July 2010

Q: Dr. Snodgrass What is the main cause of cavities?

A: There is no main reason for cavities.  Cavities are caused by multi-factoral reasons.  The most common cause in infancy is prolonged bottle or breast-feeding, especially at night.  For children past the toddling stage, it’s usually a combination of frequency, duration, and concentration of sugar in addition to poor oral hygiene; and for teenagers, it’s too many sweets and not enough attention to hygiene.

Q:  Why can’t you put porcelain-fused to metal crowns on baby teeth?

A:  PFM crowns are not usually advocated for baby teeth for many reasons: one, they are too expensive to place on teeth that will soon be lost.  Two, the pulpal tissue in baby teeth consume too much of the inner portion of the teeth to allow a layer of metal, then a layer of porcelain, and three porcelain is too hard and unforgiving to the opposing teeth and growing jaws.

Q:  Dr. Oakes, I am interested in braces, but my 14 year old still has quite a few baby teeth.  Is this normal?

A:  While it is not within the norm for a teenager to still have baby teeth, it is not a condition to be alarmed about.  I myself had baby teeth well into my teens.  The only problem is that, orthodontically, it’s treatment gets slightly delayed until a later age.  Most children (and parents for that matter) hope to have orthodontics completed by their early teens.  So, kids that are slightly delayed in loosing teeth may just need to wait on the start of braces.  However, the best way to fully analyze delayed loss of baby teeth would be to have an orthodontic evaluation as soon as possible.  It is always possibility that there could be an underlying reason not readily detected for the slower than average tooth loss. 

May 2010

Q:  Why are children so afraid of the dentist?

A:  There are many reasons for this fear.  Usually by the time we see children they have already been poked and prodded many times by well-meaning people in white coats.  The fears of the parents are also transferred to the children.  When they finally do make it to our office and they see other happy children playing games and watching the fish in the fish tank some of these fears are abated.  The office’s bright colors; the staff’s cheerful attitude; and a dentist in blue jeans (no white) also helps.  I’ve also found that very young children can carry on quite a conversation if one will simply take the time to listen.

Q:  My child’s lower front permanent teeth are coming in behind baby teeth.  Is this a source of concern in which I need to consult our pediatric dentist?

A:  This is a common concern in which pediatric dentists see just about every day in their practices.  This phenomenon is called prolonged retention.  Many times the primary teeth have undergone extensive root resorption and may not foliate in a timely manner.  Prolonged retention can occur in patients with an arch length deficiency and in children with an adequate amount of spacing of the baby incisors.  Is this a concern that needs to be evaluated immediately?  Yes, as soon as this is detected by you, the dentist needs to examine your child in order to decide if treatment is necessary.  In many cases there is justification for removal of the baby tooth or teeth in order to help alleviate crowding and allow the permanent tooth or teeth to align themselves spontaneously in a more favorable position over time.

Q:  Dr. Oakes, my son was just told he needs braces.  He is only 11 years old.  If he gets braces now will he have to have them again later in life?

A:  This is a question I am often asked.  The answer to your question is no.  I realize that 11 seems to be young to some people to have braces.  However, I feel the typical best time to have braces is 11 to 12 years of age for boys and 10 to 11 years of age for girls.  These ages for both sexes are ideal due to the fact that children are just about to begin puberty.  Teeth seem to move more efficiently and hurt less if braces are started when peak growth is about to begin.  Since most boys and girls grow around these ages, this treatment timing is ideal for most patients.  As long as your son wears a retainer as instructed after treatment, his teeth will continue to remain as beautiful as they were the day braces were removed.

April 2010

Q:  Dr. Snodgrass and Dr. King, what is the difference between a pediatric dentist and a family dentist?

A:  There is no specialty in dentistry called family dentistry.  Pediatric dentistry is one of eight recognized dental specialties.  A Pediatric dentist receives two additional years of specialty training beyond a four-year dental degree.  This additionaltraining focuses on growth and development, child management, child psychology, sedation, hospital dentistry, interceptive orthodontics, growth guidance, advanced restorative procedures, etc. as it pertains to growing children.  Pediatric dentists are trained to work closely with pediatricians and other medical specialistsin a hospitalenvironment where medically compromised and special needs children often have to be treated.  The pediatric dental staff must be highly trained.  And, the pediatric dental office must be designed to be a child-friendly environment.  The goal of every pediatric dentist is to make dentistry as pleasant an experience as possible for not only the child, but also the parent.

