FLUORIDE
Contrary to their appearance, teeth are not rocks. Like bone, teeth are made up of a mineral within an organic matrix or form. Fluoride is an element that can help make our teeth more resistant to decay. When mouth bacteria eat what you eat, they give off acid by-products that undo the mineral structure of our teeth. This shows up as a soft spot when the dentist checks your teeth with an explorer.
There are different kinds of fluoride and different uses for each. There is 'systemic' and 'topical' and stannous and sodium.
Systemic fluoride is the kind you take inside your body, like a vitamin. It gets inside the enamel that your body is making on the grown-up teeth that you are growing. You can take systemic fluoride while still a tiny baby. When you are born your grown up teeth are already growing in your head, so adding fluoride as they grow can make them more resistant to decay than they normally would be. Systemic fluoride is usually taken as drops or chewable tablets, like vitamins. These are MEDICINE and only your parents should give them to you. DO NOT take them yourself.
Topical fluoride is put on the top of the teeth that you can see in your mouth. Between the ages of 11 and 16 we stop forming enamel. We have to apply it to our teeth directly, we can't add fluoride to them by eating or drinking it. We can get topical fluoride from fluoride toothpaste, fluoride mouthwashes, fluoride prescription gels, and the fluoride gel the dentist puts in your mouth when you come for your check up are all ways to add fluoride to your teeth.
It's VERY important that you don't swallow fluoride that you add to the top of your teeth. Whether it's the mouthwash you swish at home or the stuff the dentist adds to your teeth, be sure to spit it out well. You shouldn't rinse after because it's better if it can soak into the teeth for 1/2 hour, but if you swallow it, it can make you feel sick, and if you swallow too much, it can make you throw up. Don't Panic if you do. It's better to throw up and get it out of your stomach.
If fluoride is applied regularly, it can take the place of the calcium that was lost from the enamel, and re-harden our teeth. This protects them from decay. Sometimes, if you have the beginning of a cavity, you can stop it by the regular and consistent removal of plaque and the application of fluoride. However, don’t expect fluoride to save you from decay if you insist on eating and drinking sugary foods all day long.
Sodium fluoride is a bit acidic which helps it to get into the enamel and makes it taste kind of sour. Stannous fluoride is often used for people with a lot of crowns (caps) because it's not acidic and doesn't ruin the shiny surface of a crown.
Actually, the use of topical fluoride by adults and teenagers is especially important. When we’re little we can store up fluoride in our enamel by ingesting or eating it. Fluoride in water, juices and formula, and tablets that the dentist or pediatrician prescribes all serve to help to combine fluoride with the calcium in the enamel of your teeth and make your teeth more resistant to decay from the get go.
If you are on well water, your water is NOT fluoridated and you and your children should be applying fluoride in some way. Ask your dentist which regimen is right for you. You may get fluoride in some beverages. Depending on where they were bottled, juices, soft drinks, and water can have fluoride in them. These factors are to be considered and mentioned to the dentist when asking how much fluoride for you and your children. We recommend fluoride tablets and drops, but in a dosage that takes into consideration the child’s weight and diet.
Check the surrounding water systems in our community and their fluoridation status
Which brings us to the the subject of: FLUOROSIS (or “white/brown spots")
Too much of anything is not necessarily a good thing. Even fluoride. An overdose of it can cause enamel fluorsis, which causes white or brown stains to appear on the teeth, and these are often permanent, because, they go where the fluoride goes, which is into the tooth structure. Carefully follow the recommendations of your dentist to avoid this. They are trained to know how much is enough.
There are great cosmetic treatments for “spotted teeth”. Please ask us about them.
MOUTHGUARDS
Mouthguards are custom made appliances that are worn during high contact sport activities. They protect your teeth from breakage, from being pushed up into your head, or from being knocked out.
Your dentist takes an impression of your teeth and the models are used to make the mouthguard. It is then delivered to you.
