“That kid is growing like a weed!” Every proud parent likes to hear something like that about their child: It means they’re growing up—and it shows!
As nature takes its course, your child will physically transform into an adult. And that also includes their mouth: By the time they enter early adulthood they will have had two sets of teeth and their jaw structure will have changed dramatically.
All of this happens without you needing to do anything. But there can be bumps along the road like tooth decay or abnormal bite development. For that, you can and should intervene by preventing or at least slowing the formation of such situations.
The best way to do this is to form a partnership with your child’s dentist. Like any partnership, each party contributes something to the relationship.
For you that means first and foremost keeping up your child’s regular oral hygiene practice. This should start even before they begin showing teeth. As an infant you should start wiping their gums after each feeding with a clean wet cloth to hold down bacterial growth. When teeth appear, you can graduate them to brushing and flossing, teaching them along the way to do it for themselves.
You can also boost their dental health by cutting back on sugar consumption, which feeds bacteria. Besides monitoring their snacks, also avoid sending them to bed with a bottle filled with a sugary liquid (including formula, breast milk, or regular milk). And be sure you provide them a nutritious diet filled with tooth-strengthening foods.
On your dentist’s part, they provide regular cleanings that help ensure decay-causing plaque doesn’t build up on the teeth. They’ll also monitor for any signs of decay, and provide treatment when necessary. To further protect them against decay, dentists can apply sealants and topical fluoride to your child’s teeth, especially if they appear to be at high risk. And they’ll also be watching for early signs of a bite problem: Early intervention could prevent or at least minimize this development.
With that kind of solid partnership, your child’s normal dental development can proceed as smoothly as possible. Avoiding the possible pitfalls will help them achieve optimal oral health now and throughout their lives.
Most of us are quite familiar with what traditional braces look like. But occasionally we see more complex-looking devices being worn by young orthodontic patients: thicker wires that extend outside the mouth, with straps that may go behind the neck or over the chin. What are these devices, and why are they sometimes needed?
In general, orthodontic appliances with external parts braced by the head, neck or chin are referred to as “headgear.” These devices may be used to handle a number of particular orthodontic situations, but they all have one thing in common: They provide the additional anchorage needed to move teeth into better positions.
It may come as a surprise that teeth, which seem so solid, can actually be moved fairly easily over time. This is because teeth are not fixed directly into bone, but are instead held in place by a hammock-like structure called the periodontal ligament. Using a light, controlled force — such as the force of springy wires and elastics in traditional braces — teeth can be moved slowly through the jaw bone, like a stick being pulled through sand.
Of course, to pull a stick through sand, you need a firm anchorage — your legs, for example, bracing against a rock. Most of the time, the back teeth, with their large, multiple roots, provide plenty of support. But sometimes, the back teeth alone aren’t enough to do the job.
If a very large space between teeth is being closed, for example, the back teeth might be pulled forward as the front teeth are pulled back; this could result in poor alignment and bite problems. In other cases, the front teeth may need to be pulled forward instead of back. The back teeth can’t help here; this is a job for headgear.
Some types of headgear have a strap that goes behind the head or neck; they use the entire head as an anchorage. Other types, called “reverse pull” headgear, have a strap that comes over the chin or the forehead; they can pull teeth forward. Headgear can even influence the proper growth of facial structures — that’s why it is usually seen on preteens, whose growth isn’t yet complete.
Headgear is usually worn for 12 hours per day, for a limited period of time. In some cases, rather than headgear, appliances called “temporary anchorage devices” (TADS) may be recommended. These are tiny screws that are implanted into the jawbone in a minimally invasive procedure, and serve a similar function.
While it may not look pretty, orthodontic headgear is capable of moving teeth into their proper positions in a relatively short period of time — and ending up with a great-looking smile is what orthodontics is all about.
As the host of America's Funniest Home Videos on ABC TV, Alfonso Ribeiro has witnessed plenty of unintentional physical comedy…or, as he puts it in an interview with Dear Doctor–Dentistry & Oral Health magazine, "When people do stuff and you're like, 'Dude, you just hurt yourself for no reason!'" So when he had his own dental dilemma, Alfonso was determined not to let it turn onto an "epic fail."
The television personality was in his thirties when a painful tooth infection flared up. Instead of ignoring the problem, he took care of it by visiting his dentist, who recommended a root canal procedure. "It's not like you wake up and go, 'Yay, I'm going to have my root canal today!'" he joked. "But once it's done, you couldn't be happier because the pain is gone and you're just smiling because you're no longer in pain!"
Alfonso's experience echoes that of many other people. The root canal procedure is designed to save an infected tooth that otherwise would probably be lost. The infection may start when harmful bacteria from the mouth create a small hole (called a cavity) in the tooth's surface. If left untreated, the decay bacteria continue to eat away at the tooth's structure. Eventually, they can reach the soft pulp tissue, which extends through branching spaces deep inside the tooth called root canals.
