Children’s dental health

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Oral health care begins early for little ones
By Dental Hygienists’ Association of the State of New York*

Health care begins at birth for little ones – and that should include attention or oral health. Establishing good, consistent oral healthcare at home from birth is a key element for your baby’s well-being and is like that old saying that an ounce of prevention avoids a pound of problems later. Dental hygienists see the results every day and share advice for this early care at home and planning for the first visit to the dentist.

Begin care at birth and continue
Yes, at birth. Hygiene for that little mouth is critical and care certainly cannot wait until the first permanent teeth come in and lack of care can cause problems that affect the permanent teeth. Oral hygiene at home for children should begin immediately. This should include thorough gentle cleaning of the child’s mouth and gums with either a damp gauze pad or infant washcloth after feedings and before bedtime. That removes food residue and plaque—that sticky filmy bacteria.
Once a baby’s primary (baby) teeth appear, parents can use a small, soft-bristled infant toothbrush dampened with water (not toothpaste) to clean them gently. Continue your gentle cleaning of gums and while you are doing this, watch for any changes, such as white or brown spots on teeth, which can be a sign of decay, or any changes in gums. That’s a signal to make an appointment with the dentist. Your child should begin dental visits by age one or when that first tooth arrives – see checkups and establishing a “dental home” below.
Please don’t put your child to bed with a bottle of milk, juice, formula or other sweet liquid, as bacteria can use these sugars to attack the teeth and cause decay. Likewise, avoid letting the child walk around with a bottle or sippy cup of such sweetened liquids. And as the state Health Department notes, dental decay is an infectious transmissible disease so please don’t test the baby bottle temperature or clean the pacifier with your mouth or share a spoon.
By the age of two or three, parents can teach their children how to brush with a pea-sized amount of fluoridated toothpaste. You will need to monitor the brushing. How about using the buddy system and brush together? If the child has trouble holding the brush, place your hand over his/hers and guide them, or select a brush with a larger handle. Always do a check up to see that all the teeth get brushed. The American Academy of Pediatric Dentistry suggests a “find the hidden teeth” game as an incentive for thorough brushing and singing a song together to consume the recommended two minutes of brushing, which can otherwise seem like forever to a little one. Floss your child’s teeth that come in without gaps; you’ll probably need to do that until about age seven or eight. Teach your child to spit out the toothpaste and not swallow it; if he/she can’t grasp spitting, show him/her how to dribble the paste into the bowl.
Parents should continue to help their children care for their teeth until age seven or eight, when they have enough dexterity to brush and floss alone, but still do a check up to ensure they are getting to all the places in the mouth.

Get children ready for checkups and a ‘dental home’
The Dental Hygienists’ Association of the State of New York (DHASNY) recommends that your child’s first checkup begin at the age of one or when they get their first tooth. That’s a recommendation of the American Dental Association and American Academy of Pediatric Dentistry, as well.
Taking children to a dental office might seem frightening to them at first, but there are a number of specific things parents can do to help children enjoy their first visit to the dental hygienist. Here are some tips:
1. Brushing buddies: This starts at home with parents setting a good example by brushing and flossing together with their children every day.
2. Be positive: Talk positively about the appointment. Parents who may have had negative oral healthcare experiences should not communicate those feelings or any anxiety to children, as that will make them fearful.
3. Set the stage: Using a toothbrush, parents can demonstrate to children how their teeth might be cleaned by a dental hygienist. They can also tell children that there will be some noise involved and that the dental hygienist will be wearing a mask and gloves to protect themselves and the children from bacteria. In addition, dental hygienists recommend that parents let their children watch them get their own teeth cleaned. They will realize that if it didn’t hurt their parents, it won’t hurt them.

