Proactive dental care is an essential part of childhood growth. But that care can be much harder for children with chronic health issues than for healthier children.
“Chronic condition” is an umbrella term for any permanent and ongoing health issue. Asthma, Down’s syndrome, cystic fibrosis, congenital heart defects and many others fall under this umbrella, with varying symptoms and degrees of intensity. But they all have one common characteristic — a long-term effect on all aspects of a child’s health.
That includes the health of a child’s teeth and gums. Here, then, are a few areas where a chronic health condition could impact dental care and treatment.
Ineffective oral hygiene. Some chronic conditions like autism or hyperactivity disorder (ADHD) that affect behavior or cognitive skills can decrease a child’s ability or willingness to brush or floss; some conditions may also limit their physical ability to perform these tasks. Parents and caregivers may need to seek out tailored training for their child’s needs, or assist them on a regular basis.
Developmental defects. Children with chronic conditions are also more likely to have other developmental problems. For example, a child with Down, Treacher-Collins or Turner syndromes mayÂ be more likely to develop a birth defect called enamel hypoplasia in which not enough tooth enamel develops. Children with this defect must be monitored more closely and frequently for tooth decay.
Special diets and medications. A child with a chronic condition may need to eat different foods at different times as part of their treatment. But different dietary patterns like nutritional shakes or more frequent feedings to boost caloric intake can increase risk for tooth decay. Likewise, children on certain medications may develop lower saliva flow, leading to higher chance of disease. You’ll need to be more alert to the signs of tooth decay if your child is on such a diet or on certain medications, and they may need to see the dentist more often.
While many chronic conditions raise the risk of dental disease, that outcome isn’t inevitable. Working with your dentist and remaining vigilant with good hygiene practices, your special needs child can develop and maintain healthy teeth and gums.
If you would like more information on dental care for children with chronic health conditions, 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 “Managing Tooth Decay in Children with Chronic Diseases.”
Once upon a time, braces were the way to straighten a smile. They were—and continue to be—an effective orthodontic treatment especially for younger patients. But braces do have a few drawbacks, one of the biggest being appearance: when you're wearing braces, everyone can see you're wearing them.
That changed a couple of decades ago with the introduction of clear aligners. Removable plastic trays that incrementally move teeth, aligners have quickly become popular for a number of reasons. Perhaps their biggest attraction is that they're barely noticeable.
There's now a third option for correcting crooked teeth: lingual braces. They're similar to the traditional version, but with one big difference: all of the hardware is on the back side of the teeth.
Ironically, two orthodontists an ocean apart developed the idea, and for different reasons. A Beverly Hills orthodontist was looking for an invisible tooth-moving method that would appeal to his image-conscious patients. The other in Japan wanted to offer his martial arts patients, who risked injury from facial blows with traditional braces, a safer alternative.
These two motivations illustrate the two biggest advantages to lingual braces. The brackets and other hardware are attached to the back of the teeth (on the tongue side, hence the term "lingual") and exert the tooth-moving force by pulling, in contrast to the pushing motion of labial ("lip-side") braces. They're thus invisible (even to the wearer) and they won't damage the soft tissues of the cheeks, lips and gums if a wearer encounters blunt force trauma to the mouth.
They do, however, have their disadvantages. For one, they're often 15-35 percent more expensive than traditional braces. They're also a little more difficult to get used to—they can affect speech and cause tongue discomfort. Most patients, though, get used to them within a week. And, being a relatively new approach, not all orthodontists offer them as a treatment option yet.
If you're interested in this approach to teeth straightening, speak with your orthodontist to see if they're right for you. But if you do take this route, you may have a more pleasing and safe experience.
If you would like more information on orthodontic treatment with lingual braces, 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 “Lingual Braces: A Truly Invisible Way to Straighten Teeth.”
Wearing braces will probably never make your list of Most Pleasurable Life Experiences: you'll have to avoid certain foods and habits, endure some occasional discomfort, and perhaps feel some embarrassment about your appearance. The good news, though, is that at worst, these are mostly no more than inconveniences and additionally they're well worth the straighter, more attractive smile you'll achieve.
But there's one downside to braces that can lead to something more serious. The braces hardware makes brushing and flossing more difficult—and that could increase your risk of dental disease.
The principal goal of oral hygiene is to remove dental plaque, a thin film of accumulated bacteria and food particles that can cause tooth decay or periodontal (gum) disease. Without effective brushing and flossing, plaque can build up quickly and make the chances of having either of these two diseases more likely.
Not only does the braces hardware hinder your toothbrush's or floss's access to the parts of the teeth it covers, but it can also create "hiding places" for plaque build-up. Several studies have found that braces wearers on average have up to two to three times the plaque build-up of non-braces wearers.
