When you think orthodontics, you may instantly picture braces or clear aligners worn by teenagers or adults. But there’s more to orthodontics than correcting fully developed malocclusions (poor bites). It’s also possible to intervene and potentially reduce a malocclusion’s future severity and cost well beforehand.
Known as interceptive orthodontics, these treatments help guide jaw growth in children while mouth structures are still developing and more pliable. But timing is critical: waiting until late childhood or puberty could be too late.
For example, we can influence an upper jaw developing too narrowly (which can cause erupting teeth to crowd each other) with an expander appliance placed in the roof of the mouth. The expander exerts slight, outward pressure on the upper jaw bones. Because the bones haven’t yet fused as they will later, the pressure maintains a gap between them that fills with additional bone that eventually widens the jaw.
Functional appliances like the Herbst appliance influence muscle and bone development in the jaws to eventually reshape and reposition them. The Herbst appliance utilizes a set of metal hinges connected to the top and bottom jaws; when the patient opens and closes their jaws the hinges encourage the lower jaw to move (and eventually grow) forward. If successful, it could help a patient avoid more invasive treatments like tooth extraction or jaw surgery.
Some interceptive objectives are quite simple in comparison like preserving the space created by a prematurely lost primary tooth. If a child loses a primary tooth before the incoming permanent tooth is ready to erupt, the nearby teeth can drift into the empty space. Without enough room, the permanent tooth could erupt out of position. We can hold the space with a simple loop device known as a space maintainer: usually made of acrylic or metal, the device fits between adjacent teeth and prevents them from drifting into the space until the permanent tooth is ready to come in.
Interceptive orthodontics can have a positive impact on your child’s jaw development, now and in the future. For these techniques to be effective, though, they must begin early, so be sure your child has a complete orthodontic evaluation beginning around age 7. You may be able to head off future bite problems before they happen.
When you're first startled awake in the middle of the night by a loud, gritting sound emanating from your child's room, you may have two questions: how can such a loud racket not be harmful to their teeth? And, how can they sleep through it?
While it sounds earth-shattering, teeth grinding (medically known as bruxism) is a common habit among children. It involves an involuntary grinding, clenching or rubbing of the teeth together, either during the day or during night sleep.
While certain medications or conditions could be factors, it's believed most teeth grinding arises from the immaturity of the part of the neuromuscular system that controls chewing. It's believed to trigger a night episode as the child moves from deeper to lighter stages of sleep toward waking. Older children and adults typically handle these sudden shifts without incident, but a young child's under-developed chewing response may react with grinding.
If a child's teeth are normal and healthy, teeth-grinding typically won't create any lasting damage. But because grinding does generate pressures greater than the teeth normally encounter, it can be harmful to decayed teeth or those with enamel erosion due to high acid from consumption of sports and soda drinks. And it's also a cause for concern if the habit continues into later childhood or adolescence.
To avoid these problems, it's best to keep your child's teeth as healthy as possible by practicing daily brushing and flossing, and regularly seeing a dentist for cleanings, treatments and preventive measures like topical fluoride or sealants. And be sure to limit sugar and acidic foods and drinks in their diet to protect against decay and erosion.
You can also take steps to minimize teeth grinding and its effects. Consult with your physician about any medications they're taking that might contribute to the habit. If there are psychological issues at play, seek therapy to help your child better manage their stress. Your dentist can also fashion a custom night guard worn while they sleep that will prevent their teeth from making solid contact during grinding episodes.
Most importantly, let your dentist know if your child grinds their teeth. Keeping an eye on this potentially harmful habit will help lead to appropriate actions when the time comes.
If you would like more information on teeth grinding, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “When Children Grind Their Teeth: Is the Habit of 'Bruxism' Harmful?”
More than likely your child already receives fluoride from your drinking water or toothpaste. So, is it really necessary for them to receive topical fluoride during their regular office checkups?
We highly recommend they do. A naturally occurring chemical, fluoride has the ability to make enamel more resistant to acid attacks that lead to tooth decay. It’s most effective when it works its way into the structure of the enamel during early teeth development.
Both fluoridated drinking water and dietary fluoride supplements (recommended by a doctor or dentist) can be the vehicle for this to occur while the teeth are still forming in the jaw before eruption (when teeth become visible). After the teeth have erupted, fluoride applied directly to the enamel surface (topically) can become infused with it as it continues to develop during early growth.
But can’t fluoride toothpaste accomplish the same result? No — the fluoride added to toothpaste and other hygiene products is relatively low, and only strong enough to maintain and protect enamel. The fluoride levels in topical applications like gels, foam or varnishes are much higher (in the tens of thousands of parts per million) and remain in contact with the teeth during a treatment session for much longer. Some fluoride varnishes, in fact, will continue to leach fluoride into the tooth surface for a month or more.
