My decision to create this site was made because of the many questions I get as a dentist from parents regarding their children’s oral health. It seems that many of the “What to Expect ” books and childcare guides omit something very critical in raising and caring for children. A subject that is so simple but so easily dismissed as common knowledge or topics that your pediatrician will discuss with you. Unfortunately, most pediatricians know VERY LITTLE about the dental health of your child. So, this leaves many parents wondering if they are providing adequate dental care for their children. Too often this lack of knowledge causes irreversible damage to their kid’s teeth and a serious dent in their wallets.

I hope you find the information on this site to be a  mildly humorous, very informative, myth-busting, easy to understand guide that should help you feel confident that you are on the right track with your child’s oral health. My other hope is that this knowledge will allow you to save money when it can be saved, and to spend it when it really needs to be spent.

These questions were chosen because they are by far the most common I receive at the dental office or more often, when I am at social functions for my own kids! The answers are then provided in a way which I think just about everyone can understand. I hope after reading some of these posts, you find yourself empowered and fully informed.
I hear all of these questions far too often, which leads me to believe that there is a serious lack of knowledge on the subject. Since dental decay in children is the #1 childhood disease, it is very important that parents are well educated on the subject. I feel strongly that we can better help the future of our children if we can share the knowledge to prevent these dental problems. These problems are far too often physically, mentally and financially challenging for parents and children, both short and long term. So, my hope is that after you find something useful or helpful, you feel confident in sharing the vital information with others so that they too can avoid some of the costly or worrisome situations.
You may also have friends in your social circle with younger children who may have questions that you will now feel confident answering for them. Even though you may only have a teenager now, life can be full of many unplanned miracles-so it is always better to be prepared now! Whatever the reason, share the knowledge with your friends and family.

In the last decade, cosmetic dental services, including tooth whitening, has grown to a multi-billion dollar industry. More, now than ever, even in a down economy, people are still paying top dollar to improve their smiles. Some may argue that even more money is being spent on cosmetic teeth whitening than before, as an aid to increase competition in this already difficult job market.

There are many ways to whiten teeth and much of choosing depends on the person’s goals and personal preferences. Home whitening kits, both professional and over-the-counter can be successful, depending on the magnitude of white teeth a patient desires, as well as the initial color and yellowness of the teeth to be whitened. If teeth are extremely dark, then whitening of the teeth by the dentist may be necessary in order to achieve a patient’s cosmetic desires.

A visit to the dentist prior to starting any teeth whitening treatments is recommended, as there are situations that teeth whitening may be harmful to the teeth. In addition, you may actually save money by whitening in a way specific to your teeth rather than blindly spending money on things that may not work on you.

There are many over-the-counter tooth whitening kits available with many different types and concentration of bleach. Be sure to educate yourself on what you are buying in order to increase your chances of the whitest, brightest smile for the money!

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.

My biggest piece of advice is this: Do not allow or at least minimize the amount of soda, diet soda, sports-energy drinks and fruit juices you allow your children to have. This is particularly so with teenagers. With all of soda “hype” and advertising geared toward kids these days, there’s been a significant increase in the number and frequency of cavities in kids of all ages. Advertisers have been successful in their marketing and the results have been devastating. Kids are getting so many more cavities, and much, much earlier. This has had a huge ripple-effect in many areas of health, not just teeth, including obesity, diabetes, high blood pressure and more.

Dental work is not an exact science, Things wear out, break down, stop working and need to be replaced eventually. At some point, teeth can no longer be filled and fixed. After multiple fillings or other procedures, there sometimes just isn’t enough tooth left to work with. With so much soda exposure (diet and regular), teeth are being filled much earlier in our children.

This increases the rate at which this “dental fatigue” occurs, leading to earlier and more abundant tooth loss. Because of the way in which sodas and all of these new sugary drinks work, they almost always cause cavities in multiples. Rather than a single cavity in few years, kids now come in with 10 or more at one time before they are even 18 years old. This can be very traumatic to the child, very expensive for the parents and result in continual dental problems throughout the child’s life.

So I hope that my message was loud and clear and that you will take it very seriously. Even if your child is not a soda-drinker or a sweets-lover, they may still be prone to getting cavities for other reasons such as poor hygiene or even a family history. There are other things you can do to help prevent tooth decay which are discussed in the “General Information” category.

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.

As mentioned in a previous post, this too is a highly controversial question. The general consensus by orthodontists today is that the presence or removal of wisdom teeth have no effect on the crowding of permanent teeth. This is what is taught in dental schools currently. So, of course I will tell you that I agree with this. However, I will add in a bit of the general public’s view on the matter as I have seen it in my practice.

I cannot tell you how many patients I have encountered who swear to me that their teeth have shifted since their wisdom teeth came in or were removed. Since I cannot remember everyone’s teeth exactly and don’t have before and after photos, I have no way to verify this. I am not in the practice of taking random dental photos for no apparent reason and so I have none to reference. I do believe, however, that most people are greatly in touch with their bodily happenings and as such wouldn’t make the statement up for no good reason. So, this will remain a question that I cannot answer with absolute certainty. One thing I have learned is, that science can change and so I can’t always be sure of what is absolute and what is not. So, maybe in the future, new studies will reveal that the presence of wisdom teeth do have an impact on crowding and straightening!

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.