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What is Infant Tongue Tie?

Infant tongue tie is something that has come to light in the past few years as more and more of us mommies are breastfeeding our babies. I have been getting questions at an increasing rate on this topic. Does my baby have tongue tie? Is it a problem? Do I need to do something about it?


What is tongue tie?
Tongue tie is when the tip of the tongue is attached to the floor of the mouth. There are varying degrees of tongue tie from minimal attachment to the full length of the tongue being attached to the floor of the mouth.

What problems can it cause?
In infants, it can cause difficulty feeding/latching and for momma, it can cause nipple pain upon feeding.

Do I need to do something about my infant’s tongue tie?
This is the process I use to decide if my patients are candidates for the surgical procedure to relieve the tongue: I ask parents if it is causing a problem?” If the parents say no, it is usually something they have noticed visually and not noticed problems. These children are not a candidate. If the parents say “yes,” then I ask what problems they are experiencing. If the parents say the child has colic or gastric reflux and is fussy, they are not typically a candidate. These issues are best brought up to the child’s pediatrician and once GI issues have been ruled out, they may be a candidate. If the parents say the child is having difficulty eating, is in a low weight class, or the mom is having pain on feeding, then the surgery may be helpful. Notice, I said MAY be helpful. This is the controversial part! Scientific research has found a correlation between the surgical removal of the attachment and better feeding/less nipple pain. Is it a relatively harmless procedure? Yes. Is the recovery difficult? Not typically. Is it helpful in some cases? Yes. Is it 100% effective? No. Am I going to recommend it to all of my patients with tongue tie? No. A serious discussion needs to occur between the provider and the parents where the pros and cons of the procedure are weighed to determine if it is the right course of action. A good clinical evaluation is important. Sometimes the tongue is not the main source of the problem. Occasionally, the top lip can be attached firmly and is not allowing the baby to latch effectively.

Who performs this type of procedure?
Due to its controversial nature, only a select few doctors perform it. The best place to start in most cases is a lactation specialist. Although they do not perform the procedure, usually they know who in your area does. Among the list may be Ear, Nose and Throat physicians, Neonatologists, Periodontists (dentists who specialize in gums), Pedodontists (children’s dentist), and Oral Surgeons.

What does the surgery entail?
There is a section of gum tissue under the tongue that attaches to the floor of the mouth. This tissue is called a “frenum” or “frenulum.” The frenum is cut with either scissors, a scalpel, or a soft tissue laser to allow the tongue to move freely. Sometimes it is necessary to place stitches to allow the tissue to heal, but it is not always required.

Will my baby have to be put to sleep?
This depends on the surgeon you are using. Typically these babies are less than 6 months of age and general anesthesia is not required. Some ENT physicians may combine this procedure in with another surgery, for example, if your child also needs ear tubes. Most of the time, these procedures can be completed with your baby awake.

Will my child feel pain?
Babies are like adults. They do feel pain just like anyone else. But, there are risks to giving infants numbing medication because they are so small, and it is easy to give them too much. Some practitioners are of the school of thought that the child will not remember the procedure, so they do not give the baby numbing medicine. This is a topic to discuss with your surgeon and decide how you would like to proceed.

What is the recovery like?
Typically, following the procedure, the provider will give the baby to the mom to begin breastfeeding and help soothe the child. Yes, unless your child was put to sleep, your baby will scream throughout the procedure. This is normal and is not necessarily indicative of pain. Most babies do not like to have their mouth messed with, and their only known way of responding is to cry. Before you leave with your baby, you may be given instructions to do tongue and lip exercises at home. Typically the surgeon will schedule a follow up exam a week to a month following the surgery. This will allow them to monitor the healing and make sure the procedure was successful. In the meantime, Tylenol/Motrin can be used for any post-operative pain unless the pediatrician recommends otherwise.