Once infection gets a foothold there, it's time for root canal treatment! In this procedure, the area is first numbed; next, a small hole is made in the tooth to give access to the pulp, which contains nerves and blood vessels. The diseased tissue is then carefully removed with tiny instruments, and the canals are disinfected to prevent bacteria from spreading. Finally, the tooth is sealed up to prevent re-infection. Following treatment, a crown (cap) is usually required to restore the tooth's full function and appearance.
Root canal treatment sometimes gets a bad rap from people who are unfamiliar with it, or have come across misinformation on the internet. The truth is, a root canal doesn't cause pain: It relieves pain! The alternatives—having the tooth pulled or leaving the infection untreated—are often much worse.
Having a tooth extracted and replaced can be costly and time consuming…yet a missing tooth that isn't replaced can cause problems for your oral health, nutrition and self-esteem. And an untreated infection doesn't just go away on its own—it continues to smolder in your body, potentially causing serious problems. So if you need a root canal, don't delay!
If you would like additional information on root canal treatment, please contact us or schedule a consultation. You can learn more by reading the Dear Doctor magazine articles “A Step-By-Step Guide to Root Canal Treatment” and “Root Canal Treatment: What You Need to Know.”
Tooth decay and developing bite problems could be major obstacles to your child's normal growth and development. Without good, preventive dental care at home and from the dentist, these obstacles could impact their health now and well into adulthood.
Here are 3 things you should do to help your child stay ahead of harmful dental problems.
Start daily hygiene early. To protect your child from tooth decay, you should begin cleaning their teeth and gums early, even before teeth appear. For your first hygiene efforts use a clean wet cloth to wipe their gums after feeding to reduce bacterial growth in the mouth. After teeth begin to erupt start brushing them with a fluoride toothpaste—a slight smear for infants and up to a pea-sized amount when they get older.
Keep sugar to a minimum. The bacteria that causes tooth decay thrive on sugar. To minimize bacterial growth, keep your child's sugar intake to a minimum by providing dental-friendly snacks and foods. Also, try to limit any sugar they eat to mealtimes rather than with snacking through the day. And avoid sending them to bed with a bottle filled with a sugary liquid (including formula and breastmilk).
Begin dental visits around age one. Dentists and pediatricians recommend regular dental visits for children starting around their first birthday. This increases the chances of detecting disease or bite problems early before too much damage occurs. Your dentist can also provide preventive measures like sealants or topical fluoride to reduce the risks of tooth decay. And early visits lessen the chance of your child developing dental visit anxiety, a phobia that could continue into adulthood.
The longer many health problems go on, the worse they become. Treating them as early as possible could stop or slow their development.
That holds true for poor bites: while we can certainly correct them later in life, it's often better to "intercept" the problem during childhood. Interceptive orthodontics attempts to do this with treatments that influence how the jaws and other mouth structures develop during childhood. Many of these techniques are usually best implemented before puberty.
For example, some very complex problems called cross bites can occur if the upper jaw grows too narrowly. We might be able to stop this from happening by using an orthodontic appliance called a palatal expander during the childhood years. It works because the bone at the center of the palate (roof of the mouth) has a gap running back to front until the early teens when the gap closes.
We fit the palatal expander up under and against the palate, then extend out metal arms from a center mechanism to the back of the upper teeth that exert outward pressure on them. This widens the center gap, which the body continually fills with bone as the device gradually exerts more pressure. Over time this causes the jaw to widen and lessens the cross bite. Timing, though, is everything: it's most effective before the gap closes.
Another way to aid jaw growth is a Herbst appliance, a hinged device that alters the movement of the jaws. As a child wears it, a Herbst appliance draws the lower jaw forward to develop more in that direction. Like the palatal expander, it's best used before significant jaw growth occurs.
These are just two examples of techniques and tools that can guide structural growth and prevent bite problems. Because they're most effective in the early years of oral development, your child should undergo an orthodontic evaluation as early as age 6 to see if they need and can benefit from an interceptive treatment.
Interceptive orthodontics can stop or at least slow a growing bite problem. The effort and expense now could save you much more of both later on.
If you would like more information on interceptive orthodontics, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Interceptive Orthodontics: Timely Intervention can make Treatment Easier.”
Teeth grinding is one childhood habit that sounds worse than it usually is: often the most harm done is to your night’s sleep. That said, though, it’s still a habit to keep your eye on.
Also known as bruxism, teeth grinding is so common among children that it’s considered normal behavior by many healthcare professionals. As for causes, some suggest a child’s immature neuromuscular chewing control may trigger it, while others point to the change from deeper sleep to a lighter stage as a possible cause. Problems like airway obstruction, medications or stress also seem to contribute to the habit.