A custom mouthguard is preferable because, number one, it will be more comfortable for you to wear, and two it will stay in place better.
SUGAR'S ROLE IN DECAY
When you eat, the digestion of food food begins in the mouth, not the stomach. Starches are complex carbohydrates that are broken down into simple sugars in the mouth. Simple sugars are quickly used by our bodies. They are also quickly used by the bacteria in our mouths, who eat the same food you eat. As with all living things, their digestion produces waste products. These waste products leech or pull the calcium out of our teeth and leave the soft ‘matrix’ or form behind. This leaves a soft spot in our tooth that the dentist finds with his explorer and is what we call a cavity. “Caries” is the correct term for the disease.
Generally, most sugar is washed out of our mouths in about 30 minutes by our saliva. Whether you chew gum or not! This can put a big dent in the bacteria’s ability to cause caries. However, if we nibble or sip foods and drinks with sugar in them, we continue to keep sugar in our mouths for a much longer time. Every time you put something else in your mouth the imaginary timer starts over and it will take 30 minutes from the time you swallow for the sugar to wash out of your mouth. Bathing your teeth in sugar all day long gives the bacteria lots of time to to make caries.
Bushing and flossing, rinsing after eating or drinking any sugary foods or beverages will help to remove the food source for the bacteria, making it more difficult to produce decay and keeping your teeth healthier. It also helps to keep your gums healthier.
Watch out for hidden sugars, too. Much of our American diet is loaded with sugar in things you wouldn’t even suspect, like ketchup, BBQ sauce, unsweetened cereals, breads, popcorn--the starch breaks down into sugar, and often sticks to your teeth for a while. Raisins. Sure, they are healthy, but sugar is sugar. Juices and sodas are often the culprits in much decay. Granted, juices are more nutritious than soda but, again, sugar is sugar. And it doesn’t matter if you water it down. The bacteria don’t care how much sugar is present as long as it is present.
So, put water in that sippy cup unless that child is sitting down to a meal (and milk is still the best and first choice if your child can tolerate it). Switch to diet soda for you grownups, or better yet drink fresh, clear water between meals. (Ask your pediatrician about giving diet drinks to children. There have been questions raised about artificial sweeteners for young children. And one soda with caffeine in a child is about the same as, like, 5 cups of coffee in a grownup!).
Kids, save that soda for special occasions, like when you have pizza. Gotta have soda with pizza, right?! Otherwise, drink your milk! When it’s mealtime, finish your drink before you leave the table, and if you’re thirsty and it’s not dinner time yet, have a glass of water.
Mom’s and Dads, sometimes a cool straw or neat looking bottle or cup can make water drinking more fun for kids, so you don’t have to fight with them about it. But ultimately, you’re the parents and you do what’s best for your kids. If they complain about it, let ‘em! A glass of water is better than a mouthful of decay. Sometimes we have do what’s right for them, even if they don’t like it. And eventually they’ll get used to it.
Oh, and hey, some parents even find that their child’s appetite improves when they get rid of the sippy cup of juice, making them hungry for more substantial, healthy foods. Putting sugar into that little tummy all day long suppresses the appetite for kids. Would you be hungry if you snacked all day?
Start them young, too. Don’t give that baby a bottle of sugar water, juice or formula when they go to bed. Let them drink it before they enter the crib or bed. If they must take a bottle to bed, only water, please. They’ll adjust. Kids are wonderfully resilient and adaptable.
When a baby falls asleep with a bottle the milk or juice often puddles in the mouth and emerging teeth spend several hours in a milk bath. That’s a mouthful of cavities just waiting to happen. And who wants to put their child through a bunch of fillings at the age of two?
Nursing moms, please be aware of this, also. If your child falls asleep while at the breast remove them immediately, and let them continue their nap without their mouths full. Babies often suck in their sleep and it’s best not to let them continue to dribble milk into their mouths for a long time. Cuddle them as much as you want, just not with their mouths full!
