David L. Gordley, D.D.S., LLC

During the preteen and teenage years, the jaws are growing and maturing, therefore it is easier to shift teeth at this stage rather than later on in adulthood.

More adults are choosing to have orthodontic treatment in order to improve the appearance of their teeth. Since their jaws are no longer growing, treatment may take a little longer.

BRUXISM

the habitual grinding of teeth, is a common occurrence in people with cerebral palsy or severe mental retardation. In extreme cases, bruxism leads to tooth abrasion and flat biting surfaces.

Refer to a dentist for evaluation; behavioral techniques or a bite guard may be recommended.

DENTAL CARIES

or tooth decay, may be linked to frequent vomiting or gastroesophageal reflux, less than normal amounts of saliva, medications containing sugar, or special diets that require prolonged bottle feeding or snacking. When oral hygiene is poor, the teeth are at increased risk for caries.

Counsel the parent/caregiver on daily oral hygiene to include frequent rinsing with plain water and use of a fluoride-containing toothpaste or mouth rinse. Explain the need for supervising children to avoid swallowing fluoride. Refer to an oral health care provider and/or gastroenterologist for prevention and treatment. Prescribe sugarless medications when available.

EARLY, SEVERE PERIODONTAL (GUM) DISEASE

can occur in children with impaired immune systems or connective tissue disorders and inadequate oral hygiene. Simple gingivitis results from an accumulation of bacterial plaque and presents as red, swollen gums that bleed easily. Periodontitis is more severe and leads to tooth loss if not treated. Professional cleaning by an oral health care provider, systemic antibiotics, and instructions on home care may be needed to stop the infection.

Explain that the parent/caregiver may need to help with daily toothbrushing and flossing and that frequent appointments with an oral health care provider may be necessary.

GINGIVAL OVERGROWTH

may be a side effect from medications such as calcium channel blockers, phenytoin sodium, and cyclosporine. Poor oral hygiene aggravates the condition and can lead to superimposed infections. Severe overgrowth can impair tooth eruption, chewing, and appearance.

Refer to an oral health care provider for prevention and treatment. A preventive regimen of antimicrobial rinses and frequent appointments may be needed. Consider alternative medications if possible.

Take time to talk and listen to parents and caregivers.

Tell parents and caregivers to seek a dental consultation no later than a child's first birthday.

Seek advice on behavior management techniques; early intervention and familiarization with the dental team may take several visits.

Evaluate and treat orthodontic problems early to minimize risk of more complicated problems later in life.

Advise caregivers to avoid serving snacks at bedtime.

FIRST VISIT

Your child's first visit to the dental office should be around his/her first birthday, but could be as early as you'd like (as soon as the first tooth erupts or even sooner). Here are some Do's and Don'ts.

Do:

have a tour of the dental office by going in for a casual, friendly, get acquainted visit and checkup

make an appointment for a visual check of your child's teeth

have a discussion with your dental hygienist or dentist about oral health care for your child

familiarize your child with the dental office. Consider taking them along when you or a sibling has a dental appointment

MALOCCLUSION

a poor fit between the upper and lower teeth, and crowding of teeth occur frequently in people with developmental disabilities. Nearly 25 percent of the more than 80 craniofacial anomalies that can affect oral development are associated with mental retardation. Muscle dysfunction contributes to malocclusion, particularly in people with cerebral palsy. Teeth that are crowded or out of alignment are more difficult to keep clean, contributing to periodontal disease and dental caries.

Refer to an orthodontist or pediatric dentist for evaluation and specialized instruction in daily oral hygiene.

MILK AND TEETH

Milk and other dairy foods, like cheese and yogurt, are very good sources of calcium. One 8 ounce glass of milk has about 300 milligrams of calcium. Just a few glasses can go a long way toward giving kids the calcium they need each day. Milk also has other vitamins and minerals that are good for teeth and bones. The vitamin D in milk helps the body absorb calcium.

Other healthy foods with calcium are dark green, leafy vegetables; orange juice with calcium added; and soy milk with calcium added. Be sure to see the food list on page 7 for some other foods with calcium.

PIERCINGS

Body piercing is becoming quite popular. Piercing parts of the mouth (oral) as body decoration. Oral piercing are seen in people of all ages and of all ages and of all professions but are more common in young adults.

