As Spring turns to Summer, millions of students will depart high school in the time-honored rite of passage called graduation. At the same time, quite a few of these graduates will be experiencing another maturity milestone: the eruption (coming in) of their last permanent teeth.
Typically, these are the back third molars, better known as “wisdom teeth,” emerging on either end of both the top and bottom jaws sometime between the ages of 18 and 24. Their arrival heralds the end of a long development process that began in infancy.
But this auspicious event can give rise to dental problems. Because they’re the last to come in, wisdom teeth often erupt in an environment crowded by earlier teeth. Depending on jaw size and other factors, there may not be enough room for a normal eruption.
Wisdom teeth can thus erupt out of position, creating a poor bite (malocclusion). Or they might not erupt at all—becoming stuck fully or partially within the gums and bone, a condition known as impaction. Impacted teeth can also cause problems for the adjacent teeth, damaging the roots of the second molars or disrupting the surrounding gum tissue, making them more susceptible to periodontal (gum) disease.
Because of these and other issues, impacted wisdom teeth are among the most common type of teeth removed: an estimated 10 million each year. And many of these are removed before they show signs of disease or complications as a preemptive strike against developing dental problems.
Although unnecessary surgery should always be avoided, according to some research, there’s a one in three chance that erupting wisdom teeth that are not showing signs of trouble will eventually become problematic. And the earlier they’re removed, the lower the risk of post-extraction complications.
Wisdom teeth should always be evaluated on a case by case basis. Those with obvious signs of disease or complications do require prompt treatment, including possible extraction. Others that are asymptomatic can be monitored over time: If they’re tending to become problematic, we can adjust the treatment plan accordingly. Our goal is to ensure these particular teeth signaling the end of childhood won’t detract from dental health in adulthood, so a measured approach seems to be the best and safest one.
If you would like more information on treatment options for wisdom teeth, please contact us or schedule an appointment for a consultation. To learn more, read the Dear Doctor magazine articles “Wisdom Teeth: Coming of Age May Come With a Dilemma” and “Wisdom Teeth: To Be or Not to Be?”
Regular dental visits are an important part of teeth and gum health at any age, including young children. But the clinical nature of a dental office can be intimidating to children and create in them an anxiety that could carry over into adulthood and disrupt future care.
You can, though, take steps to "de-stress" your child's dental visits. Here are 3 ways to reduce your child's dental anxiety.
Start visits early. Most dentists and pediatricians recommend your child's first visit around age one. By then, many of their primary teeth have already erupted and in need of monitoring and decay prevention measures. Beginning visits early rather than later in childhood also seems to dampen the development of dental visit anxiety.
Take advantage of sedation therapy. Even with the best calming efforts, some children still experience nervousness during dental visits. Your dentist may be able to help by administering a mild sedative before and during a visit to help your child relax. These medications aren't the same as anesthesia, which numbs the body from pain—they simply take the edge off your child's anxiety while leaving them awake and alert. Coupled with positive reinforcement, sedation could help your child have a more pleasant dental visit experience.
Set the example. Children naturally follow the behavior and attitudes of their parents or caregivers. If they see you taking your own hygiene practices seriously, they're more likely to do the same. Similarly, if they notice you're uncomfortable during a dental visit, they'll interpret that as sufficient reason to feel the same way. So, treat going to the dentist as an "adventure," with a reward at the end. And stay calm—if you're calm and unafraid, they can be too.
If you would like more information on effective dental care for kids, 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 “Taking the Stress out of Dentistry for Kids.”
While dental diseases tend to be a greater concern as we get older, they also pose a potential threat to children. A particular type of tooth decay called early childhood caries (ECC) can severely damage children's unprotected teeth and skew their normal dental development.
Fortunately, you can protect your child's teeth from disease with a few simple practices. First and foremost: start a hygiene habit as soon as possible to remove disease-causing bacterial plaque. You don't have to wait until teeth appear, either: simply wipe the baby's gums with a clean wet cloth after nursing to minimize the growth of oral bacteria.
When their teeth do begin to erupt, you can switch to brushing (you can add flossing as more teeth erupt—but until the child shows appropriate dexterity, you'll need to do it for them). For infants, brush gently but thoroughly with a soft-bristled brush and a smear of fluoride toothpaste. When they grow older you can increase the toothpaste to a pea-sized amount. And as soon as you can, get them involved with learning to perform these vital habits on their own.