More than a smile at stake
By helping children learn oral hygiene early, parents can help to prevent cavities and other oral health problems. The Centers for Disease Control has found that dental caries (cavities) is 7 times more common than hay fever and 5 times more common than asthma in children. According to CDC reports, more than 1 in 5 or 23 percent of children ages 2-5 had experienced tooth decay in primary teeth. The statistics show 1 in 5 or more than 21 percent of children ages 6-11 and nearly 3 in 5 or 58 percent of youth ages 12-19 have experienced tooth decay. Of those teenagers, 15 percent had untreated decay. Oral health problems not only affect the ability to eat and smile, they can mean impact social interactions, concentration, result in lost school hours and more.
*DHASNY, a constituent of the American Dental Hygienists’ Association, is the professional association for dental hygienists in New York State. Its mission is to support the advancement of the art and science of dental hygiene to ensure access to and delivery of quality preventive and therapeutic oral health care services to all New Yorkers in a cost effective manner; through education and outreach to the public, increase awareness of the benefits of preventive dental hygiene services; and promote the highest standards of dental hygiene education, licensure, practice and research and integration of dental hygiene as a component of interdisciplinary health care to improve the public’s total health.

School’s Not a Pain to Bobby… But His Teeth Are
Dental problems not only make it hard for students like Bobby to pay attention in class.
• Troubles with teeth don’t go away; can cause difficulties eating, sleeping and learning— and can be a signal of other disease.
• More than 51 million school hours are lost each year to dental-related illness.
• 1 in 5 youth ages 6-11 and nearly 3 in 5 ages 12=19 have experienced tooth decay.
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That’s why good oral health habits, non-sugary diets, and regular visits to a dental hygienist are so important to your child’s good health.
Ask your Registered Dental Hygienist and learn more at www.dhasny.org.
Dental Hygienists’ Association of the State of New York


Child oral health
What you and your pediatric dentist watch for

By Jennifer Charlesworth, DMD*

A visit to the pediatric dentist encompasses more than just a dental cleaning and checking for caries (cavities). During dental school and residency training, a pediatric dentist learns to become a part of a child’s overall health team. The jaws, teeth and soft tissues of the mouth contribute to the health of your overall body. The specialized training of pediatric dentists prepares them to meet the needs of infants, children and adolescents, and persons with special health care needs. A large part of our daily work is communicating to parents about the most important issues of dental health. This article will briefly touch on some of those key topics that parents should look out for and discuss with your child’s dentist.
Nutrition is a major topic that a pediatric dentist will focus on with parents. Many parents may not realize how important a good, balanced diet is for the health of a child’s teeth. In particular, the dentist will counsel the parent to not only carefully monitor sugar intake, but also carbohydrate intake in general. In our bodies, the breakdown of common carbohydrates, such as crackers, breads and cereals, results in increased acid production in our mouth. Retentive or sticky foods, such as fruit snacks and gummy vitamins and candies, also add to the acid attack on the teeth. This acid-rich environment contributes to the formation of cavities. Continuous exposure during the day (grazing or frequent snacking) will promote more damage to the teeth because this will increase the time that bacteria can be active in the mouth. The intake of sugary beverages, such as fruit juice, should also be very limited.
During a dental exam, the dentist will also be looking for signs of medical-related issues. Any irregularities in the oral exam may indicate that another health issue needs to be addressed. Also, if a child has known medical problems or takes medications, the pediatric dentist will alert the parent to be aware of certain issues.
Asthma is one of the major medical conditions prevalent in children that can also have effects on the teeth if a parent is not aware of certain potential problems. A child with asthma will likely be taking medications to control asthma or using inhalers. One of the side effects of many asthma medications is dry mouth, or a lessening of the salivary production. Having less saliva available to cleanse the teeth naturally can contribute to the child getting more cavities. In addition, many asthma medications and other medicines contain sugar. The pediatric dentist will advise the parent that the child should rinse his/her mouth with water after taking the medicines to help remove the sugars and protect the teeth.
Gastroesophageal Reflux Disease (Acid Reflux) is another medical issue that a pediatric dentist often encounters and helps diagnose. Sometimes, the first symptoms that a child will display are related to the mouth. Some common symptoms of teeth with erosion due to acid reflux might be pain or irritation in the mouth, sensitivity to certain foods, a darkening of the teeth due to loss of enamel, or a very smooth, glossy look to the enamel in certain areas. Upon finding these dental changes, the pediatric dentist will advise the parent and alert the child’s physician that testing may be necessary to diagnose acid reflux. If left untreated, acid reflux can cause significant, long-term damage to the teeth, but also the child’s overall health. If a child complains of sensitive teeth, difficulty swallowing, regurgitation or heartburn, a parent should mention these symptoms at the dental examination appointment.
Oral sores or ulcerations (commonly known as canker sores) should also be brought to the attention of the dentist. In certain cases, these sores may simply be a result of some trauma, such as injury to the tissues during brushing. However, in other cases, oral sores can be a sign of other medical issues. Certain viruses can cause painful oral ulcerations and may be accompanied by pain and fever. Other cases of oral sores may be related to allergies or vitamin deficiencies. The dentist will examine the mouth and the oral sores to help determine the cause and may also work with the child’s physician to determine if more testing or treatment is necessary.
Dental injuries are another common topic at the pediatric dental office. Accidental injuries to the jaws, teeth and soft tissue can have serious long-term effects if not treated. These types of injuries can happen in any sport, including “non-contact” sports, such as baseball, soccer and basketball. If your child suffers an injury to the mouth, your dentist should be contacted immediately. The dentist will advise what actions need to be taken depending on the type of injury. If a tooth is broken or knocked out during the injury, the tooth or the broken segment should immediately be placed in a cup of milk, with minimal handling of the tooth. Timing is a critical factor in the prognosis after an injury. If it is after-hours, the dentist’s office will let you how to get in contact. If at any time, a child is unconscious or has suffered a severe head injury, 911 should be contacted immediately and any dental concerns should be handled later.
Prevention of injuries is not always possible but there are certain strategies that can help minimize the extent of an injury. Wearing a helmet or face mask when possible may help prevent many severe head injuries. In addition, children and adolescents involved in sports activities should wear a mouth guard to help prevent major injuries to the teeth and jaws. The mouth guard can be custom made to best fit your child’s bite alignment and, therefore, will be better fitting than one purchased at the store. The mouth guard will help cushion the jaws and teeth if there is an accidental blow to the face. If your child is involved in sports, ask your dentist about mouth guards and what is recommended for your child.
*Dr. Charlesworth practices at the 9 Century Hill Drive, Latham location of Where Smiles Grow; wheresmilesgrow.com 785.3911.

