Oak Dental Frisco

Why do teeth hurt?

Man with toothache
 Why do teeth hurt?

Sometimes it is helpful to understand what is going on in your body.  Knowledge can give you a sense of control over the situation. I find this to be true for my patients who have tooth pain. 

The problem is that most people try to cover up the pain with medication in order to delay treatment.  This only makes things worse.

The purpose of medication is not to mask pain but to facilitate treatment so it isn’t such a bad experience.  Drugs themselves can also be therapeutic allowing and helping the body to heal.  In addition they can lessen pain.

Over the counter medications can definitely help pain, but sometimes the body will give you even more pain when you are not paying attention to a lower level of pain.

Tooth pain is this way.  Teeth are alive with blood supply and nerves.  Unfortunately the only nerve in a tooth is a pain nerve.  Any stimulation of a tooth will feel painful.

We feel pain in our teeth because this pain nerve is awakened.  This can be caused by extreme temperatures, bacterial decay, or trauma.  This is the body telling you that you need to take action. 

Sometimes the pain is extreme and lasts a long period of time.  This is different than sensitivity which is more a dull ache that is not spontaneous and goes away quickly.  In this publication I will discuss severe pain and not sensitivity (I will write again on sensitivity in the future) that wakes you up at night.

Pain is motivating.  If infection is allowed to continue without pain, death or permanent damage to the body is a possibility.  That is why pain is good.

But wait a minute doc!  I don’t like pain.  It hurts after all!!!  What are you going to do about it?   Pain that is no longer helpful can and should be treated, once the cause is indentified and cured.

Teeth that are dying cause the most pain.  This is because pressure builds inside the tooth where the nerve is enclosed, much like your brain is encased in your skull.  This greatly stimulated the pain nerves inside teeth

Pressure is caused by gases created by bacteria that invade the living part of the tooth.  We remove the entire living part during a root canal and replace it with filling material to stop and prevent infection.

But what about biting pain?  Chewing pain can be caused by trauma or infection outside of the tooth about the gums and ligaments that line the bony socket where the tooth lives. 

Usually, the cause of the infection is the tooth itself which leaks bacteria into the surrounding ligament and bone.  This is what happens when a tooth dies.  The now dead tissue rots and is very dangerous. 

At this point the tooth does not hurt at all because the nerve inside the tooth is dead.  However, there are plenty of nerves outside the tooth in the ligament and bone that will also feel the pressure of the infection.

Pain is caused by anything touching the tooth.  It can even be spontaneous and keep you up all night.  When this happens, don’t wait another minute, go right to the dentist.

Sometimes root canals don’t get started until this point.  Antibiotics are critical here as well as pain medication.  There are two important places for antibiotics to go: inside and outside the tooth.

Pill antibiotics will travel through the blood stream to the bone and ligaments, and medicine is placed directly into the tooth once the tooth is opened with a root canal.

I usually have my patients take pill antibiotics before and several days after to first root canal appointment.  During the root canal I place antibiotic in the now empty canal and let it sit for two weeks.

Once the body shows signs of healing without pain, I determine that the root canal can be treated and remove the medicine and place the final root canal filling.

That’s fine doc but what if it takes me some time to get to you.  What over-the-counter medications can I take to help?

1.  Oral topical anesthetics are useful for gum pain but won’t get inside a tooth or bone in a more significant infection.  Examples are Orajel and Anbesol. 

2.  If there is a missing filling you can use over-the-counter temporary fillings to cover the hold which will usually lessen the tooth pain. Cloves are a natural tooth pain reliever and are a part of most temporary fillings.

3. If you can take Motrin or Advil which are both made from the drug ibuprofen, I recommend taking 800mg three times a day for adults.  If you have stomach problems use Tylenol XS or generic acetaminophen 500mg instead.

Do not take more than 8 Tylenol a day as this can harm your liver.  Do not take more than 3200mg of Motrin a day either as this can harm you digestive system.

