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Posts for tag: tooth decay

By Gary W. Machiko, DMD
February 18, 2018
Category: Oral Health
Tags: tooth decay  
AlthoughaChallengeChronicallyIllChildrenNeedToothDecayPrevention

Families of children with chronic conditions face many challenges. One that often takes a back seat to other pressing needs is the prevention of tooth decay. But although difficult, it still deserves caregivers’ attention because of the dental disease’s potential long-term impact on oral health.

Chronically ill children are often at higher risk for tooth decay, most commonly due to challenges in practicing effective oral hygiene. Some conditions create severe physical, mental or behavioral impairments in children’s ability to brush and floss: for example, they may have a heightened gag reflex to toothpaste in their mouth or they may not be able to physically perform these tasks on their own.

Some children may be taking medications that inhibit salivary flow as a side effect. Saliva is critical for disease prevention because it both neutralizes mouth acid (which can erode tooth enamel) and is a first line of defense against disease-causing bacteria. And a child’s diet, while designed to support treatment of their chronic condition, may conversely not be the best for supporting their dental health.

It’s best if caregivers and their dentists develop a strategy for decay prevention, which should include the following:

  • Regular dental visits beginning at Age One. Besides monitoring dental health, dental visits also provide cleanings and other preventive measures like topical fluoride or sealants;
  • Brushing and flossing support. Depending on a child’s physical and mental capacities, caregivers (or an older sibling) may need to model brushing and flossing, or perform the tasks for the child;
  • Medication and diet changes. If medications are causing dry mouth, caregivers can speak to their physicians about possible alternatives; likewise, they should see if modifications can be made to their diet to better support dental health.
  • Boosting salivary flow. It’s especially important with children who have dry mouth to drink more water or use aids (like xylitol gum or candies) to boost salivary flow.

Although it requires extra effort and time to give attention to a chronically ill child’s dental health, it’s well worth it. By working to prevent tooth decay early in life, these children will be more likely to enjoy good dental health in the future.

If you would like more information on dental care for children with special needs, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor article “Managing Tooth Decay in Children with Chronic Diseases.”

By Gary W. Machiko, DMD
December 15, 2016
Category: Oral Health
ActorDavidRamseyDiscussesBabyBottleToothDecay

Cavities can happen even before a baby has his first piece of candy. This was the difficult lesson actor David Ramsey of the TV shows Arrow and Dexter learned when his son DJ’s teeth were first emerging.

“His first teeth came in weak,” Ramsey recalled in a recent interview. “They had brown spots on them and they were brittle.” Those brown spots, he said, quickly turned into cavi­ties. How did this happen?

Ramsey said DJ’s dentist suspected it had to do with the child’s feedings — not what he was being fed but how. DJ was often nursed to sleep, “so there were pools of breast milk that he could go to sleep with in his mouth,” Ramsey explained.

While breastfeeding offers an infant many health benefits, problems can occur when the natural sugars in breast milk are left in contact with teeth for long periods.  Sugar feeds decay-causing oral bacteria, and these bacteria in turn release tooth-eroding acids. The softer teeth of a young child are particularly vulnerable to these acids; the end result can be tooth decay.

This condition, technically known as “early child caries,” is referred to in laymen’s terms as “baby bottle tooth decay.” However, it can result from nighttime feedings by bottle or breast. The best way to prevent this problem is to avoid nursing babies to sleep at night once they reach the teething stage; a bottle-fed baby should not be allowed to fall asleep with anything but water in their bottle or “sippy cup.”

Here are some other basics of infant dental care that every parent should know:

  • Wipe your baby’s newly emerging teeth with a clean, moist washcloth after feedings.
  • Brush teeth that have completely grown in with a soft-bristled, child-size toothbrush and a smear of fluoride toothpaste no bigger than a grain of rice.
  • Start regular dental checkups by the first birthday.

Fortunately, Ramsey reports that his son is doing very well after an extended period of professional dental treatments and parental vigilance.

“It took a number of months, but his teeth are much, much better,” he said. “Right now we’re still helping him and we’re still really on top of the teeth situation.”

If you would like more information on dental care for babies and toddlers, please contact us or schedule an appointment for a consultation. You can also learn more by reading the Dear Doctor magazine articles “The Age One Dental Visit” and “Dentistry & Oral Health for Children.”

TreatingaBabyToothwithInnerDecaycanbeComplicated-butStillNecessary

Even though a child’s primary (“baby”) teeth eventually give way, it’s still important to treat them if they become decayed. Primary teeth serve as guides for the emerging permanent teeth — if they’re lost prematurely, the permanent tooth may come in misaligned.

If the decay, however, affects the tooth’s inner pulp, it poses complications. A similarly decayed adult tooth would be treated with a root canal in which all the pulp tissue, including nerve fibers and blood vessels, are removed before filling and sealing. Primary teeth, however, are more dependent on these nerves and blood vessels, and conventional filling materials can impede the tooth’s natural loss process. It’s better to use more conservative treatments with primary teeth depending on the degree of decay and how much of the pulp may be affected.

If the decay is near or just at the pulp, it’s possible to use an indirect pulp treatment to remove as much of the softer decay as possible while leaving harder remnants in place: this will help keep the pulp from exposure. This is then followed with an antibacterial agent and a filling to seal the tooth.

