Knowing what to do—and what not to do—when your child is sick can greatly affect their health and well-being. That's especially true with dental problems.
Here then are some Dos and Don'ts for 3 common problems children experience with their teeth and gums.
Teething. An infant's first teeth breaking through the gums is a normal but often unpleasant experience. Fortunately, teething episodes only last a few days. And, there's usually no need to see the dentist unless they have a fever or diarrhea while teething. In the meantime:
- Do: provide them chilled (not frozen) cloth or plastic items to bite and gnaw, and massage their gums to relieve painful pressure. You can also give them an age-appropriate dose of a mild pain reliever.
- Don't: rub any medication on their gums, which can irritate them and other soft tissues. Never use alcohol or aspirin to alleviate teething discomfort. And avoid using anything with benzocaine, a numbing agent which can be hazardous to young children.
Toothache. Whether a momentary sensitivity to hot or cold or a sharp, throbbing pain, a child's toothache often signals tooth decay, a bacterial disease which could eventually lead to tooth loss.
- Do: make a dental appointment at your child's first complaint of a toothache. Ease the pain with a warm-water rinse, a cold compress to the outside of the jaw, or a mild pain reliever.
- Don't: rub medication on the teeth or gums (for similar reasons as with teething). Don't apply ice or heat directly to the affected tooth or gums, which can burn them.
Bleeding gums. Gum bleeding from normal brushing or flossing, along with red or swollen gums, may indicate periodontal (gum) disease. Although rare in children, it can still happen—and it can put an affected tooth in danger.
- Do: see your dentist if bleeding continues for a few days. Continue to brush gently with a soft-bristled toothbrush around the gums to remove plaque, a thin-biofilm most responsible for gum infection.
- Don't: brush aggressively or more than twice a day, which could unnecessarily irritate and damage the gums. And don't stop brushing—it's important to remove plaque buildup daily to lessen the gum infection.
The mouth is a crowded place with nerves, blood vessels and sinus cavities sharing common space with the teeth and gums. Although important in their own right, these structures can also hinder treatment for complex dental situations like dental implant surgery or impacted teeth.
Treating these and similar situations depends on getting an accurate depiction of “what lies beneath.” Conventional x-rays help, but their two-dimensional images don't always give the full picture. There's another way—cone beam computed tomography (CBCT).
Similar to CT scanning, CBCT uses x-ray energy to take hundreds of “sliced” images that are then re-assembled with special software to create a three-dimensional model viewable on a computer screen. CBCT is different, though, in that it employs a scanning device that revolves around a patient's head, which emits a cone-shaped beam of x-rays to capture the images.
A dentist can manipulate the resulting 3-D model on screen to study revealed oral structures from various angles to pinpoint potential obstacles like nerves or blood vessels. The detailed model may also aid in uncovering the underlying causes of a jaw joint disorder or sleep apnea.
CT technology isn't the only advanced imaging system used in healthcare. Another is magnetic resonance imaging (MRI), which excites hydrogen atoms in water molecules. This produces different vibration rates in individual tissue structures, which are then translated into detailed images of these structures. Unlike CT or CBCT, MRI doesn't use x-ray energy, but rather a magnetic field and radio waves to produce the atomic vibrations.
But while providing good detail of soft tissues, MRI imaging doesn't perform as well as CBCT with harder tissues like bone or teeth. As to the potential risks of CBCT involving x-ray radiation exposure, dentists follow much the same safety protocols as they do with conventional x-rays. As such, they utilize CBCT only when the benefits far outweigh the potential x-ray exposure risks.
And, CBCT won't be replacing conventional x-rays any time soon—the older technology is often the more practical diagnostic tool for less invasive dental situations. But when a situation requires the most detailed and comprehensive image possible, CBCT can make a big difference.
If you would like more information on advanced dental diagnostics, 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 “Getting the Full Picture With Cone Beam Dental Scans.”
Narcotics have long played an important role in easing severe pain caused by disease, trauma or treatment. Healthcare professionals, including dentists, continue to prescribe them as a matter of course.
But narcotics are also addictive and can be dangerous if abused. Although addictions often arise from using illegal drugs like heroin, they can begin with prescriptive narcotics like morphine or oxycodone that were initially used by patients for legitimate reasons.
As a result, many healthcare providers are looking for alternatives to narcotics and new protocols for pain management. This has led to an emerging approach among dentists to use non-addictive non-steroidal anti-inflammatory drugs (NSAIDs) as their first choice for pain management, reserving narcotics for more acute situations.
Routinely used by the public to reduce mild to moderate pain, NSAIDs like acetaminophen, ibuprofen or aspirin have also been found to be effective for managing pain after many dental procedures or minor surgeries. NSAIDs also have fewer side effects than narcotics, and most can be obtained without a prescription.