I hope this helps!  Please be aware that I keep my cell phone on me all the time and I can respond to after-hour emergencies.  Please call me at 972-800-2312 if you are have extreme tooth pain. 

If you have never been seen by me, I will not be able to prescribe medications but will make you an appointment early the next day.  If you are a patient of record who I have seen in the last year, I can call in medications after-hours and on weekends.

God’s blessings to you,

Dr. Philip N. R. Estes

When should my child get braces?

Teen with braces

A common question I get asked is “When should my child get braces?” 

The answer is an ambiguous “it depends” and then I open up some key factors to consider:

First of all, braces are for kids who already take good care of their teeth.  “Do you question your kid’s oral hygiene?  Do you constantly have to bug them to brush and floss?”  If the answer is yes, it’s not the right time to get braces. 

They need to mature and to show you they are ready.  Braces are a privilege that must be earned.  Otherwise the gums will get puffy and bleed and cavities can occur.  Another likely outcome is having white spots that halo around the bracket where bacterial plaque stayed too long.  This takes out the minerals on the tooth surface leaving behind a chalky-white unsightly appearance on the front teeth.  Not what anyone wants.

Second question is, “does your child want braces?”  Sometimes it’s mom or dad who is driving the decision to get braces.  But does your child want them?  If not, that’s okay and as we all know kids change a lot.  Sometimes they need to understand why braces are a good thing.  Maybe they need to be a little older.  Convincing most boys about age 12 takes some doing.  Pushing them is a big mistake.

So what are some reasons to consider?  There is the obvious case when a child has a skeletal problem with a severe over or under-bite.  Usually this requires tooth extractions and maybe even oral surgery like I had as a kid.  This is the category I fell into and it was easy to convince me by age 14.

Less obvious are cases where your child is starting to wear off certain key teeth and chipping front teeth.  This can be a sign of a bite that is off and destructive to the teeth.  This is the case where braces can prevent a life time of avoidable dentistry.

Crowding can be a hygiene problem.  Kids might not be proud of their teeth and decide that they aren’t worth the trouble if they don’t like themselves.  Showing them that there are ways to straighten the teeth and make them easier to clean might motivate some children.

Prevention of jaw pain.  Having an ideal bite lessens the wear and tear on the jaw joints, muscles and nerves.  If you suffer from this, it might be worth checking out to see where your child is with their bite.  Once jaw pain starts there is already some amount of damage taking place.  Best time to act is early.

Timing.  They say timing is everything, this is true with braces.  Two approaches are common.  first is an early, usually two-stage approach and the other is a single stage approach.

Assuming that your child has good oral hygiene and that they want braces, the next step is to see an orthodontist for a consultation.  Age seven or eight is the best time.  This is because much can be done to influence the growth of your child to correct problems at that age.  If untreated, surgery and tooth removal becomes more likely.  Early intervention usually requires a second stage after all permanent teeth are erupted, about age 12 or so.

If all permanent teeth are able erupt and there is no need to create extra room, a single stage approach might be sufficient beginning when your child has all permanent teeth.

Having a good long-term relationship with your dentist will lead to better information for yourself and your child.  They will be better able to catch the early intervention cases and will be able to follow your child’s growth and development.  That means better TIMING for braces.  It also means prescribing necessary treatment without over-treatment.

I hope this discussion helps, please let me know if you have any questions.  Thank you!

Dr. Philip Estes

 

Are Baby Teeth Important?

Smiling kid
Are Baby Teeth  Important?

Simply put, yes! I have seen many parents opt to pull their child’s baby tooth rather than fill a cavity because “it is only a baby tooth and will come out eventually anyway.” Baby teeth serve important purposes such as helping the child to speak and chew normally.  Baby teeth also hold a place for permanent teeth to come in properly.  They also serve as scaffolding for growth and development of facial structures.

Will Pacifiers and Thumb Sucking Harm My Baby’s Teeth?

According to the Academy of Pediatric Dentistry, pacifiers and thumb sucking only present a problem if they persist for a long time, such as when the permanent teeth began to arrive, about age six.

