Search for tag: "teeth"

Interviewer: Why you should consider a mouth guard for your child even if they play other sports other than hockey, that's next on The Scope.

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Interviewer: Dr. Hans Reinemer is the Section Head of Pediatric Dentistry at University of Utah School of Dentistry. When it comes to mouth guards, I think there's a perception out there that hockey players thereabout, maybe football players need it. But you contend that any active child should consider a mouth guard for a lot of really good reasons. Let's talk about that.

Dr. Reinemer: Sure. Football players, hockey players, any sport that involves contact, that's the perception most parents have is that we need to protect their teeth. That's absolutely the case. But we see in springtime and early summer, when kids are back outside, they tend to be back on their bikes, their skateboards, their rollerblades, just running down the street. They're young, growing kids. They tend to be a little uncoordinated at times, and they can certainly suffer similar dental injuries even though they're not playing contact sports.

Interviewer: So you recommend for those activities and those kids to wear a mouth guard, especially between, like, the ages of 5 and 7 when they tend to be a little bit more clumsy. Is that the age?

Dr. Reinemer: Sure, yeah, 5 to 7, even 7 to 11, statistics show that kids are most prone to dental injuries. They have newly erupted permanent teeth that tend to stick out a little bit. They're a little bit more prone to the actual injury themselves.

Interviewer: Really?

Dr. Reinemer: Absolutely. Anytime kids are jumping on the trampoline or doing any of those recreational activities that predispose them to bumping their face, their lips, their mouth, their teeth, a mouth guard certainly is appropriate. We recommend that our kids wear helmets, so why not protect their mouth and their teeth with a mouth guard?

Interviewer: Got you. For a parent that's going to try to convince their child that they need to do this, right, sometimes just like glasses or helmets, they're not cool. Tell parents how effective they are if something does happen. Do we have some research on that?

Dr. Reinemer: Well, in the case of contact sports, 60% of dental injuries can be eliminated with the use of a mouth guard. Statistically speaking, for a child on a rollerblade, for example, we don't have quite the similar stats, but certainly those injuries do occur. The challenge is getting a child to wear a mouth guard. There are a couple of things we can do. We can . . .

Interviewer: You've faced this question before.

Dr. Reinemer: Oh, absolutely. We can make it more comfortable, and we can make it look cool. There are ways to do that. You can buy a stock mouth guard at Dick's Sporting Goods, for example. They're gel fit or a boil to fit. Those work okay. They're not the most comfortable to wear.

The best option is to go to your dentist. Have them make a mold of your teeth and custom fit a mouth guard. It's going to be comfortable. You can talk with it. You can breathe better. It's not falling in and out of your mouth. And they can use all kinds of different designs and colors. If your child is engaged with the way it looks and the way it feels, they're more apt to wear it.

Interviewer: Yeah, they can make them kind of a little bit more cool.

Dr. Reinemer: It's customizing a mouth guard not unlike you customize an orthodontic retainer.

Interviewer: That's very cool. Also, mouth guards not only protect the teeth, they can protect children from concussion as well.

Dr. Reinemer: Absolutely. When you're hit in the jaw, for example, the force that's generated when your teeth are slammed together transmits up to your brain and your skull. By cushioning the blow of that impact, it reduces the incidence of concussion as well.

Interviewer: I feel like we've covered things pretty well. I think you've given us a pretty good picture of some of the activities that maybe traditionally we wouldn't think you'd wear a mouth guard for and the benefits of that. Is there anything that you would like to also add?

Dr. Reinemer: Well, just if your child is going to wear a mouth guard, great. If they're not and they do suffer a dental injury, again it's important to make sure that you have a good relationship with your dentist, somebody that you know and trust, that you can contact after hours or on the weekends. In the case that a dental emergency does occur, you have somebody to call, because time is of the essence when emergencies like this do occur.

Interviewer: About how much for one of those custom made mouth guards?

Dr. Reinemer: Oh, it varies. Typically they run along the same price as an orthodontic retainer. I think they can easily be done for less than $100. It's a little bit more than you're going to pay for a sporting goods store, but again your child is more apt to wear it, they offer better protection, and the investment pays.

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Interviewer: Your child fell down or ran into something and they hit their teeth. What should you do? That's next on The Scope.

Announcer: Health information from expects, supported by research. From University of Utah Health, this is TheScopeRadio.com.

