WHAT MOM’S ARE ASKING!!!

Recently we developed a video called “Mom’s Dental Questions”.  We filmed some of our “Mom patients” asking the questions that have been most frequently heard in the office over the years.  Then Dr Hammond and Dr. Couch were filmed answering those questions in a manner everyone can understand and appreciate.  This post is a condensed version of that video into written format.  We hope that this is helpful to our readers and patients and if you want to view the video, you can go to our website  http://www.couchandhammonddentistry.com

• What is the best toothpaste?

We get asked this a lot!  What really matters here is that your child likes the toothpaste, will use it appropriately and the toothpaste bears the ADA seal of approval.  Toothpaste has to meet strict criteria to get that seal.  Look for it on the packaging.  If your child is 6 years or older, and has  a high risk for dental decay, we will often prescribe a  5000 ppm Fluoride toothpaste.  The kind we are currently endorsing is Clinpro 5000 with Tri-calcium Phosphate made by 3M.  Also, if your child suffers from a lot of canker sores use a toothpaste without Sodium Laurel Sulfate.  The is the ingredient that makes toothpaste foam and basically is a soap.  If you want a “whitening” toothpaste, look for one that has carbide peroxide in it.  Rembrandt makes a good one called Rembrandt Whitening Plus.

• When should I start brushing my child’s teeth and what should I use?

We recommend parents start a “brushing program” even before the baby teeth appear.  Use a soft baby’s washcloth on your finger and massage the gums.  This starts patterning your child to have you putting something in the mouth which you will change over to a small brush like device that slips over your finger and then to a toothbrush.  Introduce toothpaste when teeth appear.  Remember to just put a small amount on the brush.  Toothbrushes should always be soft or extra soft and even when the teeth erupt gently scrub the gum line!  Introduce floss at around age two when both of the baby molars are visible.

• What should I do if a tooth is knocked out?

The first thing to do is stay calm and don’t panic.  Verify that the whole tooth came out!  If you can find it  and it is intact, it is possible to re-implant the tooth back into the socket, but time is the critical factor.  The tooth needs to be put back into the socket within 30 minutes.  Establish the time of the injury.  If you can get to our office within the time frame, all the better.  Emergency rooms are not always that helpful and the likelihood to be seen and the Physician knowing what to do is not always reliable.  More than likely, you will do a better service to put the tooth in the socket yourself.  Before you do, carefully remove any visible debris from the root service.  DO NOT SCRUB THE ROOT!!  This damages the microscopic cells that are vital for the tooth to reattach.  Those cells start to die after 30 minutes of being outside of a biocompatible medium.  A quick rinse of the tooth with water or contact lens solution or even your own saliva can help clean it.  Do not soak it in water!  Once you have removed the “visible” debris, orient the tooth, hold your child’s head and place it back into the blood filled socket.  Instruct your child to bite down as best as he or she can and get to our office.  Now if you are not able to re-implant the tooth and you have to transport your child and the tooth for us to  replace it, then you must transport the tooth in a medium that is “isotonic” (a fancy word for a solution that won’t harm the living cells attached on the outside of the root).  Some acceptable solutions that could be readily available would be saline solution , milk or saliva.  placing ice on the face over the injury is good as well.

• What should I do if a tooth is chipped or broken?

Again, don’t panic!  Most of the time there is no immediate “get to the dentist within minutes” need.   The gums may bleed, lips may be split or swollen and the tooth will feel sharp and jagged.  First, establish any other injuries that may need to be seen by a physician.  If the lip is badly split, it may need stitches which we can usually fix.  Contact our office and let us know about the injury.  If a large part of the tooth broke off and you found it…. keep it moist and bring it with you to the office.  Sometimes we can use the piece and reattach it.  If there are no pieces to be found, don’t worry, we can use composite or porcelain.  The tooth may be sensitive to temperature so baby it!  If you see a small red spot in the middle of the tooth, then the pulp or nerve of the tooth may be exposed.  This will need more immediate treatment since it will be more painful and an entry point for infection.

• What if a tooth has been knocked loose?

The good news here is that most of the time it was knocked a little loose and will eventually tighten back up.  Make sure your child can bite together OK and call the office to let us know what happened.  We will want to eventually take an x-ray to make sure the root did not fracture.

• What if my child’s gums are swollen around a tooth?

Swelling is always something to pay attention to.  Swelling is a component of inflammation.  Inflammation can be caused by infection and trauma.  The mouth is full of bacteria so swelling in the mouth usually means infection.  As soon as you notice the swelling, contact our office even if your child doesn’t have pain.  We will definitely want to see your child soon because usually pain will eventually arrive on the scene.

• What if my child complains of a toothache at night or after hours?

Usually alternating children’s Tylenol and Children’s Advil every 2 to 3 hours is the best over the counter remedy for pain relief.  Children also generally do well with codeine.  Our office after-hours message will contain Dr. Couch and Dr. Hammond’s personal cell phone numbers.  We do this so that you can call us for advice or to set up an after hours visit for your child at the office.  We know that tooth pain can sometimes be very unbearable at inconvenient times.  We give you those phone numbers because if you must call it is usually a genuine emergency.  Sometimes a tooth has to be opened and infection drained before relief will come.

• All the other kids are loosing teeth but my child hasn’t…. is that normal?

There are so many different variations of tooth eruption patterns and timing.  It is very hard to say what is normal.  Generally the lower front two teeth are the first to loosen and fall out.  Look for this in Kindergarten or first grade.  The first permanent molars come in around age 6.  We call those molars the six-year molars.  The second permanent molars come in around age twelve.  Some mom’s have asked if because their child’s teeth came in later than other children’s does that mean the child will be developmentally delayed in other physical aspects?  There has never been shown a correlation between tooth eruption patterns and other areas of development either physically or mentally.  Teeth tend to erupt when they just plain feel like it!

