When a tooth gets a cavity it must be filled or it will continue to decay and get worse - even to the point of death. What kind of materials are available to fix holes in teeth? The most common material for about a century has been silver and copper mixed with mercury with a little tin.  This mixture is called amalgam or simply silver filling. Silver has anti-microbial propertities that helps prevent bacterial growth.  The copper and tin control the amount of expansion and contraction that occurs to reduce the number of teeth that crack with filling expansion. The most controversial part is the mercury.  Mercury in its purist from can dissolve other metals to form an alloy at room temperature.  This makes it unique. Unfortunately, when mercury combines with other materials like fats or carbohydrates, it can be more easily accumulated from the environment.  Many fish have accumulated enough mercury in their tissues that eating too much fish can be bad for you. Mercury released from silver fillings has been extensively studied and concluded to be safe.  The amounts released are very, very little and the form of mercury is not easily combined with our tissues. Neverthe less, many people prefer not to have silver fillings for fear of even the smallest amounts of mercury, because the fillings are dark, and because they can crack teeth after many years. The next most common filling material is composite plastic.  A composite is a mixture of several materials and the materials mixed for this filling is plastic and extremely finely ground glass. Recent concerns about bis-phenol A in plastic packages has caused some concern about the plastic in fillings.  Dental fillings use bis-phenol B. The advantages of Composite fillings: they look great have the ability to stick to tooth structure, wears well it insulates from hot and cold, there is no problem biting metal foil. The disadvantages of composite fillings are: they are very sensitive to getting wet during placement, that...

Many parents are rightfully confused about when is the right time to start their children's dental visits.  Some Pediatricians say the first dentist visit should be about age two or three. Many general dentists have difficulty managing young children so they ask parents to bring them in after age three. The American Academy of Pediatric Dentists recommends that the first dental visit be soon after the first tooth erupts or by age one. My opinion is that is different children have different needs.  First born should have their first dental visit by age one, the next kids can come at age two. I am a big believer in birth order differences and I think that a first child should be treated differently than a second child or a third-born child. Personally, I had a lot of learning to do with my first son and my second son benefited from this parenting experience.  Some of the things my wife and I agonized over with the first one, we did not hesitate to do with our second. Some advantages of age one dental visits: developmental problems can be detected parental counseling is provided as below some insurance has incentives for regular care so starting early reduces costs the sights, sounds, and smells of a dental office become routine Disadvantages of age one dental visits: counseling may be redundant for second-born children more expensive if not covered by insurance incentives Parents should learn with their first child that: fluoride supplements should start at age six months, brushing and flossing are required daily even with the first couple of teeth, nursing should stop around age one, the only drinks the under-three crowd should have are milk and water. First children need to see the dentist by age one because well-intentioned parenting might cause cavities or orthodontic problems by the age of 18 months. I have had to fix many 18 month old toddlers with all their top teeth decayed due to sleeping with a bottle of juice or sleeping with their mother and nursing all...

The American Academy of Pediatric Dentists recommends the first dental visit to be whenever the first tooth erupts or by the child's first birthday. I agree that this works for first children but I think than once parents have been through the practice of taking their infant off the bottle by age one, brushing and flossing daily, watching sweets, and using fluoride suplements appropriately, the following kids can wait until two or even three for their first dental appointment. At the first dentist visit, we usually show kids around, ride on the chair or sit in a parent's lap, take easy x-rays of front teeth, brush the teeth with our power toothbrush, floss, and apply topical fluoride, then go over home care and finally examine the teeth, mouth and jaws. Some parents tell me that the first time to the dentist can be more stressful for parents than for the kids. Parents are worried for a variety of reasons.  How does your child respond to meeting your adult friends for the first time?  Are they shy with strangers?  If so, expect the same behavior at the dentist. If they greet extended family members for the first time with a smile, then they can do the same for the dentist! The best preparation for an infant's first dental visit is casual mention of how fun it is to ride in a moving chair and what great prizes they may get to take home. There is really no need to prepare them for anything difficult because  a good Pediatric Dentist and their assistants will be able to read your child's needs and accomodate them. Some children do better with their parents close by and others do better with their parents out of the room.  Sometimes parents are surprised that their child behaves better for strangers without them. Other parents know that their child always gets glowing reports from pre-school about what a perfect child they have and wonder why that angel seems to feel free to make life tough for their parents at home. My theory on this is that the child follows the old...

