Pediatric Dentistry, PLLC

Sandra Armstrong, DDS · Amy Watts, DDS, MS

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Smile Info

Office Information | Early Dental Care | Prevention | Oral Health Problems | Emergencies | Treatment

Office Information

Girl in cheer outfit smiling at Giggles and Grins Pediatric Dentistry in Southlake, TexasHow are appointments scheduled?

The office attempts to schedule appointments at your convenience and when time is available. Preschool children should be seen in the morning because they are fresher and are thus more comfortable. School children with restorative work to be done should be seen in the morning for the same reason. The Education Bill states that students MUST be excused for temporary absences resulting from visits to a dental office, nor can they be penalized for their absence when receiving dental care. Missing school due to toothaches or decay can be kept to a minimum if regular dental care is continued.

Since appointed times are reserved exclusively for each patient, we ask that you notify our office 24 hours in advance of your scheduled appointment time if you are unable to keep your appointment. We realize that unexpected things can happen, but we ask for your respect and assistance in this regard.

What about finances?

Payment for professional services is due at the time dental treatment is provided. As a courtesy to you we will assist you with your insurance claims which will require your providing us with your insurance information when scheduling the appointment. We accept cash, personal checks, debit cards and most major credit cards. When financial arrangements are needed, we offer low interest monthly payments through Care Credit.


If you have dental insurance, we are here to help you receive your maximum allowable benefits. In order to achieve these goals, we need your assistance and your understanding of our payment policy.

Payment for dental services is due at the time the service is delivered unless otherwise arranged with our office. We accept cash, checks, MasterCard, Visa, Discover, American Express and Care Credit. Care Credit allows you to pay overtime with LITTLE or NO INTEREST. If we accept your insurance as payment, you are required to provide our office with complete insurance information when scheduling the appointment.

Your insurance is a contract between you, your employer, and the insurance company. We are not party to that contract; however, we will do what is legally and ethically allowed to help you obtain your benefits.

Many consumers believe that their insurance pays most or all of their dental expenses. In reality most plans pay only 50-80% of dental fees. How much your insurance reimburses for dental services is controlled by your employer, not our office.

Our fees fall within the acceptable range of most insurance companies. Many insurance companies reimburse their policyholders based on a fee schedule which is not determined by the current standard of care.

While the filing of insurance claims is a courtesy that we extend to our patients, all charges are your responsibility from the date services are rendered.

Early Dental Care


Normally the first tooth erupts between ages 6 to 12 months. Gums can be sore, tender and sometimes irritable until all of the baby teeth have erupted. Rubbing sore gums gently with a toothbrush or a cold wet cloth can help soothe the gums. Another tip that works well is to brush the baby’s entire mouth as if teeth were present. The stimulation of the gums will allow for easier teething and less discomfort. Teething rings work well, but avoid teething biscuits—they contain sugar that is not good for baby teeth.

Why Primary Teeth are Important

The primary, or “baby,” teeth play a crucial role in dental development. Without them, a child cannot chew food properly and may have difficulty speaking clearly. Primary teeth are vital to the development of the jaws and for guiding the permanent (secondary) teeth into place when they replace the primary teeth which begins around the age of 6.

Since primary teeth guide the permanent teeth into place, infants with missing primary teeth or infants who prematurely lose primary teeth may require a space maintainer. A space maintainer is a similar to orthodontics which can be used to hold the natural space open. Without a space maintainer the existing teeth tilt toward the empty space and can cause the permanent teeth to come in crooked or not at all. When permanent teeth drift into the space where a baby tooth was lost early it can result in YEARS of expensive and extensive orthodontic care. The way your child cares for his/her primary teeth plays a critical role in their overall health for the rest of their lives. Children are more susceptible to plaque and decay due to their snacking habits, poor dexterity, carbohydrate rich diet and thinner enamel. The need for regular care and dental checkups is vital for your child’s health.

Tooth Development

Dentist checking child's teeth at the Pediatric Dentist serving Southlake, Keller, Grapevine and Fort WorthThroughout your child's life, they will have two sets of teeth: primary (baby) teeth and secondary (permanent) teeth. At age 6-8 months, the primary teeth may begin to appear with all 20 being in place by the age of 3 years.

