By Steven D. Dunning DDS
October 21, 2017
Category: Oral Health
Tags: thumb sucking  
MonitoringYourChildsThumbSuckingCouldHelpAvoidFutureBiteProblems

Although distressing to many parents, infants and toddlers sucking their thumb is a common if not universal habit. Most children phase out of it by around age 4, usually with no ill effects. But thumb-sucking continuing into late childhood could prove problematic for a child’s bite.

Thumb sucking is related to how young children swallow. All babies are born with what is called an infantile swallowing pattern, in which they thrust their tongues forward while swallowing to ensure their lips seal around a breast or bottle nipple when they nurse. Thumb-sucking mimics this action, which most experts believe serves as a source of comfort when they’re not nursing.

Around 3 or 4, their swallowing transitions to a permanent adult swallowing pattern: the tip of the tongue now positions itself against the back of the top front teeth (you can notice it yourself when you swallow). This is also when thumb sucking normally fades.

If a child, however, has problems transitioning to an adult pattern, they may continue to thrust their tongue forward and/or prolong their thumb-sucking habit. Either can put undue pressure on the front teeth causing them to move and develop too far forward. This can create what’s known as an open bite: a slight gap still remains between the upper and lower teeth when the jaws are shut rather than the normal overlapping of the upper teeth over the lower.

While we can orthodontically treat an open bite, we can minimize the extent of any treatments if we detect the problem early and intervene with therapies to correct an abnormal swallowing pattern or prolonged thumb sucking. For the former we can assist a child in performing certain exercises that help retrain oral and facial muscles to encourage a proper swallowing pattern. This may also help diminish thumb sucking, but we may in addition need to use positive reinforcement techniques to further discourage the habit.

To stay ahead of possible problems with thumb sucking or the swallowing pattern you should begin regularly taking them to the dentist around their first birthday. It’s also a good idea to have an orthodontic evaluation around age 6 for any emerging bite problems. Taking these positive steps could help you avoid undue concern over this common habit.

If you would like more information on managing your child’s thumb-sucking habit, 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 “How Thumb Sucking Affects the Bite.”

By Steven D. Dunning DDS
October 13, 2017
Category: Oral Health
Tags: saliva  
These3TasksShowHowSalivaisAmazing

Saliva probably doesn’t rate high on your amazement meter. You’re more likely to notice its absence and the dry irritation that results.

But you might be more impressed with this unsung bodily fluid if you knew all the things it does. It’s definitely a multi-tasker, performing a number of jobs (including aiding in digestion) that not only keep your oral health on track, but your general well-being too. And there are even new testing methods where saliva may even tell us when you’re not doing so well.

Here are 3 more tasks your saliva is doing for your mouth right now that truly makes it amazing.

Cleansing. Your teeth’s chewing action shreds food so it’s easier to digest. But that also leaves behind tiny particles in your mouth. Bacteria feast on these particles (especially carbohydrates like sugar) and produce acid as a byproduct, which can increase your risk of tooth decay. Saliva serves as a kind of “rinse cycle” for your mouth, helping to wash a good bit of these errant particles down your throat and away from hungry bacteria.

Defense. Speaking of bacteria, your mouth is home to millions of them. While most are harmless or even beneficial, a fraction can harm your teeth and gums. Saliva is your first line of defense, emitting an antibody known as Immunoglobulin A that targets these bacteria. Saliva also produces an antibacterial substance called lyzozyme that prevents bacteria from growing.

Enamel Protection. Although it’s the strongest substance in the body, your teeth’s enamel can’t withstand the effects of mouth acid, the by-product of bacterial feeding and growth. Acid levels naturally rise after eating; but even this sudden rise can begin the process of demineralization where minerals in enamel dissolve. Saliva saves the day by first neutralizing the acid and restoring the mouth’s normal pH in about thirty minutes to an hour. It also helps restore minerals in enamel, a process called remineralization. It’s all in a day’s work for this remarkable fluid.

If you would like more information on the importance of saliva to 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 “Saliva: How it is used to Diagnose Disease.”

By Steven D. Dunning DDS
October 05, 2017
Category: Oral Health
Tags: oral health  
OralHealthConcernsforPreteens

As if the preteen years didn’t give kids and their parents enough to think about, new oral health concerns loom on the horizon. Along with major changes to the body, brain and emotions, additional risk factors for tooth decay and gum disease appear during adolescence — the period of development starting around age 10 and extending through the teen years that marks the transition from childhood to adulthood.

Even with declining rates of tooth decay across the nation, the cavity rate remains high during adolescence. According to the American Academy of Pediatrics, 1 in every 5 adolescents has untreated tooth decay. What’s more, the onset of puberty — usually beginning around age 10-11 in girls and 11-12 in boys — brings changes in hormone levels that can affect gum health.

We all have millions of microorganisms in our mouth, representing hundreds of different species of mostly helpful, but some harmful, bacteria. Research has shown that total oral bacteria increases between ages 11 and 14, and new types of bacteria are introduced, including some that are not friendly to teeth and gums. Some unfamiliar microbes trigger an exaggerated inflammatory response to dental plaque, so gum bleeding and sensitivity are experienced by many children in this age group. In fact, “puberty gingivitis,” which peaks around age 11-13, is the most common type of gum disease found during childhood.