Can I Brush My Baby’s Teeth?

Yes, but without fluoride toothpaste. You can use a small toothbrush with soft bristles at bedtime to remove plaque and bacteria. Instead of using adult toothpaste with fluoride, just use a small amount of children’s toothpaste. There are several soft bristled toothbrushes and toothpaste on the market that are designed specifically for infants.

When Can I Use Fluoride Toothpaste for my Child?

At age six, a child should be ready to use toothpaste with fluoride. It is very important that only a small amount of toothpaste is used, such as the amount of a pea. The child should also be watched while brushing to be sure they spit out the excess toothpaste instead of swallowing it.

What Is the Proper way to Brush my Child’s Teeth?

Brushing your children’s teeth at least twice a day is very important, but it should also be done properly.  Make large circle movements or up and down.

When Should I Take My Child to the Dentist for the First Time?

According to the American Academy of Pediatric Dentistry, children should visit a  dentist when their first tooth comes in or no later than their first birthday.

How Often Should my Child Have a Dental Check Up?

Most children should see their dentist for a regular cleaning and check up every six months. Your dentist will determine if there are any special circumstances that might require more frequent visits.

What Will Happen at My Child’s Check Up?

Many children are terrified of the dentist, but going to the dentist doesn’t have to be scary if they know what to expect.  Following an older sibling can help but so can going every six months to the same dentist.  Building a relationship with your dentist and the entire dental team is the best ways to prevent fears.

When Will my Child get Permanent Teeth?

Each child is different.  Some start as early as 5 others as late as 8.  Children who get their baby teeth late will lose them late as well.  Children take about five to six years to lose them all which is usually about age 11 or 12.  That is why it is so important to prevent and treat cavities as early as possible.  Early tooth loss at age 4 or 5 must be dealt with carefully to allow all of the permanent teeth to erupt normally.

I hope you have enjoyed this discussion on baby teeth.  Please send in your comments and I will address them.  Thank you!!

Dr. Philip Estes

Sleep Apnea Treatment

TAP appliance

Oak Dental Frisco now is offering through Patterson Dental and Airway Management the Thornton Adjustable Positioner (TAP). The TAP is a proven treatment modality for patients suffering from snoring and Obstructive Sleep Apnea (OSA). The TAP fits over the teeth similar to a mouth guard and advances the jaw forward during sleep, keeping the airway open and eliminating snoring and sleep apnea.

Fully adjustable for comport and adaptation, the TAP is much more accepatable to patients who suffer from OSA than conventional snore guards.

The TAP  allows the jaw to move side to side without restriction.  At the same time it can be adjusted to the point where it works.

During the initial treatment, patients take home a pulseoximeter that measures the oxygen saturation that you experience during the night.  The home “sleep study” allows the dentist to adjust the TAP to the amount necessary to acheive desired oxygen saturation results.

Typically, patients diagnosed with OSA are prescribed a Continuous Positive Airway Pressure (CPAP) device and facemask to wear while sleeping. While CPAP has been proven effective, many struggle to use the device regularly due to side effects that can range from mask discomfort to nasal congestion, irritation and headache.

Patients who seek treatment now have a choice and are no longer limited to wearing a CPAP and mask while sleeping.   According to the National Sleep Foundation, 20 million Americans have sleep apnea.  Are you one of them?

If you are interested in having more information about your options when treating sleep apnea, please contact our office at 972-335-4145.  If you haven’t already done so, contact your Medical Doctor who can order a hospital sleep study for sleep apnea diagnosis.

Dr. Philip Estes

I hate my dentures, what do I do?

Dentures

Complete denture wearers suffer with about 20% or less of the natural function they used to enjoy when they had teeth.  They suffer with adhesives and embarrassing situations such as having the dentures come out in public while speaking or sneezing.

Can’t something be done?  YES!  Nobel Biocare is a leading implant company that has developed a system called “Bar Attachment Denture” that can solve this problem once and for all.  Their system involves four or more titanium implants placed in each dental arch with a stream-lined denture that screws into place.

