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With dental disease continuing to be a significant public health problem in children, brushing with fluoride toothpaste and flossing are still effective preventive measures to reduce cavities in children. But for something that sounds so straightforward to do, it isn’t. As if brushing itself isn’t a large enough hurdle to get over, let’s not forget about flossing to get in between your child’s teeth.

Before discussing some tips on helping with your child’s oral health care, there are many reasons children’s teeth may not be cleaned well. Some reasons include:

  • Your child may be highly active and unwilling to stay still long enough for brushing and flossing to be done.
  • Your child may have oral discomfort because they are teething, or they may have soreness because their teeth may be very loose and are going to fall out soon.
  • Your child may push you away from brushing their teeth because they have sore teeth from cavities or a broken tooth that’s getting irritated when their teeth are brushed.
  • Your child may be disinterested or uncooperative in the process.
  • Your child may have a medical condition, making the process difficult.
  • Your child may have an oral infection.
  • There may be a combination of any of the above, where there is more than one reason why brushing and flossing is difficult.

As such, a first visit to a dentist should occur within six months of your child’s first tooth coming in. This way, an evaluation can be done to learn if there are any underlying reasons for the challenges you are facing in regard to your child’s home oral health care.

Although it is ideally recommended to brush and floss teeth twice a day, a minimum of once a day is necessary.

As a specialist in pediatric dentistry, many parents approach me to learn better ways to clean their child’s teeth. I have put together several tips to share:

Brushing your young child’s teeth may be a two-person job. Certainly, there are parents who are able to brush their child’s teeth by themselves without any help. For those who have difficulty doing this alone, consider using a two-person approach. This method is based on an infant oral exam done at a dentist’s office. In this method, one person (Person A) is going to do the cleaning while the other person (Person B) is going to help hold the child safely during the cleaning.

Here’s how it works: Person A and Person B sit on their own chairs with their knees facing each other, ensuring a short distance is present, separating both parties. Person B holds the child up so the child is facing them first and then gently lays the child down on their back, so the child’s head is now on Person A’s lap. The right leg of the child is then positioned to the left side of Person B while the left leg of the child is then positioned to the right side of Person B. This is important to ensure your child doesn’t kick off the stomach of Person B.

The hands of your child are then held gently by Person B, so the child knows they are safe.

In this position, Person A can focus on brushing the teeth without having to also focus on the child’s behavior – the latter being the focus of Person B. During each session of brushing and flossing, it is encouraged that both parties give lots of positive feedback and reinforcement to the child.

While brushing, it is important to ensure that excess fluoride is not swallowed and, as such, care needs to be taken to ensure that children under three years old use a small amount of toothpaste – only about a rice-size amount. Although studies have shown that plaque on teeth is not a barrier to the uptake of fluoride in enamel, it is an irritant and causes the gums to bleed (gingivitis) if left on teeth.

If you do see bleeding gums when you are brushing your child’s teeth, it’s always important to see your dentist to determine the reason why.

Brushing technique. With regard to brushing technique, although it is recommended to use a circular motion, often parents find more success initially brushing their child’s teeth up and down and side to side. The important thing is getting the teeth clean the best you can while using a soft toothbrush.

For infants with very few teeth, consider using 2×2 gauze to wipe the teeth clean rather than using a toothbrush. Sometimes using gauze on an infant is better tolerated than using an age-appropriate toothbrush.

For some kids, brushing all of the teeth, top and bottom, in one session won’t happen. Don’t give up! Split it up! Consider brushing only the top teeth during your first session and then during the next session that day, only brush the bottom teeth. In time, as your child warms up to the routine, you may very well be able to brush both the top and bottom teeth in a single session.

Introducing flossing to your child. When first starting flossing, you may find your child is a natural born flosser and will let you floss between all of their teeth without issue, or you may find your child won’t let On day three, attempt to floss three times between four teeth in the morning and then three times between four teeth before bed, and so on. Continue this slow introductory approach over several days until you are successful at flossing between all of your child’s teeth. If there is a struggle, step back and floss less teeth the next time and try again, adding more teeth to floss during your next session.

