Affiliated Pediatric Dentistry and Orthodontics

Injuries to Permanent Teeth

2010-10-21T10:16:00.000-07:00

Whether its a toddler falling in the bathtub or a middle school basketball player getting elbowed, the mouth seems to be a magnet for trauma. Accident prevention by careful adult supervision is very helpful but no matter how hard we try, as soon as we turn our backs, our child slips and falls into the coffee table and hits his/her mouth. When an injury occurs in the mouth and is sufficient enough to cause concern, it is always best to call your dentist for advice. Even after hours, your dentist can provide valuable information and help make decisions in the best interest of your child. One tip, please call your dentist shortly after the incident as some injuries require immediate attention.

Injuries to permanent teeth are frequently seen in our practice. They occur from all sorts of situations like falling off a skateboard or bike, slipping with roller shoes, and most sports. Any injury to a permanent tooth from a direct blow or a chip should be evaluated by your dentist. While many situations do not require immediate attention, the dentist should be consulted to help make that decision.

The most common injury occurs when part of a tooth is chipped off. Permanent teeth seem to be more sensitive then primary teeth after an injury. Some chips may require a protective temporary bonded coating over the exposed area to help reduce sensitivity and protect the nerve. Large chips, where the nerve is exposed, will require more extensive treatment of the nerve and later a cosmetic filling or bonding.

Injuries from traumatic blows where a tooth may be mobile but in position are also important to observe. Any pain, swelling or change in the color of a tooth should be immediately reported to the dentist. Also, any injury to a tooth that is pushed out of position should be seen by your dentist.

The best way for parents to prevent accidents to permanent teeth in by the use of mouth guards. While more sports such as hockey, lacrosse and football require their use, others don't seem to emphasize their importance. While baseball players wear helmets, most accidents occur in the field from missed balls, for example, misjudged fly balls or a ball taking a "bad hop". Use of a well fitting mouth guard may be helpful in these situations. Mouth guards can be purchased at most sporting good stores and many dental offices. There are many other play and sporting activities where the use of a simple mouth guard may not be "cool", but offers protection from injury. We insist that our children sit in a car seat, then seat belts, wear helmets when they bike or skate. Perhaps we should also evaluate the use of mouth guards in our children more frequently in situations where dental injury is more prevalent.

Braces 101: Cooperation: Is it a big deal?

2010-09-29T09:59:00.000-07:00

A big question on the minds of many orthodontic patients is: How much do I actually need to be involved in the treatment to get it done right? Cooperation from patients has always been an important ingredient in successful orthodontic treatment. The orthodontist asks for cooperation in three basic categories: (1) The application of additional forces with rubber bands, headgear, retainers, etc. to assist with tooth movement and jaw growth, (2) Maintenance of good oral hygiene in order to prevent cavities, gum problems, etc, and (3) Attending all scheduled appointments so that treatment progress can be monitored and progressed properly. This article will focus on the first category.

Most orthodontist want to rely on patient cooperation as little as possible and have designed methods of treatment to increase predictability of results with or without patient involvement. Non-compliance appliances are designed to limit the need for headgear and elastic wear by placing fixed or cemented appliances in the mouth to accomplish this task in a different way. Yes...these appliances came about because of patients who would not comply with instructions, but orthodontists use these on most patients now because of their effectiveness and relative comfort. Head gears and elastics are still necessary in certain circumstances, but are much less common now then in decades past.

The success of non-compliance appliances lies in the design. These appliances can apply forces on teeth full time to make changes occur. Headgear is typically worn (even with best cooperation) 12-14 hours per day, while rubber bands are (at least) taken off during eating. The application of proper calibrated continuous forces enables safe, efficient, and predictable tooth movement.

An important home message is that your orthodontist will do his/her best to make your experience with braces as good as possible. You may be asked to help your progress along with rubber bands, head gear, or something else along the way. Remember, all of these requests are made to benefit the patient and improve the quality of the outcome. Ask lots of questions so that you fully understand why you need to be involved.

What? An Increase in Cavities in Children?

2010-09-21T15:05:00.000-07:00

Everyone was surprised by the Center for Disease Control (CDC) recent report stating that children from ages 2 to 5 actually had an increase in tooth decay over the past 15 years. The CDC report clearly shows that young children are not receiving the proper oral health care they for optimal dental health.

