- Teething & Sore Gums
- Thumb Sucking
- Dental Caries (Tooth Decay)
- Abscessed Tooth
- Severe Early Childhood Caries (Baby Bottle Decay)
- Gingivitis (Gum Disease)
- Ankyloglossia (Tongue-Tie)
- Canker Sores & Cold Sores
- Malocclusions (Improper bite)
- Impacted Wisdom Teeth
Teething & Sore Gums
When babies are teething, usually between the ages of four months and 2.5 years, they often have sore and tender gums. The pain can usually by soothed by gently massaging the baby's gums with a clean finger, a soft plastic device, or a teething toy kept in the freezer. Expect increased drooling, fussiness, and hands constantly going in the mouth. Hang in there Mom - this too shall pass.
Thumb sucking, use of a pacifier, or sucking on a play toy is very common and age-appropriate behavior for young children comforting themselves. Unfortunately, these behaviors can cause orthodontic problems if they are allowed to continue for an extended period of time.
Braces move teeth by exerting a relatively small force on the them for an extended period of time - not only moving the teeth, but changing the shape of the underlying bone. The same is true of these "non-nutritive sucking" habits. That is why we recommend parents work with their children to help stop these behaviors before the age of four.
Here's a great book to use as a conversation starter! We also have a ton of strategies to share with you that we gleaned from awesome parents throughout the years.
Dental Caries (Tooth Decay)
"Caries" is the medical term for decay and "cavity" is just a fancy word for hole. Baby teeth have a thin layer of enamel that allows cavities to grow quickly, often spreading to the nerve chamber on the inside of the tooth causing pain.
Susceptible tooth surfaces + oral bacteria + dietary sugars = dental decay. If you remove any one of these three items - no decay. Well, we can't get rid of our teeth but we can protect susceptible surfaces with sealants. We can't eliminate the oral bacteria but we can keep them from forming a harmful layer of plaque on the teeth by brushing and flossing. And we can't fully eliminate sugars from our diet but we can be careful about how frequently we indulge in sugary snacks and beverages.
When a tooth sustains an injury, or has deep decay that causes the tissues on the inside of it to die, it can form a pocket of pus in the surrounding bone called an abscess. An abscess can be an extremely painful condition that usually requires the extraction of the baby tooth and placement of a space maintainer (depending on the tooth and the patient's age) to keep the space open for the adult tooth later. Most abscesses don't require use of an antibiotic unless there is severe pain, facial swelling, or other signs of infection.
Severe Early Childhood Caries (Baby Bottle Decay)
S-ECC (or baby bottle decay) is a severe form of decay with a specific pattern of destruction mostly involving the top front teeth and upper molars. This occurs when sweetened liquids, such as milk, formula, and fruit juice, are left to pool in an infant or toddler's mouth for long periods of time. Baby bottle decay can lead to severe cavities in your child's mouth causing pain and infection.
Putting a baby to bed for a nap or at night with a bottle containing anything other than water can cause this serious and rapid tooth decay. If you must give the baby a bottle as a comforter at bedtime, it should contain only water. If your child won't fall asleep without the bottle and its usual beverage, gradually dilute the bottle's contents with water over a period of two to three weeks.
Similarly, sippy cups should only be used as a training tool from the bottle to a cup and should be discontinued by the first birthday. If your child uses a sippy cup throughout the day, fill it with only water (except at mealtimes).
Currently, the World Health Organization (WHO) recommends that a child breastfeed for at least two years. The American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) recommends breastfeeding with appropriate complementary foods for at least one year.
We, too, support breastfeeding and want to promote your child's dental health while you share this special time together. Breast milk is nature's perfect food and alone doesn't cause cavities - but in combination with other snacks (puffs, O's, crackers) it can be as harmful as sucrose. The American Academy of Pediatric Dentistry cautions against "ad-lib" breastfeeding (greater than 7 times daily - especially at night) because of its strong association with early decay. After each feeding, wipe the baby's gums and teeth with a moist washcloth or gauze pad to remove plaque and residual milk.
Gingivitis is the medical term for early gum disease, or periodontal disease. In general, gingivitis is caused by long-term exposure to plaque and food debris left behind after eating. Early warning signs include tender or painful swollen gums and minor bleeding after brushing and flossing. Thankfully, this condition responds well to improved hygiene and can resolve on its own in 10-14 days.
Ankyloglossia (tongue-tie) is a condition characterized by an abnormally short lingual frenum - the skin attachment from the underside of the tongue to the floor of the mouth. In moderate to severe cases of ankyloglossia, the tongue will have a restricted range of motion and sometimes causes difficulty with breastfeeding and speech development later on.
Treatment involves a very safe and simple procedure called a frenectomy. The attachment is surgically released, healing is quick, and improvement can be observed immediately.
Canker Sores & Cold Sores
Canker sores (also called recurrent aphthous ulcers) and cold sores are often confused with one another but they are completely unrelated. Both can be painful, however, and knowing the differene between the two can help you take appropriate steps to keep your child comfortable and protect your family.
A canker sore typically occurs on the delicate tissues on the inside of your mouth. It is usually light colored with a bright red exterior border. Their cause is unknown, but it is thought they can be brought on by exposure to allergens like flavoring agents, certain nutritional deficiencies (Vit B12 / iron), or stress.
A cold sore, on the other hand, usually occurs on the outside of the mouth near the nose or lips. These fluid-filled lesions are caused by the herpes simplex virus and are therefore quite contagious. Take care to avoid skin-to-skin contact with these areas, including preventing your child from touching their own eyes or other mucous membranes after contact with the lesions. Have your child wash their hands thoroughly and often.
In most cases, patience, a healthy diet, and maintaining excellent hygiene are the best remedy for both. Avoid excessively acidic or salty foods while a canker sore is present and use Tylenol (acetaminophen) or Motrin (ibuprofen) as needed for discomfort. The duration of a cold sore can be shortened with over-the-counter topical creams or an antiviral medication prescribed by the doctor.
Malocclusions (Improper bite)
Developing malocclusions, or improper bites, can be recognized as early as 2-3 years of age. Often, early steps can be taken to reduce the need for major orthodontic treatment at a later on.
At an early age, we are concerned with underdevelopment of dental arches, premature loss of primary teeth from decay or trauma, and harmful habits such as thumb or finger sucking. As the adult teeth start to emerge around age six, we will continue to evaluate your child's smile and assess whether they would benefit from a referral to the orthodontist.
The American Academy of Orthodontists (AAO) recommends children see an orthodontist by the age of seven if a problem is identified. But don't worry, most kids don't need braces until all of their adult teeth are in at around age twelve.
Impacted Wisdom Teeth
Wisdom teeth are the third and final set of molars that erupt in the back corners of the mouth between the ages of 17 and 21. Unfortunately, most people don't have room in their jaws for these teeth to emerge and need to have them surgically removed to avoid dental problems.
Discomfort from wisdom teeth usually presents as a deep pain in the back of the jaws that radiates toward the ears. If your child is experiencing these symptoms, please contact our office so we can evaluate if it's time for them to be referred to the oral surgeon.