Dr Hardeep Bhatta & Dr Allen Friesen
Suite 205 - 1465 Salisbury Ave
Port Coquitlam, BC V3B6J3
In dentistry (as well as other branches of medicine) pediatric conscious sedation is becoming more widespread than ever — but some people aren’t yet familiar with this beneficial therapy. Conscious sedation can remove anxiety and produce a feeling of calm and relaxation during dental treatment; however, unlike general anesthesia, it doesn’t cause the loss of consciousness. That means patients can still breathe normally and can respond to certain stimuli, while feelings of pain and anxiety are blocked.
Conscious sedation is often employed for invasive procedures such as tooth extractions or root canals — which cause some people a great deal of apprehension, no matter what their age. It can be especially useful for children, however, who may have a more limited ability to understand (and cooperate with) their dental treatment. Because the medications are commonly administered orally (by mouth), there’s no needle to provoke fear. And when it’s over, there is usually little or no memory of the procedure that was done.
Pediatric conscious sedation is typically administered in an office setting by a dentist with special qualifications. The American Dental Association, the American Academy of Pediatric Dentistry, and the American Academy of Pediatrics have jointly established criteria for its use. Specialized training and continuing education are part of the qualification process; additionally, the dental office must be equipped with advanced life-support equipment and trained staff, who can help in the unlikely case of an emergency.
While your child is receiving conscious sedation, he or she will be monitored by a designated staff member who keeps a close watch on vital signs like blood pressure, oxygen levels, pulse rate and respiration. This helps to ensure that the level of sedation remains safe, yet effective. When the procedure is over, the medications wear off quickly; however, children will certainly need a ride home, and shouldn’t return to school until the next day.
As new medications are developed, more dentists receive special training, and the cost of associated equipment becomes more reasonable, the practice of pediatric conscious sedation is becoming more widespread. For many kids, it could mean the difference between having fearful childhood memories of the dental office that linger on through life — and remembering almost nothing at all.
If your child has dental anxiety or requires invasive procedures, pediatric conscious sedation may be a good option for you to consider. For more information, call our office to arrange a consultation. You can learn more in the Dear Doctor magazine article “Sedation Dentistry for Kids.”
One of the most common parental concerns is the habit of many children, even late into childhood, to suck their thumbs or fingers. Many parents have asked us, “Could this affect their teeth?”
The answer, unfortunately, is yes — thumb sucking can contribute to a malocclusion (bad bite) that could eventually require orthodontic treatment. Before making any assumptions, however, we need to understand the bigger picture.
To begin with, infants have a different swallowing mechanism than adults and older children. When you as an adult swallow, you'll notice the tip of your tongue positions itself just above the back of the top front teeth. An infant, however, will thrust their tongue between their upper and lower jaw as they swallow (also known as an infantile swallowing pattern or primary tongue thrust). The infant normally begins changing to an adult swallowing pattern when their primary (baby) teeth begin to erupt.
However, if a child's swallowing transition is slower than normal and the tongue rests between the jaws for a longer duration, it can inhibit the full eruption of teeth, believed to be the main cause of an open bite (a gap between the upper and lower teeth when the jaws are shut). The thumb during sucking resting between the teeth can have the same effect.
Thumb sucking may not necessarily lead to a malocclusion — for example, an abnormally developing jawbone could be the culprit. If prolonged thumb sucking does become a concern, however, there are steps we can take to reduce the impact of the habit. We can install a thin metal “tongue crib” behind the upper and lower incisors that will not only discourage thumb sucking, but also help retrain the tongue not to rest between the upper and lower teeth. There are also exercise routines known as orofacial myofunctional therapy (OMT) that can retrain specific muscles in the mouth to encourage more normal chewing and swallowing patterns.
These steps may not prevent future orthodontic treatment, but they could reduce its extent. The key is regular dental checkups and consultation to ensure your child's teeth and bite are developing normally.
If you would like more information on the effects of chronic thumb sucking on the mouth, 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 “How Thumb Sucking Affects the Bite.”
In the early 1900s, a Colorado dentist noticed many of his patients had unusual brown staining on their teeth — and little to no tooth decay. What he unknowingly observed was the power of a chemical substance in his patients' drinking water — fluoride. While commonplace today, fluoride sparked a revolution — and some controversy — in dental care during the 20th Century.