I hope this is helpful and not overwhelming. I am attaching links to this post with more information on the topic.

http://www.aapd.org/assets/1/25/kupietzky-27-1.pdf

https://www.ncbi.nlm.nih.gov/books/NBK299106/

What is Dental Fluorosis?

“You’ve got what?!?  Dental fluorosis?  That sounds serious.  I hope it’s not catching.”

 Fluorosis is a dental condition that occurs during the years that a tooth is developing.  Excess fluoride is absorbed through the gut and can be stored in bones and teeth.  It is noted clinically as white striations but can appear brown that may be attributed to dietary staining of the effected enamel.  Severe fluorosis can present as pitted enamel.  Microscopically, the enamel layer is more porous and thus, weaker in nature. 

The age that fluorosis occurs is during the time the permanent teeth are forming, but it is not seen clinically until the teeth erupt into the mouth.  The top front four teeth are where fluorosis is the most commonly visible.  These teeth are affectionately called the central and lateral incisors.  The incisors begin forming early in a child’s first year of life and the visible portion of the tooth (crown) completes forming when the child is 4-5 years old.  Teeth begin forming at the bottom edge and form upwards until the root has been completed.  As you can see in the picture above, the staining occurs in lines.  The fluorosis is seen in the tooth layer that was forming at the time the child received excess fluoride. 

For example, in the picture above, the central incisors have a brown line near the top third of the tooth.  The lateral incisors have brown staining in the bottom third of the tooth.  It is likely that the fluorosis occurred at the same time, but the centrals and the laterals were at different stages of crown development.

Fluorosis is more common in the southwestern United States due to its higher naturally occurring fluoride levels.  Typically, fluorosis occurs from a long-term ingestion of excess fluoride and is not noticeable if a child has an acute fluoride toxicity event from eating a tube of toothpaste.  One instance that can cause fluorosis is using fluoridated water to mix infant formula.  Since this is the basis of the infant’s diet, especially early on, fluorosis can occur if fluoridated water is used on a regular basis. 

How do we treat a tooth with dental fluorosis?  Back in the day, the only treatment options were to use a high-speed handpiece to remove the stained tooth structure and place a filling or a crown.  I’ve said it before and I’ll say it again, I love the day and age we live in because we have more conservative options at our disposal.  I will list the options from most conservative to most aggressive:

  1. Tooth whitening – no tooth structure will be removed, but the discolored tooth may blend with whitening treatments.  Follow up treatment is usually required.
  2. Resin infiltration: a treatment option where the enamel is opened with an acid to release staining, apply a bleaching agent to the tooth, and apply a sealant to protect the tooth and prevent future staining.
  3. Microabrasion: the top layer of the enamel is removed with an abrasive to reveal a more esthetic layer of the tooth (not always an option for fluorosis, due to it affecting the entire depth of enamel)
  4. Remove the stained portion with a dental handpiece and apply a filling
  5. Remove tooth structure to allow for an esthetic crown to be placed

To summarize, causes of fluorosis can be atributed to long-term fluoride ingestion such as, drinking fluoridated water at levels higher than recommended by the CDC or using fluoridated water to mix infant formula.  Fluoride varnish is the most commonly placed dental fluoride at cleaning appointments.  Research studies do not support a correlation between increased dental fluorosis and fluoride varnish application.

References:

Dental fluorosis:

https://pdfs.semanticscholar.org/0fb5/28d4b7a7e193e90bd533b5ea54f816b04375.pdf

Dental Tooth Formation Chart:

https://www.aapd.org/globalassets/media/policies_guidelines/r_dentalgrowth.pdf

Correlation of fluorosis and fluoride varnish placement:

https://www.aapd.org/assets/1/7/Fluoride_varnish.pdf

American Academy of Pediatric Dentistry Fluoride Guidelines:

https://www.aapd.org/media/Policies_Guidelines/P_FluorideUse.pdf

What is Silver Diamine Fluoride?