Q:  Dr. Oakes, my child just got his braces off and he has prominent white spots on his teeth.  What are these and can bleaching get rid of them?

A:  These white spots are called decalcifications.  These are caused by poor oral hygiene.  When a child has braces and does not brush and floss properly plague build up around the appliances begins to damage teeth.  When the braces are removed the damaged areas appear white.  The undamaged areas, or the areas protected by the braces, appear healthy or tooth colored.  These “white spots” can only be fixed by restoring these affected areas with tooth colored fillings.  Bleaching will not cure the damaged done by poor brushing and flossing habits.  The good news is that these “white spots” are totally preventable.  Proper monitoring of a child’s oral hygiene by the patient, the parent, and the orthodontist will prevent any permanent damage to the teeth. 

March 2010

Q: Dr. King, Are sippy cups okay for my child’s teeth?

A:  Most children begin holding a cup around age 8 months.  Sippy cups are wonderful for children if the parents follow two certain rules.  Here are the rules.

(1)  Children should not be given fruit juice, powdered liquids, or soda pop in sippy cups if the cup and its contents are to be made available to the child through out the day.  In other words, sugary liquids in sippy cups are okay only at mealtime.

(2)  As soon as your child can hold a cup of liquid without making a mess, it is time to discard the sippy cup.  Prolonged usage can abnormally wear the teeth and cause anterior open bites.

Q:  Dr. Oakes, my pediatric dentist told me that my nine year old is ready for an orthodontic evaluation.  Is nine years of age too young for braces?

A:  Ideally, I like to start female patients around age 10 to 11 and my male patients around age 11 to 12.  however, not every child can be held to there age parameters.  Some nine year olds have all or most of their permanent teeth, and are dentally ready to start braces.  Having said that, these same nine year olds that have very mature mouths may no have mature oral hygiene habits.  Therefore, as a parent you must decide if a nine year old child can take care of his/her teeth while being treated with braces.  We all love beautifully straight teeth, but there is nothing worse than straight teeth that have been damaged during orthodontic treatment due to poor brushing and flossing habits.

February 2010

Q:  Dr. Snodgrass and Dr. King, They’re just baby teeth. “Isn’t he going to shed ‘em anyway?”

A:  We wish we had a dollar for every time the past 18 years we’ve heard someone express or suppress that thought.  Of course they are baby teeth.  Of course your child is going to loose them.  The problem is that your child has to have their first set of teeth in order to properly nourish their young bodies until around the age of twelve.  They also have to have these teeth in order to guide their permanent successors into the proper parking spaces of the mouth.  Have you ever had a toothache? Did you know that in 1999, 90,000 children in the State of Tennessee went to bed with a toothache? Of these 90,000 toothaches, 99% were avoidable and 100% cost more to treat than to prevent.  Your child will have as nice and healthy a smile as you are willing to put into it.  This means beginning the first dental visit by age one with a pediatric dentist focused on prevention; brushing and flossing your child’s teeth for them at least once a day until age ten; regular six month dental check ups, sealants at age six; and orthodontic treatment whenever indicated.  These are just baby teeth but dog-gone-it, they’re important.

Q: Dr. Oakes, my child is 11 and still sucks here thumb.  I have been told that she needs braces.  Will braces alone cure her thumb sucking habit?

A:  No.  Braces alone will not cure a thumb or finger habit.  When a patient has suck a habit and is ready for orthodontic treatment I will place braces as well as a habit appliance.  The purpose of the habit appliance is to simply remind the child not to suck his/her finger or thumb.  The appliance is painless and fits in the roof of the mouth.  Although it is low profile it can affect speech temporarily as well as be a bit of a food trap.  Patients with habits should be diagnosed as early as possible.  Putting off habit correction until a later time is not the best decision.  The longer a habit persists the harder it is to correct.  Not only are long term thumb and finger habits are very difficult to break, but they can also cause significant altering of a patient’smouth, teeth, and facial profile.

