Looking for the Best Dentistry Clinic

Most children do quite well for dental treatment. Remember every child responds differently in the dental office. There might be a three year old getting a filling doing just fine sitting next to a twelve year old who is extremely anxious or defiant. You can get them used to coming to the dentist with regular early visits. The children get used to the water and noises of a cleaning so when more extensive treatment is needed, it is not such a big deal to them. For those children who have a harder time than most, well there are several tools that can be employed. The best and most often used are verbal techniques like positive reinforcement, tell-show-do, and voice tone control. Often, pharmcologic methods are necessary to comfortably accomplish treatment. The most common is Nitrous Oxide or Laughing Gas. It is a fairly benign easy way to help the child. Often additional medications are needed to help kids to be comfortable and cooperate to accomplish treatment. Sometimes it is even necessary to do treatment under General Anesthesia in the Hospital. Many times, however, the hospital is not an option due to lack of insurance coverage, limited treatment needs, or parental preference. The option of in-office Conscious Sedation has been a good option to help kids and parents.

Things can be unpredictable as medications elicit different responses in different children. Different medications (usually oral medications) are used for different situatuions. The younger the child, the more unpredictable the medication's effect. A certain dosage on one child may make them quite sleepy and sedated, while the same exact dose will not seem to do anything for the next child. Studies have found an individual child's temperment has a lot to do with their response. Therefore, some kids are better served with treatment under general ansthesia. In fact, if there is so much work that several sedative appointments will be required to complete the treatment, then the option of general anesthesia is usually discussed.

One problem with sedation in pediatric dentistry is that you can only give what is considered a "safe" dosage. Those chidren who do not respond to that dosage, well, you don't just give twice the dose and hope it will take. That could lead to trouble. Whatever is used, you monitor vital signs in accordance with the AAPD guidelines. The whole process is some what of an art as much as a science.

I am going to start series of posts on Sedation in Pediatric Dentistry and related topics. As this is too big a subject to address in one post, here are some important links to related topics (coming in the next few weeks):

How Children Behave at the Dentist, What to Expect

Many parents expect their children either to act up or be little angels at the dentist. With children, you really never know quite what you are going to get. Here is a list of what I generally see with children at different ages and what to expect as far as behavior in the dental office. I have to say I have had one and two year olds who do better than teenagers. I also have seen parents in worse shape than their kids. The behavior is what I usually see for dental exams or cleanings. If they do have cavities or other treatment needs, I use the cleaning/exam appointment to evaluate their response. If I think they will be fussy for treatment, then we discuss how to make that better. There are always exceptions to what I am presenting here, but this is how it goes:

Babies-They usually do well for an exam or just cry a little. Give them their pacifier and they are as good as new.

One year Olds-they usually do quite well although if they are closer to two things can get a little loud.

Two Year Olds-They don't call this age the "terrible twos" for nothing. These kids are by far the hardest to examine. They almost always cry to be examined. I mean they really scream like there is no tomorrow. They fight too. This is the age that they begin to establish independence. This is especially true for the "headstrong" kids. They really don't like to lie down for an exam. I can look a little with them sitting up, but can't really do a complete exam. So, we have them lie down, the parent holds their hands, and I take a really quick look. I don't mind the noise, although the resistance can make the exam more difficult. I always hope the parents realize this kind of fussing is normal for this age. I don't want them to think the child is in any kind of real distress. I don't want them to be mad at me for just looking at their child's teeth. The parents I worry most about are the first timers. Parents who have more than one child often understand the normal reactions. I know the child is not traumatized for life just for counting their teeth. In fact these fussy two year olds often become model patients after a couple more years of regular visits.

Three Year Olds-this is a transition age. Some three year olds are just as fussy as the two year olds just bigger and stronger. Some are model patients who let you lay them down, clean their teeth, and often do fillings without protest. Even a particular three year old may respond differently depending on what side of the bed he woke up on that day. You know what I am talking about.

Four year Olds-I like four year olds. Most of the time they are the best patients. They hop up into the chair; let you take x-rays, fillings, whatever. They can't do this for long, but most do quite well. Again, there are exceptions. Some are as "head strong" as the two year olds.

