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Dental Education



How Prone Are You To Developing Dental Cavities? (Part I)
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Having dental cavities is the number one reason in the United States why people visit the dentist. A lot of people think that developing cavities is a natural part of life and is mostly due to genetics and/or luck. After all, we all know those lucky individuals who do not brush or floss regularly and still never get them. The reasoning behind a person’s susceptibility for cavities goes much deeper than luck. There is now a lot of information known about the cavity process, giving us more control than we had originally thought.

A cavity is soft, demineralized, infected tooth containing acid producing bacteria. These bacteria can be passed on from individual to individual. In fact, children frequently receive these bacteria from their parents which can be transmitted by simply sharing a utensil. The bacteria ferment the sugars we eat, creating an acid environment in our mouths which dissolve minerals (calcium and phosphate) from our teeth. If this process is not reversed and enough calcium and phosphate are lost from the tooth, it may become a cavity.

When there is a cavity, the dentist will drill a hole in the tooth to remove the decay before patching it up with a white or silver filling. A big filling from a mechanical viewpoint can be bad because it could result in a weaker tooth that is more prone to future fracture and possibly more major dental work. Many adults are now faced with crowns, bridges, implants, and dentures as a result of large fillings placed in their teeth as children. A healthy tooth has the best long term chances if nothing is ever done to it. However, if a cavity is beyond the stage/size that can be reversed, it must be drilled-and-filled.

The good news is that we can actually heal, reverse, and prevent certain types of cavities. Understanding how a cavity develops and knowing all of the risk factors involved is extremely important in order to intervene and halt the process. For example, if the acid pH caused by the bacteria can be neutralized before cavitation occurs, the cavity may be able to be reversed. Also, if we can somehow make the concentration of calcium and phosphate in the saliva higher than in the tooth, we can increase the chances of reversing a cavity. Therefore, cavities management in a dental office should go much deeper than only diagnosing and filling a cavity. It should also include assessing a person’s risk factors and protective traits for developing cavities.

There are several main factors involved in a person’s chances of developing cavities. The first is the amount or concentration of the acid producing bacteria in an individual’s saliva. The more bacteria there are, the higher the risk for cavities. Another factor is the individual’s diet. The more simple sugars in the diet, the more bacteria will produce acid. Lastly, the amount of saliva produced by an individual’s salivary glands can also have an effect. We have natural enzymes and buffers in our saliva that kill bacteria. A person with more saliva could also have more of these enzymes and buffers, better neutralizing the pH and allowing more bacteria to be killed.

Due to limited space, in this month’s segment we have only discussed the cavity process and some of the factors that may influence an individual’s susceptibility to developing cavities. In the next segment, which will appear next month, we will explore in greater detail how to improve cavity prevention and what we can do to help reverse the cavities that we currently have.




How Prone Are You To Developing Dental Cavities? (Part II)
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In the last issue, we discussed in detail how cavities are formed and the multiple factors which may influence an individual’s susceptibility to cavity development. In this segment, we will focus on how to prevent cavity formation and how to reverse it. For a copy of Part 1, please refer to www.alisoshoredentist.com.

As discussed previously, consumption of starches (especially simple sugars) causes certain mouth bacteria to secrete acid, lowering oral pH. This may cause the tooth to lose calcium and phosphate, a process called demineralization. A demineralized tooth may eventually form a cavity. In contrary, re-mineralization involves neutralizing oral pH and restoring calcium and phosphate back into the tooth. This process can be enhanced with the application of fluoride.

In part 1, we discussed factors which may increase a person’s cavity risk. This included but is not limited to individuals with dry mouth, soft teeth, bad oral hygiene, high bacteria counts, high sugar intake, and/ or acidic saliva. With the guidance of their dental office, such individuals should determine their unique cavity risk and develop an interventional treatment plan that may halt demineralization and favor re-mineralization. This begins with reviewing the medical history, improving brushing, flossing techniques, and modifying diet (including sugar intake). If necessary, a person’s cavity risk may include measuring saliva production and pH levels, bacteria strains and counts especially if the individual is at high cavity risk. It is important to note that individuals with dry mouth may result from taking certain medications, stress, depression, drug use, radiation therapy, HIV, or Sjogren’s syndrome.