After decades of research and testing, most dentists now agree that fluoride reduces decay by interfering with the disease process. The optimum pH level for the mouth is neutral; however, this environment constantly changes as we eat, especially if we ingest foods or beverages high in acidity. A high acid level softens tooth enamel (a process called de-mineralization) and can lead to erosion if not neutralized. In addition, a thin layer of bacteria-rich plaque called biofilm that adheres to tooth surfaces is also acidic and is the cause of tooth decay, possibly more so in teeth made more susceptible from enamel erosion.
When fluoride is in “the right place” (present on the tooth surface and in our saliva, the body's natural acid neutralizer), it helps inhibit de-mineralization and aids in the re-hardening of the enamel (re-mineralization).
Although fluoride needs to come into direct contact with tooth enamel for optimum effectiveness, ingesting it can also prove beneficial. The fluoride we ingest eventually becomes deposited in bone. As bone grows and changes it releases this reserved fluoride back into the bloodstream where it eventually becomes part of saliva; the saliva brings it into contact with tooth surfaces.
The two most prominent ways we encounter fluoride are through fluoridated drinking water and in toothpaste. There continues to be concerns about what constitutes safe levels of fluoride in drinking water and over possible side effects like teeth staining and changes in bone structure. However, extensive studies have conclusively shown that even minimal levels of water fluoridation and the use of fluoride toothpaste have reduced tooth decay.
As the Colorado dentist discovered over a hundred years ago, fluoride is truly remarkable as a cavity fighter. Whether you have access to fluoridated water or not, we encourage you to use fluoride toothpaste to strengthen your teeth against decay.
If you would like more information on fluoride, 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 “Fluoride & Fluoridation in Dentistry.”
Many youngsters look forward to finding a surprise under their pillow after a visit from the “tooth fairy.” This fable may comfort children who wonder why their first teeth come out. Parents need to know that losing baby teeth, also called primary or deciduous teeth, is completely normal, but at the right time and the right “space.”
A child's first set of teeth must be lost to create room for the adult or permanent teeth that have been forming beneath them. The buds of the permanent teeth grow within a child's jawbone just under the baby teeth. The tops, or crowns, grow first, followed by the roots. Then as the roots develop, the permanent teeth push the baby teeth above them up through the gum tissues. As this happens, the roots of the baby teeth are resorbed, or melted away.
With their roots gone, eventually the baby teeth become so loose that they can be easily removed or fall out on their own, making room for the adult teeth to appear. Sometimes, when a baby tooth is so loose, it can be wiggled out. It leaves a little bleeding gum tissue that heals easily. This is also normal.
Besides making sure the tooth fairy comes, parents need to be sure that their children are evaluated to determine whether baby teeth are being lost in the right sequence so they will act as guides for the adult teeth. If teeth are lost prematurely because of decay or trauma, it is important that space is maintained for the adult teeth when they come in.
Contact us today to schedule an appointment or to discuss whether your child's baby teeth are being lost in the right sequence and the adult teeth are coming in correctly. To read more about losing baby teeth, see the article “Losing a Baby Tooth: Understanding an important process in your child's development.”
Losing a baby tooth is an important milestone in a child's life. Be sure to take a photo of that toothless smile — it will be something you treasure as your child grows up.
You may be wondering what is really happening when a baby tooth becomes loose and eventually falls or is pulled out. Read on for some answers.
What are baby teeth?
An infant's teeth begin to form before birth, by the fifth to sixth week after conception. When the baby is born, 20 primary (baby) teeth are almost completely formed inside the jaws. These first teeth, also called deciduous teeth, begin to erupt through the gums at about the time the baby begins to eat solid food. The front teeth (incisors) are usually the first to come in, at age six months to a year.
Why are they called deciduous teeth?
Deciduous means “falling off at maturity.” The same term refers to trees that lose their leaves every fall. In many mammals, including humans, it refers to the first teeth, which need to come out to make room for the larger permanent teeth to come in.
What causes the deciduous teeth to become loose?
