Doctor's Clinical Updates

Contents:

Starting Early: When to See an Orthodontist

The general rule is to see an orthodontist whenever there is a question about the alignment of the teeth or the bite. Sometimes, crowding or rotated teeth are obvious signs that a visit to an orthodontist is needed. Other times, this may not be as obvious. It is the latter situation that leads most pediatric dentists to recommend an evaluation by the age of seven.

By this time, the permanent first molars and some permanent front teeth are already present in the mouth. If this does not happen, there may be a problem in development of the teeth. Since the growth of teeth varies in different individuals, an evaluation by an orthodontist is important to know whether the eruption of the teeth is going smoothly. Although most patients do not need treatment at a very young age, catching problems early on can potentially prevent more severe problems in the future.

An orthodontist can generally determine if there will be adequate room for the remaining permanent teeth. This is done through the use of a panoramic X-ray which will often be taken by your pediatric dentist as well as the orthodontist and through a thorough orthodontic examination. If there is not enough room for the permanent teeth, early treatment can be started such as the use of appliances to expand the jaws or the removal of deciduous teeth. The purpose of these approaches is to increases the chance that the remaining permanent teeth will erupt ideally aligned. It might avoid or aid in future orthodontic treatment such as braces.

In addition to the treatment of dental crowding early, many orthodontists will also give advice on the correction of certain bite problems early on as well. One of the most important bite problems encountered by children is the crossbite, which is when the upper teeth fit inside or behind the lower teeth. When it is untreated, crossbites may lead to the permanent deformation of the lower jaw. As a result, permanent teeth would wear down and may require oral surgery for correction. The orthodontist may recommend an upper retainer or appliance to expand the palate and encourage the forward growth of the upper jaw to prevent the crossbite.

On the opposite end of this situation is an overbite. An overbite may result when the upper jaw grows more quickly than the lower jaw. It may also be because of protrusive front teeth. If the jaw is the reason, treatment will usually consist of an orthopedic appliance to help stimulate the growth of the lower jaw. The advantages of treating overbite early include the improved ability to chew, easier speech and facial esthetics as well as avoiding trauma to protruding front teeth. Finally, orthodontists can recommend methods on how to treat harmful habits such as thumb sucking and tongue thrusting for young age. There is a strong link between habits such as these and orthodontic problems.

While it is recommended for the child to see an orthodontist by age seven, a majority of patients seen at that age do not undergo treatment. Usually, they will be monitored during annual dental examinations by the orthodontist until treatment can begin at the optimal time.

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Healthy Snacks for Kids

Busy families sometimes have difficulty in serving three healthy meals each day. It is thus not surprising that snacking has become an important part in the daily food intake. In recent studies, it was discovered that twice as many kids today eat snacks such as crackers, popcorn, and chips compared to kids 20 years ago. Soda consumption in children has increased by up to 37 percent. Not only does this mean extra calories, but it could also lead to tooth decay.

For parents, this means that they should pay particular attention to the snacks served to their kids as much as the regular meals. Many healthy options can be found within each of the food groups such as fruits, vegetables, grains, and legumes.

Fruits and vegetables should make it into the snack menu of all children. Realistically speaking though, it is more difficult for parents to make their children eat these foods than any other types of snacks. One way for kids to enjoy their meals is to conduct taste tests or let kids choose the new fruits and vegetables they would like to try.

Fruits and vegetables can be served whole, sliced, cubed, or skewered. Changing their appearance or presentation can make them more appealing to children. Canned, frozen, and dried fruits are easy alternatives for those who do not have time to prepare. However, make sure that they are not packed with extra sugar. Otherwise, it would defeat the purpose of healthy snacking.

It is perfectly acceptable to pack in a dip with the fruits and vegetables if this would encourage the kids to snack on something healthier. Cheese with vegetables can be a yummy treat while a drizzle of chocolate over fruits is irresistible to kids. Also, choose snacks that make use of whole grains that are low in fat and sugar. Muffins, chips, breakfast cereal, popcorn, and other types of snacks come in this form. The good news is that these are tasty too. Avoid refined grains like pretzels and cookies as much as possible.

While dairy is an important part of a child?s diet, low-fat alternatives may also be considered. Protect the children?s bones and hearts by giving them low-fat or fat-free snack items. Yogurt and low-fat pudding are tasty treats. Since cheese is one of the top sources of heart-damaging saturated fat in children?s diets, choose low-fat cheeses such as 2% cottage cheese and serve them in small portions. To up the health ante, they can also be served with other foods like fruit, vegetables, or whole grain crackers.