The nice thing with an early introduction to flossing when your child is an infant is there are very few teeth in the mouth to floss between, so you will be doing this approach naturally and only adding more teeth to floss between as more teeth erupt in the mouth; this allows time for you and your child to get used to the routine of daily home care with brushing and flossing.

Supervision. As children age, many desire to be self- sufficient and brush and floss on their own; encouraging independent oral health care is important. Until children are eight (and some children even longer than that), it is recommended that you help brush your kid’s teeth as they may not have the manual dexterity to do a good job. Consider having your child brush their teeth first and then go over their ‘work’ after to ensure it is a job well done. When your child brushes their teeth, supervision is important.

Success in having a healthy mouth and a healthy smile comes from being open to trying different techniques with oral health care. What works for one child may not work for another. What works for your child one day may not work for them another day. Brushing can be tough to do for children. For some kids an electric toothbrush really helps. For others, not so much. Brushing and flossing isn’t a one-time show, it’s a lifelong journey. The goal is to find what works best for your child and keep their teeth cleaned, consistently.

If you have any specific questions or concerns about your child’s oral health, contact a member of your dental team.

Written by Dr. Rory Vinsky
Published in Calgary’s Child

A common question asked by parents is, “Why do we need to fix baby teeth when they are going to fall out anyway?” There are many reasons dentists check baby teeth, all of which are important to a child’s current and future health.

When do baby teeth fall out?

Your memories of childhood regarding the loss of your own baby teeth may be cloudy. Although you know they were lost, you may be unsure when it happened. Were you two years old, or four years, or six or nine? Or was it later than that?

Normally, the first teeth children lose are the baby front teeth and this occurs about six or seven years old. From this age until your child reaches about age 13, the remaining baby teeth are lost and replaced by adult teeth. The final baby teeth are lost when the second baby molars are replaced by the permanent second bicuspids.

There is a pattern of loss that primary teeth follow in order to ensure the adult teeth come in the most favorable position. If one or more baby teeth are lost too early, it can delay or dramatically affect the position of adult teeth, and braces may be needed to correct this. Sometimes, however, baby teeth do not fall out (exfoliate.) This may be a result of several conditions. There may be no adult tooth ready to replace the baby tooth. A misguided successor tooth may be disrupting the process – this often occurs when your child’s teeth are crowded. Lastly, the root of your child’s baby tooth may be attached to the bone itself, a problem called ankylosis.

It is important all children have a complete dental examination at an early age to confirm all adult teeth are present. If an adult tooth is missing or delayed, you can learn the options available to ensure the best care of your child’s dental condition.

What should I know about cavities?

Baby teeth, like adult teeth, develop cavities. If left untreated long enough, this can lead to a life-threatening infection.

For a cavity to develop in children or adults, three factors must be present.
Firstly, bacteria called mutans streptococci are needed. These bacteria start to live in your child’s mouth when the first tooth erupts about the age of six months. Before this time, the specific bacteria are not present.

The second factor required is a tooth.
Finally, sugars are needed for the bacteria to eat. This includes fruit sugars (fructose,) milk sugars (lactose,) as well as candy sugars (glucose and sucrose.) As we know, the foods most enjoyed by children are the ones which are highest in these sugars. Children who often eat sticky foods containing sugar or who sleep with a bottle (bottle cavities) are at the greatest risk for developing cavities.

Once these sugars are digested by the bacteria, acids form and cause the decay of the tooth. It is only in the earliest stages of cavity formation that the process can be reversed with fluoride. Once the outer surface of the tooth breaks down, the cavity will not ‘go away.’ It will only worsen.
The decay continues until the cavity reaches the nerve (pulp) which is found in all teeth. Once there, the nerve becomes infected and dies. This is of great concern because the infection can spread throughout the body and cause a life-threatening infection. If you notice any swelling in the mouth or difficulty breathing and swallowing, it is extremely important that you call a dentist or medical doctor as soon as possible. The swelling may be an indication of a life-threatening infection caused by an advanced dental cavity.

Children who develop cavities experience pain, but may not have the right words to tell you. Restless nights, weight loss and a poor disposition are often indications that your child has a cavity needing treatment. It is important to consult a dentist if you suspect this is the case.

