If your county or city provides your drinking water, you are more likely to be receiving the correct amount of fluoride. Most U.S. cities that have a municipal water supply are now mandated to monitor and adjust the amount of fluoride in the communities’ drinking water. Community water fluoridation is considered to be the single most effective public health measure to prevent tooth decay. It has been successful in the reduction of tooth decay among different populations and is the most cost-effective form of public prevention. Fluoridation is endorsed by the Centers for Disease Control and Prevention, which has listed community water fluoridation as one of 10 great public health achievements of the 20th century.

The optimal fluoride level in drinking water is 0.7 – 1.2 parts per million, an amount which has been proven beneficial in reducing tooth decay. Naturally occurring fluoride may be below or above these levels in some areas. Under the Safe Drinking Water Act, the U.S. Environmental Protection Agency requires notification by the water supplier if the fluoride level exceeds 2 parts per million. People living in areas where naturally occurring fluoride levels in drinking water exceed 2 parts per million should consider an alternative water source or home water treatments to reduce the risk of fluorosis for young children
Children drinking well water for their primary source should have their well water tested for fluoride concentration. The results should be discussed with the child’s pediatrician or dentist to determine whether or not the child should be given fluoride supplements. NEVER, I repeat, NEVER give a child any kind of fluoride supplement pill or vitamin without having your well water tested and consulting your physician/dentist. Too much fluoride is dangerous and can have devastating effects on the appearance of your child’s teeth as discussed above.

However, correct systemic fluoride amounts (taken in through drinking water) are very beneficial. Because I live in an area of suburban and rural populations, I have been exposed to patients both with and without well-water as their primary drinking water supply. The difference is astounding. In fact, it is so obvious, that an individual can usually be identified as a well-water patient just during an exam!

The use of an American Dental Association approved fluoridated toothpaste at least twice a day for at least two minutes each time is a great start. Any toothpaste with the ADA approval seal is sufficient for use. I don’t personally recommend non-fluoride toothpaste, as I have seen a dramatic difference in the number of cavities in children and adults who use it. Fluoride helps to strengthen, protect and harden teeth, making them more resistant to tooth decay. However, the decision is ultimately up to you as the parent, so do whatever you feel is best for your child.

First, if the tooth is only fractured part of the way off, call your dentist immediately. The child will need an x-ray, evaluation and treatment right away to help prevent further complications.

If the tooth has come all the way out (called and avulsed tooth), there are a few things which need to be done and all must be done quickly for the tooth to have any chance of surviving. First, find the tooth and lightly wipe it off with a moist, clean cloth to remove any debris. Ideally, the tooth should be placed in the child or parent’s cheek in an area where it won’t be accidentally swallowed or inhaled. (I know, pretty gross, but it is for the sake of your child). If this is too upsetting or you are afraid it will be swallowed, the tooth can be placed in a glass of milk.

You should immediately take your child to the dentist, ideally within the first 10 minutes of the occurrence. The dentist will likely try to place the tooth back into the socket once it is clean and lacking debris which might cause later infection. The tooth will then likely be splinted to the adjacent teeth for support, to help minimize movement. This support will help the tooth re-tighten back into the socket and is sometimes left for up to two to three weeks. The tooth will likely need a root canal since the nerve was severed, but this likely won’t be done for two or three days after.

If the tooth has been out of the mouth for longer than fifteen minutes, your child still needs to see the dentist immediately to avoid more complication or possible permanent loss of the tooth. Bring the tooth with you as mentioned above.

If you are far from the dentist, the tooth is clean and you feel that the tooth is intact, you can attempt to put it back in the socket yourself. Be sure that if you are going to attempt this, you place it in the correct way! The child should immediately be taken to the dentist for an evaluation. If the tooth cannot be found, the dentist may refer you to the emergency room for a chest x-ray to be sure that it has not been inhaled during the accident.

I won’t go into great discussion about the further treatment sequence in dealing with an avulsed tooth, as it is varies with the child and the extent of the injury. The biggest point being that you should take your child to the dentist immediately to avoid further complications which can be both emotionally and financially draining.