December 2009 and January 2010

Q:  Hey Dr. Snodgrass and Dr. King, why should my child receive fluoride?

A:  One of the local television stations just last week did a news story on the toxicity of fluoride and how environmentalists across the country were advocating the removal of fluoride from municipal drinking water.  Fluoridated drinking water along with penicillin probably had the greatest effect of positively influencing human lives during the Twentieth Century than any other development, and now they want to take it away.  Have they forgotten how many of their parents wore dentures?  Fluoridated drinking water insures that your child’s teeth develop more resistant to tooth decay.  The fluoride in your drinking water is referred to as systemic fluoride.  As your child drinks water, the Fl- ion is absorbed into the bloodstream.  This ion is removed from the bloodstream by the cells, which form enamel of the tooth makes the tooth harder and more resistant to decay.  Another form a fluoride is called topical fluoride.  We, pediatric dentists, apply topical fluoride in high concentrations to children’s teeth every six months.  Topical fluoride is applied directly to the outside surfaces of the teeth in the form of a gel or rinse.  To be 100% effective topical fluoride should be applied to the teeth every six months.  Having been a pediatric dentist for over twenty years, I’ve witnessed the teeth of children raised on farms with well water and no fluoridation.  Their teeth are softer and much more prone for decay.  This time history must not repeat itself.

Q:  Dr. Oakes, my child is 10 years old and still has four baby teeth left.  Is it too early for braces and will she need them again in the future if we start orthodontic treatment now?

A:  Every child and orthodontic case is different.  However, having four baby teeth left at 10 years of age is not abnormal.  It is also no abnormal for starting orthodontic treatment with baby teeth still present.  Under normal and ideal circumstances, I like to start female patients around 10 or 11 years of age and 11to 12 years of age for boys.  When orthodontic treatment is started it typically lasts for two years.  If children wear their retainers as directed no further orthodontic treatment will be needed.  As always I say, it is never too late to have braces and improve your smile.  It’s simply easiest to correct orthodontic problems when a patient is growing.  During growth spurt times teeth move more efficiently.  Furthermore, there seems to be the added bonus of less discomfort while in treatment.

November 2009

Q: Dr. Snodgrass and Dr. King, does swallowing toothpaste harm or help my child’s teeth?

A: It is not good for any child to swallow toothpaste. Most toothpaste has fluoride. Fluoride is meant to inhibit bacterial formation on the outside surfaces of the teeth. It is not meant to be ingested as a food source because it is toxic. Many parents and children simply place far too much toothpaste on the toothbrush. It has the effect of gagging the child and makes the whole brushing experience more difficult for the parent and the child.

Q: Dr. Oakes, my child has recently developed a nickel allergy. Do braces contain any nickel?

A: This is an important question that I honestly do not often get. Yes, stainless steel (or silver) braces do contain trace amounts of nickel. However, a true allergic reaction to nickel is rare. Most often patients with nickel allergies are female. The reason that this is so is due to the fact that most nickel exposure is encountered though jewelry (i.e. earrings) wear. This trend may change with more males beginning to wear jewelry and other objects containing nickel. Even when a patient exhibits an allergic reaction to nickel containing objects; a reaction to nickel in braces does not always occur due to the limited amounts contained in stainless steel braces. Patients seeking orthodontic treatment who might be hypersensitive to nickel can be tested for a true nickel allergy prior to treatment or seek treated with alternative materials such as ceramic or clear braces which do not contain nickel. Nickel free wires can also be used during treatment.

October 2009

Q:  Dr. Snodgrass and Dr. King, I have a two year old child who absolutely will not be still while I’m brushing his teeth.  Can you recommend a solution?