Interviewer: It's bound to happen once in a parent's life. Their kid falls and the brunt of the impact is on the teeth, and you cringe. What do you do at that point? Dr. Hans Reinemer is the section head of pediatric dentistry at the University of Utah School of Dentistry. What should a parent do next if a kid puts like that impact on their teeth?

Dr. Reinemer: Well, it's a very good question, and kids are always stumbling, falling, especially this time of the year when kids are back outside on their skateboards, roller blades. They're falling down. Especially, in the five to seven-year-old age group, kids are always banging their teeth. So it's important that parents be aware of what to do.

Interviewer: All right. So it's not always, worst case scenario, tooth gets knocked out. There are some other things that can happen. So let's just start with maybe what those are.

Dr. Reinemer: Sure. It could be a simple bump of the tooth where you get some bleeding around the gum tissue. It could be a fracture of the tooth. It could be a tooth that's knocked out of place but still in the mouth, and it could be a tooth, worst case scenario, that's completely knocked out of the socket. And so first thing the parents need to be aware of is it's important to have a relationship with the dentist, so, in the case of any of those situations, they have somebody to call.

Interviewer: All right, because you can't necessarily go to an emergency room?

Dr. Reinemer: You can, but there will be a longer wait time and physicians don't always know. Most emergency rooms are not set up for dental emergencies. So the relationship with a dentist is your best bet.

Interviewer: All right. So, as a parent, if one of those emergencies does happen and I have a dentist, I can call and, generally, get in fairly quickly then?

Dr. Reinemer: You should be able to. Make sure when you establish your relationship with your dentist that they have an emergency number, so in the case of an accident after hours or during the weekends you have somebody to call.

Interviewer: All right, good. So what's kind of the least of the worst in these scenarios and what should a parent do?

Dr. Reinemer: The least of the worst is a bumped tooth that maybe slightly loose on a young child. If the tooth is in a normal position, very often, those teeth will tighten back over time. So soft diets, making sure you keep it clean, those things will tend to heal on their own. But, again, there can be some underlying issues there. So, even if it looks minimal, it's good to have a check by a dentist relatively soon just to make sure that it's in good shape.

Interviewer: All right. And I guess it just comes down to how quickly you need to get to the dentist at that point.

Dr. Reinemer: Absolutely, yes.

Interviewer: The least of the worst scenario, you should still go to a dentist, have them take a look at it to make sure everything's okay. But other than that, really not a lot to do.

Dr. Reinemer: Not in the short term. Even if you just bump a tooth and it appears to be okay, the tooth has the potential to die down the road, because there are nerves and blood vessels inside the tooth and if those are traumatized, it could cause the tooth to die. So that's why getting some baseline information, a good first look, is important.

Interviewer: All right. What's the next kind of up the ladder of severity?

Dr. Reinemer: Might be a couple examples of that. One would be a fractured tooth. For example, the crown of the tooth or the part of the tooth that you see, maybe a piece of that has been chipped away or broken off. Another example might be a tooth that's knocked out of position slightly. So those are teeth that need to be repositioned and then splinted. Those require a little bit more sense of urgency. Again, a relationship with a dentist is good.

Interviewer: Is there anything the parent should do in between when it happens and when they end up at the dentist if it's a chipped tooth or one of these other instances you just mentioned?

Dr. Reinemer: If a tooth is fractured, a piece is broken off, if you can find the piece that's broken off, oftentimes that can be bonded right back on to the remaining tooth structure. If a tooth is knocked out of position and is slightly loose, keep the child comfortable. Keep it clean. But, again, get into the dentist ASAP.

Interviewer: All right. And what's after that? We're getting worse and worse here.

Dr. Reinemer: Well, yeah, worse and worse. Worst case scenario would be a tooth that's completely knocked out. Now, in the case of a baby tooth, if you have the ability to determine if it's a baby tooth or permanent tooth. If it's a baby tooth, we generally do not put those back in. Again, important follow-up, because a piece of the tooth could remain in the socket, so it's good to establish that it was completely lost.

In the case of a permanent tooth, then we're dealing with probably the worst case scenario. Best thing to do is put the tooth back in the socket if you can. If you cannot, then it's important to put the tooth in a good storage medium such as cold milk. There is actually a commercially available product out there called Save a Tooth, which is the ideal storage medium, and then transport that with your child to the dentist as soon as possible. Time is of the essence. You want to get the tooth back into the socket in 30 minutes or less if possible. If you can't, prognosis goes down.

Interviewer: So, when you put it back in the socket, you just have the child hold it with their finger, their tongue, or . . .

Dr. Reinemer: Yeah.