More teens can be treated with Invisalign now.  Techniques for treating patients with more complicated orthodontic problems were recently discussed in a lecture near Portland. Invisalign trays move teeth step by step by wearing a series of slightly different aligner trays that push teeth into new positions. When Invisalign was first developed, it was directed only at adults.  Now teens can be treated and even be treated for significantly crooked teeth, even for teens whose teeth must be extracted. The Invisalign aligner trays can be modified and rubberbands worn to move lower teeth forward or upper teeth back. Advantages of Invisalign treatment: clear and transparent smooth on the inside of lips removable for ease of cleaning teeth preprogramed computer accuracy Disadvantages of Invisalign treatment: must be worn 22+ hours daily may not move tooth roots fully may take longer for certain movements Using chewy rubbers five minutes in the morning and again in the evening helps seat the plastic aligner trays onto the teeth for more complete engagement and better tooth movement. Even children can use Invisalign for partial treatment, if it is understood that there may be more treatment required later when all the permanent teeth erupt. Ask about invisible braces the next time you are in for a checkup.

Summer is the time for kids to get outside and have fun.  Unfortunately, it is also the time of year when many accidents occur.  In addition to our page on dental emergencies, here are some things you should know: 1.   Preventing dental accidents is usually better than dealing with the sometimes serious problems that can occur with a fall or blow to the mouth. Mouthguards are a proven method of preventing knocked out or broken teeth.  The inexpensive ones you can buy at the sporting goods store seem to do an adequate job for most uses. If you are in a sport like boxing or martial arts, you may want to get a custom made one to ensure maximum protection.  We can take an impression of your teeth and make a mouthguard that will help you breathe well and still protect you from a hard right cross. 2.  If a tooth gets chipped enough that the middle bleeds, you need to see your dentist right away. Bleeding from the middle of a broken tooth generally means that the nerve has been exposed and although it may not hurt immediately, once it gets infected, it will abscess and become more painful. 3.  A tooth that gets knocked out should be replaced in the hole it came from immediately. There are living cells on the root surface that MUST be kept alive or the tooth will eventually be lost . If the root is dirty, gently wash it off but avoid tap water; milk or spit work better. Have fun this summer but be careful.

Some children are unable to hold still for dental care even with conscious sedation.  For children with many cavities that will take a long time to fill or children too young to understand the need to sit still, we are able to have them go to sleep for their dental fillings. Today I had a four year old boy from Molalla and a three year old girl from Gladstone needing deep sedation.  Deep sedation is not quite general anesthesia like for medical operations but keeps patients just barely asleep. There are options to treat while awake or to get sleep dentistry in a hospital or in our office. Sleep Dentistry Advantages: Able to complete all treatment at one time Comfortable during treatment Sleep Dentistry Disadvantages: More expensive than without Some drug risk In-office Sleep Dentistry Advantages:  No uncomfortable breathing tube is used. Recovery time is much faster with the drugs we use. Kids leave for home within about 30 minutes. Hospitalization Advantages: Sick children have emergency doctors close by. Hospitalization Disadvantages: Much more expensive than in-office care. More uncomfortable afterwards due to sore throat and nausea. Takes much longer to check in, do work, recover, and check out. I use an anesthesiologist in my office to give the kids a quick shot in the arm that within a minute has them not paying attention to their surroundings.  He will then start an IV and keep them asleep while we finish their dental care. The kids wake up within minutes and go home after about half an hour. This has become my preferred treatment method for children that need to go to sleep for their dental care.

Enough parents ask about toothpaste for their kids that it is worth revisiting. See this page for more information on children's toothpaste.  Most of these questions are concerning fluoride in toothpaste.  See the article on Fluoride for more information. Common questions about children and kid's toothpaste: At what age should I start brushing? As soon as they have teeth use a soft toothbrush with infant toothpaste or a cloth to wipe them clean. How often should I brush their teeth with toothpaste? Usually brushing with toothpaste after breakfast and before bed are enough. Is there a difference between the brands? The difference between children's toothpaste brands are mainly in the flavor, the source of the fluoride, the type of soap used, and the type of sweetener. Should I use a toothpaste with fluoride? Parents that are very concerned with oral health and brush their child's teeth three times daily using a fluoride toothpaste, use a fluoride mouthwash, and give fluoride supplements may be providing too much fluoride, especially in a child under 3. Children under the age of three are most likely to swallow toothpaste so I recommend using a toothpaste without fluoride up until children are 30 months to three years old. How much toothpaste should I use? If your child uses a fluoride toothpaste, only apply a small smear of about a dry grain of rice to the bristles. Is it bad if my child swallows some of the toothpaste? If they only have a small smear of toothpaste, then is is generally OK to swallow.  Their permanent front teeth are developing up to age 3 so too much fluoride may form small white spots on these front teeth. Does it matter that the children's toothpaste is super sweet? The super sweet flavor of most children's toothpaste is just fine.  They are usually sweetened with an artificial sweetener that does not cause cavities. For parents that want a more natural sweetener, I recommend they buy toothpaste sweetened with xylitol, a sugar substitute that...