You mean you’ve never heard of silver diamine fluoride?  It is hot, hot, HOT, right now!  I’m surprised it is not trending on Twitter.  Silver Diamine Fluoride, known among dentists as SDF, is a liquid with a high concentration of fluoride that is applied to a cavity to prevent it from getting larger. 

You may ask, why would one apply this to a tooth instead of just getting a filling?  A filling or crown would be a more permanent fix, but what if the child is two years old and is unable to behave for a filling?  What if the child has special needs that make it dangerous to sedate or have the fillings done under general anesthesia?  What if the child is eight years old and will lose the tooth in a year or two and the parents insurance benefits have been maxed out for the year?  These are all reasons to consider SDF in a dental treatment plan.

As costs increase and dental insurance benefits stay the same, it is becoming more and more of a struggle for parents to pay for their children’s dental needs.  SDF may not be long term treatment, but if there is a need to defer treatment, it can be applied to the teeth to prevent the cavity from becoming larger.  Typically, SDF needs to be applied every six months until the final treatment can be completed, or the tooth falls out.   Some practitioners will place it once and follow up a week later to add another coat.  Some practitioners will place the SDF and add some type of temporary restoration to further protect the tooth from breakdown. 

It sounds too good to be true, right?  There is always a catch, isn’t there?  The downside to SDF is, it turns the cavity black.  When I say black, I mean black!  It not only turns cavities black, it turns anything it touches black, as well.  If it were to touch a child’s cheek, the soft tissue would be black for a week.    For some children, if they cannot follow instructions and will be fighting the treatment, they are not candidates for SDF.  For some parents, the esthetics would eliminate SDF as a treatment option completely.  Attempts have been made to make SDF more esthetically pleasing, but at this time, they do not look as natural as a traditional filling. 

If SDF is placed and a white filling is indicated later, the dark staining can be removed with a dental handpiece, but it is not always completely successful.  This is one reason why SDF is not commonly used on adult teeth.  It is great for baby teeth, because they fall out in a few years and you get a “do over.”  In the past when treatment needed to be delayed, the cavity sat exposed for six months or a year until treatment could be completed and what originally needed a filling now needs a crown or extraction.  SDF prevents cavities from getting larger, so in theory, a cavity that requires a filling should still require a filling in six months following SDF application.  SDF is not recommended on teeth that have been deemed non-restorable and need to be removed to prevent the risk of infection. 

What are the advantages of SDF?

  1. No injection is required
  2. Sedation can be prevented or delayed as the child matures
  3. Lower cost than a filling
  4. Promotes a positive dental attitude for the child

I hope you found this post informative.  I love working in this time period because we are blessed to have so many treatment options at our disposal, and we can customize it to the needs of the individual.  I am happy to have this option in my wheelhouse, but I very much hope it does not put me out of business!

References:

American Academy of Pediatrics:

https://www.aappublications.org/news/2016/08/05/SilverDiamine080516

https://www.healthline.com/health/silver-diamine-fluoride#cost

Jeanette MacLean Placement of SDF between teeth:

https://www.youtube.com/watch?v=nPyYpZYfrHQ

Help! My Child Ate Toothpaste!

A common reason for parents to call Poison Control is because their child ate an unknown amount of toothpaste containing fluoride.  And who can blame them?  Toothpaste, with its sweet flavors, is quite tempting to some kids. 

We have discussed in previous blog posts that fluoride is an ion that wants to bind to another ion.  When it is used correctly, it binds to the enamel ions to make fluoroapatite which makes enamel less likely to get cavities.  When it is swallowed, the fluoride binds to hydrogen in the stomach creating hydrofluoric acid.  The acid is corrosive and can cause an irritation to the stomach lining, presenting as nausea, vomiting, and diarrhea.  Typically, this is the extent of the episode.  But what if we could have the fluoride bind to something besides stomach acid?  The treatment of choice when your child has eaten a small to moderate amount of fluoridated toothpaste is to give your child a milk-based snack, i.e. a glass of milk or bowl of yogurt.  The calcium in the milk binds the fluoride to make an inert salt (CaF2) that is excreted from the body.