Interviewer: Just however they can do it?

Dr. Reinemer: Very gently grab the tooth by the crown of the tooth or the top part of the tooth and put the tooth back into the socket, and then, just have the child hold it. Even if it goes in backward, just get the tooth in the socket, because as soon as it's surrounded by blood and saliva, that's a more natural environment, and the cells that surround the root of the tooth will stay viable and live longer, and increase your chance of success.

Interviewer: So that's the optimal situation.

Dr. Reinemer: That's the best. Now, you may not reposition it perfectly, but to get it in the right spot, the dentist can then reposition it and then splint it.

Interviewer: Fascinating. And the gel medium that you mentioned?

Dr. Reinemer: So there's a product out there called Save a Tooth.

Interviewer: Which would be great for like if you are a coach of a sporting team or something like that?

Dr. Reinemer: Absolutely. This is even a product that could be kept at home. It costs less than $20. You can get it on Amazon. But certainly every coach or athletic trainer should have this in their first aid kit.

Interviewer: So it sounds like that if there's any sort of a tooth damage for your child, whether it's a baby tooth or an adult tooth, you should always go see a dentist because there could be stuff going on you're unaware of. The severity would dictate how quickly you need to go do that. Is it within a day or two, or is it immediately? Even if it doesn't look like there's anything wrong, if somebody took a hit to the teeth, dentist trip probably a good idea?

Dr. Reinemer: Always good to follow up with your dentist because, again, like I said before, there could be some underlying conditions that are not visible to the eye. Maybe it requires an x-ray. It requires some other testing to make sure that it's in good shape. And, again, it provides you baseline information if you can correlate with down the future as you follow this too.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

updated: June 19, 2019
originally published: June 20, 2017

Interviewer: Fluoride in your drinking water. Is it bad? We're going to find out the real deal next on The Scope.

Announcer: Health information from expects, supported by research. From University of Utah Health, this is TheScopeRadio.com.

Interviewer: There are some people that say fluoride is bad for us as humans and it shouldn't be in our toothpaste or in our water. Now, the thing that I struggle with, is that if it was really that dangerous, why would we still be doing it? And I wanted to find out from an expert. Dr. David Okano is a periodontist with 30 years of experience and is currently an assistant professor at University of Utah School of Dentistry. So help me sort through this. Have you had to have this conversation with a patient that is very concerned about the fluoride in the water or their toothpaste and being poison the body?

Dr. Okano: That's a question that all dentists are asked about on a regular basis, dental hygienists also. We've known for over 50 years that fluoride has a very beneficial effect to the developing tooth and the areas that had naturally-occurring fluoride were areas where it was found that they had very strong teeth, very few cavities, very few fillings were necessary in those areas. And as a result of those regions having naturally-occurring fluoride, teeth were very strong. It was found that by adding fluoride into the municipal water supply, that the developing tooth in children, in the child, could then benefit by becoming stronger and much less susceptible to tooth decay.

Interviewer: So there's research that shows this?

Dr. Okano: Absolutely. At a very small amount, the fluoride is very beneficial. And that's when you get your best benefit from fluoride in water is if you're a child with a developing tooth that will become strong for the rest of their adult life.

Interviewer: Okay. So when you go on the Internet and you do some research on fluoride in water and you find those there are those that are against it, they say that it is poisonous, they point to the back of the toothpaste tube and it says don't swallow because there is fluoride. They point to a study from the Harvard School of Public Health that talks about how it can cause a reduction in IQ points. Help me sort through . . . that doesn't feel right. Help me sort through what's going on here.

Dr. Okano: You're correct. "That doesn't feel right," is a good way to say that. The studies have indicated a lot of bias in many instances. The sample sizes have been of concern. Really, the locations where these studies have been conducted we really can't relate to the American system. So the fluorides we have known at a very low concentration . . . in fact, the American dental association has reduced the amount of concentration that's recommended in drinking water for fluoride. Too much of anything is not good.

We have chlorine added to the municipal water supply already. Too much chlorine there can be a real problem, and has been in some cases, but there are a lot of safeguards in the water systems to prevent excessive amounts of fluoride from accidentally being placed into your water supply.

Interviewer: From what I understand, that's what a lot of these studies are talking about, are locations where it was a large amount, beyond what was safe.

Dr. Okano: That is correct.

Interviewer: And we have a very good idea, based on research, what is safe.

