In the battle against tooth decay, fluoride is an important weapon. Since the discovery of its dental health benefits a century ago, fluoride has been credited with saving countless teeth.
But over its history in dental care, this natural-occurring chemical has also had its share of controversy with concerns raised from time to time on potential health dangers. These run the gamut from “conspiracy theory” speculations to credible research like a 2006 National Research Council study that suggested a possible increased risk of bone fracture or cancer from over-consumption of fluoride.
Even so, there is actually little evidence or even record of incidence for such dire consequences. The only definitive health effect from fluoride found after decades of copious research is a condition called fluorosis, a permanent staining effect on the teeth. Fluorosis poses a cosmetic problem but does not harm the health of the teeth.
Moderation in fluoride use seems to be the key to gaining its health benefits while avoiding fluorosis. One influential fluoride researcher, Dr. Steven Levy, estimates 0.05-0.07 milligrams of fluoride per one kilogram of body weight (about a tenth the weight of a grain of salt for every two pounds) is sufficient to gain the optimum dental benefit from fluoride.
The real question then is whether your family’s current consumption of fluoride is within this range. That will depend on a number of factors, including whether your local water utility adds fluoride to your drinking water supply and how much. You may also be ingesting fluoride through processed foods, juices and even some bottled waters. And you can encounter fluoride in dental care including toothpastes and clinical treatments.
One way to moderate your family’s fluoride intake is to be sure all your family members are using the correct amount of fluoride toothpaste for their age while brushing. Infants need only a slight smear on the end of the brush, while older children can brush adequately with just a pea-sized amount. For other tips and advice, talk to your dentist about your family’s fluoride intake and how you might adjust it.
Even with the possibility of fluorosis, fluoride still provides an incredible benefit in preventing tooth decay. By understanding fluoride and keeping your intake within normal ranges you can maximize its benefit for healthier teeth and minimize the fluorosis risk.
If you would like more information on the role of fluoride in dental health, 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 “Fluoride & Fluoridation in Dentistry.”
Children losing their primary (“baby”) teeth is both natural and necessary. So, is it really that much of a concern if they lose one early?
The answer is yes — premature primary tooth loss could have long-term consequences for the permanent teeth as they develop within the jaw before eruption. Primary teeth play a crucial role in this development: as the permanent teeth form and grow the primary teeth serve as placeholders until they’re ready to erupt. A natural process then takes place in which the primary tooth’s roots dissolve (resorb) to allow them to fall out. Once they’re out of the way, the permanent teeth can then erupt.
If, however, they’re lost before the permanent teeth are ready, it leaves a space in the child’s bite. The dynamic mechanism between teeth and the periodontal ligament causes adjacent teeth to move or “drift” into the space. This can crowd out the permanent tooth intended for the space, causing it to come in improperly forming a malocclusion (bad bite), or it may become impacted and remain partially or fully below the surface of the gums.
This poor dental development could lead to extensive orthodontic treatment later in life, which is why we seek to preserve even decayed primary teeth for their entire natural lifespan. If the tooth is lost, however, we need to take action to preserve the space for the permanent tooth and avoid costly treatment later.
This usually calls for a “space maintenance” appliance — a type of orthodontic “retainer” — worn by the child to prevent other teeth from drifting into the space. Designed by your orthodontist, the appliance can also perform a cosmetic and social function by causing the space to appear unnoticeable.
Maintaining that space requires monitoring — especially by an orthodontist — and continued dental hygiene and care both at home and at the dentist’s office. The extra care preserving the space caused by premature tooth loss will help to ensure your child’s dental structure develops properly and their future smile will be an attractive one.
If you would like more information on the care and treatment of primary 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 articles “Early Loss of Baby Teeth” and “Losing a Baby Tooth.”
The best way to prevent dental visit anxiety in your children is start those visits around their first birthday, and continue with them through childhood. Age One visits are the best way to ensure they're comfortable with the dentist now and that they'll continue the habit into adulthood.
