5 Ways to Prepare Your Child for the First Dental Visit

It is an honor to see a child for their very first dental appointment.  Having seen countless numbers of children for their first dental visit, I have come to recognize ways parents can help the appointment to be more successful. 

A child’s first dental visit can set the tone for future dental appointments.  My goal, as a pediatric dentist, is to create a positive experience by keeping the mood light, taking extra time to introduce our dental instruments, and using verbiage that will allow the child to feel comfortable in this new environment.  The first dental visit is as much for the parents as it is the child.  It is the parent’s responsibility to discuss issues with cleaning at home or any dental concerns.  It is the dentist’s responsibility to instruct the parent on the most recent dental recommendations as well as to address the parents’ concerns to set the child up for healthy dental habits at home.  It is extremely important for the parents and dentist to be on the same page and, as a team, work together to give the child the best possible dental health.

1. Stay Positive

Many people experience anxiety when it comes to visiting the dentist. The anxiety typically stems from a negative experience that occurred in the past. It is important to shield your child from these feelings. Children are sensitive to their parent’s emotions and can become anxious if they know their parent is afraid of the dentist. Dentistry has changed drastically over the past 20 years and continues to change daily to allow for a better dental experience.

2. Brush Your Child’s Teeth at Home

Setting your child up for a positive dental experience starts at home.  If a child sees a toothbrush and a toothbrush being regularly used at home, then when they come to the dentist, although the environment is new, they will see familiar items and understand what they are used for.  People are comfortable with the familiar, and oftentimes anxiety stems from the fear of the unknown.

3. Use the Right Words

In becoming a pediatric dentist, I developed a language all my own.  It is important to translate what is being done or what a child will feel into words they can relate to and be okay with.  Avoid the S-H-O-T word at all costs, especially prior to the first visit.  Unless it is an emergency visit, there is no need for an injection at the first visit.  This goes along with cleaning at home.  I cringe every time I hear a parent say, “If you don’t let me (or the dentist) brush your teeth, you are going to get cavities, and the dentist is going to give you a shot.”  Threats like this are scary, unnecessary, and make the child afraid of going to the dentist. 

Instead tell your child, “The dentist is going to brush your teeth and may take some pictures of your teeth.”  In my office, the dental explorer is called a “tooth counter.”  The suction becomes “Mr. Thirsty.”  The air is “wind.”  The water is my “squirt gun.”  The mirror is called my “Barbie mirror.”  And so, it goes.  Perhaps one day I will be asked to write the Milling Pediatric Dental Dictionary, but until that day arrives, I will continue developing its vocabulary.   

4. Read a Book

Numerous books and characters go to the dentist.  If your child likes Peppa, there is a book for that.  If your kid likes Daniel Tiger, there is a book for that.  The Berenstain Bears?  You got it.  There is a book for that.  No book will ever be able to explain the exact dentist and dental office because all offices are different, but the general idea and themes will be there.  Often children want to experience what their favorite characters experience.  Now, if only I could get Spiderman to go to the dentist. 

5. Do Not Make It a Big Deal

Going to the dentist for the first time is a big deal, and I would never want to cheapen it.  It is a milestone in our little children’s lives, and as mothers, we want every milestone to be picturesque.  What if they misbehave?  What if they cry?  What if they spit in the dentist’s face?  What if they bite the hygienist?  How will this reflect on my child or my parenting?  Do not go down the rabbit holes of “what ifs.”   

If your child is young, it is perfectly normal for a few tears to be shed.  Does your child cry or fight you at home when brushing?  Then why would it be any different at the dentist.  If I may be so bold as to give another piece of advice, do not hover.  Give your child and the dentist space so a trusting relationship can be built.  Parents are the ultimate authority in a child’s life.  Even though a parent’s intentions are often to be helpful, when a parent interjects reprimands or encouragement, it detracts from what the dentist is saying and doing.  It can be confusing to a child to hear multiple people telling them what to do.  A child always hears a parent over any other authority figure.  Although they do not always do what we say, as parents, they are always listening for that familiar voice they know and love.

If you keep in mind these five things, you will set your child up for a great first visit.  And if the appointment goes south, do not be too hard on yourself or your child.  Go into the appointment with an open mind, and give your child the opportunity to flourish in this new environment.

What Is a Pediatric Dentist?

