Wisdom Teeth

Wisdom TeethAs your child reaches his or her late teens or early 20’s, wisdom teeth may appear. In some individuals, all four erupt, while in others, anywhere from one to three teeth may emerge. The appearance of wisdom teeth is generally a painless experience but, for others, the eruption of wisdom teeth brings major discomfort and increases the risk of dental disease.

The Purpose of Wisdom Teeth

Our ancestors’ diets were quite different than ours. They ate rough foods, such as leaves, nuts, seeds and meat, on a regular basis. Consequently, they needed strong jaws and teeth to manage those foods. As a result, their jaws were larger, making plenty of room for an entire set of 32 teeth. With the advent of softer foods, as well as utensils such as forks and knives, evolution has given us smaller jaws and no need for these vestigial teeth.

The Source of The Name, “Wisdom” Teeth

Wisdom teeth are technically called “third molars.” Because they generally erupt between the ages of 17 and 25 years of age, when an individual is supposedly becoming wise in the ways of the world, they were dubbed “wisdom” teeth!

Wisdom Teeth Problems

Some people go their entire lives completely unaware of their third molars. They have no pain, no swelling, and no problems with food becoming trapped in their wisdom teeth. Others, however, aren’t so lucky. Here are some problems created by wisdom tooth eruption:

  1. Partially erupted teeth can trap food, leading to decay and/or infection.
  2. Crowding of permanent teeth can occur whether or not wisdom teeth erupt to the surface of the gum line.
  3. Impacted wisdom teeth can form cysts that increase the risks for bone destruction.

What is an Impacted Wisdom Tooth?

An impacted tooth is one that fails to fully erupt, usually due to dental crowding—there’s simply not enough room in the patient’s jaw for this extra tooth to emerge. It may exist at an odd angle or become stuck below the gum. Although wisdom teeth begin to develop when your child is in elementary school, those that do not fully erupt by the late teens to early 20’s are considered impacted. Impacted wisdom teeth cause pain, and can lead to gum disease and infection.

When Wisdom Teeth Should be Removed

According to the American Association of Oral and Maxillofacial Surgeons, approximately 85% of wisdom teeth are removed due to discomfort or problems such as those listed above. For the lucky 15% who have completely erupted third molars that are decay-free and easily cleaned, extraction can be avoided unless there is a concern that their presence may disturb the patient’s “bite,” by throwing off the alignment of the second molars or due to concerns that the patient cannot adequately brush and floss these teeth.

How Wisdom Teeth Are Removed

The removal procedure differs depending upon whether the molars are above the surface of the gums or impacted. Those above the gum generally require simple extraction under local anesthesia plus sedation or general anesthesia, while those patients with impacted wisdom teeth may require general anesthesia to provide easy access to incise the gum tissue in order to remove the tooth.

If your teen or young adult son or daughter complains of jaw or dental pain, please make an appointment to see me in my Manhattan pediatric dental office. If the problem is due to wisdom teeth, we refer our patients to Oral and Maxillofacial Surgeons Drs. Swain, Zargari, and Lustman, a wonderful group next door to our Manhattan pediatric dental office.

Gummies are Yummy

Gummies are YummyEvery parent is familiar with “gummy” candy. They’re small, rubbery little candies that kids love. Gummy candies come in endless colors, flavors and shapes—worms, astronauts, flowers, mushrooms, crayons—you name it, there’s a gummy in that shape. Some even have a textured, sugary glaze on them. Yes, gummies are yummy. So yummy, in fact, that children’s vitamin manufacturers have extended the qualities of gummy candies to vitamins. And they are flying off the shelves as well-meaning parents purchase bottle after bottle to supplement their children’s nutrition.

Gummy Vitamins
Good parents give their kids healthy foods, set limits on TV and iPad time, encourage them to play outdoors, enroll them in gymnastics, dance and sports activities, make sure they brush and floss daily, and take them to the pediatric dentist and pediatrician regularly. They often give their children a daily multi-vitamin to compensate for any potential nutritional lack due to their child’s appetite levels or food preferences. What parents might not know is that gummy vitamins contain 3-5 grams of sugar and, like gummy candy, that sugar creates cavities.

Sweet and Sticky: A Bad Dental Combo
While all candies contain sugars, which we know can damage teeth, gummies are a step beyond because of their stickiness. Gummy vitamins, like fruit leathers, fruit snacks and even raisins, have a combination of sweet + sticky=bad for teeth! Unlike chocolate, for example, the gelatin in gummy candies and gummy vitamins enables the sugar to literally cling to your child’s teeth long after the candies or vitamins are eaten. This level of exposure is what sets gummy vitamins and candies apart from other sweet treats

I advise my New York pediatric dental patients to chose a non-gummy, chewable children’s vitamin. These vitamins have less surgar and no sticky gelatin to encourage cavities. While not pushing any brand in particular, I notice that the Honest Company has organic children’s vitamins with only 1 gram of fruit sugar and they offer a free trial!

