The Thumb and the Mouth: An Amicable Breakup

Children are born with a strong sucking impulse; that’s why pacifiers are such big sellers. Even after most children outgrow their pacifiers, the sucking impulse remains. It usually tapers off between the ages of 2 and 4, but the habit can persist beyond then. If left unchecked, thumb-sucking can affect the development of a child’s mouth and cause misalignment of the teeth, including protrusions and overbites.

So what can you do about it? First of all, determine whether your child is actually sucking his or her thumb and not just putting it in the mouth. Simply having a clean thumb in the mouth isn’t a problem, so this battle may not be worth the fight.

From infancy, the sucking action provides a sense of security. Thus, when children suck their thumbs, chances are they feel insecure. You can approach this problem by finding and eliminating the source of your child’s anxiety.

Another option would be to use positive reinforcement to praise your child for not thumb-sucking in times of insecurity. Scolding or punishing children for sucking their thumbs when anxious only increases their anxiety. Children want to earn praise from their parents. Give them what they want when they earn it. Consider using rewards if they give up the habit for a long enough period of time. Mention the problem to us during your child’s next visit so we can explain the problem of thumb-sucking in terms your child will understand.

Appliances exist that we can attach to your child’s upper teeth that make thumb-sucking more difficult and less enjoyable. But this should be a last resort, used only after addressing the anxiety and the habit through noninvasive means has failed.

At your child’s next visit, we can discuss with you and your child the best approaches for permanently ending the thumb-sucking habit.

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Teenagers and Tooth Whitening: Not Yet

Teenagers have a hard time of it. Their bodies undergo rapid and profound changes. Their social lives become more important and more fraught with drama. The need to fit in becomes paramount.

As children grow into their adult bodies, their teeth become a central part of their self-esteem. Good teeth give them a bright, winning smile, while discolored teeth can cause embarrassment and shame at a time when they feel they can afford neither. The temptation to use tooth-whitening products can become intense. But however powerful that pressure, dentists recommend that anyone younger than 16 years wait to use these whitening products until later adolescence. Why?

Whitening toothpastes and other products such as gels and strips use peroxide to literally bleach the teeth white. Unfortunately, peroxide can have a number of adverse effects, including increased tooth sensitivity and abraded enamel. Even adults can suffer these results; in fact, almost half the people who use tooth-whitening products cite increased sensitivity as an adverse effect.

Although adolescents may feel like adults, their teeth cannot be considered fully mature until they are in their late teens. Tooth enamel does not become fully mature until after a process called enamel calcification, which tends to occur close to age 16. Before calcification, teenage teeth are more permeable and have an enlarged pulp, the part of the tooth that contains the nerves. Bleaching before the enamel is fully mature could expose the pulp to more peroxide than intended, irritating it or causing nerve sensitivity.

Younger teens often misuse tooth-whitening products, using them too often, leaving them on for too long or even swallowing them, all of which can lead to adverse effects. And bleaching products may work faster on teens than on adults, making accurate use difficult.

We can perform whitening procedures in our office that can help whiten your teenager’s teeth and reduce embarrassment. One of the fastest methods for whitening involves our placing a whitening gel on the teeth and exposing the teeth to a laser. Other methods of chairside bleaching may require more than one office visit, each taking from 30 minutes to an hour.

To determine whether you should allow your teen to use whitening products, ask us at the next regular checkup.

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Treating Temporomandibular Joint Disorders in Children

The temporomandibular joint (TMJ) connects the lower jaw to the side of the skull and allows people to talk and chew comfortably. Over-exertion of this joint, impact injuries and several dental conditions can lead to TMJ disorders (TMDs). While more common in adults, TMDs can occur during childhood, as well. Studies have found cases of TMJ pain in children as young as infants.

The TMJ begins to develop just 6 to 7 weeks after conception; the primary parts of the joint continue to form and develop at a significant rate during the first 10 years of life.

Symptoms of TMDs can appear as spasms of the chewing muscles, headaches and neck pain. Certain conditions—sinus pain, allergies, ear pain and muscle pain—can also mimic TMDs. If your child experiences any TMJ problems or jaw pain, address these issues immediately so corrective steps can be taken to relieve symptoms and potentially halt the progression of TMDs.

TMDs are typically managed rather than cured. The most common treatments are conservative in nature and do not cause permanent changes to the structure or position of the jaw or teeth. In adolescents, most TMDs can be effectively treated through simple therapies.

Self-care practices:

  • resting the jaw when tired
  • reducing stress
  • avoiding hard or chewy foods that can strain muscles
  • applying moist heat to help relax the muscles surrounding the TMJ

Physical therapy treatments:

  • performing range-of-motion, stretching and jaw-strengthening exercises
  • applying deep heat or ultrasound
  • engaging in biofeedback, a type of relaxation that uses electronic instruments to give your child immediate feedback about the effect of relaxation exercises on the TMJ and facial muscles

In cases that don’t respond to simple therapies, we can insert occlusal splints or biteguards for orthopedic stability to help decrease grinding and clenching habits.

If your child is experiencing any symptoms of a TMD, schedule an evaluation with us. Because the anatomy of the TMJ is still developing, evaluating and treating young patients requires specific expertise and skill. The earlier TMDs are diagnosed and treated, the better. Call our office today to discuss your concerns with us.

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Filling the Holes in Your Cavity Prevention Knowledge

Tooth decay is the most common childhood disease, yet with good dental habits, cavities are nearly 100% preventable! The first step comes even before your baby arrives. Taking care of your own oral health during pregnancy with regular brushing and dental visits can help prevent transmission of cavity-causing bacteria to your newborn.

