Posts for: July, 2015

By Edward Joseph, D.D.S.
July 28, 2015
Category: Oral Health
KnowtheFactstoReduceYourChildsTeethingDiscomfort

The arrival of your child’s first set of teeth is a natural and expected process. But that doesn’t mean this period of development, commonly known as teething, is an easy time: your baby will endure a fair amount of discomfort, and you, perhaps, a bit of anxiety.

Knowing the facts about teething can help you reduce your child’s discomfort — as well as your own concern — to a minimum. Here are a few things you need to know.

Teething duration varies from child to child. Most children’s teeth begin to erupt (appear in the mouth) between six and nine months of age — however, some children may begin at three months and some as late as a year. The full eruption sequence is usually complete by age 3.

Symptoms and their intensity may also vary. As teeth gradually break through the gum line, your baby will exhibit some or all normal teething symptoms like gum swelling, drooling and chin rash (from increased saliva flow), biting or gnawing, ear rubbing, or irritability. You may also notice behavior changes like decreased appetite or disrupted sleep. These symptoms may be a minimal bother during some teething episodes, while at other times the pain and discomfort may seem intense. Symptoms tend to increase about four days before a tooth emerges through the gums and about three days afterward.

Diarrhea, rashes or fever aren’t normal. These symptoms indicate some other sickness or condition, which can easily be masked during a teething episode. If your child exhibits any of these symptoms you should call us for an exam to rule out a more serious issue.

Keep things cool to reduce discomfort. There are a few things you can do to reduce your child’s discomfort during a teething episode. Let your child chew on chilled (but not frozen) soft items like teething rings, wet washcloths or pacifiers to reduce swelling and pain. Gum massage with your clean finger may help counteract the pressure from the erupting tooth. And, if your doctor advises it, pain relievers in the proper dosage may also help alleviate discomfort. On the other hand, don’t use rubbing alcohol to soothe painful gums, or products with the numbing agent Benzocaine in children younger than two unless advised by a healthcare professional.

If you would like more information on dealing with teething issues, 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 “Teething Troubles.”


By Edward Joseph, D.D.S.
July 20, 2015
Category: Dental Procedures
TakingtheDreadOutofDentalVisits

We always look forward to seeing our patients, but not all of you look forward to seeing us! If you’re one of them, don’t worry — we don’t take it personally. Dental anxiety prevents many people from seeking the care they require to restore or maintain a healthy smile.

But if dental problems are allowed to progress, they can affect not only the beauty of your smile and health of your mouth, but your overall wellness, too. Infection can travel from the mouth to other areas of the body, and dental disease exacerbates chronic health conditions like heart disease or diabetes.

Overcoming Apprehension

Fear should never be an obstacle (in the immortal words of President Franklin Roosevelt, “…the only thing we have to fear is fear itself…”). And fortunately there are some safe options for those of us who can’t get past our anxiety when it comes to dental care:

Oral Sedation. A sedative medication can be prescribed that you take by mouth approximately an hour before your dental visit to minimize anxiety and promote relaxation.

Intravenous (IV; “intra” – inside, “venous” – vein) Sedation. If oral sedation isn’t entirely effective in facilitating treatment, then a medication combining a sedative for relaxation and a pain-blocking anesthetic can be delivered through or small needle or catheter that is gently inserted into a vein. This is referred to as “conscious sedation” because you are in a semi-awake state during which you are able to respond to verbal direction. It takes effect quickly, and you can come out of it quickly. However, you may not remember much about your procedure. It is very different from general anesthesia during which you are completely unconscious.

Safety First

Dentists who offer IV sedation receive extensive training after which we must pass an exam and apply for a special permit that we maintain through continuing education. We carefully screen patients for eligibility and monitor you throughout so you can rest easy before, during, and after your procedure.

If you would like more information about sedation in dental care, please contact us or schedule an appointment for a consultation. You can also learn more about the subject by reading the Dear Doctor magazine article “Oral Sedation Dentistry.”


By Edward Joseph, D.D.S.
July 19, 2015
Category: Oral Health
Tags: topical fluoride  
TopicalFluoridecanEnhanceYourChildsDentalCare

More than likely your child already receives fluoride from your drinking water or toothpaste. So, is it really necessary for them to receive topical fluoride during their regular office checkups?

We highly recommend they do. A naturally occurring chemical, fluoride has the ability to make enamel more resistant to acid attacks that lead to tooth decay. It’s most effective when it works its way into the structure of the enamel during early teeth development.

Both fluoridated drinking water and dietary fluoride supplements (recommended by a doctor or dentist) can be the vehicle for this to occur while the teeth are still forming in the jaw before eruption (when teeth become visible). After the teeth have erupted, fluoride applied directly to the enamel surface (topically) can become infused with it as it continues to develop during early growth.

