For many parents, the image of an infant intently absorbed in sucking a pacifier — or her own thumb — is one of the cherished memories of babyhood. But if this habit goes on for too long, it can cause problems with the child's bite. Want to know what the potential predicaments are, when you should be concerned about the behavior, and what you can do? Read on!
Thumb sucking is a natural, comforting behavior of humans (and some other primates) related to nursing. It usually goes away on its own by the time the permanent teeth are coming in. But it can be a hard habit to break — and if it becomes a persistent behavior, the consequences may include a problem called an “open bite.”
In a normal bite, the top teeth slightly overlap the bottom teeth. When the thumb (or any other object) constantly rests between the upper and lower teeth, however, the pressure it exerts may prevent the teeth from fully erupting (coming out from the gums into the mouth) and alter the shape and development of the upper and lower jawbone. This result is a gap between the upper and lower teeth.
The same problem may also be caused by prolonging the “infantile swallowing pattern,” a forward-thrusting position of the tongue which, like thumb sucking, normally begins to cease around age four. That's when it is replaced by the adult swallowing pattern, where the tongue is held behind the teeth, against the roof on the mouth. Researchers believe that most open bites result from the failure to change from the infantile to the adult swallowing pattern.
When should you be concerned about the thumb sucking habit? If the behavior continues much past toddlerhood, or if the sucking is particularly active, you may wish to have us evaluate your child's bite. The American Academy of Pediatric Dentistry recommends having the habit stop by age 3. Persistent thumb sucking can actually push the teeth forward and change the growth patterns of the jaw, creating more difficult problems.
There are several methods for controlling the behavior and correcting problems with the bite. One is an appliance called a “tongue crib.” This thin metal device is placed behind the upper and lower incisors. It discourages thumb sucking, while at the same time helping to keep the tongue from inserting itself between the upper and lower teeth. Eliminating these unhelpful habits is essential to allow the teeth to erupt into proper position and to allow for the normal development of the jawbones.
Recent research has also shown that individualized exercise routines called orofacial myofunctional therapy (OMT) can be highly effective in preventing open bite relapses. These exercises are designed to retrain muscles in the face, tongue and lips, and can help to create good chewing and swallowing patterns.
If you would like more information about thumb sucking or children's bite problems, please contact us or schedule an appointment for a consultation. You can also learn more about these issues by reading the Dear Doctor magazine article “How Thumb Sucking Affects The Bite.”
If your infant is extra cranky and seems to want to chew everything in sight, it's a good bet that the first tooth is on the way! For parents, this is cause for both celebration and concern. After all, no parent wants to see a child suffer even a little bit. Decades ago, when a teething infant showed signs of discomfort, a parent might have rubbed some whisky or other strong liquor on the child's gums — a misguided and dangerous practice. There are far safer, more effective ways to help your child through this exciting yet sometimes uncomfortable phase of development. Here are our top five teething remedies:
Chilled rubber teething rings or pacifiers. Cold can be very soothing, but be careful not to freeze teething rings or pacifiers; ice can actually burn the sensitive tissues of the mouth if left in place too long.
Cold, wet washcloths. These are great for gnawing on. Make sure the washcloth is clean and that you leave part of it dry to make it more comfortable to hold.
Cold foods. When your child is old enough, cold foods such as popsicles may soothe sore gums. However, make sure you confine them to mealtimes because sugars can cause tooth decay — even in very young children.
Gum massage. Massaging inflamed gums with your clean finger can help counteract the pressure from an erupting tooth.
Over-the-counter medicine. If teething pain persists, you can give your baby acetaminophen or ibuprofen, but check with a pharmacist or this office for the correct dosage. The medicine should be swallowed and not massaged into the sore areas, as this, too, can burn.
So when does it all begin? Some babies start teething as early as three months or as late as twelve months, but the typical time frame is between six and nine months. Usually the two lower front teeth erupt first, followed by the two upper front teeth. The first molars come in next, followed by the canines (eyeteeth). Most children have all 20 of their baby teeth by age 3.
If you have any questions about teething or the development of your child's teeth, please contact us or schedule an appointment for a consultation. You can also learn more by reading the Dear Doctor magazine article “Teething Troubles.”
If you have noticed white spots or enamel pitting on your teeth, something in your diet may be the cause. If accompanied by other general symptoms, these dental problems may stem from a possible intolerance to gluten.
Gluten is a protein found in grains like wheat, barley or oats. Some people (an estimated one in 130 Americans) have a condition called Celiac Disease (CD) in which their immune system mistakenly treats gluten as a threat and initiates an attack of antibodies (individual proteins made by the immune system to target and kill specific foreign substances) against it. Tiny hair-like structures in the small intestine called cilia that aid in nutrient absorption may be destroyed in the process. As a result, the body can't properly absorb nutrients.