The other item I want to discuss is something called “Hank’s Solution” or “Hank’s Balanced Salt Solution.” This is a special liquid formulated by a scientist that is extremely compatible with living tissues and can help to stabilize an avulsed tooth until it can be placed back in the mouth. This solution is better than milk or any others that I am aware of and can help to increase the likelihood that the tooth will be successfully re-implanted. The only catch is that you have to have it before the injury happens! A great addition to your home first-aid assortment is the “save-a-tooth” kit. It Uses the specially formulated pH balanced solution, as well as a unique removable basket and net container that protects tooth root cells crucial to the success of the re-implantation process.

If I had a quarter for each time I was asked this question, I would be retired on a beach, relaxing with an umbrella drink in my hand! This question, as well as the one after it, has many different answers, depending on who you talk to. The reason being is this: Removal of wisdom teeth is predominantly a practice philosophy rather than an exact science. What I mean is, there is much leeway, discussion and debate among all types of dentists as to what is the best treatment of wisdom teeth is. So, what I will give you is my personal philosophy, but the decision is ultimately yours!

Wisdom teeth are the last teeth to erupt and are the teeth furthest toward the back of the mouth. They are also referred to as “third molars,” and will frequently never appear in mouth. This can be due to lack of space in the mouth or simply because many people are born without them. Often times, there is no room for the wisdom teeth to erupt, leaving them trapped in the jaw or only partially erupted. So let’s discuss a few of the problems which arise from extracting them vs. leaving them and you will quickly see why there is so much debate.

If the wisdom teeth do have space to come in completely, then a few scenarios can occur. If your child is able to reach all the way back there and keep them immaculate, then typically there are not any problems with keeping them. However, it has been my experience that few adults are able to keep them clean enough to avoid cavities or gum disease around the teeth. It is extremely rare that I actually get to witness the miracle of cavity-free wisdom teeth. Generally, it takes awhile to get a cavity back there (it usually shows up in your mid-twenties to mid-thirties.)

Once a cavity is present, the tooth either needs to be filled or extracted. Attempts to fill wisdom teeth are mediocre at best, unless you have the ability to open very wide. Because the teeth are so close the jaw-joint, it is very difficult for the dentist to see if all the decay has been removed, or keep the tooth dry enough to retain the filling.

In most cases, the filling eventually fails and the tooth has to be extracted anyway. The same holds true for gum disease. Because they are hard to clean, they very often are afflicted with moderate to severe gum disease. If left, the gum disease can cause bone loss around the tooth, bad breath and possibly increase the risk for spreading the disease to the rest of the mouth.

As adults, we heal much slower, experience more pain and have the added trouble of having to take time off of work. I personally tend to be more pro-active with recommending extraction of wisdom teeth, especially those that will likely fully erupt into the mouth. This is because I know the child will be thankful I did once they are an adult!

The other advantage is, that when you remove the wisdom teeth before they are completely developed, they are actually much easier to remove. This results in less pain after surgery, faster healing time and less of a risk of complications from the procedure. So, the possibility of reducing these risks by extracting them as an adolescent is very appealing to me as a mom and a dentist!

Well, let’s suppose that the wisdom tooth is not in at all, partially in (but stuck that way), or has no space whatsoever to come in. An x-ray (a panorex or panoramic film) will have to be evaluated by the dentist or oral surgeon before a decision can be made. Most times the teeth can still be removed with relative ease and without complication. However, there are situations which may predispose your child to temporary or permanent complications.

Close proximity of the lower wisdom teeth to the main nerve supplying all the teeth can be a concern. Injury to this or any other nerves in the areas can cause partial or complete, permanent or temporary numbness to the lip, chin, teeth, gums, tongue or skin in the area. In addition, the top teeth may be so high up in the jaw that risk of damage to the sinuses and other structures can occur. Your oral surgeon will be aware of these complications and any others as they apply to your child.

So, if the wisdom teeth seem risky to extract and the likelihood of the teeth ever erupting is low, then I typically recommend leaving them. The benefits of extraction must be carefully measured against the risks involved and be sure to discuss them in detail with your surgeon.

I also want to bring up the importance of the oral surgeon here. As we discussed earlier, specialists exist in dentistry because they are necessary! While there are general dentists who can take out wisdom teeth with great proficiency, I still strongly encourage having an oral surgeon perform the procedure.