Five through Eight-Regular kids. Most do quite well. I can communicate with these kids and can guide them through almost anything.

Eight to Eleven-Most do well, but these are the "needle-phobic" years. You can have a perfectly calm child who throws a giant fit if he thinks he is going to get a "shot". Read here for more info on that bad word: Pedo Lingo. After they have received appropriate anesthesia, they revert back to cooperative patients.

Teenagers--Most do well although some have typical teenager "attitudes". You have to take into account whether they are the "I'm too cool to care/whatever" type or (usually young ladies) who are extremely preoccupied with their appearance.

Special Needs Patients--If you take your child to a Pediatric Dentist, you will likely see other children around of all ages and temperaments. You also may see some patients who have medical or developmental conditions like Down's Syndrome, or Cerebral Palsy. These children are welcome in our offices. Some can be very loud or resistant to treatment. Even just an exam can be difficult. Others are some of the best behaved in the office. In other words, there is great variety in Pediatrics. You can expect lots of commotion and activity.

If you want more, go back to the home page or click here:Pediatric Dentistry

Important Tips for Baby Dental Problems

I see this every day. A child comes in with his permanent lower incisors coming in behind the baby teeth. We sometimes call it "Shark" teeth. The baby teeth have not come out like they were supposed to. It is most common with the lower front teeth when the child is six years old and then the upper back molars when the child is around eleven years old. A common "emergency" is when a parent notices a permanent tooth coming in behind a primary (baby) tooth. It's not really an emergancy, but needs to be addressed.

In the normal course of events, the permanent teeth slowly dissolves the baby tooth root as it comes in up under the baby tooth. Finally, there is not much root left. The baby tooth gets loose and eventually falls out. The permanent tooth then comes in where the baby tooth used to be. Well, it doesn't always happen just like that.

If the child doesn't have enough room for the permanent teeth, then the permanent tooth may not come in right up under the baby tooth. Even when there is lots of room, the new tooth may not be able to resorb the baby tooth root fast enough. It then takes the path of least resistance, which is to come in behind the baby tooth. That means there is nothing "pushing" the baby tooth and there may be quite a lot of baby tooth root left.

The good news is that the permanent tooth will tend to move forward into the correct position on it's own IF there is nothing in the way and there is enough room. That usually means the dentist will need to remove the retained baby tooth and make more room by removing the adjacent baby teeth or making the baby teeth more slender by "disking" them. If the new tooth hasn't come in very much (you haven't waited too long), then the new tooth will slowly move forward. This takes a few weeks or months to move forward into a better position. They may even straighten out a little if they were coming in crooked.

Often teeth come in pairs, so if one tooth is not coming in correctly its partner on the other side won't either. A lot of parents hold out hope the baby tooth will fall out on it's own. Some children are very aggressive in wiggling their teeth. Some just let them hanging there. Remember however, that there may be more root on that baby tooth than you think, otherwise it would have come out by now. Most of the time the dentist has to get in there and get the tooth. Even if you can get that tooth out, is there enough room for it to come forward? Many times teeth come in funny because there is some inherent crowding. If the dentist needs to get it out, it's not a big deal. Most kids do quite well for this. Plus, they get to have their tooth to put under the pillow for the tooth fairy!

