Canker sores (aphthous ulcers) are those annoying little white spots on your cheeks and gums that hurt a whole lot compared to their size. A canker sore is usually formed when a part of one’s oral mucosa gets traumatized. Other factors include stress and hormone changes. They are characterized by a small, white, exquisitely tender area surrounded by a red “halo”. The underlying cause of canker sores is unknown, although they can tend to run in families which means that there could be a hereditary component. Although a canker sore is a totally benign condition, it does need to be distinguished from more serious afflictions such as cancer or diseases of the immune system. If the ulcer disappears in a week to ten days, then it’s probably nothing to worry about. As far as treating the ulcer, usually symptomatic relief such as numbing ointment is usually sufficient. I have prescribed a mild steroid preparation that works well if applied to the sore on its first day, however after that, it merely lessens the severity.
Night grinding* (nocturnal bruxism) is a very common occurrence in children. It is possible that it could be caused by the stresses of everyday life which is new to a child. Some theories include attempting to open up the middle ear to equalize the pressure. Regardless of the cause, most childhood grinding does not need to be treated. A majority of the cases tend to clear up as the child gets older. I have seen many cases where a child has ground their baby teeth down to little numbs only to end up with a fully healthy set of permanent teeth. The first line of defense for night grinding in an adult is the construction of a nightguard. However, a child is actively growing and wearing a nightguard can stunt the growth of the roof of the mouth, causing more problems in the future than there would have been with no treatment. So if you go into your child’s room at night and hear sounds of gnashing teeth reverberating off the walls, don’t be too concerned.
There is no need to worry about your child’s thumb-sucking habit during their pre-school years, however, if they have not stopped by the time that the permanent teeth come in, then life long damage can occur. Many times, peer pressure in school alone can cause a child to stop the habit. However, an occasional child will still persist, especially at night while sleeping. Many methods have been proposed and tried to break the habit. No one technique works for every child. There are positive and negative ways. Using positive reinforcement can be very effective but requires a lot of work. You can get a calendar and stick a star on for everyday that the child doesn’t suck their thumb. So many days in a row can earn a reward. This requires lots of parental participation and is difficult to break nighttime sucking. Other methods include wrapping the thumb in tape or gauze or placing a sock over it while sleeping.
By not stopping a thumb-sucking habit by the time that the permanent teeth erupt, the child will not swallow properly. This causes a dreadful muscle imbalance which affects the direction and growth of the jaw bones and the final placement of the teeth. The upper arch tends to be long and narrow since the tongue tends to thrust forward with each swallow. The lower jaw will tend to be smaller because the tongue will usually be swallowing forward. Once the thumb-sucking habit is stopped, the orthodontic problems persist since the muscles are in imbalance. When orthodontic treatment is done, the muscle imbalance and swallowing issues must be addressed or else rapid relapse can occur. Things such as myofunctional therapy or tongue exercises are best instituted before any orthodontics is started. This will allow for a much more stable result.
Thumb-sucking is a natural reflex for babies. The habit can continue for the first few years of childhood without any permanent damage being done. However, if the habit is not discontinued by the time that the permanent teeth erupt, then the mouth can become permanently deformed. The classic look of a chronic thumbsucker is tiny prominent upper central incisors (or buck teeth) along with a receded chin. It’s possible that there can be a speech impediment also. It’s not really the pressure of the thumb physically pulling the teeth forward that causes the deformity. When the thumb is present when the child swallows, it redirects the tongue downwards away from its natural position in the roof of the mouth. When the thumb is not present, the tongue will continue to thrust forward causing the upper teeth to shift forward and the pressure from the cheeks will collapse the arches inward.
The first teeth to appear in the mouth are usually the lower central incisors. They tend to erupt anywhere from six to twelve months of age. The rest of the baby teeth follow suit with the second molars coming in at around two years of age. After that, things are pretty constant until kindergarten. The permanent teeth tend to erupt at 6-7 years of age, however, a range of 5-8 years is still within the normal range. Just because your child has not lost their first baby tooth by their eighth birthday, would not be a cause of concern. However, if no teeth have been shed by age nine, it is best to consult a physician just to rule out any possible endocrine problems. The first permanent molars usually come in around six years of age, hence the name “six year molars”. The twelve year molars are the second molars, and the third molars are the wisdom teeth that usually erupt between 17 and 25 years of age.
Putting a child to bed with a bottle of milk or juice can cause a rampant, severe case of cavities. When a child is dozing off to sleep with a bottle, the liquid will tend to pool around the front teeth. The sugar in the liquid is the fuel that the cavity causing bacteria use to produce acids which eat away at the tooth enamel. Baby bottle cavities are characterized by a significant number of cavities in the front teeth. The decay can result in such deep cavities that could cause pain and accesses. The choices to take care of the problem is either expensive restoration or removal of the teeth. Since the front teeth are not as important for maintaining space for the permanent teeth, removal is not a bad option, however, it can have psychological effects on the child one they go to school. Therefore, prevention is the best policy. If the child does need a bottle to go to sleep, then it should only have water in it.
You should brush your children’s teeth twice a day. Afterwards, I recommend giving the toothbrush and floss to them to let them go through the motions. Even though they will probably not do the most thorough job, at least they get into the routine of good habits which should help them throughout the rest of their life. You should use a children’s size of toothbrush so that you can access all parts of their tiny mouths. The toothpaste should be one that has been approved by the American Dental Association. It should have fluoride in order to help strengthen the enamel and make them more resistant to cavities. You should only use enough toothpaste to form the size of a pea. And your child should spit out the excess toothpaste when you are done. Swallowing a little bit of toothpaste won’t hurt anything, however, ingesting moderate amounts can cause a condition called fluorosis which is white splotchiness of the tooth enamel. Ingesting large amounts can be toxic and so you should monitor your child.
Young children do not have the manual dexterity to brush and floss their teeth on their own. Therefore, you must take a toothbrush to their teeth at least twice a day. When my kids were small, I would sit down in the bathroom and have them lay their heads back into my lap. That gave me plenty of access to all of their teeth. It would only take a half a minute to scrub their pearly whites. As they got older, I could have them tilt their heads back from the standing position. Once the last set of baby molars come in, you must start flossing their teeth. You only need to floss between the molars since those areas are prone to decay and will be around for number of years. You can use regular floss or you can use a floss-pick, the little “U”-shaped device that holds a short piece of floss taut and has a handle to hold on to. For children, it is best to get the floss-pick that have safety handles so that there are no sharp ends to injure your child.
Teething is when teeth are erupting through the gums and the symptoms associated with it. There are many myths on all of the maladies that teething will cause, most being totally untrue. Surely the teething infant can get a little fussy because the gums do get sore, but it doesn’t cause fever, nasal congestion, diarrhea, etc. It is best to avoid all of the drug store teething preparations. Local anesthetics should not be used because they have too much difficulty with proper dosing. Too much benzocaine or lidocaine can cause seizures and in severe cases, death. The best thing to use for teething discomfort is a rubber teething ring that can be place in the refrigerator. It is thought that cool pressure placed over the gums can be soothing. In cases where an analgesic is needed, be certain to carefully follow the dosing instructions since infants are tiny and susceptible to overdosing.