Pediatric dentistry is a growing subset of dentistry.  Children are not little adults and require different tactics than adults when it comes to dentistry.  What works for one child may not work for another.  It is my job to be reading the mood of the child and create a comfortable environment where the child can have a positive dental experience.  Before becoming a pediatric dentist, many of my adult patients were holding onto bad dental experiences they had as a child.  It is my goal to prevent negative dental experiences, so every child will continue to seek preventative care for the rest of his or her life.

A pediatric dentist completes four years of dental school and progress to two (sometimes three) years of specialty training to receive our degree.  Every pediatric dental residency is required to train its students in eight areas: prevention, trauma, sedation/general anesthesia, growth/development and orthodontics, treating patients with special needs, oral pathology, and behavior management.

Prevention: Dentistry is one of the few professions that is constantly trying to put themselves out of business.  Preventing disease is a better form of treatment than fixing the disease once the process has started.  That begins with starting good oral hygiene at an early age.  At my patients’ first visit, I have a discussion with the parents about their child’s dental home care and give my recommendations on how to prevent their child from getting cavities.  This is the first step in setting a child up for a positive dental experience.

Trauma: Accidents happen.  Teeth get bumped, bruised, broken, knocked out, knocked in, you name it!  I am well-versed in what to do and how to give the tooth the best chance to survive after having an injury.  Some teeth respond well and unfortunately some do not, depending on the injury, but all I can do is follow the recommendations for each injury based on the best scientific research we have at our disposal.

Sedation/General anesthesia: Dental sedation is when a patient is prescribed a medication to relieve anxiety or prevent memory so dental treatment that is medically necessary can be completed.  General anesthesia is used when the patient’s dental needs are too great to be completed with sedation.  These tactics are used with adults as well as children.  Sedation of children became more popular when certain behavior management techniques fell out of favor (i.e. physical restraints and voice control).  Sedation and general anesthesia are always something to be taken seriously by making sure your provider has the proper training to administer the medication as well as the skills required to rescue a child if they become too sedated.    

Growth/Development and Orthodontics: Unless a pediatric dentist is dually trained, he or she is not an orthodontist.  With that said, every pediatric dental residency is required to train in orthodontics.  Some pediatric dentists feel more comfortable in this realm than others, but all pediatric dentists are specialists in growth and development.  At each dental appointment, it is important to monitor for potential issues associated with the growth of the patient and whether there is a potential problem with crowding, spacing, discrepancy in number of teeth, size of teeth, malocclusion (problems with the way the child is biting), etc.

Patients with Special Needs: A pediatric dentist can treat patients of all ages who have special needs.  Special needs include physical disabilities such as rheumatoid arthritis, cleft lip and/or palate, or spina bifida.  Patients can also have mental disabilities such as Asperger’s, autism, or Down syndrome.   Every person with special needs is unique, and it takes a bit of creativity to find a dental health regimen or treatment strategy that is successful for each patient.

Oral Pathology: Because the oral cavity is the gateway to the body, many pathologies have oral presentations.  Sometimes the first signs of certain diseases present orally.  For example, patients with Crohns disease and other autoimmune diseases can present in the mouth prior to any other presentations.  Tobacco use presents in several ways in the mouth and conversations can be had on stopping tobacco use.  Bulimia also has oral indications and can be discussed so the patient can receive the help that they need.

Behavior Management: Behavior management is what sets a pediatric dentist apart from a family or general dentist.  There are many general dentists who are fantastic when it comes to treating children, but when all you do is see children, managing their behavior is a well-honed skill that only comes with practice.  All the aforementioned areas are pillars of what a pediatric dentist knows, but behavior management cannot be taught by books.  It is learned through treating countless children, knowing when to use TLC, when to take extra time, when to encourage, when to sing a song, when to distract, or when to recommend dental sedation. 

The Scary (Or Not So Scary) Truths about Halloween Candy and Your Child’s Teeth

Beside Christmas, Halloween is my children’s favorite holiday.  They love Halloween books, and we read them all year round.  They adore playing dress up which we also do all year round.  And they, like most children, enjoy candy which we do our best not to eat all year round.

I have a problem.  Dentists have always been painted out to be anti-candy, anti-sugar, and anti-fun.  I happen to love candy, sugar, and fun, so what is a poor dentist to do?  I will never be the dentist who hands out toothbrushes instead of candy for Halloween.  I do, however, know some facts about candy and can help your child (or you) enjoy their haul without putting their teeth at risk.