A:  This common problem often leads the parent to simply settle for the best job they can do.  This can lead to cavities.  Most parents try to brush their child’s teeth while the child sits on the sink and the parent works from the side.  Proper access and keeping the child from moving is extremely difficult in this position.  We recommend that parents lay their children down on the bathroom floor or their bed.  With one hand pull the child’s cheek back so you can see what you are doing.  With the other hand brush all of the teeth and the gums using a scrub stroke (the up and down or circular stroke is only recommended in older children).  Remember, you must brush top teeth, bottom teeth, the fronts of the teeth, the tops of the teeth; and when you are finished, you should floss the child’s teeth anywhere the teeth touch.  Flossing is just as important as brushing!  We recommend using only a child-sized soft-bristled toothbrush with a minimalamount of toothpaste(BB-sized).  If you use too much toothpaste the child will gag, choke, and swallow it.  The only to requirements on the toothpaste are that you use a toothpaste with fluoride and that your child likes the taste.  Parents are mislead when they think a child can brush their own teeth at age 3 or 4.  Most children do not develop the manual dexerity to do an adequate job brushing until they are around age 10.  We recommend that four year old children be encouraged to brush their own for a minute (use a timer) after breakfast every morning.  A parent should always brush the child’s teeth every night.

Q: “Dr. Oakes, my son wants to get his lower lip pierced and was just informed that he needs braces by his dentist.  How would having a pierced lip affect his treatment?”

A:  Over the last few years oral piercings has become increasing popular.  Gold, silver, stainless steel, glass, and acrylics are the most widely used materials for piercing.  Regardless of whether a patient has braces or not, oral jewelry can cause redness, swelling, throbbing, and warmth at the site.  Infection can also occur if a patient exhibits poor oralhygiene.  There is also an issue of initial disturbances in speech, taste, and swallowing.  Allergies can also develop to these materials.  More drastic occurrences with piercing include dislodgement and aspiration of the studs and post as well as damage done to the teeth by the constant trauma of the jewelry against the dentition.  In my opinion oralpiercings should be avoided simply becauseof all the trouble they can cause.

September 2009

Q:  Hey Dr. Snodgrass and Dr, King, how do you do complicated restorative dentistry on extremely, young children?

A: There are only three way to do restorative dentistry on children without harming them.  (#1) Do tell-show-do.  If the child is old enough to reason and you can gain enough trust to give them a shot without it hurting, you might be able to do a less complicated procedure.  (#2) General anesthesia - Extremely expensive - child must be hospitalized and put to sleep in an out patient facility.  Some medical insurances flat-out deny this coverage.  In our practice we reserve this option for medically compromised and/or physically handicapped children mainly.  If a parent insists, we do not mind going to the Operating Room but it is often cost prohibited. (#3)  Mild, light sedation - This by far the best option.  Notice the word mild or light sedation.  heavy sedation is too life threatening, and too complicated for most dental practitioners.  We use and extremely, light technique that is very safe and allows the child to go through comprehensive, complicated dental procedures without the child remembering it as a traumatic event.  The child simply drinks a sedative Kool-aid and one hour later we begin.  The child is not asleep.  The child does get shots to numb the areas to be treated.  He/she simply is in a twilight state during the procedures.  We attempt to treat all areas in one visit.  It is much easier for the child because he only has to heal once.  It is also easier and less costly for the parent.

Q:  Dr. Oakes, my son is 12 years old and is in braces.  He is complaining of pain in the very back of his mouth behind his last tooth.  Could this be his wisdom tooth coming in?

A:  While it is possible it is highly unlikely that a wisdom tooth would be erupting on a 12 year old patient.  The pain your son is feeling is most likely from a 12 year old molar.  It is common for these teeth to cause pain when they are coming into the mouth.  The best thing to do for this kind of discomfort is to take an anti inflammatory as recommended by your dentist or orthodontist.  Most, but not all, people have these three sets of molars: the 6-year and 12-year molars, which come in typically at age’s 6 and 12, and the wisdom teeth or molars (12 total).  Most patients do not have enough room for wisdom teeth in their mouth and need these teeth extracted prior to their eruption.  Thus, wisdom teeth are not a cause of concern until late teens to early 20’s.  I typically send my orthodontic patients to an oral surgeon after braces to have the wisdom teeth evaluated.

August 2009

Q: Hey Dr. Snod and Dr. King, what is “enamel hypocalcification” and what causes it?

