It’s common for kids to be less than enthusiastic about visiting the dentist. For some, though, it’s even more of a challenge: A child with extreme anxiety and fear during dental visits could interfere with them receiving the dental care they need. The impact could even extend into adulthood.
Recognizing the need to reduce this high anxiety, dentistry has used a number of pharmacological tools for many years that relax a child during dental care. Sedatives have often been the only choice for reducing anxiety, especially during extensive procedures and treatments. But now there’s a promising new approach in dentistry that doesn’t depend on drugs.
Cognitive behavioral therapy (CBT), a psychotherapeutic method used for decades to treat depression, phobias and eating disorders, has been investigated recently as a possible approach for relieving children’s dental anxiety. During CBT, trained therapists use specific behavioral techniques to help patients develop mental and emotional strategies for dealing with stress.
During the usual course of CBT therapy, a therapist meets in counseling sessions with patients weekly over several months to help them change their routine thinking or behavior surrounding a stressful issue. Initially, the therapist guides the patient toward understanding the underlying causes for their negative reaction to the issue. They then work with the patient to devise an objective way to test whether those emotions and beliefs about the issue are true.
Using this effective method for changing behavioral and emotional responses for dental anxiety has had encouraging results from initial research. One study found CBT successfully reduced dental anxiety among a majority of a group of European children ages 9 through 16 who participated in the method.
CBT isn’t an overnight cure, often requires a number of months to achieve results. But for children who suffer from extreme fear of professional dental care, this drug-free method may provide long-term benefits that extend well past their childhood years.
Is a chipped tooth big news? It is if you’re Justin Bieber. When the pop singer recently posted a picture from the dental office to his instagram account, it got over 2.6 million “likes.” The snapshot shows him reclining in the chair, making peace signs with his hands as he opens wide; meanwhile, his dentist is busy working on his smile. The caption reads: “I chipped my tooth.”
Bieber may have a few more social media followers than the average person, but his dental problem is not unique. Sports injuries, mishaps at home, playground accidents and auto collisions are among the more common causes of dental trauma.
Some dental problems need to be treated as soon as possible, while others can wait a few days. Do you know which is which? Here are some basic guidelines:
A tooth that’s knocked out needs attention right away. First, try and locate the missing tooth and gently clean it with water — but avoid holding the tooth’s roots. Next, grasp the crown of the tooth and place it back in the socket facing the correct way. If that isn’t possible, place it between the cheek and gum, in a plastic bag with the patient’s saliva or a special tooth preservative, or in a glass of cold milk. Then rush to the dental office or emergency room right away. For the best chance of saving the tooth, it should be treated within five minutes.
If a tooth is loosened or displaced (pushed sideways, deeper into or out of its socket), it’s best to seek dental treatment within 6 hours. A complete examination will be needed to find out exactly what’s wrong and how best to treat it. Loosened or displaced teeth may be splinted to give them stability while they heal. In some situations, a root canal may be necessary to save the tooth.
Broken or fractured (cracked) teeth should receive treatment within 12 hours. If the injury extends into the tooth’s inner pulp tissue, root canal treatment will be needed. Depending on the severity of the injury, the tooth may need a crown (cap) to restore its function and appearance. If pieces of the tooth have been recovered, bring them with you to the office.
Chipped teeth are among the most common dental injuries, and can generally be restored successfully. Minor chips or rough edges can be polished off with a dental instrument. Teeth with slightly larger chips can often be restored via cosmetic bonding with tooth-colored resins. When more of the tooth structure is missing, the best solution may be porcelain veneers or crowns. These procedures can generally be accomplished at a scheduled office visit. However, if the tooth is painful, sensitive to heat or cold or producing other symptoms, don’t wait for an appointment — seek help right away.
Justin Bieber earned lots of “likes” by sharing a picture from the dental office. But maybe the take-home from his post is this: If you have a dental injury, be sure to get treatment when it’s needed. The ability to restore a damaged smile is one of the best things about modern dentistry.
If you have questions about dental injury, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Repairing Chipped Teeth” and “Porcelain Crowns & Veneers.”
Once upon a time, braces were the way to straighten a smile. They were—and continue to be—an effective orthodontic treatment especially for younger patients. But braces do have a few drawbacks, one of the biggest being appearance: when you're wearing braces, everyone can see you're wearing them.
That changed a couple of decades ago with the introduction of clear aligners. Removable plastic trays that incrementally move teeth, aligners have quickly become popular for a number of reasons. Perhaps their biggest attraction is that they're barely noticeable.
There's now a third option for correcting crooked teeth: lingual braces. They're similar to the traditional version, but with one big difference: all of the hardware is on the back side of the teeth.
Ironically, two orthodontists an ocean apart developed the idea, and for different reasons. A Beverly Hills orthodontist was looking for an invisible tooth-moving method that would appeal to his image-conscious patients. The other in Japan wanted to offer his martial arts patients, who risked injury from facial blows with traditional braces, a safer alternative.