GUM DISEASE
Plaque forms on the teeth when we leave behind the food that we eat. The bacteria, having an abundant food source, multiply. The body responds by sending white blood cells into the area to fight off what it sees as an infection. While the bacteria that cause gum disease are almost always present in the mouth, when they get a chance to increase and multiply, as happens when we fail to remove the food, the bacteria grows to such numbers that the body sees it as an infection.
Because so many white blood cells come into the area, swelling occurs, and so the gums bleed easily when we touch them. That’s why your gums bleed when brushing or flossing or getting your teeth cleaned at the dentist.
Removing the food regularly is the best way to keep the bacteria in check. There can be other disease factors, which your dentist could diagnose should ordinary measures prove ineffective. But generally, daily brushing AND flossing is the best way to clean your teeth. The brush and floss are a team, one is not more important than the other. The brush goes where the floss doesn’t and vice versa. Find a time of day that is convenient to take the time or associate it with something else you do daily to help you remember. Most people bathe daily. Keep the floss in the shower! Or some keep it in the living room and do it while watching TV. Whatever works for you. Just get it in there once every 24 hours.
It will take about 2 weeks for all swelling and bleeding to disappear, so be patient and persevere. And many people say that after they get in the habit, they have to floss and brush daily, because they can tell right away when they build up plaque!
Maybe now, when kids are little it’s not such a big deal, but good gum health is important for the long term health of your teeth. If you want to keep them for your whole life, and there’s no reason why you shouldn’t be able to, it’s important to keep them clean your whole life.
Doctors are discovering that bad gums can cause other problems with your body, too, like heart disease. Bleeding gums allow bacteria to enter the blood stream, so that it can get to all the parts of your body! Eeeeuuuuuuwww!
Your hygienist can instruct you on the proper use of the brush and floss because while you want to do it well, you don’t want to cause damage from too much enthusiasm.
There are a lot of cleaning tools out there, many of which have specialized uses. Again, your hygienist can recommend those tools which are best for you.
RADIOGRAPHS- What’s the point?
Radiographs, or X-rays are taken periodically to diagnose hidden decay. The best time to catch a cavity or caries, is when they are small. Smaller caries means less trauma to the tooth to restore it.
Very often when teeth touch it is difficult or impossible to see between them or get an instrument in there to check, but there is enough space for plaque to form and for bacteria to cause decay.
Generally, we take radiographs once a year to check for decay in the back teeth. Sometimes, for kids with a high risk of decay, we will take them every six months, as recommended by the American Academy of Pediatric Dentistry.
BW is short for BiteWings.
PANOREX
Another type of radiograph that is taken is called a panorex. A panorex takes a full shot of the head, spread out, kind of like a world map. The world is actually globe, but a map takes the globe and lays it out flat. A panorex does a similar thing to your head.
Panorex’s allow us to see the placement of developing teeth that have not yet erupted, placement of wisdom teeth, and allow us to check the other structures of the lower head, checking to make sure there are not defects or tumors, anything that’s not supposed to be there.
Occlusal Radiograph
When kids are rather young, like, 3 years old, we will take an occlusal radiograph. These photograph the teeth from bottom up or the top down. We can see the placement of the front teeth and detect any problems that may arise early, before any teeth have been lost. An occlusal is easier to take on a three year old who may have trouble standing still in a panorex machine.
These days radiographic x-ray beams are tightly focused, so they go where we want them and do not often affect other parts of the body. We use the fastest film available today, which allows for lower radiation settings, and reduced exposure time. We do use a lead shield though, as an added precaution.
|
NITROUS OXIDE
Most kids do great at the dentist. Sometimes though a child will feel anxious. Anxious kids wiggle or cry, and this can prolong the visit, make it more difficult to complete the procedure or even make the procedure impossible because of gagging or increased saliva flow. We want our patients to be comfortable, to have their procedures done to the best of our ability, and reduce the time they have to spend in the treatment chair, which makes the visit more pleasant for them. Nitrous oxide can greatly help to make a child’s time at the dentist a pleasant experience.
