How often should you go to the dentist?

Most dentists are reluctant to stray from recommending a six-month checkup schedule. There is good reason for this, for example: In pediatrics I have witnessed in a child an undetectable cavity progress to a cavity large enough to nearly expose the nerve of the tooth in just six months. Had they elected to return on a one-year checkup schedule the child would have had an abscess and an emergency before the check up was accomplished. Pre-cancerous lesions can show up at a six-month checkup and be treated appropriately. If the check up interval is 12 months, that lesion can be frank cancer with a very different treatment outlook.

The dentist looks at a large number of factors for a patient when determining his approach for care. This includes: history of cavities. Risk level of new cavities. Diet patterns that will affect teeth and other mouth tissues. Existing diseases like diabetes, hypertension and obesity. Current medications which will affect oral conditions. Existing history of typical changes that occur at current check up intervals. Habits and lifestyle patterns like smoking, Drinking, coffee, etc.

Deteriorating Oral Health Over Generations

Think about this. During the 50s, 60s, 70s, and 80s dentistry witnessed a steady decrease in cavities and improvement in oral health. It is not surprising then that studies done by the CDC every 10 years have shown improved oral health each decade since then for all segments of the population in all specialty areas of dentistry ....... except:

EXCEPT children age 1 to 5. Cavities in children have increased by 30% every 10 years for 30 years now. It started in the 80s. Cavities in children are worse than ever, with 60% of 1st graders already having cavities. Since oral health patterns are established by age 3, it is not hard to realize today's young population will have immense oral health problems in their retirement years including loss of teeth (like my grandfather's generation) and eating lots of over-prepared soft foods (baby food). Hmmmmm. Baby food for retirement....

Help your children have a healthy, disease free and comfortable mouth by establishing good oral health early. Good oral health is immensely less expensive and more comfortable than cavities and gum disease. The first tooth deserves a dental home. Learn from your dentist what it takes and the easy way to create excellent oral health for your children.

P.S.  Are you aware that today's generation of young people will live significantly shorter lives than us due to increasing chronic disease brought on by current lifestyle choices? Those elderly years will also be much less comfortable than ours due to the chronic diseases they will be dealing with!

How Valuable - Your Teeth?

A sad statistic that 25% of those over 60 have no teeth. Those who still have teeth have an average of 19 teeth; fewer than when they were a toddler. This leads to a significant decrease in eating fruits, vegetables and other nutritious fiber foods. It also leads to increased consumption of high carbohydrate and high fat soft foods. It is not surprising to discover there is a clear independent correlation between tooth loss and chronic heart disease, hypertension, stroke, cancer and other systemic diseases.

The sad reality for me is that the biological foundation for oral health establishes itself by age 3, before most people even consider taking their children to the dentist. One of our bylines in our practice is "The first tooth deserves a dental home." We recommend the first dental visit for a child as soon as the first tooth appears. The primary focus of that visit is a consultation with parents about how to create a healthy mouth free of cavities and gum disease. Creating good oral health is easier, takes less time and is immensely less expensive than fixing the ravages of cavities and gum disease.
And, obviously, from the statistics above it is easy to see it leads to vastly improved quality of life. Even if we ignore the countless uncomfortable and expensive visits to the dentist for treatment of oral disease and just think of over age 60. Are you planning on 20 to 30 years of "baby food" in those glorious retirement years?

Doing the right things for your children early will make huge differences for their long term health and enjoyment of life. The first tooth deserves a dental home.

Ask Your Children's Dentist

When you take your children to the dentist, are you getting what you want? These days the parents are usually thrilled there is sooo much entertainment and distraction for the children to make their dentist visit pleasant. Most parents do not have those pleasant memories. All that is great. I want also to ask you what is your true objective for bringing your child to the dentist? Is that being accomplished too?

In my office for instance: My number one objective is teaching each child how to have a lifetime of cavity free, healthy, beautiful smiles. That starts by teaching the parents how to simply, quickly and effectively prevent cavities before they get started. How to stop them if they have started. How to transition from baby teeth with cavities to adult teeth without cavities (difficult, not impossible). To do this, does your dentist:

1) Start with the parent child team as soon as the child has her/his first tooth? By age 3 the bacterial environment (for high or low risk for cavities) around the teeth has established itself for a lifetime. What parents do those 3 years will influence that environment and the dental health of their children for a lifetime.
2) Teach the parents effective and quick (20 seconds) ways to clean their children's teeth? I find I must include parents with me at chair side for all visits to successfully demonstrate this. What to do and how to coach the team changes as the child grows?
3) Teach how to evaluate your own effectiveness at home so you can verify you are getting the job done well without waiting for that 6 month check-up?
4) Teach how to evaluate how well your child is cleaning her/his mouth so you know when you can allow them to "do the job" and you know how to evaluate periodically to assure they are actually getting the job done?
5) Communicate well with your child so when she/he isn't listening to you, she/he may actually be listening to the dental team?
6) Include educating the parents early and the children later about the outside influences that will damage oral health and how to handle them in the family?