The three probable causes for this problem are lack of parental knowledge on the proper age to visit a dentist, limited use of fluoride, and over use of carbohydrates in their children's diets. The American Academy of Pediatric Dentistry recommends that parents use the following practices to help prevent tooth decay in young children:

The one year dental visit: Dental visits should begin when your child is about a year of age. These visits are extremely important as they educate the parents with proper oral hygiene techniques, fluoride recommendations, dietary suggestions, and review oral habits. The dentist also evaluates your child's cavity risk by asking the parent questions on their oral health habits and those of other siblings in the family.
Fluoride use: The proper use of fluoridated products is very important in young children. Clinical studies have proven that proper amounts of fluoride used daily significantly reduce cavities. Please check with your dentist for their recommendations.
Healthy eating habits: Children should eat a balanced diet with limited snacks. Increasing the frequency of eating snacks or drinking juices (even diluted juices) are definitely one of the causes of the increase in tooth decay. I try to explain the situation by telling parents that if their child takes even one sip or drinks two ounces of juice/carbohydrates (the amount is not the same), the bacteria in the mouth produce cavity causing acid for about 20 minutes. Sipping on juice, off and on for hours will produce hours of cavity causing acid production. The simple solution is to serve juice/carbohydrates at meals only and let your child sip/drink water throughout the day.

Finally, with another surprising conclusion, CDC found a decrease in cavities in all other age groups. They attributed this to regular dental visits, the cumulative effects of fluoride as children become older and the use of sealants. So, there is a light at the end of the tunnel!!

Thumb Sucking! What should I do?

2010-09-13T08:31:00.000-07:00

One of the more common reasons parents of very young children enter an orthodontic office is to discuss thumb sucking. Thumb sucking is a very soothing, subconscious habit that can make permanent changes in the tooth and jaw positions if persistent. Many parents and their children have significant difficulty deciding why, when and how to address this issue.

When should I start to worry?

Most dentists and orthodontist agree that if the habit is broken by age 4 or 5 there should be few long term issues associated with the habit. Most importantly, thumb sucking should be ceased by the time the first permanent teeth are erupting. Usually children will stop sucking their thumb during the day due to peer pressure. How intensely a child sucks on fingers and thumbs will determine whether or not dental problems may result. Children who rest their thumb passively in the mouths are less likely to have difficulty than those who vigorously suck their thumb.

What will happen to my child's teeth?

The thumb can make a very powerful impact on the development of proper alignment and occlusion (biting) of the front teeth and form of the upper jaw. You may see the upper front teeth pushed forward with or without spaces between the teeth. The lower front teeth may be pushed back. The upper and lower front teeth may have some space between them in an up and down direction. This is called an open bite and sometimes causes difficulty chewing and/or with pronunciation of certain sounds. If the habit persists long term, it can cause the front teeth of the upper jaw (the premaxilla) to deform permanently to accommodate the presence of the thumb.

Secondary to the thumb habit, other long term effects may be present. Even after a thumb habit has ceased, an open bite in the front teeth may persist due to the presence of a tongue thrust. This is a forward positioning of the tongue during speech and swallowing that seals off the spaces between the teeth as a compensation during normal functioning. This habit can be even more difficult to break than the thumb habit sometimes requiring retraining exercises over an extended period of time. The presence of the thumb in the mouth also causes the tongue to rest lower in the mouth, taking away its ability to aid the development of the proper width of the upper jaw. This lower posture can lead to the development of a narrow upper jaw and a cross bite of the back teeth.

How can I help my child break the habit?

Most children stop sucking their thumbs without much intervention at all. However, some individuals need more help. First of all...in order to stop, they need to want to stop. Make sure you use positive reinforcement when trying to break this habit. And...don't be shy about involving your child's dentist, physician or orthodontist. A discussion with someone other than a parent can be helpful encouragement and take some of the pressure away from other family members when dealing with this sensitive issue.

Many devices have been developed to stop children from sucking their thumbs. Plastic thumb guards, thumb splints, spicy or bitter tasting paste to paint on the thumb, socks on hands, and other methods have been developed to aid parents with this difficult task. These methods can all be effective, but will not work for all children. Most importantly, don't make your child feel bad if they are having difficulty. Stopping this habit is the same as taking away a comfort item like a blanket or pacifier. They should be rewarded and encouraged when they have made positive changes. Also...sometimes the first attempt at habit modification is not successful. If this happens, take a short break and try again. Eventually, with persistence, you will be successful.

Consult your local orthodontist if you are having difficulty and need advice. And, remember...ask questions! The more you understand the information being presented to you, the better you will feel about the decisions you will make.

Care of Your Child's Teeth

2010-09-08T10:06:00.000-07:00

Begin daily brushing as soon as your child's first tooth erupts. A pea-size amount of fluoride toothpaste can be used after the child is old enough not to swallow it. By age 4 or 5, children should be able to brush their own teeth twice a day with supervision until about age seven to make sure they are doing a thorough job. However, each child is different. Your dentist can help determine whether your child has the skill level to brush properly.

Proper brushing removes plaque from the inner, outer and chewing surfaces. When teaching children to brush, place toothbrush as a 45 degree angle; start along gum line with a soft bristle brush in a gentle circular motion. Brush the outer surfaces of each tooth, upper and lower. Repeat the same method on the inside surfaces and chewing surfaces of all the teeth. Finish by brushing the tongue to help freshen breathe and remove bacteria.