Beverages should also be considered when snacking. Water should be the main drink served because it satisfies thirst without adding any unnecessary calories or sugars. If you chose to serve fruit juice make sure they are not loaded with extra sugars or preservatives. Look at the labels to make sure that it is not high in fructose corn syrup. Limit juice, even the all natural ones, to no more than 6 ounces per day and make sure it is served with meals only! Milk has many great qualities such as calcium and vitamins, but it is also full of sugar and should be served with meals. In between meals it is healthiest for children?s little bodies as well as their teeth to drink water. Please make sure you keeps kids away from carbonated drinks such as sodas of any kind since they not only are loaded with sugar but also have high acidity which cause demineralization of fragile enamel (the outer part of teeth).

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Practical Tips for Proper Brushing and Flossing for Kids

The truth about teeth is that they should be cleaned as soon as they appear. An early start on oral hygiene means that the kids will get used to the daily routine. For babies, a soft washcloth wrapped around the finger, or a ?finger brush? can substitute for a brush. For older kids, there is simply no better choice that the traditional methods of brushing and flossing.

The reason for brushing and flossing is the removal of plaque. Plaque is a coating of bacteria on the teeth that will in long term cause decrease of pH of saliva and the start of dental decay (cavities). Brushing and flossing can also stimulate the gums and keep them healthy. Avoiding gum disease is just as vital as keeping the teeth healthy. It is not unusual for some kids to want to avoid flossing and brushing. In order to make it more interesting for them, allow the children to choose their own toothbrush and toothpaste. You can also let them use any of the mechanical or ultrasonic toothbrushes if it will make brushing more attractive to your little ones.

On the average, children spend about a minute brushing their teeth. However, experts recommend that brushing should be done for at least two minutes. To help kids properly brush their teeth, a timer in the bathroom or a toothbrush with a timer built in can be used. We provide all our patients with an hour glass that helps them measure 2 minutes of brushing time and most mechanical toothbrushes have a built in timer. A fun alternative is to have them brush for the length of a song that lasts two to three minutes.

Kids should brush their teeth in the morning and at night, but it is of particular importance that kids brush their teeth before going to bed at night. At night all functions of the body shut down including salivary flow that stimulates cleaning of teeth. The time spent sleeping gives bacteria plenty of opportunities to feed on food particles left inside the mouth. As a result, enamel-eating acid could be produced. Saliva flow is lower at night so it is less likely for food to be washed off the teeth. If your child is too young to brush properly, you may have to help out to make sure that the teeth are properly cleaned.

To brush the teeth of kids, place the toothbrush alongside the teeth. Ideally, the bristles should be held at a 45-degree angle to the gum line. Gently move the brush in small circular motions and make sure to have a system so none of the teeth are missed. Brush across the surfaces used for chewing and make sure the bristles get into the spaces in between the teeth. The most easily missed parts of the teeth are the molars and the tongue side of the bottom front teeth so make sure to pay close attention to these areas.

Flossing should be done as soon as teeth start touching each other. Flossing is necessary because it helps prevent cavities by removing plaque and food caught between teeth where a toothbrush cannot reach. Usually, children can be allowed to floss on their own by age seven. For younger kids, use about 18 inches of floss and slide the floss between teeth in a sawing motion. You can also use ?floss fingers? that can be easily bought at a grocery store or a pharmacy. Once it reaches the gums, wrap the floss around one tooth and pull it to move it up and down against the tooth then the other tooth and then repeat on the other teeth.

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Hypoplastic Baby and Permanent Teeth

Unsightly defects and discolorations found in baby and permanent teeth are a cause of concern for many parents who encounter them. The truth is that nearly 40% of all baby front teeth have some sort of enamel defect that can be seen. These defects are not just about the unsightly appearance. They can cause aesthetic problems and have a higher tendency for dental caries (cavities). The two most common causes of enamel defects are developmental irregularities and minor facial traumas. These can occur before, during, or after birth of the child. Some of the he treatment options for enamel defects in children include aesthetic composite (filling material) veneering and microabrasion.

One example of such a tooth irregularity is the enamel hypoplasia. This condition is a defect in tooth enamel that can result in lesser quantity of enamel than normal. It can appear as a small pit or dent in the tooth. Discoloration of excess white, yellow or brown on the teeth is also a symptom of this condition. When severe, enamel hypoplasia can make the entire tooth appear small and misshaped. Enamel hypoplasia can be seen in both permanent and baby teeth. It can cause tooth sensitivity and lead to dental caries. The inconvenience and potential harm of this situation is what calls for the immediate attention to this problem.

More than 75% of enamel defects in the primary teeth of children are considered to be developmental in nature. Most of these problems can be seen in the middle third of the upper incisors. The location of these defects coincides with the neonatal line. The neonatal line is seen on the facial surface of primary incisors and is thought to be brought about by hypocalcemia during development of these teeth (which takes place in utero). Less than 25% of the defects in the enamel of primary teeth are caused by minor facial pressure or trauma. Such defects mostly manifest themselves as hypoplastic spots on the primary canines. These hypoplastic defects can be a result of perinatal or postnatal minor pressure, which includes the passage through the birth canal. Hypoplastic defects in primary canines are what is known as quantitative defects, which means that they relate to a reduced thickness of enamel.

