight management, medicines to relieve nasal congestion, special appliances to expand the arches and positional therapy, may be helpful to open your child’s airway for proper rest, growth and development.

Nothing is more stressful than a child with an injury. What’s worse, most injuries occur at the most inopportune times! We completely understand, and that is why we have introduced the ToothPIC! When your child experiences a dental injury, and you aren’t sure whether it needs to be addressed right away feel free to call our office, or “snap a pic” with your phone and email us! We are available to you 24 hours a day 7 days a week.

Inspect the tooth for any lodged food or debris. Evaluate the timing of the toothache, and document.

• Does it hurt most when child is eating or drinking?
• Is it sensitive when they bite down?
• Is the gum tissue red or swollen?
• Is the pain spontaneous and keeping them up at night?

Answers to these questions allow your pediatric dentist to give a more accurate diagnosis.

Apply ice to injured areas to help control swelling. If there is bleeding, apply firm but gentle pressure with a gauze or cloth. In many instances, there is no need for further treatment, but if bleeding cannot be controlled by simple pressure, call a doctor or visit the hospital emergency room.

Contact your pediatric dentist during business hours. This is not usually an emergency, and in most cases, no treatment is necessary.

If possible, find the tooth. Time is of the essence for these emergencies, and your pediatric dentist should see the child WITHIN 1 HOUR for best chance of success. Hold the tooth by the crown, not by the root. You may GENTLY rinse the tooth with water only. DO NOT clean with soap, scrub or handle the tooth unnecessarily. Inspect the tooth for fractures. If it is sound, try to reinsert it in the socket. If you cannot reinsert the tooth, transport the tooth in a cup containing the patient’s saliva or milk until you can see your dentist.

Contact your pediatric dentist.

Time is an essential factor here if the nerve of the tooth is exposed; therefore, contact your pediatric dentist immediately. Taking appropriate steps early can prevent infection and reduce the need for extensive dental treatment. If possible, locate and save any broken tooth fragments and bring them with you to the dentist.

Keep the jaw from moving and take your child to the nearest hospital emergency room.

After treatment, the local anesthetic can often take up to one to two hours to subside. For children new to this, it is very easy to accidentally chew, bite or scratch their lips or tongue, causing severe trauma to the tissues. It is recommended that your child avoid foods that require chewing during this period.

Please do not hesitate to call the office if there are any questions.

• Keep your child away from sticky, chewy, hard, or crunchy foods, such as gum, caramels, Milk Duds, licorice, gummy bears, jelly beans, beef jerky, nuts, popcorn, ice, hard candies, jaw breakers, and corn on the cob, as these can break down the cement or distort the wires of the space maintainer.
• Tell your child to avoid pulling on or poking the wire(s).
• If your child’s space maintainer comes loose or breaks, call our office so we can evaluate and decide whether the appliance needs to be reinforced or rebuilt.

• Your child should have a soft diet the remainder of the day.
• The gums may appear red and feel sore after the placement of the crown. This is normal and should improve within a week. If child indicates their gums are sore, administer Children’s Tylenol, or Motrin as directed on the bottle.
• Keep the area clean with brushing and flossing. Dental plaque should be removed with brushing. The gums may bleed initially. This is normal and brushing should not be discontinued if this occurs.
• Your child may describe the crowns as feeling different. Speech and bite may temporarily be affected. Please allow time for your child to acclimate to their new crown.
• Your child may have initial sensitivity to hot or cold foods and/or liquids. This will subside over a few weeks as the tooth acclimates to the new crown/s.
• Your child should avoid sticky candies, gums, etc. They may weaken the adhesive cement that was used to permanently place the crown on the prepared tooth. If the crown does come off, save the crown and call our office. Do not wait too long as the tooth without the crown may move in the mouth and require the tooth to be re-prepared for a new crown; if a crown is left off a tooth too long it can result in tooth loss.

• Often when a tooth is traumatized there are several things to be aware of, including; mobility in teeth, darkening or greying of teeth, or swelling in gum tissue above the tooth. These are often signs that the nerve tissue is dying.

