The Mouth: the first stop in your health care.

The healthcare of a child is a challenging prospect. It often starts prior to conception (pre-natal vitamins) later evolving into a modified behavior changes (no-alcohol, no-smoking etc) and all through delivery. Then the real fun starts: inoculations, well visits, flu shorts, and the list goes on. At some point, the oral health is also considered, often due to pain, discomfort or concern about the child’s mouth and teeth.

While oral-health is secondary to overall health, it can certainly help maintain the overall health of the child. Ideally good oral health should start early. There are a few preventative and early intervention tools to ensure desired results from childhood. This article will briefly touch on those recommendations.

Pregnancy: It is the most critical time for development for the infant. It is why alcohol, smoking and other risky behavior can be detrimental to the health of the baby. Conditions such as cleft-lip, cleft-palate, and other similar deformities usually occur as a developmental deficiency during this time; fortunately they are correctable (surgically) early on.

Tetracycline stained teeth: A fairly common antibiotic, that when taken during pregnancy, results in permanently dark/grey stained teeth. While this is a fairly known fact now, until 1980’s this was the antibiotic of choice for the treatment of many bacterial infections. It is better regulated now.

Teething: Many infants begin teething in their fourth month. An effective method to reduce the child’s pain during the eruption of baby teeth is gently rubbing the newborn’s gums with wet gauze. This reduces the accumulation of debris and bacteria on the gums. Many parents report decreased discomfort and even painless eruption of baby teeth following the use of this method.

Brushing the baby’s teeth: Few toddlers will allow a parent to just pick up a brush and start cleaning their teeth. One of the most effective methods is creating a non-threatening situation. This can be accomplished by letting the child watch as the parent brushes their teeth. Then ask the child to help hold the brush as the parent is brushing. Make happy sounds as the two of you brush your teeth. Then give the child their brush to hold and play with. As the toddler views this as a non-threatening situation, he/she will be more agreeable to let the parent help them hold their brush and gently touch the child’s teeth. Tooth paste is not necessary in the first few days and can be introduced incrementally over time.

Baby bottle caries syndrome: A preventable condition that results from falling asleep with a bottle (juice or milk). While the baby sleeps, the teeth are bathed in either liquid, which is an ideal growth medium for dental caries. This condition is unmistakable, because as the child smiles, large dark holes are visible within the teeth. This is a preventable condition. If a baby insists on sleeping with a bottle (for comfort) fill the bottle with water. Water will not act as an accelerant for caries. If the child insists on milk or juice, try to have the child finish it prior to falling asleep. If that too is not possible, consider diluting the milk or juice with greater quantities of water with each day, until finally there is about 5% juice or milk with 95% water. At that point the appeal of the bottle is usually lost, and the problem is solved.

Pacifier and thumb sucking: Using a pacifier over the age of 3 may result in crooked teeth. The most common one is the open bite. This creates an esthetic and periodontal problem. Esthetically: this is due to the inability to close the front teeth, incisors. These teeth often tend to flare forward, pushing the upper lip forward. Later on this condition can be carried over to the adult teeth by thumb sucking.

Losing the “Baby teeth” prematurely: Baby teeth serve a vital function. While they are temporary (5-10 yrs), they are not disposable. The “Baby” teeth serve as a trial run for the adult teeth in both hygiene and function. Children that can learn to keep their baby teeth clean and cavity-free, are more likely to have adult teeth that are clean and cavity free.

Functionally these teeth serve as guides to the adult teeth. They reserve the correct spot for the corresponding adult teeth. In other words, if one is missing baby teeth prematurely, he/she will likely lose some of the space that the adult teeth require to erupt properly. The adult tooth may be blocked or deflected. To correct this situation in the future the child will have to undergo orthodontic (braces) therapy, which is both long and costly. In many of these cases, early intervention can reduce the need for corrective orthodontic therapy.

Retained baby teeth can also lead to serious orthodontic complications. An adult tooth trying to come out may be blocked or deflected by an over-retained baby tooth. It is important to have regular check-ups from age 5 to help facilitate the smooth eruption of the adult teeth.

Fluoride treatment: this inexpensive additive to water helps prevent dental caries. Bottled water does not contain fluoride. If the primary source of drinking water is bottled, routine application of dental fluoride should be a part of dental care, for children and adults.

Child oral health care is mostly preventive. Recognizing and dealing with potential problems saves money and effort later on. A good impression from a first dental visit can also reduce future anxiety. It is recommended that a toddler without any obvious problems, have a first dental visit before the first birthday (American Academy of Pediatric Dentistry). If the first visit is not one where the child is in pain, it is not likely to leave a traumatic memory. Subsequent visits would be tolerated better.