Permanent teeth will begin to grow into the mouth around 6 years of age and are usually all present by the age of 14, excluding the wisdom teeth (3rd molars).

Permanent teeth are just that, they are permanent with no replacement. For that reason meticulous care at home and regular dental appointments are important for your child’s general overall health.


Good Diet and Healthy Teeth

The teeth, bones and soft tissue of the mouth require a healthy, well-balanced diet. A variety of foods from the five food groups can help avoid cavities and other dental problems. Many snacks that children eat largely contribute to developing cavities. Healthy foods like vegetables, low-fat yogurt and cheeses, which promote strong teeth, are great choices!

Preventing Baby Bottle Tooth Decay

Baby bottle tooth decay which is associated with bottle or Sippy cup usage is a significant public health problem. Pediatric dentists and parents should implement preventive practices to decrease a child’s risks of developing this devastating disease. Dental decay (caries) is a transmissible infectious disease. Some transmission is attributed to a caregiver passing their cavity causing microbes to the child. Children whose mothers are high risk for dental decay are at a greater risk of becoming cavity prone themselves. Tooth decay in infants can be minimized and with optimum care can be totally prevented. Infants that need a bottle to comfortably fall asleep sucking should be given a pacifier after their first tooth erupts. In addition oral cleanings following feedings, if not previously implemented, need to begin with eruption of the first baby tooth as well. Dr. Armstrong and Dr. Watts are dedicated to eliminating baby bottle tooth decay.

  • Other methods of prevention for early childhood caries is minimizing saliva-sharing activities (i.e. utensils) between an infant or toddler and his/her family.
  • Oral hygiene measures should be instituted at home prior to the eruption of the first tooth and continued stringently upon eruption of all teeth.
  • Tooth brushing for children with teeth should be performed twice daily with a fluoridated toothpaste and a soft, age-appropriate sized toothbrush. Parents should use a “smear “of toothpaste to brush the teeth of a child less than 2 years of age. For the 2-5 year old, parents should dispense a “pea-size” amount of toothpaste and perform or assist with the child’s tooth brushing. Flossing should be initiated when adjacent tooth surfaces cannot be cleaned by a toothbrush.
  • Most importantly, establishing a dental home within 6 months of eruption of the first tooth and no later than 12 months of age to conduct a caries risk assessment and provide parental education including anticipatory guidance for prevention of oral diseases.
  • Grazing aka repetitive consumption of any liquid containing fermentable carbohydrates from a bottle or no-spill training cup should be avoided. Between meal snacks and prolonged exposures to foods and juice or other beverages containing fermentable carbohydrates should be avoided.

Thumb Sucking

Child sucking on thumb at the Pediatric Dentist serving Southlake and KellerThumb sucking is completely normal for babies and young children. It provides security. For young babies, it is a way to make contact with and learn about the world. In fact, babies begin to suck on their fingers or thumbs even before they are born. Thumb, finger and pacifier sucking affects the teeth and jaws in essentially the same way. However, a pacifier habit often is easier to break. Most children stop sucking on thumbs, pacifiers, or other objects on their own between 2 and 5 years of age. For those who don’t cease the habits their upper front teeth may tip toward the lip or not come in to place properly. Frequent or intense habits over a prolonged period of time can affect the way the child’s teeth bite together, as well as the growth of the jaws and bones that support the teeth. Please find on our web site a chart which can be utilized in your home to assist your child with breaking the habit. The chart has 30 days for recognition representing each day the child does not “perform” the habit. A small token or prize daily for the child who is on track to break their habit is important. A child is best assisted with breaking a habit by a “daily” reward, since long term goals for them are difficult. We suggest parents provide a “small token” award daily as they mark their calendar, with a BIG prize for the achievement after 30 days of no sucking. We are here to help you congratulate them and have an office award for them as well which includes a certificate when they bring us their chart of completion.


