Your Child's First Happy Visit

I’m sure that you are not the only parent out there who has a million questions about your child’s first dental visit!  Well, with help from the College of Dental Hygienists of Ontario and tips from a few professionals, we will let you know everything you need to know about this ‘Happy Visit’.  It is recommended by professionals that your baby have their first visit roughly around the time of their first birthday, or shortly after the primary teeth have erupted (CDHO, n.d).  This is because “Almost all children at this age have an oral environment at risk for disease” (CDHO, n.d.).  Why is it so important for a child to visit the Dentist so early you ask?  According to the American Dental Association, “A dentist can show you how to clean your child’s teeth, discuss diet and fluoride needs and recommend oral care products,” (ADA, 2013).  We spoke with an experienced Dental Assistant who assists the Dentist during these very first visits and she was able to give us a quick list of what to expect and how to prepare for your child’s first visit!


  • One of the biggest purposes of a “happy visit” (your child’s first trip to the dentist), is for the child to be introduced to the setting and meet the dental team.

  • It is best to arrive only a little bit early for you appointment, as the children do not always do well if having to wait a long period of time.

  • Once the child is brought in, he/she will be introduced to the assistant as well as the Dentist.

  • It will take a few moments for the child to adjust to the treatment room and more than likely will be a little unsure at this point! We suggest holding a parent/guardian’s hand throughout this process.

  • The child will be shown a lot of different equipment and tools and be encouraged to explore all senses.

  • The child will normally sit on the parent’s lap, who will be in a knee-to-knee position with the Dentist. The child’s head will then rest on the Dentist’s knees so that he/she can have a good look in the mouth.

  • The treatment that is provided throughout the appointment is only decided on how co-operative the child is. It will only continue as long as it still is a positive experience for the child.

  • The Dentist will decide on treatment from there and decide when it's time for the next visit.

  • Before leaving, the Dentist will review home oral hygiene instructions for the parent and discuss any concerns they may have.

http://www.washingtonparent.com/articles/1302/first-dental-visit.php

I hope after reading this you have a better understanding on what to expect in your child’s first dental visit and know how important it is to start your child/renwith a happy and healthy dental care routine! That’s all for now!
Sincerely,
Emma Duncan
References:
Ong, C., & Szeto, A. (n.d.). You and Your Baby. Retrieved November 20, 2015, from http://www.cdho.org/publicbrochures/oralhealthmatters_yourbaby.pdf

Dr. Johnson, J. (2013). Your Child's First Dental Visit. Retrieved November 20, 2015, from http://www.ada.org/~/media/ADA/Publications/Files/ADA_PatientSmart_First_Dental_Visit.ashx 

How to Spot Cavities

      Hello concerned parents on the web! Have you recently noticed a sudden increase in cavities in your child’s mouth? Oftentimes parent’s don’t find the cavities until it’s too late and their only option is to get their child’s teeth filled or crowned. However, there are ways to help prevent these situations from occurring.

      Before we begin, let me explain the different layers of a tooth. A tooth is made up of multiple layers; the first one is the white portion on the outside of the tooth called enamel. The enamel is the protective layer that keeps the inside layers of the tooth nice and safe. (Colgate, 2015). The next layer underneath the enamel is the dentin; it is yellow and is a weaker version of the enamel (Colgate, 2015). Lastly, there is the pulp, which has nerve endings and blood vessels which can cause tooth sensitivity or pain if it is exposed (Colgate, 2015).

      There are many ways to prevent cavities from reaching the pulp which are very sensitive areas. Simply taking your child to frequent dental checkups is the best way to help spot and prevent cavities from forming. Traditionally, your dentist may poke around the teeth with an explorer (the sharp, pointy instrument) to see if they can find sticky spots. They may also use a special dye to stain areas where a cavity is present (Christensen, 2006). A more recent method that is now available are light-based lasers that can detect early signs of cavities (Johannes, 2015). For the more difficult areas not visible to the eye (ie. in between teeth), the dentist can prescribe radiographs (also known as x-rays) for your teeth. If cavities are present, the radiograph of the tooth will have darkened spots.