When a person’s unique cavity risk is determined, there are many different home treatments a person can consider besides using better brushing and flossing techniques. If the problem is bacteria, chlorhexidine and xylitol should be considered as they have been shown to significantly reduce bacteria levels. Chlorhexidine is a mouth rinse that can be prescribed by a dentist. Xylitol is a naturally occurring sugar that cannot be fermented by oral bacteria. Xylitol can be found in granular form to replace table sugar and can be found in candy, mouth sprays, toothpastes and mouth gels.

Fluoride can also be considered and it has been long known to inhibit plaque bacteria and enhance re-mineralization. It comes in over the counter and prescription toothpastes, prescription tablets, and mouth rinses. The strength a person requires will depend on their cavity risk.

Other solutions include using calcium and phosphate paste, and baking soda products. Calcium and phosphate pastes have been shown to effectively re-mineralize teeth. And for individuals with acidic levels in their saliva, baking soda products such as toothpaste and gum can be considered.

If is very important to know that to optimize the efficacy of the above products and to avoid negative outcomes, the amounts, duration, combinations, and frequencies in using one or more of these products must be discussed with each individual’s dental office. For example, a person who uses chlorhexidine and fluoride should take them at least 30 minutes apart or else they will be less effective. Taking too much fluoride may lead to fluorosis. Excessive use of xylitol may cause diarrhea. It is both exciting and a relief that we now have so much knowledge about how cavities are formed. This has allowed us to develop specific, minimal intervention treatment/prevention modalities. In doing so, we hope to greatly reduce this epidemic of cavities and minimize on the old-fashioned modality of drill-and-fill dentistry.




Saving a Knocked Out Tooth
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Having an active lifestyle can unfortunately result in accidents involving teeth. Whether the cause is from a tumble over the handle bars of a bicycle, a skateboard accident, or due to horseplay, understanding how to handle a dental trauma emergency is very important since time is the key factor in saving teeth. This is especially true in situations where the whole tooth is completely knocked out (avulsed). In these cases, the best chance for a tooth to be saved is if it is replanted within 15 minutes of the trauma.

If it is impossible to immediately see your dentist, replanting the tooth on-site can be attempted. First of all, try to be calm. Then, handle the tooth by the crown (top portion), trying not to touch the roots of the tooth. This will prevent damaging the tissue tag fibers attached to the root of the tooth, which would greatly decrease the chances of saving the tooth long term. Rinse the tooth under cold water but make sure the drain is closed in case you drop it. Then replant the tooth back into the socket in the correct orientation. Immediately see your dentist for further treatment.

If replanting the tooth on-site cannot be done, carefully place the tooth in a glass of milk and transport it to the dentist, making sure not to touch the roots. Milk is an excellent liquid to transport an avulsed tooth because it helps to preserve the vitality of the root tissue tag fibers. If milk is unavailable, saliva is the next best substitute. The avulsed tooth can be transported to the dentist in the mouth.

What follows next at the dental office depends on the condition of the tooth and whether or not the root is fully developed. In general, if the tooth was replanted by the patient prior to seeing the dentist, the dentist will check to see if the tooth is correctly replanted. If done correctly, the dentist will likely splint the teeth together and within the next couple weeks, perform root canal therapy. If the patient did not replant the tooth, but presents it instead, the dentist will need to determine if the root tissue tag fibers have not been damaged. If undamaged, the dentist will likely replant the tooth, splint the teeth together, and perform root canal therapy within two weeks. If the tooth is still immature, there is a possibility that root canal therapy may not be needed.

In the future, remember that time is of the essence when dealing with an avulsed tooth. Try to take action and immediately contact your dentist.




Problems with the TMJ?
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Bruxism, the clenching and grinding of teeth, is a very common problem many people unknowingly face. Bruxing usually happens at night during sleep but may also occur any part of the day. Bruxing can lead to restless sleep, head and neck muscle soreness, and certain headaches. It can also cause fractured and excessive wear of teeth, limited opening of the mouth, clicking and popping of the jaw, and lock jaw. Often times, these symptoms are ignored and passed off as something not serious, especially when there is little pain. Ignoring one or more of these symptoms may lead to irreversible and long-term problems in the jaw joint, known as the temporomandibular joint (TMJ).

