Fluoride has been proven to strengthen tooth enamel against decay. That’s why it’s not only added to toothpaste and other dental products, but also to drinking water — in nearly three-quarters of U.S. water systems.
While research has eased most serious health questions about fluoride, there remains one moderate concern. Too much fluoride over time, especially in infants and young children, could lead to “enamel fluorosis,” an excess of fluoride in the tooth structure that can cause spotting or streaking in the enamel. While often barely noticeable, some cases of fluorosis can produce dark staining and a pitted appearance. Although not a symptom of disease, fluorosis can create a long-term cosmetic concern for the person.
To minimize its occurrence, children under the age of 9 shouldn’t regularly ingest fluoride above of the recommended level of 0.70 ppm (parts per million). In practical terms, you as a parent should monitor two primary sources of fluoride intake: toothpaste and drinking water.
Young children tend to swallow toothpaste rather than spit it out after brushing, which could result in too much fluoride ingestion if the amount is too great. The American Academy of Pediatric Dentistry therefore recommends a small “smear” of toothpaste for children under two, and a pea-sized amount for children up to age six. Brushing should also be limited to no more than two times a day.
Your child or infant could also take in too much fluoride through fluoridated drinking water, especially if you’re using it to mix infant formula. You should first find out the fluoride levels in your local water system by contacting the utility or the health department. If your system is part of the U.S. Centers for Disease Control and Prevention’s (CDC) “My Water’s Fluoride” program, you may be able to access that information on line at //apps.nccd.cdc.gov/MWF/Index.asp.
If the risk for developing fluorosis in your area is high, you can minimize your infant’s intake with a few recommendations: breastfeed rather than use formula; use “ready-to-feed” formula that doesn’t need mixing and contains lower fluoride levels; and use bottled water specifically labeled “de-ionized,” “purified,” “de-mineralized,” or “distilled.”
Fluoride can be a wonderful adjunct to dental care in reducing risk for tooth decay. Keeping an eye on how much fluoride your child takes in can also minimize the chance of future appearance problems.
If you would like more information on the possible effects of fluoride on young children, 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 “Tooth Development and Infant Formula.”
While they're resilient, your child's teeth aren't invincible. Daily hygiene and regular dental visits are important, but you should also be alert for problems and take action when they arise.
Here are 4 areas that could cause problems for your child's teeth, and what you should do — or not do — if you encounter them.
Teething. This is a normal experience as your child's first teeth erupt through the gums. The gums become tender and painful, causing constant gnawing, drooling, disturbed sleep and similar symptoms. You can help relieve discomfort by letting them bite on a chilled (not frozen) teething ring or a cold, wet washcloth. Pain relievers like ibuprofen in appropriate dosages can also help — but don't apply ice, alcohol or numbing agents containing Benzocaine directly to the gums.
Toothache. Tooth pain could be a sign of decay, so you should see us for an examination. In the meantime you can help relieve pain with a warm-water rinse, a cold compress to the outside of the face, or appropriately-dosed pain relievers. If the pain is intense or persists overnight, see us no later than the next day if possible.
Swollen or bleeding gums. If you notice your child's gums are red and swollen or easily bleed during brushing, they could have periodontal (gum) disease. This is an infection caused by bacterial plaque, a thin film of food particles that build up on the teeth. You can stop plaque buildup by helping them practice effective, daily brushing and flossing. If they're showing symptoms, though, see us for an exam. In the meantime, be sure they continue to gently brush their teeth, even if their gums are irritated.
Chipped, cracked or knocked out tooth. If your child's teeth are injured, you should see us immediately. If part of the tooth has broken off, try to retrieve the broken pieces and bring them with you. If it's a permanent tooth that was knocked out, pick it up by the crown (not the root), rinse it with clean water and attempt to place it back in the socket. If you can't, bring the tooth with you in a container with clean water or milk. The sooner you see us, the better the chances for saving the tooth — minutes count.
Your sweet, happy baby has suddenly become a gnawing, drooling bundle of irritation. Don't worry, though, no one has switched babies on you. Your child is teething.
For most children, their first teeth begin breaking through the gums around six to nine months. Usually by age three all twenty primary (“baby”) teeth have erupted. While the duration and intensity of teething differs among children, there are some common symptoms to expect.
Top of the list, of course, is irritability from pain, discomfort and disrupted sleep. You'll also notice increased gnawing, ear rubbing, decreased appetite, gum swelling or facial rash brought on by increased saliva (drooling). Teething symptoms seem to increase about four days before a tooth begins to break through the gums and taper off about three days after.
You may occasionally see bluish swellings along the gums known as eruption cysts. These typically aren't cause for concern: Â the cyst usually “pops” and disappears as the tooth breaks through it. On the other hand, diarrhea, body rashes or fever are causes for concern — if these occur you should call us or your pediatrician for an examination.