There are ways, though, to make hygiene easier while wearing braces, particularly with flossing. Floss threaders or interproximal brushes can both be used to access between teeth while wearing braces. Another option is a water flosser or irrigator that sprays pressurized water between teeth (and beneath brackets and wires) to remove plaque. And braces wearers can get a prevention boost with topical fluoride applications or antibacterial mouth rinses to reduce disease-causing bacteria.
Besides taking a little extra time with brushing and flossing, you can also boost your mouth's health with good nutrition choices, less sugar consumption and keeping up regular dental visits. And, you should also see your dentist promptly if you notice any signs of tooth or gum problems—the sooner you have it checked and treated, the less damage any dental disease is likely to cause.
It's not easy keeping your teeth and gums plaque-free while wearing braces. But with a little extra time and effort, a few helpful tools and your dentist's support, you can maintain a healthy mouth during orthodontic treatment.
If you would like more information on best hygiene practices while wearing braces, 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 “Caring for Teeth during Orthodontic Treatment.”
Everyone loves a concert where there's plenty of audience participation… until it starts to get out of hand.Â Recently, the platinum-selling band Fifth Harmony was playing to a packed house in Atlanta when things went awry for vocalist Camila Cabello. Fans were batting around a big plastic ball, and one unfortunate swing sent the ball hurtling toward the stage — and directly into Cabello's face. Pushing the microphone into her mouth, it left the “Worth It” singer with a chipped front tooth.
Ouch! Cabello finished the show nevertheless, and didn't seem too upset. “Atlanta… u wild… love u,” she tweeted later that night. “Gotta get it fixed now tho lol.” Fortunately, dentistry offers a number of ways to make that chipped tooth look as good as new.
A small chip at the edge of the tooth can sometimes be polished with dental instruments to remove the sharp edges. If it's a little bigger, a procedure called dental bonding may be recommended. Here, the missing part is filled in with a mixture of plastic resin and glass fillers, which are then cured (hardened) with a special light. The tooth-colored bonding material provides a tough, lifelike restoration that's hard to tell apart from your natural teeth. While bonding can be performed in just one office visit, the material can stain over time and may eventually need to be replaced.
Porcelain veneers are a more long-lasting solution. These wafer-thin coverings go over the entire front surface of the tooth, and can resolve a number of defects — including chips, discoloration, and even minor size or spacing irregularities. You can get a single veneer or have your whole smile redone, in shades ranging from a pearly luster to an ultra-bright white; that's why veneers are a favorite of Hollywood stars. Getting veneers is a procedure that takes several office visits, but the beautiful results can last for many years.
If a chip or crack extends into the inner part of a tooth, you'll probably need a crown (or cap) to restore the tooth's function and appearance. As long as the roots are healthy, the entire part of the tooth above the gum line can be replaced with a natural-looking restoration. You may also need a root canal to remove the damaged pulp material and prevent infection if the fracture went too far. While small chips or cracks aren't usually an emergency (unless accompanied by pain), damage to the tooth's pulp requires prompt attention.
If you have questions about smile restoration, please contact us and schedule an appointment. You can read more in the Dear Doctor magazine articles “Porcelain Veneers: Strength & Beauty As Never Before” and “Porcelain Crowns & Veneers.”
Pediatricians and dentists alike recommend beginning your child's regular dental visits at an earlier age rather than later. Most say children's first visits should happen around their first birthday.
Some may question whether that's necessary given the state of a child's dental development at that age. At that stage they normally have only a few primary teeth, which will eventually give way to their permanent set soon enough.
But regular dental visits can make a positive difference even at that early age. Here are 3 oral health areas that could benefit from seeing the dentist by Age One.
Protecting primary teeth from decay. It's true that primary teeth don't last long when compared to a normal lifespan. But during their short tenure, they do play a critical role in a child's health and development. Not only do they provide a child dental function for eating, speaking and smiling, they also preserve the space for the permanent teeth that will succeed them. Without them, permanent teeth can erupt out of position to form a poor bite (or malocclusion). That's why early dental care to prevent and treat decay in primary teeth helps them remain for as long as they should.
Detecting developing malocclusions. A malocclusion doesn't form overnight—there can be subtle signs of its development during early childhood. A dentist, especially a pediatric dentist or orthodontist, can often detect those signs before the malocclusion fully develops (one reason why every child should have an orthodontic evaluation around age 6). With early detection, an orthodontist can use interventional techniques that will lessen or even stop a malocclusion from forming. As a result, later orthodontic treatment may not be as extensive—or expensive—as it could have been.
Developing a healthy dentist-patient relationship. Dental anxiety is a real problem for many adults—in some cases it can be so severe they avoid professional dental care altogether. The roots of that dental fear often go back to unpleasant experiences during childhood. Starting dental visits when a child is very young appears to minimize the development of dental anxiety. A young child, especially visiting a "kid-friendly" dental clinic, will more likely view dental care as a routine part of life and will less likely be afraid.
If you would like more information on dental care for children, 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 “Age One Dental Visit: Why It's Important for Your Baby.”
“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.”
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