Important Tips for Dental Implants Surgery

OsseoNews (ON): Could you present an overview of the immediate loading protocols that you and Dr. Wolfinger have developed and are utilizing at the Institute of Facial Esthetics.
Dr.: There are several basic concepts that distinguish our protocols from the traditional approach to implant placement and restoration. In the first place, we utilize an immediate loading approach where we place the implants and subject them to loading on the day of surgery. This is our standard operating procedure in contradiction to the traditional placement followed by a waiting period where the implant fixture is undisturbed and undergoes osseointegration. We have been collecting data over two decades and have firmly established that our protocol produces a very high rate of success over the long term.
ON: Could you explain how you have encorporated computer software into your protocols.
Dr.We make a CT scan of the patient to generate a three dimensional virtual replication of the bone, soft tissue and alignment of teeth. We feed this data into our software program to generate a surgical guide, which selects the most advantageous implant sites and angulations. The surgical guide will have three guide pins, which will securely stabilize the guide stent during the drilling and placement of the implants. The stent will first be used as a guide to drill a hole for each of the guide pins. The guide pins will then be inserted through the stent and into the bone. The advantage of this technique is that the drilling and placement of the implants is very precise and accurate. The implants end up exactly where you want them, at the desired angulation and the desired occlusogingival height.
ON: How do you generate the prosthesis?
Dr.:The prosthesis is generated by the software program based on the data from bone, soft tissue and alignment of teeth. We do a CT scan of the patient at the proper vertical dimension of occlusion in centric relation position.
ON: What if the patient is already wearing removable partial dentures or complete dentures?
Dr.: We scan the patient wearing the removable dentures. We do a second scan of the removable dentures alone. All of this information that we collect enables our software program to generate a fixed-detachable partial or complete denture that will fit the abutments torqued into the implant fixtures.
ON: The permanent abutments then are also torqued down at the time of implant placement?
Dr.: The permanent abutments are torqued down permanently at the time of implant placement. They are not removed after they have been torqued down. The final form and orientation of the abutments is established at the time of implant placement.
ON: The CT scan and software program provide accurate enough data to produce a prosthesis that precisely fits the abutments?

Best Tips to Prevent from Cavities

Like most drugs, fluoride causes what it purports to cure. And fluoride can't protect teeth from a bad diet.

Dentists tell us that drinking “optimal” levels of fluoridated water - 1 part per million or 1 milligram fluoride per liter (quart) - each day, reduces tooth decay without serious side effects. But this dental dogma has never been proven scientifically. However, research shows, above optimal fluoride levels causes tooth decay; and most Americans get more fluoride then they need.

The severe outward sign of fluoride overdose is dental fluorosis - yellow, brown or black stained teeth. Cavities increase in people with severe fluorosis according to a dentistry textbook entitled, “Dentistry, Dental Practice and the Community,” by Burt and Eklund.

This phenomenon has been demonstrated in the United States from National Institute of Dentistry and Craniofacial Research studies in seven communities in northern Illinois. The results of the dental decay examinations, related to fluoride concentrations in drinking water, form a J-shaped curve. With increasing fluoride levels, cavity experience diminishes to a certain point and then starts to rise again, the authors report.

These data suggest that the true relationship between water fluoride levels and dental decay is the J-shaped curve, with the turning point in the J being something between 3 and 4 times the optimal level, they write.

The problem is that children already receive above optimum doses of fluoride even without drinking fluoridated water, studies show. By 1974 samples of duplicate meals indicated more than ten times as much fluoride as had been found thirty years earlier – and this study didn't factor in fluoride content of snack foods.

Maybe excess fluoride is why tooth decay is still a major U.S. dilemma. Even though U.S. children are fluoride saturated from water, air, foods, beverages and dental products, the surgeon general reports that tooth decay is still a major problem and an epidemic in our poor and minority populations.

Yet, children from the African country of Uganda have less tooth decay than American children even though most Ugandan children don’t use fluoride toothpaste or even a toothbrush to clean their teeth. In fact, Ugandan children who drink high fluoride water have more tooth decay than their equals in low fluoride districts, according to “Clinical Oral Investigations."

“No teeth were lost due to caries (cavities) in the low fluoride district but 6 of 135 (4%) in the high-fluoride district,” report authors Rwenyonyi, et al. Ugandan children, aged 10 to 14, with similar socioeconomic backgrounds and diets, who lived their entire lives in either low fluoride (0.5 mg fluoride per liter) or high fluoride water districts (2.5 mg fluoride per liter), were examined for tooth decay by the same dentist, with results verified. “Surprisingly, there was a significantly higher caries prevalence and DMFT (decayed, missing, filled teeth) score in the high-fluoride district than in the low-fluoride district,” the authors write.

“In one low fluoride area..., all children were caries-free compared to 75% to 86% in the other areas,” they report.