• My child has cavities!! What am I doing wrong?

Decay happens when bacteria eventually gets past the protective enamel covering of the tooth.  The enamel weakens and breaks down because of acid.  Bacteria produces acid as it metabolizes the food particles left around our teeth after we eat.  Most of the bacteria that gets left undisturbed  (acid then builds up) are found in the pits and fissures of our teeth and in between our teeth.  Brushing and flossing is intended to fluff the bacteria and keep the acid attack from building up.  Some enamel is more resistant to acid than others.  Fluoride strengthens enamel.  Also,not all bacteria is created equal.  Some stains of bacteria produce more acid.  So you can see decay is not just a simple formula.  Brushing, flossing, sealants and fluoride are the best weapons against decay.

• I have heard that fluoride is bad for your bones and is rat poison…. Why should I be giving this to my child?

Yes Sodium Fluoride is a rat poison.  At rat poison doses you would have to drink a bathtub plus full of fluoridated water to receive a potentially fatal dose.  Fluoride can and will get incorporated into the bones and toxic levels can make bones brittle.  Fluoride however gets also taken up into our enamel and makes the enamel really strong.  Fluoride as a supplement to help strengthen teeth, has been studied extensively.  Fluoride can be delivered to our developing teeth through either the drinking water or a chewable daily pill that a pediatrician or dentist prescribes.  Birth to age six is the optimal time to get fluoride into the enamel.  After age 12, the benefit reduces significantly.

• Is the water in this area fluoridated?  Who should I get a fluoride RX from?

The State of California passed a law years ago that mandated all public drinking water to be fluoridated.  However, they failed to provide funding.  Most local municipalities have not found the funding to accomplish the mandate.  EID at the present does not fluoridate our water in El Dorado County.  The city of Placerville, however, has a fluoridated water supply.  Most well water in this area does not have any natural occurring fluoride.  Supplemental fluoride table RX’s can be dispensed by pediatricians or our office.  Just ask if you need one for your child.

• I have heard that there is mercury in dental fillings….Should I be concerned?

Yes, there is mercury in silver dental fillings.  These fillings are called amalgam and the main metals are silver, tin and mercury.  Amalgam fillings have been extensively researched over the years and the American Dental Association has found amalgam to still be an acceptable dental finning material.  Many countries have banned the use of amalgam.  The safety of amalgam in our mouths remains a heated debate.  At Couch and Hammond dentistry we have chosen to not offer amalgam as a choice of filling materials in the office.  We feel that amalgam has served the public well for many years, but in this day and age there is no need for it especially in our young patients with developing nervous systems.  We recommend placing either composite or glass ionomer fillings.  For more information about the different types of filling materials just ask our office staff.

• What is the best way to protect my child’s teeth while playing sports?

Hands down, a professionally made mouth guard is the best.  The drawback is that because it is such a custom fitted appliance it may not fit over a long period of time because your child’s mouth may still be growing and changing.  The over-the-counter “boil and bite” mouth guards can be acceptable if they are fitted correctly.  Professional mouth guards have also been shown to reduce the severity and frequency of concussions.

• At night, I hear my child grinding his teeth in his sleep.  What can be done about this?

A lot of kids will grind their teeth.  Usually as the six-year molars erupt and the bite stabilizes, this habit goes away.  If we see that the permanent teeth are showing signs of early wear then a night guard would be appropriate.

• I always had nitrous oxide for dental work when I was young.  Could we do the same thing for my child?

Yes… but!  First thing to consider is that dentistry has changed a lot since we were kids.  I can remember crying my eyes out at age nine in the dentist chair for no good reason.  Most of our young patients do just fine without nitrous oxide and they are establishing a confident easier way to be treated as an adult.  Our advice is to give us and your young one a try first without the nitrous.  We can always use it if necessary.

• When should we start looking at braces?

Some kids will need early intervention orthodontically.  We have seen that to be as early as age 8.  Many orthodontists can get the bones orthopedically moved and aligned and then at age 13 or 14 the full braces can go on.  It’s never too early to get an orthodontic opinion.

• My child’s permanent teeth are coming in really yellow!  When can we bleach them?

Adult teeth are always yellower than the brighter, whiter baby teeth.  When we see them next to the baby teeth we think they are just plain yellow.  It is sort of an optical illusion.  Wait until all of the adult teeth are in… usually by age 14 and then we can evaluate really how yellow they are.  If you want us to whiten your child’s teeth we can usually start that after age 14 or 15.  Just ask us for a menu of whitening services.

• When should my child start seeing the dentist?

The Academy of Pediatric Dentist’s recommends that children start seeing a dentist when the first teeth erupt.  We feel that is good advice, but we like to throw in a little practicality and common sense to the mix.  We tell our mom’s to bring the kids with them to  their appointments.  The infants will get a lot of attention from our staff and the toddlers usually do great with some entertainment we can provide while mom or dad are getting their teeth cleaned.  We can easily do a complimentary check of the child’s mouth and make recommendations.  We feel that around age three, your child can be comfortable with us and a full exam and cleaning can be scheduled.  Every child is different but we like to be seeing the child regularly by age four.

We hope that these commonly asked questions and their answers are helpful to you and your family.  If you have any other questions, please never hesitate to give our office and call.  We love children and want you to be confident that you are prepared for all dental emergency situations and are well equipped to keep your child’s smile healthy and beautiful for a long time.