 I have attached a chart that Georgia’s Poison Control uses to determine if a child needs a trip to the emergency room:

In rare cases, a child can ingest a larger amount of fluoride than is safe to treat with milk or yogurt.  Usually, when this occurs, a young child is involved.  It does not take much toothpaste to cause a problem in a very small child.  For this reason, it is extremely important to keep toothpaste out of reach of small children and behind childproofed drawers or cabinets.  The symptoms that follow are nausea and vomiting that progresses to seizures and muscle spasms.  It can potentially lead to death if left untreated.  Poison Control will let you know if inducing vomiting is recommended.  Once the child is admitted to the emergency room, activated charcoal may be given to help bind the fluoride and the child will be treated by physicians who will be monitoring the child’s vital signs until they have recovered.

When dealing with children, emergencies can happen in a heartbeat, and if you find yourself in this situation, I hope you find these resources helpful.

References:

Poison Control: 1-800-222-1222

https://www.poison.org/articles/2015-dec/toothpaste

http://kidemergencies.com/toothpasteingestion.html

Water Fluoridation: To Drink or Not to Drink

In my last post, What Is Fluoride, I discussed what fluoride is and how it affects our enamel.  It aids in remineralizing enamel and prevents the demineralization of enamel.  It can also prevent bacteria from producing cavity enhancing acid. 

Community water fluoridation began in the 40s because studies showed that residents with higher naturally fluoridated water had fewer dental cavities.  To this day, it is touted as the most equitable and cost-effective method of delivering fluoride to all members of most communities.  Over the years, a significant decrease in dental cavities has been seen.  In the United States, the amount of fluoride in the water is from a range of 0.7-1.2 mg fluoride ion/L part per million (ppm). 

There are several classes of people that I run into:

  1. Those that believe fluoride works and is beneficial
  2. Those that think fluoride is toxic and harmful
  3. And people who do not care either way

I get asked on a regular basis if I actually believe in fluoride.  It’s almost the same as if someone asked me if I believed apples came from apple trees.  Through my four years of college, I learned about the how fluoride effects our teeth at an atomic level.  During my four years of dental school, I read countless articles that have undergone meta-analysis and systematic reviews (highest level of validated research).  And during my two years of pediatric dental residency, I have seen how fluoride has been beneficial to one of the poorest and most underprivileged communities in the nation.  I believe in fluoride because I have seen its benefits first-hand.  But I do understand that not everyone has had the same experiences I have had so it is normal to be skeptical.  Is it possible that I live in the Truman Show and everything I have learned is a big hoax?  I sure hope not!

To the people who believe that fluoride is toxic and harmful, all I can say is, “You are absolutely right.”  Just about anything in excess is not good for you.  Even drinking too much bottled water when drunk too fast at a large amount can cause your sodium levels in your blood to drop and be fatal.  It is well known that when a small child ingests too much fluoride (typically by eating toothpaste from a full tube), the side effects can affect their gastrointestinal system by causing nausea, vomiting, diarrhea, and abdominal pain.  If a very large amount is ingested, it can affect the central nervous system and symptoms of convulsions, numbness, and possible cardiovascular collapse.  So, yes, I would say it is toxic and can be harmful when used outside of its recommended guidelines.

A few years back, a study came out of Harvard University called Developmental Fluoride Neurotoxicity: A Systematic Review and Meta-Analysis.  I have provided the link below for your reading pleasure.  This paper collected studies from around the world that compared children’s water fluoridation levels and their IQ.  “The results supported the possibility of an adverse effect of high fluoride exposure on children’s neurodevelopment.  Future research should include detailed individual-level information on prenatal exposure, neurobehavioral performance, and covariates for adjustment” (Choi 2012).  I reviewed the studies that were listed and the fluoride levels that are present in many of the studies are 3-4 times higher than the amount used in the United States water fluoridation.  It is very interesting that these studies are evaluating a long-term effect of fluoride on children’s brains.  This research paper was well conducted by a highly prestigious university and is something to be cognizant of.