If your child eats gummy vitamins, fruit leathers and similar treats, please be sure he brushes immediately after eating either gummy vitamins or fruit leathers. And, although fruit leathers, strips and similar treats are easy to eat without making a mess, fruit is really a better choice than fruit-flavored treats, even the organic ones.

My career is dedicated to fostering the dental health of generations of children. Enabling you, as a parent, to make the best choices for your child’s dental health is one of my goals.

Are Misaligned Teeth Genetically Based?

Are Misaligned Teeth Genetically Based?Many parents come to my NYC pediatric dental practice wondering if their child needs braces, also known as orthodontic care. This is often based on the assumption that, if the parents had orthodontia, the child will also need this. Is this true?

While children do inherit their parents’ bone structure, along with many other characteristics, tooth alignment is part genetics and part dental and general health.

How Dental Health Impacts The Need for Orthodontic Treatment
Baby teeth are incredibly important; much more important than many parents believe, as a matter of fact. Because our children eventually lose their baby teeth, it’s easy to think that these teeth need less care than permanent teeth. In reality, any damage to baby teeth, such as trauma or untreated cavities, can negatively affect your child.

  • Dental alignment . Missing teeth cause incoming permanent teeth to use extra space, making nearby teeth more crowded. This can lead to a need for orthodontia. .
  • Speech difficulties. Our children’s speech development is predicated on a full mouth of baby teeth for accurate speech. Missing teeth can result in lisps and other speech disorders that require treatment.
  • Missing baby teeth. Some children are missing baby teeth for unknown reasons. They just never appeared. This, just like teeth that were lost to trauma or decay, can result in speech problems and spacing problems with adult teeth.
  • Chewing problems . Decayed and/or missing teeth, whether baby teeth or permanent teeth, can cause problems with chewing. This can lead to overdevelopment of the jaw bones on the unaffected side of the mouth, as well as problems extracting nutrition from foods.
  • Prematurity . Premature babies are known to have delayed dental development. If the infant had prolonged intubation (breathing tube) and nutritional issues, dental development may be further damaged, leading to a need for later orthodontic treatment.
  • Thumbsucking and tongue thrusting quite often contribute to flared teeth, as the child is constantly applying pressure to the teeth, pushing them outward.
  • Asthma, allergies, and/or frequent colds that result in mouth breathing can also cause incorrect jaw development, leading to tooth crowding.

If you have concerns about any of the above issues, please talk to me at your child’s next 6-month dental appointment! No question is too big or too small to ask! I’m here to help your child develop a beautiful, healthy smile for life!

Cavities in Baby Teeth

Cavities in Baby TeethIt’s hard to imagine that a young child could develop cavities in baby teeth, but it’s all too common. According to the American Academy of Pediatric Dentistry Association, approximately 40% of children between the ages of 2 and 5 have cavities!

Infants are born without the harmful bacterial that causes dental decay. However, once your child’s mouth has become colonized with the bacteria (called mutans streptococcus), your child will be more prone to cavities in both baby and permanent teeth. The bacteria feed on sugar, producing acid that eats away at the teeth by destroying the calcium. It also causes plaque, which contains even more acid. When the spot on a calcium-depleted tooth enlarges, the surface of the tooth collapses—which is a cavity.

The Cause of Cavities in Baby Teeth

  • Bacteria spread by transferring saliva, such as when giving baby a bite of something off your spoon or by “cleaning” a dropped pacifier by popping it into your mouth.
  • Sleeping with a bottle of milk or other sugary liquid.
  • Drinking soda and/or fruit juice, both of which are highly acidic and loaded with sugar.
  • Poor dental hygiene:
    • It’s difficult to brush baby teeth, as children are often wriggly during tooth-brushing time.
    • Likewise, flossing can be challenging.
  • Lack of early dental care
    • Many parents do not understand the importance of taking a baby to the dentist as soon as the first tooth appears. By the time several teeth have come in, the child may already have cavities.
    • According to dental studies, only 10% of 1-year-olds and 24% of 2-year-olds have ever been to the dentist.