Also if you notice any discoloration of your child’s teeth, check with your dentist. This may be an indication of a problem with the teeth. Because all the factors which cause cavities are present when your child’s tooth erupts, children should be seen by a dentist at this time or earlier. It is not recommended to wait until the child is three years of age to see the dentist for the first time.

What is the value of baby teeth?

Baby teeth have an important role to help guide adult teeth into their correct positions.

When these first teeth are maintained well and kept in their position for the appropriate length of time, adult teeth are able to follow properly. If a baby tooth is lost prematurely, several problems can occur.

These may include:

  • The shift of the next tooth into the newly created space. This leads to crowding.
  • A delay in the eruption of its succeeding adult tooth.
  • Healthy baby teeth are necessary for your child’s growth and development. Unless cavities are treated, children may be unable to eat properly and may experience weight loss and poor overall development. As a result, they will lack enough of the necessary building blocks needed to preserve their overall health.
  • Baby teeth are necessary to ensure a child’s speech develops properly. Without teeth, your child will be unable to form various sounds such as “th” and “f.”
  • Finally, baby teeth are needed to give your child a beautiful smile. We all want to feel good about ourselves. Your child’s ability to flash a winning smile from an early age will go a long way to promoting that needed self esteem.

Written by Dr. Rory Vinsky
Published in Calgary’s Child

Primary teeth play important role in a child’s jaw development

By Dr. Cameron M. Zealand,

BSc(CE), MSc(Eng), BSc(Dent), DMD, Cert Ped. Dent., MS(Pedo), FRCD(C), Diplomate, American Board of Pediatric Dentistry

Dental hygiene is important for everyone – including babies. It is important for parents and caregivers to take an active role in caring for their baby’s teeth by cleaning them at home, providing a balanced diet and scheduling regular dental check-ups.

A common misconception is that primary or “baby” teeth are not important because they will eventually fall out. On the contrary, a child’s first set of pearly whites sets the stage for good overall health.

Primary teeth are important for chewing and maintaining a healthy diet, facial development and preparing the jaw for the arrival of permanent teeth.

Unfortunately, tooth decay can begin as soon as the teeth emerge, as early as six months of age. Decay in the primary teeth may cause pain. It can also harm erupting permanent teeth developing inside the gums.

The good news is that tooth decay is totally preventable by following some simple, basic tips.

First, never allow a baby to fall asleep with a bottle containing milk, juice, sweetened liquids or a pacifier dipped in sugar or honey. This causes Baby Bottle Tooth Decay (BBTD) or more commonly known as Early Childhood Caries (ECC), the leading cause of dental decay in young children.

Second, start oral health care early. Even before the first tooth comes in, wipe baby’s gums with a clean gauze pad or towel after each feeding. Begin brushing the teeth with water as soon as the first tooth appears in the mouth.

Finally, talk to a pediatric dentist about scheduling the child’s first dental visit. Both the Canadian and American Academy of Pediatric Dentistry suggest that it is beneficial for the first visit to occur within six months of the first tooth erupting and no later than the baby’s first birthday.

Regular dental checkups, at an early age, get your child comfortable with visiting the dentist and play a big role in preventing tooth decay. It’s an important step in building healthy, beautiful smiles for life.

At North Calgary Pediatric Dentistry, pediatric dentists, Drs. Vinsky and Zealand take an active role in promoting oral health. We strive to provide a professional environment that is child friendly.

Through personal attention, we seek to provide valuable information and specialized care to our young patients and their parents.

North Calgary Pediatric Dentistry is located at 8290 Centre Street North. For more information visit northcalgarypediatricdentistry.com or to make an appointment, call (403)-295-8010.

As babies start to crawl and explore the world, they meet many obstacles where they might be hurt. Though the active years of childhood and adolescence, these obstacles become even more common. Injuries causing damage to the teeth, bone, gums, cheeks, and lips are common. Childhood dental injuries can have a long-lasting serious effect. They may lead to discomfort, discolouration, altered tooth development, infection (if left untreated) or tooth loss.