Some kids are born with a tight connection between the bottom of their tongue and the inside of their lower front teeth that is commonly called tongue-tied, or technically called ankyloglossia. Newborn babies will sometimes be so tongue-tied that they cannot suckle and need it clipped near birth so they can feed.  Most people are not that bad and get by fairly well although some people believe that speech is affected. My son was mildly tongue-tied but I never thought much about it and had not considered getting it clipped until a Portland periodontist friend clipped it for him during a minor gum surgery.  This procedure is called a frenulectomy. This simple procedure was very eye-opening for both my son and for me.  Since he had never been able to move his tongue much, he was never aware of how much easier it would be to lick his lips, clean his teeth with his tongue, or do a myraid of other things until he experienced it. After my son's experience, I have encouraged many more parents to consider this procedure. Frenulectomy Procedure: Taking ibuprofen, if possible, before any oral surgery is very helpful A powerful topical anesthistic is placed under the tongue A local anesthestic is injected into the tongue A scalpal blade, an electrosurgical tip, or a laser tip cuts the attachment sutures are often not needed Continue to take ibuprofen regularly for 2 - 3 days Canker sore medicine is applied to exposed cut tissue for several days The tongue heals in about a week If your child has this problem, discuss the possibilities with your doctor or dentist.

Many of the parents in my practice are surprised to see that primary or baby teeth have roots. The only baby teeth they had ever seen had no roots at all and they never really thought about what keeps them in. Actually, the baby teeth have very strong roots that hold them firm when chewing and biting.  As the adult teeth begin to grow, they push against the baby tooth roots and dissolve them away. The timing of tooth eruption can be found at this link. The mechanism of tooth eruption is not completely understood, but we do know that they only begin to move when the roots start to develop. Apparently, the ligaments holding the tooth to the jaw bone pull and push the teeth toward the surface and out of the bone.  Pressure on bone or tooth makes it dissolve away. The pressure from the moving tooth makes the bone move out of the way and eventually the roots of teeth will as well. Although most of the time the permanent teeth erupt in the correct direction, sometimes the tooth starts off going in the wrong directing and can end up impacted into other permanent teeth. Many wisdom teeth are removed because they are impacted.  Interestingly, the wisdom teeth tend not to dissolve the other molars they are pressing against. Pressure from the moving permanent teeth causes the primary roots to dissolve and when they are all dissolved away, the baby tooth falls out. The Shark Teeth article discusses what to do if they don't fall out normally. Impacted canine teeth are fairly commonly found against the roots of permanent incisors and have caused serious permanent tooth root damage, and even tooth loss.

When children have lots of very large cavities and they are too young to hold still while hours are spent fixing the cavites, what do you do? A child from Molalla came to the Oregon City office recently with just such a problem. This little boy had cavities on almost every one of his baby teeth and most of the decay was very close to the pulp nerve tissue and probably needing baby root canals (pulpotomies). Recently published articles recommend an Alternative Restorative Treatment (ART) to removing all the decay and filling with permanent restorations. They strongly recommend trying to stop the decay from progressing into the nerves by scooping out some of the rotten tooth material on every tooth during one short appointment and filling the holes with glass ionomer. Click here for more information on glass ionomer fillings. There are several advantages to this technique: The filling provides fluoride to strengthen the tooth and keep germs from growing the decay deeper. All the cavities are stabilized so fewer germs are spreading around the mouth and infecting other teeth. Leaving some of the rotten tooth under the filling provides a separation that permits the nerve to heal and back away from the decay. It costs less at our office through a special Glass Ionomer Caries Control program we have developed that caps out of pocket expenses. We used this ART with the little boy from Molalla.  He now can grow older without pain and then replace the ART with definitive restorations as his patience, and parent finances, allow. I would call this a win-win-win situation.

