DR VALERIE WOO completed her pediatric dental residency at the Children’s Hospital in Boston, MA, and opened her pediatric dental practice, NOVA Pediatric Dentistry, in Ashburn in 2006. Dr. Val is a board-certified pediatric dentist and is actively involved in our local Autism Society, Northern Virginia Dental Society, and the American Dental Association.
All opinions from Guru experts are based on available and presented information. The expressed opinions are not a substitute for medical or psychological care and should not be viewed as such.
Pediatric Dentist Guru: Without examining your son and reviewing the radiographs, I cannot make an appropriate recommendation. It looks like you have received a few consultations from different specialties. You need to fully understand your treatment options before making a decision. I think that careful monitoring of the tooth is necessary. I wish I could be more helpful. You are more than welcome to schedule an appointment at our practice so that I can provide you with a recommendation.
Pediatric Dentist Guru: It sounds like she lost the teeth naturally (not due to trauma) and the teeth are taking their time coming in. Often if the space available for the new teeth is too small for how large the permanent teeth are the teeth take a longer time to erupt. If you want to be certain, you should have your child’s dentist examine her and review past radiographs or take a new radiograph to ensure that she does not have the permanent tooth missing or have an extra tooth in that area that could be preventing the tooth from erupting.
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A: Your daughter is at the average age of losing her first tooth. If there was a history of trauma to that tooth when she lost it, an x-ray may be needed to ensure that the entire tooth has been removed. You can bring her in to see me, along with the tooth (unless the tooth fairy has it now J), just to be on the safe side. I hope that helps!
FACT 1: Tooth decay is the number one- leading chronic disease. It’s fi ve times more common than asthma, according to the 2000 U.S. Surgeon General’s Report.
FACT 2: Half of U.S. school children have decay in permanent teeth.
FACT 3: 90% of all cavities are preventable.*
The solution to this sweeping problem is simple and can be found in fi ve easy steps.
1.Good home care with parental supervision: Supervise your children’s brushing and fl ossing and encourage at least twice daily cleaning – aft er breakfast and before bed are the best times.
2.Regular dental check-ups: Th e American Academy of Pediatric Dentistry recommends children see a dentist by the age of one.
3.Appropriate use of fluoride to strengthen tooth enamel: Water fl uoridation is one of the best sources of fl uoride. Parents should speak to their child’s dentist to discuss appropriate fl uoride options if your water is not fl uoridated.
4.Protect your teeth: Wear a mouth guard for all sports where physical contact occurs, even if your league does not require it.
A: This is a very common experience – especially with the 2 year molars since they are the biggest/widest teeth to erupt into the mouth. Two –year molars can take a couple of months to up to a year or longer to completely erupt into the mouth. The teething process and discomfort usually lasts until the tooth breaks through. Chewing on cold teethers, teething biscuits, and pain relievers such as ibuprofen or acetaminophen can help with this process. Hang in there…it shouldn’t be that much longer! The next set of molars to erupt will be his 6 year molars so that won’t be for another 4+ years and by then he’ll be better able to express himself. I hope the sleep for you and your son improves!!
A: Yes we see children with all special needs, including Autism. We have several children with autism who have a routine when they come to our office. They always come to the office around the same time of the day, have their cleaning/procedure done in the same chair and with the same dental assistant because we understand that consistency is important. Every child is different and we feel it is very important to make each child feel comfortable and safe in their environment. We invite all children and their parents to take a tour of the office prior to their visit to become acquainted with the office and our team. We do not push any child to do something that they do not want to do. We also make sure that the parents are comfortable with our approach. We first talk with the child about what we are going to do, then show them on their hand or their parents hand to model what we want to do in their mouth, and then we try to do it in their mouth. Sometimes we suggest breaking the exam and the cleaning into two visits so we can show the child what is going to happen at their next visit and then they can practice at home with their parents or siblings. We take our time with each child to feel as comfortable as possible and this can take several visits before we complete a cleaning but the end result is that the child feels safe and will improve at each visit!
I hope that helps and we invite you and Mark to take a tour of our office and meet the team!
A: Dear Rick, what you are describing could be signs of teething. Before a new tooth erupts, it can cause a red, swollen, bruised-looking area on your baby's gums. Sometimes the gum bulges with the emerging tooth, which you can see faintly beneath the skin. This can also cause your baby to have some discomfort when brushing.
