Thumb-sucking (Part I)

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.

Normal Eruption of Teeth

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.

Baby Bottle Cavities

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.

Home Care for Your Child’s Teeth (Part II)

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.

Home Care for Your Child’s Teeth (Part I)

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

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.

First Trip to the Dentist (Part II)

A very common question is “What is the best age to bring my child for their first dental visit?” The American Academy of Pediatric Dentistry recommends at the appearance of the first baby tooth. Although parents are welcome to bring their children in at that time, in the absence of any obvious decay, we usually start seeing children around their third birthday. Most children are able to sit in the dental chair and get their teeth cleaned and checked at that age. For those who are too fearful, we do a “knee to knee” exam. A parent holds the child in their lap facing them. The parent has the child’s legs straddling their lap, and holds on to their hands. The seated parent faces the seated dentist “knee to knee” and lowers the child so that their head in in the dentist’s lap. Since the child is facing the parent, they remain calmer and are safe from sharp objects since the parent is holding their hands. This way, the dentist can safely examine the child’s mouth, the child does not get out of what they thought would be an unpleasant situation by acting out, and still feels comfortable by being with the parent.

Ectopic Eruption (Part II)

Another common situation where a permanent tooth is not in its normal path of eruption is when the first molars (six year molars) are attempting to come in too far forward thus resorbing the roots of the baby tooth that is ahead of it. If this situation is allowed to continue, then it will cause the baby tooth to be lost prematurely. The offending permanent molar will then erupt too far forward, thus leaving no room for the bicuspid to erupt later. I have found that by pushing the molar back before the baby tooth is lost, then the baby tooth can be retained until its normal time to come out. The procedure is call distalization. I connect orthodontic bands on a couple of molar teeth and connect them to a spring. I then bond a hook on the chewing surface of the offending tooth and engage the spring. This pushes the tooth back into its normal position. I remove the spring and allow the tooth to erupt normally. The process takes from two to four months.

Ecotopic Eruption

Ectopic eruption is where a permanent tooth is in an eruptive path that is out of line with the norm. The most common example is that of wisdom teeth. Since there is not very much room for them to come in normally, it is extremely common for the wisdom teeth to be directed in all sorts of directions. The usual corrective procedure for that is removal of the wisdom teeth. A common occurrence of ectopic eruption is when the permanent lower incisors erupt too far on the tongue side. It kind of looks like shark teeth with them in two little rows. I have had many a frantic patient rush their child into my office to show me that problem. I have found that if the baby teeth are extremely mobile, they can be allowed to come out naturally. However, if not, I recommend extracting the offending baby tooth or teeth. By doing that at the proper time, the tongue will push the permanent teeth forward into their natural place without the need for expensive orthodontic treatment. 

Orthodontic Evaluation during Dental Exam

An orthodontic evaluation during routine dental examination is very important for children. In many cases, early treatment of orthodontic problems can make subsequent phases much easier, less expensive, or may even eliminate the need for further treatment. Many parents think that one has to wait until all of the baby teeth come out and the permanent teeth are in before starting orthodontic treatment, however, many problems – such as lack of space or crossbites – can be corrected early while there are still baby teeth present. The results can be much more stable when done early. The muscle tone of the lips, cheeks, and tongue are still in a states of flux in a young child. The muscle tone usually doesn’t become set for life until all of the permanent teeth come in. That gives a little window of time that the size of the jaw can be changed and the result will be relatively stable, whereas, doing it later in will have a high rate of relapse.