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Common Questions

Baby Tooth Care
Baby Tooth Care

Healthy teeth are important to your baby's overall health. Teeth help your baby chew food and form words and sounds when speaking. They also affect the way your baby's jaw grows.

Every baby is different. Generally, the 2 front teeth start to appear between 4 and 7 months of age. Teething is usually painless, but it can make some babies uncomfortable and fussy. Giving your baby a cold teething ring or a cold washcloth to chew or suck on may help. Teething does not cause a fever. If your baby has a fever, you should talk to your doctor.

Start cleaning your baby's teeth twice a day as soon as the first tooth appears. Until your child is 1 year old, you can use a wet wash cloth or gauze to clean your baby's teeth and gums. At about 1 year to 18 months of age, you should start using a soft baby toothbrush and a small dab of toothpaste that does not have fluoride in it. This type of toothpaste is safe for your baby to swallow.

Be sure to take your baby to a dentist by his or her first birthday, especially if there is a high risk for cavities or any other problems with his or her teeth. It is better for your child to meet the dentist and see the office before he or she has a tooth problem.

Can you do all the work at once with a sedation?
Can you do all the work at once with a Sedation?

In cases with extensive decay, we are limited by the maximum dosage of local anesthetic that we can use. As a rule, we also consider your child's comfort after he/she leaves the clinic in order to determine how much local anesthetic we can use.

Very young children are at high risk of biting their lips or chewing on the inside part of their cheeks after they receive local anesthetic (a lidocaine shot). This usually happens because of their natural curiosity; they try to feel the area or areas that are numb.

For these and other reasons, it is unlikely that we could work on all of your child's teeth at once. An exception to this rule would be a child that is taken to the operating room.

Children's Tooth Development

Children continually get new teeth from age 3 months to the age 6 years. Most children have a full set of 20 primary teeth by the time they are 3 years old. As a child nears the age 6, the jaw grows making room for the permanent teeth. At the same time, the roots of the baby teeth begin to be resorbed by the tissues around them and the permanent teeth under them begin to erupt.

Primary teeth are just as important as permanent teeth for chewing, speaking and appearance. They also serve as placement holders for the permanent teeth. Primary teeth also provide structure to help shape the child's face.

Early Childhood Caries

Now known as 'Early Childhood Caries' is an aggressive form of caries that occurs in infants and very young children. It is typically associated with prolonged consumption of liquids containing sugar, and affects initially the top front teeth, later spreading to other 'baby teeth'. Because of the aggressive nature of this disease, early intervention is necessary.The American Academy of Pediatric Dentistry (AAPD) and the American Academy of Pediatrics (AAP) recommend that ALL children should see a dentist before age one.

Gaps between childs teeth
Gaps between childs teeth

It is normal and even 'ideal' for baby teeth to have spacing between each other. Keep in mind that when permanent teeth erupt, their size will be considerably larger than that of baby teeth. As the baby teeth are lost, the erupting permanent tooth will quickly take advantage of this excess space. Children who do not have spacing in their primary dentition can have a higher incidence of crowding (crooked teeth) in the permanent dentition.

Having baby-teeth pulled
Having baby-teeth pulled

How is that going to affect him or her? Children require extraction of one or more primary teeth in certain situations. These situations may include extensive decay on their front teeth, and/or localized infection (for example an abscess or a gum boil). Extractions are also necessary in cases of trauma, where the baby teeth have been pushed back, pushed forward, broken, or simply knocked out. Parents are obviously concerned of the aesthetic and functional effects (on speech, feeding, and breathing) of removing one or more front baby teeth. There is good evidence that has shown NO long-term speech impediments on these cases. We also know from our professional experience that once the gums heal, children will be able to eat almost anything, since they can still bite-and-cut with the remaining teeth. As far as aesthetics is concerned, your pediatric dentist can offer you information on fixed appliances that can replace the missing tooth/teeth, assuming your child meets the right criteria.

How Enamel Fluorosis occurs
How Enamel Fluorosis occurs

By swallowing too much fluoride for the child's size and weight during the years of tooth development, a child can develop enamel fluorosis. This can happen in several different ways.