With all of this said, it does not make a difference to me if someone “believes in fluoride.”  I do find it important that my patients are well informed so they can decide what is right for their family.  Fluoride is not essential to having healthy teeth, but it is a tool that can be helpful if there is an imbalance in the oral cavity where cavities are forming.  If you feel fluoride could be helpful for your child, drinking fluoridated water and brushing your child’s teeth with fluoridated toothpaste is a good place to start.  If you do not wish to have your child exposed to fluoride, drinking bottled or distilled water is always an option.  Newer refrigerators have reverse osmosis filtration systems which utilizes tap water but removes fluoride, as well as, other things like lead and chlorine. 

I hope this post was helpful in deciding what is right for your family.  And for those people who do not care one way or another if their water is fluoridated, keep doing what you are doing and thanks for reading!

References:

https://www.aapd.org/media/Policies_Guidelines/BP_FluorideTherapy.pdf

https://jada.ada.org/article/S0002-8177(85)02022-0/pdf

Developmental Fluoride Neurotoxicity: A Systematic Review and Meta-Analysis: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3491930/

Link to Check Your Water Fluoridation Level:

https://nccd.cdc.gov/DOH_MWF/Default/WaterSystemList.aspx

What is Fluoride?

The short answer to this question is fluoride is an ion that bonds to enamel and hardens its chemical structure.  If you are curious about the chemistry behind it, keep reading.  If you are fine with the previous answer, there is no need to suffer through this one!

Let’s take a journey back to middle school.  Reach into the depths of your brain to find the periodic table.  The periodic table is a chart of elements.  Elements are building blocks for everything: trees, rocks, gases, skin, and food.  Everything is made up of elements.

Fluorine is an element and fluoride is the ionic (active) form of fluorine.  Most ions do not like floating around by themselves.  They bind with other ions to create molecules which are more stable.  For example, oxygen is not often found by itself.  It binds to another oxygen element to form an oxygen molecule.  Fluorine is a very special element.  It has the highest electronegativity of any of the ions, forming strong ionic bonds. 

Are you bored yet?  Let me get to the point.  Why is fluoride important in the dental field?  To answer this, I must explain what enamel is.  Enamel is the hardest substance in our bodies and is the white covering of our teeth.  Enamel, like anything else, is made up of elements, such as calcium, phosphorus, and hydrogen.  When our mouth becomes acidic after eating or drinking, the enamel releases hydroxide into the mouth to help bind the acidic ions and bring the mouth back to a neutral environment.  When this happens, the enamel has two courses of action: it can continue to breakdown further (demineralization) and result in a cavity, or ions/compounds can bind to damaged enamel to restore the structure (remineralization). 

When teeth are formed, the enamel is made up of interlocking molecules called hydroxyapatite.  The fluoride can replace hydroxide in the molecule to create a stronger substance called fluorapatite.  Fluoride changes the structure of the tooth at a chemical level to make it stronger.  Fluorapatite is stronger than hydroxyapatite and is less likely to breakdown.

I hope this post did not stress you out, because it sure stressed me out!  I am sorry it was dry and heavy in the sciences.  I am, ultimately, a scientist and am tasked with the burden of learning the “why” behind everything I do.  I am going to continue down the fluoride rabbit hole, but I think this is enough information for one blog post.  Soon I will address the sources of fluoride and its beneficial and harmful effects.  As always, I love your feedback and any additional questions you may have on this topic. 

References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4851520/

https://pdfs.semanticscholar.org/d18f/c15a17a82c5a89acd3023decec0b578f7fcb.pdf

Can My Baby Use Orajel for Teething Pain?