Dentistry for children has certainly become more entertaining than it used to be. That doesn't change the FACT that children's cavity experience is worse than it has ever been and is getting worse by 30% every 10 years for the last 30 years. Start your child on a healthy path early.

Oral Health begins before birth. Oral disease establishes before age 3. For the elderly who have lost their teeth, there is NOTHING in their "I Wish List" that rates higher than having their teeth back. Set the right standard with the first tooth.

2 Minutes 2 Times

Brush your child's teeth for 2 minutes, 2 times a day!

As I have told you in previous blogs, doing fillings and crowns on teeth does not improve oral health or dental health. Effective prevention of dental disease requires a little simple education of the patient and the desire to have healthy, cavity free beautiful smiles. With that in mind the California Dental Association and American Academy of Pediatric Dentists and 12 other organizations have started a nationwide educational program designed to help patients improve their own oral health and prevent cavities.


2min2x.org is the website it will originate from and where you can find all the information needed to create oral health for you and your children. It includes great videos to educate, entertain and motivate your children to want and achieve good oral health.  Check it out!

Winning With Smiles - Pediatric Dentistry
Meadow Vista, California 95722

Flossing your Teeth is Critical...for kids and parents!

Cavities between the teeth are slow, insidious and begin showing up between age 3 and 5 years old. They account for 90% of cavities that I see; the majority of them happening between 5 and 9 years old. I cannot apply preventive sealants between teeth. Tooth brushing will not clean between the teeth.  Flossing will, however, and will help protect those areas. Since brushing will not help prevent these cavities, lets make flossing easy and bring it up high in the parent priority list, higher than brushing.


Floss anywhere. At evening story time on the couch, they can lay with head on your lap, looking up with mouth open wide. It is easy to see in that mouth and the head is supported, making the job quick, easy and comfortable for the younger kids. It is part of snuggle time.

When my kids were 6 years old they were OK though not yet great brushers. Since flossing was the real important issue, I chose to let them brush and bring me a piece of floss afterward. They handed me the floss, turned their back to me and tipped their head way back against my stomach. Mouth is wide open, easy to see, took 10 – 15 seconds of my time, and if their brushing job was really poor I saw it and sent them back. They soon improved their brushing to avoid being sent back. By about 10 they were doing their own flossing.

Set up their flossers. Many kids want to floss themselves and can’t get the floss wound on the flossing handle tightly enough. So the flossing goes undone or severely lacking. How about winding up 7 days worth for them to have in their bathroom? Ask us for more handles if you want them. They are inexpensive and we would love to give you what you need.

There are pre-strung single use flossers in the stores which I caution against. Floss-Picks and Wild-Flossers and such are attractive, but the little piece of floss is limp and the handle is flexible. Caution: Kids get very independent minded and insist on flossing themselves. Many haven’t developed adequate hand skills yet.  They go through the motions with the limp floss that does not get between the teeth and are rudely surprised later when cavities show up.  It is too late then, when we point out to the parents that the children have not been using the floss effectively.

Hypocalcified Teeth: White, Yellow and Brown Blemishes

Teeth occasionally experience a disturbance during development that results in the enamel developing atypically. It is usually observed as a discoloration; white, yellow or brown. I most commonly see it on the first permanent molars and central incisors (two front teeth) though it can happen to any of the teeth.

When this anomaly occurs on the front teeth, there may be some cosmetic concerns to address. In its mildest form it shows as white marks on the teeth, typically near the chewing edge, though it may be anywhere on the tooth. They are often hydration dependent meaning if the tooth dries out the white spots become prominent and when the tooth remains wet the spots diminish or disappear. These are a cosmetic concern only and since an adult’s facial posture keeps lips closed more than children, these blemishes typically remain wet and diminish. We do not recommend any treatment procedures until at least the mid teen years when a more adult facial posture has developed.

White blemishes that are larger and more opaque will likely need removal of the blemish and filling with a cosmetic filling material.

Blemishes of a more yellow or brown nature are often improved with bleaching techniques that can be done at any age. If the blemish does not respond to bleaching we can offer other cosmetic procedures to remove discolorations and refill the blemishes with cosmetic filling materials

If the aberration is severe enough it will result in soft enamel that chips and/or decays easily. It may also result in an atypical shape for the tooth. I usually observe this on the molar teeth. When this occurs, it is important to remove the very soft enamel and place a filling in the area. I do this in a conservative fashion by bonding on a filling material to replace the lost or decayed portion of the tooth. This usually needs “touching up” as the tooth grows and exposes more of the compromised enamel. The soft enamel may also chip around the bonded filling necessitating occasional repairs. Occasionally the aberration in the enamel is extensive enough that we recommend a stainless steel crown as a temporary crown during the growing years. A large percentage of these molar teeth will be best served with a full crown restoration after all permanent teeth have emerged, growth is finished and the occlusion has stabilized (age 18 or older). In the mean time we will maintain the integrity of the teeth with conservative repairs.