Nitrous oxide is a combination of oxygen and nitrous oxide. The child wears a nosepiece that is connected to a hose through which the nitrous oxide/oxygen mix flows. Nitrous oxide relaxes them, reducing anxiety and shutting down or reducing the gag reflex. Consequently, the child can more easily cooperate which makes the treatment go more smoothly for him or her. Often we will see a child, who begins with tears, finish up with giggles!
There are no lasting effects. After the procedure is completed, the dentist turns off the nitrous oxide and gives straight oxygen for a few moments during the which the child recovers from the effects. Sometimes it makes you feel a little floaty and can effect balance, so we allow the child to return to his or her previous state before allowing him or her to get out of the chair.
Nitrous oxide is very safe. Matter of fact, it is the safest sedative in dentistry. It’s mild and the body eliminates it quickly. The child remains conscious throughout the procedure, though for some kids it relaxes them so much, they doze off!
It’s a good idea not to give your kids any food, or very little anyway, before the visit. Occasionally, kids will feel nauseous or toss their cookies if they have a full stomach.
And if your child has any respiratory problems, like a stuffy nose, let us know. This can limit the effectiveness of nitrous oxide. If they are breathing through their mouth, and the hose is on their nose, they’re not going to take in much nitrous oxide and it won’t work. It may be better to reschedule. Or giving them a decongestant prior to coming to the appointment may help them be more comfortable. Of course, always let the dentist know if the child is taking any medications on the day of the appointment.
Nitrous oxide may not be effective for all patients because no two children are alike and the health of your child may vary from day to day. The dentist will be able to advise you if other methods of sedation are right for your child.
SPACE MAINTENANCE
There are times when a child looses a tooth too early, which could be from decay or from being knocked out. The dentist needs to keep the space open in order for the permanent tooth to have space to come into the mouth, especially in kids who don’t have enough room to start with!
Our teeth shift around all the time, though we don’t notice it. If there is a space, the natural inclination of the teeth is to move toward the front of the mouth. Sometimes this is an actual shift forward, and sometimes they only move from the top, which causes the teeth to tip over. When a baby tooth is lost the tooth behind it can make this shift. If this occurs before the permanant tooth can come in, the space may be too tight for the permanent tooth to erupt. Intervention will then be necessary. Either the tooth is lost or orthodontics may need to be applied. This can be a long, drawn out and often costly procedure.
A space maintainer will do the job of keeping that back tooth in place until the permanent tooth can erupt. Once that occurs the space maintainer can be removed and nature can take its course.
SEALANTS
As our back teeth form, they often develop grooves on the chewing surfaces. You can see these yourself if you open wide and look in the mirror. On some people these grooves come together completely. For alot of others the grooves never completely merge. This space can be very small and narrow, too small even for toothbrush bristles to penetrate. Unfortunately, not small enough to keep bacteria out.
There is no way, no matter how diligent you are, that you can remove bacteria or plaque from these grooves. However, we have a way to keep it from getting in in the first place.
A sealant is liquid material that can be applied to a tooth surface to prevent bacteria and plaque from entering the groove. It flows down into the space, rather like putting spackling in a crack in the wall. It fills the space, prevents the plaque from entering, and subsequently prevents decay.
Sealants aren’t always 100% effective. If you don’t keep your teeth clean it can effect the durability of the sealant. If you grind your teeth heavily at night, or chew hard foods like ice or hard pretzels--the big fat ones that are wonderfully salty and really----but I digress. Or if you eat chewy sticky stuff, like taffy or Bit-O-Honey’s. Things like that can pull them off.
Having a sealant put on is a piece of cake. (Oh, great! Another food reference! You’re making me hungry!)
