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Your Child’s Teeth

Published in Gilroy Today by Jernell Escobar, DDS.

One of the most frequently asked questions by parents in my practice is, “when should I take my child to the dentist?” In this article, we will address when to initiate dental care for your child and discuss milestones in your child’s treatment. 

The American Academy of Pediatrics suggests that a child’s first trip to the dentist should occur shortly after the appearance of their first tooth and no later than their first birthday. Often, the follow up question is, “why would I take my child to the dentist at such a young age?” The first visit to the dental office does not involve cleaning the child’s teeth. It is important to introduce your child to their new “dental home” to familiarize them with the environment. The appointment begins with a brief check of the oral cavity. This exam can tell the dentist a lot about a child’s development and health. It is possible to observe chromosomal abnormalities and health problems that can manifest themselves in the teeth and gums. Second, it is especially important for first-time parents to become educated about how to take care of the teeth of the newest members of their family. The dentist can give guidelines as well as cleaning demonstrations so that you can provide the best home care for your child. In addition, the dentist can give some practical advice that could potentially prevent costly and painful dental procedures. One example of this is the prevention of “baby bottle rot.” Many parents find that a great way to pacify a child is to send them to bed with a bottle of milk. Over time, this graduates to juice and in some circumstances soda. The constant contact of sweet liquid on the teeth can lead to rampant tooth decay. During the first visit, the dentist will also make a recommendation as to how frequent subsequent dental visits should occur. 

Pediatric dental visits are also an important time to talk about other topics such as fluoridation. Fluoride can be a touchy subject for some. However, if it is your intention to give your child fluoride, than the time frame as well as the dosage is important. Frequently, the pediatrician prescribes oral fluoride in conjunction with a multivitamin. However, there are things to consider that the pediatrician may or may not take into account. It is important to determine whether or not your child is receiving any fluoride from their municipal water source and if so how much. Once this determination is made, the correct dosage can be prescribed. This is very important because too much fluoride can be deleterious to teeth. 

The next milestone in your child’s dental care will be their first dental cleaning. This should occur between two and three years of age. At this visit, the child is introduced to the variety of instruments and equipment at the dental office. The instrumentation is referred to by clever names and the children are encouraged to play with them to see how they work. The oral exam conducted at the cleaning will be a time to review how well the home care is progressing and to point out areas that could use improvement. 

Around the age of five, the dentist will recommend that your child have their first set of dental radiographs. The purpose of the radiographs is two fold. First, the dentist is screening for cavities and infection that may be developing that are not visible during an examination. This is especially true of cavities that originate in between teeth. Second, the dentist is checking for the presence and to monitor the development of the incoming adult teeth. It is important to identify congenital problems, such as missing teeth, so that you and your dentist can be proactive about how to plan appropriately to repair or replace these teeth. If your child has required radiographs prior to this time frame, they likely have suffered some kind of dental trauma or infection.

Between the ages of six and eight, your child has likely lost some of their baby teeth and the adult teeth are beginning to make an appearance. This is a crucial time to evaluate the incoming position of the adult teeth and to do a comprehensive orthodontic evaluation. It is important because if the child is found to be deficient, early orthodontic intervention can mean avoiding costly procedures to correct a severe malocclusion. Also, around this time, the first adult molars have come in to view. At this point, your dentist may talk to you about sealing the top and side surfaces of the molars. This is done to protect the pits and fissures that are part of normal tooth anatomy and to prevent them from accumulating food and plaque. This should help to prevent the onset of cavities in those teeth. 

In conclusion, it is crucial that your child’s first dental experiences be positive as well as instructive. It is important that your child develops a trusting relationship with your family dentist so that routine care is straightforward and lessens the likelihood that your child will develop dental anxiety in the future.

Nutrition for Oral Health

Published in Gilroy Today by Jernell Escobar, DDS. May/June 2015.