An oral surgeon does this procedure every day, many times a day and they are simply better, faster at it and are more familiar with the complications which can occur from their removal. They are also more familiar with the internal jaw anatomy which is rarely seen by a general dentist. This is not to say that a general dentist is not capable, as there are plenty out there that would do just as good as any oral surgeon. However, my experience has been that this is the exception and not the rule.

The answer is absolutely! In fact, many sugar-free gums today contain an amazing substance called Xylitol. Xylitol has been shown in studies to actually help decrease tooth decay and acts as a mild antibacterial agent. Some of the brands which contain xylitol are, Orbitz, Koolerz and Trident’s sugar free gum. There are more brands now on the market, so just read the package to see if it is in the gum. Generally, the closer the desired ingredient is to the beginning of the list on the package (in this case xylitol), the more it contains.

In addition, chewing gum stimulates saliva flow which helps to fight further against cavities. Saliva contains many natural anti-cavity substances in it and is just one more hopeful way to protect teeth. So let them chew like crazy!

There are various aids to help fend off cavities caused by dry mouth, including anti-cavity rinses, prescription toothpastes and more (discussed in the general questions section). There are also several over-the-counter items that can be used to help stimulate saliva flow and moisten a dry mouth, such as Biotene brand products (sold in pharmacy area of most grocery stores). Chewing sugar-free gum is also a great way to increase saliva flow and helps with the effects of dry mouth syndrome.

If your child suffers from a dry mouth, have them drink water throughout the day. Do not allow them to sip on soda, diet soda or fruit juice, or you will likely see cavities very quickly. A dry mouth alone can increase the rate of getting cavities significantly, as saliva contains many anti-cavity substances. So, once you add sugars to the mix, it is a recipe for disaster!

The only other significant effect that steroid inhalers can have on the mouth is increasing the risk of getting oral yeast infections. You may have also heard it called “thrush” or “candidiasis.” “Thrush” is a condition caused by the overgrowth of a normal bodily fungus called, “Candida Albicans.” This fungus is normally present, but occasionally (especially while taking antibiotics or steroid-containing medicines) can grow in more abundance than usual. Thrush is very frequently seen in babies during the bottle or nursing stage, but less often with inhaler use It can range in severity but looks like “curdled milk” in the mouth that won’t wipe off. If it caused by an inhaler, it is usually seen on the roof of the mouth and throat.

It doesn’t usually hurt anything but can cause irritation or burning to the oral cavity and look unsightly. However, you don’t want to leave it untreated, as it is possible for the fungus to infect the blood or other areas of the body. This is rare but should be mentioned, as to avoid a potentially life threatening situation.

Both children and adults can get candidiasis, but adults typically get it in others areas of the body and is experienced much more by women. The best way to avoid both “thrush” and dry mouth from inhaler use is to rinse the mouth out with water out after each use. This is true for both children and adults who use steroid inhalers. There are medications to treat oral yeast overgrowth and they are usually very simple and work very well. Again, if you see any white areas in your child’s mouth anywhere, always consult your dentist or pediatrician, as it could be caused by other more serious things.

The good news is that it could also be nothing. There are other causes of tooth pain which may be transient. If your dentist can find no apparent source for the pain, then they will likely search for other possible sources for it. Some of these may include simple things, such as night-time grinding (to be discussed later), food impacting in the gum, and irritation from flossing (this is not typical, since kids in the range usually refuse to floss)!

There are other reasons for tooth pain that can be a sign of something more serious. This is unusual, however, the possibility should not be overlooked. Your dentist should be aware of these and will likely evaluate for them if the problem continues with no apparent cause for the pain.

Another form of sedation which many parents opt for is “laughing gas”. The medical term for “laughing gas” is nitrous oxide sedation. It is a combination of nitrous oxide and oxygen gases, administered to adults and children through a little mask which fits on the nose. The patient breathes in through the nose and the gas flows through the body allowing a general sensation of overall relaxation. The gas does not put you to “sleep” in the medical definition sense (either general or twilight anesthesia/sleep), but rather can truly allow you or your child to fall asleep during a procedure.

During other sedation procedures, the definition of “sleep” has to do with a temporary nervous system alteration (almost like being paralyzed) and the patient may stop breathing part or all of the time. During non-breathing periods, the patient’s breathing is provided by artificial means and controlled precisely throughout the “sleeping” period of the procedure.

