http://www.trianglepedo.com/index.php en drbuddy@trianglepedo.com Copyright 2011 2011-01-14T15:22:23+00:00 http://www.trianglepedo.com/index.php/blog/gerd_grief_-_my_childs_teeth_are_eroding/ http://www.trianglepedo.com/index.php/blog/gerd_grief_-_my_childs_teeth_are_eroding/#When:15:22:23Z GERD is a condition in which the stomach contents leak back into the esophagus and sometimes even all the way back into the mouth.  An early clue that a child may have GERD is the erosion of tooth enamel. There is a saying in medicine and dentistry that the mouth can be considered a portal to the rest of the body.   Did you know that the mouth and teeth can often give clues that there can be problems going on in other areas of the body?  Dentists can act as tooth sleuths and find any clues in the mouth that can indicate that something isn’t quite right elsewhere in the body.  As one example, the link between oral health and cardiovascular disease has been in the news a lot in the last few years (link).  Another interesting health condition that has many early warning signs noticed in the mouth is GERD (GastroEsophageal Reflux Disease).     GERD is a condition in which the stomach contents leak back into the esophagus and sometimes even all the way back into the mouth.   The acidic stomach contents can cause a person to experience frequent heartburn (one of the most common symptoms), frequent belching, chronic coughing, laryngitis, pharyngitis, painful swallowing, and tooth enamel erosion.  If untreated over long periods of time GERD can even lead to other more serious problems including cancer. With children it is sometimes difficult for parents to even realize that their child may be experiencing GERD. Children can’t always tell you that they are experiencing some of the early symptoms of GERD (heart burn, etc.) and the symptoms may be mistakenly attributed to other problems or disregarded all together.  An early clue that a child may have GERD is the erosion of tooth enamel.  Children with GERD can be subject to acidic stomach contents coming up into the mouth multiple times during the day.  In addition and even more concerning, much of the regurgitation of acidic stomach contents seen in GERD occurs during sleep resulting in several exposures of the teeth to acid at a time when saliva in not being produced to buffer the acid.  Over time these frequent attacks by the acidic stomach contacts will cause the tooth enamel to erode. Erosion of tooth enamel can often be confused with attrition (wearing away of tooth structure) from grinding the teeth.  Tooth wear from grinding usually wears the teeth out in very flat patterns whereas erosion from GERD tends to cause the loss of tooth structure in more of a reversed architecture formation.  The enamel erosion seen from GERD often manifests as worn craters on the cusps of the molars or in more severe cases “cupping out”  of the chewing surface of the teeth.  This erosion can make the teeth sensitive as well as make them more prone to cavities (and make any existing cavities worse).  Another pretty clear cut sign that the lost tooth structure is from acid erosion is that any filling will appear taller than the surrounding tooth structure (instead of being worn down to the same level as the tooth structure).                                      "Raised fillings" due to enamel erosion When erosion of tooth structure is noted we must first rule out possible sources of enamel erosion in the diet.  These other sources could include acidic drinks (soft drinks, sports drinks, juice, etc.) or acidic candy (sour gummies, sour skittles, sour gummy vitamins, etc.).  If the diet has been ruled out the next step is usually consultation with a physician.  If a child is found to have GERD they can often be treated with medications such as an acid reducer like Zantac or an acid blocker such as Prilosec or Prevacid.  A few other tips to help with reflux are: Don’t eat a large meal within 2 hours of bed time (this increases the likelihood of regurgitation during the night) Raise the head of the bed by about ½ a foot so the stomach contents are more likely to stay in the stomach Follow up with a physician 2011-01-14T15:22:23+00:00 http://www.trianglepedo.com/index.php/blog/flossing_for_children/ http://www.trianglepedo.com/index.php/blog/flossing_for_children/#When:18:39:23Z Many parents ask me, “Do I need to floss my toddler’s teeth“?   The answer is yes!  Flossing is perhaps the most overlooked part of keeping a child’s teeth clean, one that is critically important in preventing cavities.  Flossing is important because it enables you to clean between the teeth where the toothbrush cannot reach and where many cavities start.  Once the primary teeth (baby teeth) begin to touch together it is necessary to begin flossing a child’s teeth.  Sometimes this is as early as when the front four teeth come in (around 10 months), but for some children with more spacing in between their teeth the teeth do not necessarily need to be flossed until the back molars come in and begin to touch together (around 2 years of age). With younger toddlers and preschool aged children the easiest way to floss their teeth is with a floss stick.  These can be purchased at any drug store, grocery store, etc.  Big adult hands and small mouths can make flossing the back molars very difficult.  Floss sticks allow you to get floss in between children’s back teeth without having to stick your hands all the way to the back of their mouths.  