Oral Hygiene and Diet at Home
We see many children at our office and we work hard to provide a relaxing environment for them! We like to work with children and their parents to minimize the need for interventive dental treatments. The parents we see are wonderful and care greatly about the wellbeing of their children. Below, are parents’ most commonly asked questions and our answers to them:
Does my child need braces?
Many will disagree with me but the vast majority of children and teenagers do not “need” braces. Don’t get me wrong, in some cases orthodontic alignment can effectively treat speech impediments, correct crowding and improve tooth cleansability, and even improve gum-related problems like deep pocketing and recession in certain cases. So, there is certainly value to orthodontic alignment. However, we have to be clear about benefits when we discuss this topic together.
I often ask parents if their child has any concerns that they vocalize regarding the alignment or “straightness” of their teeth. I ask the child or teenager as well. In most cases of mild misalignment, both parent and child are happy and comfortable and it is not my job to disrupt that level of comfort. Some parents request orthodontic consults based on minor misalignments or crowding and I often advise them that, in the case of their child, nature has given them pretty straight teeth. I also find it to provide perspective by giving a percentile ranking to the straightness of their child’s teeth. For most concerned parents, my telling them that their child “is around the 85th percentile for tooth straightness” diminishes their interest in orthodontic treatment. I will still review costs and benefits of orthodontic treatment in all cases, however, I am very conservative in recommending orthodontic treatment and do so only in cases where benefits will far outweigh risks and complications.
It is important to keep in mind that there are challenges and potential risks to orthodontic treatment that any Orthodontist will openly share. These include:
- Potential psychological and self-esteem effects related to the look of metal braces
- Soreness and discomfort associated with soft tissue contact with metal brackets and wires
- Discomfort inherent to orthodontic tooth movement
- Increased time requirement for cleaning teeth and gums thoroughly (4-5 minute hygiene routine including brushing and flossing is often sufficient in absence of braces; orthodontic patients typically describe needing 10-12 minutes to properly brush and floss teeth and clean gums in presence of braces)
Why is my child getting cavities? What can we do to prevent them? Is it something they are eating?
Children and teens develop “cavities” or tooth decay for a number of reasons. With a few questions and a little bit of information supplied by Mom or Dad, I can often determine causes contributing to repeated instances of tooth decay. Common causes for tooth decay and related solutions are:
- Deep grooves on the biting surfaces of posterior teeth and insufficient cleaning habits. Grooves are the #1 site for retaining plaque and food particles leading to dental decay (the #2 site is in between teeth where flossing provides proper cleaning function). It can take as many as 80-100 passes or rotations of your toothbrush to fully clean grooves on the biting surface of a tooth. A helpful exercise is to brush your child’s teeth after they have consumed dark food (i.e. an Oreo cookie). The darkness provides visual feedback for you to assess how much food/plaque has been removed while brushing and, therefore, the typical amount of time required to completely remove these contaminants from the surface of a single molar or premolar. Generally, a 3-4 minute brushing routine with proper access to all surfaces/sides of your child’s teeth will provide adequate hygiene (in conjunction with nightly flossing – see below!).
- Insufficient flossing. Above, I noted that the second most likely site for developing tooth decay is in between your teeth or on the “interproximal surfaces”. This provides another plaque-retentive area where oral bacteria can access sugar-rich plaque leading to demineralization of enamel and eventual tooth decay. Tooth brush bristles can access approximately 65-75% of a tooth’s surface area. That means that if the only tool you use to clean your teeth is a toothbrush, you are missing out on cleaning one-quarter to one-third of each tooth. When washing a car, nobody cleans only the doors and windows and leaves the rest untouched. So why do this with your teeth? The take-home message is simple: floss at least once per day and nighttime before bed is the best time to do it!
- Consumption of pop/soda, energy drinks or excessive amounts of juice. This is a common contributing factor in development of tooth decay in children and teens. The combination of high concentration sugar/carbohydrate and acidity inherent to these beverages has a very destructive effect on teeth. The best solution is discontinuing consumption of pop and energy drinks and/or decreasing consumption of juices (which might provide some nutritional value by supplying vitamins and minerals). In some cases, we recommend the use of a high-fluoride toothpaste temporarily to increase the acid-resistance of already weakened enamel.
- “Soft” or demineralized enamel. Tooth “hardness” varies greatly between people. Some patients have very hard, resistant enamel and dentin. Some patients have very soft, susceptible enamel and dentin. Many patients are in between. Empirically, we see evidence of this disparity in tooth hardness all the time. At our office, we occasionally see individuals who have not seen a dentist for 10-plus years, brush their teeth infrequently, and never floss. Some of these individuals present to us without a single cavity or decay site. Other times, you see regular patients, who brush and floss vigilantly and they develop tooth decay frequently. Now, there are many other factors that contribute to tooth decay including tooth position, diet, systemic health, saliva content however, there exists a noticeable difference in tooth hardness between individuals in the general population. I can also feel this when I am restoring a broken or decayed tooth. I often coach individuals with a history of decay in spite of good habits and a good diet to:
- Boost your homecare routine. Increase brushing and flossing frequency. For high decay-risk patients, brushing 3-4 times and flossing 2-3 times daily will provide a MASSIVE benefit.
