Tooth Truths: Answers to the Most Common Dental Questions

At what age should my child be scheduled for their first dental visit?

ANSWER: The American Academy of Pediatric Dentistry (AAPD) recommends the first dental visit be at first tooth eruption or at approximately age one. This first visit is equivalent to a “well baby visit”. A clinical exam is important, but parental guidance is crucial (anticipatory guidance). Topics discussed include: teething, habits, trauma, home care, fluoride, nutrition, bottle use, and strep mutans transmission.

Pediatric DentistQUESTION #2
My child is 12 months old and still has no signs of any teeth. Should I be concerned?

ANSWER: No. Sequencing is much more important than timing. Early radiographs can put parent’s mind at ease but often are only partially diagnostic. Begin to be concerned if no signs of teeth being present at 15 months. There are numerous systemic and congenital factors that may contribute to delayed eruption, ie. Down Syndrome.

Both parents have had a lot of cavities. Can our child inherit cavities from us?

ANSWER: Inherit = NO, Transmissible = YES! Dental caries is a disease process. Transmission of strep mutans can occur from caregiver to child. The window of infectivity is 11-36 months (emergence of colonizing surfaces). Risk factors for Early Childhood Caries (ECC): frequency of feeding (bottle, breast, sippy-cup, grazing), medications, enamel quality, colonizing units of strep mutans, oral hygiene.

I worry about fluoride. Should my child take fluoride supplements? Can he/she get too much?

ANSWER: Systemic fluoride intake an be achieved by drinking fluoridated water, ingestion of select foods, and prescribed supplementation. Systemic fluoride helps to strengthen the developing permanent teeth. Central Oregon does not have a fluoridated water supply, therefore fluoride supplements are recommended until about age 13. Like any “drug”, too little fluoride results in increase disease potential and too much fluoride results in potential complications, ie. fluorosis.

My son/ daughter still sucks his/her thumb and he is almost three-years-old. Should I try and make him stop?

ANSWER: Although it may cause alterations in the occlusion depending on which digit is being used, these changes are reversible in the primary dentition. Most children will emotionally mature and show signs stopping between ages 4-6. Intervention is possible once permanent teeth erupt.

At what age should I take my son’s/daughter’s pacifier away?

ANSWER: Ideally between the ages of 18 months and 2 years. The pacifier habit is easier to control than the thumb habit, however, waiting longer results in a true “habit”. Potential complications with prolonged use: include anterior open bite and speech issues. Tips for stopping use: cold turkey, gradual, ceremonies and rewards

Dark ToothQUESTION #7
My child’s tooth has turned dark. What does that mean? What should I do?

ANSWER: There are two types of discolorations in teeth. Extrinsic= food stain, iron staining, Intrinsic= trauma related. A common childhood injury, is a pulpal bleed or bruise of the tooth due to trauma. This does not necessarily mean that the tooth is non-vital. An evaluation by a dentist is recommended for a definitive diagnosis.

And Finally… Is there really  a Tooth Fairy, and if so, what is the going rate per tooth these days?

ANSWER: Yes – Those who believe shall receive. Pennies, nickels, dimes and quarters are out, and dollars are in (especially silver dollars). Highest quote ever heard $20.00/tooth!

All About Xylitol

What is Xylitol?

Xylitol, a naturally occurring sugar substitute, is clinically proven to be a natural enemy of bacteria. Xylitol is often referred to as wood or birch sugar because it was typically manufactured from birch trees. However, today xylitol is mainly extracted from corncobs. This is more practical considering the vast amounts of xylitol that is being produced and consumed. Other natural sources of xylitol include plums, strawberries and raspberries. Pure xylitol looks like sugar because it has a white crystalline appearance and it even tastes like sugar. However, it has 40 percent less calories than sugar. Only one-third of the absorbed xylitol gets metabolized in the body.

How does it Work?

Over 400 strains of bacteria inhabit the human mouth. Sugar is one of the major energy sources for these bacteria and helps them proliferate.When these sugars are consumed, acid is produced, creating a highly acidic environment in the oral cavity that demineralizes enamel and makes it vulnerable to attack by bacteria, leading to tooth decay. Because xylitol is a five-carbon polyol, it is not metabolized by mouth bacteria, and a result, no acids are produced in the mouth that can cause tooth decay. The sweetness also stimulates saliva flow, which neutralizes any acids that have been formed and rinses away excess sugar residue. Xylitol helps keep an alkaline environment in the oral cavity that is inhospitable for mouth bacteria. Thus, xylitol is both non-cariogenic in that it
does not contribute to caries formation, and it is cariostatic because it prevents or reduces the incidence of new caries. Xylitol actually reduces the amount of plaque and the number of Mutans streptococci (MS) in plaque.

How long has it been around?

German chemist Emil Fisher and French chemist M.G. Bertrand first discovered xylitol in the late 1800’s. The first attempt at producing xylitol was mixture with a syrup-like consistency. Xylitol was not manufactured in a crystalline form until World War II, when war-associated sugar shortages created the need to find alternative sweeteners. Early on, xylitol was primarily used in diabetic diets and infusion therapy for burn and shock patients in Europe and Asia. It was when further study into xylitol’s biological properties, including dental, that large-scale production was needed.Industrialized xylitol manufacturing began in Finland in the early 1970s in the form of gum and mints. It quickly became a daily part of Finnish life. Over the next 35 years, global awareness of the significant advantages xylitol offers continues, as does the variety of items that contain the substance.

How much does my child need?

It was previously thought that the benefits of xylitol were dose related, not frequency related. However, researchers from the University of Washington did a series of studies in order to potentially substantiate these responses on Mutans streptococci’s (MS) prevalence and possible reductions with xylitol.In one study, the efficacious dosage of xylitol was researched and the researchers concluded that MS levels were reduced in increasing doses of xylitol. The effect leveled off between 6.88 grams and 10.32 grams per day.In the second study, the participants consumed 10.32 grams per day of xylitol divided into two, three and four administrations per day.After five weeks of use, there was no significant differences in MS levels in either plaque of unstimulated saliva in groups consuming xylitol two times per day.However, significant differences were seen in the groups consuming 10.32 grams of xylitol over three and four administrations per day. These results confirmed previous suggestions regarding xylitol dosage and frequency of consumption.A dose range of 6 to 10 grams divided into at least three consumption periods per day is necessary for xylitol to be effective with chewing gum as the delivery system. Thus, the frequency is as important as the amount of xylitol use.

Where can I find it?

Many products in local grocery stores contain xylitol. The easiest to find are gum and candy, but check the ingredients. Just because one flavor or type contains xylitol does not mean that all types of gum from that manufacturer will contain it.Health food stores will carry a larger selection of products, such as mouthwash, toothpaste, mints, individual packets to use in coffee/tea, bulk packaging to use in cooking, nasal sprays and neti pots.Search the Internet for brands and then ask your local pharmacy, grocery or health food store to stock the product. Many items may also be ordered directly from the manufacturer.

Are there any disadvantages?

Xylitol was approved by the U.S. Food and Drug Administration (FDA) in 1963, and it has no known toxic levels or serious known side effects for humans; up to 40 grams per day have been noted with little more than a mild laxative effect.Nonetheless, if should be mentioned that it may be dangerous if consumed by pets, such as dogs and cats.