When Off Color Isn’t a Joke
Your child eats a grape popsicle; his or her tongue turns purple. When your child’s tongue temporarily absorbs the color of a food or beverage just consumed, that’s no cause for alarm. But if your child’s tongue changes color for another reason, does that indicate a problem? Possibly. Here are some guidelines for different colors on your child’s tongue.
Black. A black tongue may occur when the tongue’s papillae (projections) aren’t shedding properly and appear longer than usual (a condition called “black, hairy tongue”). The discoloration is related to less-than-ideal oral hygiene or dry mouth: Bacteria or other matter collect between the papillae and these substances physically turn dark. Other times, the black color can come from your child’s consumption of a drug containing bismuth (such as Pepto-Bismol), which harmlessly combines with sulfur on the tongue. Rarely, a black tongue indicates pellagra, a potentially dangerous niacin deficiency, or overuse of antibiotics. See us or your pediatrician if the problem persists more than a few days.
Yellow or brown. A yellow or brown tongue usually indicates that your child is developing black, hairy tongue.
Red. If your child’s tongue has gradually turned red, it may be due to a nutritional issue (folic acid or vitamin B12 deficiency, for instance). A bright strawberry red tongue accompanied by enlarged taste buds; a high, persistent fever; swollen extremities; skin peeling and rash; and/or joint pain may indicate Kawasaki disease. Though quite serious, Kawasaki disease is a rare condition occurring most frequently in East Asian children younger than five years old that causes inflammation of blood vessels throughout the body.
White. If the white area of your child’s tongue has a cottage cheese-like consistency, the likely cause is oral thrush, a treatable yeast infection sometimes seen in infants. In other cases, a local temporary irritation may be to blame.
A color change in the tongue accompanied by a smooth surface may indicate glossitis (tongue inflammation). The papillae seem to recede, and the tongue appears smooth. Sudden glossitis can be a sign of an allergic reaction or a side effect of medication; gradual development may indicate an iron or B12 deficiency.
Keeping a vigilant eye on your child for unusual changes to his or her tongue—or any part of his mouth—helps us help you keep your child healthy.
Dental Hygiene: A Bone of Contention
When people think about their dentists, they tend to think only about their teeth and gums. Most people don’t think about their bones. It’s very easy to think of your teeth as little bones that grow out of your gums, but when we talk about bone loss, we aren’t just talking about tooth decay. We are talking about your child’s jawbone and skull.
Every part of the body is connected. Just as the leg bone is connected to the hipbone, the jawbone and skull are connected to the teeth and gums. Poor dental hygiene can cause harmful acids and bacteria to build up not just on your children’s teeth and gums but in the jawbone and skull, causing them to wear away. Your children’s teeth live in little holes in those bones. If those holes get eaten away and become too big, your children’s teeth can loosen or even fall out.
Another preventable cause of bone loss is osteoporosis, a weakness of the bones caused by a lack of calcium. While this condition is uncommon in children, childhood diet may influence osteoporosis later in life. The best way to prevent osteoporosis and a good piece of health advice in general, is to ensure that your child has a diet rich in calcium and vitamin D. It’s never too early to reduce the risk of developing this very serious condition later in life.
Certain conditions such as cancer and autoimmune diseases can cause bone loss; so can certain medical treatments. It’s important to let us know when your children have significant changes in their health or if they are taking new medications. We know the best ways to mitigate the effect of these changes on their teeth.
Bone loss is a serious problem, but one that can be effectively fought.
Does My Child Need a Tooth Pulled?
Dental extraction is one of the most feared reasons to visit a dentist’s office. To many parents, extraction represents a worst-case scenario. Many causes of tooth extraction are preventable, although others are not. While unfortunate, it’s important to remember that, when your child’s dentist pulls a tooth, it is to benefit the overall dental health of your child.
The preventable causes of tooth extraction are related to general safety and good oral care. Sports accidents are one of the leading causes of broken and dislodged teeth. If your child is engaged in sports, particularly contact sports, it is important that he or she wears a mouthguard. Another leading cause of tooth extraction is severe decay. The best way to prevent this outcome is to make sure that your child regularly brushes, flosses and visits the dentist.
However, some reasons for tooth extraction are not preventable. Sometimes, if a child’s baby teeth don’t fall out at the proper time, they can prevent adult teeth from coming in correctly. That may require removing the baby tooth. If your child needs braces, it is occasionally necessary to remove a tooth to ensure that the rest of the teeth align properly. A large number of children and adults will need to have impacted wisdom teeth removed. Finally, certain prescription drugs or medical procedures can result in changes to your child’s gums or teeth. If a child is undergoing radiation therapy, irradiated teeth may need to be removed.
Fortunately, children can be much more resilient than their parents, and losing a tooth is usually less painful and less uncomfortable for them. If your child has been especially good, you might want to consider inviting the tooth fairy over for a visit. It will certainly help blunt the sting of losing a tooth.