The most likely causes of dental injuries in children are falls and tripping over objects. For young children, playing near sharp-edged coffee tables or fireplaces, running at the swimming pool, and wearing socks on slippery linoleum floors are common activities that often cause falls and dental injuries. Anyone of any age who plays sports without the protection of a mouthguard also risks severe dental injury. A tooth may be knocked out, moved, broken or suffer from a severe blow (concussion) when left unprotected. Other dental injuries seen by dentists result from fights, car accidents, rough play, electrical burns and, unfortunately, child abuse.

Dental injuries can be divided into those involving the “baby” or “primary” teeth and those involving the “adult” or “permanent” teeth. Baby teeth begin to appear at about six months of age. By two-and-a-half to three years all baby teeth should be present. The exchange of baby teeth for adult teeth begins at about age six and continues until about age 13.

Although baby teeth are not permanent, their presence is valuable in the growth and development of the mouth and its structures. They guide the adult teeth into their appropriate spots, and aid in speech and appearance. If the early teeth are lost or altered, these important functions can be affected. Even though the permanent teeth cannot be seen when you look into your child’s mouth, injuries to the baby teeth can have a dramatic influence on later tooth development. For this reason, all dental injuries should be evaluated by a dentist. Some injuries, if left untreated, can lead to nerve death with that tooth. In case of baby teeth this can also damage the developing adult tooth associated with it.

Injuries to Baby Teeth

Bumped front tooth • These injuries may occur as early as the days when a child is learning to crawl. As a result of the concussion, the tooth may be loosened and bleeding may occur around the gums. This type of injury causes concern for dentists because the tooth may be so loose the child could inhale it. The dentist will also want to check the position of the tooth to ensure that it has not been moved in a way that would interfere with the child’s normal bite. Most teeth that have been bumped tighten up on their own within one to two weeks after the injury.

Injured teeth may discolour by turning grey or brown. Because the baby teeth are so white, the colour change is easy to see when compared to the surrounding teeth. The colour change may be the result of normal healing or a sign of an underlying infection developing. Therefore, examination by a dentist is important.

Your dentist will decide how often the injured tooth should be checked. It may be a schedule such as one week, three weeks, six weeks, three months and six months after the injury occurred, or longer.

Teeth Knocked Out • For baby teeth only, a knocked out tooth is not replaced into its original spot. Doing so may damage the permanent tooth that is developing. The success rate is also poor for re-implanted baby teeth.

The lost tooth should be located. If it cannot be, an X-ray should be done to see if the tooth has been pushed into the gums and bone. If it is still not found, an X-ray of the chest and abdomen may be needed to see if the tooth has been swallowed or inhaled. A follow-up with a doctor may be indicated if the tooth is located by an X-ray of the chest or abdomen.

Your dentist will want to make recommendations about the space that results after a baby tooth is lost due to injury. Sometimes no further treatment is necessary. Other times the space will need to be maintained so there will be enough room for the permanent tooth when it comes through. This is done after the injured area heals.

Broken Teeth • For children ages three to six, this is the most common injury. Your dentist will want to take an X-ray to assess the extent of the injury. Dental fractures may involve:

  • the enamel or outer layer of the tooth only – often no treatment is needed.
  • the enamel and dentin (the layer beneath the enamel but above the nerve or pulp). These need to be seen by your dentist as a sedative dressing is often required to soothe the tooth (for example, sensitivity to cold). The dressing also helps protect the pulp. A tooth-coloured filling is placed over the sedative dressing and bonded to the tooth to restore the shape and your child’s smile.
  • the whole tooth where the nerve is exposed. In this case, you will notice bleeding coming from within the tooth itself. You will want this checked by your dentist as soon as possible. The time elapsed since the injury will guide your dentist on the best course of treatment. It may involve placing a sedative dressing over the exposed nerve, or a partial or complete nerve removal. Once again, a tooth-coloured filling will be used to restore the appearance. If left untreated, the tooth may become infected and develop an abscess. Your dentist may want to complete a baby root canal or remove the rest of the tooth depending on several circumstances.
  • fractures of the root. The tooth portion above the fracture will need to be removed. Your dentist will discuss the option of removing the root below the fracture. If this is done, the developing tooth associated with it may be affected. If the root is left in place, the dentist will monitor it closely in case an infection develops. In the latter case, the remaining root will then need to be removed.