The dentist or hygienist cleans off the tooth surface to make sure you don’t have any plaque there. Then they apply a gel called an etchant. This makes the sealant hold on better. Often we will widen the grooves slightly to allow better access of the sealant into the groove.
If you look under a strong microscope you will see that our teeth are not really solid, but more like a honeycomb. The inside of all the little cells of the honeycomb are packed full of calcium. When plaque makes a cavity, it takes the calcium out of these cells.
When we put the etchant on, it opens these up a little, and when the sealant flows down into them it helps it to hold on to your tooth better. That’s called retention.
The etchant is rinsed off, and something called a primer is applied with a little tiny fuzzy applicator. This is dried a little to spread it out, and we shine a special curing light on it to harden it.
Then the sealant itself is put on. We spread it thin, and shine the light on it to harden it. We spread it thin, because we try to make it fit your other teeth as best as possible. Sometimes when it’s done, it may feel like your teeth do when you have cereal or chips stuck in your teeth. This usually goes away after you eat a few times. If the feeling persists, be sure to let your dentist know so they can adjust it. If it throws your bite off it can give you other problems that we won’t go into just now.
That's pretty much it, really. You can eat on them right away. The only downside to the procedure is that it tastes a little funny, and we have to put a bunch of stuff in your mouth to keep the tooth dry. It is absolutely essential that your tooth be dry. If it gets wet, the sealant won’t stay on the tooth for very long, and we’ll have to start the whole procedure over again.
OVER-RETAINED TEETH
When baby teeth hang around too long they interfere with the eruption of the permanent teeth. This often happens because for some reason the permanent tooth does not line up under the baby tooth, and so it doesn’t dissolve the root of the baby tooth properly. This ‘dissolving’ ('absorption' is the proper term) is what causes the baby tooth to fall out.
If they are not lined up right, the permanent teeth sometimes come out to the front or behind or to the side of the baby tooth. If this happens it’s important to get the baby tooth out so the permanent tooth can line up right. The pressure of the tongue and lips will slowly push the permanent tooth into place if the baby tooth is not in the way.
Sometimes this can be done by wiggling the baby tooth well and often. However, if there is still a lot of root left, it won’t be wiggle-able. The dentist will have to take it out to allow the permanent tooth to come in. The permanent tooth may be ‘stuck’ in the jaw which could result in a bone-damaging cyst.
PRE-MEDICATION
There are a few conditions that make it necessary to take an antibiotic before a dental visit. The American Heart Association recommends taking an antibiotic before dental treatment to prevent Bacterial Endocarditis (an infection of the heart that can be very serious) A patient should take a prophylactic (protective) antibiotic for the following conditions:
- Prosthetic (artificial) cardiac valves
- Previous bacterial endocarditis (if you’ve had it before)
- Complex cyanotic congenital heart disease (your parents or doctor can tell you if you have this)
- Surgically constructed systemic pulmonary shunts or conduits (same thing, your parents or doctor would know)
- Most other congenital cardiac malformations (congenital means you were born with it)
- Acquired valvular dysfunction (like rheumatic heart disease, something that made you sick and makes it easier for your heart to catch an infection)
- Hypertrophic cardiomyopathy--an enlargement or thickening of heart muscle.
- Mitral valve prolapse with valvular regurgitation (your heart valves close a little funny and sometimes push the blood backwards a little bit--ask your mom & doctor)
If you have any of these risk factors, your dentist can tell you if you will need to take an antibiotic before any treatment. Not all dental procedures require an antibiotic beforehand.
ANTIBIOTICS
For parents: while antibiotics are a wonderful discovery, and a great help to mankind, they should be used with discretion. In our society today, people seem to think a pill will solve any problem.
Don’t throw antibiotics at your child any time they have a sniffle, or cough, or complain of a slight sore throat. While antibiotics can destroy many kinds of bacteria, they are virtually non-effective on viruses. The common cold is a virus not a bacteria. Different critter.