A: Enamel hypocalcification is a condition that effects the formation of the enamel of either the baby teeth or the permanent teeth. It can be localized (involving only one tooth) or generalized. If the front teeth exhibit enamel hypocalcification, it is usually a cosmetic problem, that depending on the severity, may require treatment with esthetic filling materials. If the posterior teeth are severely affected, the treatment often requires restoring the tooth with a stainless crown. Enamel hypocalcification can be caused by many factors. The most common cause is thought to be a virus. Many lay people blame antibiotics, but it is not thought to be the antibiotics that cause the problem. It is the viruses or the bacteria that the antibiotics are being given for that is the culprit. We commonly see enamel hypocalcification involving the six-year molars. Severe cases require aggressive treatment.

Q: “Dr. Oakes, I had braces as a child and was treated for almost three years. How long do children typically wear braces?

A: I also wore braces for almost three years when I was a teenager and I will be the first to admit that three years is a long time to be in braces. However, my orthodontic needs were complicated. A typical orthondontic case is usually two years in length. It is rare when a case goes over that two year time period. Factors that can increase treatment length are degree of difficulty, breakage, and non-compliance (i.e. missed appointments and failure to wear rubber bands) There are few things that cause a patient to be in treatment longer than average. Keeping regular appointments and taking good care of orthodontic appliances is the best way to get the quickest results.

June 2009

Q:  Hey Dr. Snodgrass and Dr. King, My 8 yr. old child has to wear a mouth guard to play football, yet doesn’t to play baseball, soccer, or basketball.  Should he also wear a mouth guard while playing these sports?

A:  Absolutely.  In my opinion, in any organized athletic program where physical contact is expected, the child should be required to wear a protective mouth guard.  If the sport or sponsors of the sport do not requires a mouth guard then responsible parents should requires the mouth guard be in place prior to the child participating in the sport.  Injuries to permanent teeth are permanent.  Enamel doesn’t grow back and teeth knocked out or knocked loose often require expensive crown and bridge work and/or root canals to repair.  Mouth guards are easily obtained and extremely inexpensive.  They are also easy for almost any parent to fabricate by simply following the directions on the box.  The Spring and Summer of every year bring out the Four B’s (bats, balls, bikes, and boards).  Every year our pediatric dental practice sees traumatic injuries to children from the four B’s.  The severity of these injuries can be avoided or certainly reduced if the children were wearing appropriate gear (mouth guard).  When your child rides his bike and puts on his helmet, he/she should put in his mouth guard.  When your child picks up a bat or ball, he should put in his mouth guard.  And lastly, anytime any child steps on a trampoline or plays on the monkey bars, he/she should put in their mouth guard.

Q:  Dr. Oakes, I am 23 years old and I am interested in getting braces and I still have my wisdom teeth.  Should I have these removed prior to orthodontic therapy?

A:  In most cases the answer is no.  You do not have to have your wisdom teeth or third molars removed prior to orthodontics.  However, most people do not have enough room in their mouths for wisdom teeth and eventually have to have them removed.  Even when there is enough room for the third molars in the mouth they are difficult to clean as often cause problems with other teeth.  It has been thought that third molars can cause crowding of the lower incisors.  I always check wisdom teeth when I do an orthodontic evaluation.  I usually suggest removing them in the mid to late teens for several reasons.  Teenagers heal much faster and better than adults and it is more difficult for adults to find the time to set aside for wisdom teeth to be removed.  Teenagers usually have summers off or holiday vacations when removal of wisdom teeth can be easily and conveniently preformed.  It is always best to have and oral surgeons evaluation when considering removing third molars.

May 2009

Q:  Hey Dr. Snodgrass and Dr. King, why is it important to floss baby teeth?