Oral piercing sites include the tongue, the uvula (the soft tissue hanging at the back of the mouth), the lower and upper lips, the cheeks or even a combination of these sites. The tongue, being the most common area, is usually pierced in the middle, towards the tip. It may be pierced through its width, from right to left, or through its thickness.

Common Symptoms Include:

Pain, swelling, infection due to digital manipulation (handling) of the jewelry and large amounts of bacteria in the mouth, increased salivary flow, and redness due to the high blood flow to the tongue.

Risks Include:

Transmission of diseases such as Hepatitis, HIV, Herpes Simplex Virus, Tetanus.

Prolonged bleeding if blood vessels are punctured.

Hazard to the airway by swelling of the tongue or aspiration of the jewelry.

Allergy to metals and galvanic currents.

Loss of taste, mobility and numbness of the tongue.

Constant irritation to the oral tissues, including gingival injury.

Difficulty with mastication, speech and swallowing.

Abrasion and fracture of the dentition and restorations.

Damage to the pulp of the tooth.

Obstruction of radiographs of the oral cavity and skull.

Prevents proper oral examination.

TOOTH ANOMALIES

are variations in the number, size, and shape of teeth. People with Down syndrome, oral clefts, ectodermal dysplasia, or other conditions may experience congenitally missing, extra, or malformed teeth.

Consult an oral health care provider for dental treatment planning during a child's growing years.

TOOTH ERUPTION

may be delayed, accelerated, or inconsistent in children with growth disturbances. Gums may appear red or bluish-purple before erupting teeth break through into the mouth. Eruption depends on genetics, growth of the jaw, muscular action, and other factors. Children with Down syndrome may show delays of up to 2 years.

Offer information about the variability in tooth eruption patterns and refer to an oral health care provider for additional questions.

TEETHING

May make your baby restless and irritable. If fever, vomiting, or diarrhea occur do not relate this automatically to teething, as it is not generally the cause of these conditions. See your doctor first.

Some signs that your baby may be teething:

red cheeks or rash on cheeks

increased saliva/drooling

restlessness

irritability

loss of appetite

What to do?

Let your child chew on a cold, hard object, such as a teething ring. The coldness helps ease the discomfort and the hardness will speed up the eruption of the tooth.

Massaging your child's gums with a clean finger can help reduce pain and discomfort during teething.

Teething gels or ointments (ask your pharmacist for a brand name) are used to numb the gums and reduce the discomfort.

Teething cookies or biscuits are not a good choice as they contain sugar and may lead to tooth decay.

TRAUMA

to the face and mouth occur more frequently in people who have mental retardation, seizures, abnormal protective reflexes, or muscle in co-ordination. People receiving restorative dental care should be observed closely to prevent chewing on anesthetized areas.

If a tooth is avulsed or broken, take the patient and the tooth to a dentist immediately. Counsel the parent/caregiver on ways to prevent trauma and what to do when it occurs.

SEALANTS

Sealing Out Dental Decay

While cavity prevention starts with a healthy diet, brushing twice a day, daily flossing, and regular dental checkups, sealants can offer additional protection against tooth decay. Sealants are thin, plastic coatings painted on the chewing surfaces of the back teeth (premolars and molars). This clear, plastic coating bonds into the depressions and grooves (pits and fissures) of the chewing surface effectively sealing out the decay-causing bacteria, and reducing the risk of cavities and tooth decay.

Here's How it's Done

The application of sealants is easy, painless, and takes only a few minutes to complete. First, the tooth is thoroughly cleaned and then etched with a solution to help the sealant adhere to the tooth. The sealant is then 'painted' onto the pits and fissures, where it bonds directly or is hardened with a high-intensity light. Sealants usually last several years before a reapplication is required. Your dentist will monitor your sealants during your regular checkup.

Although children and teenagers will benefit most because they have the highest incidence of pit and fissure decay, adults with difficult to clean molars or wisdom teeth may benefit, as well. Ask your dentist if sealants can help with your preventive care.

SNACK SMART

How do sugars attack your teeth?

Invisible germs called bacteria live in your mouth all the time. Some of these bacteria form a sticky material called plaque on the surface of the teeth. When you put sugar in your mouth, the bacteria in the plaque gobble up the sweet stuff and turn it into acids. These acids are powerful enough to dissolve the hard enamel that covers your teeth. That's how cavities get started. If you don't eat much sugar, the bacteria can't produce as much of the acid that eats away enamel.