Fighting the silent epidemic of childhood tooth decay
American Dental Association
Half of all children enter kindergarten with tooth decay, and a disproportionate share of tooth decay, approximately 80 percent, is suffered by the poorest children in America. Children with untreated tooth decay often have more school absences, difficulty paying attention in school, and lower self-esteem.
Dentists nationwide, supported by the American Dental Association (ADA) and the ADA Foundation, are working to fight this silent epidemic.
Through National Children’s Dental Health Month in February, the ADA brings together thousands of dedicated dental professionals, healthcare providers, and educators to promote the benefits of good oral health to children, their caregivers, teachers and many others.
And Give Kids A Smile (GKAS) is the national grassroots movement through which volunteer dentists and others help kids, who otherwise may not have access to oral health resources, get the help they need. This year marks Give Kids A Smile’s 15th anniversary. A group of dentists started GKAS as a one-day, grassroots volunteer event in St. Louis, Missouri where they and other volunteers set up 15 patient chairs to provide free dental care to nearly 400 children in need.
The ADA soon took the lead in launching GKAS as a national program. It is now the largest children’s oral health charitable program in the U.S., with more than 1,300 local GKAS events taking place across the U.S. each year. More than 5.5 million children in need have received free oral health services, including education, screening, and treatment, from GKAS volunteers since that first event.
Top tips for children’s dental health:
• Brush 2 times a day for 2 minutes with a fluoride toothpaste
• Floss once a day
• Eat a well-balanced diet with limited snacks
• Avoid sugary foods such as soda and juices
• Visit your dentist regularly Visit www.mouthhealthy.org/en/babies-and-kids for more information. If your child needs oral health care, visit www.ADAFoundation.org/GKAS and click “Find Dental Care for Your Child” for a list of resources or call 1.844.490.GKAS (4527) to see if there is a GKAS program available in your area. Visit New York State Dental Association also for patient information at nysdental.org/patients.



Pediatric orthodontics Early treatment is key

By Michael J. Sbuttoni, DDS*

Pediatric orthodontics is generally described as treatment provided before braces. We term it early treatment. This is before all the permanent teeth have erupted. We have been providing this category of care in our offices for over 30 years.
The American Association of Orthodontists recommends an initial orthodontics screening for all children around age 7. This is the optimal time to evaluate space requirements and jaw alignment. Treatment during this age period is directed at guiding the growth and development of the teeth and jaws. It is important that problems at this age be evaluated by an orthodontist with expertise in early treatment.
Conditions that are best treated “early” are generally related to crowding and bite problems caused by jaw alignment. The list of conditions include cross bite, open bite, over bite, severe crowding, gummy smiles and problems related to thumb and finger habits.