Orajel is a topical numbing agent that’s uses range from relieving pain from canker sores, tooth and gum pain, as well as for cold sores.  The active ingredient in Orajel is 20% Benzocaine which is a topical local anesthetic (pain reliever).  Some formulations also contain Menthol which is obtained from mint oils.  Menthol increases blood flow to the area and provides at cooling sensation. 

Benzocaine has been used for decades to relieve oral pain temporarily.  Dentists most commonly use it to place on their patient’s oral tissue prior to an injection of numbing medicine.  How does it work?  Pain is caused by stimulation of specific types of nerve endings.  Benzocaine stops the nerve from being stimulated temporarily by blocking the uptake of the molecule that stimulates the nerve.

Like any drug, we must be aware of its potential side effects, especially when we are talking about young children.  It is generally safe and non-toxic when applied topically.  So, what’s the problem?

Benzocaine has been associated with an uncommon, but serious condition called Methemoglobinemia (pronounced Met–hemo– globe-in-emia).  I found out it was one of my husband’s pet peeves when it is called METH-hemoglobinemia.  To avoid a lengthy and yawn-inducing discussion over its chemical formula, and why it is called METhemoglobinemia, I am stressing its pronunciation.  Please!  Not again!

I will try to keep my “sciency stuff” to a minimum.  Bear with me.  Let me start with explaining what hemoglobin is.  Hemoglobin is the oxygen carrying molecule in red blood cells.  It delivers oxygen to the tissues in the body.  The oxygen bond with hemoglobin is not strong.  Some may say, it’s down-right weak!  It sounds terrible, but it is actually a great thing.  The weak bond of hemoglobin is what allows oxygen to be released to the oxygen-depleted tissues.  Methemoglobin is a different chemical formula of a hemoglobin molecule that binds strongly to oxygen, thus not allowing for its release to the body.  When this occurs, the body is unable to function well due to the decreased oxygen availability.

What is methemoglobinemia?  When benzocaine is applied to the tissue and is absorbed into the blood stream, it can convert normal hemoglobin to methemoglobin and cause an oxygen depletion.  It has been found to be severe, especially in children ages 2 and younger.  Unfortunately, this age group most often suffers from teething discomfort.

What are the symptoms of methemoglobinemia?  Pale, gray, or blue skin color, shortness of breath, fatigue, headache or lightheadedness, and rapid heart rate.  These symptoms can occur in minutes to hours after Benzocaine’s application.

What is the treatment to reverse methemoglobinemia? The child would be placed on oxygen and given a substance called methylene blue through an IV.  The improvement is typically rapid.

Methemoglobinemia is well known by the Orajel company, so they have come out with a children’s version without Benzocaine.  In fact, they have two kinds: daytime and nighttime teething gel.  It is called Orajel Non-medicated Cooling gels for Teething.  The active ingredient in the daytime gel is Simethicone.  It is commonly used to relieve colic in babies.  Simethicone drops allows for smaller gas bubbles to come together in the stomach and become one big bubble to aid in the baby burping.  I have been unable to find how it aids in relieving teething pain.  The nighttime active ingredient is chamomile in addition to the simethicone.

I love a good cup of tea and chamomile is one of my favorites, but I also have the unfortunate quality of being a skeptic when it comes to homeopathic remedies.  Some research out of the University of Michigan supports the use of crushed chamomile tablets mixed with water and given in a dropper to your child can relieve diarrhea associated with teething.  Many herbalists suggest that chamomile has anti-inflammatory and calming properties to alleviate teething pain, but currently there is not enough research I have found to prove or disprove this theory.  The bottom line is, chamomile has not been found to be harmful for children.  One way that it can be used is by making a cup of chamomile tea, dipping a corner of a washcloth in the tea then freezing it for your child to chew on.  The rule of thumb with anything is “Everything in Moderation.”

References:

https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-reports-rare-serious-and-potentially-fatal-adverse-effect-use-over

http://www.med.umich.edu/yourchild/topics/paininf.htm

When Will My Baby’s Teeth Come In?