Flossing removes plaque between the teeth where a toothbrush cannot reach. Flossing should begin when any two teeth touch. You may wish to floss your child's teeth until he or she can do it alone. Use about 18 inches of floss, winding most of it around the middle fingers of both hands. Hold the floss lightly between the thumbs and forefingers. Use a gentle, back and forth motion to guide the floss between the teeth. Curve the floss into a c-shape and slide it into the space between the gum and tooth until you feel Resistance. Gently scrape the floss against the side of the tooth. Repeat this procedure on each tooth. Don't forget the backs of the last four teeth!

The First Dental Visit

2009-12-21T12:12:00.000-08:00

In the good old days, dentists and physicians did not suggest children visit the dentist until they were 5 or 6 years old. Gradually, these recommendations have become more evidence based and currently, all major dental and medical organizations recommend the age 1 dental visit.

One of the most important aspects of an early dental visit is to focus on prevention of Early Childhood Caries (ECC). Yet, there is much more involved and for good reason. Let's look at the two phases of the infant oral health exam.

When the parent/caregiver brings their infant to our office, we review the medical history and also the parent's dental and social history. We understand that there is a very high correlation between parent's oral health and past dental disease and transmission to their child. This information is part of our caries risk assessment because if parents or siblings are at high risk, the infant should also be considered as such. We then review the causes of caries and prevention that partially includes breast/bottle feeding, diet counseling with emphasis on frequency (especially juices), toothpaste/fluoride, and any other guidance on growth or development issues like teething and oral habits such as thumb/finger sucking or pacifier use. Then we make sure to touch on trauma prevention and what to do if a child has a dental emergency. Finally, we welcome the parent to their new "dental home" and encourage them to call us with their questions and make sure they understand that we are available for their child 24/7 for emergency care.

We are not done yet! We still need to examine the infant. We tell the parent their child is going to cry, much like going to the pediatrician. We then ask the parent to face us (knee to knee) with the child facing them and lay the child's head in the doctors lap. Now, we demonstrate how to brush their teeth, do our examination and decide if we want to place fluoride varnish on the teeth depending on the caries risk evaluation we have just performed. We sit the infant up and place in mom/dads loving hands for a hug and ask if there are any further questions.

The infant's first visit may sound like a big deal, but think about what we have accomplished. We have educated the parent about dental disease, prevention, oral habits, and trauma. We have examined the child to make sure there are no signs of disease. We have established the child's new dental home where his/her oral health is managed in a comprehensive, continuously accessible, coordinated and family-centered way by a licensed, board certified dentist.

What have we been up to?

2009-09-29T14:43:00.000-07:00

Hello Everyone,

This is Dr. Tim. I am one of the pediatric dentists at Affiliated Pediatric Dentistry and Orthodontics. Welcome to our Blog. I want to share with you some exciting things we have been up to the past year.

This September was the Arizona Academy of Pediatric Dentistry's Fall meeting. I am currently the Secretary/Treasurer for the academy and arranged for internationally known, Dr. Kevin Donly to speak to our members. Dr. Chaet also gave a presentation on new technologies for restoration.

Dr. Chaet recently spoke with the family practitioner residents at Scottsdale Healthcare Osborn. He spoke with them about the importance of baby oral health and fluoride varnish. The residence valued his presentation so much that he has been asked to come back to speak again.

In June, I drove to Tucson and met with a number of Arizona Academy of Pediatric Dentistry members. We had dinner and discussed many issues relevant to improving the oral health care of children in Arizona.

Dr. Julie, Lesley and myself traveled to Sedona and presented an educational poster to the American Academy of Pediatrics Arizona Chapter. This meeting was the Arizona AAP's annual convention. Our presentation included educational information on infant oral hygiene and fluoride varnish applications. The doctors were well received and look forward to attending the meeting again next year. Here we are with Dr. Ron Fischler, who is the President for the Arizona AAP.

This past April, I was joined by Dr. Feinberg, Nancy and Lisa at the Doll House's Safety Saturday. The Doll House is a toy store located in the Promenade at Scottsdale Road and Frank Lloyd Wright. Police cruisers, fire trucks and kids were in abundance. Fire properly checked and buckled car seats for parents, while APDO gave out toothbrushes, stickers and toys.

Our lead assistant, Nancy, painted children's faces. Do you like the sun on my face?

Halloween 2008 spooked Dr. Julie, Lisa and myself. We were hanging out at Desert Sun's Fall Festival. I lurked behind the bean bag toss. We gave prizes to pixie hollow fairies, zombies, robots and more. I am the one dressed as Cat in the Hat. My daughter Ally was Cinderella. Nancy's husband Doug, made our tooth shaped board. While Nancy sewed together Star Wars bean bags for the toss.