A:  One of the first phrases that I learned in dental school while sitting in period class went like this, “You don’t have to floss all of your teeth, floss just the ones you want to keep.”  Adults primarily losetheirteeth from periodontal disease, mainly created by their own lack of flossing.  Children lose theirs from normal exfoliation and dental caries.  Simply brushing their children’s teeth is not enough.  Parents who do not floss their children’s teeth are simply playing roulette with the most common infection of man, dentalcaries.  All parents should bring their children to a pediatric dentist no later than age one.  Every parent should not only be told that brushing, flossing, and diet are important, but they should also receive hands-on  instruction from qualified, registered dental personnel on the proper techniques.  Ninety thousand school aged children in Tennessee went to bed last year with a toothache and many of these toothaches could have been avoided if the parents knew to begin their dentalvisitsatageone, not four, and to brush, floss, begin a proper diet, and regular visits every six months.  Frankly, I’m tired of hearing a parent say to me, “They’re only baby teeth.  Aren’t they going to fall out anyway?”  It’s these baby teeth that lay out the foundation upon which that child will smile, gain their self-esteem, nourish their bodies, and grow into successful young adults.

Q: Dr. Oakes, my son will be getting braces soon.  How much discomfort is there with braces?

A:  Most orthodontic patients can expect mild discomfort from braces.  At the same time most children and adults say that the process of putting braces on is painless.  However, it is hours after the braces are placed that patients may feel slight pain.  I always advise anyone who is starting orthodontics to take Ibuprofen, Tylenol, or Advil prior to the first appointment so that any discomfort can be avoided.  Taking these pain relievers for a few days after each orthodontic appointment significantly improves a patients tolerance to their new braces.  I am often told that any unpleasant sensation from braces ceases after the first few visits.  Discomfort from monthly adjustments also decreases as treatment progresses and teeth become straighter.  While the mild pain experienced from braces at the beginning of treatment is unfortunate, I have yet to have a patient tell me that their beautiful smile was not worth all the effort.

April 2009

Q:  Dr. Snod and Dr. King, my child is 9 months of age and does not have any baby teeth. Do I need to worry?

A:  I would not worry right now. Delayed eruption of baby teeth can be a common event. My own son who is 8 months of age is experiencing a similar situation except his only baby tooth appears to be an upper lateral incisor and his eruption pattern is out of sequence.  My wife says he looks like a pumpkin. The timing of eruption of baby teeth can be influenced by genetics, trauma, certain systemic conditions (Down syndrome and low birth weight), and cysts. Some children have thick fibrous gum tissue that can hold up the normal eruption process. Occasionally, a small incision is made in the gum pad to allow the teeth to penetrate the tissue.

Here are guidelines on the general tooth eruption patterns for infants to 3 year olds. At about 6 months of age the lower centralincisors(bottom front teeth) generally erupt. These are followed by the upper incisors and both maxillary central incisors (upper) and mandibular (lower) lateral incisors. By the first year, 8 incisors are usually present.

At about 15 months of age, the first primary molars (back teeth used for grinding food) erupt. By age 2, the canines are present. Shortly there after, the second primary molars erupt. By 3 years of age, all the primary teeth are generally present. Remember these are average ages. Some children’s teeth erupt sooner and some later. To ease your concerns, visit your pediatric dentist so he/she can answer questions you may have about your child. 

Q:  Dr. Pete, my 10 year old daughter will be getting her braces soon. She is very active in dance and drama and she is concerned about the way her braces are going to look. Can you do invisible braces?

A:  There are a few options available to make your orthodontic treatment less noticeable. Many children and teens like choosing different colors to put over metal braces as an expression of their personality. The rubber o-rings that hold the wires in place come in a wide variety of colors, but you can also get silver or clear for a more subtle look. Another option that we offer is clear braces that are very popular with our adult patients. These are made out of a tooth colored ceramic and are more aesthetic than the metal brackets. We also offer invisalign, which is a way of doing orthodontics without braces. They are a set of clear removable retainers that you change out every few weeks. These are the most aesthetic, but they are not for everyone. They are the most effective in treating cases of mild crowding or for people who have had braces before and have had some relapse. Invisalign cannot be used to treat difficult cases.

March 2009

Q:  Hey Dr. Snod and Dr. King, why is it necessary to place dental sealants on my child’s teeth, and do they really prevent cavities?