Dr. Okano: Yes, very much so. We have 50 years of data showing the benefits of fluoride. And if you look at the children, especially in communities that do not have fluoride, and the challenges they have with tooth decay, and the concerns they develop because of their fears of dentistry, and you look at other children who do not have decay and what great experiences they have in the dental setting, it's remarkable what the benefit of fluoride has been for those 50 years.

Interviewer: And I think a lot of times when you look at a lot of things in life, it's risk-benefit. It's that risk-benefit balance.

Dr. Okano: Absolutely. The benefits are substantial for having fluoride in your water supply. My daughter is a Ph.D. candidate in public health and she has mentioned to me that fluoridation in water has been one of the top five community health benefits in public health, the first being indoor plumbing, the second being antibiotics for infectious disease, and I believe she told me fluoride in the water supply was the number three best benefit that has ever been done for public health.

Interviewer: That's pretty good for fluoride. That's quite a list, indoor plumbing and antibiotics, right, and fluoride is number three. In good company. So if you've had conversations with patients before that have raised concerns, generally, after they have the talk that we just had, does it kind of alleviate those?

Dr. Okano: Generally speaking, it does. They recognize the fluoride that's been placed into the municipal water supply or the fluoride in your toothpaste is of such low concentration that it's not dangerous and the benefits are great. Nonetheless, there are some folks who do not believe in it and they are skeptics for the rest of their lives. But we can't convince those folks. But for the masses, where so many people have benefited, people understand the benefits of fluoride to their dental health.

Interviewer: And I think the interesting thing that you said is that it's a naturally-occurring element or chemical in a lot of water and it hasn't affected us. It's just those high concentrations that, really, you've got to watch out for.

Dr. Okano: That is correct.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

updated: December 7, 2018
originally published: July 13, 2016

Interviewer: If you've ever had any questions about baby teeth, are they important? Is it okay if a child has a baby tooth knocked out? Is it a big deal or not? What about when you can start brushing? We're going to cover baby teeth next on The Scope.

Announcer: Medical news and research from University Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: Dr. James Bekker is with University of Utah's School of Dentistry and he's going to give us some tips and information on baby teeth because you get a lot of questions about baby teeth. First of all, are baby teeth important or are they just that first set of teeth and I don't have to worry about them too much?

Dr. Bekker: Yes. Thanks for the question. That's a good one and we do get that a lot. Parents will often ask or say, "Gee. Why do I need to take care of these baby teeth? Why do I need to go through the expense or the experience of getting them taken care of?"

Interviewer: Or even the hassle of getting your kid to brush, right?

Dr. Bekker: Exactly. Baby teeth are very important because they are connected to where the permanent tooth is developing. So if you have a tooth that gets a cavity and gets infected, that infection can go from where it is in the baby tooth and into the jaw around where the permanent tooth is developing. Permanent teeth can be affected by baby teeth that are neglected.

Now if you lost a baby tooth, that brings up the other reason they're important is they hold space. If you lose a baby tooth early, it's like having bricks in an archway. If you pull out a brick in an arch, all the other bricks fall into that hole. Same thing happens with teeth. Everything else shifts and then your permanent teeth don't come in the right place.

So if you lose a tooth early it's important to hold the space and to maintain that space for the permanent tooth. It's also important to know that you're still losing baby molars when you're 12 years old. You've got some permanent teeth in your mouth when you have baby teeth in your mouth and that caries process or cavities process that happens with baby teeth really can affect the permanent teeth that you have.

Interviewer: So if you get a cavity in the baby tooth, is the effect on the permanent tooth underneath even more drastic than if I'd just got a cavity, like an adult got a cavity in a regular tooth? Does that make sense? Does it go beyond just the cavity in that situation?

Dr. Bekker: It depends on how far that cavity is allowed to go. If you just get a small cavity in a baby tooth and it gets fixed then there's probably no repercussions on the permanent tooth. But if that cavity is allowed to go on to get into the nerve, have the nerve become infected, and that infection travel down through the roots to where the permanent tooth is, it can have an effect on the permanent tooth development.

Interviewer: When should a child go to the dentist for the first time? You're talking about how important it is to take care of these baby teeth. When should you really start being concerned?

Dr. Bekker: We like to have children at the dentist at about a year of age.

Interviewer: Really?

Dr. Bekker: Yes.

Interviewer: That's much younger than I would . . . do most people find that to be younger than they expected?

