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, in rare cases, the parent may notice wear (teeth getting shorter). The cause of grinding often remains unknown. One thing we do know is that it is VERY common. Bruxism is often noticed around the time the PRIMARY molars are erupting, and continues until the last PERMANENT tooth has erupted. One theory suggests that all children grind; some are just louder than others. It is a way for the primary teeth to send signals to the adult teeth to continue their development, and begin to erupt. A second theory as to the cause involves a psychological component. Stress due to a new environment, divorce, changes at school, etc., can influence a child to grind their teeth. Finally, a third theory relates to 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, this may explain why children that are prone to frequent ear infections, may have a tendency to grind more or louder than others.
The majority of cases of pediatric bruxism do not require any treatment. 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 the ages 6-9 and children tend to stop grinding between ages 9-12. If your child grinds their teeth, discuss the issue with Dr. Anokhi. She can advise you whether treatment is necessary for your child.
THUMB / FINGER SUCKING
Sucking is a natural reflex and infants and young children may use thumbs, fingers, pacifiers and other objects (blankets, stuffed animals etc) on which to suck. It may make them feel comfortable, or provide a sense of security at difficult periods. Since thumb / finger sucking is relaxing, it may induce sleep.
Thumb / finger sucking that continues after the eruption of the permanent teeth can cause problems with the proper growth of the mouth and dental alignment. The intensity with which a child sucks on fingers or thumbs will determine whether or not dental or skeletal problems will occur.
Children should discontinue thumb / finger sucking by the time their permanent front teeth are ready to erupt. Usually, children stop between the ages of two and four. Peer pressure causes many school-aged children to stop.
Dr. Anokhi recommends the use of positive reinforcement starting around age 3 to try to discontinue a finger or thumb habit. Instead of scolding your child for sucking their thumb / fingers, praise them when they are not. Older children often suck their thumb / fingers when they are feeling insecure, tired, or hungry. Focus on correcting the cause rather than the habit itself. Reward children when they refrain from sucking.
If all of these methods have not helped to decrease the habit by age 4 or 5, try putting a sock, or mitten on the hand at night. DO NOT put bandages, Band-Aids, or tape on the fingers or thumb (a common practice by some parents). ALL of those items can be choking hazards to a young child.
If these approaches don’t work, Dr. Anokhi may recommend the use of fixed appliance therapy, such as a bluegrass appliance or a thumb crib / fence to be used as an aid in discontinuing the habit.
Pacifiers are no substitute for thumb sucking. They can affect the teeth essentially the same way as sucking fingers and thumbs. However, use of the pacifier can be controlled and modified more easily than the thumb or finger habit.
Dr Anokhi recommends discontinuing pacifier use on or around your child’s third birthday. Prior to the age of 3, discuss discontinuing pacifier use with your child. Begin by limiting pacifier use to nap time and bed time only using positive reinforcement and praise. Once this has been adopted as the new routine, begin limiting its use to bed time only; and subsequently discontinuing its use all together. If all else fails, you can always throw away all pacifiers and have a few “sleepless nights.” Your child will soon forget that they ever relied on a pacifier at all.
GOOD HABITS! – PREVENTING CAVITIES
Good oral hygiene removes bacteria and the leftover food particles that combine to create cavities.
The American Academy of Pediatric Dentistry recommends visits every six months to the pediatric dentist, beginning at your child’s first birthday. Routine visits will start your child on a lifetime of good dental health.
CARE OF YOUR CHILD’S TEETH
Begin daily brushing as soon as the child’s first tooth erupts. For infants, use a wet gauze pad, a soft toothbrush, or a clean washcloth to wipe the plaque from teeth and gums after a meal or bottle. The easiest way to do this is to sit down, place the child’s head in your lap or lay the child on a dressing table or the floor. Whatever position you use, be sure you can see into the child’s mouth easily.
For older children, brush their teeth at least twice a day, after breakfast and immediately before bedtime. Also, floss at least once a day, at bedtime, if there are no spaces between the teeth. Watch the number of snacks containing sugar that you give your children.