      Interestingly enough, there are ways you can possibly spot cavities in your child’s mouth too. When minerals on your child’s teeth start to wear off there will be white spots that look visibly different from the rest of your child’s teeth (NIH, 2013). These white spots can be signs of early caries that have not fully formed yet (Christensen, 2006). Once the caries are formed into cavities, they will start off small. The decay in the enamel will appear as a tan or brown colour (Christensen, 2006). At this point these are early cavities, and the great thing about finding these early cavities is that they can be reversible! This only applies to the small cavities that have not gone completely past the enamel of the tooth (NIH, 2013). To reverse the small white spots there will need to be change (for the better) in what is happening at home with brushing, flossing, and application of fluoride, as well as a change in diet (Christensen, 2006). However, the white spots on your child’s tooth may not necessarily be demineralization. It could also be fluorosis which looks very similar to demineralization; Dental fluorosis will appear much harder than demineralization (Walsh, n.d.). Demineralization on the tooth anatomy will appear much softer and can only be identified with an explorer from a dentist (Christensen, 2006).

      This does not only apply to the children, but can also be used as a helpful guide for adults to prevent cavities. So keep an eye out for both you and your child!

Happy hunting,
Christine

References
Christensen, M. (2006). Stages of tooth decay. Daily Miner and News, and Enterprise. Local Kenora News Publicatons. Retrieved from http://kenoradentist.com/dental-articles/stages-of-tooth-decay/

Johannes, L. (2015). Tooth decay detected by lasers and light systems. The Wall Street Journal. Retrieved from http://www.wsj.com/articles/tooth-decay-detected-by-laser-and-light-systems-1420483113

NIH. (2013). The tooth decay process: how to reverse it and avoid a cavity. Nation Institute of Dental and Craniofacial Research. Retrieved from http://www.nidcr.nih.gov/oralhealth/OralHealthInformation/ChildrensOralHealth/ToothDecayProcess.htm

Tooth Anatomy (2015). Colgate. Retrieved from http://www.colgateprofessional.com/patient-education/articles/tooth-anatomy

Walsh, L. (n.d.). White spots. GC Europe. Retrieved from www.gceurope.com/pid/126/leaflet/en_White_Spot_Lesions.pdf
 

Treatment Options for Early Childhood Caries

During our previous blog posts, we have identified many ways on how to prevent Early Childhood Caries. What if, upon reading these blogs you have realized that your child is suffering fromECCs and you are now left wondering what the possible treatment options are? It is important to get this disease treated as soon as it is diagnosed so that the child is not left with other challenges that may affect their life. “[The] consequences can affect the immediate and long-term quality of life of the child and family, and can have significant social and economic consequences beyond the immediate family as well” (Colak, Dulgergil, Dalli and Hamidi, 2013). Some of these consequences of leaving this disease untreated include pain, infection, ability to eat, nutritional deficiencies, sleep disturbances and somatic growth (Ezer, Swoboda, Farkouh, 2010).  The cost of the treatment is also a factor many parents will take into consideration. “The cost of restoring teeth afflicted with ECC will likely exceed $1,000 per child. In addition, general anaesthesia or sedation is often required, which can further increase the cost of treatment to nearly $6,000, (Ezer, Swoboda,Farkouh, 2010).  So, the next time your child is crying and won’t go to sleep, reconsider the bottle of juice or milk you may want to send to bed with them and think about what it could cost you in the long run!

