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.

There have been many scientific developments in the field of oral health in the last decade. One of the most important studies has to do with the link between gum disease and several other health conditions. I won’t go into depth here about the other health conditions, as they don’t relate pregnancy but I will briefly mention them due to their extreme importance. There has been a proven relationship of gum disease to diabetic complications, stroke and heart disease. The oral bacteria which causes gum disease (which is different from those causing cavities) has been found in the heart and brain tissue of those who have had a fatal encounter with a stroke or heart attack. Diabetics with gum disease also experience more uncontrolled blood sugars. I would suggest a Google search the internet if you are interested in finding out more on the details of this relationship.

So, what does this have to do with pregnancy? Well, let me first give you a quick lesson on gum disease, since most of the population really doesn’t understand what it is. What it typically means to most people is the dreaded “you have to floss more” lecture from your dental hygienist. Basically, flossing your gums (notice I did not say teeth here) allows you to clean out the debris below the surface of your gums-in the area where popcorn kernels get caught. If that debris is not removed, it can turn into a concrete-like, bodily substance called “tartar” or “calculus” from the minerals in your saliva. This tartar can then become strongly adhered to the tooth root beneath the gums, causing inflammation which may be called gingivitis or gum disease.

Once tartar is present, it is not possible to be removed by flossing any longer. It will only come off with those dreaded scrapers we all hate at your dental cleaning appointment. Everyone gets tartar, but some people get it more abundantly than others either due to genetics, nutritional habits and/or mineral composition of saliva. This is why a dental cleaning or “prophylaxis” is needed every six months. It takes about six months for the body to develop enough tartar to elicit the start of the gum disease process.

If you don’t have your teeth cleaned, the tartar stays on the tooth root and allows more tartar to continue building on top of the existing tartar layer. This causes an even more inflammation of the gums. Eventually, the body “sees” this tartar layer as a “foreign object” and tries to get rid of through chemical and biologic means. So, this is good, right? Well, I have only told you part of the story. While the body is trying to help, it also releases special mediators that unfortunately destroy the bone around the teeth in an effort to get rid of the tartar.

If left untreated, the cycle of tartar deposited and more bone destroyed continues, causing the teeth to become loose. I always use the analogy of a “For Sale” sign in the yard-if you keep taking away the dirt around the big wooden post, eventually it becomes loose and falls out. Teeth are really as simple as that analogy. Eventually the teeth either fall out on their own, or have to be pulled because they cause a choking hazard.

In addition to this, pregnancy causes a huge hormonal shift which causes a lot more than tears, weight gain and cravings. An increase in the hormone progesterone during this time causes the gums to become more sensitive and prone to gum disease if plaque and tartar are not controlled. Signs of gum disease may be as follows: Sore, sensitive, swollen, red gums which may bleed spontaneously or especially while brushing or flossing. You may notice a black, yellow or brown, rough-appearing, grainy-looking substance along the gum-line of your teeth. You may also notice an increase in bad breath or a bad taste in your mouth.

You may hear your dentist call this process “gum disease” or “periodontal disease” (they mean the same thing) and they may tell you that you have “pockets” around your gums. These “pockets” are the popcorn-kernel-catching areas I was referring to earlier and get deeper with the deposition of more tartar over time. Certain ethnicities, such as African Americans and Hispanics are more genetically prone to getting gum disease. If you are of either of these descents, I strongly encourage you to see a dentist regularly and be sure that they are actually checking your gums every 6 months. Especially if your gums bleed when you floss or are highly sensitive.

So, of course we can see that one implication of gum disease as it relates to pregnancy would be the loss of teeth and therefore inadequate nutrition due to the inability to chew. While this is a huge concern, the primary concern is actually systemic in nature. Scientists have linked the presence of gum disease to increased incidence of pre-term delivery and low birth weight.

As mentioned earlier, the body’s attempts to resolve gum disease result in the release of bodily chemicals. These chemicals can cause the early onset of contractions, leading to pre-mature birth. Premature birth can cause a myriad of problems for the baby including, breathing difficulties (due to immature lung development), seizures and bleeding in the brain, difficulties in feeding and thus slow weight gain and poor nutrition. There are many other problems which can arise from pre-term labor and if you have concerns regarding this link with gum disease, talk to your physician and dentist. The best protection against this is to brush and floss regularly and to see your dentist regularly for a check-up and cleaning before, during and after pregnancy.

I know most people hate flossing (myself included) and despise going to the dentist. I know too that food is one of life’s greatest pleasures, especially during pregnancy. However, as parents, something in us changes and causes us to care for our children (event the unborn ones) and allows us to do the best for our children. Modification of routines and following a few simple guidelines will only eliminate one more thing to have to worry about during pregnancy. They are factors which we can control when so many other things during this amazing time are out of our control.