I still have teeth the are not savable, does this work for me too?  YES!

Do the teeth come out?  Only once a year for maintenance and cleaning at the dental office.  Otherwise, they ARE your teeth.  No more adhesives.  No more taking them out at night and putting them in a glass.

How well do they work?  Chewing efficiency and function is FOUR TIMES better than dentures alone.  All foods are back on the menu.   You don’t feel the individual pressure from each tooth, just on the implants.  Therefore you still lack the tactile sensitivity that natural teeth have.

My dentures feel bulky like I’m wearing a mouth guard, how is this different? There is no longer excessive denture material next to the cheek, lips or on the palate.  The final prosthesis is just the teeth and enough pink acrylic to cover the titanium bar underneath.

How soon do I get my teeth?  Immediately!  The implants are fixed with temporary teeth at the time of the surgery.  After about 3 months a final set of teeth is made.

Can I customize my look?  Yes!  The final teeth can match any shade, shape, position, and other features of your former teeth.  We can use old pictures too.  A mock-up can even be fitted into your mouth to see how it looks before it is completion of the teeth by the lab.

How bad is the surgery, does it hurt afterward?  No worse than getting a tooth pulled.  Most patients say that it is painless.  Sedation is used so that you have no memories of the surgery at all.

Sounds too good to be true.  How much does it cost?  There is a flat rate of $20,000 per arch.   Yearly maintenance following the procedure costs $300 per arch which includes changing out the screws and cleaning the teeth.

How do I learn more?  Contact my office at 972-335-4145 to schedule a no cost consultation.  Tell the receptionist you are interested in the “Bar Attachment Denture” consultation.

I hope this has helped you learn more about the options that you have when it comes to getting rid of your dentures.

Philip N. R. Estes, DDS

Does it make sense to have dental insurance?

Woman scratching head

Frustrated about dental insurance?   We can help!  We work with most PPO type plans and can help you navigate through the plethora of insurance companies.  If that isn’t enough each company has a multitude of plans types and options.  Selecting the right plan to fit your needs is critical.  Having the wrong plan can cost you a lot of money over the yeas.

What about just going cash?  Sometimes the best insurance is no insurance at all.  If you evaluate your risk and are good about having money available should the need arise, maybe you can pocket the premiums.  After a few years of setting aside the same money that you would have used to pay for insurance premiums, you can usually afford quite of bit of work.  This takes discipline and dedication.

If you are a new patient and don’t have insurance, we offer a low-risk comprehensive exam and x-rays for only $99.  With the exam you will get a treatment plan and complete estimate for your dental care needs.  That can assist you in figuring out how much need, or lack thereof, for insurance that you have.

We accept CareCredit http://www.carecredit.com/  which can help you spread out the burden of dental fees over a six month period with no interest monthly payments.  Ask Jenny for more details.  972-335-4145.

There are good points to insurance to be sure.  For starters, going to a participating office limits how much you can be charged as the rates are already negotiated.  Even if the plan does not pay for certain items, it still saves you money.

Secondly, insurance companies do their homework to ensure that each office meets basic standards of care and maintains them.  This protects you as a consumer who might not know anything about dentistry.

Thirdly, if you do not keep much of a cushion of cash in your budget, insurance allows you to minimize the impact of an expense.

Whatever your situation we want you to have the tools available to you in order to make the best informed choices to save you money and to make the treatment you need a reality.  Because in the end, we want you healthy and happy!

I hope this information has helped.  Please contact our office for your specific concerns.

-Dr. Philip N. R. Estes

What do I do if a tooth gets knocked out?

Tooth

Injuries always involve a certain level of shock.  The victim will not be thinking clearly.  Throughout treatment calmly talk to the injured person and assure them that help is coming.   

Whenever there is trauma to the body always look for head injuries too.  If any injury causes loss of consciousness, severe bleeding, breathing trouble, extreme pain, threat to a limb, threat to eye sight, or if you are uncertain of the extent or risk of an injury, CONTACT THE EMERGENCY MEDICAL SERVICES (EMS), usually by dialing 9-1-1.   Do not delay in getting medical help!!!