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The brighter smile

Orthodontics, the applied science of moving teeth, was developed with the intent of correcting the misalignment and malocclusion (improper bite) of teeth. While most people want that beautiful smile, Orthodontic correction also helps maximize the efficiency and function of teeth.

It does so by removing potential food traps created by crowded teeth, or teeth that are too far away. This allows for better access to clean more of the tooth surface helping reduce tooth decay and periodontal disease. Overcoming the effects of thumb-sucking, open bites or deep bites also fall under the prevue of orthodontic correction. Done properly these changes can recreate facial contour more effectively then any plastic surgery.

The field of Orthodontics has come a long way. Braces and wires are no longer the only way to correct overbites, overcrowding or open spaces between teeth.

The new method, Invisalign, has been in the market for the past decade. It has been used for over 750,000 patients. The system is based on work conducted by Dr. H.D Kesling in 1945. In the 1990’s the system, thanks to computer imaging, became cost effective.

Both traditional orthodontics and invisalign utilize the same type of constant pressure to manipulate and reposition teeth. While the results are fairly similar, the methods that generate these forces are very different.

Traditional orthodontics (called traditional because this was the only way to move teeth until recently) uses metal brackets and braces in combination with wires to create a point of pressure that either pulls or pushes a tooth, slowly forcing it to shift.

Invisalign uses removable clear plastic molds with build in pressure points to generate that same force.

Each of these methods has clear advantages and disadvantages.


Advantages of Traditional Orthodontics:

Traditional braces are bonded onto the teeth and a wire is used to “guide” (persuade) the teeth to their intended new location. This is a tremendous advantage for the forgetful or non-compliant patient. With traditional orthodontics, once the braces are on the patient has no choice. The pressure is ever present.

The dentist simply makes a bi-weekly adjustment to the wire for the case to progress. Not showing up for those regular corrections simply ensures that the braces will stay in the person’s mouth longer.

There are several types of cases that can only be done with this method: Palatal Expansion, Molar Up-Righting etc.


Disadvantages include:

Esthetics- smiling now is a very self conscious effort.

Discomfort- wires can break; brackets de-bond and can require repositioning. The tongue and lips tend to become raw and sensitive in the initial stages of the treatment.

Average case: 2-3 years.

Braces, brackets and wires tend to trap food more readily then the smooth surface of the teeth. Oral hygiene has to be excellent and frequent to prevent these food traps from causing cavities or periodontal problems.


Invisalign advantages –

Invisalign uses a 3D image to develop calculated incremental and precise movements. In other words the patient can “see” what the case looks like before and after.

This system uses a series of clear removable trays, called aligners, to persuade the teeth to move to the desired location.

The removable aligner is ideal for oral hygiene. The aligners must be removed for meals and for brushing. The lack of Hardware (braces, brackets and wires) makes eating and brushing easier and more enjoyable.

Esthetics: a patient does not need to have Hardware (brackets, braces, and wires) showing every time they speak or smile. The aligners do take some getting used to, but most patients have a very hard time getting used to metal Hardware of traditional braces.

Treatment is shorter, particularly for compliant patients.


Invisalign disadvantages –

Gag reflex- people with high gag reflex may need the aligners trimmed to avoid triggering this particularly unkind reflex.

Compliance is the key to the success of Invisalign cases. Since the aligners can be removed, a forgetful or non-compliant patient may delay or disrupt treatment by not wearing their aligners. For such patients traditional braces may work better, because they are not removable.

Children have to be over 14 or have all their baby teeth out before they can qualify for this treatment.


Ancillary benefits:

The aligner also acts as a Night-Guard. For those who suffer from grinding or clenching their teeth at night get this additional benefit due to the design of the aligners.

Weight loss: Aligners must be removed before any meal or snack. After eating, the teeth should be brushed before wearing the aligners again. Compliant patients tend to avoid unnecessary snacks, limiting food intake to “must meals” only. A significant number of patients report some weight loss.

Whitening: The last set of aligners can be used as whitening trays. Anyone wishing to bleach their teeth, they only need to purchase the whitening paste ($200-$300 savings).

Many adults avoided any orthodontic work due it its cumbersome side effects. Seeing kids with braces is not unusual, but adults tend to be more self-conscious. Today, with new methods and benefits, many adults who shied away from orthodontic correction may want to revisit that option.

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“An ounce of prevention….”

The current political debates about healthcare and universal coverage center on the restorative and financial aspects of healthcare. The preventative aspect of healthcare is usually left up to the individual healthcare provider and the recipient. This article presents some basic information about several preventable dental conditions.