While teething must run its course, there are some things you can do to minimize your child's discomfort:
Provide them a clean, soft teething ring or pacifier to gnaw or chew — a wet washcloth (or a cold treat for older children) may also work. Chill it first to provide a pain-reducing effect, but don't freeze it — that could burn the gums.
Use a clean finger to massage swollen gums — gently rubbing the gums helps counteract the pressure caused by an erupting tooth.
Alleviate persistent pain with medication — With your doctor's recommendation, you can give them a child's dosage of acetaminophen or ibuprofen (not aspirin), to take the edge off teething pain.
There are also things you should not do, like applying rubbing alcohol to the gums or using products with Benzocaine®, a numbing agent, with children younger than two years of age. Be sure you consult us or a physician before administering any drugs.
While it isn't pleasant at the time, teething is part of your child's dental development. With your help, you can ease their discomfort for the relatively short time it lasts.
If you would like more information on relieving discomfort during teething, 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 “Teething Troubles.”
As spring weather heats up, so do a lot of outdoor sports like baseball or soccer. Unfortunately, the chances of sports-related injuries increase as well. Your child’s mouth in particular is a prime target for injury—and you need to be prepared.
First and foremost, players should wear a mouthguard during contact sports to reduce their risk of injury. Mouthguards can absorb much of the force generated during impact—and may make the difference between minor bruising and a fractured or knocked-out tooth.
“Boil and bite” mouthguards available from the local pharmacy or sporting goods store are popular because of their cost and availability. These are softened in hot water before the wearer bites down to create a semi-customized fit. An even better option, though, is a custom mouthguard that is made from a precise impression of your child’s teeth that we take in our office. This type of mouthguard costs more, but it provides greater protection and comfort than one from your corner store.
A mouthguard can significantly reduce the risk of injury but won’t eliminate it entirely. If a dental injury does occur, you need to know what to do. This will depend mainly on the type of injury: If the tooth is chipped but not pushed out of position, you can collect any tooth fragments and see us within 12 hours for an examination and possible repairs. If the tooth has moved or is loose, you should see us even sooner—within 6 hours so we can readjust the tooth and, if needed, splint it until it is securely reattached.
A more serious injury is a tooth that has been knocked completely out of its socket. It can often be saved, but you’ll need to act quickly—optimally, within 5 minutes—by reinserting the tooth in its socket. Although it sounds daunting, it’s really a matter of a few simple steps: First, find the tooth and rinse off any debris with clean water. Holding it by the crown (the visible part you are used to seeing) insert the root end into the empty socket. If your placement isn’t “just right,” don’t worry; we can adjust it later, but it will require some pressure to place it in the socket. Have the person bite down on a piece of gauze or clean cloth to hold the tooth in place. Call us immediately. If you cannot reach us, go to an emergency room.
Quick action and prompt follow-up dental care after a mouth injury increase the chance of a happy outcome. Along with proper mouthguard protection, remembering these pointers will help ensure that your family has an enjoyable sports season this year!
If you would like more information about sports-related dental injuries, please contact us or schedule an appointment for a consultation. To learn more, read the Dear Doctor magazine articles “Athletic Mouthguards” and “The Field-Side Guide to Dental Injuries.”
While pediatric dentistry has made great strides in making young patients’ dental visit experiences more relaxing, some children and teenagers still have difficulty with anxiety. Their anxiety in turn can make necessary care much harder to provide.
For difficult cases, many dental providers for children now incorporate a technique known as conscious sedation to help ease anxiety. With this technique, they’re able to perform procedures like cavity-filling or tooth-extraction that are more difficult with an anxiety-prone patient.
While general anesthesia creates a total loss of consciousness, conscious sedation uses precise medications to suppress consciousness at different levels ranging from light to deep suppression, and create a relaxed state for the patient. A child under sedation can still breathe normally and respond to certain stimuli, including touch and verbal commands. For only a light or minimal effect, a dentist normally administers the sedation drug as a pill the child takes orally. For deeper sedation, the medication is most likely delivered through a vein (intravenously).
Sedation reduces fear and anxiety but not necessarily pain, so it’s often accompanied by some type of anesthesia, either a local anesthetic delivered by injection to the procedure site or with a nitrous oxide/oxygen gas combination that’s inhaled through a mask worn by the patient.
Even though the child isn’t completely unconscious, one of the dentist’s staff will monitor vital signs (heart and respiration rates, blood pressure and blood oxygen level) throughout the procedure. This continues even after the treatment is over until the child’s vital signs return to pre-sedation levels. Once released, they will need a ride home and should rest for the remainder of the day. They can then return to school and resume other normal activities the next day.
With the advent of newer and safer drugs, conscious sedation is becoming a more widespread technique in both medicine and dentistry. Using it to ease a child’s anxiety increases the chances they’ll receive all the dental care they need without unpleasant memories of their visit that could follow them into later life.
If you would like more information on the role of conscious sedation for children, 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 “Sedation Dentistry for Kids.”
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