Treatment can vary for each individual case, depending on the age of the child and the progression of the cavities. “The treatment of ECC has many repercussions as it is expensive, invasive and time-consuming” (Ezer, Swoboda, Farkouh, 2010).  Severe Early Childhood Caries are usually treated in a hospital because the child will require general anesthesia due to the level of cooperation and behaviour sometimes seen by a child (Berhowitz, 2003). The most common treatment options for Severe Early Childhood Caries include stainless steel crowns and extractions of the infected tooth. “Treatment of ECC is usually restricted to surgical removal or restoration of carious teeth coupled with recommendations regarding feeding habits” (Berhowitz, 2003). A stainless steel crown fits on top of the infected tooth (after the infection is removed from the tooth) to protect the tooth from further decay.  For more mild lesions, professionals may also place a composite resin, which is a clear/white filling that blends in with the colour of the tooth. It is also important to realize that even after surgery, without proper correction to previous habits (such as dietary habits), early childhood caries can return (Berhowitz, 2003).

Preformed stainless steel crowns placed on the lower primary molars
www.castlegatedental.com

I understand that this blog may be alarming or traumatizing to certain readers, but it is the reality of the disease.  Of course, it is also important to realize that that these treatment options are implemented when the disease is in a serious state. By following some of the preventative strategies previously mentioned in our other blogs, you will decrease the risk of your child developing early childhood caries.

Yours Truly,

Julia


Resources:

Berhowitz, R. (2003). Causes, Treatment and Prevention of Early Childhood Caries: a microbiologic perspective. Journal of the Canadian Dental
Association, (69), 5, pg. 304-307.

Colak, H., Dulgergil, C.,  Dalli, M., and Hamidi, M. (2013). Early Childhood Caries Update: A review of causes, diagnoses, and treatments. Journal of Natural Science, Biology and Medicine. Retreived from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3633299/

Ezer, M., Swoboda, N., Farkouh, D. (2010). Early Childhood Caries: The Dental Disease of Children. Oral Health Group. Retreived
from: http://www.oralhealthgroup.com/news/early-childhood-caries-the-dental-disease-of-infants/1000353805/?&er=NA

Baby Bottle Be Gone!



  With all of this talk about Early Childhood Caries (ECC), it is important for me to explain how children can develop these caries. How many parents of young children encourage the use of a sippy cup or baby bottle? Many of you, I am sure answered yes. Well, of course, you do not want a mess on your carpets and furniture! Also, isn’t that what infants and toddlers should use? Well, you may want to take these sippy cups and bottles away from your child/children as soon as possible after reading this blog.

  Researchers have identified that a child's frequent use of a baby bottle with sugary liquids, while sleeping or as a pacifier, is a major risk factor for ECC by exposing newly erupted teeth to fermentable carbohydrates (Sealy, P.A., Farrell, N., Hoogenboom, A., 2011). This is not to say you cannot ever use a bottle or sippy cup, however, it is the high frequency of feedings, such as when they are put down for a nap that increases the risk of ECC (Sealy, et al., 2011). When you put your child down for a nap or to bed, it is extremely important a bottle or sippy cup filled with juice, even if it is diluted, or milk does not join them (American Academy of Pedodontics, American Academy of Pediatrics, 2014). I know that when I have children, cleaning up a little mess from my carpets and/or furniture will be nothing compared to paying for my children/s oral surgeries to fix their teeth.

  Some suggestions as an alternative to sending your child to bed with a baby bottle filled with anything other than milk or juice is to simply fill it with water instead. Also, when your child is hanging around the home, only fill their sippy cup with water and reduce their intake of fruit juice to 4 to 6 ounces from an open cup with a meal or snack (Sealy, et al., 2011). You could also try putting them down for their nap or bedtime with a blanket or stuffed animal for comfort instead of the bottle or sippy cup. The American Academy of Pedodontics and American Academy of Pediatrics (2014) suggests weaning your child off of the bottle or sippy cup around the age of one to allow them to drink from a real cup.  Although these changes could take some getting used to, it will save money and health of your child’s future.

Yours truly,

Corey C.

American Academy of Pedodontics and the American Academy of Pediatrics. 2011. Policy on early
        childhood caries (ECC): Classifications, consequences, and preventive strategies. American
        Academy of Pediatric Dentistry, 37 (6), 15-16.


