A dentist for your child, from the first tooth to the teenage years.

What a children's dentist actually is

A child's teeth are not a small copy of an adult's. Decay moves faster in baby teeth, and permanent teeth are forming right underneath them. A three-year-old does not understand the words a ten-year-old does, and is not afraid of the same things. That is why paediatric dentistry is its own field: a child needs a different approach from an adult.

Dr. Adnan Alakhras holds a clinical master's degree in paediatric dentistry and a professional diploma in fixed orthodontics. So a child who comes in for a cavity also gets a look at how the jaw is growing, how the teeth are coming through, and whether anything needs an early orthodontic assessment. Read about the doctor and the clinic.

This page is for you if you are thinking “my child needs a dentist”, or “my child is scared”, or “she's one, is it too early?”. If you have recently moved to Amman and are starting from scratch with a new dentist, it is for you too. The answers are below, starting with the first visit. And two questions you can answer at home right now: Your child's teething chart shows which teeth are due at their age, and Is your child ready for braces? tells you whether it is time for an orthodontic look.

Your child's first visit, step by step

The aim of the first visit is that your child leaves wanting to come back. The examination matters, but the relationship matters more, because it is what makes every visit after this one easier.

1. 1

   Before the appointment: what to say, and what not toDescribe the visit in a couple of calm words: “The dentist is going to count your teeth and see how clean they are.” Don't say “don't be scared” or “it won't hurt”, and don't mention needles, because a child hears the word, not the “not”. The day before, play dentist at home: they open wide, you count their teeth out loud.

2. 2

   Getting to know each other before the chairFirst we talk to your child about their name and what they like, not about their teeth. There is a children’s play area in the clinic, and that is where they start, not in the chair. They stand on their own two feet and look around the room and at the instruments. The chair comes later, when they are ready. And if they are still a baby, we examine them on your lap, with no chair at all.

3. 3

   The examination, if they agreeWe tell them what we are going to do in words for their age, we show them the instrument on their hand or fingernail before it goes anywhere near their mouth, and then we do exactly what we said, nothing more. If they say no today, we don't force it, and we take a step back.

4. 4

   You are with themYou stay in the room with them, and sometimes we ask you to sit behind them or step out for a minute if we see that it settles them, and we tell you why beforehand. That decision is made with you, not for you.

5. 5

   The end of the visitWe finish on something your child did well, and we name it exactly: “You opened wide and let me count every single tooth”, rather than just “well done”. Then you hear what we saw, what needs follow-up and when the next visit is. Any treatment is talked through before it is done and gets its own appointment, unless something is urgent and we agree on it there and then.

What we do for children

Here is what we do for children. The doctor decides which of it your child needs after the examination, not before, and tells you why.

• A full examination and a cleaning. We count the teeth, look at the gums and the bite, and clean off tartar and stains with instruments suited to their age. A digital x-ray in the clinic if one is needed, not as routine, because decay between the teeth cannot be seen by eye.
• Fluoride. A varnish painted onto the teeth in a few minutes that strengthens the enamel against decay. It is repeated every few months depending on how high your child's decay risk is, and it can stop the first white spots of decay before they turn into a cavity.
• Fissure sealants. A thin layer placed in the grooves of the back teeth where a toothbrush cannot reach, with no drilling and no numbing.
• Fillings and treatment of decay in baby and permanent teeth, in a tooth-coloured material. When a baby tooth is treated and when it comes out is in the next section.
• Watching the jaws grow, the teeth come through and the bite develop, with an early orthodontic assessment when the time is right. This is where Dr. Adnan's two fields meet: children and braces.
• Children's dental emergencies. A tooth broken or knocked out in a fall, or a pain that keeps them up at night. What to do in the first hour is at the bottom of this page.
• Laughing gas. An option for the child who is scared, and the doctor decides whether it suits them: a small mask over the nose, the child stays awake and talking, the level is adjusted during the appointment, and it ends with plain oxygen. It is not for every child: it needs a child who can breathe through their nose and follow instructions, and not one with a cold or an ear infection.
• Children with special needs. A service here, not an exception, and the visit is arranged around each child: its own time, less noise, and fewer steps at each visit. More on the doctor's page.