The TMJ is a very delicate joint resembling a ball and socket. When a person opens his mouth halfway, there is a hinge movement in the TMJ similar to a door hinge. As the mouth continues to fully open, the lower jaw and the ball portion of the TMJ moves in a down and forward motion. At rest, the TMJ is in harmony. The muscles, tendons, and ligaments are relaxed and the ball is seated intimately within the socket whether or not the teeth are touching.

One of the main reasons why someone may brux is by having an abnormal and unbalanced bite, leading to one or more of the above symptoms. This bite may have occurred as the result of missing and/or shifting of teeth. When teeth are in balance and harmony with the TMJ, muscles of the head and neck are generally relaxed. An abnormal and unbalanced bite causes tension and firing of muscles in the head and neck contributing to bruxism. Bruxing can lead to arthritis, scar tissue and degeneration of the TMJ.

If bruxism is determined to have resulted because of an abnormal bite, a dentist must decide how to relax the muscles of the head and neck to ensure that the TMJ is in its most relaxed position. This is generally accomplished with a splint orthotic (not to be confused with a nightguard, which helps prevent wearing of the teeth due to bruxism, but may not do much in regards to relaxing a misaligned TMJ). The dentist can then proceed to adjust the person’s bite to match this correct TMJ position. This may mean removing high spots on the teeth, altering the surfaces of teeth with crowns or onlays, performing orthodontic treatments, filling in missing spaces with bridges or implants, or a combination of these. It is important to fully discuss this with your dentist if you feel that you are possibly experiencing problems from a bad bite.




Confusion in Cosmetic Dentistry
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In this day and age of mass marketing and advertising efforts by large companies and dentists on cosmetic dentistry, how do you know where to begin your search and what is the best way to go? Should you try traditional orthodontics or Invisalign™ (clear, removable aligners)? Should you whiten your teeth or have veneers placed instead? If you choose to have veneers placed, what type should you select? Would Lumineers™, Da Vinci™, or MAC™ veneers work for you? What about bonding? When does a tooth need a crown instead? What type of crown is most aesthetic? Or would using multiple cosmetic procedures yield a better outcome?

Everyone presents with different cosmetic concerns. The correct treatment plan begins with understanding your own cosmetic challenges. What is it about your smile that you do not like? Is it the color, open spaces, or overlapping teeth? Is it chipped, worn teeth? Are your teeth too small or too big? Do you have a gummy smile or a protruding jaw? Is it all of the above? Once you have a clear idea of what you do not like about your smile, the next step is to understand what can be accomplished with each of the cosmetic procedures. Although the number of different procedures available is very extensive and often confusing, only a couple of the more common procedures will be discussed in this article due to limited space.

Orthodontics, whether traditional or Invisalign™, is one procedure that can help reposition misaligned teeth. It can close spaces, correct teeth overlap, reposition the smile line and gum levels, and even help with an uncomfortable bite. Treatment time can be as little as a few months to a couple of years depending on the amount of tooth movement required. The key advantage to moving teeth, regardless of whether or not veneers or any other cosmetic procedure is to be performed following orthodontics, is that correctly positioned teeth are usually healthier in the long run. People with straight teeth generally have healthier mouths and fewer cavities because their teeth are easier to clean and maintain.

Another procedure is the placement of veneers, which are thin laminates bonded over the visible side of teeth to correct color, shape, length, and help with minor positioning. Veneers are usually made out of resin or porcelain. It should also be noted that there are several different types of porcelain. For example, the well known Lumineer™ veneer is made from a unique patented formulation of porcelain, whereas the Da Vinci™ and the MAC™ veneer uses a different formulation of porcelain. The aesthetics, thickness, and strength of the final restoration depend on the type of porcelain used and the way that it is made. A veneer can by made using a layering technique or a wax and cast technique. There are some types of porcelains that are very strong but not as aesthetic, while some are just the opposite.

Some patients may require only one type of procedure, while others may require multiple procedures for optimal results. Due to the extensive possible treatment options and combinations, it is highly recommended that you seek the guidance from a knowledgeable cosmetic dentist about all of these procedures to help you understand every one of your options and alternatives.




The Most Prevalent Chronic Childhood Disease in California - Tooth Decay
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Children are susceptible to dental decay as soon as their first teeth appear, usually around the age of six months. If not treated and controlled, dental decay can trigger a domino effect of negative outcomes, including oral infections and extraction of baby teeth. Early loss of baby teeth could later contribute to the drifting of adult teeth causing a crowded and crooked smile that could have negative and lasting effects on a child's health, well-being, and self-confidence.