Sealy, P.A., Farrell, N., Hoogenboom, A., (2011. Caregiver self-report of children's use of the sippy cup
        among children 1 to 4 years of age. Journal of Pediatric Nursing, 26, 200-205.

What’s all this talk about Early Childhood Caries, and what you need to know about them?

Listen up parents! There is a new epidemic out there taking children’s mouths by storm!  This epidemic is better known as Early Childhood Caries (ECC’s) and is affecting 60% of children by the time they are 5 years old! (American Academy of Pediatric Dentistry, 2013). What are early childhood caries you ask?  “It is a rapid form of tooth decay and is the most common disease among young children” (American Academy of Pediatric Dentistry, 2015).  Unfortunately, it is so common that it is 5 times more common than Asthma and 7 times more common than Hay Fever among American children (American Academy of Pediatric Dentistry, 2015).  ECC is also quite commonly known as ‘rampant caries’ or ‘baby bottle syndrome’, but no matter what it is called, it still poses the same terrifying threat to a child’s overall health.
Now, Let us get into what can cause this horrible dental disease and how it is impacting the lives our children!  It has been discovered that the socioeconomic status of the child’s family does have a strong relation to whether or not they develop ECC, the degree of the problem, as well as what the outcome of the situation will be (AAPD, 2013).  “One of the major causes of caries is putting young children to bed with bottles of juice, milk, or formula.  The sugar in these drinks pool around the upper front teeth, mixing with caries producing bacteria, giving rise to rapid tooth decay”(Hack, 2014). Letting your child suffer from ECC will influence many aspects of their lives, not just their teeth (AAPD, 2013).  This is why it is so important to make and keep your child’s oral health a top priority. This horrible disease can be easily prevented just by causing global awareness for this issue, as well as, monitoring closely the diet and oral hygiene of the child (Seminario & Ivančaková, 2003.)  It is also a great idea to start those routine dental check-ups at a young age (Hack, 2014)!

Question of the week:
A frequently asked question from concerned parents and a helpful, resourceful answer!      

Q: Why can’t the primary teeth just be pulled once they’re affected?
A: Majority of parents out there would strongly consider having the problematic primary teeth extracted to save time and money.  However, there are beneficial and crucial reasons to justify keeping them until they are ready to go on their own! The primary teeth hold the spot for the corresponding permanent teeth to erupt.  If this sequence is disturbed, it may cause crowding, unusual tooth rotations, and even worse, impactions.  (Ahamed, Reddy, Krishnakumar, Mohan, Sugumaran & Rao, 2012).  So when contemplating the cost of fillings or root canals vs. extractions for those primary teeth, compare the price of oral surgery and braces that may be needed down the road!

Thanks for listening!

References
 Ahamed, S. S. S., Reddy, V. N., Krishnakumar, R., Mohan, M. G., Sugumaran, D. K., & Rao, A. P. (2012). Prevalence of early loss of primary teeth in 5–10-year-old school children in Chidambaram town. Contemporary Clinical Dentistry, 3(1), 27–30. http://doi.org/10.4103/0976-237X.94542

Hack, L. (2014, February 19). Tooth decay is epidemic among today's kids. Retrieved November 2, 2015.

Oral Health and Children. (n.d.). Retrieved November 2, 2015, from http://www2.aap.org/commpeds/dochs/oralhealth/index.html

Seminario, A., & Ivančaková, R. (2003). Early Childhood Caries. Charles University in Prague, Faculty of Medicine in Hradec Králové: Department of Dentistry, 46(3), 91-94. Retrieved November 2, 2015, from PubMed.

The State of Little Teeth. (2013). American Academy of Pediatric Dentistry. Retrieved November 2, 2015, from http://www.aapd.org/assets/1/7/State_of_Little_Teeth_Final.pdf

Caring For Your Baby's Gums




In one of the previous posts, we discussed the importance of baby's teeth and how important it is for children to brush their teeth properly. A baby’s first tooth comes in between 6 and 10 months after birth and during this time it is important to care for the baby’s gums (ADA, 2005). But how do we take care of a child’s oral health before their teeth come in?