The choice of dental defects treatment should take into account the child's ability to cooperate during dental treatment. It also depends on how severe the enamel hypoplasia is on the tooth. One option for treating enamel defects is to cover up the unsightly areas with a cosmetic material the same color as the tooth enamel. This may be the best option for very young children because it is less intrusive and easier to conduct. In this technique, the surface of the tooth is covered by a bonded composite resin.

Another option for consideration is the microabrasion. In this case, dental stains and surface defects are removed using a combination of acid and abrasives. Enamel microabrasion is particularly useful in removing superficial enamel demineralization defects and decalcification lesions. It can be used in children as young as six years of age.

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Establishing a Dental Home for kids: What to Consider when Choosing a Dentist

An excerpt from the American Academy of Pediatric Dentistry states that

The AAPD encourages parents and other care providers to help every child establish a dental home by 12 months of age. The AAPD recognizes a dental home should provide:

  1. comprehensive oral health care including acute care and preventive services in accordance with AAPD periodicity schedules
  2. comprehensive assessment for oral diseases and conditions;
  3. individualized preventive dental health program based upon a caries-risk assessment and a periodontal disease risk assessment
  4. anticipatory guidance about growth and development issues (ie, teething, digit or pacifier habits);
  5. plan for acute dental trauma;
  6. information about proper care of the child's teeth and gingivae. This would include the prevention, diagnosis, and treatment of disease of the supporting and surrounding tissues and the maintenance of health, function, and esthetics of those structures and tissues;
  7. dietary counseling;
  8. referrals to dental specialists when care cannot directly be provided within the dental home;
  9. education regarding future referral to a dentist knowledgeable and comfortable with adult oral health issues for continuing oral health care; referral at an age determined by patient, parent, and pediatric dentist. The AAPD advocates interaction with early intervention programs, schools, early childhood education and child care programs, members of the medical and dental communities, and other public and private community agencies to ensure awareness of age-specific oral health issues.

Taking care of a child's teeth is one of the most important aspects of their overall health. In order to prevent dental problems in the future, it is best to start young. The ultimate goal is to find someone who the child can feel comfortable with by seeing them regularly. Finding the right pediatric dentist is an important step to take.

A good pediatric dentist will have the necessary qualifications such as an extra two to three years of academic training and associated lab and intern work. Without the degree in pediatric dentistry, there is no assurance to the quality of work that can be received in the field of children's dentistry.

Studies in sedation dentistry, children's growth and development, and children's behavior are signs of a commitment to providing the best possible dental care for kids. The practice of children's dentistry is a field that offers advancements in techniques and technologies each year. Pursuing of continuing education courses that are required each year to keep the license and related seminars can help the dentist improve their practice and translate a better service for children.

Aside from the medical qualifications, there are other qualities that are more subjective. The actual practice of a good pediatric dentist should be reflected in their genuine care for children's dental health and bedside manner. They should be gentle, patient, and someone that the child can feel safe and comfortable with. It also helps if they explain to the child what the procedure is for and what will happen. They should have staff that from the time a child walks into the office to the moment they walk out will treat him or her as a special friend that gets the time and attention that they deserve.

The dental office should be friendly and appealing to children. Colorful walls and artwork can make the office less clinical. Some dental offices have toys and games for children so they do not get bored while waiting. The important thing to consider is that children do not think the same way as adults. Children need to actually see that the dentist's office is not meant to be feared to understand it and enjoy their visits.

The experience of going to the dentist can be anxiety prone for many kids so the staff and the office can help alleviate these fears. A caring and welcoming atmosphere that caters to a child's need can help them relax. This is not just about making the child comfortable. It is also a way to promote their dental health. If the child associates the dentist's office with something negative, then it will be more difficult to get them to return for regular checkups and will make them a fearful patient for years.

The pediatric dentist, patients, and parents of the patients should trust each other. The child must be able to properly relate to the dentist in order to allow them to perform the necessary procedures such as examination and treatment of the oral areas. The parents or caretakers of the child must also trust that the dentist is capable of providing the child with the best possible dental care.

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An Introduction to OraVerse

Numbing agents such as Novocaine (more commonly now used are Lidocaine and Septocaine) have played an important role in dentistry for the sheer usefulness of their purpose: they help patients have their dental work performed without the pain. However, one of the problems associated with the use of dental anesthetics is that there is a tendency to take several hours to recover from the numbing effect.

For most, this extended feeling of numbness can get in the way of work and other daily activities. The numbness can result in drooling at the corners of the mouth and difficulty in speaking. What essentially happens is that a dental procedure that is supposed to last for 20 minutes can affect an individual for as long as half a day.