How can I "snack smart" to protect myself from tooth decay?

Before you start munching on a snack, ask yourself what's in the food you've chosen. Is it loaded with sugar? If it is, think again. Another choice would be better for your teeth. And keep in mind that certain kinds of sweets can do more damage than others. Gooey or chewy sweets spend more time sticking to the surface of your teeth. Because sticky snacks stay in your mouth longer than foods that you quickly chew and swallow, they give your teeth a longer sugar bath.

You should also think about when and how often you eat snacks. Do you nibble on sugary snacks many times throughout the day, or do you usually just have dessert after dinner? Damaging acids form in your mouth every time you eat a sugary snack. The acids continue to affect your teeth for at least 20 minutes before they are neutralized and can't do any more harm. So, the more times you eat sugary snacks during the day, the more often you feed bacteria the fuel they need to cause tooth decay.

If you eat sweets, it's best to eat them as dessert after a main meal instead of several times a day between meals. Whenever you eat sweets -- in any meal or snack -- brush your teeth well with a fluoride toothpaste afterward.

When you're deciding about snacks, think about:

The number of times a day you eat sugary snacks

how long the sugary food stays in your mouth

the texture of the sugary food (chewy? sticky?)

If you snack after school, before bedtime, or other times during the day, choose something without a lot of sugar or fat. There are lots of tasty, filling snacks that are less harmful to your teeth -- and the rest of your body -- than foods loaded with sugars and low in nutritional value. Snack smart!

Low-fat choices like raw vegetables, fresh fruits, or whole-grain crackers or bread are smart choices. Eating the right foods can help protect you from tooth decay and other diseases. Next time you reach for a snack, pick a food from the list inside or make up your own menu of non-sugary, low-fat snack foods from the basic food groups.

SMART EATING HABITS FOR CHILDREN

Pick a variety of foods from these groups:

Fresh fruits and raw vegetables

berries

oranges

grapefruit

melons

pineapple

pears

tangerines

broccoli

celery

carrots

cucumbers

tomatoes

unsweetened fruit and vegetable juices

canned fruits in natural juices

Grains

bread

plain bagels

unsweetened cereals

unbuttered popcorn

tortilla chips (baked, not fried)

pretzels (low-salt)

pasta

plain crackers

Milk and dairy products

low or non-fat milk

low or non-fat yogurt

low or non-fat cheeses

low or non-fat cottage cheese

Meat, nuts and seeds

chicken

turkey

sliced meats

pumpkin seeds

sunflower seeds

nuts

Others (these snacks combine foods from the different groups)

pizza

tacos

Remember to

choose sugary foods less often

avoid sweets between meals

eat a variety of low or non-fat foods from the basic groups

brush your teeth with fluoride toothpaste after snacks and meals

Note to Parents

The foods listed in here have not all been tested for their decay-causing potential. However, knowledge to date indicates that they are less likely to promote tooth decay than are some of the heavily sugared foods children often eat between meals.

Candy bars aren't the only culprits. Foods such as pizza, breads, and hamburger buns may also contain sugars. Check the label. The new food labels identify sugars and fats on the Nutrition Facts panel on the package. Keep in mind that brown sugar, honey, molasses, and syrups also react with bacteria to produce acids, just as refined table sugar does. These foods also are potentially damaging to teeth.

Your child's meals and snacks should include a variety of foods from the basic food groups, including fruits and vegetables; grains, including breads and cereals; milk and dairy products; and meat, nuts, and seeds. Some snack foods have greater nutritional value than others and will better promote your child's growth and development. However, be aware that even some fresh fruits, if eaten in excess, may promote tooth decay. Children should brush their teeth with fluoride toothpaste after snacks and meals. (So should you!)

Please note: These general recommendations may need to be adapted for children on special diets because of diseases or conditions that interfere with normal nutrition.

VIRAL INFECTIONS

are usually due to the herpes simplex virus. Children rarely get herpetic gingivostomatitis or herpes labialis before 6 months of age. Herpetic gingivostomatitis is most common in young children, but may occur in adolescents and young adults. Viral infections can be painful and are usually accompanied by a fever.

Counsel the parent/caregiver about the infectious nature of the lesions, the need for frequent fluids to prevent dehydration, and methods of symptomatic treatment.