Caution!  I am about to get “science-y.”  Anytime we eat or drink anything other than water, our mouth becomes acidic.  Our saliva attempts to bring our mouth back to a neutral pH, but if beverages or snacking are frequent, the mouth will stay at an acidic pH for an extended period.  An acidic environment allows the bacteria that create cavities to thrive and thereby allows cavities to form.  The bacteria that encourage cavity formation love to eat sugar.  It is what they digest the best and the by-product is even more acid.  Can you see the slippery slope?

Not all candies are created equal.  Chocolate candy, although sugary, is easier for the saliva to rinse away than sticky candies like skittles, sour patch kids, taffy, etc.  Suckers and hard candies do not tend to stick to teeth as long as sticky candies, though they do stay in the mouth for an extended period of time.  Basically, the chocolate candies tend to not cause as many problems. (And they happen to be my favorite too!)

Here are a few strategies you can try:

  1. Have your child pour out all of their candy on Halloween night and tell him or her he or she can eat as much as he or she wants, but whatever is leftover is getting thrown away or, even better, donated to a candy give-back program for the troops.
  2. Let your child eat the candy he or she wants on Halloween night, take up the rest, and put it away for after dinner snacks.  Brush and floss teeth before bed. 
  3. Keep the candy stash and give as treats every now and then but do it at times when the candy will not sit on the teeth for an extended period.  Follow the candy with a cup of water to help neutralize the mouth.

Do not give candy as incentives throughout the day.

Do not put the candy in a place that is easily accessible to your child.

Do not give candy before bed without brushing afterward.

If you follow these recommendations, your child should have no problem with his or her teeth.  I hope you find this helpful and HAPPY HALLOWEEN!!!

COVID-19 and Your Teeth

When I first discussed doing a blog post with my advertising guy during the COVID-19 crisis, I pretty much shut down.  Aside from feeling extremely overwhelmed with having to close my business, figure out what governmental loans to apply for and at what specific time to apply for them, I was navigating being a stay at home mom for the first time since my oldest child was five months old.  I was thinking, “You’ve got to be kidding me.  Social media is not a priority that is even close to being on my radar right now.”  Thankfully, my advertising guy is my husband’s best friend, and allows me space when I need it but gives me honest feedback.  He encouraged me to continue with my social media and blogging.  Insert eye roll here.

He was right.  As I have accepted this situation I find myself in, I have been able to see how drastically our day-to-day lives have changed.  When yesterday, I was getting up, exercising, eating breakfast, out the door, dropping the kids off to school, arriving at work, answering emails, etc, and today, I am getting up and trying to imagine how this pandemic will unfold, filling my days with anxiety-laden thoughts.  Heaven forbid I watch the news!

I have never been in a situation where I could not leave my house and have no interaction with people besides my immediate family.  When the mandate was placed that I was not able to work anymore aside from urgent dental needs, I decided to go home, take my kids out of daycare to save money, and make the best of my new situation.  It was up to me to create a new routine, and I have learned that a loose schedule is key. 

So, how does COVID-19 affect your teeth?  To my knowledge, COVID-19 has no effect whatsoever on your teeth.  But wait for it!  During this quarantine, I have found that in my own house, when we are off our routine, self-care is often the first thing to go.  The nighttime brushing typically gets completed, but in the morning it’s off to the races.  I get up early and get my husband off to work.  Then my kids are up begging for their breakfast, and soon it’s nap time and I realize I never brushed my teeth let alone my children’s teeth.  Making a conscious effort to remember to take care of ourselves during this time is important. 

One of the other things I have realized that can increase the risk of getting cavities is, I snack more when I am at home than when I am on the go.  The more frequently snacking occurs, the more often the mouth is under acidic attack and has less time to recover.  It is not always the food that is the problem, but how often snacking occurs.  A big problem that can lead to cavities is sipping on beverages that are not water throughout the day.  Oh, it’s no big deal.  It’s a diet coke.  Yes, there is less sugar in diet coke than regular coke.  Both are acidic and can cause your enamel to decay.  The person who drinks a cup of coffee with breakfast is a lot less likely to get a cavity than the person who sips on coffee throughout the day.

The last thought I will leave you with is this: kids are vaping.  Kids can sense the tension that is going on in this world and are more likely to be vaping on a regular basis because they are bored, have more time on their hands, miss their friends, and are anxious.  I have not found many studies on what vaping does to oral tissues.  It is still too early to say anything definitively, but from my own personal practice, I see more issues with dry mouth in kids that vape.  Saliva is important in maintaining a healthy oral flora and counteracting an acidic environment to prevent cavities.

