I have a toddler. When I should take her to the dentist?

The answer

Just a few days ago, I asked the mother of a toddler if she had taken him to their dentist yet. Her answer was not uncommon: “My dentist told me to bring my toddler when he is a bit older.”

But pediatric dentists are very adamant that soon after the first tooth comes in, a child should be seen.

Two years ago at the annual meeting of the American Academy of Pediatrics, pediatric dentists offered a symposium on dental care in children. The idea behind the symposium was for pediatricians to learn more about dental care, because often pediatricians are the first clinicians to see a cavity or early signs of dental erosions. (See www.aapd.org for various topics regarding pediatric dentistry.)

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Source: The Globe and Mail

Brush twice a day with a soft-bristle toothbrush.
Brush by placing half the bristles on the tooth and half on the gum (at a 45 degree angle).
Slow, short, vibrating, or back and forth (not up and down) strokes are made while the tips of the bristles remain in the same place. This is a wiggly type motion.
Brush in a definite order: first, outside surfaces; then, inside surfaces, followed by chewing surfaces.
Brush the top of the tongue to remove plaque that may accumulate there.
Change toothbrushes when they become worn (about every 3-4 months) or after an illness.

Flossing

Since only 60% of the plaque is removed by toothbrushing, flossing is necessary to remove the plaque from between the teeth. Unwaxed floss is the preferred kind and should be used at least once a day. Take about 18 inches of floss and wrap it around the middle finger of each hand, so that the index fingers and thumbs are free to guide the floss around the tooth and under the gumline. Gently seesaw the floss between the teeth, curve the floss against the tooth and move it up and down under the gumline. See How to Floss.

Dental Products

Dental products are only aids to the toothbrush and floss; it is the brushing and flossing that count. Toothpaste is not absolutely necessary for brushing of teeth. Many kinds of toothpaste contain fluoride, which is an important component in strengthening the teeth. Toothpaste also helps freshen breath.

Source: Texas Department of State Health Services

If you have been told you have periodontal (gum) disease, you’re not alone. Many adults in the U.S. currently have some form of the disease. Periodontal diseases range from simple gum inflammation to serious disease that results in major damage to the soft tissue and bone that support the teeth. In the worst cases, teeth are lost.

Whether your gum disease is stopped, slowed, or gets worse depends a great deal on how well you care for your teeth and gums every day, from this point forward.

What causes gum disease?

Our mouths are full of bacteria. These bacteria, along with mucus and other particles, constantly form a sticky, colorless “plaque” on teeth. Brushing and flossing help get rid of plaque. Plaque that is not removed can harden and form “tartar” that brushing doesn’t clean. Only a professional cleaning by a dentist or dental hygienist can remove tartar.

Gingivitis

The longer plaque and tartar are on teeth, the more harmful they become. The bacteria cause inflammation of the gums that is called “gingivitis.” In gingivitis, the gums become red, swollen and can bleed easily. Gingivitis is a mild form of gum disease that can usually be reversed with daily brushing and flossing, and regular cleaning by a dentist or dental hygienist. This form of gum disease does not include any loss of bone and tissue that hold teeth in place.

Periodontitis

When gingivitis is not treated, it can advance to “periodontitis” (which means “inflammation around the tooth.”) In periodontitis, gums pull away from the teeth and form spaces (called “pockets”) that become infected. The body’s immune system fights the bacteria as the plaque spreads and grows below the gum line. Bacterial toxins and the body’s natural response to infection start to break down the bone and connective tissue that hold teeth in place. If not treated, the bones, gums, and tissue that support the teeth are destroyed. The teeth may eventually become loose and have to be removed.

Risk Factors

* Smoking. Need another reason to quit smoking? Smoking is one of the most significant risk factors associated with the development of gum disease. Additionally, smoking can lower the chances for successful treatment.
* Hormonal changes in girls/women. These changes can make gums more sensitive and make it easier for gingivitis to develop.
* Diabetes. People with diabetes are at higher risk for developing infections, including gum disease.
* Medications. There are hundreds of prescription and over the counter medications that can reduce the flow of saliva, which has a protective effect on the mouth. Without enough saliva, the mouth is vulnerable to infections such as gum disease. And some medications can cause abnormal overgrowth of the gum tissue; this can make it difficult to keep gums clean.
* Illnesses. Diseases like cancer or AIDS and their treatments can also negatively affect the health of gums.
* Genetic susceptibility. Some people are more prone to severe gum disease than others.

Who gets gum disease?

People usually don’t show signs of gum disease until they are in their 30s or 40s. Men are more likely to have gum disease than women. Although teenagers rarely develop periodontitis, they can develop gingivitis, the milder form of gum disease. Most commonly, gum disease develops when plaque is allowed to build up along and under the gum line.

What can I do to prevent gum disease?

* Brush your teeth twice a day (with a fluoride toothpaste)
* Floss every day
* Visit the dentist routinely for a check-up and professional cleaning
* Don’t smoke

source: NIH Publication No. 10-1142

If your gums are swollen and bleed when you brush, you may have gingivitis. The most common cause of gingivitis is poor oral hygiene. Good oral health habits, such as daily brushing and flossing, can help prevent gingivitis.

Symptoms
Signs and symptoms of gingivitis may include:
* Swollen gums
* Soft gums
* Occasionally, tender gums
* Gums that bleed easily when brushing or flossing
* Bad breath
* A change in the color of your gums from a healthy pink to dusky red

Because gingivitis is seldom painful, you can have gingivitis without even knowing it. You may first realize something’s wrong when you notice that the bristles of your toothbrush are pink — a sign that your gums are bleeding with just slight pressure.

When to see a dentist
Healthy gums are firm and pale pink. If your gums are puffy, dusky red and bleed easily, see your dentist. The sooner you seek care, the better your chances of reversing damage from gingivitis and its progression to more serious problems.