With children additional risk is severe mutilation of the lip or tongue tissue as little ones tend to play with the numb area and bite on it easily. Such self inflicted injuries take days to heal and can be very painful and debilitating for eating, speaking and normal function for up to a week.

Fortunately, the new drug OraVerse, formulated by Dr. Stuart Levy, aims to alleviate the extended periods of numbing. It can be quite instrumental in the care of patients? teeth without feeling orally disabled for the greater part of the day. OraVerse is the first local formulation designed to reverse the effects of dental anesthesia as it accelerates the process of regaining sensations in the mouth by dilating local vessels and allowing for the anesthetic to clear out of the system easily.

According to Novalar, the pharmaceutical company that manufactures OraVerse, it can be used by adults and children who are six years old and above. The minimum weight requirement of those who can use it is 33 pounds. But safety of the drug has been proven on children as young as three years of age.

The dentist injects OraVerse to the affected area once the dental procedure is finished. Since the mouth is already numb by the time the OraVerse is administered, there is no additional pain from the use of OraVerse. After OraVerse is given, patients can expect the numbness recovery time to be shortened by as much as half the time it usually takes.

OraVerse works differently on each individual. It may produce more noticeably faster results in some patients. On the other hand, it may not be as noticeable in some people. However, its results are effective enough that it merits approval for use by the general public.

The use of OraVerse should not produce any additional discomfort especially on minimally-invasive procedures such as the filling of cavities. It is also a worthwhile option to consider because the extended numbing felt in the mouth offers no additional benefit to the patient. In fact, there is really only a need to numb a small portion of the patient?s mouth while a dental procedure is being performed. There is no need for long-lasting effects of numbing agents because the pain disappears almost as soon as the procedure stops.

OraVerse is the latest development in dental technology. It allows for more convenient dental work by cutting down on the periods of oral numbness. Here at Smiles For Kids Dr. Lindhorst feels that what this drug translates to in practical terms is that there is no longer the need to clear the schedule or miss school for the entire day just because of a dentist?s appointment. After all, a simple procedure should not affect the accustomed lifestyle and preferred schedule.

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NuSmile Crows: Aesthetics and Function for Children

Dental practitioners have had the easy option for the placement of stainless-steel crowns on children in the past. These stainless-steel crowns have always been the primary choice of restoration because they are quite convenient to install and are very durable. Children who have been affected by early childhood caries benefit from this type of crown the most, especially because it is a durable and permanent restoration that will last a life time of a baby tooth.

However, the problem with using stainless steel crowns is that although they are durable and easiest to place, they are not particularly attractive as they are silver in color. They do not hide very well and are quite obvious. The esthetic problems with stainless steel crowns are not a secret to the dental community.

NuSmile Crowns is a response to this concern. First introduced in 1991, it offers crowns that look good as well as offer high quality. There are many other companies that offer similar products but according to its makers, NuSmile Crowns did better in laboratory studies in terms of fracture and fatigue resistance as well as color stability. This combination of natural esthetics and durability make it a popular choice when it comes to pediatric crowns.

At Smiles For Kids we chose NuSmile Crowns for all our patients needing anterior (front teeth) restorations and we give parents an option to use them also for the back teeth. We believe that it is important for parents to have this choice if esthetics of the child?s smile is important to them.

The look and feel of NuSmile Crowns largely depends on the way that they are fitted. It differs slightly from the way traditional stainless steel crowns are placed on the mouth. The product is available in both anterior (front teeth) and posterior (back teeth) versions and offers anatomically correct crowns for natural-looking teeth. In fact, the surface of the product has the color of actual teeth so the restoration does not stand out.

NuSmile Crowns are designed in order to provide access to a strong, color-stable, and full-coverage option for the protection of the remaining tooth structure. It is thus a viable alternative to the cumbersome stainless-steel crown. It is also better than the composite strip crown because it is not as sensitive when it comes to application techniques and wear and tear.

There are several styles available when it comes to NuSmile Crowns. The anterior crowns are designed with both point angles that are slightly square so that the distal point angle may be more rounded in the operatory. The purpose of this is to make a distinction between the right and left crowns. Usually, creating right or left crowns come with no additional charge. In addition to this, the regular length crowns come in uniform lengths, which are the same sizes as the standard sizes of the stainless steel crown. Short length crowns are 1mm shorter and may be best used for the very young dental patients.

The colors of NuSmile Crowns also vary depending on what is needed. Extra Light Crowns are the original shade for children. Light Crowns are tinted with more yellow than the original color for more shade match options, especially on some single tooth applications.

There are many advantages associated with NuSmile Crowns: easy placing on the teeth, full protection and durability are just some of the qualities which make this particular product a reasonable choice for those who need dental work done.

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