A:  If dental sealants were around in my generation we would have far fewer fillings, crowns, bridges, and dentures.  Our goal as pediatric dentist is to help you raise your children cavity-free.  Dental sealants are an excellent way to do that.  Usually the first dental sealants placed are on the occlusal (top) surface of permanent six year molars as soon as these teeth erupt into the mouth.  As the bicuspid and twelve year molars erupt later, they too are sealed.  The molar and bicuspid permanent teeth erupt with deep, developmentalpits and fissures which are very difficult to keep clean even with proper brushing.  Food (especially hard sugary substances) gets packed in these pits and fissures to provide a substrate for bacteria to create cavities.  As soon as the molar and bicuspid teeth erupt, we clean the pits and fissures using a sandblaster0type instrument and sealthemwithanopaque, fluoride releasing sealant material. The materialis applied as a liquid and cured to a hard substance with an ultravioletlight.  Ir is designed to stay attached to the teeth; seal off and smooth the grooves; and release cavity-preventive fluoride throughout a child’s cavity prone years 9diets high in carbohydrates).  Along with regular six month dental check ups and fluoride treatments, dental sealants are an excellent way to prevent cavities.  Dental sealants are easy to apply and maintain. 

Q:  Hey Dr. Pete, my 9 year-old son has a really bad overbite and I’m concerned about his appearance.  When is the best time to treat this problem?

A:  Much of the development of the face and jaws occurs during the growth spurt at puberty.  Treatment during this period allows orthodontist to favorably influence the facial profile of a growing child.  Once the bones of the face have stopped growing, correction of a skeletal problem will usually require surgery.  One of the most common types of bites that we treat is an “overbite” or when the lower jaw has not grown forward enough to match the upper jaw.  In profile this appears as a deficient chin.  There are orthodontic appliances that, when placed before the growth spurt, allow us to enhance growth of the lower jaw and/or slow the growth of the upper jaw.  These are called functional appliances and they can be very effective when used at the right time.  Everyone is different in the timing of their growth spurt so it is best to come in for an evaluation sooner rather than later.

February 2009

Q:  Dr. Snodgrass and Dr. King, my seven year old had a baby molar tooth removed and our dentist said she needs a space maintainer.  Is this really needed?

A:  Yes! If a baby tooth is lost too soon, especially a primary (baby) molar, the tooth or teeth beside it may move or drift into the empty space.  Teeth in the opposing jaw may move up or down to fill the gap.  When adjacent teeth shift into the empty space, they create a lack of space in the jaw for the permanent tooth or teeth.  This will cause the permanent tooth or teeth to erupt in a crowded or rotated fashion eventually leading to orthodontics in the future.

Space maintainers are appliances made of metal or plastic that are custom fit to your child’s mouth.  The appliance will hold open the empty space left by the lost tooth and prevent unnecessary movement until the permanent tooth erupts into its natural position in the jaw.

Q:  Dr. Pete, will my wisdom teeth cause other teeth to become crowded after my braces are removed?

A:  Trapped plaque and debris causethe gums to become inflamed.  If plaque is allowed to accumulates over a period of time, the inflammation can causethegumstobleedduringbrushing.  Moving teeth through unhealthy gums can cause periodontal recession.  The enamel of the teeth can also become decalcified which results in permanent white spots.  The best way to avoid these problems is to maintain good oral hygiene.

It is much harder to keep the teeth clean with braces and other orthodontic appliances.  Therefore, it is very important to have a daily routine that is diligently followed.  This includes thorough brushing after each meal and flossing at least once a day.  A floss threader may be helpful to get the floss under the wire in between each tooth.  Ultrasonic toothbrushes, interproximal brushes and fluoride rinses can also help in maintaining oral health during orthodontic treatment.

January 2009

Q: Dr. Snodgrass and Dr. King, what kind of toothbrush is best for my child?

A: The selection of a toothbrush depends on your child’s developmental stage. All toothbrushes should have soft, rounded bristles. You should never buy the medium hard, or extra-hard bristled brushes. These bristles will abnormally wear enamel and enamel does not replenish itself. Infant toothbrushes should have small heads and be easy for the parent to hold and use. Toddlers need big-handled brushes with soft grips. Middle-aged and teenage children should use brushes designed to clean the teeth without damaging gingival structures.

Q: Dr. Pete, will my wisdom teeth cause other teeth to become crowded after my braces are removed?