Typically, babies get their teeth in pairs. First come the middle two on the bottom. A month or so later, the two above those arrive. Still, it's not uncommon to see a baby with four bottom and no upper teeth, or the reverse. A general timeline:
6 months: lower central incisors
8 months: upper central incisors
10 months: lower and upper lateral incisors
14 months: first molars
18 months: canines
24 months: second molars
A: Dear Maya, There is no known relationship of strep throat affecting the gingival tissues so his discomfort on the facial surface of the lower front teeth is caused by something else –is there a history of trauma to the gums? If it hasn’t resolved after 7-10 days you may want to have your son seen by a pediatric dentist to examine the area. Since your son is on antibiotics (which contains lots of sugar) be sure to either rinse his mouth with water or brush his teeth after each dose in order to remove the sugar off of his teeth and to help prevent cavities. Hope this helps!
Q: Is it normal for tweens to have bad breath? what could be causing it and should i get it checked out?
A: This is a very common question. Bad breath, or halitosis, can be a symptom of various conditions including: dry mouth, dental problems, post-nasal drip, and sinusitis. Halitosis in children is often due to the decomposition of mucus secretions and debris which accumulate on the tongue, in the nose, and between the teeth.
Halitosis is an offensive odor which comes from the mouth, nose, or airway. It is also defined as exhaled air containing more than 75 parts per billion of odor-producing volatile sulfur compounds.
COMMON ORAL SOURCES OF HALITOSIS:
Dry mouth (xerostomia):
Dry mouth may be due to: mouth breathing, a decrease in salivary flow, sleeping, dehydration, salivary gland disease, chemotherapy, diabetes, and certain medications. Saliva is very important because it cleanses the teeth and mouth, and destroys oral microorganisms.
The tongue: The most common source of bad breath is the back of the tongue.
An abscessed tooth or dental caries can cause halitosis. In the case of dental caries, food debris gets stuck between the teeth and can cause putrefaction. Faulty dental restorations or poorly fitting crowns allow food and bacteria to accumulate – producing a foul odor.
Oral fungal infection:
Children who take antibiotics for a long time may develop a Candida infection in the mouth. Children undergoing chemotherapy, or who are immunosuppressed, are prone to develop oral fungal infections. Such oral yeast infections produce a characteristic sweet odor.
NONORAL SOURCES OF HALITOSIS:
Bad breath can also be caused by systemic (medical) problems such as:
Respiratory and sinus conditions, tonsils and medications.
Respiratory and sinus conditions:
Postnasal drip is probably the most common cause of halitosis in children. Secretions from a sinus infection, runny nose, or nasal allergy drip down the back of the throat and onto the tongue. Odor-causing bacteria thrive on these secretions, and produce volatile sulfur compounds (VSCs). VSCs are the gases which cause bad breath.
Asthmatic children who use corticosteroids may develop bad breath due to the development of oropharyngeal candidiasis.
Enlarged adenoids may lead to mouth breathing.
If a child’s tonsils have deep crypts, food and debris will accumulate in them, producing some halitosis. Sometimes tonsilloliths form in the crypts. These tonsilloliths are small, soft, whitish-yellow secretions which produce a foul odor as they break up.
Antihistamines, antipsychotics, bronchodilators, antidepressants, and antispasmodics cause dry mouth (xerostomia).
Children who have been taking antibiotics during the last month often have halitosis which is bacterial in origin. This oral malodor is transient, and usually disappears when antibiotic therapy has ceased.
WHAT IS THE TREATMENT FOR HALITOSIS?
Gentle daily cleaning of the back (dorsum) of the tongue is very important. A small, soft-bristled brush should be used to gently clean the tongue surface or a tongue cleaner.
Routine oral hygiene procedures such as brushing and flossing are very important. Remember that children younger than 8 years of age are usually not able to floss on their own. Mouth rinses can also be useful, but only for children who have learned to expectorate.
When bad breath is due to dry mouth, treatment involves having the child drink lots of sugar-free fluids. Sugarless gum may stimulate salivary flow. In very severe cases, an artificial salivary substitute such as carboxymethylcellulose may be needed.
If halitosis is due to dental disease, treatment will be needed to restore dental caries or defective dental restorations. In case of a dental abscess, endodontic or surgical treatment may be needed.
For more information check out the American Dental Association website on the topic at http://www.ada.org/public/topics/bad_breath.asp