When and Why should I bring my child to the dentist?

2009-09-28T08:07:00.000-07:00

When should I bring my child to the dentist is a frequent question asked by parents to their health care providers such as pediatricians, family practice physicians, and dentists. The typical answer is "around 3 or 4 years of age" or "when little Billy or Susie can sit in the dental chair." However, if your Billy or Susie develops cavities at 18 months of age, perhaps these were not the best answers. The appropriate reply is when your infant's teeth start erupting between 6 months to 1 year of age.

The reason for such an early dental visit is simple-PREVENTION. Dental disease is very common in young children, 5 times more common than asthma. The Centers for Disease Control and Prevention says that 40% of the population of children entering kindergarten has cavities.

Everyone knows that sugar "causes" cavities, but why do some children get cavities and others, who eat similar diets, do not? The partial answer begins by understanding that all of us have a normal, healthy relationship with the flora (bacteria) that is on our bodies and in our mouths. This flora is important to our very existence and in the case of infants; it begins to be established in the mouth when the first tooth starts erupting. The mother is the source for the flora approximately 71% of the time in the dental population and 88% of the time in breastfed infants.

It has been recognized that high levels of cavities fun in families and are passed down from mother to child. Yet, it is not as simple as that since we all know the story of the child in the family that does "everything wrong" and never has a cavity, while your "perfect brush and eater" has lots of cavities. The reason is that not everyone's bacteria are created equal. Some children have fairly harmless flora while others have bacteria that consistently produce higher levels of of acid (when exposed to sugary foods) that dissolve the outer enamel of the tooth.

Another important variable when discussing cavity potential is the fact that the formation of the cavity is determined by many factors. For example, diet, oral hygiene, fluoride exposure, salivary glands, etc. will play a role in cavity activity. Modification of a child's diet, better tooth brushing and flossing, and optimal exposure to fluoride may help prevent cavities by reducing the more active acid producing bacteria.

It can now be seen why early dental visits are important to help prevent cavities because the process starts as soon as teeth erupt. The only way to help a parent prevent cavities in their infant and toddlers is to discuss the mothers past dental history, review the cavity producing process, and offer preventative suggestions.

Braces 101: Adult Treatment- What are my options?

2009-08-26T10:53:00.001-07:00

A growing population of patients in many orthodontic practices consists of the 18 years and older crowd. Orthodontic treatment has become more accessible and palatable in recent years due to the variety of options for treatment that exist. Some may have never had treatment at all; and some may have had years of braces as a child or an adolescent with many more years since having not worn retainers. Problems may be slight or dramatic and a variety of treatment options may exist given new research and technology.

Adult Orthodontic Challenges

The greatest obstacle for the adult patient to overcome is the level of acceptability of orthodontic treatment in the workplace or social setting. Any adult entering treatment must be comfortable to interact with their peers while showing some type of orthodontic appliance while they speak. Nowadays, this is not a big obstacle. Orthodontic treatment has become wildly acceptable in adult circles.

A challenge present for all orthodontic patients is hygiene, although it is a social challenge in many adult situations. Adolescent patients generally can get by with poor hygiene in social situations, while adults have pressure to keep their teeth sparkling clean. Extra time must be spent in the mirror after meals to ensure that nothing unsightly is left on their braces or teeth before continuing on with their day.

Braces

Adults entering the orthodontic office generally seek the most cosmetic, efficient and hassle-free type of treatment that will address their chief concern. Although other options may exist, braces are usually the most predictable way to move teeth to their final destination and achieve the best possible results. Braces can be silver, gold or clear. Modern braces are small and applied directly to the tooth surface with few or no metal bands. Braces allow a three-dimensional grip on the tooth which allows the orthodontist full control of all tooth movement.

Length of treatment can vary based on the difficulty level of the case. Simple cases can be as short as a few months, while very difficult cases can take up to or more than two years to complete. New advances in orthodontics are helping to shorten this treatment time dramatically. Technology has allowed orthodontist to have custom braces and/or wires fabricated by robots to make treatment more efficient and increase precision of tooth movement. Shorter treatment time sometimes makes traditional braces a more realistic option for adult patients.

Aligners

Individuals with mild to moderate orthodontic needs may be candidates for aligners to move their teeth to correct crowding or other bite issues. This type of treatment involves a series of clear plastic retainers that will move teeth progressively over time. Excellent compliance is essential to treatment success. The aligners must be worn full time in order to produce proper tooth movement. Aligner treatment is a good option when braces are not an acceptable option for an adult patient. Ask your doctor to determine if you may be a candidate for this option and whether it can properly address your treatment goals.

Proper diagnosis and treatment planning are essential to determine the possible options that will meet the needs of each individual. Multiple options may exist with different potential outcomes. Be sure to ask questions and have a thorough understanding of the information presented to you. The more you understand, the better you will feel about the decision you will make.