For most children, teeth grinding usually fades by age 11 with no adverse effect on their teeth. If the habit extends into adolescence, however, there’s an increased risk for damage, mainly tooth wear.
This can happen because grinding often produces chewing forces 20-30 times greater than normal. Over time this can cause the biting surfaces of the teeth to wear and reduces the size of the teeth. While teeth normally wear over a lifetime, accelerated wear can pose a significant health risk to your teeth. Any sign of tooth wear in a child or adolescent is definitely cause for concern.
If your child’s tooth grinding habit appears to be developing into a problem, your dentist may recommend a few treatment options. The most common is a thin, plastic night guard worn in the mouth during sleep that prevents the upper and lower teeth from making contact. If the suspected cause is airway obstruction, they may refer you to an ear, nose and throat (ENT) specialist to seek treatment for that, as well as other professionals to help with managing stress or medications.
Like thumb sucking, the habit of teeth grinding usually ends with no permanent ill effects. But if you notice it continuing late into childhood or your dentist finds tooth wear or other problems, take action to avoid problems long-term.
If you would like more information on childhood bruxism, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “When Children Grind their Teeth.”
If there's anything that makes Alfonso Ribeiro happier than his long-running gig as host of America's Funniest Home Videos, it's the time he gets to spend with his family: his wife Angela, their two young sons, and Alfonso's teenaged daughter. As the proud dad told Dear Doctor–Dentistry & Oral Health magazine, "The best part of being a father is the smiles and the warmth you get from your children."
Because Alfonso and Angela want to make sure those little smiles stay healthy, they are careful to keep on top of their kids' oral health at home—and with regular checkups at the dental office. If you, too, want to help your children get on the road to good oral health, here are five tips:
- Start off Right—Even before teeth emerge, gently wipe baby's gums with a clean, moist washcloth. When the first teeth appear, brush them with a tiny dab of fluoride on a soft-bristled toothbrush. Schedule an age-one dental visit for a complete evaluation, and to help your child get accustomed to the dental office.
- Teach Them Well—When they're first learning how to take care of their teeth, most kids need a lot of help. Be patient as you demonstrate the proper way to brush and floss…over and over again. When they're ready, let them try it themselves—but keep an eye on their progress, and offer help when it's needed.
- Watch What They Eat & Drink—Consuming foods high in sugar or starch may give kids momentary satisfaction…but these substances also feed the harmful bacteria that cause tooth decay. The same goes for sodas, juices and acidic drinks—the major sources of sugar in many children's diets. If you allow sugary snacks, limit them to around mealtimes—that gives the mouth a chance to recover its natural balance.
- Keep Up the Good Work—That means brushing twice a day and flossing at least once a day, every single day. If motivation is an issue, encourage your kids by letting them pick out a special brush, toothpaste or floss. You can also give stickers, or use a chart to show progress and provide a reward after a certain period of time. And don't forget to give them a good example to follow!
- Get Regular Dental Checkups—This applies to both kids and adults, but it's especially important during the years when they are rapidly growing! Timely treatment with sealants, topical fluoride applications or fillings can often help keep a small problem from turning into a major headache.
Bringing your kids to the dental office early—and regularly—is the best way to set them up for a lifetime of good checkups…even if they're a little nervous at first. Speaking of his youngest child, Alfonso Ribeiro said "I think the first time he was really frightened, but then the dentist made him feel better—and so since then, going back, it's actually a nice experience." Our goal is to provide this experience for every patient.
If you have questions about your child's dental hygiene routine, call the office or schedule a consultation. You can learn more in the Dear Doctor magazine article “How to Help Your Child Develop the Best Habits for Oral Health.”
In many ways, the teenage years are the best time to have orthodontic treatment. It’s a good time emotionally because your teen is likely to have friends who also wear braces; orthodontic treatment becomes a rite of passage they can go through together. It’s also advantageous in a physical sense because all 20 baby teeth have come out, and most of the 32 adult teeth (except the 4 wisdom teeth) have emerged. At the same time, especially with younger teens, jaw growth is not yet complete — allowing orthodontists to harness the growing body’s natural adaptability. We can use a variety of appliances to do that — some of which weren’t around a generation ago!
In many cases, traditional metal braces are still the best way to achieve the desired results. However, these are not the “train tracks” of old. Braces are smaller and lighter, with brackets that are cemented to the front surfaces of teeth rather than to bands that encircle the entire tooth (except in the very back). Braces can be made much less noticeable by using ceramic brackets that are clear or tooth-colored; however, ceramic brackets are easier to break than metal. An even stealthier way to undergo orthodontic treatment is with clear aligners. These removable clear plastic “trays” are custom made with the help of computer software that divides the treatment process into two-week stages. After each two-week period, the tray is changed and the next stage of movement takes place until the teeth are in correct alignment. The Invisalign system has two modifications especially for teens: “eruption tabs” that hold space open for emerging molars, and “compliance indicators” that can tell parents and orthodontists if the teen is keeping the trays in for the prescribed amount of time. We’d be happy to discuss whether clear aligners would be an option for your child.