Why Good Dental Health is Important

Volumes of studies and research prove the importance of starting children early in their lives with good dental hygiene and oral care. According to research, the most common chronic childhood disease in America is tooth decay, affecting 50 percent of first graders and 80 percent of 17-year-olds. Early treatment prevents problems affecting a child’s health, well-being, self-image and overall achievement.

The National Institute of Dental & Craniofacial Research estimates that children will miss 52 million hours of school each year due to oral health problems and about 12.5 million days of restricted activity every year from dental symptoms. Because there is such a significant loss in their academic performance, the Surgeon General has made children’s oral health a priority.

Parents are responsible for helping their children practice good dental hygiene until the child is at least 10 years of age and should start these practices during infancy. The American Academy of Pediatric Dentistry states that a good oral hygiene routine for children includes:

  • Thoroughly cleaning your infant’s gums after each feeding with a water-soaked infant cloth or toothbrush. This stimulates the gum tissue and removes food.
  • Gently brushing your baby’s erupted teeth with a small, soft-bristled toothbrush and using a smear sized amount of fluoridated toothpaste until 2, and changing to a pea sized amount once the child turns 2 years of age.
  • Even if the child is resistant to brushing, it is mandatory that teeth get brushed daily. Consistency and training will help your child develop a healthy mouth, as well as a healthy perception of oral care. In reality, children typically do not like getting their diaper changed, however as parents we push through their crying and resistance. The mouth is even MORE important to clean daily than a diaper. When the diaper is not changed it is uncomfortable for the child and those who provide care for them, with the result being rashes and the like. In contrast when the mouth is not cleaned, it can result in debilitating dental disease which can be financially devastating as well as affect their overall health for their entire lives.
  • Regular visits with Dr. Armstrong and Dr. Watts to check for cavities in the primary teeth and for possible developmental problems.
  • Asking Dr. Armstrong, Dr. Watts or their staff about sealant application to protect the chewing surfaces of your child’s teeth.


Brushing Tips:

  • Starting at birth, clean your child's gums with a soft cloth and water.
  • As soon as your child's teeth erupt, brush them with a soft-bristled toothbrush.
  • If they are under the age of 2, use a small "smear" of toothpaste.
  • If they're 2-5 years old, use a "pea-size" amount of toothpaste.
  • Be sure and use an ADA-accepted fluoride toothpaste and make sure your child does not swallow it.
  • When brushing, the parent should brush the child's teeth until they are old enough to do a good job on their own.

Flossing Tips:

  • Flossing removes plaque between teeth and under the gumline where a toothbrush can't reach.
  • Flossing should begin when any two teeth touch.
  • Be sure and floss your child's teeth daily until he or she can do it alone.

Tooth Decay Prevention

Tooth decay is a progressive oral disease resulting in the interaction of bacteria that naturally occur in the mouth with sugars in the everyday diet. Sugar causes a reaction in the bacteria, causing it to produce acids that break down the surface of teeth, forming a cavity. Avoiding unnecessary decay requires strict adherence to a dental hygiene regimen: brushing and flossing twice a day, regular dental checkups, diet control and fluoride treatment. Practicing good hygiene avoids unhealthy teeth and costly treatment.


Oral Health Problems

Tooth Decay

Caries, or tooth decay, is a preventable disease. While caries might not endanger your child’s life, it may negatively impact their quality of life.

When teeth and gums are consistently exposed to large amounts of starches and sugars, acids may form that destroy tooth enamel. Carbohydrate-rich foods such as candy, cookies, soft drinks, sports drinks and even fruit juices feed the bacteria that produce acid. Don’t be hoodwinked by the fact that “natural” or “no sugar” added fruit juice is safe. Fruit juice is as bad for our teeth as Coca-Cola due to its acidic nature and sugar content known as fructose.

Canker Sores

Canker sores (aphthous ulcers) are small sores inside the mouth that often recur. Many apthous ulcers are caused by trauma such as injuring the gums with a toothbrush. However, sometimes they can be caused by a chemical found in many toothpastes. Generally lasting one or two weeks, the duration of canker sores can be reduced by the use of antimicrobial mouthwashes or topical agents or can be cauterized in our office, if needed. A canker sore has a white or gray base surrounded by a red border.

