Tooth Development in Children Monday, Oct 31 2011 

The office receives a great number of questions about teeth in children and when they should first appear and what to do about certain problems children have with their teeth. So, in this blog, I will address some of those questions and concerns.

First, children have two sets of teeth, primary(baby) teeth, and permanent (adult) teeth. All teeth are important for speech, chewing and give the face structure. In addition, the primary teeth help children develop the muscles necessary for chewing and  also act as placeholders for the permanent teeth, which erupt later in life.

The first primary tooth will usually erupt around the age of 6 months. After that happens, the parents should brush the child’s teeth twice daily to prevent tooth decay. Generally, at 2 years of age, all 20 primary teeth will erupt. Parents should continue to brush the child’s teeth until he or she is able to avoid swallowing the toothpaste.

One common misconception of parents is that primary teeth do not require dental care since they are temporary and will eventually be replaced by permanent teeth. If a primary tooth is lost before the scheduled time of eruption of its permanent successor, it is likely the space will reduce in size, or even close due to drifting of near by teeth, which can cause the permanent tooth to grow in crooked. A baby tooth which has a large cavity which is not treated, can abscess. This infection can actually harm the permanent tooth which is developing under the baby tooth.

The primary teeth are lost between 7 and 12 years of age and are replaced with permanent teeth. This phase of development is typically referred to as the “mixed dentition” stage because children have both primary and permanent teeth.

There are a total of 32 permanent teeth; the additional 12 teeth will erupt behind the primary teeth and are called the molars. All permanent teeth erupt by the age of 14 with the exception of the “wisdom teeth” or third molars that erupt between the ages of 17 and 25.  Not everyone develops “wisdom teeth”, but those of us that do typically have them removed for one reason or another.  Usually because they are so far back in the mouth and are often difficult to properly clean.  This does not interfere with chewing as the “wisdom teeth” are not generally used for chewing.

That is a quick over view of the primary or “baby” tooth story. The most common question or concern that parents express is when the lower permanent front teeth begin to erupt. It can look strange, like the child is actually getting a second set of teeth behind the front baby teeth.  Actually, what you see are the two permanent teeth erupting behind the baby teeth. As the permanent teeth come in, they will move forward and actually “push” the baby teeth out.

The pictures should help with the “average” time-table of when baby and permanent teeth should appear in a child’s mouth. It can vary by months, so do not get too concerned if your child seems a bit slow with his tooth development. If you are worried, the dentist can take an x-ray and show you the permanent teeth developing in your child’s mouth.

House Call–A Story about Real Doctors Wednesday, Oct 19 2011 

A  long time ago, when I was seven or eight years old( this would have been in the mid 1950’s) I managed to convince my father and grandfather to let me accompany them to visit one of my grandfathers sick patients. Just a bit of back ground would be order at this time. My father was a physician -ObGyn, and my grandfather was a real country doctor. His father,  my great-grandfather was also a country doctor. They were  from eastern North Carolina and at this time my grandfather was practicing in Zebulon ,North Carolina.

We drove out in the country around Zebulon to a small house surrounded by fields. The wife of the farmer was ill and my grandfather wanted a second opinion about her situation. As I recall, the situation was not good and there was some concern about how to treat her. When we drove up, everyone came out from the house except the mother. I was instructed to remain by the car while they tended to the patient. Their equipment was a real “doctors black bag”–blood pressure cuff, stethoscope, few other odds and ends and a watch with a second-hand. Very primitive by the standards of today, but the two of them were not concerned. They had their hands, eyes, and a wealth of diagnostic skills built up with time.

There was no doubt the family was poor–tenant farmer, share cropper, I am not sure what the family did. There were a number of children, various ages and we stared at each other as children will do when confronted with a new situation. I have seen many houses like the one they lived in over the years. Most derelicts falling down and covered with vines and weeds. The house was built up off the ground with some brick pilings  and made from rough finished timber which was agedto  a sort of black brown and had never see any paint.  I don’t remember the windows having any curtains or even screens.

After a period of time, father and grandfather walked out of the front door and spoke with the husband. As I remember, they walked back to the car and had a discussion of sorts. It dealt with the womans situation and my father was not optimistic. Grandfather concurred and there was bit more discussion. I believe that he went back to the house and had a brief talk with the husband.

This was all on a Sunday afternoon, as Sunday was generally the day we visited my grandfather. It was a beautiful day, lots of sunshine and late summer. Not much was said on the ride back although I am sure that I made attempts at talking, but was  encouraged  to be quiet,as everyone was not in a talkative mood.

I have no idea what happened to the woman and her family. Obviously, the event impressed me as I can remember most of what happened. But I never asked my father or grandfather about it and they never spoke of it, at least not when I was around. But I was witness to an event that no longer exist–doctors making a house call to visit a sick patient. No fancy machines and lab test, only their knowledge and diagnostic abilities backed up by their examination with hands and eyes. This is still the way many doctors make their diagnosis, but it is rendered in an office or hospital instead of a farm-house miles from any city. I think that I find myself reflecting on this event more and more, with the discussion of the vast changes that have occurred in health care, and the potential changes that are coming. It was a simple time with simple yet time-tested techniques. Money was not much of an issue; the man had little if any and probably paid my grandfather with something from the farm. He received a high-powered specialist consultation from my father, who asked for nothing–he was helping his father and another physician with a difficult case. I feel lucky to have been present for this small vignette of medical history. A real country doctor at work.