First, a child may take more of a fluoride supplement than the amount prescribed.

Second, the child may take a fluoride supplement when there is already an optimal amount of fluoride in the drinking water.

Third, some children simply like the taste of fluoridated toothpaste. They may use too much toothpaste, and then swallow it instead of spitting it out.

Missing Permanent Teeth
Missing Permanent Teeth
Hypodontia (the common dental term) describes a situation when fewer than 6 permanent teeth are missing, the term Oligodontia is used when more than 6 permanent teeth are missing (they were never formed). The most common missing teeth are the third molars (otherwise known as the Wisdom Teeth), followed by the premolars and the lateral incisors. Although it is not uncommon to have one missing tooth, patients with multiple missing teeth generally have a strong genetic component and it has been linked to conditions such as Ectodermal Dysplasia and several syndromes. Because early recognition aids in proper treatment, your dentist will refer you to specialists (orthodontist, oral surgeons, etc) that will determine which options suit you best to replace the missing teeth.
My child has crooked teeth; will he or she need braces?
My child has crooked teeth; will he or she need braces?

Crooked or crowded teeth are very common in the growing patient. Even patients that get braces may develop a minor degree of crooked (crowded) teeth, particularly in the front teeth of the jaws, as they grow old.

The first step in determining the need for treatment is what we call an orthodontic consult. During this appointment, we may obtain special records and special x-rays of your child's jaw. This information will allow us to make a decision based on predicted growth patterns that your child may show later. In orthodontic terms, we refer to this as Early Treatment.

Early Treatment refers to ANY orthodontic (braces) or orthopedic appliances (like Headgear) treatment that begins when the child is in primary dentition or in early mixed dentition (when the first permanent teeth begin to erupt).

Early Treatment has been proven to be effective despite objections by some people in the orthodontic community.

The American Academy of Pediatric Dentistry (AAPD) recognizes that early diagnosis and successful treatment of developing malocclusions can have both short-term and long-term benefits, while achieving the goal of occlusal harmony, function, and facial aesthetics.

My child is getting shark teeth; what can i do?
My child is getting shark teeth; what can i do?

One of our most common consults occurs when children around the age of seven begin to lose their lower front teeth. Many of our parents become overly worried about this phenomenon. It is VERY NORMAL for permanent lower incisors (front teeth) to erupt behind their predecessors (baby teeth); however, if a baby tooth is not loose by the time half of the permanent incisor has erupted, it may be necessary to pull it.

My child's teeth have stains on them, are these cavities?
My child's teeth have stains on them, are these cavities?

When a baby tooth changes color, it can mean many things. Baby teeth can and do normally change in color, particularly close to the time that they become loose; however, this change is minimal and should not be confused with a carious lesion (cavity). The best way to determine if your child has a stain or a true cavity is to take him or her to a pediatric dentist. Caries is an infectious disease; it progresses if left untreated, and usually is associated with pain (especially when the cavities are large). Teeth with cavities typically assume a darker (brown) discoloration; and depending on the extent, may exhibit loss of tooth structure. Teeth that have been previously 'bumped' may also change in color. Traumatized baby teeth can assume a yellow or a dark discoloration, which may or may not be associated with pain. Other less common causes of changes in color may be: fluorosis, food staining (particularly tea or colas), systemic disease (hepatitis), etc.

Pediatric Dental X-Rays
Dental X-Rays for Children

Dental x-rays are one of the more comprehensive resources readily available, as they allow dentists to find and diagnose and treat health conditions that cannot be detected during a clinical examination. Early diagnosis is key to comfortable and affordable health care, which Dr. Madani is committed to providing to every patient.

For children, x-rays are even more important than adults, as they are at higher risk for tooth decay, combined with the fact their mouths grow and change rapidly and need frequent monitoring. The American Academy of Pediatric Dentistry recommends x-ray examinations every six months for children with a high risk of tooth decay; children with a low risk of tooth decay require x-rays less frequently. X-rays aid in detecting a variety of things, including:

  • Cavities
  • Erupting teeth
  • Diagnose bone diseases
  • Evaluate the results of an injury
  • Plan orthodontic treatment

We take extra care to minimize young patients’ exposure to radiation; however, with modern safeguards and technology, the amount of radiation received in a dental x-ray examination is negligible, and the risk is far smaller than letting undetected dental problems continue to progress.