Bruxism: (a.k.a. grinding) this medical term describes the grinding of teeth by clenching the jaws against one another. It is a para-functional activity, an action that is not part of the design or function of teeth, and as such, it causes gradual damage to the teeth and surrounding tissue. Bruxism occurs in children and adults.

Bruxism is characterized by distinct signs: morning headaches and migraines, morning soreness of the facial muscles leading to the temples; jaw pain or TMJ pain (aching during opening and closing of the jaw, radiating to the ears); wear and tear signs on teeth (wear facets) that shorten and blunt the curvature of teeth.

Side effects may include insomnia and eating disorders (due to chewing difficulty). Long term effects include loss of tooth shape, causing a collapse of the facial profile, which may require extensive crown and bridgework to correct.

Long term sufferers of bruxism, with worn-out teeth may benefit from using a protective guard (a.k.a. nightguard, mouthguard). These clear molded trays help disengage the teeth, removing the impetus of grinding or allowing a person to grind at the softer plastic, rather than damage the tooth enamel. Correct use of a protective guard can lead to reduction in pain, less stress at the TMJ and better sleep at night.

Generic protective guards (over-the-counter) are not molded to the individual’s teeth. The occlusion (high spot) is not corrected and if worn at all, these guards may worsen the problem. Custom fabricated guards are made from an impression of the individual’s teeth and need to be adjusted for “high spots”. They usually take a few nights to get used to, but in the long run they tend to help relieve symptoms and preserve tooth structure.

In children (ages 2-10), bruxism may be normal. The grinding of the teeth against one another helps loosen the baby teeth and pave the way for the adult teeth to erupt. Parents should consult with their child’s dentist about the specifics of their case.

Clenching: This form of bruxism is usually stress or exercise induced. While bruxism frequently occurs during sleep, clenching takes place while the person is awake. People who exercise and those undergoing physical or mental strain may clench their teeth as a physiological manifestation. This action is manifested by pressing the two jaws against one another with tremendous pressure and forcing the teeth to grind against each other.

Malocclusion: A condition created when the upper and lower teeth are not properly aligned. This can be a naturally occurring condition (due to eruption of teeth) or an induced one (after dental work).

New dental crowns and fillings are usually checked for “high spots”. If these “high spots” are not removed they can cause the brain to send a signal to the facial muscles to clench down and “grind away” those high spots. Turning on that signal is easy; the ????Off’ button doesn’t always work.

Induced malocclusion can be corrected at the dental office by physically removing any “high spots” after the dental procedure. This is usually done by using a carbon paper to leave tell-tale signs of incorrect contacts, which are reduced by the dentist. Malocclusion due to orthodontic mal-alignment of teeth can be corrected with braces or Invisalign.

Tooth brush abrasion: This condition can result from forceful brushing alongside the gum-line. This is often due to using the wrong toothbrush (medium or hard toothbrush) with too much toothpaste (the abrasive). This combination often leads to wearing down the tooth structure around the waist of the tooth. In that area of the tooth, the enamel is thinnest and abrading it away exposes the softer dentin underneath. Whether this damage occurs from overbrushing or excesive biting forces, the end result is identical. The exposed dentin increases the sensitivity to cold and sweets.

Damage to the enamel can also be caused chemically via acid erosion. It is a tell-tale sign of bulemia when it occurs only on the inner surface (tongue side) of the teeth, or of a citrus fixation (longterm sucking on oranges, limes or lemons) when it occurs only on the facial surface (lip side).

Pharmaceutical companies manufacture various tooth sensitivity pastes. These are great, but must be accompanied by a change in the brushing technique to be effective. A soft adult tooth brush, a dab of toothpaste, and mild pressure in short controlled motions is adequate to maintain a good oral hygiene.

Biologically, teeth and their supporting bone should last for an average person’s lifespan. Today’s high sugar diet, coupled with constant snacking, present a unique challenge to everyone’s health. Poor oral hygiene, aside from the obvious side effects of (bad smell, taste and appearance), can obstruct or obscure tell-tale signs of other disease processes that may be going on.

Recent research found a direct correlation between poor oral hygiene and more frequent episodes of stroke, heart disease, lung disease, diabetes, G.I ulcers, osteoporosis and pre-term babies. In other words, people with poor oral hygiene tend to have higher incidence of these medical problems.

Preventitive care coupled with routine dental check-ups and hygiene cleaning can help maintain proper oral health. The benefits of good oral hygiene will also affect a person’s physical appearance, digestion (properly breaking down food before it reaches the stomach), and demeanor (better sleep, lack of pain or discomfort involveing the facial muscles and mouth).

This would be a good example of when “an ounce of prevention is… priceless!”

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