What is this???

From the desk of Dr. Smith

A frenum is part of the normal anatomy of the mouth.  There are actually several frenula in the mouth, the two most prominent being one under the tongue and a second between the upper incisors.  Both can vary in size.  It was once thought the upper incisor frenum, called the labial frenum, would interfere with the positions of the permanent incisors if allowed to retain after the age of seven.  There is some validity to that, but we are far less aggressive in our reduction of that frenum than twenty years ago.  That frenum is of concern to many parents of infants, as it is appears extraordinarily large and bulky in a young mouth.  But as the mouth develops and the teeth migrate downward, the frenum is left behind and appears relatively smaller with age.  I am very conservative about its reduction.  

The frenum under the tongue generates more controversy in pediatric dental circles.  Generally, my rules of thumb is the frenum should attach under the tongue about ten millimeters from the tip of the tongue, and it should not pull down on the gum tissue behind the lower incisors.  Rarely do we reduce either of these frenula.

Dental decay is a disease. It is actually the most common contagious disease of childhood. It’s hard to believe it’s more common than the common cold, but these are two different kinds of diseases. When you catch a cold, you get over it. Cavities leave a hole in your tooth that you never get over. Even after it is filled, a part of the tooth is missing and it can’t grow back. We are at a point in dental care where we can prevent most cavities for children. You can expect more from dentistry than you are accustomed to having provided at regular visits. It gives a whole new look to dental care and dental visits. I hope you come to us with your questions and help us create a new generation of kids without cavities.

Will we ever be Cavity Free??? It's in the future!

I saw a plaque that read “you are entering a stress-free zone”.  I want a plaque outside my office that reads “you are entering a cavity-free zone”.  But I won’t just make such a plaque, we have to earn it.  I think we can focus our practice on that goal.  There are other more lofty goals like ending world hunger, but this is one I think is within our ability to affect.  Too many pre-school children grow too many cavities that have to be restored.  Let’s change that.

Will we ever witness an end to dental cavities?

Will we ever witness an end to dental cavities?  Will we be able to prevent tooth decay? 

We are close.  Researchers at UCLA and other institutions around the world are focusing their attention solely on finding the cause of, and the solution to, this devastating disease of childhood.  As pediatric dentists, we see the devastation in our offices each day.  I don’t speak of devastation on the level of a typhoon that recently hit Philippines.  But cavities leave scars, both physical and emotional.

Personally, my greatest reward is seeing my patients come and go with smiling faces.  It is disturbing to me personally that some children will come with smiles and leave with tears because our services include numbing their mouths and drilling tiny holes in their heads.  I don’t believe that any child enjoys dental work when a “drill” is involved.   Some may be pretty good at ignoring the discomfort of noise and vibration, but at some level they all hurt at least a little.  Children of five and under haven’t learned to ignore the discomfort and usually let us know loudly and clearly.  There can be no mistake…a child of four or five crying and resisting during dental treatment is crying for help.

What can we do?  With moms and dads on board, we can make a difference today.  We can test for a child’s risk for developing cavities.  We can use minerals directly applied to tooth surfaces at home to reduce the progression of decay.  We can alter eating habits by replacing acidic foods with foods that will reduce the activity of decay-causing bacteria in the mouth and reduce acidity.  Where there is no acid, there is no decay.  It works, we have seen it work.  We just have to get past the notion that cavities are inevitable and not preventable and to the knowledge that cavities can, and should, be eliminated.  

Robert R. Smith, DDS

Kids have accidents and often the teeth are involved. What do you do?

The safest answer is... call us!

What we will want to know are the child's age and the extent of the injury to the tooth, or teeth.

In all cases a quick photo with your phone will enable us to view the injury quickly from the office or from home and advise the next action to take. Please email the photo to info@toothclub.com. If you are calling from the emergency hot line we will give you a phone number you can text it to or an alternate email address.

Age is a factor in our treatment advice. Children under six have most likely injured a primary or "baby" tooth, and treatment is in most cases of little urgency. However, if the front teeth are displaced making biting difficult or impossible, urgent attention should be considered.
If the permanent teeth are involved, the type of injury must be assessed quickly. Usually, injury results in a fracture of the enamel and dentin components of the crown of the tooth. These fractures can be small enough to ignore, but are often large enough to warrant sealing of the fractured surface within the first twenty-four hours. Many times the fragment that is fractured from the tooth can be bonded back into position. Esthetically, the restoration of these fractures is excellent. You want to do this very soon after the accident and be sure and bring the fragment with you to the office so we can put it all back together.