A different paper, presented at a June 2001 meeting of the International Association of Dental Research by Louw, et al, shows the same unexpected results with a different African population. Children drinking 3.0 mg/L water fluoride have more cavities than children drinking .19 and .48 mg/L fluoride. In contrast, only 65% of fluoride-saturated American 10-year-olds are cavity-free and a, mere, 35% of 14-year-olds are cavity-free.

Americans drink fluoridated water, use fluoridated toothpaste, eat foods and beverages made with fluoridated water, along with fluoride pesticide residues. Fluoride supplements, mouthrinses, treatments, varnishes, and other fluoridated dental products are used profusely in the U.S. And fluoride is a major industrial air pollutant.

The big difference between American and Ugandan children is diet. The basic Ugandan diet is composed of complex carbohydrates, e.g., cooking banana, cassava, potatoes, maize and sorghum eaten at regular meals. About 80% of the children reported no between-meal intake of sugar containing items.

According to “Fast Food Nation,” by Eric Schlosser, Americans drink soda at an annual rate of about fifty-six gallons per person - that’s nearly six hundred twelve-ounce cans of soda per person. And, since sales of soda is subsidizing education in many U.S. school districts, children are encouraged to drink more, rather than less, soda while in school. This leaves less room and desire for milk in schoolchildren's diets.

Schlosser reports that twenty years ago, American teenage boys drank twice as much milk as soda, now they drink twice as much soda as milk. And soft drink consumption is common among American toddlers.

Milk contains calcium and magnesium, essential nutrients required to form healthy teeth. Soda depletes the body’s calcium stores. Fluoride is neither a nutrient nor essential. Fluorosed teeth contain more fluoride and less calcium than normal teeth, according to A. K. Susheela, Ph.D., Director, Fluorosis Research and Rural Development Foundation, in “A Treatise on Fluorosis.”
One would think dentists would be campaigning to have calcium placed in the drinking water but then they might lose the financial support they enjoy from fluoride manufacturers of toothpastes and other dental materials. When dentists endorse fluoride, people buy it.

Dentists report they are seeing more tooth decay among their soda drinking patients despite full fluoride “protection.” Ironically, many soft drinks and juices contain “optimal” fluoride levels because fluoridated tap water is used to make them.

And a study in the Journal of “Contemporary Dental Practice” shows that, among people who drink fluoridated water and use fluoride toothpaste, tooth decay still progresses after snacking on cola, apple juice or sweetened yogurt between meals. However, cavities remineralized (partially reversed) when snacks were whole milk, skim milk, 2% milk, cheddar cheese, plain yogurt and chocolate milk or no snacks at all.

An article in “RDH” (Registered Dental Hygienist) reports, “Dr. Carole Palmer, professor of nutrition and preventive dentistry at Tufts University, says, ‘We’re looking at why these things (nutrition in dentistry) have fallen by the wayside. There was a perception, perhaps, that fluoride had resolved the problem (of caries), but that’s far from the truth. A lack of research and funding in nutrition and oral connections has made it difficult to move forward. But nutritional counseling and diet counseling need to be important components of preventive dental care.’”

One such study presented at the International Association for Dental Research meeting this year shows, to no one's astonishment, that obesity and tooth decay are linked. There is also an epidemic of obesity in the U.S. according to the Centers for Disease Control.

Tooth decay is a disease of poor nutrition and high fluoride. Based on thirty years of study on .4 million children, Teotia and Teotia report "Our findings indicate that dental caries was caused by high fluoride and low dietary calcium intakes, separately and through their interactions."

Further substantiating the hypothesis that nutrition and not fluoride is the answer to less cavities: Ireland, 73% fluoridated since the 1960’s, has a higher tooth decay rate than five other European countries that don’t fluoridate the water, according to the June 30, 2001, Irish Independent. The Irish are also fluoride saturated; but tooth decay is still rampant in under-privileged areas of Ireland, they report.

In fact, an Irish legislator is calling for a ban on fluoridation in Ireland immediately.
Like most things American, fluoride is overblown, over-prescribed, and over-used. Along with the expansion of fast food restaurants and American waistlines, fluoride's expansion into the food supply via the water supply is out of control and may be creating instead of curing tooth decay. It's time to stop water fluoridation. Fluoride can't fix a poor diet.