Thumb Sucking
Thumb Sucking

It is completely normal and healthy for your baby or young child to suck on a thumb, finger, or pacifier. Children usually give up sucking habits on their own by the time they are 4 to 5 years old.

If they stop the habit at this age, the shape of the jaw is usually not affected and the teeth grow in normally.

Children who continue sucking on a pacifier, finger, or thumb when their permanent adult teeth start to come in are more likely to have bite problems.

Sucking can cause:
- The top front teeth to slant out
- The bottom front teeth to tilt in
- The upper and lower jaws to be misaligned
- The roof of the mouth to be narrowed
- The need for braces

Treatment: Your doctor may decide to construct an appliance to discourage thumb sucking.

Toothpaste for my child
Toothpaste for my child

There is no such thing as the best toothpaste. We recommend ONLY products that have been ADA (American Dental Association) accepted or approved.The selection is usually made on a case-by-case basis, however the main consideration when selecting toothpaste is your child's age.This is due to the risk of fluorosis in younger children that swallow toothpaste during regular brushing. A child may face the condition called enamel fluorosis if he or she gets too much fluoride during the years of tooth development. Too much fluoride can result in defects in tooth enamel.

What is general anesthesia and how safe is it?
What is a general anesthesia appointment and how safe is it?

The use of general anesthesia for dental work in children is sometimes necessary in order to provide safe, efficient, and predictable care. The general anesthetic is given to your child by a specialist (anesthesiologist) and ONLY after the child has been thoroughly screened by a physician. The American Academy of Pediatric Dentistry (AAPD) recognizes the need for general anesthesia in certain situations where challenges relating to the child's age, behavior, medical conditions, developmental disabilities, intellectual limitations, or special treatment needs may warrant it.

Pediatric dentists are, by virtue of training and experience, qualified to recognize the indications for such an approach and to render such care. Your pediatric dentist and his staff will discuss all the necessary steps that must be taken in order to promptly and safely complete your child's dental treatment after this treatment option has been chosen.

Like any procedure in which a child's conscious state is altered, there are some risks involved. The main risks (serious complications) associated with an oral sedation include, but are not limited to: Allergic reaction, respiratory arrest, cardiac arrest, and death. Statistically, the chances of a serious complication are similar to those of being involved in a life-threatening motor vehicle accident. Please make sure you fully understand as a parent or legal guardian all the risks involved with this procedure. Also review the instructions that you must follow the day before the procedure.

What is oral sedation?
What is oral sedation?
A conscious oral sedation is a procedure in which a child is given an oral medication that causes a depressed level of consciousness. The American Academy of Pediatric Dentistry (AAPD) has clearly defined the indications for this procedure, and they are as follows:
A) Preschool children who cannot understand or cooperate for definitive treatment.
B) Patients requiring dental care who cannot cooperate due to a lack of psychological or emotional maturity.
C) Patients requiring dental treatment who cannot cooperate due to a cognitive, physical or medical disability.
D) Patients who require dental care but are fearful, anxious and cannot cooperate for treatment.
As with any procedure in which a child's conscious state is altered, there are some risks involved. The main risks (serious complications) associated with conscious sedation include, but are not limited to: aspiration, respiratory arrest, cardiac arrest, and death. Because your child will be partially awake, local dental anesthesia (a lidocaine shot) is still needed; and this may limit the extent of work that we can provide. Sedation dentistry is also an option in cases of accidents or trauma; but in these situations, the decision to administer the medication must take into consideration the risk of aspiration (breathing vomit into the lungs) and any head trauma that may have occurred. If your child is a candidate for a conscious sedation, please make sure you follow the instructions provided by your pediatric dentist.
Will you need to give my child a shot to do the dental work?
Will you need to give my child a shot to do the dental work?

This is the one of the most commonly asked questions that we get from our patient's parents. We try to minimize the discomfort of the injection by placing a gel that works as a local anesthetic and numbs the tissue were the injection will be administered.