A: This has been a topic of controversy within the dental community for many years. During the 1980’s the wisdom teeth were blamed for causing orthodontic relapse after the completion of treatment. In 1990, a research article was published (Ades et al, AJODO) which concluded that there is no basis for the removal of wisdom teeth with the objective of alleviating or preventing lower anterior crowding. Most people will develop some amount of crowding of the lower front teeth as they age. This can occur at the same time as the wisdom teeth are coming in, but there is not a cause and effect relationship. The best way to prevent relapse after teeth are straight is to wear retainers as instructed by your orthodontist.

December 2008

Q: Dr. Snodgrass and Dr. King, my seven year old has a baby molar tooth removed and our dentist said she needs a space maintainer. Is this really needed?

A: Yes! If a baby tooth is lost too soon, especially a primary (baby) molar, the tooth or teeth beside it may move or drift into the empty space. Teeth in the opposing jaw may move up or down to fill the gap. When adjacent teeth shift into the empty space, they create a lack of space in the jaw for the permanent tooth or teeth. This will cause the permanent tooth or teeth to erupt in a crowded or rotated fashion eventually leading to orthodontics in the future.

Space maintainers are appliances made of metal or plastic that are custom fit to your child’s mouth. The appliance will hold open the empty space left by the lost tooth and prevent unnecessary movement until the permanent tooth erupts into it’s natural position in the jaw.

Q: Dr.Pete, why are so many children getting braces at a very young age?

A: Children who receive braces between the ages of 6 and 10 are considered to be in Phase l of Interceptive Treatment. It is only recommended if there is a definite need. The goal of this stage of treatment is to intercept a severe orthodontic problem early in order to reduce or eliminate it. These problems include crossbites, crowding or severely malpositioned teeth. Phase l treatment lasts 8-12 months and it turns a difficult orthodontic problem into a more manageable one. Most patients that have had Phase l will require a second stage of treatment, Phase ll, when most of the permanent teeth have erupted. The goalofPhasellisto achieve an ideal bite and to address cosmetic concerns.

November 2008

Q:  Hey Dr. Snodgrass and Dr. King, how do you do complicated restorative dentistry on extremely young children?

A:  There are only three ways to do restorative dentistry on children without harming them.

(#1) Do tell-show-do. If the child is old enough to reason and you can gain enough trust to give them a shot without it hurting, you might be able to do a less complicated procedure.

(#2) General anesthesia - Extremely expensive - child must be hospitalized and put to sleep in an out patient facility. Some medical insurances flat-out deny this coverage. In our practice we reserve this option for medically compromised and/or physically handicapped children mainly. If a parent insists, we do not mind going to the operating room but it is often cost prohibited.

(#3) Mild, light sedation - This is by far the best option. Notice the word mild or light sedation. Heavy sedation is too life threatening, and too complicated for most dental practitioners. We use an extremely, light technique that is very safe and allows the child to go through comprehensive, complicated dental procedures without the child remembering it as a traumatic event. The child simply drinks a sedative Kool-aid and one hour later we begin. The child is not asleep. The child does get shots to numb the areas to be treated. He/She simply is in a twilight state during the procedures. We attempt to treat all areas in one visit. It is much easier for the child because he/she only has to heal once. It is also easier and less costly for the parent.

 Q: Dr. Oakes, my son is 12 years old and is in braces. He is complaining of pain in the very back of his mouth behind his last tooth. Could this be his wisdom tooth coming in?

A: While it is possible it is highly unlikely that a wisdom tooth would be erupting on a 12 year old patient.

The pain your son is feeling is most likely from a 12 year molar. It is common for these teeth to cause pain when they are coming into the mouth. The best thing to do for this kind of discomfort is to take an anti inflammatory as recommended by your dentist or orthodontist.

Most, but not all people have three sets of molars: the 6-year and 12-year molars, which come in typically at age’s 6 and 12, and the wisdom teeth or molars (12 total). Most patients do not have enough room for wisdom teeth in their mouth and need these teeth extracted prior to their eruption. Thus, the wisdom teeth are not a cause of concern until late teens to early 20’s. I typically send my orthodontic patients to an oral surgeon after braces to have the wisdom teeth evaluated.