An effort for a healthy set of teeth for a newborn starts before a child even has teeth, and pediatric dentists work to ensure a $1 million smile doesn't cost $1 million to fix later.

The American Association of Pediatric Dentistry recommends taking a child to a pediatric dentist within the first year of life.

"The main reason for that is to explain some things to parents: not to sleep with bottle at night, because that can cause cavities, as well as to answer questions about thumb sucking and pacifier habits," said Dr. Thomas Jackson, a pediatric dentist at Dentistry for Kids in Cranberry Township.

"A lot of general dentists will not see kids until they are 4 or 5, and that is way too old for a first visit," said Karl Kobil, practice manager at Stephanie Kobil DMD LLC on Route 8 south of Butler.

"It's also good to visit early for clinical reasons. We've seen children with a first tooth by 8 or 9 months, which is extremely unusual," he said.

Pediatric dentists follow up dental school with an additional two to three years of training emphasizing child psychology, growth and development.

"It's the only specialty that's age-related," Jackson said.

"You learn a little bit about everything, from sedation and diet to the way kids' thought processes work."

That extra education is reflected in the dentists' demeanor with patients and parents along with the office itself. What once appeared to children as a medieval dungeon full of archaic torture devices is now, well, inviting.

"All of our offices have video games in them. It's nice to have a toy to create a relaxed atmosphere," Jackson said.

"You want to make sure that the back rooms are kid-oriented so that there's something they can focus on to be happy."

For example, the Cranberry office for Dentistry for Kids has a circus mural on the wall and the North Hills offices have ceilings painted and lighted with a relaxing rain forest motif.

Keeping the children at ease, as well as a few flat-screen TVs in the waiting rooms, allows parents to breathe a sigh of relief.

"You'll still find parents who didn't have it easy growing up in terms of dental care. They don't have fond memories," Jackson said.

"So we try to make our waiting rooms comfortable for them since they are the ones sitting there waiting."

Kobil said he has rooms decorated in "Star Wars" and other movie themes with an aviation room likely being added later.

"Our office is geared a lot with fun-oriented distractions, colors in the decor and things hanging from the ceilings, like SpongeBob SquarePants and stuffed animals," he said.

"Our whole goal here with the children is to build a trust and a bond. Everything here is explained to them so they know what we're doing, and we use hand signals so they can let us know if they want anything or are uncomfortable."

Terminology is different, too. Kobil said an extraction is called a "wiggle," and the words "needle" and "shot" are never used.

Pediatric dentists show children how to brush properly, and Dentistry for Kids turns it into a game by giving patients a score each time they visit, with contests and prizes for good brushers.

Out of the office, Kobil doubles as Flossy the Bunny, visiting schools and day care centers to teach children about good oral hygiene.

Central to that hygiene is actually keeping the teeth.

Stephanie Kobil offers children free, custom-fitted mouthguards to protect their teeth.

"I can't say enough for mouthguards. A lot of people think of football, but soccer and basketball are where most of our injuries come from," Karl Kobil said.

Jackson advised that, if a baby tooth is knocked out, don't put it back in. But, if a permanent tooth is knocked out, putting it back in increases the chance it can be saved.