Winter Park Dentistry-Pediatric Dentistry (part 2)
Dr. Ramzi Matar (Winter Park Dentistry): Yeah, I remember seeing that and you teaching me the psychology of it. I think that’s good note, I always liked that, even the way the office is built and tailored, it’s for kids. You go into your office, there’s paintings on the wall, giraffes, etc. I think it’s nice that it’s sort of tailored for children. To know that there’s a rationale that makes sense.
Dr. Charlie Bertot: We definitely have fun with it.
Dr. Ramzi Matar (Winter Park Dentistry): Okay, a little bit of home discussions for parents. I want to mention a big topic, fluoride. You mentioned it, and I want you to give me your opinion on fluoride as far as at home, and this is a big topic for everybody, how do parents clean their kids’ teeth, when they have less teeth. Do they use tools, like a little finger cut you can buy, when do you use a toothbrush, when do you start using fluoride, and then I’ll address the thumb sucking after that. So tell us your thoughts or recommendations for every parent watching this video, about fluoride, yes or no, it’s sort of a debatable hot topic a lot of times, and then how to clean their kids’ teeth out?
Dr. Charlie Bertot: Okay. Fluoride is a naturally occurring mineral in the environment, so we’re all exposed to it. It’s just a matter of are we being exposed to the optimal amount. Most of Central Florida has community fluoridated water. If you live in certain parts of Central Florida, let’s say Apopka, certain parts of East Orange County, they do not have fluoride in their drinking water. So those children may need to be supplemented. Certainly if you’re well based, well water system, you likely have trace amounts of fluoride, so those children are going to need to be supplemented as well. As you know the purpose of fluoride is to help strengthen the teeth, it makes the tooth stronger and less susceptible to the acid breakdown that is the cavity attack on the tooth. We know that a cavity is basically a bacterial infection, and the presence of bacteria creates and acidic environment that softens and breaks down the tooth, very much like if you would put muriatic acid on a surface, the first thing it’s going to do is bleach or whiten that surface, so we see the white spot lesions on teeth, so you know what those are. Not all white spots, so we don’t alarm the parents, not all white spots are cavities, but beyond that eventually the enamel starts to get rough, kind of chalky, and it breaks own, and we get a cavity.
Exposing the teeth to fluoride helps strengthen the weaker areas, the white spots that are pre-cavity lesions, and the healthy enamel makes it stronger, so that we don’t see those white spot lesions. Fluoride can be applied in two different ways, you have topical applications which come as toothpaste, or rinses. We don’t really advocate rinses for children under the age of six, because we’re concerned that they may swallow that, and that’s really not healthy for them, and generally I don’t like to have parents expose children to fluoride toothpaste prior to 2 years of age. That has to do with the concern of fluorosis. That being said, if I have an 18 month, or a 20 month old child that’s in the office, and they’re rated at high risk, I’m definitely going to have fluoride toothpaste be employed during the home routine. The key is the quantity of toothpaste that’s put on the toothbrushes. You can limit how much toothpaste is swallowed if you limit how much toothpaste you put on the brush.
Fluoride isn’t poison, I’m a big advocate of it, I understand that not everybody with what fluoride is and what fluoride does, but you and I know that in dentistry fluoride is our magic touch, it’s our golden rule, and I can tell you when I see kids that have loads of cavities, it’s usually he child whose parent is against fluoride and they’re not buying the fluoride toothpaste, they’re not drinking the fluoridated community water, and that is precisely the child that needs more fluoride. 99 times out of 100.
Dr. Ramzi Matar (Winter Park Dentistry): I do get that. Let’s talk about tooth grinding, some parents tell me “my kid is grinding his teeth at night”, tell me about that, I know you probably get this a lot as well.