Dental decay is a multifactorial disease initiated primarily by the bacteria Streptococcus mutans. Dental decay in infants and young children is called baby bottle tooth decay. When children intake sweetened liquids such as juices and milk, this bacteria breaks down the sugars and produces acid which softens the teeth. Each time a child drinks these liquids, the acid attacks can last 20 minutes or longer. It is especially a bad idea to give a child these sweetened liquids prior to bedtimes and naps, as it allows the bacteria to do their damage for an extended amount of time.

The good news is that the most prevalent chronic childhood disease in California is a preventable one. Here are some tips to help reduce dental decay:
  • For infants, replace sweetened liquids such as juices and milk in their bottles with water, especially before bedtimes and naps.
  • Wipe your baby's gums with gauze following each feed. Begin brushing as soon as the first tooth has erupted, and start flossing when all the teeth have grown in.
  • Limit the amount and frequency of simple sugar consumption found in candy and processed foods.
  • Talk to your family dentist about the fluoride levels your child encounters and whether or not dietary supplements or fluoride dentifrices are needed.
  • Start regular dental visits by the child's first birthday. Having a great relationship with your dental office can greatly reduce the chances of developing dental decay and gum disease and prevent small problems from becoming major ones.

Did you know?

  • More than 40 % of children have tooth decay by the time they reach kindergarten.
  • Children between the ages of 2-5 who have not had a dental check-up in the last 12 months are more likely to have dental decay.




Bad Breath - Maybe More Than Just an Embarrassing Problem
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Bad breath, otherwise known as halitosis, is an unpleasant and embarrassing condition for many people. Millions of dollars each year are spent on dental products in hopes of controlling this nagging problem. The truth is that halitosis can be a very complex and often a frustrating problem that can present itself for different reasons. In fact, it may just be a symptom of a more serious illness.

More commonly, ingesting certain foods, such as onions and garlic, can contribute to bad breath. As foods are absorbed into the bloodstream, the odor is transferred to the lungs where it is forced out when a person exhales. Brushing teeth and the tongue will help, but the odor may continue until the food is expelled. Be patient, this may take a few hours!

Another frequent cause of halitosis is gum disease. The bacteria in plaque and tartar can cause swollen gums, deterioration of bone, and halitosis. Controlling gum disease can greatly help in reducing halitosis. However, it is very difficult for individuals to accomplish this on their own as brushing and flossing alone are not enough. It is highly recommended that everyone also have routine visits to their dental office for periodontal checkups and cleanings (at least two times a year). Bacteria can hide in places where most people cannot access (there are 160 tooth surfaces in a full adult dentition and 100 in a full child's dentition).

Dry mouth (xerostomia), caused by the lack of saliva, can also cause bad breath. Natural enzymes and buffers in saliva help flush and kill bacteria and neutralize pH levels in the mouth. Without saliva, bacteria can multiply to extreme levels, leading to bad breath. Dry mouth can result from taking certain medications, being a mouth-breather, having stress or salivary gland or other glandular disorders. Increasing fluid intake and eating sugarless candy may help. For more severe cases, artificial saliva can be prescribed.

Other factors which may contribute to bad breath include (but are not limited to) dieting, using tobacco products, and having medical conditions such as respiratory tract infections, postnasal drip, sinus infections, diabetes, gastrointestinal problems, liver or kidney problems. If it is determined that the mouth is healthy, a physician may need to determine if there are any other conditions.

Halitosis can present in individuals as the result of one or more of the above reasons, with the severity dependent on the complexity of the source of the problem. Diagnosing the cause of bad breath is the key to coming up with a solution. Brushing, flossing, and using mouthwash may be helpful, but may not be long-lasting, especially if the root of the problem is more complex.




Minimal Intervention (MI) Dentistry
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You may begin to hear more about the term "Minimal Intervention (MI) Dentistry". MI is a less invasive approach to dentistry, involving use of existing knowledge and available resources to aid dental practitioners in establishing and maintaining good oral health in their patients. The goal is to heal the mouth while reducing the need for removal of tooth structure. This is important because once "holes" are made in a tooth, such as when a cavity is removed, the tooth becomes forever weakened and vulnerable. This could lead to possible major reconstructive dentistry in the future.