While your child is using his primary teeth to bite and chew, his adult (permanent) teeth are quietly growing inside his jawbone. Starting with tooth “germs” (the word comes from germination, meaning the start of growth), the top part of each tooth, called the crown, grows first. Then the bottom part, or root, begins to grow and elongate. As the roots develop and the permanent teeth take up more room in the child's jaw, they begin to push against the baby teeth. This causes the roots of the baby teeth to melt away or resorb. Eventually little or nothing is left to hold the baby teeth inside the child's gums, they become wiggly, and finally they can easily be pulled out. This may leave a little bleeding gum tissue that quickly heals.
What should you watch for in the transition from primary to permanent teeth?
As the permanent teeth erupt (push through the gums and become visible), you may notice that they are too crowded, have too much space between them, or are crooked. It's a good idea to have an orthodontic (from ortho, meaning straight and dont, meaning tooth) evaluation at age five to seven. Watch to see that the baby teeth are lost in the right sequence. If one is lost prematurely, for example from decay, make sure that the space that it occupied is maintained to make room for the adult tooth that will replace it. We can help you with this.
Contact us today to schedule an appointment to discuss whether your child's baby teeth are being lost in the right sequence and if the adult teeth are coming in correctly. For more information see the Dear Doctor magazine article “Losing a Baby Tooth.”
If you asked a room full of parents about their opinions on thumb sucking and pacifiers, the odds are good that you would get a wide variety of opinions. The truth is that this habit is a perfectly normal behavior in babies and young children; however, it is something that parents and caregivers should monitor. This is why we want to share a few basic myths and facts to set the record straight.
So how early does thumb sucking start?
It is interesting to note that thumb sucking for some babies actually starts before birth. This fact is proven quite often when expectant mothers “see” their unborn child sucking fingers or a thumb during a routine mid to later term sonogram. Sucking for babies is absolutely normal; it provides them with a sense of security. It is also a way they test, make contact and learn about their world.
At what age should a parent be concerned if their child still sucks a pacifier, finger or a thumb?
Recent studies have shown that if a sucking habit continues after the age of two, there may be some long-term changes in the mouth that have can have a negative impact on jaw development and/or with the upper front teeth. (It can cause these upper front teeth to become “bucked” or protrude forward towards the lips.) The American Academy of Pediatric Dentistry recommends that parents and caregivers encourage children to cease this habit by about age three.
Do children ever stop this habit on their own?
Absolutely! If left alone, many children will naturally stop sucking their fingers or thumb between the ages of two and four. The main points to remember are that sucking habits are totally natural and should stop on their own. You should not make it a problem unnecessarily. If, however, your child is getting older and still seems dependant upon this habit, feel free to contact us today to schedule an appointment for your child or to discuss your specific questions about pacifiers and finger or thumb sucking. You can also learn more about this topic by continuing to read the Dear Doctor magazine article “Thumb Sucking in Children.”
Nearly everyone who has ever played a sport, or had a child participate in one, has had that panic-filled moment when they witness an injury. And when you consider that there are more than 22,000 dental injuries each year in children younger than 18 years of age, you see there is fact to backup this concern. This is just one reason why we strongly encourage all of our patients who are involved in activities such as football, soccer, hockey, wrestling, lacrosse, skateboarding, field hockey and more to wear one of our custom-fitted professional mouthguards. It is especially true for basketball and baseball, which are responsible for the largest number of dental injuries.
The following are some key issues to help you understand the importance and advantages mouthguards offer.
Yes there are several. Age, gender, dental anatomy, and the type of sports being played are the four categories used to measure the risks for dental injuries. Young male teens still top the list of most likely to be injured; however, the gap is closing with more females getting involved in sports. Learn which sports or exercise activities made the American Dental Associationâs list of recommendations for using a custom mouthguard, when you continue reading “Athletic Mouthguards.”
We are often asked this very important question. While some over-the-counter (OTC) mouthguards provide what is advertised as a “custom-fit” to your teeth, it is nowhere near the fit — and thus protection — you receive from our mouthguards that are crafted from precise molds of your teeth. Additionally, because all aspects of our mouthguards are tailored to each specific mouth, they provide much more protection and comfort. This important fact can enhance performance as the athlete can literally breathe easier while wearing one of our mouthguards.
The first important fact to know is that you do not have to be a dental or healthcare professional to assist. However, before jumping in to help out, consult Dear Doctor's Field-Side Guide to Dental Injuries. This pocket-sized, quick-reference guide details what you should do at the scene of a dental injury based on the type of injury. But best of all, it is available to you free of charge from Dear Doctor.