You should also limit your child's consumption of sugar. Our favorite carbohydrate is also a favorite of bacteria, who consume any remnants in dental plaque as a primary food source. So, keep sugary snacks and foods to a minimum and limit them mainly to mealtimes. And don't put a baby to sleep with a bottle filled with a liquid containing sugar (including formula and breastmilk).
Finally, begin taking your child to the dentist regularly by their first birthday for routine cleanings and checkups. Besides removing any hard to reach plaque, your dentist may also apply sealants and topical fluoride to help protect and strengthen tooth enamel. Regular visits make it more likely to detect the early signs of decay, before it does extensive damage. And beginning early makes it less likely your child will develop a fear of dental visits that could carry on into adulthood.
These and other steps will go a long way in protecting your child's teeth and gums so they develop normally. A little prevention and protection will help ensure a happy, healthy smile later in life.
If you would like more information on helping your child develop healthy teeth and gums, 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 “Top 10 Oral Health Tips for Children.”
Although teething is a natural part of your baby's dental development, it can be quite uncomfortable for them—and upsetting to you. During teething, children can experience symptoms like pain, drooling or irritability.
Teething is the two or three-year process of intermittent episodes of the primary ("baby") teeth moving through the gums. These episodes are like storms that build up and then subside after a few days. Your aim as a parent is to help your baby get through the "stormiest" times with as little discomfort as possible. To that end you may have considered using over-the-counter products that temporarily numb irritated gums.
Some of those numbing products, however, contain a pain reliever called benzocaine. In recent years, this and similar ingredients have been found to increase the level of a protein called methemoglobin in the bloodstream. Too much methemoglobin can result in less oxygen delivered to body tissues, a condition known as methemoglobinemia.
This oxygen decrease can cause shortness of breath, fatigue or dizziness. In its severest form it could lead to seizures, coma or even death. Children and infants are at high risk for benzocaine-induced methemoglobinemia, which is why the U.S. Food and Drug Administration has banned marketing for benzocaine products as pain relievers for teething infants and children.
Fortunately, there are alternatives for helping your child weather teething episodes. A clean, chilled (not frozen) teething ring or pacifier, or a cold, wet washcloth can help numb gum pain. You can also massage their gums with a clean finger to help counteract the pressure exerted by an emerging tooth. Be sure, though, that you're not allowing anything in your child's mouth like lead-based paint that could be toxic. And under no circumstances should you use substances containing alcohol.
For severe pain, consult your physician about using a pain reliever like acetaminophen or ibuprofen, and the proper dosage for your child. With these tips you can help your child safely pass through a teething episode.
When a tooth is beyond repair due to disease or injury, it may be necessary to remove it. A “simple” tooth extraction is among the most common in dentistry and certainly not the agonizing procedure depicted in common lore.
They’re referred to as simple extractions because the shape of the tooth and root allows for a fairly straightforward and uncomplicated removal. An example would be the normally cone-shaped upper front tooth that doesn’t offer a lot of resistance during the extraction process.
The process itself is fairly straightforward. Teeth are held in place by the periodontal ligament, an elastic tissue made of tiny fibers that attaches the tooth to the supporting bone. These fibers can be dislodged from the tooth with some careful manipulation — in the hands of an experienced dentist there’s a deft “feel” to the fibers loosening. Once they’ve detached, it requires little effort to remove the tooth; with the aid of local anesthesia, you won’t feel anything but a little pressure.
Immediately after the tooth is removed, we commonly insert bone grafting material in the socket to minimize bone loss until a permanent replacement like a dental implant can be installed after tissue healing. We then place sterile gauze over the site for a few minutes to control bleeding and, depending on the size of the wound opening, we may also place a few stitches to close it. We then give you instructions for caring and cleaning the site over the next few days, and prescribe antibiotics to reduce the chance of infection and anti-inflammatory drugs for any discomfort.
Although a simple extraction is a routine procedure, it’s important to perform a proper assessment of the tooth and the surrounding bone beforehand, including x-rays to determine the tooth’s exact shape and position. If we discover a complication that makes a simple extraction impractical (like multiple roots at acute angles), we may then refer you to an oral surgeon for a more complicated surgical extraction.
It’s our hope you’ll have your natural teeth for as long as you live. But if you must have one removed, you can rest assured it’s a common — and uneventful — experience.
If you would like more information on tooth extraction, 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 “Simple Tooth Extraction.”
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