FIRST AID is critical to minimizing permanent tissue damage and disability.  First make certain that it is safe to approach the victim.  If safe, assess the victim for injuries.  Contact EMS 9-1-1 or send someone competent to contact them. DO NOT delay in getting help.  Once you are sure that EMS is activated, begin first aid within the limits of your abilities. 

Education is paramount in preparing for rending first aid.  This post will only focus on tooth trauma.  I highly recommend taking an American Red Cross First Aid class or classes from other similar agencies.  Do not give first aid if you are non certain of your abilities.

First Aid treatment for teeth that have been knocked out:

1. Determine if the tooth is a baby or an adult tooth.  Baby teeth are not re-implanted.   Front baby teeth do not hold space for the adult teeth that will begin to erupt at age six, and the early loss of one of these teeth rarely causes harm to the adult dentition.

2. Handle the adult tooth by the enamel “crown” part and NOT the root.  Touching the root will damage the cells still attached to it and will minimize the chance of successful tooth re-implantation.

3. Look to see if the adult tooth has any sharp edges or if bone is still attached.   If the tooth has a sharp part and not rounded, then the root of the adult tooth is broken and re-implantation is not possible.   This means that the trip to the dentist may be put off until it is convenient.  The only things a dentist can do under such circumstances it to prescribe pain relievers, antibiotics and to place artificial bone in the socket for possible implant placement at a later date by an oral surgeon or a periodontist.

4.  Look for dirt on the tooth and clean the non-fractured adult tooth by having the victim spit on it.   If the tooth is dirty, simply have the patient remove all dirt with their own saliva.

5. Once cleaned of visible dirt, place  the tooth into its socket. Any  tooth must be re-implanted in the socket within 60 minutes if the re-implantation is to have a reasonable chance of working. This may be done at the site of the accident by any adult  or the patient  provided the tooth is fairly clean and provided it slips back into the socket easily with light finger pressure.  If the tooth goes back into its proper position so that the patient may bite down without pushing the tooth out of its normal alignment, then the process has been successful.

6. Contact the dentist.  You still must take the patient to a dentist, but the major emergency has been averted and there is less urgency associated with the emergency once the tooth is back in its position.

If the tooth cannot be replaced in the socket (for any reason), then there are four ways to transport the tooth to the dentist’s office:

1. Have the victim store the tooth in their own mouth in the pouch between the cheek and the top back teeth.  DO NOT SWALLOW THE  TOOTH.  Transport the patient to a dentist ASAP.

This is NOT advisable if the child is under the age of six since the child may swallow the tooth.  If this is the case, proceed to the next two options.

     2. Place the tooth is a cup of clean sterile saline (salt water) as with contact cleaner.

3. Place the tooth in a cup of fresh milk (any fat content).  This has nearly the same advantages as saline.

4.  Place the tooth in a cup of a commercial product that is available for the storage of an avulsed tooth if you, or someone you know happens to have it in their medicine cabinet.  The manufacturer states that the tooth may be re-implanted up to 24 hours after the avulsion if it is kept in this solution.

Once you are at the dentist office be ready to give details about the event.  This will help to provide the dentist with information to better treat the patient.

I hope that you never have to use this information but it will come in handy if you do.

-Philip N. R. Estes, DDS

Title: What is a root canal and why do I need one?

Diagram of a tooth's inside

Anytime you say the woods “root canal” most people suddenly have the urge to be somewhere else, even at work, driving in heavy rush-hour traffic, doing their taxes, or visiting with their in-laws.

Okay, so if this is such a terrible event, why is it done?  And if it must be done, how can we make it any better?

The fact is that deciding to do a root canal is a very complex process and can take several visits to diagnose.  Pain is the main reason that leads a patient to finally decide to go to the dentist.  Initially, cavities are not painful.  It isn’t until the cavity infection nears the nerve of the tooth that it hurts.  This is why routine dental exams are so important to keep this from happening in the first place.