With laughing gas, breathing is never stopped (at least not on purpose) and any “sleep” obtained is by the same means in which we do at night. Most times with laughing gas, the patient stays awake, but is so relaxed, they don’t care what is going on. They can usually carry on a conversation in some form and are very aware of what is going on. However, if their bodies are the type to be sleepy from laughing gas, they may not converse or be very aware at all.

Once the procedure is over, the dentist should allow the patient to breathe pure oxygen for five minutes to flush the remaining laughing gas out of the body. One of the best advantages of laughing gas is that once the gas is removed, the patient is usually fully returned to their normal mental and physical state with no side effects. The patient usually remembers everything about the entire experience unless they fell asleep.

Every person reacts differently to the gas. Some people laugh or become “silly”, but most people just feel relaxed or feel as if they have had a few glasses of wine. The gas only works if the patient breathes it in and the patient can more or less control their level of sedation by how they breathe. The gas dosage is also controlled by the dentist, but both the patient and doctor will both have some control in obtaining the desired effect. Unfortunately, there are some people, children included, that are not affected by the gas at all. This doesn’t occur often but can be frustrating for both the patient and the dentist.

In general, laughing gas is very safe when given appropriately. There are very few medical conditions that make the gas impossible for use. These are rare and your dentist should consult your child’s physician if there is any question. Laughing gas can pose some dangers, just as with any medication given. One of those dangers is overdose on the gas. The maximum percentage of laughing gas that can be given before “overdose” can occur is at ratios greater than seventy percent nitrous oxide.

Almost all nitrous oxide units today are now made so that it is impossible to give more than 70% nitrous oxide. They contain a special internal regulator that will not allow it to give gas at levels higher than 70 percent. Older offices may still have some of the dated laughing gas equipment that allows you to go beyond the seventy percent dosage. If you or your child are seeing a dentist in which the office appears “out of date” with respect to technology or the appearance, be sure to ask if their laughing gas unit has the protective device on it.

Laughing gas is a great first option to consider for your child should they need any form of sedation. If your child is a “screamer” or very apprehensive, you may find that they will refuse to even put the mask over their nose. Exceptionally fearful children may have the same problem, but you can always attempt it and move forward with another type of sedation if unsuccessful. Remember, the goal here it to give children a positive dental experience so they don’t acquire dental phobias as adults. So it will often require a team effort and a lot of patience!

Sometimes, despite what the dentist does to calm a child during a procedure, the tactics and strategies are unsuccessful. Additionally, sometimes a child needs so much dental work at such a tender age, that it just isn’t appropriate to have them completely coherent throughout the procedure. For these reasons, sedation may then become a good option.

There are many types of sedation, ranging all the way from laughing gas to putting the child completely asleep. Each type of sedation comes with different risks and you should inform yourself well and choose sedation once you feel comfortable and knowledgeable. Also, not all dentists perform sedation. Most general dentists (as discussed at the beginning of the book) do not perform the type of sedation where the child is put into either a “twilight sleep” or “complete sleep”. This requires a special certificate of training and special monitoring equipment in order to perform. It is possible, however, for a general dentist to perform partial-sleep “twilight” sedation with the proper training. The reason many generalists choose not to do this, is because of the outrageous expense of the monitoring equipment and the high cost of liability insurance to do so.

A pediatric dentist is already trained and certified and the special equipment is part of their everyday cache of inventory. The pediatric dentist may also decide to perform the treatment in an operating room under the supervision of an anesthesiologist. This typically happens when the dental treatment is more extensive and the dentist feels it is in the child’s best interest to be put under general anesthesia or completely “asleep.” In this case, an anesthesiologist is necessary, as he provides the complete care of sedation of the child during the entire length of the procedure. This allows the dentist to focus only on the dental treatment, and helps prevent any potential complications of inadequate monitoring of sedation.

Sedation can be achieved in several ways. Three sedation techniques include oral sedation (child takes an oral sedative prior to dental work), I.V. sedation (child receives sedation medication through an I.V., usually in the arm) and inhalation anesthesia (child breathes anesthetic). A combination of any of the three can also be used. All methods require special training and equipment for monitoring and reversing sedation as needed. Each have their own risks and benefits and should be discussed thoroughly with your dentist before undergoing treatment

Laws for sedation can vary by state and the dentist performing the sedation should be familiar with the requirements needed to achieve a safe and legal sedation experience. Be sure to discuss the risks and advantages with your dentist and anesthesiologist completely prior to committing to any sedation experience.