These two motivations illustrate the two biggest advantages to lingual braces. The brackets and other hardware are attached to the back of the teeth (on the tongue side, hence the term "lingual") and exert the tooth-moving force by pulling, in contrast to the pushing motion of labial ("lip-side") braces. They're thus invisible (even to the wearer) and they won't damage the soft tissues of the cheeks, lips and gums if a wearer encounters blunt force trauma to the mouth.
They do, however, have their disadvantages. For one, they're often 15-35 percent more expensive than traditional braces. They're also a little more difficult to get used to—they can affect speech and cause tongue discomfort. Most patients, though, get used to them within a week. And, being a relatively new approach, not all orthodontists offer them as a treatment option yet.
If you're interested in this approach to teeth straightening, speak with your orthodontist to see if they're right for you. But if you do take this route, you may have a more pleasing and safe experience.
If you would like more information on orthodontic treatment with lingual braces, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Lingual Braces: A Truly Invisible Way to Straighten Teeth.”
Each year doctors treat about 150,000 new cases of severe facial pain. If you're one of those people, you don't have to suffer—there are ways to gain relief from these painful episodes.
Those recurring episodes are known as trigeminal neuralgia (TN). As the name implies, the source of the pain are the trigeminal nerves, which originate in the brain stem and extend on either side of the face. Each is divided into three branches (hence the "tri" in trigeminal) that serve the upper, middle and lower parts of the face and jaw.
TN can involve one or more of these branches, resulting in mild to severe pain that can last for several seconds. Jaw movements like chewing or speaking can trigger an episode, as well as a light touch to the face.
There are various proposed causes for TN, including links with inflammatory disorders like multiple sclerosis, which damages the insulating sheathing around nerve cells. The most common cause, though, appears to be a blood vessel pressing against the nerve. The compression causes hypersensitivity in that area of the nerve so that it transmits pain at the slightest sensation.
Other conditions like jaw joint pain disorders (TMD) or a dental abscess can cause similar pain symptoms, so it's important to get an accurate diagnosis. If your doctor does identify your condition as TN, you may then need a comprehensive approach to treatment involving a team of care providers, including your dentist.
For the most part, TN can be managed, beginning with the most conservative approach to gain relief, often with medications to block the nerve's pain signals to the brain or decrease abnormal nerve firings. If that proves insufficient, though, more intensive treatments are available.
One possible treatment for an impinging blood vessel is a microsurgical procedure to expose the affected nerve and relocate the vessel. While this can be effective, the surgery does carry some risk of facial numbness or decreased hearing. If the risks are too high for conventional surgery, an alternative procedure uses a precise beam of high-dose radiation to relieve the pressure from the vessel.
The most important thing to know about TN, though, is that it is possible to control it and relieve future pain episodes. If you're experiencing these symptoms, see your dentist or doctor for an exam and accurate diagnosis.
If you would like more information on trigeminal neuralgia, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Trigeminal Neuralgia: A Nerve Disorder that Causes Facial Pain.”
Pediatricians and dentists alike recommend beginning your child's regular dental visits at an earlier age rather than later. Most say children's first visits should happen around their first birthday.
Some may question whether that's necessary given the state of a child's dental development at that age. At that stage they normally have only a few primary teeth, which will eventually give way to their permanent set soon enough.
But regular dental visits can make a positive difference even at that early age. Here are 3 oral health areas that could benefit from seeing the dentist by Age One.
Protecting primary teeth from decay. It's true that primary teeth don't last long when compared to a normal lifespan. But during their short tenure, they do play a critical role in a child's health and development. Not only do they provide a child dental function for eating, speaking and smiling, they also preserve the space for the permanent teeth that will succeed them. Without them, permanent teeth can erupt out of position to form a poor bite (or malocclusion). That's why early dental care to prevent and treat decay in primary teeth helps them remain for as long as they should.
Detecting developing malocclusions. A malocclusion doesn't form overnight—there can be subtle signs of its development during early childhood. A dentist, especially a pediatric dentist or orthodontist, can often detect those signs before the malocclusion fully develops (one reason why every child should have an orthodontic evaluation around age 6). With early detection, an orthodontist can use interventional techniques that will lessen or even stop a malocclusion from forming. As a result, later orthodontic treatment may not be as extensive—or expensive—as it could have been.
Developing a healthy dentist-patient relationship. Dental anxiety is a real problem for many adults—in some cases it can be so severe they avoid professional dental care altogether. The roots of that dental fear often go back to unpleasant experiences during childhood. Starting dental visits when a child is very young appears to minimize the development of dental anxiety. A young child, especially visiting a "kid-friendly" dental clinic, will more likely view dental care as a routine part of life and will less likely be afraid.
If you would like more information on dental care for children, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Age One Dental Visit: Why It's Important for Your Baby.”
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