Can a Family History of “Soft Teeth” Result in More Cavities?
While some families believe that they have “soft teeth” as the cause of frequent cavities, this is scientifically incorrect. What’s more likely is that families with high levels of decay-causing bacteria pass the bacteria on to the kids. In fact, 80% of cavities happen in just 25% of children. This can explain why some kids eat lots of sugary sweets and drinks and never seem to get cavities, while other children, kept on a more sugar-restricted diet, develop them even with their parents’ best efforts at prevention.

Can Antibiotics Eliminate Cavity-Causing Bacteria?
Unfortunately, no. Because of this, your Manhattan pediatric dentist will ask you about your dental history at your child’s first appointment, to ascertain if your child is at a higher risk for dental caries.

But it’s important to treat cavities in baby teeth: These first teeth serve as space holders for permanent teeth, so losing one prematurely can cause alignment problems that will need to be corrected with braces later.

Preventing Cavities in Baby Teeth

  • Infants:
    • Even before your baby has teeth, wipe your infant’s gums with a clean, damp washcloth after each feeding.
    • When that first tooth appears, purchase a soft infant toothbrush and, after eating or drinking, rub the wet brush around the tooth surfaces and gum line.
      • No toothpaste should be used.
    • Never put baby to bed overnight or even for naptime with a bottle containing milk or sugary beverage. If your child must sleep with a bottle, put water in it.
    • Schedule an appointment with me as soon as the first tooth appears.
    • Likewise, flossing can be challenging.
  • Toddlers
    • Begin brushing your child’s teeth with fluoride toothpaste at the age of 2 years: just a smear is enough.
    • Aim to brush for a full minute after breakfast and before bed.
    • When 2 or more teeth are lined up beside one another, floss between them.
  • Kindergarten & First Grade
    • Brush with your child to encourage both of you to stick to a schedule
    • Aim to brush for a full 2 minutes; using a timer helps!
    • Most children can brush their own teeth at around 7 years of age, but be sure to check your child’s teeth after he or she brushes, to look for leftover food particles.
  • All Children
    • All children should see me at least twice a year.
    • Limit the intake of sugar, which is the #1 cause of dental cavities. Exposing the teeth to sugars, even those in juices, crackers, pasta, cereals or raisins, prevents saliva from effectively cleaning the teeth.
    • Offer water immediately after exposure to sweets, carbohydrates or sugary liquids, including milk.
    • Brush and floss your child’s teeth at least twice daily.
    • Many parents find it easier to floss with individual one-use flossing sticks.
    • Training children with dental disclosing tablets helps them see for themselves where they need to brush more effectively

Ask me about protective fluoride varnish, which is applied twice a year. Studies show that 1-year-olds who received this treatment twice annually were four times less likely to have cavities in their baby teeth. We will also discuss sealants, which are incredibly effective at preventing children’s tooth decay.

Never Underestimate the Importance of Baby Teeth
The health of your child’s baby teeth cannot be left to chance. Losing a baby tooth to decay can affect the alignment of your child’s permanent teeth, increasing the chance for orthodontic treatment. Missing teeth can affect your child’s speech and contributes to additional decay.

Children and Gum Disease

Children and Gum DiseaseGum disease, called periodontal disease in dentist-speak, isn’t just limited to adults. According to recent studies, gum disease is an increasing problem among children of all ages.

Check out these sobering statistics:

  • Over 85% of American adults have gum disease
  • Approximately 66% of young adults have gum disease
  • About 50% of children under the age of 18 have gum disease
  • 12% of 3-year-old children have gum disease
  • The most common cause of tooth loss in adults is periodontal disease
  • Next to trauma, gum disease is the second most common form of tooth loss in children

How to Recognize Gum Disease in Your Child
If your child’s gums are shiny, tender and/or red; if they bleed easily; if they appear swollen, it may indicate gum disease. Children often experience pain while eating, so take note if your child complains about pain in his or her mouth at mealtime or when brushing.

How to Prevent Gum Disease in Your Child
1. The most common cause of gum disease, in both children and adults, is poor oral hygiene. It’s imperative that, from the earliest age, children’s gums and teeth are brushed and flossed at least twice daily. Until your child is at least 6 years old, he or she needs your assistance in brushing and flossing to develop skills in this area. As your child grows, supervision of brushing and flossing remains an important bedtime ritual to be certain your child’s gums and teeth are adequately cleaned. Studies show that flossing cleans 35% of the teeth’s’ surfaces!

2. Regular twice-yearly visits to your pediatric dentist are essential. Thorough examination will catch problems early on, and regular dental cleaning will eliminate the growth of tartar on the teeth, a main contributor to gum disease.
3. Do not share bacteria from your mouth with your child by licking pacifiers, eating off shared utensils or drinking from the same cup. Gingivitis can be passed from person to person through the saliva.