If you suspect any type of dental fracture, your child should be seen by a dentist to have the damage assessed and monitored.

Teeth Pushed Out of Position • Sometimes a tooth will be injured and its position altered. You may find that the tooth is in the way of your child being able to close the teeth together or the tooth may be pushed into the gums and bone. You will want your child to see a dentist in any case. X-rays will be needed to assess the extent of the injury.

If the crown (the part of the tooth you brush) is angled backwards towards your child’s tongue, it may represent a “favourable displacement” or “favourable injured position.” This is because the root (the part that holds the tooth to the bone) will have likely moved forward towards the lip. Since most top adult teeth are forming behind the roots of the baby teeth, the root movement will be away from the developing adult tooth. Although the baby tooth may need to be removed, it may not have affected the forming adult tooth.

For teeth that are pushed into the gums and bone, often the tooth will be allowed to return to its original position (re-erupt). It is possible that the adult tooth may have been damaged as the baby tooth was pushed into it. Your dentist will want to monitor this injury to ensure the tooth is re-erupting and to check that infection is not developing.

Fractures of the Jaw  Fractured jaws in children account for two to eight per cent of injuries. Children will need emergency care immediately whenever there is significant injury involving the mouth.

Injuries to the Adult Teeth

There are several different type of injuries that occur to permanent teeth.

Crown Cracks • These are cracks in enamel that may be horizontal, oblique or vertical. There is no treatment recommended other than monitoring by your dentist.

Crown Fractures • This fracture involves the crown of the tooth only. It may encompass:

  • the enamel only. Here the rough edges are smoothed or a tooth-coloured filling is bonded to restore the tooth’s appearance.
  • the enamel and dentin (the layer below the enamel). This fracture will require immediate care and should be seen b your dentist. A protective sedative dressing will need to be placed to soothe the tooth and protect the underlying nerve. Your dentist may decide to restore the tooth to its original form that day or place a temporary tooth-coloured filling over the injured area. If this second choice is made it is called a “band-aid” solution. Once the tooth has had time to heal (three to four weeks) the bonding may be completed.
  • the enamel, dentin and pulp (nerve). Immediate care is necessary by your dentist. Partial or complete nerve removal may be required depending on the length of time the nerve has been exposed. Depending on the tooth’s maturity at the time of injury, your dentist may want to encourage the tooth to develop more quickly than it would normally, then do a root canal.

Root Fractures • This type of injury may involve the crown as well. It may be a horizontal, oblique or vertical fracture. Immediate care by your dentist is necessary. The location of the fracture will dictate if the tooth can be saved and determine the treatment needed. It may involve splinting the tooth for a week to 10 days, or even longer. A follow up root canal may also be required. Because these fractures can be complicated, other treatments may be recommended by your dentist.

Displaced Permanent Teeth • This type of injury may push the tooth forward, backwards, into the gum and bone or almost completely out of the bone. You will need to see your dentist immediately. Usually the tooth is replaced into its original position and splinted for a select period of time. A root canal may be needed. If the tooth is pushed into the gum, it may be allowed to re-erupt once again. Braces (orthodontics) may also be needed to reposition the tooth.

Knocked Out Teeth • Here the tooth is completely lost from the socket. From one to six per cent of dental injuries are of this type. Immediate treatment is urgent as the longer the tooth is outside the socket, the poorer the chance it can be saved. The tooth should be rinsed with water (being held only by the crown, not the root) and replaced into the socket and gently held in position until seen by a dentist. If the tooth cannot be replaced in the socket, it should be placed in milk or under the tongue. The dentist will splint the tooth in place. A root canal is highly likely. Any cuts to surrounding tissues will need to be assessed and treated accordingly.

Immediate Care

Any injury to the mouth (teeth, gums, bone) should be examined by a dentist as soon as possible after the injury. This increases the chance the dentist’s treatment will be successful. It is better to have an injury checked than to wait and have the situation become worse.

Dental injuries to children may be common but they should not be taken for granted and ignored. Have the dentist check your child’s teeth whenever such an injury occurs. It could make a lifelong difference.

Written by Dr. Rory Vinsky
Published in Calgary’s Child