Profound local anesthesia is usually obtained five to ten minutes after the injection, depending on the area of the mouth where the anesthetic was placed. We always check to confirm that the area is numb before we begin to work. In cases of localized infection or trauma (like broken teeth), it is very difficult to obtain profound anesthesia. However, we do have other means of supplementing the anesthetic (like conjoined use of nitrous-oxide gas, medications, or conscious sedation).

Younger children, particularly pre-schoolers, may interpret the feeling of numbness as pain, and therefore cry. Please follow the post-operative instructions that we give you, in order to minimize complications such as lip biting.


Framingham Dentist Ratings - Dr. Madani
Overall Dental Practice Rating - ★★★★★ 5 out of 5 based on 9 ratings.
Framingham Dentist Reviews.

★★★★★
Dr. Madani is a wonderful dentist! He is very skilled and knowledgable, and I feel very confident and comfortable with him; I know I'm in good hands. His warmth and friendliness put me right at ease, and his whole staff is always so friendly. My family feels the same way. Harriet Shapira

★★★★★
Thank you so much for 15 years of the most outstanding dental care a patient could ever receive. your skill at diagnosis, compassion, hands of pure gold, easy-to-understand explanations and fabulous 'chair-side' manner which immediately puts even the most fearful patient at ease all combine to make seeing you a pleasurable experience. how many people can say that they actually ENJOY going to the dentist and emerge with perfect results every time?? You are one of a kind.

★★★★★
I just wanted to drop you a note to say thank you so very much for my lovely smile. I get so many compliments on my teeth thanks to you. You did a job well done, and for all your patience, and time, I'm not afraid of the dentist anymore! Thanks to you and the staff.

★★★★★
Thank you for all the good work throughout all those years we had spent as your patient. Many Thanks for everything your happiness, good spirit, and above all your excellent job.
We are going to miss you guys.

★★★★★
Dear Dr. Madani, I just had to thank you again for my happy birthday ballon. I want to thank you for your kindness, patience, your good heart, your expertise in the care you've given me. I hope your future along with your beautiful bride will be blessed with happiness, good health and success in all your endeavors. Lucky me to have someone so sympathetic to my needs and the help you've given me in so many ways. You really are a great representative for the Gentle Dental Assoc. P.S. The dental assistants and the girls at the front desk are all sweethearts too.

★★★★★
Thank you for helping create the perfect smile for my wedding day!

★★★★★
I saw Dr. Reza Madani for the consultation of a difficult big bridge replacement. This problem has existed for a few years, but I never understood completely all the issues. Dr. Madani went through this problem area tooth by tooth using my x-rays and even drawing pictures for a better understanding. he patiently explained to me all the options, advantages and disadvantages of every option. When I left the Centre Street office I though it was my best dental appointment - and I have had quite a few of them over my lifetime! I also liked very much the supportive team - receptionist, assistant, hygienist - who are professional and friendly. I really recommend this place.

★★★★★
I really appreciate for the treatment of my front teeth .... even for free. It was the niggest complex but I can smile confidently now. Thank you so much! I'm going back to Virginia tomorrow to finish my college degree. Thanks for helping and being kind to my parents. My family really likes you haha.

★★★★★
I can tell that this crown is stable and after a week, it is solid and feels great! Dr. Madani also suggested I wear a night guard to protect my crown (since I grind my teeth at night) which I have done.
I also want to say that Imelda O'Connor, the Office Manager is a wonderful and efficient manager and should also be commended. She was able to coordinate with the JP office to work out the financial issue in regard to solving my crown problem. It is a true pleasure going to this Gentle dental office and I will recommend it to all my friends. The entire staff there; Dr. Lozada and Dr. Madani's assistants are wonderful as well.
This has been a great experience for me, a woman who has had many tedious and painful visits to dentists over the past 5 years. Presently I am unemployed and not able to afford the additional dental care I would love, since the medical insurance I am paying is quite high, but I hope to be working full time soon and will be sure to make an appointment at Gentle Dental West Roxbury for my overdue cleaning. I have always tried to keep up my dental appointments because I know that it is very important for overall health.