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Posts for tag: pediatric dentistry

By Paul David Epstein, D.M.D. & Associates, P.C.
November 04, 2019
Category: Dental Procedures
TreatingaBabyToothwithInnerDecaycanbeComplicated-butStillNecessary

Even though a child’s primary (“baby”) teeth eventually give way, it’s still important to treat them if they become decayed. Primary teeth serve as guides for the emerging permanent teeth — if they’re lost prematurely, the permanent tooth may come in misaligned.

If the decay, however, affects the tooth’s inner pulp, it poses complications. A similarly decayed adult tooth would be treated with a root canal in which all the pulp tissue, including nerve fibers and blood vessels, are removed before filling and sealing. Primary teeth, however, are more dependent on these nerves and blood vessels, and conventional filling materials can impede the tooth’s natural loss process. It’s better to use more conservative treatments with primary teeth depending on the degree of decay and how much of the pulp may be affected.

If the decay is near or just at the pulp, it’s possible to use an indirect pulp treatment to remove as much of the softer decay as possible while leaving harder remnants in place: this will help keep the pulp from exposure. This is then followed with an antibacterial agent and a filling to seal the tooth.

If the pulp is partially exposed but doesn’t appear infected, a technique called direct pulp capping could be used to cover or “cap” the exposed pulp with filling material, which creates a protective barrier against decay. If decay in a portion of the pulp is present, a pulpotomy can be performed to remove the infected pulp portion. It’s important with a pulpotomy to minimize the spread of further infection by appropriately dressing the wound and sealing the tooth during and after the procedure.

A pulpectomy to completely remove pulp tissue may be necessary if in the worst case scenario the pulp is completely infected. While this closely resembles a traditional root canal treatment, we must use sealant material that can be absorbed by the body. Using other sealants could inhibit the natural process when the primary tooth’s roots begin to dissolve (resorb) to allow it to eventually give way.

These all may seem like extraordinary efforts to save a tooth with such a short lifespan. But by giving primary teeth a second chance, their permanent successors will have a better chance of future good health.

If you would like more information on treating decay in primary teeth, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Root Canal Treatment for Children’s Teeth.”

By Paul David Epstein, D.M.D. & Associates, P.C.
October 25, 2019
Category: Oral Health
ModerateYourChildsJuiceDrinkingtoLowerToothDecayRisk

Along with daily brushing and flossing, limiting your child’s sugar consumption is an important way to prevent tooth decay. We all know the usual suspects: candy, sugar-added snacks and sodas. But there’s one category you may not at first think fits the profile—juices. But even natural juices with no added sugar can raise your child’s risk of tooth decay if they’re drinking too much.

Tooth decay is caused by certain strains of bacteria in the mouth, which produce acid. Sugar in any form (sucrose, fructose, maltose, etc.) is a primary food source for these bacteria. When there’s a ready food source, bacteria consume it and produce abnormally high levels of acid. This can cause the mineral content of tooth enamel to dissolve faster than saliva, which neutralizes acid, can reverse the tide.

Juices without added sugar still contain the natural sugar of the fruit from which they originate. The American Academy of Pediatrics conducted a study of the effect of these natural juice sugars on dental health. Their conclusion: it can have an effect, so the amount of juice consumed daily by a child should be restricted according to age.

They’ve since published guidelines to that effect:

  • Under age 1 (or any child with abnormal weight gain): no juice at all;
  • Ages 1-3: no more than 4 ounces a day;
  • Ages 4-6: no more than 6 ounces a day;
  • Ages 7-18: no more than 8 ounces (1 cup) a day.

Again, these are guidelines—you should also discuss the right limits for your individual child with your dentist or pediatrician. And if you’re wondering what kind of beverages pose less risk of tooth decay, you can look to low or non-fat milk. And, of course, don’t forget water—besides containing no sugar, nature’s hydrator has a neutral pH, so it won’t increase acidity in the mouth.

Tooth decay is one of the biggest health problems many kids face. But with good teeth-friendly habits, including restricting sugar intake in any of its many forms (including juices) you can go a long way in reducing their risk of this destructive disease.

If you would like more information on best dental care practices for children, please contact us or schedule an appointment for a consultation.

By Paul David Epstein, D.M.D. & Associates, P.C.
August 16, 2019
Category: Oral Health
TakeStepstoTreatChronicMouthBreathingasEarlyasPossible

Many things can affect your child’s future dental health: oral hygiene, diet, or habits like thumb sucking or teeth grinding. But there’s one you might not have considered: how they breathe.

Specifically, we mean whether they breathe primarily through their mouth rather than through their nose. The latter could have an adverse impact on both oral and general health. If you’ve noticed your child snoring, their mouth falling open while awake and at rest, fatigue or irritability you should seek definite diagnosis and treatment.

Chronic mouth breathing can cause dry mouth, which in turn increases the risk of dental disease. It deprives the body of air filtration (which occurs with nose breathing) that reduces possible allergens. There’s also a reduction in nitric oxide production, stimulated by nose breathing, which benefits overall health.

Mouth breathing could also hurt your child’s jaw structure development. When breathing through the nose, a child’s tongue rests on the palate (roof of the mouth). This allows it to become a mold for the palate and upper jaw to form around. Conversely with mouth breathers the tongue rests behind the bottom teeth, which deprives the developing upper jaw of its tongue mold.

