What you should know about your child’s oral health

December 10th, 2012

Your child’s good oral health begins as early as conception.  In fact, the primary or baby teeth begin to form as early as the 6^th week of pregnancy and the permanent teeth begin to form at the 20^th week.¹ Therefore, a mother’s nutritional habits during pregnancy can affect the development of the child’s teeth.  Her diet should have adequate amounts of calcium, phosphorus, vitamin C, and vitamin D.  She should also avoid the antibiotic tetracycline during this time (unless otherwise directed by a physician) as it can cause the developing teeth to permanently look gray or brown once they erupt.²  Mothers should continue their regular cleanings with their dentist during pregnancy to ensure the very best overall health.  An expectant mother should be sure to inform her dentist of her pregnancy as it could affect her prescribed treatment regimen.³

After birth, instituting a regular oral health routine is important.  An infant’s gums should be wiped with a warm rag or gauze after every feeding.  As soon as the first tooth comes into place, it is time to start brushing with a soft-bristled toothbrush designed for babies and  to take your child for their first well-baby dental visit.  Remember to use water rather than a fluoride toothpaste for children under 2 years, unless your dentist recommends otherwise. Once your child is old enough to spit, he or she may use a pea-sized amount of fluoride toothpaste, but only under adult supervision.  Be sure to remind your child to spit out the toothpaste instead of swallowing it.² Overexposure to fluoride is toxic and should be avoided.

Extensive research has shown that optimal levels of fluoride can reduce cavities in children and adults too.  Community water fluoridation is an effective and inexpensive means of achieving the fluoride exposure necessary to prevent tooth decay.  According to the American Dental Association, the optimal level of fluoride is between 0.7 and 1.2 parts per million.  You can contact your local water supplier to determine your local fluoride level.⁴  If you and your family are drinking only bottled water, then you should check the label to ensure that the optimal levels of fluoride are present, as often the fluoride is lost during the pre-bottling treatment. ⁵

Sippy cups are an important transition from the bottle to a regular cup. To help prevent decay, this should occur by the child’s first birthday.  When choosing a sippy cup, choose a cup without a no-spill valve.  Sippy cups with a no-spill valve are nothing more than a bottle in disguise as they require the child to suck the liquid from the cup instead of sipping as is desired.  To help avoid spills, choose a self-uprighting cup with a weighted bottom.⁶

Maybe more important than the type of cup is what goes in it.  Regular sipping of sugary liquids such as milk and juices can cause extensive decay of the teeth.  The ADA recommends that these drinks be given only at mealtimes.  If your child is thirsty between meals, then water should be the drink of choice.  The ADA also warns against children carrying a sippy cup around with them as toddlers are often unsteady on their feet and a fall while drinking could result in trauma to the mouth.⁶

Thumb, finger, or pacifier sucking is a natural reflex for an infant.  It often starts as early as in the womb and helps children to feel secure as they are introduced to their new world. Most children stop their sucking habit between the ages of 2 and 4 (the earlier the better).  Prolonged thumb sucking can cause problems with the proper growth of the mouth and the alignment of the teeth.  It is very important that the habit cease before the eruption of the first permanent incisor (front tooth) to prevent problems with the permanent dentition.  Some tips for breaking a sucking habit include praising the child for not sucking their thumb or finger, rewarding the child for avoiding the sucking habit during times of stress, and placing socks over the hands during sleep.⁷ If the habit persists, your orthodontist can provide an appliance to help block the thumb or finger and prevent the sucking habit from continuing.

Figure 1. Results of Prolonged Thumb Sucking

The American Association of Orthodontists recommends that all children have their first orthodontic visit by the age of 7.  This allows the orthodontist to evaluate the growth and development of the teeth and jaws and intervene if necessary before a problem becomes severe.  Sometimes, just the timely removal of primary (baby) teeth can help the permanent teeth to erupt correctly.  Through an early evaluation, you will give your child the best opportunity for a healthy, beautiful smile.

In summary, helping your child to obtain a healthy, beautiful smile starts with early awareness.  Do not wait until your child has all of their teeth to begin teaching and practicing good oral health.  Those practices taught early will become part of your child’s natural routine, and he or she will carry them into adulthood.  With routine dental visits, proper brushing and flossing, and a healthy diet, your child can enjoy a lifetime of excellent oral health!

For more information about one of the above topics or to schedule a complimentary examination, visit www.jcoxortho.com or call 662-429-8022.  You can also visit the American Dental Association’s public health pages at  http://www.mouthhealthy.org/en/babies-and-kids/

References:

1. Ten Cate, A. R. (1998). Oral histology: development, structure, and function. St. Louis: Mosby. pp. 81–102. ISBN 0-8151-2952-1.

2. For the Dental Patient….Your Child’s Growing Smile. JADA 143(1) http://jada.ada.org January 2012

3. For the Dental Patient….Oral Health During Pregnancy…What to Expect When Expecting.  JADA 142(5) http://jada.ada.org May 2011

4. For the Dental Patient…Fluoride: Nature’s Tooth Decay Fighter JADA, Vol. 140   http://jada.ada.org  January 2009

5. For the Dental Patient…The Facts About Bottled Water.  JADA 1287(134) September 2003
6. For the Dental Patient…From Baby Bottle to Cup:  Choose Training Cups Carefully, Use them temporarily. JADA 387(135) March 2004

7. For the Dental Patient…Thumb Sucking and Pacifier Use.  JADA, Vol. 138 http://jada.ada.org August 2007

What is two phase orthodontic treatment?