MI continues to promote what most people have already heard from their dental offices, which is that cavities (caries) and gum disease can be prevented or minimized through proper brushing, flossing, and having routine professional cleanings. The problem is that dentists now also have available technologies such as digital x-rays and laser cavity detectors (Diagnodent) to help detect caries at early stages. Although detecting caries at earlier stages could prevent further decay, treatment does not always necessitate removal of tooth structure but still depends on the caries location, and the medical condition and habits of the patient.

MI advocates that not all small caries need to be treated by tooth removal. Superficial caries that have not penetrated to the deeper layers can still disappear or remineralize. Brushing and flossing can help delay the progression of the caries. However, this may not be enough. The environment of the mouth is a very important factor in influencing the development of caries and gum disease. This includes pH levels, salivary flow, and mineral levels. Ideal saliva has neutral pH and contains proper amounts of buffers and minerals, including calcium and phosphates. When we eat or drink, the pH level of our saliva drops to acidic levels causing our teeth to "soften", making them susceptible to decalcification. This happens because most foods and drinks are acidic and this acidic environment allows acid loving bacteria to flourish. These bacteria actually secrete more acid as a bi-product, further lowering pH levels. The natural enzymes and buffers in a normal mouth would neutralize saliva pH within 20 minutes. However, people with certain medical conditions, on certain medications or with salivary gland dysfunction may not be able to neutralize their saliva pH within this normal amount of time. Therefore, having a specialized regimen of calcium/phosphate pastes, bicarbonate/fluoride toothpastes, xylitol products, in addition to having a good diet and oral hygiene becomes very important. This regimen can even help people with normal saliva who have begun to develop insipient caries. In other words, we can heal or reverse certain types of caries making it unnecessary to make "holes" in teeth. This should make everyone smile.

Did you know?

  • It is more effective to floss before brushing.
  • Eating or drinking immediately following tooth polishing softens teeth and increases your chances in developing caries. After a dental cleaning, wait at least 30 minutes before eating or drinking.




Sensitive Teeth: Possible Early or Late Signs of Something More Serious
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Tooth sensitivity is a common problem faced by many people. Whether the pain is initiated by hot coffee or ice cold water, pressure from hard foods, or bristles of a toothbrush, this problem may not only be annoying but may indicate early or late signs of something more serious. Things that may cause tooth sensitivity includes (but not limited to): dental decay, root exposure from receding gums, periodontal disease, a cracked tooth, worn or thin enamel, worn or thin fillings, leaky restorations, or a dying tooth.

The outer covering of a tooth is surrounded by enamel. Enamel is the hardest substance in our body and protects out teeth from cavities and tooth sensitivity. Dentin is the middle layer of a tooth and is much more porous than enamel and also contains fluid-filled tubules with nerve fibers extending from the pulp (the innermost layer of a tooth containing nerves and blood vessels). If the enamel is damaged or if the dentin layer is exposed, any stimulants including but not limited to hots, colds, sweets, or pressure can all trigger the tooth to be sensitive. Finding the cause of tooth sensitivity is very important because each cause will lead to different treatment options. However, sometimes it may not be obvious as to the cause of a sensitive tooth, especially if the there are multiple causes.

One of the more common reasons why people have sensitive teeth is through gum recession from periodontal disease and/ or improper brushing. Bacteria contained in dental plaque if uncontrolled may cause deterioration of the supporting gums and bone levels. Using a medium or hard bristled toothbrush in conjunction with aggressive side-to side sawing motions can have the same effect. The outcome is root exposure. It is important to know that roots do not have enamel and exposed roots may lead to painful sensitivity. And once gums are lost, they usually cannot come back. Having regular check-ups and profession cleanings can prevent further damage to the gums and bone. If detected early, your dentist may be able to resolve or reduce your tooth sensitivity by prescribing sensitivity toothpaste, placing or replacing old fillings or crowns, placing a protective varnish layer. The more the deterioration, the more likely more aggressive procedures such as gum surgery, root canal therapy, and extraction may need to resolve the symptoms.

Did you know?

Whitening and Tartar control toothpaste can make tooth sensitivity worse. Whitening and tartar control toothpaste generally contain more abrasive particles and if used routinely can cause external tooth structures to be abraded and thinned out.