Causes
Gingivitis almost always begins with plaque. This invisible, sticky film is composed mainly of bacteria. Plaque forms on your teeth when starches and sugars in food interact with bacteria normally found in your mouth. Brushing your teeth removes plaque. But plaque re-forms quickly, usually within 24 hours.

Plaque that stays on your teeth longer than two or three days can harden under your gumline into tartar (calculus). Tartar makes plaque more difficult to remove and acts as a reservoir for bacteria. What’s more, you usually can’t get rid of tartar by brushing and flossing — you need a professional dental cleaning to remove it.

The longer that plaque and tartar remain on your teeth, the more they irritate the gingiva, the part of your gum around the base of your teeth. In time, your gums become swollen and bleed easily.

Risk factors
Factors that can increase the risk of gingivitis include:
* Poor oral health habits
* Tobacco use
* Diabetes
* Older age
* Decreased immunity, such as that occurring with leukemia or HIV/AIDS
* Certain medications
* Certain viral and fungal infections
* Dry mouth
* Hormonal changes, such as those related to pregnancy
* Poor nutrition
* Substance abuse
* Ill-fitting dental restorations

Although anyone can develop gingivitis, many people first experience gum problems during puberty and then in varying degrees throughout life.

Complications
Untreated gingivitis can progress to periodontitis, a much more serious form of gum disease. Periodontitis can cause tooth loss and may even increase your risk of heart attack and stroke. What’s more, women with periodontitis are far more likely to give birth to premature babies than are women with healthy gums.

Preparing for your appointment
If you notice any symptoms of gingivitis, make an appointment with your dentist. Here’s some information to help you get ready for your appointment, and what to expect from your dentist.

What you can do
Consider preparing a list of questions to ask your dentist. Some questions you may want to discuss include:
* What is likely causing my symptoms?
* What kinds of tests, if any, do I need?
* What is the best course of action?
* Can I treat gingivitis on my own?
* What are the alternatives to the approach you’re suggesting?
* Are there any restrictions that I need to follow?
* Are there any brochures or other printed material that I can take home with me?
* What Web sites do you recommend visiting?

Don’t hesitate to ask other questions during your appointment at any time if you don’t understand something.

What to expect from your dentist
Your dentist may ask you questions about your symptoms. He or she may ask:
* When did you first begin experiencing symptoms?
* Have your symptoms been continuous or occasional?
* What is your oral health routine?
* What medical conditions do you have?
* What medications do you take?

Tests and diagnosis
Diagnosis of gingivitis is generally simple. Diagnosis is based on your description of symptoms and an exam of your mouth and tongue. Your dentist will look for plaque and tartar buildup and may check for easy bleeding.

If it’s not known what has caused your gingivitis, your dentist may recommend that you get a medical evaluation to check for underlying medical conditions.

Treatments and drugs
There are several ways to treat gingivitis, including:
* A thorough dental cleaning
* Antiseptic mouth rinse
* Brushing
* Flossing
* Fixing dental restorations, if necessary

Gingivitis treatment usually starts by thoroughly cleaning your teeth. This includes removing all traces of plaque and tartar — a procedure known as scaling. The cleaning may be uncomfortable, especially if your gums are already sensitive or you have extensive plaque and tartar buildup. Your dentist may also recommend using an antiseptic mouth rinse to clear away bacteria. Your dentist will also review brushing and flossing techniques to make sure you’re doing these effectively.

Misaligned teeth and poorly fitting crowns, bridges or other dental restorations make it harder to remove plaque. If any of these is contributing to your gingivitis, your dentist may recommend fixing these problems as well.

Gingivitis usually clears up after a professional cleaning — as long as you continue to follow a program of good oral hygiene at home. If you’re consistent with your dental hygiene, you should see the return of pink, healthy gum tissue within days or weeks. You’ll need to practice good oral hygiene for life, however, so your gum problems don’t return.

Lifestyle and home remedies
You can take steps at home to help reduce or control gingivitis, such as:
* Get regular professional dental cleanings, on a schedule recommended by your dentist.
* Use a soft toothbrush and replace it at least every three to four months.
* Consider using an electric toothbrush, which may be more effective at removing plaque and tartar.
* Brush your teeth twice a day, or better yet, after every meal or snack.
* Floss daily.
* Use a mouth rinse to help reduce plaque between your teeth.
* Use an interdental cleaner, such as a dental pick or dental stick specially designed to clean between your teeth.
* Don’t rely on tartar-control toothpaste to do the job that brushing and flossing should.

Prevention
The best way to prevent gingivitis is a program of good dental hygiene, one that you begin early and practice consistently throughout life. That means brushing your teeth at least twice daily — in the morning and before going to bed — and flossing at least once a day. Better yet, brush after every meal or snack or as your dentist recommends. A complete cleaning with a toothbrush and floss should take three to five minutes. Flossing before you brush allows you to clean away the loosened food particles and bacteria.

Also, see your dentist or dental hygienist regularly for cleanings, usually every six to 12 months. If you have risk factors that increase your chance of developing gingivitis, you may need professional dental cleanings more often.

Source: Georgia Department of Community Health (provided by the Mayo Clinic)

For all children, you should

Brush teeth with a fluoride toothpaste
Provide healthy foods and limit sweet snacks and drinks
Provide low-fat milk and dairy products high in calcium
Schedule regular dental check-ups

Forming good habits at a young age can help your child have healthy teeth for life.

Source: NIH—National Institute of Dental and Craniofacial Research

Since Willow Tree Dental decided earlier this month not to renew its contract to provide Medicaid dental services, the practice has laid off 25 staff members, including four dentists, and received more than 100 calls a day from concerned patients requesting referrals.

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