CD can be difficult to diagnose because its symptoms resemble other conditions like Irritable Bowel Syndrome. Typically, though, CD causes digestive issues like diarrhea, bloating and stomach aches, as well as fatigue, growth abnormalities and vitamin deficiencies. In the mouth, the most common symptoms are enamel defects like spotting and pitting. Patients may also lose a portion of their enamel in the grooves of the central incisors where the enamel may appear chalky or opaque rather than shiny, evidence of a condition called decalcification. CD may also cause canker sores.
Determining if you have CD is a two-step process. You must first undergo a blood test to see if antibodies are present for gluten. If the test returns positive confirming you have CD, the next step is a biopsy in which a small amount of intestinal tissue is removed and analyzed. This measures the degree of damage to the stomach lining, which will indicate whether or not you should remove foods containing gluten from your diet.
While research is ongoing to develop counteracting medications, removing gluten from your diet remains the most effective treatment for CD. Enamel defects caused by CD can also be treated with fluoride toothpastes and other aids to foster re-mineralization (restoring calcium and other mineral content to the enamel), and with cosmetic techniques to reduce any discoloration effect. CD patients should continue with normal oral hygiene efforts, with one exception: hygiene products (including polishing pastes and fluoride gels used in professional cleanings) should be gluten-free.
If you would like more information on how gluten may affect your oral health, 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 “Gluten & Dental Problems.”
Clenching, or grinding of your teeth (also known as bruxing) are common habits. Biting forces are normally small, gentle, fleeting and very frequent throughout the day. In fact, it's the normal stimulus necessary to keep your teeth and jawbone healthy. When you clench or grind your teeth you apply forces up to ten times normal (in the 200 lb range). And it's not just the force, it's the duration and frequency with which they're applied. High forces lasting for seconds or minutes, frequently exerted, can affect some or all of the masticatory system. This includes the teeth, jaws, jaw joints and muscles, causing aching jaws, headaches, earaches, neck and even backaches; and the teeth themselves causing excessive wear, fractures, or even loose teeth.
Why does grinding occur? Habitual grinding is most frequently a reaction to stress. Sometimes abnormalities in your bite or malocclusion (“mal” – bad; “occlusion” – bite) can trigger clenching or grinding. It is normal for children to sometimes grind their teeth when new teeth are coming in, but it may be indications of stress too. You may be grinding your teeth subconsciously in your sleep, but it may be so loud as to awaken your sleeping partner. Or our office may be the first to suspect it during a dental exam because of the apparent signs of change to muscles, joints and teeth especially abnormal tooth wear.
What can be done about teeth grinding or bruxing? If you are symptomatic, having pain, muscle, joint or tooth soreness, the first step is to get you comfortable. Generally, a mild non-steroidal anti-inflammatory medication (aspirin, ibuprofen) and muscle relaxants will help in addition to moist heat and mild jaw exercises. Stress management is also helpful. To prevent further damage, we may recommend a bite guard made of wear-resistant plastic that fits over the biting surfaces of your upper teeth. These customized unobtrusive appliances when properly fitted and adjusted stop clenching and grinding activity, or at least the damage they can do. A bite guard can be worn day or night especially during stressful periods.
If you have recently noticed swelling, bleeding or pain in your gums, you may have developed a gum abscess. It's the result of periodontal disease, an infection in the gum tissue caused by bacterial plaque that has adhered to the teeth. It's important in the short term to treat the abscess, and in the long-term the underlying gum disease for the survival of the affected tooth and your overall health.
A gum abscess is a sac filled with infection that has developed between the tooth and gum. Besides swelling, you may also notice tenderness when you bite down on a tooth or feel that the tooth is loose. If the abscess originates from a root canal infection it tends to be much more painful, and the pain will seem generalized rather than from a specific tooth.
The first step in treatment is to drain the abscess. We would numb the area with a local anesthetic and then allow the infection to drain. After drainage we would clean and irrigate the infected root surfaces to remove any noticeable bacterial plaque, and possibly prescribe antibiotics and anti-inflammatory medication to reduce swelling and pain. The drained abscess should heal in a few days to a week.
The next step is to treat the underlying cause of the abscess. Depending on what we find in our examination, this can include root planing and scaling (deep plaque and tartar removal), or a root canal treatment where the infected pulp within the root canal is removed, and the canal is then cleaned, filled and sealed.
It's also a good idea for patients with gum disease to have a thorough health checkup. It's possible that other general health conditions such as diabetes or heart disease may be contributing to the gum disease, and vice-versa.
Treating a gum abscess and the underlying cause is about more than relieving pain or discomfort — you're also protecting your dental and general health.
If you would like more information on the treatment of abscesses or gum disease, 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 “Periodontal (Gum) Abscesses.”