If a permanent tooth is knocked out of the mouth, time is CRITICAL. Someone must put the tooth back into its socket within the first half hour, preferable immediately. If you are courageous enough to this yourself, do not wash the tooth. You may rinse it gently, but do not scrub the surface. Place the tooth in the position that looks normal to you and transport the patient to a dentist ASAP! The dentist will make sure the tooth is positioned correctly and then splint it for up to ten days. Antibiotics may be prescribed. A root canal procedure may follow, but not always. If you are not courageous enough to do the re-implantation yourself, keep the tooth moist in mile or saline water and get to the nearest dentist immediately.
Primary or "baby" teeth cannot be re-implanted.

Over the past few years, we have seen a marked increase in the number of cavities in the
three to five year age range. We find that distressing, if only because cavities are the most unwanted news a parent of a pre-schooler can hear. These cavities are almost, without exception, in the surfaces between the baby molars and those teeth will be in the child’s mouth until the age of ten to thirteen, so we must maintain their good health.

Improving the resistance of the enamel surfaces to decay is our best strategy if we hope
to reverse the trend. Of course, oral hygiene practices, including daily flossing, is helpful, but many children grow cavities in-spite of their “best efforts”. Recently we have been recommending that toddlers start using a small amount of fluoride tooth paste at their bedtime brushing.

When I say “small amount”, I mean a smear on the brush bristles barely
enough for the child to notice the taste. During this young age, the child will likely swallow all of what is on the brush, but if we are using only the recommended amount to barely register
on the taste buds, the child will get his or her daily dose of fluoride. Fluoride can be used in excess, so this routine requires careful parental supervision. This recommendation is for night time brushing only. The reason night time exposure to fluoride is important is that the fluoride mineral will remain in the mouth longer during periods of sleep. Ideally, you should brush the toddler’s teeth right before bedtime using a tiny smear of fluoride tooth paste and then make sure the child goes right to bed without anything to eat or drink.

One brand of tooth paste that is most popular with the toddlers is Tom’s of Maine Strawberry with fluoride. And, of course, try to control the sticky sweets and refined carbohydrates, and no sodas.

Can childhood breathing patterns effect the development of the mouth and lower face?

Can childhood breathing patterns effect the development of the mouth and lower face?

Breathing is something that we don’t think about. It just happens involuntarily. That’s a good thing because getting oxygen into our systems is vital to life. But because we don’t think about it, we don’t think about how we breathe. What I mean by that is breathing with an open nasal airway facilitating most of the oxygen passing through the nose is very different than breathing with the mouth open allowing most or all of the oxygen to pass through the mouth. From a growth standpoint, mouth breathing requires the tongue to drop from the roof of the mouth in order to allow for air passage through the mouth. Tongue position is a huge factor in the developing the width of the jaw bones, particularly the width of the upper jaw. What we see in children who are habitually breathing with their mouths open is a narrowing of the upper jaw so, over a period of a couple years, the upper and lower teeth fail to meet in a functional bite relationship. That altered bite relationship is referred to simply as a cross-bite of the posterior (back) teeth.
Well, cross-bites of the posterior teeth are common and can be corrected. But unless the cause of the cross-bite is changed, the cross-bite will re-develop. So in order for growth and development to proceed naturally and with optimum outcome, the child should use his or her nose for breathing purposes most of the time. That proves to be challenging for many children with chronic allergies, rhinitis conditions, or swollen adenoids. These children are the ones who snore at night and seem to gasp occasionally for air while sleeping.
Beyond the immediate growth effects to the mouth, the oxygen that reaches the lungs is actually better if brought through the nose. Air passing through the nose passes through a series of narrowing and opening flaps, called concha, or turbinates. These concha propel the air, giving it more speed as it reaches the lungs and consequently the air penetrates deeper into the lungs allowing for more oxygen absorption. The concha also regulate temperature of the air and provide important immunological functions. More healthy life giving oxygen reaches the blood if the child breathes through his or her nose.

How do children transition from mouth to nose breathing? The first thing is making sure there is an open airway through the nose. Breathing difficulties usually result from physical obstacles in the nose—swollen adenoids, swollen concha, dried mucus, rhinitis. These should be evaluated by the child’s pediatrician and treated according to the severity.