  It is imperative that your child be seen by the pediatric dentist as soon as possible, and will likely need to be on a soft diet for up to one to two weeks. Many teeth need to be treated gently as you would a sprained ankle. Avoiding foods and beverages that are too hot, too cold, too hard and too acidic will assist in the most optimum healing.

  Extractions:

  • Be mindful of numbness for up to 2-4 hours post extraction
  • Do not use a straw or spit for at least 24 hours
  • Avoid carbonated beverages, spicy foods, acidic foods, or crunchy foods
  • Avoid tampering with extraction site
  • Bleeding: tooth may ooze for up to 24 hours. This is normal, and expected. If bleeding occurse, place guaze over extraction site and bite down to allow pressure to stop bleeding. This should be done for 10 minutes.
  • The day of the extraction should be a movie day, with little strenuous activity. Sports should be kept to a minimum.

  If necessary, OTC use of Children’s Tylenol, Advil, or Motrin as directed for the age of the child can be sued for discomfort.

Please do not hesitate to call the office if there are any questions.

• Be mindful of numbness for up to 2-4 hours post extraction
• Do not use a straw or spit for at least 24 hours
• Avoid carbonated beverages, spicy foods, acidic foods, or crunchy foods
• Avoid tampering with extraction site
• Bleeding: tooth may ooze for up to 24 hours. This is normal, and expected. If bleeding occurse, place guaze over extraction site and bite down to allow pressure to stop bleeding. This should be done for 10 minutes.
• The day of the extraction should be a movie day, with little strenuous activity. Sports should be kept to a minimum.

If necessary, OTC use of Children’s Tylenol, Advil, or Motrin as directed for the age of the child can be sued for discomfort.

Please do not hesitate to call the office if there are any questions.

Sealants decrease the risk of decay on the biting surfaces of the back molars by place a thin covering over the tooth. Poor oral hygiene, or sticky and sugary foods can break down sealants, because they are chemically bonded to the tooth, not mechanically drilled into the tooth.

Sealants will be evaluated at every visit, and should be replaced every few years.

According to the American Academy of Pediatric Dentistry (AAPD), every child should be seen by a pediatric dentist no later than one (1) year of age. Getting an early start may lead to detection of early stages of tooth decay that can be easily treated, stopped or even reversed. Regular dental care is an important step on the road to teaching your child healthy habits for life.

Dental decay is the single most common chronic childhood disease- 5 times more common than asthma. The most important reason to see a dentist so early is to begin a thorough prevention program. Dental problems can begin early, and once a child’s diet includes anything other than breast-milk, erupting teeth are at risk for decay. The earlier the dental visit, the better the chance of preventing dental problems. Like a “well baby” check up visit at the pediatrician, the first visit allows for counseling and guidance that lays the groundwork for your child to have a healthy smile for life.

At the first visit, we will get to know you and your child, as much as you will get to know us. Your appointment will begin with a tour of the office, and then your child will be seated at the dental chair and allowed to pick out a movie to watch. Dr. Khoury will thoroughly review your child’s medical and dental history information, and gently examine your child’s teeth, gum tissue and dental development. Dr. Khoury and her team will then decide the extent of treatment to be rendered at the visit.

An essential part of pediatric dentistry is caring for people with significant medical, physical, or mental disabilities. Our team has specialized training to allow us to address special needs and provide the very best care possible. At The Brush Stop, we realize that treatment and prevention is a team-approach, and Dr. Khoury is always available to talk to parents about any specific needs your child may have before your visit.

Preventative dentistry begins with the first tooth. Visit your pediatric dentist once your child’s first tooth appears or by age one. You will learn how to protect your baby’s dental health. The earlier the dental visit, the better the chance of preventing dental disease and helping your child build a cavity-free smile.

After evaluating your child’s dental health, Dr. Khoury will design a personalized program of home care for your child. This program will include brushing and flossing instructions, diet counseling, and if necessary, fluoride recommendations. By following these directions, you can help your child establish healthy habits for life.