Dr. Charlie Bertot: I generally hear this mainly during the summer months, when families are vacationing, everybody’s in one hotel room together, for cost-saving purposes if you will, and it’s usually the little one that’s being fast asleep for a couple of hours or deep into their sleep, and now you hear the grinding of the teeth that’s ongoing. I want to reassure all parents, this is a normal process that all of our children go through, some are more active grinders than others, but the grinding has to do with the development of their TMJ, or temporal mandibular joint, so basically the jaw joint, the lower jaw articulates with the base of our skull, and as it continues to grow and develop, your child will go through periods where at nighttime, they’re going to grind their teeth and it’s perfectly normal. It rarely presents any type of problem to our dentition, if you will, from a wearing down standpoint. Some children will wear on those baby teeth, but I have in 20 years only encountered two instances where I have, let’s say an 11 or 12 year old who actually has wear patterns on their adult teeth. I just don’t see it. Despite whatever level of wear I might see on baby teeth, I don’t really see it on the adult teeth. So it’s not a concern.
Dr. Ramzi Matar (Winter Park Dentistry): So as long as you’re monitoring the kid, as obviously you do, it’s usually going to go away for the most part. Tell me another habit that we see, thumb sucking, pacifier, how do you manage that? Is there an age limit, when should a parent watching this video say “boy, my kid has his thumb sucking habit…”, what are the limitations there?
Dr. Charlie Bertot: Sure. We call that nonnutritive sucking. It’s a habit that doesn’t bring any nutrition to us. What it does, it does soothe the child, it does calm the child, especially if they’re nervous or anxious for whatever reason. It stems from the rooting reflex or sucking reflex from when they’re babies. Usually it’s very self-limiting, a lot of children will stop before age 1, some children will continue beyond that. I usually encourage a parent that if they seem to have a propensity to favor the thumb from the sucking point, I would encourage them to use or push a pacifier, because ultimately we as parents are in control of the pacifier, we are not in control of the thumb or the finger. So there’s a pacifier that’s involved, mom and dad can certainly limit how often that pacifier is used.
Ultimately it has to do with the intensity or the duration of the habit. So if you have a child that very intensely on their, whether it’s a pacifier or finger or a thumb, and they do it frequently throughout the day, that’s when we’re most likely to see changes you know, in tooth position, or actually in the shape of our jaw that supports our teeth. Remember, at this age, it’s all very soft, very plastic, so it doesn’t a whole lot of force to work that bone that supports the tooth. So ultimately, we would like for children to be done with their thumb sucking habits, or their nonnutritive sucking habits by two and a half, three years of age.
If they continue beyond that, typically they’re going to stop on their own, by five, six years of age, usually by the time they go into grade school, if you will. If they continue at that point, that’s when I tend to get involved… This is me, this is my practice, but I rarely get into habit appliance until the child’s about six and a half, seven years of age. If basically they’ve lost their upper baby teeth, the adult teeth are coming in and we still have a sucking habit, at that point, we’re going to bring out the big gun, and the big gun is basically a passive appliance that just changes the mouth feels when the thumb is in there. It makes a child less interested because they’re not deriving the same satisfaction out of it, and they stop their sucking usually within four or five days, but we do keep the appliance in place for a year, we really want to snuff it out.
Dr. Ramzi Matar (Winter Park Dentistry): That’s great. I love it. Dr. Bertot, I really appreciate it, I just have a couple of last highlights. So if you’re a parent out there watching this video, first tooth or about 1 year, get your child to a pediatric dentist, have them evaluate it, by about 3 all your child baby teeth should be in. Certainly, and I know this too, but you definitely want to take care of these baby teeth, because they’re going to be there for a while, until 12 years, you said, right?
Dr. Ramzi Matar (Winter Park Dentistry): Up to twelve, so lots of time in there to cause problems. Teeth shift, you lose teeth, now the teeth are like books in a bookshelf, they start tipping and flailing and now you don’t have the space for the adult teeth, and we both know there’s a lot of problems with not taking care of baby teeth. You do put fillings in baby teeth, you do want to take care of it, keep them out of pain, keep your kids out of nightlong toothache. As you said, I think I’ll agree, most pediatric dentists agree with fluoride, we see the benefits of it. Some people have some preferences against it, and certainly that’s everybody’s will with their child. I really appreciate it. Everybody who’s watching this video, I hope you found it informative. Please, you’re certainly welcome to post your comments, questions, we’ll all try to get to them at the bottom of this YouTube channel, we’ll try to reply as best we can. Dr. Bertot, I really appreciate your time, I think it was really helpful. Thank you.