Oral Health Concerns

Thumb Sucking

Sucking is a natural reflex and infants and young children may use thumbs, fingers, pacifiers and other objects to suck. It has been noted during ultrasound studies that some children suck their fingers or thumbs even before they are born. It may make them feel secure and happy, or provide a sense of security at difficult periods. Since thumb sucking is relaxing, it may induce sleep.

Thumb, finger or pacifier sucking that persists beyond the eruption of the permanent teeth can cause problems with the proper growth of the mouth and tooth alignment resulting in the need for orthodontic intervention. You may be aware that the skulls of young children have a “soft spot” which allows for the growth of the brain. Similarly the jaws of young children, much like the skull; are soft, flexible and growing rapidly. With the constant pressure of a finger, thumb or pacifier sucking habit the upper jaw may narrow creating a crossbite and the upper teeth may flare forward and the lower teeth may be displaced backward toward the tongue. The upper jaw may eventually be thrust forward resulting in an open bite. How intensely a child sucks on a thumb, fingers or pacifier will determine whether or not dental problems may result. Children who rest their thumbs passively in their mouths are less likely to have difficulty than those who have a more vigorous sucking habit.

Children who cease thumb, finger or pacifier sucking by the time they have all twenty (20) primary exhibit less misalignment of their anterior teeth and less distortion to their jaws. For those children who continue the habit past the age of three (3) you should consider an evaluation to see if damage is occurring – it may be necessary to offer treatment aids to help stop the habit.

Pacifiers are no substitute for thumb sucking, however, they are more easily controlled than a thumb or finger habit. By snipping the end of the pacifier it will not provide the same sensation as an intact pacifier and many times the child loses interest. Another method is to go “cold turkey” and lose all pacifiers.

A thumb, finger or pacifier habit is usually associated with another object, a favorite blanket, stuffed animal or doll which they find comforts them. One method of discontinuing a habit is to remove the object they cling to when exhibiting the habit. Children usually adapt within two to three (2-3) days. Normally, the parents are more apprehensive about the thought of discontinuing the habit than the reality of actually doing it – it is easier on the child than the parents think.

A few suggestions to help your child get through thumb sucking:

Children often suck their thumbs when feeling insecure. Focus on correcting the cause of anxiety, instead of the thumb sucking.
Children who are sucking for comfort will feel less of a need when their parents provide comfort.
Reward children when they refrain from sucking during difficult periods, such as when being separated from their parents.
Prepare a thirty (30 )day chart allowing the child to place a sticker, star, or some other notation on the chart each day (and night) they do not suck their finger, thumb or pacifier. Suggest that after they have been successful for thirty (30) consecutive days and nights they will get a special prize or reward.
Daily rewards may help them to achieve short term goals with the idea that a larger reward will be awarded at the end of thirty days.

Dr. West can encourage children to stop sucking and explain what could happen if they continue. Dr. West will also present them a special reward if they bring their thirty (30) day chart to the office showing they have terminated their sucking habit.

If none of the above methods are successful Dr. West may recommend the use of a dental appliance.

Tongue Thrust

An orthodontic concern which is frequently undetected in young children is tongue thrusting. Like finger, thumb and pacifier habits many children exhibit this natural infantile swallowing pattern which changes as the child matures and normally ceases by six (6) years of age. If tongue thrusting persists it can lead to problems with skeletal development and tooth alignment which not only impact the oral structure but can also affect speech. If you notice jaw distortion or speech problems an evaluation for tongue thrusting is warranted. As a Pediatric Dentist and Orthodontist Dr. West is knowledgeable in treatment modalities to correct this concern.

Does Your Child Grind His Teeth At Night? (Bruxism)

Parents are often concerned about the nocturnal grinding of teeth (bruxism). Often, the first indication is the noise created by the child grinding on their teeth during sleep; or the parent may notice wear (teeth getting shorter or flatter) to the dentition. Several reasons that have been reported for this non-functional grinding are:

Stress due to a new environment, changes in family structure, changes at school, etc.
Malocclusion – the teeth not fitting together due to crossbites or misaligned teeth.
Transition from primary to permanent teeth, especially before the upper and lower first permanent molars are in solid contact on closure of the mouth.
Airway issues which cause pressure in the inner ear at night. If there are pressure changes (like in an airplane during take-off and landing, when people are chewing gum, etc. to equalize pressure) the child will grind by moving his jaw to relieve this pressure.
Some medical research has even suggested that intestinal parasites such as pinworms could cause children to grind their teeth at night.

The majority of cases of pediatric bruxism do not require any treatment; however, they should not be ignored. A thorough examination by Dr. West can help determine if treatment is necessary to correct the clenching or grinding of the teeth. It is important to get a definitive diagnosis of the cause so that the proper treatment can be instituted, if treatment is necessary. If excessive wear of the teeth (attrition) is present, then a mouth guard (night guard) may be indicated.

The good news is most children outgrow bruxism. The grinding decreases between ages six to nine (6-9) and children tend to stop grinding between ages nine and twelve (9-12) as they acquire their permanent teeth. If you suspect bruxism, discuss this with Dr. West.

Aphthous Ulcers

Aphthous Ulcers, sometimes called canker sores are small sores inside the mouth that often recur. A canker sore has a white or gray base surrounded by a red border. Many aphthous ulcers are caused by trauma such as injuring the gums with a toothbrush or biting a lip. However, sometimes they can be caused by a chemical found in some brands of toothpaste. Generally lasting one or two weeks, the duration of canker sores can be reduced by the use of antimicrobial mouthwashes or topical agents or can be cauterized in the office, if needed.

Adult Teeth Coming in Behind Baby Teeth

This is a very common occurrence with children, usually the result of a lower primary (baby) tooth or teeth not falling out when the permanent tooth is coming in. In most cases if the child starts wiggling the baby tooth, it will usually fall out on its own within two (2) months. If it doesn't, then contact our office, where we evaluate the teeth and if necessary easily remove the tooth (teeth). After removal of the retained primary tooth the tongue should help move the permanent tooth into the proper position.

When Will My Child Start Getting Permanent Teeth?

The first permanent molars are the first adult teeth to demonstrate enamel formation. These teeth have already begun formation at birth and begin appearing in the mouth around age six (6). The molar teeth do not replace primary teeth; therefore, your child may have a permanent tooth before you are aware of any baby tooth loss. At age eight (8), you can generally expect the bottom four (4) primary teeth (lower central and lateral incisors) and the top four (4) primary teeth (upper central and lateral incisors) to be gone and permanent teeth to have taken their place. There is about a one to two year break from age eight to ten (8-10) after which the rest of the permanent teeth will start to come in. This process continues until approximately 18 – 21 years of age.

Most adults develop 32 teeth, but because many have had their third molars (wisdom teeth) removed many adults have 28 permanent teeth. Some adults have also have had teeth removed for orthodontic treatment and, therefore, they may less than 28 teeth.