Dr. Bekker: The American Academy of Pediatrics and the American Dental Association have collaborated on a number of studies and it is shown that if we get in early, you do some prevention of caries with the children. But the key point is you're educating the parents. I have so many children that come in at age three and they have a mouth full of cavities. If we were able to see that child at age one and do a little prevention, cleanings and fluoride treatments, that kind of thing, and educate the parents as to how to take care of those teeth, we could probably prevent a lot of those cavities that we see at three or at five.

Interviewer: Yeah. When should a child a start brushing his teeth? Or when should a parent start brushing a child's teeth? At one?

Dr. Bekker: Yes. As soon as...

Interviewer: When that first tooth comes in, start taking care of it.

Dr. Bekker: That's exactly it. Typically the first teeth are going to come in on the lower arch, the mandible, at around six months. Of course, the little kids aren't going to want to brush their teeth at that age. But we show parents how to hold them in a safe way that allows the parent to be able to brush the teeth while they're holding the child and how to effectively help that child get used to brushing, the taste of the toothpaste, and having the brush in their mouth. It's a process. Parents say, "How old should a child be when I let them brush their teeth on their own?" And I say, "About nine."

Interviewer: Up to that point it is the parent's responsibility.

Dr. Bekker: A lot of times, we say, "Have your child brush their own teeth and then mom or dad just check." And we say "check" with big quotation marks around them. You take that brush and you get in there and you go, "Oh, you did a great job on these. And, oh these over here you did a really good job." Mom and dad check the teeth and in checking they get in and get them really brushed done.

Interviewer: Getting a little brushing done. All the way to nine, huh?

Dr. Bekker: Well, thereabouts.

Announcer: That seems like a long time.

Dr. Bekker: Somewhere along in there, when the child can really understand how to effectively brush and floss.

Interviewer: Got you. Give us one great tip to end this interview. If somebody were going to do something for their child's teeth and do it well, if there was only one thing you could tell them and that's all the time you had, what would it be?

Dr. Bekker: Just take care of the ones you want to keep.

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Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to the Scope.

Interviewer: Dr. Bryce Williams is an oral surgeon at the University of Utah Hospital. As an oral surgeon, tell me about the effects of smoking and chewing tobacco on the teeth.

Dr. Bryce Williams: That's a good question. Smoking for the oral cavity causes a lot of different changes. Primarily, it causes a dry mouth. Not having that saliva in there to protect your teeth and your gums will cause a plaque build-up on the teeth and then slowly over time you can get cavities in your teeth that cause infection and need to be removed. The other obvious changes that happen with smoking in particular are the risks of getting oral cancer. Sometimes it doesn't always show up in the obvious place. It can kind of hide behind the tongue or further down the throat. It can make it very tricky for the otolaryngologist or the oral surgeon to find those areas of concern. With chewing tobacco, there's not necessarily a higher risk of oral cancer with chewing tobacco. That's never been proven. However, chewing tobacco does damage the gums around the teeth. It can cause recession of the gums and damage to the roots of the teeth, which require removal. Sometimes that's very difficult to repair so the teeth have to be removed.

Interviewer: Out of all the things that we're putting in our mouth and that we're doing to ourselves, would you say smoking and chewing tobacco are a couple of the worst things you can do for your teeth?

Dr. Bryce Williams: I think smoking and chewing tobacco are definitely terrible for the world cavity. Something else that's not typically thought of as been awful for the mouth are sweets and those kinds of things. Especially suckers and lozenges that have sugar in them. Those can have similar effects to chewing tobacco, causing recession of the gums and cavities in the teeth. Those work kind of slower over time but they can have a devastating effect on the teeth and gums.

Interviewer: Interesting. What about chewing ice? Is that bad for me?

Dr. Bryce Williams: Chewing ice can be bad for you as well, especially if you have a lot of fillings in your mouth. The fillings tend to weaken the teeth. If you take a nice crunch down on a piece of that ice, it can fracture that tooth and then you need some expensive dental work.

Interviewer: What about opening things with your mouth? You know, clamping down on a package of whatever and opening it up. Is that bad? I've heard it is.

Dr. Bryce Williams: It's always impressive to see someone open a bottle with their teeth.

Interviewer: Have you actually seen that?

Dr. Bryce Williams: Many times. I've never seen a tooth actually break.

Interviewer: That doesn't sound smart.

Dr. Bryce Williams: It does not sound smart, no. I'm sure the day will come when I will see someone and I'll give them a talking to.

Interviewer: What about other packaging, like, plastic bags of candy or whatever?

Dr. Bryce Williams: I'd say save your teeth for the food so you'll have your teeth long-termed to chew the food with.

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