Parents can start caring for their baby’s gums as soon as they are born. Something many parents may not realize is that a baby’s gums need just as much attention as their teeth. Just like plaque builds up on teeth, plaque can build up in the baby’s gums too. Plaque buildup in an infant will leave the baby at a higher risk for cavities (ADA, 2005). “Parents and other caregivers may not realize that primary teeth are susceptible to decay as soon as they appear in the mouth, (ADA, 2005).” The primary dentition (baby teeth) is extremely important for a child's development; it helps with pronunciation, chewing and holds a spot for their permanent teeth to come in. Taking care of baby teeth is very important due to the fact that the primary dentition is very susceptible and vulnerable to bacteria building up, (ADA, 2005).

To reduce the chances of Early Childhood Caries (ECC) a parent can start by routinely cleaning their baby’s gums. Cleaning your baby’s gums is very simple. All you need is a soft, moistened washcloth or a piece of gauze to gently wipe the infant's gums. It is best to do this at least two times a day. It is also recommended to wash down the baby’s gums after each feeding and before bedtime (WebMD, nd). It is crucial to do this  before the baby goes to sleep because that is when the bacteria builds up the most.

A final tip from this post is when your baby needs comforting, you can give your baby a clean pacifier. Do not dip the pacifier in anything that would transfer sugar into the mouth (for example, dipping the pacifier in honey or syrup). Starting a routine early that includes cleaning a baby’s gums can help transition to regular tooth brushing as part of their daily oral hygiene routine.


Cheerio,

Christine

References

Tooth eruption the primary teeth. (2005). American Dental Association, Vol 136, 1619. Retrieved from www.ada.org/~/media/ADA/Publications/Files/patient_56.ashx

Caring for your baby’s teeth. N.d. WebMD. Retrieved from http://www.webmd.com/parenting/baby/caring-babies-teeth


The Link between ECC and Low Social Economic Status

Did you know that Early Childhood Caries (ECC) are completely preventable yet according to research “30% of children below the poverty line have untreated decay,” (Evans, 2013). Early Childhood Caries is diagnosed as “the presence of one or more decayed, missing (due to caries) or filled tooth surfaces in any primary tooth in a preschool-age child, i.e., between birth and 71 months of age,” (Canadian Dental Association, 2010). The question is why do people choose not to treat this decay? Why is treating this infectious disease not a priority for such a high percentage of people? Do parents think treating this decay isn’t important?  I can't be the only one having these thoughts and I'm sure many "non-dental people" might also think the same. Some of the reasoning for not treating this decay can be due to the fact that the “prevalence [off ECC] has increased, particularly in low socioeconomic status families where prevention and treatment services are often deficient,” (Evans, 2013). Let's take a minute to look at Maslow’s Hierarchy of Needs, (a model that describes needs in life). This model has the base of the triangle referring to physiological needs such as food, water, shelter, clothing, and sleep. The second base of the triangle refers to safety and security such as health; but keeping in mind that oral health may be even less of a priority for some people.  What this means is that some parents or caregivers do not have resources such as food, water, shelter, transportation etc. so they are unable to access treatment services like visiting the dentist. Some parents have trouble putting food on the table, finding a place to sleep at night, and providing clean clothes for their children for school (which are all psychological needs). It makes sense that if they can’t fulfill these psychological needs, they can’t move up to the next level which deals with health.  Ask yourself, if you couldn’t afford groceries do you think you would be spending money to get your child’s teeth fixed? Many people think this way, and although this could be some of the reasoning for why so much decay is being left untreated, we also have to keep in mind that this disease is completely preventable. With healthy eating and good oral hygiene habits a child would not have to experience this traumatic disease process.