The general reason why a person breathes through the mouth is because breathing through the nose is uncomfortable or difficult. This difficulty, though, could arise for a number of reasons: allergy problems, for example, or enlarged tonsils or adenoids pressing against the nasal cavity and interfering with breathing. Abnormal tissue growth could also obstruct the tongue or lip during breathing.

Treatment for mouth breathing will depend on its particular cause. For example, problems with tonsils and adenoids and sinuses are often treated by an Ear, Nose and Throat (ENT) specialist. Cases where the mandible (upper jaw and palate) has developed too narrowly due to mouth breathing may require an orthodontist to apply a palatal expander, which gradually widens the jaw. The latter treatment could also influence the airway size, further making it easier to breathe through the nose.

The best time for many of these treatments is early in a child’s growth development. So to avoid long-term issues with facial structure and overall dental health, you should see your dentist as soon as possible if you suspect mouth breathing.

If you would like more information on issues related to your child’s dental development, please contact us or schedule an appointment for a consultation.

By Paul David Epstein, D.M.D. & Associates, P.C.
January 08, 2019
Category: Dental Procedures
Tags: pediatric dentistry   crown  
AStainlessSteelCrownCouldHelpaStrugglingPrimaryMolarLastLonger

Although primary (“baby”) teeth have a lifespan of only a few years, they’re still important to a child’s current and future dental health. In the present, they help a child eat, speak and smile properly. They also help create a healthy future as placeholders for developing permanent teeth yet to come in.

If, however, a child loses a primary tooth prematurely due to decay, the corresponding permanent tooth could come in misaligned. That’s why we do what we can to help a decayed primary tooth reach its full lifespan. And there are different ways to do this depending on the type of tooth.

With front teeth, which don’t encounter the same chewing forces as those in the back, we may use a tooth-colored filling. This approach is also preferable for appearance’s sake since front teeth are highly visible when a child speaks or smiles.

Primary molars, on the other hand, need a more robust solution. A filling may not be able to withstand the level of long-term chewing forces that these back teeth normally encounter. And because they’re less visible than front teeth, there’s less concern about aesthetics.

That’s why many pediatric dentists prefer stainless steel crowns for molars. Just like their permanent teeth counterparts, a primary crown fits over and completely covers a tooth. They’re typically pre-formed, coming in different shapes and sizes that can then be customized for the tooth in question. After preparing and removing any decayed material from the tooth, we can usually install the crown in one visit with local anesthesia and a sedative (if the child needs it for anxiety).

While a steel crown isn’t the most attractive restoration, it typically handles the higher chewing forces in the back of the mouth better and longer than a filling. That’s especially critical for primary molars, which are some of the last teeth to fall out (as late as ages 10-12).  And besides preserving it as a permanent tooth placeholder, a crown also helps the tooth function effectively in the present.

Regardless of what method we use, though, preserving primary teeth is a primary goal of pediatric dentistry. And with a stainless steel crown, we can keep those important back molars functioning for as long as they’re intended.

If you would like more information on caring for primary teeth, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Stainless Steel Crowns for Kids.”

By Paul David Epstein, D.M.D. & Associates, P.C.
July 17, 2016
Category: Oral Health
ActorDavidRamseyDiscussesBabyBottleToothDecay

Cavities can happen even before a baby has his first piece of candy. This was the difficult lesson actor David Ramsey of the TV shows Arrow and Dexter learned when his son DJ’s teeth were first emerging.

“His first teeth came in weak,” Ramsey recalled in a recent interview. “They had brown spots on them and they were brittle.” Those brown spots, he said, quickly turned into cavi­ties. How did this happen?

Ramsey said DJ’s dentist suspected it had to do with the child’s feedings — not what he was being fed but how. DJ was often nursed to sleep, “so there were pools of breast milk that he could go to sleep with in his mouth,” Ramsey explained.

While breastfeeding offers an infant many health benefits, problems can occur when the natural sugars in breast milk are left in contact with teeth for long periods.  Sugar feeds decay-causing oral bacteria, and these bacteria in turn release tooth-eroding acids. The softer teeth of a young child are particularly vulnerable to these acids; the end result can be tooth decay.

This condition, technically known as “early child caries,” is referred to in laymen’s terms as “baby bottle tooth decay.” However, it can result from nighttime feedings by bottle or breast. The best way to prevent this problem is to avoid nursing babies to sleep at night once they reach the teething stage; a bottle-fed baby should not be allowed to fall asleep with anything but water in their bottle or “sippy cup.”

Here are some other basics of infant dental care that every parent should know:

  • Wipe your baby’s newly emerging teeth with a clean, moist washcloth after feedings.
  • Brush teeth that have completely grown in with a soft-bristled, child-size toothbrush and a smear of fluoride toothpaste no bigger than a grain of rice.
  • Start regular dental checkups by the first birthday.

Fortunately, Ramsey reports that his son is doing very well after an extended period of professional dental treatments and parental vigilance.

“It took a number of months, but his teeth are much, much better,” he said. “Right now we’re still helping him and we’re still really on top of the teeth situation.”

If you would like more information on dental care for babies and toddlers, please contact us or schedule an appointment for a consultation. You can also learn more by reading the Dear Doctor magazine articles “The Age One Dental Visit” and “Dentistry & Oral Health for Children.”