These teeth can also be very sensitive teeth for reasons we do not know. Restoring or covering the hypocalcified enamel will occasionally help this. Toothpastes for sensitive teeth (i.e. Sensodyne, Thermodent) can also be helpful. Avoiding highly acidic snack patterns (carbonated beverages, fruit juices, sour candies) will likely be very helpful as well.

Juice Revealed - Not So Sweet!

For over 2 generations now juice has been espoused as a health food. Though dentists have been aware for decades this is not really true, it has not been until very recently that the health industry and the medical establishment has taken a closer look at juice. It is definitely not a health food. The question arises if it is even healthy!

Juice now sits on the top of the list as a probable causative agent for the medical chronic disease pandemic facing our children; namely diabetes, obesity, high blood pressure, and osteoporosis, among others. The journals of the American Medical Association and the American Academy of Pediatrics have in recent years recommended that juice be avoided in an infant’s diet. They also recommend that if it is introduced to a toddler that it be limited to 6 oz. daily (a small glass) and consumed with a meal.

Juice is at the top of the list of causative agents for dental disease for our children and youth. For that matter, in today’s culture it probably is equally at cause for adult dental decay.

Juice is worse than soda! That doesn’t mean soda is good; it is also terrible for teeth and health. But, juice is worse. If you look at nutrition data for foods and compare juice with whole fruit, you quickly see what is lost when juice is squeezed from fruit. A couple highlights:

You do get water and calories; i.e., an 8 oz glass of orange juice has the calories squeezed from about 5 oranges. Who ever heard of eating 5 oranges in one sitting? And today we often do this at breakfast and again in the afternoon. Yikes… all those empty calories!

Lost with the fruit when we make juice is a) nearly all the vitamins except some of the water soluble vitamin C, b) insoluble fiber, roughage, c) soluble fiber, unique to fruit and an important aid in digestion, d) and minerals, key components to our enzyme systems that process our body functions. Without the minerals the enzymes cannot use the calories we consume so the calories get stored as fat.

Rarely mentioned about juice is the acid. Acid that will dissolve your teeth. Those of us that took analytical and organic chemistry in college know the issue here. Though organic acids are often called “weak” acids, they are far more effective in organic systems like mouths because of their sustaining power. They don’t register in the pH scale as strong (lower number) as inorganic acids because they hold their acid potential in “reserve.” As the acid is used (dissolving calcium out of teeth) the reserve releases more acid out of solution. This is part of the steady state (homeostasis) systems that sustain organic (life supporting) systems. When misused (juice rather than fruit) the power released can be devastating. It turns out the acid potential (titrateable acid) of juice is nearly twice that of colas!

So put juice at the very top of the destructive beverage list that includes: juice, sports drinks like Gatorade, sodas, juicers and sweet energy teas.

Dental Necessities for Your Child - Birth and up

Here's a list of dental care necessities from birth on up:

• Baby Teeth Cleaning: Baby teeth should be cleaned as soon as they erupt. Clean your baby's teeth with a soft washcloth or gauze after every bottle or meal. When molars erupt, use a small child-sized (age-appropriate) toothbrush with warm water to brush your baby's teeth, as instructed by your dentist.
  
  At age two begin using a pea-sized amount of toothpaste.  In select special circumstances your dentist may recommend fluoride toothpaste younger than age two.   Encourage your children with a daily brushing habit.  Help them “finish the job until their hand skills develop adequately (Age 6 or more).   Replace toothbrushes every two to three months.
  
  Children taking regular medications need extra attention including brushing after taking the medicine.  Ask your dentist regarding the specifics.
• First Dental Visit:   It is important that your child see a dentist by age one to establish a long-term dental hygiene and professional dental cleaning plan.
• Dental Sealant Application:   Dental Sealants are used to protect teeth from decay and are appropriate as soon as permanent molar teeth erupt.
• Fluoride Treatments:  Check with your dentist and water authority about the need for fluoride treatments.  Fluoride is a major component in the prevention of childhood dental caries.  This is because fluoride alters the molecular structure of the tooth, making it more resistant to acid attack and decay.
  
  However, children require the right balance of fluoride treatment. Too much fluoride could be problematic and lead to fluorosis.
• Dental Flossing: Parent-assisted dental flossing should commence when two teeth erupt next to each other, especially the molars at age 2 1/2.  Independent flossing should occur when children have the ability to do it on their own (often by eight years of age).
• Mouth Washing: Mouth washing is recommended by age six if your dentist deems there are special preventive needs.  Mouthwashes not containing alcohol are fine for anyone age 6 and older who can rinse without swallowing the mouthwash.
• Orthodontics: may be appropriate by seven years of age.

Keep in mind that these age ranges are estimates only; you should follow your dentist's recommendations.

One of the gifts parents can give their child is a start at good dental health as well as a healthy relationship with the dentist.