This is a sticky situation to be in. I will be very honest with you, as a mother I want to be privy to everything that goes on with my children. I understand the natural parental instinct that makes you want to protect your children at all costs. We want to shadow doctors and dentists to be sure that they are taking care of our kids the way that they would their own. However, the dentist side of me will tell you that most of the time children do MUCH better when parents are not in the room during treatment. Many of our mini-sized manipulators (including my own) play the “Dr. Jekyll and Mr. Hyde” game while at the dentist.

It is pretty amazing to see how a child is polite and well behaved in my dental chair until the moment a parent walks in the room. Once the parent enters, there is usually a plethora of temper tantrums and a refusal to open their mouths. When mom and dad leave the room, it is back to cooperation with a smile. However, some children actually will do better with a parent in the room, or even while sitting on the parent’s lap during treatment. I would suggest trying it without the parent first unless you know that your child will in no way go for it. We want them to have a good experience, so whatever it takes is what needs to be done.

If a dentist is good with kids and speaks their “language,” often they will let you do most dental work without much hesitation. Of course, that doesn’t apply to all kids, which is why man invented sedation. I very strongly discourage parents from coming back in the treatment room. I never refuse to allow them back and I personally don’t feel that it is appropriate to do so. If a child does well with a parent in the room, then there really isn’t any reason to have them leave. However, leaving the room can often give mom or dad a little “quiet time” and break from the daily grind. I’ll be the first to admit that those little breaks are some of the best opportunities for me to recharge before tackling the remainder of the day!

The dentist side of me also feels very strongly that a parent should not be allowed to compromise a child’s dental experience or dental treatment. So, if a child is unmanageable while a parent is in the room and the parent refuses to attempt treatment with them out of the room, then I simply decide that this is not a patient relationship that I feel comfortable continuing. As dentists, we are providing medical care to your child and so, it is very important that we have a very open line of communication and trust with you. If that relationship does not exist, then perhaps a relationship with another dentist would better suit the needs of both parties. Another thing that can be difficult about having a parent in the room is that is can be very distracting to the dentist, dental assistant and even the child.

As parents, we have a natural curiosity for the process of things and also to help soothe our children. With such a short attention span from children, it makes it very difficult to work quickly and accurately while a parent is asking questions or talking to the child (obviously if the child is asking you a question, that is does not apply). If you decide to stay in the room during treatment, I would recommend trying to be very quiet and keep questions and conversation to a minimum. Try to save questions either before treatment or after and let the staff attempt to soothe the child first. Too many people talking to the child distracts and upsets them. And please, whatever you do, avoid the trigger words that panic children, like “needle,” “shot,” “drill, “hurt,” “pain,” and the list goes on. It truly is in the best interest for your child’s care and their overall experience. Treating children is very much like playing a game of chess in the middle of a preschool classroom. It already takes a lot of concentration to get the moves right in a quiet setting, much less in the midst of noise and physical chaos! Remember, they are a moving target for us, all while we attempt to do procedures at an almost microscopic level, with materials which have to stay completely dry, with instruments that can cause tissue damage. And, all of this is done in a dark, wet place, about the size of pool ball, with a “trap door” that opens and closes without warning. Wow, I am exhausted just thinking about it!

I am sure that different states have different laws pertaining to the refusal of allowing a parent in the room, so check with your state accordingly. However, if you feel you need to check on the law, then it might be prudent to examine the relationship you have with your current dentist, as I am guessing it is not one built on trust or communication. Of course, there are special situations when refusal to allow parents back in the room is acceptable, such as legal guardianship issues and court orders (for example, restraining orders). If you have any questions regarding these specifically, always seek the advice of your attorney. Remember, try to make the experience a good one for your child. One hundred percent of my adult patients who are terrified or fearful of the dentist tell me they are so because they had a bad childhood experience. It just shouldn’t be that way! If all of your efforts still prove fruitless, then sedation may be the best option for your child.