Topical fluoride applications are especially beneficial for children who are growing up in an area without fluoridated drinking water or without the proper means for good oral care and hygiene. But even for children with access to fluoridated water and oral care, a topical application can still be helpful.
A topical fluoride treatment isn’t a stand-alone application, but a regular part of your child’s dental care of daily brushing and flossing and semi-annual dental cleanings and checkups. Topical fluoride enhances the care they already receive to help produce stronger enamel for future healthy teeth.
If you would like more information on topical fluoride applications, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Topical Fluoride: How Fluoride will Benefit Your Child.”
What do young saber tooth tigers, which have been extinct about 10,000 years, have in common with human kids today? At first glance, not a lot. Smilodon fatalis, the big cat of North America, reached adulthood at around age three and weighed up to 600 pounds. But these ice-age mammals are probably best known for their dagger-like canine teeth, which (as shown by many well-preserved skeletons) grew up to 7 inches long. And that’s where the comparison between kids and kitties gets interesting.
The toothy felines had primary (baby) teeth and adult teeth, which developed in a similar way to human dentition. The primary teeth came in first, persisted during the young cat’s development, and shared space in the mouth as the adult teeth were erupting (growing in) — with one big difference. According to a recent study reported in the academic journal PLOS ONE, those colossal canines grew at an astonishing rate: up to 6 millimeters per month! By comparison, human primary teeth emerge from the gums at around 0.7mm per month, while permanent teeth may grow up to 2mm per month.
It’s understandable why those tiger teeth developed so rapidly: Life in the Ice Age was hard, and predators needed every advantage just to stay alive. But while human baby teeth take longer to develop (and to go away), they, too, are vitally important.Â For one thing, the primary teeth let kids bite, chew, speak (and smile) properly, until they are replaced by adult teeth — a process that isn’t usually finished until a child reaches the age of 12-13. So those “baby” teeth allow kids to have good nutrition — and positive social interactions — for a significant part of childhood!
There’s another important thing primary teeth do before they’re gone: They help ensure that the succeeding teeth come in properly, by holding a space in the jaw that will later be filled by a permanent tooth. If baby teeth are lost prematurely, those spaces can close up, resulting in permanent teeth that emerge too close together, or in the wrong places. This condition, called malocclusion (bad bite), can usually be corrected by orthodontics. But it’s better to avoid the inconvenience (and cost) of braces, if possible.
That’s why it’s so important to take care of your child’s baby teeth. Even though they won’t be around forever, they have a vital role to play right now. So be sure proper attention is paid to your child’s oral hygiene: That means avoiding sugar, and remembering to brush and floss every day. And be sure to come in regularly for routine exams, cleanings, and needed care. It’s the best way to keep those little teeth from “going extinct” too soon!
If you have questions or concerns about your child’s baby teeth, please call our office to schedule a consultation. You can read more in the Dear Doctor magazine articles “Importance of Baby Teeth” and “Early Loss of Baby Teeth.”
Families of children with chronic conditions face many challenges. One that often takes a back seat to other pressing needs is the prevention of tooth decay. But although difficult, it still deserves caregivers’ attention because of the dental disease’s potential long-term impact on oral health.
Chronically ill children are often at higher risk for tooth decay, most commonly due to challenges in practicing effective oral hygiene. Some conditions create severe physical, mental or behavioral impairments in children’s ability to brush and floss: for example, they may have a heightened gag reflex to toothpaste in their mouth or they may not be able to physically perform these tasks on their own.
Some children may be taking medications that inhibit salivary flow as a side effect. Saliva is critical for disease prevention because it both neutralizes mouth acid (which can erode tooth enamel) and is a first line of defense against disease-causing bacteria. And a child’s diet, while designed to support treatment of their chronic condition, may conversely not be the best for supporting their dental health.
It’s best if caregivers and their dentists develop a strategy for decay prevention, which should include the following:
- Regular dental visits beginning at Age One. Besides monitoring dental health, dental visits also provide cleanings and other preventive measures like topical fluoride or sealants;
- Brushing and flossing support. Depending on a child’s physical and mental capacities, caregivers (or an older sibling) may need to model brushing and flossing, or perform the tasks for the child;
- Medication and diet changes. If medications are causing dry mouth, caregivers can speak to their physicians about possible alternatives; likewise, they should see if modifications can be made to their diet to better support dental health.
- Boosting salivary flow. It’s especially important with children who have dry mouth to drink more water or use aids (like xylitol gum or candies) to boost salivary flow.
Although it requires extra effort and time to give attention to a chronically ill child’s dental health, it’s well worth it. By working to prevent tooth decay early in life, these children will be more likely to enjoy good dental health in the future.
If you would like more information on dental care for children with special needs, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor article “Managing Tooth Decay in Children with Chronic Diseases.”
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