Orthodontic Problems

A bite that does not meet properly (malocclusion) can be inherited or in many instances acquired. Some causes of malocclusion include missing or extra teeth, crowded teeth or misaligned jaws. Accidents or developmental issues, such as finger or thumb sucking over an extended period of time, may cause malocclusions. Dr. Armstrong and Dr. Watts evaluate each patient for their orthodontic need and make referrals to an Orthodontist when necessary.


Worried child holding mouth at the Pediatric Dentist in Southlake and Grapevine, TXTooth Ache

Begin by cleaning around the sore tooth meticulously. Using warm salt water, rinse the mouth to displace any food trapped between teeth. UNDER NO CIRCUMSTANCES should you put an aspirin on the aching tooth or on the gum. For temporary relief, alternating an oral dose of acetaminophen and ibuprofen is highly effective for tooth pain.

In the event of a facial swelling, apply a cold compress to the area and see a dentist or go to the nearest emergency room immediately.

Cut or Bitten Tongue, Lip or Cheek

Ice can be applied to any bruised areas. For bleeding, apply firm (but gentle) pressure with sterile gauze or a clean cloth. If the bleeding does not stop with pressure or continues after 15 minutes, go to the closest emergency room.

Broken Tooth

Rinse the area with warm water. Put a cold compress over the facial area of the injury. Recover any broken tooth fragments. Most broken teeth do not require immediate care, however you should contact your dental office and discuss your child's condition.

Knocked Out Permanent Tooth

Recover the tooth, making sure to hold it by the crown (top) and not the root end. Do not clean or handle the tooth more than necessary. Reinsert the tooth in the socket and hold it in place using a clean piece of gauze or cloth if possible. If the tooth cannot be reinserted, carry it in a cup containing milk, or have a parent place the tooth in their own mouth for transport. (DO NOT PUT IN WATER.) Because time is essential, see a dentist immediately.

Bleeding After a Baby Tooth Falls Out

Fold a piece of gauze and place it (tightly) over the bleeding area. Hold the gauze or rag in place for 15 minutes. If bleeding continues, a moist tea bag, which contains tannic acid, placed on the site with pressure for 5 minutes should stop the bleeding.



General Treatment

Child brushing teeth and smiling at the Pediatric Dentist in Southlake and Fort Worth, TXOur practice can provide a wide range of dental services for your children. Our flexibility in our services saves you time and keeps your total dental care within one practice. Our emphasis is on total preventive care for our patients. Total care begins with regular hygiene visits, regular check-ups and continued home oral health routines.

We provide many preventative measures to keep your child’s teeth clean and healthy, including sealants and fluoride treatments. We also educate the parents in early detection of some common problems children may face including thumb sucking, and baby bottle tooth decay.

Our primary goal for your child’s dental development is to achieve and maintain optimum oral health through advances in techniques, technologies and by maintaining their scheduled dental exams.

The Science of Dental Decay

Streptococcus mutans is an agent of destruction for healthy teeth because it converts sugar into enamel-eating, decay-causing acid.

In the 1940s and 1950s, dental decay was widespread in the U.S. During a regular dentist visit, the question wasn’t whether you had a cavity or not, but how many cavities did you have?

Scientists and dentists, in the past, knew that cavities were caused from plaque but didn’t know how to manage its negative effects on the teeth. This is where the “drill and fill” method of dental care began. While this treatment method is still needed today, we know more about dental decay and can prevent its occurrence.

Decay is caused by specific bacteria called Mutans Streptococci (MS) and is an infectious disease with a cavity being the last step of the process. Through extensive research, we have discovered decay is caused by many factors and is reversible in the early stages. Sugar, saliva and fluoride levels are considered as well as past medical and dental history. Children between the ages of 6 months and 30 months may become infected by salivary exchange of their caretakers. It is medically and financially effective to diagnose those patients who are at greater risk and develop a preventive plan.