I hope you find this information helpful and informative.  Please stay safe and stay home to prevent further spread of this disease!

P.S.  Are your kids as uncooperative with taking pictures as mine?  Oh well, this is the best I got!  Happy Quarantining!

What Does a Tooth, Cake, and an Ogre Have in Common?

I know you remember the scene where Shrek is explaining to Donkey that ogres are more than the frightening fairy tale lore they are known for.  “They have layers.  Onions have layers” explains Shrek huffily.  Donkey thinks for a minute and replies, “Not everybody likes onions.  CAKE!  Cake’s got layers.  Everybody likes cake.” Teeth, like cake, have layers. 

The white outer layer is called enamel.  Enamel is the second hardest compound in the world, preceded only by one of my other favorite things, diamonds!  Enamel protects the inner tooth layers from extreme temperature changes and normal wear and tear from chewing food.  Enamel is densely mineralized and is constantly responding to changes in its environment.

The middle layer is called dentin.  It is less mineralized than enamel and has a yellow hue.  Dentin is amazing because it can sense if a cavity is forming, and it will lay down more dentin to wall off the cavity and protect the nerve and blood supply inside the tooth.

The innermost layer is called the dental pulp which contains the nerve and blood supply to the tooth.  This is why a tooth can feel cold, heat, and pain.  If a cavity comes close to or reaches the pulp, it can allow a pathway for bacteria to proliferate and cause an infection.   

Each layer has its unique purpose.  It is amazing how a tooth can fight a cavity without a single action from us.  Whether it be a cake, an ogre, or a tooth, I am a fan of layers, and you should be too.  Now, please pass the cake!

What is Conscious Sedation?

To sedate or not to sedate, that is the question.  Dental sedation has been brought to light by the media in the past few years and the light has not been very complementary.  Sedation is when medications are administered to create a relaxed or peaceful state.  It is a spectrum, and depending on the patient’s needs, the provider will decide what level of sedation is necessary to accomplish the desired goal.

Dental sedation can be used for adults, but I will be focusing on sedation for children since that is my area of expertise.  When I was in residency, in our first sedation class my professor said, “Children are not little adults!  Do not sedate them like they are an adult.”  At the time, I did not know what he meant.  When working with adults, there is more standardization as far as prescribing medications.  With a child, typically, prescribing should be based off his weight and not his age or maximum dosage.  Young children do not have mature respiratory systems, do not have a large oxygen reserve, and can become overly sedated quickly.

There are hundreds of medications that can be used to sedate children and as some would say, “many ways to skin a cat.”  I will not discuss specific medications, but each provider has their “go to” medications that they use depending on the situation and the desired goal.  When the term “conscious sedation” is used, I am referring to minimal sedation.  My goal for a child is that he be awake but relaxed for the procedure.  The child should be able to follow my instructions and have all his normal reflexes intact.

Conscious sedation is safe when practicing within the guidelines set forth by the American Academy of Pediatric Dentistry.  This is not to say that there should not be some level of healthy fear anytime medications are introduced.  As I stated before, sedation is a spectrum and a child can easily slip further down the sedation spectrum than may be intended.  Whenever a child is sedated, it is important to keep in mind where the child is on the spectrum, and as a provider, “Am I comfortable with how this child is responding?”  If not, what is the causing the problem and how do I fix it quickly. 

When I was in dental school, I had several patients that were terrified of the dentist.  Many of these patients had a bad experience as a child and have carried these fears into adulthood.  Sedation was not a common practice even twenty years ago.  At that time, it was not uncommon to use restraints or behavioral techniques that are not as acceptable at this day in time.  Children are impressionable creatures and do remember bad experiences that may affect them for the rest of their life.  This is one of the reasons why I decided to go into pediatric dentistry.  If I can give a child a good dental experience, then that child will carry this mindset to adulthood and is more likely to seek dental care on a routine basis instead of waiting for an emergency to arise. 