As we mention in the Fluoride article, fluoride is our best medicine to fight cavities. However, a recent meeting brought to my attention new recommendations regarding fluoride varnish and how it is used to strengthen enamel and fight cavities. We have been using fluoride varnish for many years as a topical fluoride treatment for the very young children who have difficulty holding the foam fluoride trays in their mouths for more than a minute. An interesting study looked at the use of fluoride varnish compared with the foamy fluoride and found that there is less fluoride available to swallow even though the fluoride varnish is extremely concentrated. This is because the concentrated varnish needs much less volume to coat the teeth.  This means that if children swallow it, there is less likelihood of affecting their developing permanent teeth. Other advantages of fluoride varnish include the ease of placement, that it hardens with water contact, and it stays on teeth for hours compared with minutes for the foam fluoride. Many dentists now recommend fluoride varnish as the preferred topical fluoride treatment for children under six years of age. Suggested technique:  professionally clean the teeth, dry them, brush on the fluoride varnish in a very thin coat, rinse off with water to set the resin, and vacuum away the excess, instruct the parents to avoid brushing the teeth for the rest of the day to allow the varnish to work on the teeth as long as possible, skip any fluoride supplement that day. Apparently, the best results are achieved using the brand of fluoride varnish called Duraphat. Supposedly their special carrier resin is particularly effective at adhering to dry teeth and keeping the fluoride in contact with the enamel for increased effectiveness. The Food and Drug Administration (FDA) has approved the use of fluoride varnish for lining cavities and reducing sensitivity of teeth. The use of fluoride varnish for reducing cavities is considered off label but...

If your young child has small cavities, there are three things that we do in our Portland and Oregon City pediatric dental office to arrest or stop the decay from getting worse and to delay needed repairs until your child is old enough to tolereate conventional fillings. 1. Fluoride supplements plus brushing twice a day with a fluoride toothpaste is not enough to stop active decay. Your child should also get a rice -sized speck of toothpaste placed directly on the cavities with your finger several times daily. 2. Sweets (including juice, granola, and dried fruit) feed the germs that cause cavities. Reduce the number of times your child gets sweets instead of removing them entirely. After holiday treats have been eaten in one day, the Sweet Fairy can come and take away the rest, leaving a prize instead. 3. Medicines applied to a cavity in our East Portland or Oregon City office every 2-3 months can strengthen the tooth and fight the germs. They only work when the recommendations for fluoride and sweets are also followed at home. If your kid has cavities that you would like us to take care of, call either our office in Oregon City or in East Portland.

Sedating children to help them cope with extensive or painful procedures is a great help for many kids but very worrisome for some of their parents. Because Oregon, and especially East Portland, is home to many families that care deeply about health and the substances their children are exposed to, some Oregon parents worry about using drugs or medicine with their kids. We use very safe drugs to sedate children in both our Oregon City and Portland offices.  Our first sedative drug is nitrous oxide gas.  Nitrous oxide is sometimes used for race cars but its first use was as a pain killer. In fact, a dentist in the early 1800's noticed that someone who breathed nitrous oxide gas as a intoxicant was not bothered by a cut on  his leg and after having one of his teeth pulled out using nitrous oxide gas without much pain, he discovered the first medical anesthestic gas. Nitrous Oxide gas is often called Laughing Gas, Giggle Gas, Happy Gas, etc. because in addition to its analgesic properties (ability to relieve pain), it is also a euphoric (makes you feel happier). Another sedative drug that we commonly use in our office for anxious kids is triazolam (Halcion brand). This comes as a pill that has a mild taste that kids do not seem to mind holding under their tongue or chewing up. Triazolam is related to Valium and Ativan because they are all in the benzodiazepine group of drugs.  Triazolam is an excellent choice for dental care of scared kids because it is very safe, it works within about on hour, and it wears off after only a few hours. The last sedative drug we use for kids afraid of the dentist is hydroxyzine pamoate (Vistaril brand).  This liquid tastes pretty good and it is an antihistamine drug that reduces nausea and also has some sedative effects. Nitrous oxide, triazolam, and hydroxyzine can be used singly or in combination to help children who are afraid of the dentist feel more relaxed and more cooperative without going to sleep.

Our continuing education class on medical emergencies was held by the Clackamas Dental Society in Wilsonville, Oregon.  This class covered all the most common emergencies that dentists in Portland and Oregon City might see in their offices. The most common problem is fainting, followed by hyperventilation due to anxiety and fear.  Pediatric dentists are probably the best trained dentists to reduce fear of dentistry but we still have some hyperventilating kids; luckily not to the point of medical emergencies though. Luckily, as pediatric dentists we see kids that are almost all extremely healthy so we do not have to worry much about heart attacks and strokes.  What we do have to worry about is asthma, aspirating (breathing something into a lung), allergic reactions, and sedation problems. Sedation problems are the most easily dealt with because we use very safe drugs to sedate kids into a more relaxed state and both our Oregon City and our Portland offices have monitors that tell us if kids are not breathing well enough. See our article on Sedation options if you have questions about sedating your children in Portland or Oregon City.