Fluoride is a substance that helps teeth become stronger and resistant to decay. Drinking fluoridated water and brushing and flossing regularly ensures significantly lower cavities.

Prophylaxis, or Cleaning, with the Use of Fluoride

The purpose of cleaning your child’s teeth is to remove plaque, tartar, and stains. The prescription toothpaste used is abrasive and microscopically removes the outside layer of the teeth knows as the pellicle. Following the removal of the enamel pellicle, a prescription fluoride treatment is applied. The surface of the tooth after cleaning is exposed, and the fluoride binds to the surface making the tooth harder and more resistant to decay. The advantage of the “fluoride” treatment is that in addition to it making the tooth harder and more resistant to decay, it also makes it more difficult for the decay-causing bacteria to stick to the tooth surface. Long term benefits of fluoride treatments can last 3-6 months. Clinical trials confirm the anti-caries effect (prevention of dental decay) of professional topical fluoride treatments are highly effective. Fluoride can prevent or reverse enamel demineralization (beginning of a cavity). A dental cleaning without the application of fluoride does not aid your child in the prevention of decay. Insurance companies may pay for fluoride only once a year thus some choose to only have the treatments done based on insurance coverage. Insurance companies do not make decisions based on what is best for their patients; their coverage is based on their economic formula and the employer who purchased the plan.

Flouride Varnish

The early stages of dental decay when caught early can be reversible. Decay is an ongoing process which, if not altered, will result in cavities. Until the point of cavitation, dental intervention is possible. Antimicrobial treatment (similar to an antibiotic for the mouth) is used to reduce the amount of toxic bacteria present. Currently, the drug of choice is prescription fluoride in gel, paste or in the form of varnish. Fluoride varnish was first used in Germany in 1964 and was introduced to the U.S. in 1991. Studies done in the past 30 years have proven as much as a 75 percent reduction in dental decay when fluoride varnish is used.

Orthodontic Need for Fluoride Varnish

Orthodontic patients are at an increased risk for demineralization (the first step of the decay process). When plaque acid strips the calcium from the tooth, white spot lesions are the result. Fifty percent of all patients with orthodontics have some permanent white spotting on their teeth that are more obvious when the braces are removed. Fluoride varnish can prevent spotting of the teeth for those patients and reduce their overall susceptibility for decay.

Fluoride Varnish Application

The teeth are dried and varnish is applied to the tooth surface with a small paintbrush. After the application, a film remains on the teeth until the next day when the patient can brush and remove the residue. The desired result is a decrease in the rate of new cavities and/or cavity reversal.

Post-Application Instructions

After the application of Cavity Shield, your child will feel a coating and may notice a thick sticky substance while the varnish remains on their teeth. To obtain the maximum benefit during the 4-6 hour treatment period, we ask that you take the following care when you leave our office.

  • If possible, wait until the next morning to resume normal hygiene.
  • Eat a soft food diet during the treatment period.
  • Avoid hot drinks and products containing alcohol.
  • A thorough brushing and flossing will easily remove any remaining Cavity Shield. Your teeth will return to the same shine and brightness as before treatment.


The grooves and depressions that form the chewing surfaces of the back teeth are extremely difficult (if not impossible) to clean of bacteria and food. In most instances the bristles on the toothbrush are larger than the grooves they need to clean thus acid and plaque remain even after a thorough brushing. The bacteria that remains then breaks down the tooth enamel causing cavities. Recent studies indicate that 88 percent of total cavities in American school children are caused this way.

Boy with soccer ball at Giggles and Grins Pediatric Dentistry in Southlake, TXSealants protect these susceptible areas by covering the grooves and depressions, preventing bacteria and food particles from residing in these areas. Sealant material is a resin applied to the back teeth, molars and premolars, and areas prone to cavities. While sealants are highly effective they are not a panacea for NO decay. The patient is still responsible for good oral hygiene and sealants need to be evaluated routinely so that they may be touched up from time to time.

Sports Dentistry

Your child’s smile is important! That’s why we make custom mouth guards for our patients who are active in sports. For more information, please call our office: 817-488-3533.