Okay, so your tooth is stressed out and it is letting you know by giving you pain.  Now what?  If your dentist determines that the tooth is dead or that the tooth will no longer return to normal, then it is time to have the “root canal discussion” with your dentist.  This can take a while to occur and this is not a clear-cut decision.  This is because the decision is such a lasting one.

At the point of determining the need for a root canal you have two choices: to remove the tooth-generating infection or to remove the infection inside the tooth.

Basically that’s what a root can is, removing the infection inside the tooth then sealing it off from the rest of the body.

It should be understood that a root canal is a last-ditch effort to save a tooth that otherwise is a serious health hazard and capable of leading to a potentially life threatening infection.  Root canals are a “mummification” of the tooth that is otherwise dead and harmful to your body.

That doesn’t sound good does it?  BUT root canal-saved teeth can last many years before being lost.  Five years could be considered successful; 20 years would be an extremely successful root canal.  However, eventually the tooth will fail.  Infection will leak into the surrounding bone and start another abscess.  The tooth will fracture or the body will reject the tooth which might start dissolving it.

I hate the idea of having a tooth pulled; I’ll get the root canal!  How can you make the experience better?  Nitrous oxide and or an oral sedative can help.  Profound anesthesia is a must.

I always do my root canals in at least two visits.  Why?  Root canals are long procedures.  Breaking them up in two appointments is easier on your jaw not to mention your busy schedule.  Profound anesthesia usually lasts an hour anyway. Another reason is that it gives me the opportunity to pack medicine inside the opened canals during the first appointment to kill more bacteria while you are waiting for the next appointment. A second appointment also lets the tooth, ligament, and bone start healing before the final sealing of the canals leading to a greater chance of longer survival of the root canal.  Speaking of…

To prolong the life of root canal teeth, it is important to have a crown, especially on the larger teeth like molars, to hold it together and to provide a tough biting surface for protecting the tooth.  This adds to the expense of a root canal, but at least most insurance will cover some of it.  However you might be looking at merely delayed costs…

Even with a perfectly performed root canal and crown, it might not work.  The best root canal specialists with eleven years of college (Endodontists) have about a 90% five-year survival rate.  The root canal might very likely be just delaying eventually pulling the tooth.

What if we just pull it doc?  That will solve the infection and pain problems for sure, but losing a tooth leads to other problems like drifting of adjacent teeth and over-loading the remaining teeth with the biting forces.  Teeth will move toward the space vacated by the missing tooth.  Over time this might work to close the space but can cause unhealthy hyper-eruption of opposing teeth, painfully altering your bite, and tilting teeth that are loaded in a destructive way leading to more tooth loss and pain/fractures.

If the tooth cannot be saved at all or if you decide you don’t want a root canal, there are several options to restore the missing space left behind:

1. Dental Implants- titanium screws that act to anchor new replacement teeth to the jaws.  They can also be used to retain dentures or even whole-arch fixed bridges that stay put.

2. Bridges- fixed restorations that span the space using the adjacent teeth as support like….well….a bridge.

3. Partial dentures- if you want to replace an end tooth it might not be possible with a bridge if there is no possible anchor tooth.  Partials are removed and cleaned each day.  They can be a great solution especially if you are missing several teeth on both sides of an arch with good teeth elsewhere.  They are difficult to adapt to but are more affordable than implants, plus dental insurance might cover them as well.

4. Complete dentures without implants- this in my opinion is the ultimate thing to avoid if at all possible in dentistry.  Preventing dentures is the goal of comprehensive dentistry.  IF this is necessary, look at upgrading to implants that attach the dentures to the jaws.  The cost of implants is going down and new techniques are constantly being developed to replace a complete arch, even without bone grafts!  (More to follow on that topic)

BOTTOM LINE: root canals are the conventionally way to save a tooth that otherwise must be removed due to pain and or infection.