April 4th, 2012

Two phase orthodontic treatment is sometimes used when a child presents with a large skeletal discrepancy that might affect his or her future pattern of growth or the eruption of his or her permanent teeth.   These skeletal discrepancies can  be due to a pattern of growth in which the upper jaw has outgrown the lower jaw (often termed an overbite or Class II jaw relation), the lower jaw has outgrown the upper jaw (often termed an underbite or Class III jaw relation), or the lower jaw is wider than the upper jaw.  Treatment at an early age (as early as 7 or 8 ) is focused on correcting the relationship of the jaws, so the teeth can then fit together correctly once they erupt.

Often, an overbite is corrected once all the permanent teeth have erupted.  However, in some severe cases or in cases where a child is experiencing social issues such as teasing due to the protrusive teeth, treatment can be commenced early.  Treating an overbite early can also help prevent very active children from damaging their permanent front teeth ( which sometimes occurs due to their protrusive nature).  Again, not all children will need early intervention for an overbite, but it is important to see an orthodontist early so that he or she can monitor the growth and development of the child.  Often, an overbite can be treated without the removal of permanent teeth, but only if the child is still growing.  Once all the growth is complete (or very near complete), modifying the growth pattern (and position of the jaws) is no longer possible and thus requires treatment focused on compensating the teeth to correct for the poor jaw position or surgery if a correct jaw position is desired.  Compensating teeth to this degree sometimes requires the removal of permanent teeth.

An underbite is often treated in two phases.  This is because the jaw relation is such that when a child bites down the teeth often hit in ways that do not fit correctly and thus causes him or her to bite even further forward or to one side.  This “sliding” pattern of biting can cause alterations in the growth pattern that can result in an asymmetrical facial appearance or even exacerbate the tendency for the lower jaw to outgrow the upper jaw.  Often, if the front teeth can be moved over the lower teeth early, then the lower jaw growth will be impeded by the upper jaw and the degree of malocclusion that will develop as the child grows can be decreased.

A posterior crossbite is also often treated in two phases.  This is because, a crossbite often causes a child’s teeth to fit together incorrectly when biting, and thus causes them to slide to the left or right to find a comfortable position.  This “sliding” pattern, as previously discussed, can cause alterations in growth that can result in asymmetry of the face if left for an extended period.

An anterior crossbite is often treated early as well.  This is because not only can an anterior crossbite cause a sliding pattern as previously discussed, but it can also cause recession of the gum tissue in the lower jaw.  Recession is seen due to the “trauma from occlusion” (or trauma from biting) that occurs to the lower teeth due to the incorrectly positioned upper teeth.

Moderate crowding can sometimes also be treated in two phases.  This is a controversial topic in orthodontics, however I have found that in some cases that are “borderline” extraction cases (meaning they very well might have to have permanent teeth removed in order for all the permanent teeth to have room) then early treatment to expand small and narrow arches can often create the space necessary to allow for the eruption of the permanent teeth.

Now for the real answer.  Why is it called two phase treatment?  The term developed because often a child who is treated for skeletal reasons such as an overbite, underbite, or crossbite (as previously discussed) will often need a second phase of orthodontic treatment once all their permanent teeth have erupted.  The first phase is focused on skeletal correction, and the second phase is focused on the correction of the teeth.   In some rare cases, a second phase might not be necessary if all the permanent teeth erupt into the correct position.  However, in most cases, a second phase of treatment will be necessary in order to provide an ideal smile and bite.  Most orthodontists will monitor a child at six month intervals after the completion of the first phase of treatment to ensure that the permanent teeth are erupting correctly and to determine the best time to start the second phase of treatment if necessary.

At what age should a child see an orthodontist?

March 17th, 2012

This is one of the most commonly asked questions by far! In the past, parents were told to wait until all of their child’s baby teeth are gone or until their dentist refers them to see the orthodontist.  However, this has changed.  The American Association of Orthodontists recommends that children see an orthodontist by the age of seven.  If your child sees the orthodontist early, the options and tools available for optimum treatment are greatly increased. In the vast majority of cases, no treatment is necessary for young children, however seeing them early allows the orthodontist to monitor growth and development and then intercede at exactly the right time if necessary.  Sometimes just having a few baby teeth removed early can help guide the permanent teeth into a more ideal position and prevent other problems such as impactions or root damage from developing. The orthodontist will often continue monitoring a child at 6 month intervals until all of his or her permanent teeth have erupted or until orthodontic treatment is determined to be needed.  Continued monitoring allows the orthodontist to watch the growth pattern of a child so that treatment can be more ideally timed.  At J. Cox Orthodontics, we have developed the J. Cox Kids Club in which the children in our monitoring program receive a membership card and the opportunity to earn Cox Coins and other cool prizes for learning to participate in the care of their teeth.  Our hope is that children enjoy their visits to the orthodontist, so that if treatment ever becomes necessary, they are not afraid.  Our Kids Club monitoring program is free of charge and is just one more way we are striving to provide the best care and service to our patients.  To enroll your child in our Kids Club monitoring program just call our office at 662-429-8022!