If the pulp is partially exposed but doesn’t appear infected, a technique called direct pulp capping could be used to cover or “cap” the exposed pulp with filling material, which creates a protective barrier against decay. If decay in a portion of the pulp is present, a pulpotomy can be performed to remove the infected pulp portion. It’s important with a pulpotomy to minimize the spread of further infection by appropriately dressing the wound and sealing the tooth during and after the procedure.

A pulpectomy to completely remove pulp tissue may be necessary if in the worst case scenario the pulp is completely infected. While this closely resembles a traditional root canal treatment, we must use sealant material that can be absorbed by the body. Using other sealants could inhibit the natural process when the primary tooth’s roots begin to dissolve (resorb) to allow it to eventually give way.

These all may seem like extraordinary efforts to save a tooth with such a short lifespan. But by giving primary teeth a second chance, their permanent successors will have a better chance of future good health.

If you would like more information on treating decay in primary teeth, 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 “Root Canal Treatment for Children’s Teeth.”

MinimallyInvasiveDentistryANewApproachtoPreventingandTreatingDecay

Since the late 19th Century, dentists have used established protocols to successfully prevent and treat tooth decay. But there've been changes to this approach the last few years to improve its effectiveness, changes we now refer to as Minimally Invasive Dentistry or MID.

The older approach for treating dental caries (tooth decay) follows the protocols established by Dr. G.V. Black, considered the father of modern dentistry. Black advocated removing not only decayed structure but also some of the healthier but vulnerable portions of a tooth, to avoid further decay and make the tooth easier to clean. This resulted in larger fillings, although they've become smaller as dental techniques have advanced.

MID, on the other hand, aims to remove as little tooth structure as possible while still effectively treating and preventing future decay. To achieve that goal we begin first with a complete assessment of a patient's individual decay risk, known as Caries Management By Risk Assessment (CAMBRA).

With CAMBRA, we're looking at other factors besides individual tooth health: a patient's hygiene, lifestyle and dietary habits; the types and amount of bacteria present; and the quality of saliva flow, needed to neutralize mouth acid. With these the results we develop a customized prevention and treatment strategy.

MID also focuses on detecting dental caries as early as possible. Besides traditional x-rays, we're beginning to use other methods like dental microscopes, laser fluorescence, infrared photography or optical scanning. Early detection leads to early intervention, and with techniques that are much less invasive than the traditional approach.

The new approach also changes how we repair decayed teeth. We're increasingly using air abrasion, a technology that uses fine particles in a pressurized air stream to remove softer decayed tooth material and less healthy structure than the traditional dental drill. We're also using composite resin and other advanced materials for filings: these tooth-colored materials are stronger than previous versions and are quickly taking the place of metal amalgam, requiring less structural removal to accommodate them.

MID's core principles are early disease detection, proactive prevention and treatment with less structural removal. With this enhanced approach to effective dentistry, we're keeping your teeth healthy with minimal discomfort, lower costs and less long-term impact.

If you would like more information on the benefits of the MID approach, please contact us or schedule an appointment for a consultation.

By Gary W. Machiko, DMD
December 30, 2014
Category: Oral Health
Tags: tooth decay  
HelpYourChildPreventToothDecay

Did you know that the bacteria that cause tooth decay are usually transmitted to children from their parents, through sharing the same spoon or kissing? Once inside the child's mouth, the bacteria live on the teeth in what is called a biofilm. When the child consumes sugary foods or drinks, the bacteria act upon the sugar to produce acids that eat away at the child's teeth, producing tooth decay.

These bacteria thrive on carbohydrates such as bread, sweets, and sodas. Even fruit juices, which offer more vitamins than soda, are filled with sugars that lead to decay. The child's saliva works hard to neutralize the acidity produced from these foods, but if the child often snacks between meals this neutralization process doesn’t have a chance to occur.

The first sign of decay may be white spots on the teeth, an indication that minerals in the surface enamel have been dissolved in certain locations. Before it goes any farther, this process can be reversed by reducing the exposure to acids and using fluorides to strengthen the tooth surface.

Make sure your child sees a dentist by his first birthday, to provide preventive care and treat any beginning decay.

You can also help your child develop the habit of brushing his teeth with fluoridated toothpaste. It is important to use only a smear of toothpaste on the brush for very young children, and a pea-sized amount on the brush for children over the age of 2. Sometimes small children swallow their toothpaste, and excessive amounts of fluoride can cause staining on the teeth. When your children are very young, you must brush their teeth. As they get older, they can do it themselves, with your supervision. We can also apply fluoride varnish to strengthen the tooth surface and make it resistant to acids.

Brushing twice a day is a good start. But it can't prevent tooth decay when a child is eating carbohydrates all day. One way to reduce the use of sugar is to use xylitol, a naturally occurring sweetener that looks and tastes like table sugar and improves oral health. Studies have shown that use of this sweetener reduces tooth decay in children.

Another good idea is to wean children from bottles and training cups as early as possible. Sometimes children are given bottles filled with milk or sugary beverages at bedtime to help them relax. A better idea for their teeth is to teach them to drink from a regular cup filled with milk — or preferably, with water.

Contact us today to schedule an appointment to discuss your questions about tooth decay in children. You can also learn more by reading the Dear Doctor magazine article “Managing Tooth Decay In Children With Chronic Diseases.” While this article focuses on children with health challenges, it contains excellent advice to help all children prevent tooth decay.