- Use a high fluoride toothpaste intermittently. These are non-prescription products readily available at most pharmacies. The higher fluoride content increases the acid-resistance of your teeth over time. You should ask your Dentist for his/her recommendation prior to initiating use of these toothpastes.
- Increase vigilance! You can do this by increasing the frequency of your cleanings and checkups. 6-month intervals are typically most common but some individuals can benefit greatly from having their teeth cleaned and checked slightly more often. 3-month and 4-month intervals allow an extra 1-2 checkups per year and increase the chance of catching decay lesions early while they are still small and easily treatable.
- Is my teenager going to need their wisdom teeth removed?
At our clinic, we typically start to monitor development of 3rd molars or wisdom teeth using panoramic images around 12-14 years of age. Panoramic images help us to ascertain the presence or absence of developing wisdom teeth, the size of the teeth, the orientation of the teeth, and the amount of horizontal jaw space present to accommodate their eruption. If one or more wisdom teeth are not erupting vertically or if there is insufficient space for their eruption, one or more impactions are likely to develop. There are numerous risks and complications associated with impacted wisdom teeth. These include:
- severe pain
- dental decay or “cavities”
- negative effects on adjacent teeth
- infection of the surrounding soft tissues
- pressure-induced crowding of the teeth
We recommend prophylactic removal of wisdom teeth only where these teeth pose a high risk of future risk/complication. The removal of wisdom teeth is typically of least risk and easiest to perform between the ages of 12 and 18 years of age. The ideal period for removal depends on the individual and their development. If removal is delayed, the roots continue to develop and elongate and, in some cases, become curved – this greatly increases potential complications related to tooth removal. Additionally, the teeth may assume a more horizontal position over time and this also increases difficulty related to their removal.
If you have further questions related to the surgical removal of impacted wisdom teeth at our clinic, please refer to our section on “Tooth Extraction & Wisdom Tooth Removal” which can be accessed from the “Services” tab in the menu above.
Dental Treatment for Children
Dr. Kyle Hornby has 3 children of his own and appreciates how difficult it can be for both child and parent to visit The Dentist’s Office. We are also aware of the recent trend toward increasing use of heavy sedation and General Anesthetic to enable treatment of young children. At our office, we see and treat a large number of toddlers and children, typically using only local anesthetic or “dental freezing”. In some instances, we recommend the use of nitrous oxide or “laughing gas” to provide a mild conscious sedation for children experiencing dental anxiety. Nitrous oxide is an inhaled sedative, it is very mild, and is widely considered to be the safest sedative technique in all of medicine and dentistry. Many of our parents tell us that they like how we:
- Provide routine dental treatment such as dental fillings without use of heavy sedatives or General Anesthetic
- Invite them to be present in the treatment operatory during their child’s appointment
- Share photos and x-rays with them both before and after the treatment appointment so that they know exactly what is going to be treated/repaired and why it is important
- Provide and demonstrate strategies and techniques that will help to minimize their child’s risk of future tooth decay
At Enamel Republic Clinic, we have a very low referral rate for children in need of treatment. We are typically able to provide routine dental care to our young patients with great success. This is tremendously advantageous: your child’s fear and anxiety will be greatly minimized simply by having treatment completed in a familiar place. Our technique involves:
- Proceeding at your child’s own comfortable pace
- Showing them what we use to provide cleanings and dental fillings when necessary
- Describing what we are going to do so that they are not surprised along the way
- Providing only necessary treatment and intervention
- Showing your child lots of pictures related to their treatment!
You can help to prepare your child for their appointment by reassuring them that they will be comfortable and that you will be there with them. Try to make sure they have eaten prior to their appointment unless they are receiving “laughing gas” sedation, in which case they should not eat for 2 hours prior to treatment. Generally, we recommend that children receiving dental freezing for treatment not eat for 90 minutes following the appointment. This minimizes their risk of sustaining trauma, ulceration and/or bleeding that can occur if they chew on their numb lip or tongue unknowingly.
It is best to avoid describing items like needles or anything specific that might provoke fear and anxiety. Often times, we can repair small or shallow cavities in the absence of dental freezing and this allows us to avoid use of local anesthetic altogether. If you have any questions regarding how to facilitate a smooth treatment appointment for your child or teenager, give us a call!