I hope that you have enjoyed this short discussion on root canal treatment and that it helps you in the future.  Please ask questions related to this blog and I will answer them each week.

Blessings to you all,
Dr. Philip Estes

Title: What exactly is a cavity?

Illustration of a tooth with a cavity

Cavities are an infection caused by bacteria that find their way into teeth.  Eventually they get through the enamel (the outer white part of the tooth).  I liken this to a shield.  It is the strongest stuff in the body, much harder than bone.  Even so, bacteria infect the enamel and then enter the next deeper layer of the tooth called dentin.  Dentin is yellow and surrounds the pulp and nerve deep inside the tooth.

Sugar is eaten by the bacteria who convert it to acid which is then excreted on or inside your tooth giving them room to borough to be protected from your mouth. (Think about that the next time you suck on a hard sugar candy for an hour)  Your mouth is a very dangerous place for bacteria.  Your saliva itself and fluoride kills them.  Over the millennia these simple single-celled creatures have developed the ability to protect themselves in this way by hiding inside the tooth and developing resistance to the acid that they make which actually kills competing bacteria of other strains.

Using refined simple sugars from sugarcane, we pass these specific decay-producing bacteria on from parent to child.  How do we stop this?  If you are a parent or going to be a parent, get your cavities taken care of before infecting your children.  This sounds harsh but it is 100% accurate.  Next take your family to the dentist twice a year starting at about 12 months of age.  Eradicate cavity producing bacteria from the mouths of all family members and you will keep from passing these bacteria on from generation to generation.  But we have a powerful weapon…

Fluoride is so useful because it lowers the pH levels necessary for bacteria to achieve with the acid they produce to dissolve tooth structure, making your shield stronger as the tooth is growing during childhood.  This is why we fluoridate water, not to make you a communist…The best concentrations seem to be about 1 PPM (part per million) to 0.6 PPM in drinking water.  Too much and white or brown spots form on the developing permanent teeth; too little and cavity rates increase.  Once formed fluoride does not cause spots on the teeth.  This is why we pack fluoride into ADULT toothpaste.  This is also why you want to give young children under seven years old children’s toothpaste which does not contain as much fluoride.  Kids tend to swallow adult toothpaste leading to toxic levels causing spots on the forming teeth.

After the eruption of teeth, fluoride is just as useful by microscopically patching up the holes punched by bacteria and even killing bacteria at the surface of the teeth.

Saliva kills bacteria too, but more importantly it is itself an acid buffer.  Saliva has the ability to keep bacteria-produced acid from achieving a pH strong enough to dissolve tooth structure.  There is a finite ability for your saliva to do this.  That is why snaking in-between meals is so bad.  It takes time for your saliva to “re-charge” its buffering capacity.

All sugars are not created equally.  Simple sugars like high sucrose corn syrup are easily metabolized by bacteria. Complex starchy sugars are not.  Frequent snakes with sticky sugars that hang in your mouth for hours or beverages like fruit juice, sugar soda pop and coffee are great food sources for cavity producing bacteria.

Are all bacteria bad? Why not kill them all with mouthwashes that are high in alcohol?  The truth is that very few strains of bacteria lead to infection.  It is a diet that selectively gives advantages to the few cavity-producing strains that is the problem.  A balanced diet with whole fruits and vegetables limits cavities.  Processed simple refined sugars should be limited to meal times only.

Infants and toddlers are another age-group in trouble across the country.  Baby bottle tooth decay is on the rise.  Giving babies milk, juice, or anything other than plain water is a common cause for many early childhood cavities.  Limiting your baby to active-feeding defined meal times stops this.  Introducing complex sugars in natural foods also helps.  JUICE is not healthy for teeth!  Neither are gummy candy vitamins.  Finally, all children need supervised brushing every day, even babies with just two teeth!

BOTTOM LINE: cavities are 100% preventable with adequate but not excessive fluoride, good care at home, routine visits to your dental office, and with a healthy diet.