First, dentists are definitely not all the same.  True, most of us start off with the same initial dental degree (Doctor of Dental Surgery) however, what happens after this may or may not make a huge difference.  Like medicine, dentistry has a multitude of specialties. I know, you may be thinking, “How could there possibly be that much to know about teeth?”  The truth is, that there really is that much to know about teeth. Not to mention the teeth are connected to the mouth, which are connected to the head, which is connected to the body, etc., etc.

The problem with teeth is just that. They are connected to everything else in one way or another.  The amazing thing is that so many disorders actually show up in the mouth before they appear anywhere else in the body.  So, the mouth can be a fantastic place for a first diagnosis that physicians often miss.  In addition, we prescribe and use many of the same medications and anesthetics that physicians do.  It really isn’t as simple as “drill and fill.”

Though we all start out with the same initial dental degree, some doctors choose to specialize in a particular area of dentistry.  There are a few reasons for dental specialties. First, there are many different dental needs and levels of complexity.  One type of dentist cannot adequately fulfill all the treatment needs of all individuals.  In addition to this, the type of patient (i.e. adult, child, elderly) and the medical needs of the patient all impact treatment and thus the type of individual care needed.

Dental treatment can range from very simple to highly complex, involving multiple specialties in order accomplish a final outcome.  It really isn’t possible to know everything about everything (But don’t tell my husband I said that)!  Just as I wouldn’t want my family practice doctor to perform brain surgery on me, I would not want a general practice dentist to perform my jaw surgery.

There are currently nine dental specialties recognized by the American dental association. These specialties are Oral Pathology, Oral Radiology, Endodontics, Periodontics, Pedodontics, Prosthodontics, Oral Surgery, Orthodontics and Public health.   Each of these specialists will have the same initial degree as your general/family dentist (Doctor of Dental Surgery) but have continued their education for an additional 2-6 years in specialty training for a specific type of dental treatment.  They are the highest trained in their area of expertise and are limited to performing only those procedures for that specialty.  For example, a pediatric dentist does sees only children and will not provide care for those over 18 years of age.  An Endodontist does only root canals and root canal surgeries, never fillings, crowns, etc.

The chart below lists the above named specialist and the type of treatment they provide.

Oral Pathologist:  Evaluation, diagnosis and treatment of oral or head and neck diseases out of the comfort or expertise level of any other type of dentist.

Oral Radiologist: Evaluation and diagnosis of x-ray findings of the head, neck and jaw out of the comfort or expertise level of any other type of dentist.

Endodontist:  Evaluation, diagnosis and treatment of root canal related problems or procedures out of the comfort or expertise level of any other type of dentist.

Periodontist:  Evaluation, diagnosis and treatment of gum disease or gum procedures out of the comfort or expertise level of any other type of dentist.  Periodontists also place dental implants and perform regular cleanings to patients with a history of gum disease.

Pedodontist:  Evaluation, diagnosis and dental treatment of children 18 years or younger.  They are typically certified to perform most sedations types and have privileges to practice in a hospital setting if needed to complete child’s care.

Prosthodontist:  Evaluation, diagnosis and treatment of any patient that requires more complex dental care beyond the comfort or expertise level of any other type of dentist.  These dentists will be more experienced with treating patients requiring very complex crown/bridge work, dentures or implants.  There is also a subspecialty of prosthodontists trained in facial reconstruction with prosthetic noses, eyes, oral structures, etc.

Oral Surgeon:  Evaluation, diagnosis and treatment requiring surgical methods or advanced laser procedures.  Some of these surgical procedures include wisdom teeth or other complicated extractions, placement of dental implants, oral/facial biopsy service, facial cosmetic surgery, jaw reconstruction and much more.  They are certified to use the wide range of sedation and anesthesia techniques and also have privileges for hospital-requiring treatment.  Many oral surgeons are also physicians.  This will depend on the oral surgery training program they decide to go through.

Orthodontist:  Evaluation, diagnosis and treatment of dental and skeletal problems requiring orthodontic care (braces and orthodontic appliances) out of the comfort level or expertise of any other type of dentist.

Public Health Dentist:  Evaluation, diagnosis and dental treatment in dental under served areas.  Research and statistic oriented and spends a significant amount of time studying, education and publishing information related to dental health of the public, especially in dental under served areas.

In many cases your family dentist can treat a multitude of dental problems which could also be treated by specialists.  However, specialist treat dental issues in their area of expertise which are much more complex and difficult that a general dentist would.   So, you family/general dentist may choose to refer a patient to a specialist on occasion.  This usually occurs when the level of training or experience your family dentist has is out of their scope of care, or they are not comfortable performing the needed treatment.