A combination of hormones, lifestyle changes and poor oral hygiene habits raises the risk of oral health problems among adolescents. A more independent social life may be accompanied by a change in eating habits and easier access to snacks and beverages that are sugary, acidic (like sports drinks and soda) or full of refined carbohydrates — none of which are tooth-healthy choices. And as children move toward greater independence, parents are less likely to micromanage their children’s personal care, including their oral hygiene routines. Good oral hygiene can keep dental plaque at bay, lowering the chance of having gingivitis and cavities. But let’s face it: Adolescents have a lot to think about, and keeping up with their oral health may not be top of mind.

To help your preteen stay on top of their oral health, keep healthy snacks at home for your children and their friends and make sure you are well stocked with supplies such as new toothbrushes, floss and toothpaste. In addition, most preteens (and teens) can benefit from gentle reminders about oral hygiene routines.

For optimal oral health through all stages of life, make sure your preteen keeps up with professional teeth cleanings and exams, and talk with us about whether fluoride treatments or sealants may be appropriate for your child.

For more on your child’s oral health, read “How to Help Your Child Develop the Best Habits for Oral Health” and “Dentistry & Oral Health For Children” in Dear Doctor magazine.

By Steven D. Dunning DDS
September 27, 2017
Category: Dental Procedures
Tags: dental implants  
ATeenwithaMissingToothMayNeedtoWaitonaDentalImplant

There’s a lot to like about replacing a missing tooth with a dental implant. This state-of-the-art restoration is by far the most durable and life-like option available. And unlike other replacement options implants stimulate bone growth, a major concern after tooth loss.

For that reason we encourage getting an implant as soon as possible — for adults, that is. We don’t recommend implants for younger patients because even a teenager’s jaws haven’t yet reached full maturity. Because it attaches to the jaw differently, an implant can’t move with the growing jaw as real teeth do. It would eventually look as if it were sinking into the jaw below the gum line or being left behind as the rest of the jaw grows.

It’s best, then, to postpone placing an implant until the jaw fully matures, usually in a patient’s early twenties. In the meantime, there are some things we can do to prepare for a future implant while also restoring the tooth with a temporary replacement.

As previously mentioned, our biggest concern is bone health. Like other living tissue, bone has a growth cycle of older cells dissolving and newer ones forming in their place. The teeth transmit the pressure produced when we chew to the bone to stimulate this growth. With the absence of a tooth, the adjacent bone no longer receives this stimulation — the growth cycle slows and may eventually lead to bone loss.

We can help this situation by placing a bone graft in the missing tooth socket at the time of extraction. The graft serves as a scaffold that’s eventually taken over and replaced by new bone growth. We can also try to control how fast the graft is replaced by using grafting material that’s slowly removed and lasts longer — often a preferable situation if an implant is years away.

As for appearance, we can create a custom partial denture or even a type of bridge that bonds a prosthetic tooth to neighboring teeth without significantly altering them. If the patient undergoes orthodontic treatment it’s also possible to add prosthetic teeth to an orthodontic appliance.

Eventually, we’ll be able to provide the permanent solution of a dental implant. With careful planning and measures to preserve bone health, there’s a good chance the outcome will be worth the wait.

If you would like more information on treatments for lost teeth in children and teenagers, 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 “Dental Implants for Teenagers.”

WaitingtoAffordImplantsConsideraFlexibleRPDintheMeantime

If you’ve lost some teeth you may eventually want to replace them with dental implants. Implants by far are the restoration of choice due to their life-likeness and durability. But those advantages don’t come cheaply — implants can be expensive especially for multiple teeth.

If you’re forced to wait financially for implants, you still have other intermediary options like a removable partial denture (RPD). The conventional RPD has a rigid acrylic base colored to resemble gum tissue supported by a metal frame with attached prosthetic (false) teeth at the missing teeth locations. They’re held secure in the mouth through metal clasps that fit over the remaining teeth.

But these conventional RPDs can sometimes be uncomfortable to wear and don’t always cover the bottom of the gum completely. If this is a concern, you might consider an alternative: flexible RPDs. The base of this RPD is made of a form of flexible nylon rather than acrylic plastic. They’re much more lightweight but still fit securely in the mouth with thin plastic extensions rather than metal clasps. The base can also be more easily formed to cover areas where gum tissue may have receded.

While flexible RPDs hold up better to wear and tear than their conventional counterparts, they must still be maintained like any other appliance. They can accumulate plaque (bacterial biofilm) responsible for tooth decay and periodontal (gum) disease, so daily thorough cleaning is a must. And if there fit becomes loose they can be more difficult to reline or repair than other types of dentures.

They also share a common weakness with other dentures — they can’t prevent and may even stimulate bone loss. As bone ages, old cells dissolve and new ones form to take their place. As we eat and chew our teeth transmit the forces generated through the teeth to the bone to stimulate it to grow. RPDs and other dentures can’t transmit this stimulus, so the bone replaces much slower to the point that the bone volume can diminish.

That’s why it’s best to consider any RPD as a temporary solution until you can obtain an implant for a more permanent and bone-friendly option. In the meantime, though, an RPD can provide you with a great solution for both form and function for missing teeth.

If you would like more information on RPD choices, 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 “Flexible Partial Dentures: An Aesthetic Way to Replace Teeth Temporarily.”





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