We recommend that parents floss their children’s teeth until they are able to tie their own shoes (tying shoes demonstrates that children have the abilities with their hands to floss correctly). The key to flossing a young child’s teeth is going to be the flossing position. If you have two people available to help with flossing then that is ideal. Two people can floss a child’s teeth in the knee to knee position. The two adults should sit facing each other with their knees almost touching. The child can sit in one adult’s lap facing them. Then, the child can be leaned back onto the lap of the other adult providing easy access for flossing (and brushing). If there is just one adult available for flossing then you can try to have your child lie down on a bed with his/her head in your lap. Another alternative is to have your child sit with his/her body between your legs and his/her head tilted back into your arms.  Click here to see a knee to knee demonstration (at the 1:28 mark on the video). 2010-09-10T18:39:23+00:00 http://www.trianglepedo.com/index.php/blog/fluoride_mouth_rinse/ http://www.trianglepedo.com/index.php/blog/fluoride_mouth_rinse/#When:17:12:12Z Fluoride mouth rinses can be very helpful in protecting children from cavities.  The fluoride contained in the rinse can help to remineralize and strengthen areas on teeth where enamel breakdown (one of the first steps in cavity formation) is beginning to occur.   For a mouth rinse to be truly helpful in preventing children from getting cavities it must contain fluoride.   Always ask a dentist first about having your children use a fluoride mouth rinse.  If your child is not old enough to rinse and then spit out fluoride mouth rinse then they should not use it unless your dentist has given special directions on alternative uses. Our recommendation for the best fluoride rinse for children is ACT.  It contains the proper amount of fluoride and the children’s version is alcohol free, both reasons why it is our preferred fluoride rinse for children.  Find out more about ACT fluoride rinse at http://www.actfluoride.com/parents/index.html. If you are looking at a generic fluoride rinse or another brand of fluoride rinse make sure that you check out the drug facts on the back label to ensure that your are getting a product that will work correctly.  The active ingredient listed should be Sodium Fluoride 0.05%.   You should also see on the label or on the front of the bottle that the product is alcohol free. If directed by their dentist children should use fluoride rinses once a day after they have brushed their teeth.   Children should swish with about 5-10 ml (~1 tsp)of the rinse for 1 minute and then spit it out.  It is very important that children spit the rinse out and if they do not then they should not be allowed to use it.  Avoid eating or drinking for 30 minutes after using a fluoride rinse 2010-07-23T17:12:12+00:00 http://www.trianglepedo.com/index.php/blog/juice_._._enemy_1/ http://www.trianglepedo.com/index.php/blog/juice_._._enemy_1/#When:15:37:08Z I’d like to just write a little bit about one of a Pediatric Dentist’s top enemies . . . . JUICE!  Juice (even 100% natural juice) is high in sugar and is probably the leading cause of cavities that we see in our office.  Even if “watered down”, frequent consumption of juice can still cause cavities.   We recommend that children only have one small 6 oz cup of juice a day if any at all.   Juice should be consumed with a meal or with a snack to help buffer the sugar intake.  Juice is the most dangerous for causing cavities when a child is sipping on it throughout the day in a bottle or sippie cup.  This gives the dangerous combination of too much total sugar consumption as well as a high frequency of sugar consumption.  Even if children are sipping on watered down juice throughout the day the frequency of sugar consumption is way too much.  They are getting less total sugar but are constantly “bathing” their teeth with sugar.  It is also very important that children are not allowed to drink juice (or any drink besides water) after they have brushed their teeth at night and most importantly are not allowed to sleep with a bottle or sippie cup containing juice (or any drink other than water). So what is it about juice that makes it such a hidden danger for children’s teeth?  To start, juice contains a lot of sugar!  One 6 oz Mott’s for tots reduced sugar apple juice box has 13 grams of sugar (kids should only have 20-40 grams of added sugar depending on age and activity level).  An 8 oz serving of juicy juice apple juice contains 26 grams of sugar.   These amounts of sugar aren’t that different than what you find in a similar portion of Coca-Cola (39 grams in a 12 oz can).  The bacteria in the mouth use this sugar as a fuel source for creating acid that eats away at teeth and can ultimately cause cavities.  In addition to having a lot of sugar, juice is also acidic.  Apple juice has a pH ranging from 3.5-4 which is very similar to many soft drinks.  The acidity of juice can erode the enamel on teeth which cand lead to cavity formation. The American Academy of Pediatrics recommends that the maximum amount of juice that children should have is only one 6oz serving of juice a day (about the size of 1 juice box).   Try substituting more fruits instead of fruit juices into your child’s diet as an alternative.  So, a little juice here and there is not that bad but it is important to try not to make juice a staple of your child’s diet.  If you can keep juice from becoming a daily component of your child’s diet then they will have a much lower risk of developing cavities! 2010-07-09T15:37:08+00:00 http://www.trianglepedo.com/index.php/blog/so_how_much_sugar_is_too_much/ http://www.trianglepedo.com/index.php/blog/so_how_much_sugar_is_too_much/#When:19:09:00Z Sugar is one of a dentist’s biggest enemies as it is used as the primary energy source by the bacteria in the mouth that cause cavities on your teeth (read more about how cavities form here).   If your dentist preaching about the harmful effects of sugar on your teeth isn’t enough to scare you then we’ll just have to pull out the big guns and refer you to some of the latest information from the American Heart Association (AHA).   