Start caring for your infant’s oral health before any teeth emerge. After feedings, wipe your child’s gums and inside the mouth with a damp washcloth to remove any bacteria. When teeth do emerge, brush them with an infant toothbrush and a tiny smear of toothpaste, preferably one with fluoride to help protect teeth from decay.

Your child’s first regular visit to our office should be scheduled for the earlier of his or her first birthday or when the first tooth appears. Forming a positive relationship with us at a young age goes a long way to ensuring good dental health as your child grows.

Establish a regular home oral hygiene routine in age-appropriate increments, including brushing, flossing and rinsing. Supervise your child’s oral hygiene up to about age 6 to ensure proper technique. Watch to ensure that your child does not swallow toothpaste or mouth rinse, and choose a toothpaste with fluoride, which helps protect against cavities.

Good dietary habits also help prevent cavities. During infancy, place only breast milk, formula or water in your baby’s bottle. Avoid giving juice to your child until the age of 1, and then use only in moderation. Juices are high in sugar, a major culprit in tooth decay.

As your children grow, feed them a balanced, nutritious diet rich in calcium that helps strengthen teeth. Limit their consumption of soda, candy and other sugary sweets. Frequent snacking should be discouraged, too, because this habit allows food particles to remain on teeth for longer periods of time.

Even with your best efforts, your child may be one of those people more prone to cavities. Additional fluoride or topical sealants that coat the teeth with a protective covering are some added measures we may recommend.

In short, with a nutritious diet, good oral hygiene and regular visits to our office, your child can enjoy a lifetime of few cavities and good oral health.

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Fight Tooth Decay the Fluoride Way

The mineral fluoride helps prevent tooth decay by strengthening tooth enamel, making teeth more resistant to decay-causing acids and bacteria. Fluoride can even reverse early decay in young children’s teeth. Although fluoride is available in some foods and some local water supplies, many experts recommend the use of a fluoride varnish or mouth rinse to give a child’s teeth added protection.

Fluoride varnish, a topical dental treatment that only dentists can apply, is painted onto the top and sides of the teeth with a small brush. When it comes in contact with saliva, the varnish hardens. After four to 12 hours, the excess is removed during brushing. Fluoride varnish provides an added coat of protection to the teeth, especially in the early stages of a young child’s tooth development. We generally start fluoride varnish treatment when a child’s first tooth appears and recommend two to four applications a year, depending on your child’s risk for cavities. Applying fluoride varnish is painless and takes only a few minutes. During the procedure, the child can be comfortably seated on your lap, facing us.

Fluoride mouth rinses are best used by children after their seventh birthday, because at that age they are better able to swish and spit without swallowing. We may recommend that your child use a fluoride mouth rinse daily or weekly, most effectively just before bedtime. Just make sure your child does not eat or drink anything afterward.

Safe and effective when used as directed, fluoride can be hazardous at high doses (the “toxic” dosage varies based on an individual’s weight). For this reason, it’s important that parents carefully supervise their children’s use of fluoride-containing products and keep fluoride products out of reach of children, especially those under the age of 6. Overexposure to fluoride can lead to fluorosis, a condition that causes spots or streaks on tooth enamel. It is usually associated with naturally occurring fluoride, such as that found in well water. If you use well water and are uncertain about its mineral (especially fluoride) content, have a sample tested.

Studies have shown that both fluoride varnish and rinses effectively prevent tooth decay and are safe to use. Most experts believe the benefits of fluoride outweigh the risks, especially when use is combined with regular dental visits and good oral hygiene habits. Feel free to discuss with us any concerns you may have about your child’s fluoride use.

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A Sticky Situation: Gummy Vitamins and Your Child’s Teeth

When your child is going through an “I won’t eat THAT!” phase involving healthy foods, such as fruits or vegetables, it can be reassuring to know that your child is getting essential vitamins and minerals through a daily gummy supplement that resembles candy. Gummy vitamins, as they’re usually called, contain supplemental quantities of vitamins that children need, especially A, C, D, E, and different B vitamins.

However, if you read the labels of various brands, you’ll see that these nutrients’ actual percentages vary. In fact, many varieties don’t have a high mineral content because the gummy consistency doesn’t support their addition. Iron, for instance, is often missing.

Another problem with gummy vitamins is the citric acid and sugar they may contain. Found in many sodas and candies, as well as in citrus fruits, citric acid left on the surface of teeth can contribute to the erosion of valuable enamel. To prevent this, brush away gummy vitamin residue as soon as possible. An easy way to do this is to have your child take a daily gummy vitamin after breakfast or before bed, right before brushing will occur.

Citric acid is sometimes present in gummy vitamins that contain sugar and almost always in sugar-free gummy vitamins. And you must remember that sugar is sugar. Even when it’s part of a gummy vitamin, it needs to be brushed away. That’s another reason to make sure gummies are taken right before a scheduled toothbrushing.

The gelatin often found in gummy vitamins to provide its “fun” texture can also wreak havoc with your child’s teeth over time. Its stickiness promotes the other ingredients’ inclination to hang on to tooth surfaces if not brushed away quickly.

We hope your child eats a wide variety of healthy foods—vegetables, fruits and protein sources. Using gummy multivitamins as insurance is fine, but if your child doesn’t brush soon after taking them, they could ultimately do more harm than good to his or her teeth.

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