Thumb Sucking: How Much Is Too Much
All healthy babies have a strong sucking reflex. This is normal and necessary; sucking is the only way babies get nutrition. But the instinct to suck is so strong that few babies are completely satisfied by nursing. Consequently, they suck on whatever is handy—thumbs, pacifiers, even stuffed animals and the corners of blankets.
Some infants naturally reduce their sucking habit around the time they start solid foods. But for others, the sucking habit becomes associated with food, warmth and physical closeness. Thumb sucking becomes a way of self-comforting when tired, stressed or bored. Again, this is normal and does not cause dental problems.
Around age two, many children stop sucking their thumbs because they are busy using their hands to explore the world. They may continue to suck occasionally to put themselves to sleep or when they are anxious. These short bursts of thumb sucking generally do not cause dental problems and are not a cause for concern. However, the American Academy of Pediatric Dentistry recommends that children who are still vigorous thumb-suckers after age three should have a professional dental evaluation to ensure that their sucking is not causing future dental problems.
Almost all children stop thumb sucking by the middle of the fourth year. A few are hooked on the habit and continue with thumb sucking beyond age five. The longer and harder a child sucks, the greater the chance of dental problems. Prolonged sucking can deform the jaw and cause the upper teeth to flare out so that the upper and lower teeth do not meet correctly.
If your child is still thumb sucking by the fifth birthday, it is time to stop the habit before it affects the position of the permanent teeth. We can suggest practical ways to break the thumb sucking habit including, if necessary, a dental device that eliminates the pleasure of sucking.
The Baby-tooth Truth: They’re Important!
When your child’s primary (or “baby”) teeth fall out naturally, beginning on average around age 6, you know the side effects are temporary: slight difficulty chewing, perhaps, or a little lisp. You might assume that if a baby tooth is lost prematurely—due to decay or injury, for instance—it would just mean that those temporary side effects last a bit longer and are somewhat more inconvenient.
Actually, when a child loses baby teeth too early, the impact—if left untreated—can be lifelong. It’s important to let us know if your child has lost a tooth through “unnatural” means.
Under normal circumstances, when a primary tooth falls out on its own, the space left behind doesn’t have time to change significantly before the permanent tooth starts emerging into the void. However, if that space is open for a lengthy period—say, two years—it can begin to close on its own. When the permanent tooth is ready to come in, the space may no longer be large enough to accommodate it.
To prevent this, we can create a custom “space maintainer” for the child to wear until it’s time for permanent teeth to emerge.
Another problem: When one or more baby teeth are missing for months or years, a child’s overall bite can change for the worse. The other teeth may shift to fill in the space. In extreme cases, the skeletal structure of the jaw can be affected. Missing teeth can also affect a child’s developing language skills, not to mention chewing ability and appearance.
What’s more, if a baby tooth was lost due to decay, it’s possible that the “bud” of the growing permanent tooth below it was also affected by the decay. That possibility needs to be evaluated and, if necessary, treated.
Our custom-made, child-sized mouthguards for young athletes can help prevent some injuries that might otherwise knock out primary teeth. But many more baby teeth are lost through decay than through injury. Good basic dental hygiene—brush twice a day, floss once and ask us about fluoride sealants—is the ideal preventative.
Mouth Breathing: Why It Matters
Let’s say your child has a stuffy nose for a few days and you notice that, understandably enough, he or she is breathing mostly through the mouth rather than through the nostrils. No long-term harm will result from that temporary change.
But if a child breathes through the mouth as a matter of course, week in and week out, cold or no cold, that is a cause for significant concern.
Here’s why. If left untreated, chronic mouth breathing can cause
- abnormally elongated facial development
- crowded, crooked permanent teeth that are prone to decay
- a “gummy” smile (gums more prominent than in the average smile)
- frequent upper respiratory infections
- poor school performance due to sleep deprivation caused by snoring or apnea
- possible erroneous diagnosis of ADHD (attention deficit hyperactivity disorder)
- bad breath, chronically chapped lips and abnormally fibrous gums
Mouth breathing almost always has a physiological cause rather than being a “habit.” The most common causes include chronic nasal obstruction, enlarged adenoids and/or tonsils, and allergies. If the underlying cause can be successfully treated, the mouth breathing will likely subside, with no or few permanent effects. If still breathing through the mouth by age 7, your child should see an orthodontist, who may recommend palate expansion to correct misaligned teeth and abnormal facial development. We will help your child by working in conjunction with your other medical professionals, including an ear, nose and throat doctor, an allergist and, of course, an orthodontist.
If you are not sure whether your child is a mouth breather, look for these signs:
- frequently has his or her mouth open at rest, especially while sleeping
- dark circles under the eyes
- subtle changes in facial shape
- tends to be more tired and listless than others the same age
When in doubt, err on the side of caution. Bring your concerns to us and to your pediatrician. Make appointments for evaluations and get your questions answered. Sadly, mouth breathing is often underreported and undertreated. But diligent observation and action can keep your child from suffering any long-term effects from mouth breathing.