While dental diseases tend to be a greater concern as we get older, they also pose a potential threat to children. A particular type of tooth decay called early childhood caries (ECC) can severely damage children's unprotected teeth and skew their normal dental development.

Fortunately, you can protect your child's teeth from disease with a few simple practices. First and foremost: start a hygiene habit as soon as possible to remove disease-causing bacterial plaque. You don't have to wait until teeth appear, either: simply wipe the baby's gums with a clean wet cloth after nursing to minimize the growth of oral bacteria.

When their teeth do begin to erupt, you can switch to brushing (you can add flossing as more teeth erupt—but until the child shows appropriate dexterity, you'll need to do it for them). For infants, brush gently but thoroughly with a soft-bristled brush and a smear of fluoride toothpaste. When they grow older you can increase the toothpaste to a pea-sized amount. And as soon as you can, get them involved with learning to perform these vital habits on their own.

You should also limit your child's consumption of sugar. Our favorite carbohydrate is also a favorite of bacteria, who consume any remnants in dental plaque as a primary food source. So, keep sugary snacks and foods to a minimum and limit them mainly to mealtimes. And don't put a baby to sleep with a bottle filled with a liquid containing sugar (including formula and breastmilk).

Finally, begin taking your child to the dentist regularly by their first birthday for routine cleanings and checkups. Besides removing any hard to reach plaque, your dentist may also apply sealants and topical fluoride to help protect and strengthen tooth enamel. Regular visits make it more likely to detect the early signs of decay, before it does extensive damage. And beginning early makes it less likely your child will develop a fear of dental visits that could carry on into adulthood.

These and other steps will go a long way in protecting your child's teeth and gums so they develop normally. A little prevention and protection will help ensure a happy, healthy smile later in life.

If you would like more information on helping your child develop healthy teeth and gums, 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 “Top 10 Oral Health Tips for Children.”

The sooner you get treated for tooth decay, the less likely you'll lose your tooth. That could mean a simple filling—or you might need a root canal treatment if decay has reached the inner pulp.

There's also another procedure for advanced decay called pulp capping. It's a bit more involved than filling a cavity but less so than a root canal. We can use it if decay has exposed or nearly exposed the pulp, but not yet infected it—otherwise, you may still need a root canal treatment to remove the diseased pulp tissue.

There are two types of pulp capping methods, direct and indirect. We use direct pulp capping if the pulp has been exposed by decay. After isolating the tooth to protect other teeth from contamination, we remove all of the decayed dentin up to the pulp. This may cause some bleeding, which we'll stop, and then clean and dry the tooth area.

We'll then apply a protective biocompatible material directly over the pulp to promote healing and protect it from further infection. We then restore the tooth's appearance and function with a life-like filling.

We use the indirect method, a two-part process separated by six to eight months, when the pulp tissue is close to the surface but not yet exposed. We initially remove the majority of decayed tooth structure, but leave some of it in place next to the pulp chamber. Although this remaining dentin is softened and decayed, we'll treat it with antibacterial chemicals, then cover it with a biocompatible material and a temporary filling.

Over the next several months the treated structure has a chance to re-mineralize as it heals. We then remove the temporary filling and assess the level of healing progress. If the regenerated dentin appears healthy, we can then remove any remaining decay and restore the teeth as we would after a direct pulp capping.

At the very least, pulp capping could buy your affected tooth time before a root canal will finally be needed. Under the right circumstances, it's an effective way to save an otherwise lost tooth.

If you would like more information on tooth decay treatments, 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 “Pulp Capping: A Procedure that may Save a Decayed Tooth.”

Applying braces or clear aligners to move misaligned teeth is only part of an orthodontist's overall mission to eliminate poor bites (malocclusions). Sometimes a malocclusion isn't caused by the teeth at all—the size of the jaw is the problem!

One type in particular, a cross-bite, often happens because the upper jaw has developed too narrowly. As a result, many of the upper teeth fit inside the lower, the opposite of normal. But a tool called a palatal expander can alleviate the problem if it's applied at an early enough age.

The device works because the upper jawbone initially forms as two halves that fit together along a center line in the roof of the mouth (the palate) running from the back of the mouth to the front. These two bone halves remain separate during childhood to facilitate jaw growth, but eventually fuse around puberty.

Consisting of two sets of wire arms joined together by a hinge mechanism in the middle, the expander device is positioned up against the palate. The orthodontist extends each arm to press against the inside of the back teeth, then adds more outward pressure by turning the mechanism in the middle with a small key. During wear, the patient or caregiver will turn the mechanism in the same way to keep up the pressure on the two sides of the jaw.