But in spite of your best efforts and those of your dental provider, there's no guarantee your child won't experience dental visit anxiety at some point. If that happens, we recommend conscious sedation.
Conscious sedation is the use of certain medications to help a patient relax. It's not the same as anesthesia, which eliminates pain by numbing tissues (local anesthesia) or inducing unconsciousness (general anesthesia). During conscious sedation a patient remains awake or at the most in a dream-like state, can still respond to touch or verbal commands, and although monitored doesn't require assistance in heart or lung function.
We can induce this relaxed state in a number of ways: orally, with medication given by mouth a short time before the visit; intravenously, the medication delivered through a drip directly into the bloodstream; or by inhalation, usually nitrous oxide gas mixed with oxygen and delivered by mask.
Oral sedation is the most common. On the day of the procedure, we'll give your child one or more sedative drugs, usually in syrup form. For best results we advise they eat a low-fat dinner the night before and not eat or drink any food or liquid afterward. We typically use Midazolam and Hydroxyzine, both of which are proven safe and fast acting.
During the procedure, we'll also assign a team member to monitor their vital signs while they're under the influence of the drugs. We may also employ special positioning or immobilization equipment to keep movement to a minimum.
After the procedure, we'll continue to monitor vitals until they return to pre-sedation levels. The child should remain home the rest of the day to rest and return to school the next day.
Conscious sedation is regulated by states: providers must be trained and licensed to administer sedation drugs with continuing education requirements. Even so, the use of sedation for children is becoming more widespread and helps to safely ensure they're getting the dental care they need.
If you would like more information on comfortable dentistry 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 “Sedation Dentistry for Kids.”
Watching your newborn develop into a toddler, then an elementary schooler, a teenager, and finally an adult is one of the most exciting and rewarding experiences there is. Throughout the years, you’ll note the passing of many physical milestones — including changes that involve the coming and going of primary and permanent teeth. Here are some answers to frequently asked questions about children’s dental development.
When will I see my baby’s first tooth come in?
The two lower front teeth usually erupt (emerge from the gums) together, between the ages of 6 and 10 months. But your baby’s teeth may come earlier or later. Some babies are even born with teeth! You will know the first tooth is about to come in if you see signs of teething, such as irritability and a lot of drooling. The last of the 20 baby teeth to come in are the 2-year molars, so named for the age at which they erupt.
When do kids start to lose their baby teeth?
Baby teeth are generally lost in the same order in which they appeared, starting with the lower front teeth around age 6. Children will continue to lose their primary teeth until around age 12.
What makes baby teeth fall out?
Pressure from the emerging permanent tooth below the gum will cause the roots of the baby tooth to break down or “resorb” little by little. As more of the root structure disappears, the primary tooth loses its anchorage in the jawbone and falls out.
When will I know if my child needs braces?
Bite problems (malocclusions) usually become apparent when a child has a mixture of primary and permanent teeth, around age 6-8. Certain malocclusions are easier to treat while a child’s jaw is still growing, before puberty is reached. Using appliances designed for this purpose, orthodontists can actually influence the growth and development of a child’s jaw — to make more room for crowded teeth, for example. We can discuss interceptive orthodontics more fully with you at your child’s next appointment.
When do wisdom teeth come in and why do they cause problems?
Wisdom teeth (also called third molars) usually come in between the ages of 17 and 25. By that time, there may not be enough room in the jaw to accommodate them — or they may be positioned to come in at an angle instead of vertically. Either of these situations can cause them to push against the roots of a neighboring tooth and become trapped beneath the gum, which is known as impaction. An impacted wisdom tooth may lead to an infection or damage to adjacent healthy teeth. That it is why it is important for developing wisdom teeth to be monitored regularly at the dental office.
If you have additional questions about your child’s dental development, please contact us or schedule a consultation. You can also learn more by reading the Dear Doctor magazine articles “Losing a Baby Tooth” and “The Importance of Baby Teeth.”
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.”
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