By the end of the first visit you know what your child has, what happens if we wait, and what the options are. The cost is discussed after the examination, not before it, because no two mouths are the same.

Baby teeth: the honest part before the reassuring part

“They fall out anyway. Why treat them?”

Because they usually hurt before they fall out. A baby tooth has a nerve like a permanent one, decay moves through it faster, and it can reach the nerve and form an abscess. Under every baby tooth a permanent tooth is forming, and an infection above it can affect it. So a decayed baby tooth is treated, and it is not left alone because it is “on its way out”. A decayed baby tooth: treat it or take it out?

When a baby tooth comes out, and when we keep it

A baby tooth works as a space holder: it keeps the room for the permanent tooth coming up beneath it. If it comes out early, the teeth next to it lean into the gap, the permanent tooth finds less room, and that can show up later as crowding. That is why we treat and keep the tooth whenever there is a way to.

Extraction becomes the choice when the tooth can no longer be saved, or when the permanent tooth beneath it is ready to come through anyway and the baby tooth has no job left. If we do have to take one out early, the doctor tells you whether a small appliance is needed to hold the space until the permanent tooth arrives. The decision comes from the examination and the x-ray, not from age alone.

Why an early visit, not a visit for pain

A first visit for pain teaches a child that the dentist means pain, and makes the visits after it harder. A first visit for a calm check-up teaches them that the dentist is a place where their teeth get counted and they get praised. The difference between the two can stay with them for years. And an early check-up catches decay while it is still a white spot that a varnish can treat, not a cavity that needs a filling. At what age is the first dental visit?

What prevention does, and what it doesn't

Fluoride and sealants lower the chance of decay; they don't remove it. Brushing twice a day with a fluoride toothpaste, fewer sugary snacks between meals, and no bottle left in the mouth through the night matter more than anything we do in the clinic, and no treatment replaces them.

The child who is scared or won't cooperate

Fear in a child is normal, and it is not a flaw in them, or in you. A lot of it is fear of the unknown, not of something that happened. So the whole job is making sure nothing stays unknown.

The steps above are how every child is seen. What changes with a scared child:

• We ask before we tell. What exactly is frightening? The noise? The chair going back? Something that happened before? The answer changes the approach.
• A child who has had a bad experience before. Tell us what happened, even if it was somewhere else. This child needs longer to get to know us, and the first visit is usually without any treatment at all.
• A three-year-old is not a ten-year-old. The younger child needs fewer words and more play; the older one needs to understand what is happening and why, and can agree a stop signal with us. The approach changes with age.
• We take their mind off it. A screen in front of them or headphones on, and short breaks when they need them. And if they feel anything, they raise a hand and we stop. That is an agreement we make with them before we start.

And if all of that is not enough, there is a get-to-know-us visit with no treatment at all, and after that laughing gas as the last step: an option the doctor decides on, for a child who can breathe through their nose and follow instructions. The child sets the pace, not us.

If the fear is yours rather than your child's, there is a page written for you: When the visit is hard. And for more on the child themselves: My child is afraid of the dentist.

What to do now

• If nothing hurts: book an ordinary check-up, and put it at your child's calmest time of day, not straight after school when they are tired.
• The day before: prepare them as in the first step above, with no mention of needles or pain.
• Bring with you: the name of any medicine your child takes, any allergies, and what happened at any previous dental visit, even a difficult one. If you have just moved to Amman, bring whatever you have from your last dentist. All of it changes the approach.
• If you are the one who is scared of the dentist: let the calmest person in the house bring them. A child reads your face before they read the room.

Questions people ask