Over the past 30 years there has been a huge worldwide increase in the amount of obesity and cardiovascular disease.    This has prompted the AHA to release several statements regarding sugar consumption over the last few years with its most recent statement coming in 2009.   Along with causing cavities a high intake of sugar has been shown to increase obesity, high blood pressure, heart disease and stroke.  Now that should definitely get everyone’s attention!  Sugar is naturally occurring in many foods but is added to many other foods during processing, preparation or at the table.  Sugar doesn’t have any nutritional value aside from providing calories and it can displace more nutritious foods and beverages in a person’s diet.   Calories from sugar are considered discretionary calories which are calories that are left over after someone meets their nutritional requirements (since sugar doesn’t have any nutritional value then all calories from sugar are considered discretionary calories).   Over the last 30 years the total amount of calories people consume has increased by around 300 calories a day and about half of this is from liquid discretionary calories (sugar in drinks).   So how much is too much sugar?  The AHA recommends that only about half of a person’s discretionary calorie intake should come from added sugars.  For a person that is not exercising much this would be about 36 grams (9 tsps) for men, 20 grams (5 tsp) for women and an estimate of only about 12 grams (3 tsps) for children a day.  People that are more active have higher caloric intake and can have a little more than these amounts.  As a point of reference, most 12 oz soft drinks (soda, pop) have at least 36 grams (9tsp) of sugar which is the entire suggested amount of sugar for a non-active grown man and more than the suggested amount for non-active women or children for a day. As you can see, sugar does a lot more than just cause cavities.  So next time your dentist tells you to cut back on sugar just remember that your dentist is not only saving your pearly whites but making you healthier and in better shape!  For a link to the AHA statement regarding sugar consumption click the link below. http://circ.ahajournals.org/cgi/reprint/CIRCULATIONAHA.109.192627 2010-05-03T19:09:00+00:00 http://www.trianglepedo.com/index.php/blog/the_age_one_dental_visit/ http://www.trianglepedo.com/index.php/blog/the_age_one_dental_visit/#When:13:24:09Z One of the most frequent questions that I hear as a pediatric dentist is, “When should I start bringing my child to the dentist?”  The answer:  around the time of your child’s first birthday.   The American Academy of Pediatric Dentistry, the American Academy of Pediatrics, and the American Dental Association all recommend that children have their first dental visits and establish a dental home around the time of their first birthday.  A dental home is a place where comprehensive, continuously accessible, coordinated, compassionate oral health care is available and delivered by qualified child health specialists.    Establishing a dental home is a more cost-effective and higher quality oral health care alternative to emergency care situations because dental problems can be prevented or detected before they develop into more serious conditions.  Also, the dentist is able to coordinate oral health care needs among dental specialists, pediatricians, ENTs, and other medical specialists. After I tell parents to bring in their one year olds for dental exams the comment that often follows is “but my child doesn’t have many teeth yet”.  This may be true but the purpose of the first dental visit for a young child goes much deeper than just taking a look at the teeth.   While I enjoy looking at the child’s teeth, much of the benefit of the first dental visit actually comes from talking with the child’s parents.  The focus during the first dental visit is to gather information that can be used to create a preventive program that addresses the unique issues that affect a young child’s oral health.  I do this through anticipatory guidance where I assess a child’s risk factors for oral disease, anticipate the potential oral health problems that a child may encounter based on these risk factors, and guide the parent towards ways to avoid these potential problems. Both my assistants and I do a lot of talking with the parents at the first visit but I do also like to look at the child’s teeth.  Most of the infant and toddler exams that I do take place in an infant room where I am able to bypass the potentially intimidating exam in a dental chair in favor of a more comforting “knee-to-knee” exam.  For a knee-to-knee exam the child sits in his/her parent’s lap and the parent can lean the child’s head back towards the dentist’s lap for a quick examination of the teeth and jaws.   This allows me to determine if there are any signs of dental disease present and I can even sometimes make some early predictions on the need for orthodontics in the future.  We can also demonstrate proper brushing technique for your child so that you can keep his/her teeth properly cleaned at home.    After examining the child’s teeth and talking with the parent the dental team can provide the following: A program of preventive home care including brushing, flossing, diet, and the importance of fluorides A cavities risk assessment Information about early childhood cavities which may be caused by certain nursing habits or inappropriate use of bottles or sippy cups Facts about finger, thumb and pacifier habits What you need to know about preventing injuries to the mouth and teeth Information on growth and development of the teeth and jaws Remember to get your child started early at the dentist’s office.   By starting early we have a better chance at stopping cavities before they can even form!  2010-04-29T13:24:09+00:00