Dr. Philip Estes

Title: When should I take my child to the dentist for the first time?

kid in a dentist chair

There is much confusion about this topic so I have decided to write about it in this blog.

Traditionally, general dentists have…well…not enjoyed treating infants and toddlers so they have said to bring children in once they can be reasoned with at about age 3 to 4.  The problem with this is that children begin to be inoculated with cavity-producing bacterial about the time that they first get their teeth.

Because of this children should come in for  the first time when they get their first teeth or about at 12 months.

Early childhood cavities are the fastest growing cavity rates of all age groups in the United States.  Wealth and prosperity has led families to provide JUICE and processed formula milk for their infants and toddler children around the clock.  Each of these products contain SUGAR.  If the exposures are consistent, especially at night while feeding is passive, bacterial infection can quickly destroy baby teeth, even newly erupted baby teeth.

Prevention is key.  Early childhood cavities are completely preventable with infant oral exam containing tooth brushing instructions with fluoride varnish treatment.

More importantly, children don’t come with instructions.  As a parent I have learned this frequently.  That is why education for parents also happens at the first dental visit.  This is called an “infant oral health” exam.  Dentists go over oral hygiene, diet and nutrition, growth and development, and can answer any questions about what is normal and how best to take care of their child.

I should also say a word about fluoride here.  Fluoride is VERY important to prevent cavities.  However, most children get too much and they swallow toothpaste during brushing.  That is why daily brushing should be done by parents allowing the child to “practice” with direct supervision.  Also, children should only brush with children’s toothpaste.  Adult toothpaste has too much fluoride which if swallowed can cause fluorosis which leaves developing adult teeth with permanent white or brown scars.

BUT WON’T THEY JUST SCREAM?  Let me ask you, do you avoid everything that makes your child scream?  I’m sure you change their diapers, right?  I bet they often scream.  This is a normal response for a child.  It doesn’t bother me and it also doesn’t bother your child to be examined.  And no, they aren’t learning to hate the dentist.  They are just being a kid and when a kid experiences something new, they scream.  ACTUALLY, they open wider when the scream which makes the exam easier and better.

Another key point is that kids don’t distinguish a medical facility from a dental facility.  Usually, every visit at a medical facility involves some sort of a vaccination “shot” or booster injection.  Kids normally learn this quickly and assume the same thing will happen at a dental office.  So if your child fusses when you take them to the dentist, that makes it all the more important that they learn the difference.

What if they have a cavity and need a shot?  If they have a cavity it isn’t going away on its own.  Most baby molars last in the mouth until age 11 or 12!  So they need to be fixed.  Nitrous oxide and sedatives can be used BEFORE the local anesthetic to make it painless.

THIS IS AN IMPORTANT POINT:  DON’T PROJECT YOUR FEARS ON YOUR CHILDREN.  Dentistry has changed a lot over the past 30 years and there is much more attention to discomfort and limiting anxiety using non-threatening approaches, sedatives, and building good relationships with a dentist that has earned your trust.

Talking to your child about an up-coming dental appointment should not include an emphasis on how it will or won’t be.  Saying “We are going to the dentist, but I won’t let them hurt you like they hurt me as a child!” is NOT comforting to a child.  Siblings can also get into the act with talking about inappropriate procedures.  Some older children will tell their little sister or brother how the dentist will be pulling all of their teeth and sticking them with needles all over their mouth.

Instead, the day of the appointment simply say, “We are going to the dentist so that your teeth can be cleaned and examined” is not only appropriate but TRUE.

I NEVER LIE TO MY PATIENTS and this includes toddlers.  In child terms I explain as much as they want to know and do not sneak up on them with anything.  This builds trust and confidence and forges an important relationship.

BOTTOM LINE: Forming early relationships between dentist and patient is critical.  First visits should end up with a good experience leaving your child unafraid of dental treatment for a lifetime leading to higher quality of life.

I hope that you have enjoyed this short discussion on infant oral health and that it helps you in the future.  Please post questions related to this blog and I will answer them each week.

Blessings to you all,

Dr. Philip Estes