Keeping It Clean
No matter which type of appliance is used, oral hygiene becomes even more important during orthodontic treatment. Wearing braces presents special challenges in terms of keeping teeth clean; however, it’s extremely important to do an effective job every day so that gums do not become inflamed and cavities do not develop. It’s far easier to clean teeth with clear aligners, which can be removed, but the aligners themselves can build up bacteria, leading to the same types of oral health issues if they are not cleaned each day.
Making It Count
Another way in which orthodontic treatment will not vary regardless of the type of appliance chosen is the necessity of a retention phase. Everyone who has their teeth straightened (and this goes for adults and younger kids, too) must wear a retainer to hold the teeth in their new and improved alignment while new bone grows around them. Yes, braces are easier to wear than they used to be… but no one wants to wear them twice!
If you have questions about braces for your teen, please contact us or schedule an appointment for a consultation. You can learn more by reading the Dear Doctor magazine articles “Clear Aligners for Teenagers” and “The Magic of Orthodontics.”
The American Academy of Pediatrics and other healthcare organizations recommend breastfeeding as the best means for infant feeding. While bottle feeding can supply the nutrition necessary for a baby's healthy development, breastfeeding also provides emotional benefits for both baby and mother.
But there might be an obstacle in a baby's mouth that prevents them from getting a good seal on the mother's breast nipple—a small band of tissue called a frenum. This term describes any tissue that connects a soft part of the mouth like the upper lip or tongue to a more rigid structure like the gums or the floor of the mouth, respectively.
Although a normal part of anatomy, frenums that are too short, thick or inelastic can restrict a baby's lip or tongue movement and prevent an adequate seal while nursing. The baby may adjust by chewing rather than sucking on the nipple. Besides a painful experience for the mother, the baby may still not receive an adequate flow of breast milk.
Bottle-feeding is an option since it may be easier for a baby with abnormal frenums to negotiate during nursing. But the problem might also be alleviated with a minor surgical procedure to snip the frenum tissue and allow more freedom of movement.
Often performed in the office, we would first numb the frenum and surrounding area with a topical anesthetic, sometimes accompanied by injection into the frenum if it's abnormally thick. After the numbing takes effect, we gently expose the tissue and cut it with either surgical scissors or a laser, the latter of which may involve less bleeding and discomfort. The baby should be able to nurse right away.
If you wait later to undergo the procedure, the baby may already have developed compensation habits while nursing. It may then be necessary for a lactation consultant to help you and your baby "re-learn" normal nursing behavior. It's much easier, therefore, to attempt this procedure earlier rather than later to avoid extensive re-training.
While there's little risk, frenum procedures are still minor surgery. You should, therefore, discuss your options completely with your dental provider. Treating an abnormal frenum, though, could be the best way to realize the full benefits of breastfeeding.
Ask any kid and they'll tell you just how valuable "baby" teeth really are—out of the mouth, of course, and under their pillow awaiting a transaction with the Tooth Fairy. But there's more to them than their value on the Fairy Exchange Market—they play a critical role in future dental health.
Primary teeth provide the same kind of dental function as their future replacements. Children weaned from nursing can now eat solid food. They provide contact points for the tongue as a child learns to speak. And they play a role socially, as children with a "toothsome" smile begin to look more like what they will become when they're fully mature.
But primary teeth also serve as guides for the permanent teeth that will follow. As a future tooth develops below the gum line, the primary tooth preserves the space in which it will erupt. Otherwise, the space can be taken over by other teeth. This crowds out the intended tooth, which may erupt out of position or remain impacted below the gum line.
In either case, the situation could create a poor bite (malocclusion) that can be quite costly to correct. But if we can preserve a primary tooth on the verge of premature loss, we may be able to reduce the impact of a developing malocclusion or even prevent it.
We can help primary teeth last for their intended lifespan by preventing tooth decay with daily oral hygiene or clinically-applied sealants and topical fluoride. If they do become infected, it may be worth the effort to preserve them using procedures similar to a root canal treatment.
If a tooth can't be preserved, then we can try to reserve the empty space for the future tooth. One way is a space maintainer, which is a stiff wire loop attached to metal band bonded around an adjacent tooth. This keeps other teeth from drifting into the space until the permanent tooth is ready to erupt, at which time we can remove the appliance.
Your child may be anxious to get another tooth to put under their pillow. But helping that primary tooth go the distance will be more than worth it for their future dental health.
If you would like more information on the care and treatment of baby teeth, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Importance of Baby Teeth.”
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