Early treatment can:
•Create room for crowded teeth so that they come in normally
• Create facial balance by influencing proper jaw growth
• Reduce the risk of damage to protruding front teeth
• Eliminate the need to extract permanent teeth to correct crowding
• Reduce the time a patient spends in braces
• Eliminate unwanted and harmful habits
The problems corrected by early treatment will have positive effects on your child’s appearance and self esteem. Equally important are the positive effects on dental health.
For example, protruding teeth are more susceptible to accidental chipping and other types of traumatic damage. Crossbites can result in unbalanced jaw growth and excessive wear of teeth. Open bites can cause speech impediments and problems with swallowing and digestion. Uncorrected over bites can lead to jaw joint (TMJ) problems
The most common early treatment appliances are expansion appliances, which widen the teeth and jaws laterally, making room to align crooked teeth and promoting proper eruption of permanent teeth not yet erupted. Properly managed expansion therapy will also promote symmetrical lateral positioning of the lower jaw.
Head gear therapy is commonly used in early treatment to control the position of the upper teeth. There are three types, but all have their primary impact on the upper teeth. We can move the upper teeth backward, forward or up vertically. Head gear can also be used to create space for unerupted or crowded back teeth.
The Herbst appliance is also utilized for anterior/posterior bite correction. Unlike the head gear, which primarily impacts the upper teeth and upper jaw, the Herbst appliance is used to control the position of the lower jaw. The majority of over bites are due to the position of the lower jaw and the Herbst appliance is the only treatment appliance that provides the desired orthopedic impact on the lower jaw. With modern digital diagnostics, we can precisely assess the position and size of the lower jaw and manipulate the Herbst appliance to place the lower jaw in its ideal structural and functional position.

Other appliances
Other appliances frequently used in early treatment include:
• Lip Bumpers are used on the lower teeth to alleviate crowding by making space in the anterior/posterior direction.
• Bite Plates/Retainers are used in patients with significant overbites where the front teeth tip out and the lower front teeth contact the tissue behind the front teeth. We use these retainers to move the upper front teeth back so that they are not at risk from damage due to trauma. This will also unlock the bite so that the gum tissue behind the front teeth will not be damaged.
• Partial braces are often used to align the front teeth and place them in their proper position after we have created the necessary space.
• Space maintainers are used most often to hold space for erupting permanent teeth when deciduous (baby) teeth are lost prematurely. Space maintainers can also be used when space is adequate but not properly distributed.

Other considerations
Other considerations in early treatment protocols include:
• Frenectomies: The frenum is a band of muscle fibers that stabilizes the upper lip. In some patients, this band of muscle fibers attaches in between the upper front teeth, resulting in a persistent space. In these cases, the usual recommendation is to have these muscle fibers severed. This is typically done by laser in the modern dental office. It is a relatively simple procedure.
• Extractions: If a permanent tooth is developing but not moving into precisely the correct position, the root on the deciduous (baby) tooth may not dissolve properly. In that scenario, it is generally prudent to extract the deciduous tooth so that the permanent tooth moves into its appropriate position.

In summary: early exam
The American Association of Orthodontists recommends initial examination with an orthodontist by age seven. This affords us the opportunity to identify significant problems early in their development, which usually leads to more predictable outcomes with less complicated treatments.
When early treatment is indicated, the resultant growth guidance and tooth movement generally results in less time in braces when that treatment is initiated, with a better functional and aesthetic outcome. In addition, most patients treated early do not require extraction of permanent teeth.
In our office, initial examinations are provided free of charge. We do not want there to be any barrier to our patients pursuing that initial appointment, which is often concerning for both our patients and their parents. There is much that we can do early on, often with greater ease than initially anticipated to guide growth and development, so that seemingly severe problems can be effectively dealt with before they turn into larger more complex problems. *Dr. Sbuttoni practices at Generations of Beautiful Smiles, which specializes in orthodontics. Offices are in Albany, Delmar, Latham and East Greenbush; www.albanybraces.com.

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