So the fact that your family dentist recognizes that they cannot be a master of all things is actually a very good thing, albeit an inconvenience for you.  This suggests that your dentist understands their limitations and wants what is best for the patient rather than what they can gain financially.

What you will find if you see enough general/family dentists is this: There is a significantly wide range of comfort and skill levels between general/family dentists.  While some dentists are perfectly happy and skilled at treating children, another dentist may prefer not to treat children because they are not comfortable or patient enough to work on children.  The same principle applies to many other areas of dentistry.

At the other end of the spectrum, there are dentists who elect not to refer out certain procedures to a specialist that they really should. There are plenty of procedures that practitioners are legally allowed to do but really should.  This could be from their lack of experience with the procedure or because they really just don’t have the skill or ability to do it.

One thing you must understand is that we, as practitioners cannot be perfect at everything.  We, of course want to be great at it all, but it is my strong feeling that we must recognize when a procedure done by a specialist rather than ourselves is in the best interest of the patient.  Sure, we could probably do it, but if we don’t do it really well, then I believe we are doing a disservice.

So, my general rule of thumb is that if you feel in the pit of your gut that something just isn’t right with the dentist you are seeing, then pay a little extra to have a second and possibly third opinion.  In our world today, we like to believe that everyone has great morals and ethics and everyone who graduates with a professional degree “knows their stuff”.  This just isn’t always true.  Always go with your gut instinct whether the dental visit is for yourself or for your child.  Remember the old joke, “What do they call the guy who graduates last in medical school?”  That’s right, they call him “Doctor.”  The same joke applies to dentists!

The other item on the agenda to discuss is, when choosing a dentist, you should always take into consideration the facility itself. Again, this is a go-with-your-gut kind of thing.  Does the facility appear clean and tidy?  When you are in the treatment rooms does it appear that the sinks and counter tops where dental tools are placed are wiped down? Understand though, that we use a lot of products which stain counter tops and chairs, regardless of how much you attempt to scrub it off.  It’s a lot like the impossible grass stains on the baseball uniform.  But an overall clean and organized facility can be an important reflection on the quality of care you or your child may receive.

Does the technology appear to be current or does it feel like you are in an antique store rather than at the dentist?  Technology has evolved considerably in the last ten years and you should start to see that same evolution in one form or another in the office.  Some of these changes may include patient education literature, computers in the office, possibly digital x-rays and just an overall appearance if being current with the times.

Are the staff, including the dentist wearing gloves and a mask while they work on you/your child?  Are they taking check-up x-rays every 12 to 18 months?  Do they ask about your child’s health history at every check up to see if it has changed?  Do you feel that the staff and dentist speak with confidence and sound generally knowledgeable? Also, don’t confuse arrogance with knowledge, which can sometimes cause things to be missed during a dental exam! Does your child’s dentist and staff try to educate you on dental procedures needed and ways to prevent future problems?  Does your dentist actually listen to you when you talk?

For adults, does the dentist actually take more than a minute to look around your mouth at everything?  Or do they just look quickly with a mirror and say that “everything looks good?”  Do they actually look at your x-rays?  Does the dentist or hygienist check your gums with a special instrument to check for gum disease (this likely won’t be done on your child unless the doctor suspects it, as gum disease is uncommon in children). Does the dentist or hygienist check deliberately for “lumps and bumps” inside and outside of you or your child’s mouth?  This is called a head and neck exam and should be done every six months to be sure that there is no evidence of cancers, tumors or other pathology.  Do you never have anything wrong at every check-up for years?  It is common to have small cavities or cracks come up throughout the years.  It is actually more abnormal to have patient that NEVER has anything wrong, even if it is minor.

It does happen, but if you see or feel changes in/on your teeth and your dentist always says “it’s fine,” and/or never takes an x-ray of the area, you may want to get a second opinion.  Many times dentists choose to “watch” things rather than fill them in an effort to be conservative.  Sometimes these things we “watch” are truly just stains but sometimes they are not and cavities can grow quite large without getting a “stick,” as your dentist might say.  That “stick” is a sticky sensation when we touch a special dental instrument to a suspicious tooth.  If the instrument “sticks” or “pulls back” when we push on it, generally that means there is a cavity.  However, cavities can grow beneath the surface of the tooth and the tip of that special instrument may be too large to fit into the hole. Therefore, there may not be a “stick” even though a cavity is present.

These are all questions that you should think about at your visits.  If these things are not being done, then I strongly suggest that you get a second opinion to be sure that things are not being missed.  Always go with your instinct.  If your “gut” tells you that something is not right, don’t second guess yourself.  It is always better to be on the safe side.  It can’t hurt to have a second opinion and you may feel comforted after doing so.