A purple dinosaur in a poster on the wall of the Irving and Jeanne Tapper Pediatric Dental Clinic reminds tiny tots and their parents not to let their teeth go extinct like the dinosaurs.

By the age of two, some children will make a trip to the operating room to remove severe decay (dental infection) from as many as 12-16 of their teeth and, in some cases, all of their teeth. A year later, some of those children will repeat the operating room visit, due to poor oral hygiene and nutrition.

"It's all preventable," said Seth Canion, chair of the Case Western Reserve University School of Dentistry's department of pediatric dentistry and director of pediatric dentistry at the Tapper Pediatric Dental Center located in Rainbow Babies and Children's Hospital. Approximately 10,000 patient appointments are recorded annually at the Tapper Pediatric Dental Center for infants, toddlers and adolescents who present a host of oral health concerns that include trauma, dental infection, cleft palate and serious medical conditions.

Canion directs the center's operations and collaborates with the hospital's doctors in a team approach to getting some very sick children on the road to recovery-as well as fixing some of the city's worst dental health for children with special needs. Other dentists refer many of these patients to the clinic.

His staff of two full-time pediatric dentists and four residents in pediatric dentistry is specially trained in knowing the physical, emotional and developmental needs of children from newborns to adolescents.

"We have enough knowledge today to prevent this disease if we have the willingness to roll up our sleeves and put in the effort," Canion said.

This requires a team effort between the dentist and the parents or guardians, according to Canion.

To reach that level of awareness requires something called "anticipatory guidance," which involves informing parents about how to care for their children's teeth from the appearance of the first tooth around six months. Canion said this advice, which includes making sure young children eat the right foods and keep regular preventative visits to the dentist, requires changing the attitude that baby teeth aren't important.

"We must be empathetic as well and recognize that parents have other obligations such as other siblings to care for, single parent families, children with handicapping conditions that make it more difficult to maintain adequate oral hygiene," Canion said. "We must listen to the parent in order to help them help their child."

It also means overcoming some painful memories or fears parents might have about childhood visits to the dentist.

"Dentistry has come a long way, and we can make the child's visit as comfortable as possible," he added.

When a two-year-old screams during a dental visit, Canion relies on his background in child development to explain to parents that the screaming is a result of "stranger anxiety." It is "hardwired" into the "terrible twos" and is normal for this developmental age. With this explanation, Canion then reassures parents that the dentist is not hurting the child.

Making dental treatment as comfortable as possible and being concerned about the child's developing psyche is the reasoning behind why some children with extensive infections are scheduled for the operating room where they have all the dental problems cared for at once. Follow-up preventative maintenance visits for checkups and cleanings are then scheduleded for a time when the parent or guardian can be present to begin patient education, especially for the younger child.

According to Canion, infection in the teeth is prevalent enough to keep the operating rooms busy all day Thursdays and the first and third Tuesday of the month.

Research has reported that approximately 80 percent of all dental decay resides in 20-25 percent of the population, he said.

Canion also points out that patient education and tooth-brushing instruction is not introduced to the parents who have brought a child who is in pain into the center, as the priority is to get the child out of pain and make the child comfortable. The child is then scheduled for a visit where Canion and his staff can get down to the nitty-gritty business of teaching appropriate brushing and flossing to the child and parents or guardians.

He said young children do not develop the muscles and coordination to do an adequate job of brushing until they are about seven years old, and they won't have the skills for flossing until about age nine.

He encourages parents to make it a family activity. The child can watch his mom or his dad brush their teeth and then be given the brush "to copy" what the parent did. Children like to mimic their parents, Canion said, but young children still need parental help and guidance to effectively clean their teeth.

Convincing parents that the baby teeth are important is another major hurdle, according to Canion. Yes, the teeth eventually fall out, he said, but loss of a tooth too early in the child's development can have a detrimental domino effect upon the permanent teeth. Spaces between the teeth can occur that cause the teeth to move and require braces, speech problems can develop and even eating disorders may arise.

"Baby teeth are the foundation and building blocks for permanent teeth," Canion said.

He subscribes to the philosophy that "the mouth is a portal to health," where the teeth chew the food that nourishes the body, that form the words people speak and form the smiles that lighten up their faces.

"I don't subscribe to the idea that children should be afraid to go to the dentist, but unfortunately some of the parents have this view and have subconsciously passed this fear onto their children," Canion said. "It shouldn't be that way. We try our best during the patient education session to illicit these negative feelings from the parent and try to educate them as to how this can negatively affect their child's dental visits."

CWRU recruited Canion from the University of Tennessee to come to Cleveland and design the new clinic at the hospital. The center has the capabilities of caring for children brought to the clinic in wheelchairs or other children throughout the hospital with special needs.

"Total health most certainly includes oral health," Canion said.

The clinic is named after Irving Tapper, a pediatric dentist, whom Canion describes as a visionary who believed that to be an excellent children's hospital, the facility must have a dental clinic for children in it. Whether the child is in a hospital bed or walking into the clinic, Canion said he wants parents to know that any infection in the mouth is like an infection in the body. It should be treated to give the child the best overall t