But can’t fluoride toothpaste accomplish the same result? No — the fluoride added to toothpaste and other hygiene products is relatively low, and only strong enough to maintain and protect enamel. The fluoride levels in topical applications like gels, foam or varnishes are much higher (in the tens of thousands of parts per million) and remain in contact with the teeth during a treatment session for much longer. Some fluoride varnishes, in fact, will continue to leach fluoride into the tooth surface for a month or more.

Topical fluoride applications are especially beneficial for children who are growing up in an area without fluoridated drinking water or without the proper means for good oral care and hygiene. But even for children with access to fluoridated water and oral care, a topical application can still be helpful.

A topical fluoride treatment isn’t a stand-alone application, but a regular part of your child’s dental care of daily brushing and flossing and semi-annual dental cleanings and checkups. Topical fluoride enhances the care they already receive to help produce stronger enamel for future healthy teeth.

If you would like more information on topical fluoride applications, 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 “Topical Fluoride: How Fluoride will Benefit Your Child.”


By Edward Joseph, D.D.S.
July 11, 2015
Category: Dental Procedures
Tags: gummy smile  
ImprovingaGummySmileDependsonitsCause

A “gummy” smile, in which the upper gums are too prominent, is a common condition. There are several causes for gummy smiles — determining which one is the first step to having your appearance changed.

Although perceptions vary from person to person, most dentists agree a gummy smile shows 4 mm or more of gum tissue, and the amount is out of proportion with the length of the crown (the visible tooth). Teeth normally erupt through the gums during childhood and continue development until early adulthood, shrinking back from the tooth until stabilizing in place.

This typically produces a crown length of about 10 mm, with a “width to length” ratio of about 75-85%. But variations can produce differences in the relationship between teeth and gums and the width to length ratio of the teeth. The teeth may appear shorter and the gums more prominent. Worn teeth, caused by aging or grinding habits, may also appear shorter.

If tooth to gum proportionality is normal, then the cause may be upper lip movement. When we smile, muscles cause our lips to retract 6-8 mm from the lip’s resting position. If the amount of movement is greater (meaning the lip is hypermobile), it may show too much of the gums. The upper jaw can also extend too far forward and cause the gums to appear too prominent.

There are a number of ways to improve gummy smiles, depending on the cause. Periodontal plastic surgery known as crown lengthening removes and reshapes excess gum tissue to reveal more of the tooth. Lip hypermobility can be reduced with Botox injections (to paralyze the muscles) or in some cases with surgery to reposition the muscle attachments. Orthognathic surgery can be used to surgically reposition an overextended upper jaw. Other cosmetic enhancements such as orthodontics, bonding or porcelain restorations can also prove effective.

The first step is to obtain an accurate diagnosis for your gummy smile. From there, we can devise the best treatment approach to bring your smile back into a more attractive proportion.

If you would like more information on minimizing a gummy smile, 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 “Gummy Smiles.”


ARetainer-LikeDevicecanPreservetheSpaceLeftbyaLostPrimaryTooth

Children losing their primary (“baby”) teeth is both natural and necessary. So, is it really that much of a concern if they lose one early?

The answer is yes — premature primary tooth loss could have long-term consequences for the permanent teeth as they develop within the jaw before eruption. Primary teeth play a crucial role in this development: as the permanent teeth form and grow the primary teeth serve as placeholders until they’re ready to erupt. A natural process then takes place in which the primary tooth’s roots dissolve (resorb) to allow them to fall out. Once they’re out of the way, the permanent teeth can then erupt.

If, however, they’re lost before the permanent teeth are ready, it leaves a space in the child’s bite. The dynamic mechanism between teeth and the periodontal ligament causes adjacent teeth to move or “drift” into the space. This can crowd out the permanent tooth intended for the space, causing it to come in improperly forming a malocclusion (bad bite), or it may become impacted and remain partially or fully below the surface of the gums.

This poor dental development could lead to extensive orthodontic treatment later in life, which is why we seek to preserve even decayed primary teeth for their entire natural lifespan. If the tooth is lost, however, we need to take action to preserve the space for the permanent tooth and avoid costly treatment later.

This usually calls for a “space maintenance” appliance — a type of orthodontic “retainer” — worn by the child to prevent other teeth from drifting into the space. Designed by your orthodontist, the appliance can also perform a cosmetic and social function by causing the space to appear unnoticeable.

Maintaining that space requires monitoring — especially by an orthodontist — and continued dental hygiene and care both at home and at the dentist’s office. The extra care preserving the space caused by premature tooth loss will help to ensure your child’s dental structure develops properly and their future smile will be an attractive one.

If you would like more information on the care and treatment of 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 articles “Early Loss of Baby Teeth” and “Losing a Baby Tooth.”




Burbank, CA Dentist
Edward C. Joseph, D.D.S.
2701 West Alameda Ave, Suite #503
Burbank, CA 91505
(818) 842-7628

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