Visiting the Dentist with Your ADHD Child

Parents—and pediatric dentists—know that every child is an individual. But there are commonalities among the children in certain groups, one of those being children with attention-deficit hyperactivity disorder (ADHD).

When a child with ADHD visits our office, moms and dads are especially important for two reasons: For one thing, parental attitudes toward dentistry in general (based often on their own history) influence their child to a remarkable degree. For another, we need parents to be our partners so we can successfully treat their children.

If you are a parent of an ADHD child, here are some tips that will make the dental appointment go more smoothly for you and your child:

  • If you have significant dental-related aversions, consider having another family member or friend bring your child for his or her appointment. Even if you do not voice your fears or attitudes toward visiting the dentist, children pick up on nonverbal signals quickly.
  • Prepare your child using friendly, nonthreatening language and neutral (not frightened) tones. Again, if you suspect that your own fears (especially if you have ADHD, too) might influence your child, have someone else with a more positive attitude prepare him or her. Another option is reading your child a book specially designed to help him or her anticipate what to expect at a dental visit.
  • Let us know that your child has ADHD. Is a certain time of day best for your child, behaviorally? We’ll do our best to accommodate your child. Should we schedule a shorter-than-usual appointment? Done. Can you share ideas for what makes your child happiest in uncomfortable situations? That will help us immeasurably.
  • Will medication help? Behavioral and anxiety issues can exacerbate the uneasiness experienced at dental appointments by many children with and without ADHD. We sometimes use nitrous oxide to help patients relax. Is this a technique from which your child might benefit? Consult your child’s physician before the appointment.
  • Remember necessary items, such as small games, toys, puzzles, dolls or DVDs that will help calm your child in the chair (as long as they don’t interfere with the space in which we need to work). If you forget an item, tell us and we’ll reschedule or make another accommodation.

Dental care is important for all children, including those with ADHD. We look forward to working with your child, and you, to make his or her dental care as pleasant—and successful—as possible.

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Does Breastfeeding Prevent Early Childhood Cavities?

Parents often wonder whether the choice of breastfeeding will help reduce a baby’s risk of developing dental cavities in future years. Can primarily nursing an infant instead of bottle-feeding truly make a dental difference? The answer turns out to be—maybe. What’s actually most important is to keep your child’s mouth as free of sugar as possible at all times. Just about any residual food or liquid particles, other than pure water, that are left in the mouth contain sugar or compounds that become sugar. Surprisingly, that includes breast milk as well as formula.

Cavities are actually a bacterial infection, usually caused by Streptococcus mutans (S. mutans). Because this bacterium is so common, your infant almost surely has it once he or she has one or more teeth. S. mutans can feed on any small particle of sugar left on that tooth. After consuming the sugar, the bacteria produce acid, and this residual acid causes decay.

Keeping your baby’s mouth sugar-free means cleaning his or her gums with a soft cloth after every feeding, even if no teeth have yet emerged. As an added benefit, your infant will get used to good oral hygiene, so transitioning later to toothbrushing will be easier.

Also key is not letting your infant drift off to sleep during feedings. Sugar residue remains in the mouth whether your child is drinking breast milk, formula or any other nonwater beverage. What’s more, babies (like all human beings) produce less saliva while sleeping, so those sugar particles are less likely to be “rinsed” away.

Breast milk does contain natural chemicals that are beneficial in many ways; one even offers some resistance to S. mutans. And compared with formula or juice, breast milk contributes relatively little to acid production in your child’s mouth. Still, lengthy nighttime nursing is risky for future development of cavities.

At your next visit, we’ll tell you more about how to properly care for your infant’s teeth to help him or her get a good start in avoiding cavities, whether fed primarily by breast or bottle.

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Maintain Your Child’s Smile After a Lost Tooth

Primary teeth, better known as baby teeth, have more purpose than just milking the Tooth Fairy of her hard-earned money. Besides enabling chewing and speaking, the presence of primary teeth helps guide the permanent teeth into place—assuming the timing is right.

In cases where the primary tooth falls out earlier than expected and the permanent tooth is not yet ready to take its place, there is a chance that spacing for it can be diminished. The simple reason is that the neighboring primary teeth begin to shift inward to close up the space vacated by the missing tooth. Without sufficient space to grow up and into, the permanent tooth may come in at an angle.

How can this be prevented? The answer is simple: We keep the space open with an appliance called a space maintainer. These devices maintain the width of the space formerly occupied by the primary tooth. At the most basic level, they are composed of a fixed or removable metal band and wire. The band is attached to the base teeth, and the wire is extended between the two, thus preserving the space. There are several other variations of the space maintainer, and the complexity of the one used is often dictated by the location of the tooth, shape of the jaw and patient’s age.

Not all instances of premature primary tooth loss require space maintainers. Often, the four front teeth—top and bottom—will have enough space to grow in by themselves. Ultimately, we will make the call regarding the installation of a space maintainer.

So we can monitor the spacing for the incoming teeth and the health of the gum tissue around them, it is vital that your child visit us at least twice a year. Beware of assuming that your child’s permanent teeth will grow in correctly because they are “supposed to.” We can ensure that your child’s permanent teeth will come in properly so that he or she has a healthy smile.

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Decay-causing Foods That Will Surprise You

Most of us know that, in the battle against childhood tooth decay, sweetened soft drinks are the mustache-twirling villains. There are sneakier suspects, though, that actually can do just as much damage to your child’s dental health. Pickles? Positively. Lemons? Likely. In fact, this group of edibles includes sodas, fruit juices and acidic foods that many children heartily enjoy.