4. Notify us if your child grinds his or her teeth, as grinding increases the risk of gum disease.



Fluorosis is a condition that causes staining on the permanent teeth. While fluorosis does not damage the structure or health of the affected teeth, its presence can be embarrassing, and the stains often darken over time

What Causes Fluorosis
Fluorosis is caused by excessive exposure to fluoride between the ages of 20 and 30 months of age, when the permanent teeth are developing beneath the gums. The most common sources of fluorosis include the following:

  • Swallowing toothpaste that contains fluoride
  • Swallowing mouthwashes that contain fluoride
  • Inappropriate dosing of fluoride supplements

How Fluorosis is Identified
Signs of fluorosis vary from very small, barely noticeable spots on the teeth to dark staining, including brown marks and discoloration on the permanent teeth that do not go away with brushing.

How Fluorosis is Treated
Although the stains from fluorosis are permanent, they can often be lessened with tooth bleaching, composite restorations, porcelain veneers or dental microabrasion.

How to Reduce the Risk of Fluorosis

  • Teach your children not to swallow toothpaste or mouth rinses that contain fluoride
  • Use only a pea-sized amount of toothpaste for children over 2 years of age. For children under the age of 2, use either a non-fluoridated toothpaste or a minuscule smear of fluoridated paste.
  • Avoid fluoride supplements

If you have concerns about spots on your child’s permanent teeth, talk to our lower Manhattan pediatric dentist at your next visit.

Causes of Halitosis in Children

Causes of Halitosis in Children

We all know what halitosis is: bad breath. Halitosis affects a very large segment of the population and has numerous causes. The bottom line is, if your child has bad breath, we need to find the cause and eliminate it, rather than covering up the problem with mouthwash, gum or other treatments.

Causes of Bad Breath in Children
Children most often have bad breath when they have an upper respiratory infection, such as the flu, a cold, allergies or postnasal drip. We advise this as the first thing to check out. If your child suddenly has bad breath, take him or her to the pediatrician to see if any of the above problems are the cause. If it’s the flu or a cold, it’s likely that other symptoms are also present. However, bad breath that doesn’t go away after cold or flu has passed may be due to persistent postnasal drip secondary to allergies. Only allergy testing, followed by treatment, can eliminate bad breath that results from allergies.

The second-most common reason for bad breath in children is gum disease.
Yes, children can get gum disease just like adults can. Gum disease is a result of poor dental hygiene. Even the youngest child needs to have teeth and gums brushed at least twice daily, and flossing introduced when teeth are present. If your baby’s first tooth has yet to erupt, massaging the gums twice a day with a clean, wet cloth will eliminate some of the vestiges of breast milk or formula that leaves an acidic coating on the teeth, leading to decay.

The second-most common reason for bad breath in children is gum disease.
Yes, children can get gum disease just like adults can. Gum disease is a result of poor dental hygiene. Even the youngest child needs to have teeth and gums brushed at least twice daily, and flossing introduced when teeth are present. If your baby’s first tooth has yet to erupt, massaging the gums twice a day with a clean, wet cloth will eliminate some of the vestiges of breast milk or formula that leaves an acidic coating on the teeth, leading to decay.

Untreated Cavities Cause Breath Odor
There is a distinctive odor to untreated cavities. While many parents believe that cavities in baby teeth require no treatment since the teeth will soon fall out, this is actually incorrect. Baby teeth are quite important, as they save space for permanent teeth, and aid in chewing and speech development. Here at iSmile Kids in lower Manhattan, our pediatric dentist treats cavities in baby teeth as well as in permanent teeth.

Infected Tonsils Cause Halitosis in Children
Enlarged tonsils create a constricted airway that causes mouth breathing. Mouth breathing dries the mouth, resulting in bad breath. Further, dry oral tissues compound any bacterial infection in the mouth.

Diabetes Is Linked to Bad Breath
Halitosis is sometimes one of the first indications of Type 1 diabetes, the diabetes that most often appears in childhood. High glucose levels force the body to use fats as a fuel source, which causes ketones to build up. Ketones are acids that normally are removed through the body’s waste products and through the breath. Excessive ketones cause halitosis. If you have a family history of diabetes or your child is a diabetic, check blood sugars often to be sure they remain in a safe level.