A smear of fluoridated toothpaste can be used after the child is able to spit. Until that age, use a fluoride-free (safe to swallow) toothpaste. Remember, children should spit out toothpaste after brushing to avoid getting too much fluoride. If too much fluoride is ingested, a condition known as fluorosis can occur. Fluorosis results in developmental defects (white or brown patches) on permanent teeth. When looking for a toothpaste for your child, make sure to pick one that is recommended by the American Dental Association as shown on the box and tube. These toothpastes have undergone testing to insure they are safe to use. By age 4 or 5, children should be able to brush their own teeth twice a day with supervision. Allow your child to brush his/her teeth first, then go in and brush for them after they have had a chance. Children generally do not have the manual dexterity to adequately clean all the surfaces of their teeth until they are able to write in cursive (about age 7 or 8). Our team can help you determine whether the child has the skill level to brush properly.
Proper brushing removes plaque from the inner, outer and chewing surfaces. When teaching children to brush, place toothbrush at a 45-degree angle; start along gum line with a soft bristle brush, and work the brush in a gentle circular motion. Brush the outer surfaces of each tooth, upper and lower as well as the gums. Repeat the same method on the inside surfaces and chewing surfaces of all the teeth. Finish by brushing the tongue to help freshen breath and remove bacteria.
Flossing removes plaque between the teeth, where a toothbrush can’t reach. Flossing should begin when any two teeth touch. You should floss the child’s teeth until he/she can do it alone. Use about 18 inches of floss, winding most of it around the middle fingers of both hands. Hold the floss lightly between the thumbs and forefingers. Use a gentle, back-and-forth motion to guide the floss between the teeth. Curve the floss into a C-shape and slide it into the space between the gum and tooth until you feel resistance. Gently scrape the floss against the side of the tooth. Repeat this procedure on each tooth. Don’t forget the backs of the last four teeth. You can also use disposable floss holders found at the drug store, sometimes these can be easier to use in little mouths!
Avoid putting your child to bed with a bottle filled with anything other than water. Having the child go to bed with a bottle of juice or milk can lead to early childhood caries. One serious form of decay among young children is baby bottle tooth decay (early childhood caries). This condition is caused by frequent and long exposures of an infant’s teeth to liquids that contain sugar. Among these liquids are milk (including breast milk), formula, fruit juice and other sweetened drinks. These liquids pool around the child’s teeth allowing bacteria an opportunity to produce acids that attack tooth enamel.
Healthy eating habits lead to healthy teeth. Like the rest of the body, the teeth, bones and the soft tissues of the mouth need a well-balanced diet. Children should eat a variety of foods from the five major food groups. Most snacks that children eat can lead to cavity formation. Chewy, sticky snacks like fruit snacks, fruit roll-ups, raisins, etc., can get stuck in the pits and fissures of teeth and develop cavities. Sugar in fruit juices or chocolate/strawberry milk can cause cavities between the teeth, or along the gum-line. Young children should have no more that 4 oz of juice a day. Try to limit juice and flavored milk to mealtimes only. This limits the length of exposure the liquid has to the teeth. The more frequently a child snacks, the greater the chance of developing tooth decay. How long food remains in the mouth also plays a role. If your child must snack, choose nutritious foods such as vegetables, low-fat yogurt, low-fat cheese, and peanut butter which are healthier and better for children’s teeth.
XYLITOL – REDUCING CAVITIES
The American Academy of Pediatric Dentistry (AAPD) recognizes the benefits of xylitol on the oral health of infants, children, adolescents, and persons with special health care needs. Xylitol is a sugar substitute, and is also found in certain brands of chewing gum and toothpaste. Xylitol is found in nature in small amounts in fruits, berries, mushrooms, lettuce, and corn.
The bacteria that determines caries susceptibility is generally transmitted from mother (or caregiver) to their infant within the first 3 years of life. It is transferred orally (sharing spoons, tasting food, kissing, etc). The later the child is infected with this bacteria; and the lower the mother’s caries rate, the fewer cavities the child will develop. The use of XYLITOL GUM by mothers (2-3 times per day) starting 3 months after delivery and until the child was 2 years old, has proven to reduce cavities up to 70% by the time the child was 5 years old!
Studies using xylitol have demonstrated a dramatic reduction in new tooth decay, along with some reversal of existing dental caries. Xylitol provides additional protection that enhances all existing prevention methods. This xylitol effect is long-lasting and possibly permanent. Low decay rates persist even years after the studies have been completed.