Excellent daily oral hygiene is probably the most important way to keep your teeth and gums healthy. This includes effective brushing and flossing as well as the use of various oral rinses. Often forgotten but every bit as important to good oral health is a nutritious diet. Proper vitamins and minerals are essential to the health and development of the teeth and gums. We have all been told that too much sugar in our diets causes tooth decay. However, most of us fail to recognize the sugar that is present in foods we would not normally associate with having a high sugar content. When we talk to patients about cavity causing foods, we use the term “fermentable carbohydrates.” This refers specifically to the type of sugar that the bacteria that cause tooth decay love to eat. A cavity is a hole in a tooth caused by acid erosion. When the bacteria that cause cavities eat fermentable carbohydrates, they secrete acid as a byproduct that can dissolve tooth structure, thus creating a cavity. Many foods contain these fermentable carbohydrates such as bread, milk, grains, candy, fruit and the list goes on. You should not expect to eliminate these foods from your diet but you should moderate their intake and brush thoroughly after eating. Vitamins and minerals are essential to the development and maintenance of healthy teeth and gums. Often, people supplement their diets with over the counter vitamins and minerals because their diets are poor. However, studies have shown time and again that there is no substitute for proper nutrition. This will help to build strong teeth and bones as well as healthy gums. The mineral fluoride is a very well known tool in the fight against tooth decay. Topically, fluoride aids in the hardening of tooth structure. It makes tooth enamel stronger and can actually help reverse smaller cavities. When ingested during childhood, fluoride is incorporated into the developing adult teeth making them stronger. However, once the adult teeth have completely formed, the topical application of fluoride is the delivery modality of choice. Xylitol is a sugar substitute that has been shown to have an anti-cavity effect. Xylitol is a naturally occurring carbohydrate that is typically extracted from corncobs and trees. The natural sourcing of xylitol makes it a very attractive option for those who shy away from artificial sweeteners. Xylitol can be found in many sugar free chewing gums, toothpastes, mouth rinses and mints as well as a sugar substitute in many foods. Used in moderation, xylitol can help in the fight against tooth decay. In conclusion, a healthy and balanced diet in conjunction with effective oral hygiene will keep you smiling for years to come.

Night guards: Not just a piece of plastic!!

Published in Gilroy Today by Jernell Escobar, DDS. Spring 2014.

Part of each new patient exam is a comprehensive evaluation of each patient’s dental condition. Frequently it is determined that the patient could benefit from a night guard. A night guard is a protective plastic dental appliance that is worn on the upper or lower arch of the patient’s mouth. Often, patients do not feel that they need a night guard because it is not clear to them what damage the dentist is seeing or how the night guard could benefit them. We will attempt to explain some of the common reasons for the prescription of a night guard and how the appliance could be a benefit. Bruxism or grinding of the teeth is the most common reason for the prescription of a night guard. Teeth grinding is primarily a nocturnal activity but it is also something that may happen during the day. Often the points on the teeth have been worn away and a crater begins to develop in it place. Ultimately, the enamel is worn away exposing the softer dentine underneath. This can result in tooth decay as well as temperature and contact sensitivity. In extreme cases, the patient can have a bite that collapses due to the extensive wear to their teeth. The night guard serves to act as a barrier between the teeth to prevent damaging tooth-totooth contact. Another condition is clenching. Often people wake up with a headache or find themselves with tension headaches throughout the day. This can be the result of clenching. Often people have no idea that they are clenching until someone brings it to their attention. In addition, there are physical symptoms as well. Typically this can be observed in welldeveloped jaw muscles, fractures and fracture lines in the teeth and a build up of supporting bone in the jaws. It is also important to note that some of these symptoms can also be observed in “tooth grinders” as well. The night guard serves to break the tension that would otherwise be created by clenching the teeth together. Many people report resolution of their headaches and the practitioner observes a decrease in tooth damage as well. The night guard can also serve as a first line of treatment for people having problems with their Temporomandibular Joint or TMJ. It is important to note that bruxism and clenching can both be major contributors to problems associated with the TMJ. Some people require more sophisticated appliances in order to treat their symptoms and it is up to the practitioner to make this determination. In conclusion, the recommendation of a night guard is a simple treatment to prevent a series of tooth related problems in the future. It may also provide relief for symptoms you may be experiencing now. If you have been prescribed a night guard and are reluctant to proceed, we encourage you to begin a dialogue with your dentist to help you fully understand why a night guard is being prescribed.