Image source: (Darby, 2010, p.13-14)

Yours Truly,

Julia

DH05

Resources

Canadian Dental Association, (2010). CDA Position on Early Childhood Caries. Retreived
from http://www.cdaadc.ca/_files/position_statements/earlyChildhoodCaries.pdf

Evans, E., Hayes, C., Palmer, C., Bermudez, O., Cohen, S., & Must, A. (2013).  Dietary intake
and severe early childhood caries in low-income, young children. Journal of the
Academy of Nutrition and Dietetics, Vol 133, Iss 8, 1057-1061.

Darby, M., Walsh, M., (2010). Dental Hygiene Theory and Practice, pg.13-14. St. Louis,
Missouri..

Childhood Brushing

Attention parents! For those of you that have had children that have been through the teething stage, remember how relieved you were when it was over? And for those that have not gone through it yet, don’t worry you will get through it! It was likely a difficult stage for you and your child with fevers and emotions. Your child has to go through the uncomfortable feelings of each tooth coming through their gums, why not make sure those teeth are taken care of? How many of you feel, “My child only has one or two teeth, I don’t need to brush them yet.” Many people make this common misconception and it is important to learn the facts.


http://www.oralhealthgroup.com/news/early-childhood-caries-the-dental-disease-of-infants/1000353805/?&er=NA


Early Childhood Caries (ECC), which are better known as cavities, is an issue I never realized was so prevalent. According to oralhealthgroup.com, “Approximately 40% of children have dental caries by the age of five, and 8% of two year old children have some form of decay or previous restoration(s)” (Ezer, M.S., Swoboda, N.A., Farkouh, D.R., 2010). These numbers are staggering to think of, especially because caries are generally avoidable with proper nutrition and oral health care provided by the parent and/or caregiver. In order for your child to remain cavity free, it is important to begin brushing your child’s teeth before the age of two (Heubner, C.E., & Milgrom, P., 2014). Many of you are probably thinking…”Easier said than done!” And, “do you have kids yourself?” It must be a zoo in your house getting your child up in the mornings, changing their diapers, getting them fed, bathing them, cleaning the house, all while making sure you don’t have feces in your hair when you answer the door or phone!….(DEEP BREATH). Yes, this is all after you have gotten zero sleep from tending to your child when they just couldn’t sleep through the night. However, starting to brush your child’s teeth at an early age will help incorporate it into your crazy daily routine. Perhaps your baby will learn to enjoy it, and it will be a great way to enjoy a moment of peace and quiet while protecting against early childhood caries.

A study was conducted to help parents establish a twice daily brushing routine for their children. It concluded that beginning brushing your children’s teeth as soon as the first tooth erupts maximizes the benefits of oral care and allows for adaptation into your family’s routine (Heubner, C.E., & Milgrom, P., 2014). Huebner and Milgrom also suggest reading books about tooth brushing to your children and reading pamphlets so that you, as a parent, are aware of tooth brushing techniques and tips. This may help if your child is feeling resistant to the tooth brushing, and will give you some brushing techniques that you didn’t know before.

So, put aside the fact that you may feel it takes time out of your already jam-packed schedule, and consider how effective it will be for your future. Early oral healthcare is so important in keeping your children healthy and will save you and your family a large amount of money in the long run. Please, begin tooth brushing sooner than later and I guarantee it will help instill healthy values regarding oral health in your child’s and probably your life as well. Also, let’s face it, dental work is the last thing you will want to spend thousands of dollars on when your children grow up.

Sincerely,

Corey Chowhan

References

Ezer, M.S., Swoboda, N.A., Farkouh, D.R. (2010, January 1). Early Childhood Caries: The Dental Disease of Infants. Retrieved from oralhealthgroup: http://www.oralhealthgroup.com/news/early-childhood-caries-the-dental-disease-of-infants/1000353805/?&er=NA

Huebner, C.E. & Milgrom, P. (2015). Evaluation of a parent-designed programme to support tooth brushing of infants and young children. International Journal of Dental Hygiene, 65-73.