Jane at 6 months

Those sweet, gummy smiles!  I, personally, cannot get enough of them, but at some point, we hope the teeth start to come in.  Teeth serve many purposes: they can aid in chewing food, developing the child’s speech, give soft tissue support for an aesthetic profile, direct the permanent teeth in their eruption, and aid in the growth and development of the jaws. 

On average, the first tooth comes in around 6 months of age.  Conveniently enough, this is the time that babies begin eating solid foods.  The typical pattern is the front four teeth on top and bottom come in first, followed by the first molar.  Next is the canines (the pointy teeth made popular by Dracula) and lastly, the second molars in the very back.  The teeth continue to erupt until the child is 2-3 years old.  There is a total of 20 primary (baby) teeth.

I have found that teeth do not always follow the textbooks.  Many parents are concerned when teeth are not in by 6 months.  Neither one of my babies have gotten teeth before 8 months of age.  Some children get their teeth in early, but it is far more likely for teeth to erupt later.  Genetics does play a role on eruption timing, so if the teeth are being slow, blame it on your spouse!  Children that were born prematurely often have their teeth come in later than children that were born full-term. In many cases, the teeth will come in six months following the mother’s original due date.

Teeth can be termed “delayed” if the child is fifteen months of age and no teeth are visible.  At this point, the dentist can attempt to take radiographs (x-rays) to see if teeth are present in the jaws.  Blood work can also be completed by the child’s pediatrician to rule out any systemic issues.  Most cases are simply delayed, and no treatment is needed to help the teeth erupt.  It can be important to involve the child’s pediatrician if there is a suspected hormonal imbalance or an underlying issue affecting the child’s growth and development.  But until then, enjoy those sweet, gummy smiles for as long as you can!

Julia at 8 month
Julia at 9 months
Julia at 10 months
Julia at 18 months
Julia at 24 months. She is so old, she has had to resort to reading glasses!

Amber Teething Necklaces

I had the wonderful opportunity to write an article on teething for our local Parents and Kids magazine.  Nowadays, when I discuss teething, I am frequently asked about amber teething jewelry.  Until writing the article, I had not dug deep into the research to understand all the ins and outs of this topic.  I feel like I understand it so much better now!  It is easy to spout my opinion on topics, but it’s just that… an opinion.  Let’s get to the cold, hard facts!

Amber was made popular by the cult-classic film, Jurassic Park.  What a glorious plot line: cloning a dinosaur from a mosquito preserved in amber.  That is Hollywood gold right there!  For thousands of years, amber has been touted for its healing properties.  Some believe that it cleanses the body and mind, absorbs pain and negative energy, clears depression, promotes self-confidence and self-expression.

What are amber teething beads?  They are a piece of jewelry (necklace or bracelet) that a child wears to aid in teething discomfort. 

What is amber?  Amber is fossilized tree resin.

Do they chew on the beads?  The beads are not meant to be chewed on but simply worn by the child. 

How would beads help relieve teething pain?  Amber contains a substance called succinic acid.  Succinic acid is an anti-inflammatory agent.  It has been approved by the FDA and is used to treat arthritis in creams and can be used in tablet forms as a blood pressure medication and to treat migraines.  The theory behind the amber beads is that the child’s body temperature warms the beads and as the amber is warmed, succinic acid is released and taken up by the body.  Once it is absorbed into the blood stream, the succinic acid relieves pain by reducing inflammation.

Does it work?  This is where things get debatable.  There is not enough research at this point to prove or disprove if it works consistently.  Some mamas swear by these beads and some see no difference.

What is the downside to wearing the jewelry?  The American Academy of Pediatrics and FDA have issued statements discouraging children from wearing jewelry.  Necklaces can be a strangulation hazard and the beads, if broken off, can be a choking hazard.