I am not going to lie, sedation appointments are not my favorite, but if it will give a child a good experience, I will do it.  During residency, I completed over double the amount of sedation cases required and feel comfortable with the medications I prescribe.  I maintain my Pediatric Advanced Life Support certificate.  All my staff is certified in Basic Life Support.  I complete an inventory of our crash cart monthly to make sure I have everything I need on the off chance I run into a situation where I may need to rescue a child.  We have staff meetings weekly where we discuss various office emergencies, and how we will handle them.  I hope to always maintain a healthy fear that I may need to use my advanced training.  Sedating a child is never something to be taken lightly, but it can be a useful tool in creating an enjoyable dental experience for some children.

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

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

What Age Should My Child See the Dentist?

I am going to go ahead and say it.  I have no time or space for “mom guilt” in my life.  Every single one of us is trying to do the best we can for those that we love most.  And “mom-ing” is hard.  Keep in mind that the American Academy of Pediatric Dentistry guidelines are just that: GUIDELINES.  You will never receive judgement from me, no matter what age your child is when he or she visits the dentist.  Got it?  Great!  I feel better now.

“In order to prevent dental problems, a child should see the dentist within six months of the eruption of their first tooth but no later than one year of age.”

~AAPD Guideline

I am thrilled you brought your child to the dentist by his first birthday because you would be in the 1% of parents who followed these guidelines.  Therefore, 99% of moms (or dads if “dad guilt” is such a thing) feel terrible bringing their kids in for the first time and open the conversation with an apology at their tardiness and irresponsibility.

The reason I am writing this blog post is not to make you feel guilty or anxious.  I am here to set the record straight.  Similarly, to the “fluoridated toothpaste” blog, the guidelines have changed in recent years, so the answers are all over the place.  The old recommendation was to see the dentist by age three and still, most general dentists prefer to go by this recommendation.  Typically, any child under the age of three is going to cry when a stranger gets close to looking at his teeth.  And yes, rarely are children under the age of three able to tolerate a typical dental cleaning.  So, why do we have the visit at one year of age?  Math and science.

Scientific studies have shown that it takes an average of six months for dental decay to work its way through the enamel (hard, white outer layer) of a baby tooth.  And the average age for the first baby tooth to erupt is around six months of age, so mathematically, the first dental visit should be around one year of age to prevent cavities from forming.  Prevention is the goal!

The first dental visit is as important for the parent as it is for the child.  It is my job to educate parents on taking care of their child’s teeth at home, discuss the amount of fluoridated toothpaste they should be using, discuss the child’s diet and habits like thumb-sucking and pacifiers, evaluate for possible growth discrepancies, and make sure the child is on track with his tooth eruption.

Why are so few parents bringing their children to the dentist by age one?  First and foremost, they did not know they were supposed to and secondly, FEAR.  I am going to let you in on a little secret.  I did not bring my oldest daughter into my office for her first cleaning until she was two years old.  Why do you think that was?  I was afraid she was going to throw a temper tantrum, and I was going to look like a bad mom in front of my staff and fellow doctors.  I fell into the trap of fear.

Some parents fear that their child will be traumatized by starting early and crying for each cleaning appointment.  Once again, the goal is prevention of cavities!  I much prefer having a young child who is nervous for cleanings, where a problem can be prevented than have a well-behaved five-year-old that comes in for his first visit, and we find a cavity requiring an injection and using the handpiece.  Children’s behavior will improve for cleanings.  Children’s behavior does not typically improve with multiple dental filling appointments.

But one year old… really?  When I started my pediatric dentistry residency, I thought the exact same thing.  I was blessed to attend a residency where the patient population is one of the most underserved populations in the nation.  Many of the patient families I served in south Florida lived on a level of poverty I did not know existed.  Many came from other countries and did not speak English.  All my patients were on some type of government assistance and almost all these children had mouths full of cavities. 

One of the most vivid memories I have from my time there was when an 18-month old child came to our office, and we had to pull all four of her front teeth because they were decayed beyond saving.  It broke my heart knowing that she would go six years with a gap where her teeth should be, she would have difficulty learning to say her T’s, and kids would notice and say things about her missing teeth.  But I also knew that if I left those rotten teeth in her mouth, that she could get very sick and the infection could cause damage and might discolor her permanent teeth.  I do not know whether she would still have all her front four teeth if she had come to see us at one year of age.  Maybe the decay would have been where we could have put crowns on the teeth and corrected the dietary choices that caused her teeth to deteriorate.  Maybe we still would have had to pull them.  But I will always remember that little girl and impact she made on me.  This is why I will advocate for having your child seen by the dentist by the age of one.