How do these foods damage teeth? Decay occurs when mouth-residing bacteria produce acids that wear away the hard enamel present on healthy teeth. Bacteria thrive on sugars, the compounds left behind after we consume any one of hundreds of foods and beverages.

When your teeth are not immediately cleaned, sugar from, say, soft drinks lingers on them, providing a hearty meal for bacteria. Equally bacteria friendly, though, are the sugars—added or naturally occurring—in many fruit juices. To minimize residue, have your child sip such beverages through a straw.

But here’s the kicker: Fruit juices can have a second detriment—they are acidic, as well. And acids in foods and drinks affect teeth physically just as bacteria do—they erode enamel.

So, consider acidity when you serve your child otherwise nutritionally beneficial foods, including citrus fruits (lemons, oranges, etc.), tomatoes (including pizza, soup and pasta sauce), and other fruits and vegetables, such as pickles, with high acid content. Sweet honey, too, is surprisingly acidic.

Even without sugar, zero-calorie sodas are potentially harmful. Many contain phosphoric acid, citric acid or both that wear away enamel like any other acids. And while carbonation by itself isn’t corrosive, the artificial sweeteners or flavorings in sparkling waters or seltzers boost the drinks’ acidity. Energy drinks, bottled iced teas and lemonades may contain acids that wear away tooth enamel, as well.

After your child consumes these types of foods or drinks, have him or her rinse immediately with water to dilute and wash away the acids. Because the teeth may be softer after consuming acidic foods, have your child wait 20 minutes before brushing with American Dental Association-approved toothpaste.

The less sugar and acid that remain in your child’s mouth, the fewer dining opportunities those oral-dwelling bacteria will have, and the possibility of erosion of the enamel is diminished. Ask us about other ways your child can enjoy his or her favorite foods—acidic or not—and still maintain terrific oral health.

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Anticipation, Not Apprehension for Happy Dental Visits

We are so appreciative when a child visits us with no preconceived negative ideas about dental care. How can your child fit this model by starting his or her experiences with us off on the right foot (or tooth)? Here are our best tips:

Language: Avoid the words “pain,” “hurt” or “drill” when discussing dental visits with your child. Instead, choose positive vocabulary and phrases, such as “let me see your smile,” “let me count your teeth” and “keep your teeth and mouth healthy.”

Timing: It’s almost never too early to accustom your child to dental visits. A trip to the dentist as soon as the first tooth emerges, or at age 1, is ideal. The resulting familiarity will be helpful to your child and us going forward—especially if a dental emergency ever arises.

Details: Answer any of your child’s questions honestly, but provide as few specific details as possible. We are trained to explain our procedures in child-friendly, nonthreatening language, and we have had many years of experience. Trust us to provide your child with answers that he or she can understand and that will inspire no fear.

Books and play: Picture books about dental visits featuring television characters like SpongeBob Square Pants and Dora the Explorer may be fun to read with your child before the appointment. And you can also “play dentist” in a very simple way prior to a visit: Count your child’s teeth with a toothbrush, for instance, and then let your child pretend to count the teeth of his or her favorite doll or stuffed animal (or you) in the same way.

Here are some things to avoid: Leave your child home when you have a dental appointment. If you have any apprehension, he or she may sense it and associate fear with upcoming dental appointments. And avoid offering a bribe or reward in advance, saying your child will receive it if he or she is “good” or doesn’t cry at the dentist. Your child will likely wonder what awful thing might happen that would induce crying, and fear will be created.

If you are stumped or fearful yourself about your child’s upcoming visit to our office, ask us about strategies we use to make our young patients comfortable. We’re proud of our track record on this and are more than willing to share it with parents to make the dental experience as smooth and anxiety-free as possible.

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Nothing Safe About Vaping

The popularity of e-cigarettes, or vaping, has increased dramatically in recent years. Marketed as a safer alternative to smoking, e-cigarettes offer nicotine in a liquid vapor that is inhaled like a cigarette, but without any actual tobacco. Although many people assume they are safe, there is no scientific evidence to support the safety of e-cigarettes. Nicotine, regardless of how it is delivered, can have a detrimental effect on oral health, and it is important that children and teens hear this message.

A survey conducted from 2011 to 2012 found that e-cigarette use among middle and high school students had doubled—from 3.3% to 6.8%. This trend is disturbing, especially at a time when we have not yet fully studied the effects of e-cigarettes. The U.S. Food and Drug Administration spoke about this in 2014 saying, “E-cigarettes have not been fully studied, so consumers currently don’t know the potential risks of e-cigarettes when used as intended, how much nicotine or other potentially harmful chemicals are being inhaled during use, or whether there are any benefits associated with using these products.”

However, we do know the following with some certainty:

  • E-cigarette use causes gum recession. Because nicotine reduces the amount of blood that can flow through your veins, gums may not receive the oxygen and nutrients they need to stay healthy. Also, the use of nicotine can mask the signs of gum disease, making it more difficult for us to diagnose.
  • E-cigarettes cause bad breath. The use of nicotine in any form can reduce your body’s ability to produce saliva, which, in turn, can lead to more bacteria in your mouth and, eventually, tooth decay and bad breath.
  • E-cigarettes can increase tooth grinding. Because nicotine is a stimulant, it can intensify tooth-grinding among adults and adolescents.
  • Nicotine use during adolescence can negatively impact the developing brain. And because nicotine is a known potentially lethal toxin, ingestion, inhalation or absorption through the skin or eyes can lead to poisoning, which can be fatal.

It is important that adolescents as well as adults understand these risks. If you want us to talk to your teen about the dangers of e-cigarettes, ask us at your child’s next appointment, and we will be happy to discuss this in more detail. We want your child to have a sparkling white smile, along with oral health that will last a lifetime.

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