The Case for Dental Implants Wednesday, Oct 19 2011 

If you have lost teeth and have gaps in your smile, or just don’t seem to be able to chew very well due to missing teeth, you might want to consider replacing those teeth with implants. It is one of the best and most reliable methods to restore your mouth and provide you with a great smile and a good bite for chewing food.

Implants have been around for a long time and the technology has gotten better. You can actually have a tooth pulled and place an implant in the vacant tooth socket all at the same visit. If you are missing a tooth or teeth, the process is only different in that the dentist will have to drill a very specific sized conical-shaped hole in the bone. The implant is then fitted to this space and screwed into the bone. It might sound bad, but it is really less painful and traumatic than having a tooth pulled. There is no pushing and shoving or “pulling”, only slight pressure from the drill and then the placement of the implant .

After the implant is placed it has to heal which involves the implant actually fusing or joining to the bone. In the top of your mouth (maxilla) this can take anywhere from 4 to 6 months whereas in the bottom of  your mouth it only takes 2 or 3 months to heal. Once it has healed, the implant is uncovered and an abutment is screwed into the implant. In most cases you don’t even have to be numb to have this done. The abutment is checked for how it fits in your mouth and if necessary is adjusted (outside of your mouth) and prepared for an impression. This part is actually just like you had a regular tooth and were having it fixed for a crown. Once everything is correct with the abutment, an impression is made of it. Then a temporary crown is made for the abutment. When the permanent crown comes back from the dental laboratory, it is fitted, checked and permanently cemented into place. You are now ready to get down to some serious chewing.

This implant procedure can be done for bridges, multiple crowns or in most places where you are missing teeth. The implants can even be fixed to have a small bar made that is screwed into the implant. Then a denture (top or bottom or both) can be fitted to the bar. This makes the dentures fit tightly and it will not come loose when you are chewing or talking.

There are even mini implants which can be used to help keep dentures in place. The small implants are placed in the upper or lower jaw then the dentures is fitted with female attachments which fit into the mini implants. This technique holds the dentures in place very well and is not as expensive as the full size implants.

So implants can be used in most places of your mouth to repair or replace teeth which you are missing. They can be made as a single tooth or several teeth or fitted with different parts to help hold your dentures in place. The variations and possible combinations numerous. This make the implants one of the most flexible methods of replacing your teeth.

Xylitol–The Silver Bullet for Tooth Decay? Thursday, Oct 6 2011 

Recently, the natural sweetener xylitol, has been getting a great deal of attention from the dental world and the nutrition and health food worlds as well. Xylitol, is a natural sweetener found in fibers of many fruits and vegetables and can also be found in oats, mushrooms and corn husks. Xylitol was discovered by German and French chemists in the late 19th century and has been used in Europe primarily as a sugar alternative for diabetics.

In the early 1970’s,researchers in Finland discovered the dental benefits of xylitol, since that time many more studies have been conducted.  These studies have linked xylitol to a reduction in the bacteria that can lead to cavity formation.   The way xylitol works is quite interesting.  The bacteria in your mouth mistake xylitol for their favorite food, fructose. The bacteria transport xylitol through their cellular walls to metabolize it as a food.  Xylitol is a five carbon sugar alcohol, which during this process of transportation is changed into xylitol phosphate. The bacteria are not able use this substance as a food. Over time, the xylitol phosphate accumulates inside the bacteria, creating a toxic effect.  The bacteria become starved, and may eventually die.  This results in a reduction of the number of cavity causing bacteria in your mouth.  However, the long-term presence of xylitol in the oral cavity can lead to an increase number of xylitol-resistant bacteria. This is actually a good thing since these bacteria are not as strong as their cousins and are not as capable of producing tooth decay. They also lack the ability to produce the necessary acid to adhere to your teeth. This means there will be less plaque on your teeth. 

There is some evidence that suggests the use of xylitol  can aid in the repair of damaged tooth structure by creating bacterial changes; creating an ideal environment for remineralization to occur.  Remineralization is the natural process of restoring minerals to a tooth that have been damaged by the acidic activity of bacteria.  Think of it as replacing the missing rungs in an old rickety ladder, making it strong and stable again.   While nothing can replace brushing and flossing xylitol use can be another means of combating tooth decay.

Research suggests you need to consume between four and twelve grams of xylitol a day to experience the positive effects.  Xylitol can be purchased in many different forms, such as chewing gum, various candies, sweetener packets for your coffee or tea, or in bags just like sugar. It is not difficult to find, most health food stores carry it, as well as a number of internet sites.  It can be a little pricey, but if you have high rates of tooth decay it can help with the problem.

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