What do the studies show?  Thanks to the invention of Google, it is easy to find a study to support just about any side of an argument.  My background is heavily research based.  In college, I conducted research with the University of Mississippi Dental School in the Biomaterials department and in dental school, I conducted separate research studies for the Periodontic department.  Once I was in my pediatric dental residency, I had to complete a research study and it was in community health.  I do not say this to brag, only to say that I have a bit of experience in this arena.  All research is not created equally, valid research takes time, is well thought out, must have the Institutional Review Board Approval (IRB), has a specific hypothesis/null-hypothesis, and typically uses other valid studies to support the findings.  All of this to say, because the FDA has found the necklaces to be a choking/strangulation hazard, the IRB has trouble approving studies where children are involved.  Some studies have been conducted using the beads in a saline solution that at different temperatures for a certain amount of time to measure how much succinic acid has been released from the beads to see if it reaches a therapeutic dose (dose high enough to relieve pain).  These studies have shown that the succinic acid is not released from the amber until it reaches a temperature of 392°F.  This is higher than body temperature at 98.6°F.

What are my options to relieve teething pain?

  1. Objects for the child to chew on: Sophie the Giraffe, banana toothbrush, frozen teethers, frozen or warm wash cloths
  2. Tylenol or Motrin

**Please do not use Orajel or Hyland’s Teething Tablets.  They can reach toxic levels quickly in infants.  I will write a full blog post on this topic in the future.

Can I Protect My Child’s Teeth Before They Are Born?

Congratulations!! You are having a baby!  I have been blessed to go through the process twice, and it is the best of times; it is the worst of times.  I do not consider myself an anxious person, but both times I was pregnant, my anxiety level increased significantly.  There was an overwhelming feeling of responsibility to take care of the precious bundle growing inside of me.  Suddenly, I was questioning things like, are the chemicals in my face wash safe for my baby and do I need to sleep on my left side or my right side?  No one tells you about these small decisions that seemed insignificant when you were simply taking care of yourself.  They begin to add stress to your day-to-day life.

Did you know that children’s baby teeth and some of our permanent teeth begin to form while he or she is in your tummy?  The teeth begin forming when the baby is only six weeks in utero!  Children’s dental health starts with the mom’s (and dad’s) dental health.  Research studies have shown when the primary caregiver has cavities, the child is more likely to get cavities.  Dental cavities are a transmissible disease.  A species of bacteria is directly linked to the formation of cavities… Streptococcus mutans if you are curious.  How would one pass cavities from one person to the other?  Blowing on your child’s hot food (guilty), drinking after one another (guilty), or sweet kisses (100% guilty).  Give those kiddos kisses and don’t stop!  But one way you can protect your child from getting cavities is to have any cavities you may have filled before your child is born.

Dental cleanings are safe and recommended during pregnancy.  Dental x-rays are safe for the pregnant woman if a lead apron is used to shield her thyroid and abdomen (although dentists may forgo taking x-rays while you are pregnant if you have a history of not having cavities or they do not see anything emergent).  Pregnancy does take quite a toll on your body.  As many women have found out, it can be tough on your oral cavity with morning sickness and the hormonal changes can affect your gums.  In my opinion, the best time to have your teeth cleaned and evaluated while pregnant would be during the second trimester.  In the first trimester, I was so nauseated, I was afraid the toothpaste flavor would make me sick, and in the third trimester, the weight of my baby bump made it difficult to lie on my back for any extended period. 

Another way to protect your child’s teeth is to eat a balanced diet with green vegetables and foods high in calcium. Taking your prenatal vitamins will cover your bases with any minerals you may be lacking. If you are suffering from morning sickness, swishing with a mixture of baking soda and water can bring the acidic level back to normal and prevent the enamel from wearing. It is important to stay hydrated, and drinking water with fluoride will aid in remineralizing any enamel that has been damaged.

Being pregnant is not for the faint of heart.  Just remember that this too shall pass and soon enough, you will have that snuggly little guy or girl in your arms and everything will be well worth it.  You may even do it a second or third time!