Dentists have also found that alternating ibuprofen and acetaminophen can greatly increase the pain relief effect. As such, they can be used for many more after-care situations for which narcotics would have been previously prescribed. Using combined usage, dentists can further limit the use of narcotics to only the most severe pain situations.
Research from the early 2010s backs up this new approach. A study published in the Journal of the American Dental Association (JADA) concluded that patients receiving this combined ibuprofen/acetaminophen usage fared better than those only receiving either one individually. The method could also match the relief power of narcotics in after care for a wide range of procedures.
The NSAID approach is growing in popularity, but it hasn't yet displaced the first-line use of narcotics by dental professionals. The hesitancy to adopt the newer approach is fueled as much by patients, who worry it won't be as adequate as narcotics to manage their pain after dental work, as with dentists.
But as more patients experience effective results after dental work with NSAIDs alone, the new approach should gain even more momentum. And in the end, it promises to be a safer way to manage pain.
If you would like more information on dental pain management, 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 “Are Opioids (Narcotics) the Best Way to Manage Dental Pain?”
Between the final game of the World Series in late October and spring training in February, major league baseball players work on their skills preparing for the new season. Reporters on a Zoom call to the New York Yankees' training camp wanted to know what star outfielder Aaron Judge had been doing along those lines. But when he smiled, their interest turned elsewhere: What had Aaron Judge done to his teeth?
Already with 120 homers after only five seasons, Judge is a top player with the Yankees. His smile, however, has been less than spectacular. Besides a noticeable gap between his top front teeth (which were also more prominent than the rest of his teeth), Judge also had a chipped tooth injury on a batting helmet in 2017 during a home plate celebration for a fellow player's walk-off home run.
But now Judge's teeth look even, with no chip and no gap. So, what did the Yankee slugger have done?
He hasn't quite said, but it looks as though he received a “smile makeover” with porcelain veneers, one of the best ways to turn dental “ugly ducklings” into “beautiful swans.” And what's even better is that veneers aren't limited to superstar athletes or performers—if you have teeth with a few moderate dental flaws, veneers could also change your smile.
As the name implies, veneers are thin shells of porcelain bonded to the front of teeth to mask chips, cracks, discolorations or slight gaps between teeth. They may even help even out disproportionately sized teeth. Veneers are custom-made by dental technicians based on a patient's particular tooth dimensions and color.
Like other cosmetic techniques, veneers are a blend of technology and artistry. They're made of a durable form of dental porcelain that can withstand biting forces (within reason, though—you'd want to avoid biting down on ice or a hard piece of food with veneered teeth). They're also carefully colored so that they blend seamlessly with your other teeth. With the right artistic touch, we can make them look as natural as possible.
Although porcelain veneers can accommodate a wide range of dental defects, they may not be suitable for more severe flaws. After examining your teeth, we'll let you know if you're a good candidate for veneers or if you should consider another restoration. Chances are, though, veneers could be your way to achieve what Aaron Judge did—a home run smile.
If you would like more information about porcelain veneers, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Porcelain Veneers: Strength & Beauty As Never Before.”
Introduced to the United States in the 1980s, dental implants have quickly become the go-to restoration for tooth replacement. And for good reason: they're not only incredibly life-like, they're highly durable with a 95% success rate.
But as desirable as they are, you may face a major obstacle getting one because of the condition of the bone at your implant site. To position the implant for best appearance and long-term durability, we must have at least 4-5 mm of bone available along the horizontal dimension. Unfortunately, that's not always the case with tooth loss.
This is because bone, like other living tissue, has a growth cycle: Older cells die and dissolve (resorb) and newer cells develop in their place. The forces transmitted to the jaw from the action of chewing help stimulate this resorption and replacement cycle and keep it on track. When a tooth is lost, however, so is this stimulus.
This may result in a slowdown in cell replacement, causing the eventual loss of bone. And it doesn't take long for it to occur after tooth loss—you could lose a quarter of bone width in just the first year, leaving you without enough bone to support an implant. In some cases, it may be necessary to choose another kind of restoration other than implants.
But inadequate bone isn't an automatic disqualifier for implants. It's often possible to regenerate lost bone through a procedure known as bone augmentation, in which we insert a bone graft at the missing tooth site. The graft serves as a scaffold for new bone cells to grow upon, which over time may regenerate enough bone to support an implant.
Even if you've had a missing tooth for some time, implementing bone augmentation could reverse any loss you may have experienced. In fact, it's a common practice among dentists to place a bone graft immediately after a tooth extraction to minimize bone loss, especially if there will be a time lag between extraction and implant surgery.
Bone augmentation could add extra time to the implant process. But if successful, it will make it possible for you to enjoy this popular dental restoration.
If you would like more information on dental implant restoration, 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 “Dental Implants After Previous Tooth Loss.”
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