Mints, Gum and Mouthwash to Treat Halitosis in Children
If the underlying reasons for halitosis are not being treated, masking the odor with mints, gum or mouthwash will not eliminate its cause. In addition to good oral hygiene and the use of sugar-free mints or gum, we advise brushing the tongue twice a day and drinking plenty of water to eliminate halitosis caused by too little hydration.
If you have concerns about your child’s breath, please speak to your pediatrician about it to rule out any of the above conditions. Our NYC pediatric dentist will discuss any odors in your child’s mouth that are detected during routine examinations and cleaning.

How to Treat Teething

How to Help a Teething Infant

How to Help a Teething Infant

Any parent who has walked the floor with a teething infant knows the feeling of desperation when nothing seems to comfort their baby. Teething and its associated pain are inevitable, but there are some tried-and-true ideas that can help make the experience less traumatic for everyone.

  • Freeze a clean washcloth after soaking it in a cup of chamomile tea. The combination of cold, texture and tea are comforting.
  • Offer hard foods such as a frozen banana or even a frozen, plain bagel. Watch carefully that your baby doesn’t bite off a piece and choke on it.
  • Offer your baby your clean index finger.
  • Offer a teething ring. The gnawing can alleviate discomfort.
  • Offer water in a baby bottle. Sometimes the comfort of sucking distracts the infant from the discomfort of teething.
  • Ask your pediatrician if you can give your baby age-appropriate doses of Tylenol or Ibuprofen.

If the above steps don’t help your baby’s teething pain, schedule an appointment with our NYC pediatric dentist, who is specifically trained about the unique needs of little ones.

Children’s Fear of the Dentist

As parents, we want to instill good habits in our children to foster a lifetime of exceptional health. We encourage them to eat their fruits and veggies, to take their vitamins, to get regular outdoor exercise, and to tolerate visits to the pediatrician, some of which are painful because immunizations are needed. In a similar vein, a lifetime of dental health is rooted in the childhood rituals of regular dental visits. Because the sights and smells of a dental office are a bit like that of the pediatrician’s office, your child may be apprehensive about seeing the dentist. Here are some tips to make both you and your child more comfortable when talking about and visiting our Battery Park pediatric dental office.

Check Your Own Fears at the Door
As in other areas of life, our children will “do as we do, not as we say.” If your child sees you brush and floss daily and visit the dentist every 6 months for checkups without fear or complaints, he or she will adopt a similar attitude. In contrast, if you use fearful language (“shots,” “hurt,” “pain,” “drilling,” etc) when speaking about you or your child’s upcoming dental visits, your child will be more apprehensive. Using positive phrases like, “We’re going to see Dr. Kherani to keep your teeth healthy and strong,” will help your child interpret dental visits in a more positive light.

Just the Facts, Ma’am
While you want to couch any discussions about dental treatments in a positive way, your child doesn’t need to know every detail of an upcoming dental appointment if that visit involves discomfort. While you must avoid false information (for example, saying “It won’t hurt”), it’s fine to say that everything will be done to make it as comfortable an experience as possible and that you, the parent, will be there to provide comfort and reassurance. In this way, if your child does experience pain during a dental procedure or treatment, no trust has been lost through false assurances beforehand.

Play-Acting Helps
Since your child likely sees our South Manhattan pediatric dentist only a couple of times a year, he or she may forget the experience between visits. Enjoy role-playing with your child as the dentist, with you or a stuffed toy as the patient and vice versa. Have your child “brush” the stuffed toy’s teeth, examine the toy’s teeth with a mirror, and apply sealants as a dentist or hygienist might do. Read books about dental visits, such as those on this Amazon page. In this way, your child will have some understanding of what to expect, which leads to less fear.

Trust the Dentist
Pediatric dentists, such as Dr. Anjum Kherani, are experts at providing dental care for kids. They use special words and phrases that are comforting and even fun for kids. Dr. Kherani and our staff have many years’ experience providing dental care for kids, so we know it’s normal for them to wiggle, refuse to open their mouths, fuss and sometimes cry. It’s easy for us to stay calm, whereas it might be tougher for you, the parent. So don’t be insulted if we suggest you wait along the side or ask you to be a “silent helper.” Believe it or not, sometimes kids are calmer when their parents aren’t right there.

Save the Bribes
As tempting as it is to tell your child that you’ll give him or her a special treat after the dental visit, doing so actually sends a message to your child that something bad is about to happen and you’re offering a treat in hopes that he or she will get through the experience with as little fussing as possible. It’s better to send the message that having clean, healthy teeth is important to you and to your child and that dental visits are part of creating and sustaining a healthy life.

Please don’t hesitate to call upon Dr. Kherani or a staff member if you having any questions or concerns about your child’s dental visits. We’re here to help!