Teeth Whitening: Does it really work?
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Teeth whitening is a billion dollar industry with its popularity soaring over the past several years in large part due to media exposure. Television shows, such as "Extreme Makeover" and "The Swan", along with hundreds of articles and advertisements have created an image where having beautiful white, straight teeth is the mainstream. Manufacturers have become keenly aware of this by flooding stores and infomercials with products promising to give whiter and brighter smiles. With so many products now on the market, not only is the consumer confused, but dentists are also left in a daze. A question to ask is "Do these products, such as over the counter toothpastes, paint on gels, white-strips, mouth rinses, professional take home trays and 1 hour laser systems, really work or are we spending our money in a hopeless endeavor?" Well, depending on who you talk to and what clinical studies you read, you will get a different answer.

In reality, this is a very difficult question to answer. It depends on the type and depth of the stain, the size and shape of the teeth, and the whitening procedure. In general, superficial stains from smoking, chewing tobacco, food and beverages such as coffee, colas, curry, licorice, and teas can easily be removed with the right whitening agent. Yellow stains are much easier to whiten than grayish stains. A common cause for grayish stains is tetracycline antibiotic staining commonly seen in the general public. The success of an effective whitening procedure depends on how deep the tetracyline stain penetrates into the tooth structure. This is dependent on the amount of exposure the individual had to tetracycline as a child. If the stain is relatively shallow, it can be effectively faded with air abrasion of the superficial enamel, followed with a professional deep whitening procedure. Tooth colored fillings, crowns and veneers will not whiten. Other endogenous stains due to other types of medications, genetics, childhood sickness, decalcification, and flourosis are very hard to remove and may require specialized whitening procedures or other cosmetic techniques. The good news is that there is a right answer for every type of stain!

In general, over the counter products such as whitening toothpastes are not as effective in whitening teeth compared to others. In fact, many individuals report an increase in tooth sensitivity, especially to cold. Often, whitening toothpastes contain abrasives, meant to scratch off stains if used repetitively. Not only may this be ineffective, but over time, the abrasive can also remove superficial tooth structure. Even professional teeth whitening procedures, such as home trays and one-hour in office whitening, can cause tooth sensitivity leading to extreme discomfort and pain. Fortunately, the mechanism for sensitivity is usually reversible. Basically, the whitening peroxide gels dehydrate the fluids in the teeth, with one to two days for the teeth to naturally re-hydrate and return to normal. There are also professional in-office products that can be used to reduce and prevent sensitivity during whitening.

I would recommend that individuals consult their dentist before choosing any whitening product as trial and error on the part of the consumer may not only yield a disappointing result, but can also lead to irreversible damage to teeth. Even good whitening products can lead to disappointing results if used on the wrong type of stain while also possibly subjecting the individual to unnecessary tooth sensitivity.

Did you know?

...that if you have gum disease, or if you clench or grind their teeth, you are much more likely to experience painful tooth sensitivity to whitening products?




Thumbsucking and Pacifier Use: How It Can Affect Your Child's Dentition
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Thumbsucking is one of a baby's natural reflexes. In fact, babies begin this reflex response while still in their mother's womb. For infants and young children, sucking their thumb or a pacifier serves several functions. It can give a feeling of comfort and security in new or unfamiliar situations, or it can give a soothing effect and even help induce sleep. Therefore, thumbsucking should be viewed as a natural part of a baby's development.

However, prolonged thumbsucking can lead to dental problems, especially when the front permanent teeth start to erupt (usually between the ages of 5 and 6). It can negatively affect the growth of the mouth and alignment of the teeth, causing crowded crooked teeth, and bite problems which could become difficult to reverse later in life. The amount of damage that can result from thumbsucking is usually dependent on the intensity of thumbsucking. Prolonged use of a pacifier can also affect a child's dentition similar to thumbsucking.

Most children stop thumbsucking on their own between the ages of two and four. However, if a child does not stop on his or her own by the age of five, the parent should consider contacting a dentist to explore ways to help the child discontinue this habit. Having good communication and a good relationship with a dental office will help ensure comprehensive dental care for one's family which can prevent extensive problems later in life.

Tips for successfully helping your child stop thumbsucking:

  • Praise your child for not sucking his or her thumb, and reward your child for not sucking his or her thumb during difficult situations
  • Bandage your child's thumb or place a sock over the hand at night
  • Have your dentist verbally discourage the habit
  • Talk to your dentist about a mouth appliance
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