And many micro-organisms are what we call 'opportunistic'. This means that, given the chance they will try to take over. Like teenagers. Most micro-organism populations are held in balance by the other micro-organisms that share the same space. They have to compete for food and oxygen.
If one kind of micro-organism is removed from the picture, the others race to take over their space. This can cause new problems. Classic example of this is a baby who must take antibiotics for say, an ear infection. Very often they end up with a yeast infection in the mouth. The antibiotics may have cured the ear infection but it also eliminated the bacteria in the mouth and the intestinal tract. Ever have a child develop a mild case of diarrhea after being on a course of antibiotics? They’re not sick, but the medicine wiped out good bacteria in the intestines. (Eating yogurt can help these return to normal. Just a little tip from your Aunt Deb).
The other problem with the overuse of antibiotics today is that the bacteria are growing more resistant to them. You may have heard in the news about new bacteria that are more virulent. Much of the problem is due to overuse of antibiotics. Each time they are exposed to an antibiotic they have an opportunity to adapt, and the surviving ones who manage to do this replicate and pass on this ability to be resistant to the antibiotic. New ones have to continuously be developed to overcome them.
So think long and hard about giving an antibiotic to your child. Don’t push for it if the physician thinks it is not necessary. The reasons mentioned above are some of the reasons the doctor is reluctant to prescribe them, if they are not absolutely indicated for your child's (or your!) condition.
And if you are given an antibiotic, be sure to take all of it for as long as the doctor tells you to, even if you start to feel better. If you only take part of your prescription, you give the bacteria that live within you a chance to develop a resistance to that medication. It may not kill them and the next time you need it, the medication may prove to be ineffective with those bacteria and you will need something stronger. Stronger medicines can have stronger side effects and make you feel worse than you need to feel.
MOUTH BREATHING
Some kids breathe through their mouth a lot. This is often from a stuffy nose, due to colds or allergies. Other kids are forced to mouth breathe because of very enlarged tonsils and adenoids. Having to breath through your mouth once in a while is really unimportant. What is important is if you breathe through your mouth all the time.
Chronic mouthbreathing in young children interferes with good facial growth. It also gives them a case of “chapped gums” , especially in the front of their mouths. Most kids who breath through their mouths have puffy gums in the front. They puff up because the saliva dries off of the gums, and the bacteria have a longer time to eat the plaque on the teeth, because there’s no spit to wash the sugar away.
It’s very important to clean the plaque off well each day to help prevent this. You can even put on a very, VERY thin film of vaseline or olive oil on your gums in the front to help keep them from drying out.
If your child is a big-time mouthbreather, please mention this to us, a medical consultation may be indicated.
CALCULUS
Calculus, or tarter as many people call it, is basically hard plaque. When plaque is allowed to sit on your teeth for a few days, the calcium in your saliva (spit) gets into the plaque and makes it hard. Like a fossil. Fossils get made by the bones of an animal lying in the ground for a long time. The minerals in the water and soil that surround the bone get into the bone and make it hard like stone. Something much like that happens to the plaque in your mouth only it doesn’t take as long.
Calcium is a mineral that is in our bodies. We eat it in milk and cheese and vegetables. It gets into our bones and teeth and makes them hard. It is a very important mineral for us to have.
Because it’s in our bodies it is everywhere, because our blood carries it to all parts of us so that our bodies can use it to keep us healthy. So we find it in our saliva. That’s how it gets into our plaque. If you take the plaque off every day, this is not a problem. but if you allow the plaque to build up, the calcium hardens the plaque so much that you can’t brush it off, and you have to go to the dentist to have the hygienist scrape it off. So, if you don’t like having your teeth scaled, clean them off well at home! That should minimize the work the hygienist has to do to help you, and make your cleaning visits easier!
TOOTH ERUPTION
This chart will give you information about when you can generally expect your child to lose or gain teeth. Remember that each child grows at his or her own rate, so these dates will vary for each child.
|