This continual pressure keeps the two bones moving away from each other and maintaining a center gap between them. In response, more bone forms on the two halves to fill the gap. In time, the newly formed bone should widen the jaw enough to correct any developing malocclusion.

Timing is everything with a palatal expander—if not used before the jaw bones fuse, the patient will need a surgical procedure to separate the bones to pursue treatment. To catch the problem early enough, children should have an orthodontic evaluation on or before they turn six. An orthodontist may be able to identify this or other emerging bite problems and intervene before it becomes worse. Taking this approach can help save you and your child more expensive orthodontic treatment down the road.

If you would like more information on correcting poor bites, 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 “Palatal Expanders: Orthodontics is more than just Moving Teeth.”

The March 27th game started off pretty well for NBA star Kevin Love. His team, the Cleveland Cavaliers, were coming off a 5-game winning streak as they faced the Miami Heat that night. Less than two minutes into the contest, Love charged in for a shot on Heat center Jordan Mickey—but instead of a basket, he got an elbow in the face that sent him to the floor (and out of the game) with an injury to his mouth.

In pictures from the aftermath, Love’s front tooth seemed clearly out of position. According to the Cavs’ official statement, “Love suffered a front tooth subluxation.” But what exactly does that mean, and how serious is his injury?

The dental term “subluxation” refers to one specific type of luxation injury—a situation where a tooth has become loosened or displaced from its proper location. A subluxation is an injury to tooth-supporting structures such as the periodontal ligament: a stretchy network of fibrous tissue that keeps the tooth in its socket. The affected tooth becomes abnormally loose, but as long as the nerves inside the tooth and the underlying bone have not been damaged, it generally has a favorable prognosis.

Treatment of a subluxation injury may involve correcting the tooth’s position immediately and/or stabilizing the tooth—often by temporarily splinting (joining) it to adjacent teeth—and maintaining a soft diet for a few weeks. This gives the injured tissues a chance to heal and helps the ligament regain proper attachment to the tooth. The condition of tooth’s pulp (soft inner tissue) must also be closely monitored; if it becomes infected, root canal treatment may be needed to preserve the tooth.

So while Kevin Love’s dental dilemma might have looked scary in the pictures, with proper care he has a good chance of keeping the tooth. Significantly, Love acknowledged on Twitter that the damage “…could have been so much worse if I wasn’t protected with [a] mouthguard.”

Love’s injury reminds us that whether they’re played at a big arena, a high school gym or an outdoor court, sports like basketball (as well as baseball, football and many others) have a high potential for facial injuries. That’s why all players should wear a mouthguard whenever they’re in the game. Custom-made mouthguards, available for a reasonable cost at the dental office, are the most comfortable to wear, and offer protection that’s superior to the kind available at big-box retailers.

If you have questions about dental injuries or custom-made mouthguards, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “The Field-Side Guide to Dental Injuries” and “Athletic Mouthguards.”

Untreated tooth decay can destroy your teeth; prompt action as soon as its diagnosed will help prevent that undesirable outcome. And even if decay has advanced into the tooth's pulp and root canals, there's still a good chance we can stop it with a root canal treatment. Using this procedure, we can clean out the infection and refill the tooth's interior space with a special filling to protect it from further infection.

Although root canal treatments have gained an unwarranted reputation for pain, they rarely cause even the mildest discomfort. More importantly, they work, which is why they're the go-to treatment dentists use for advanced decay.

But sometimes a unique dental situation might make performing a root canal extremely difficult—possibly even doing more harm than good. For example, trying to access the interior of a tooth with a crown restoration might require removing the crown, which could further weaken or damage the tooth. In other cases, the root canals might have become calcified due to trauma or aging and become too narrow to access.

Even so, we may still be able to save a tooth through a minor surgical procedure called an apicoectomy. Rather than access the diseased area through the tooth crown as with a root canal treatment, an apicoectomy makes access to the infected tissue at the root end.

An apicoectomy also differs from a root canal treatment in that we'll need to surgically go through the gum tissue. After numbing the area with a local anesthetic, we'll make a small incision through the gums at the level of the infection. After removing any infected tissue, we would then fill the space with a small filling to prevent re-infection. We then close the incised gum tissues with sutures and allow them to heal.

With the help of fiber optic lighting and surgical microscopes, endodontists (specialists in interior tooth problems) can perform an apicoectomy quickly and with very little trauma at the surgical sight. If you undergo an apicoectomy, you should be back to normal activity in a day or two at the most. And like its sister procedure the root canal, an apicoectomy could help preserve your teeth for many years to come.

If you would like more information on this and other treatments for tooth decay, 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 “Apicoectomy: A Surgical Option When Root Canal Treatment Fails.”