Wearing and Caring for Your Retainer

How should I take care of my retainer?
Most retainers are removable, meaning that you take them out when eating, brushing and flossing. For this reason, they are easy to misplace. Many people wrap their retainers in a napkin when eating, then forget about them afterwards and have to spend hundreds of dollars on a new retainer. A good solution is to always carry your retainer case with you and to use it whenever you’re not wearing your retainer. For added protection, never leave the case on a table or a bench — always put it immediately in your backpack, purse or pocket.

Your dentist can give you information on how to clean and care for your specific type of retainer. Regardless of the type, you need to make sure you don’t sit on, step on or otherwise damage this delicate and expensive piece of equipment.

How long do I need to wear a retainer after my braces comes off?
Your dentist can tell you how long you should keep wearing your retainer. Since the purpose of retainers is to prevent your teeth from shifting back into their original position, they should be worn at least until your jawbone and gums have had time to stabilize around your newly-aligned teeth. Many orthodontists recommend that children and teenagers wear their retainers until their early or mid-20s — until all the permanent teeth have come in and the jaw stops growing.

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Broken Braces or Wires

Problems with braces can include:

* Broken braces (brackets)
* Broken wires
* Loose bands
* Loose braces
* Wires sticking out

Call and discuss the problem with your orthodontist or office staff. You may need to visit right away, or you may be able to fix the problem yourself until your next visit to the office. If the problem with your braces was caused by an injury (such as a blow to the mouth), seek help right away. Your orthodontist will let you know if you need immediate attention or if the problem can wait until your next appointment.

What You Can Do

Braces, bands or wires sometimes break or fall off. Usually this is caused by chewing hard or sticky foods. More often, one of the parts will come loose. This can cause some discomfort. Here are a few possible problems:

* Loose bracket (brace) — The braces (also called brackets) are the metal or ceramic pieces that are attached to your teeth. They’re usually attached using a material called composite resin. It is similar to the tooth-colored material used for some fillings. If you chew something hard or sticky, the resin can weaken or break. When that happens, a bracket can come loose. It may poke into your gums, tongue or cheek. When you first get your braces, your orthodontist will give you a special wax. You can put the wax over the bracket to keep it from poking you. This should provide some comfort until you can see your orthodontist.
* Loose band — Bands are the metal rings that are cemented around back teeth (and sometimes around front teeth). If a band becomes loose, call for an appointment to have it re-cemented or replaced. If the band comes off completely, do not try to put it back on. Save it and bring it to your appointment.
* Protruding or broken wire — This is a common problem. If a wire breaks or sticks out, it can hurt your cheek, tongue or gum. You may be able to use the eraser end of a pencil to push the wire into a better position. If that doesn’t work, put a small piece of orthodontic wax over the end of the wire. Do not cut the wire. A cut wire can be accidentally swallowed or inhaled. If the wire has caused a sore, rinse your mouth with warm salt water or an antiseptic rinse. For salt water, use one-half teaspoon of salt in 8 ounces of water. Rinsing will keep the area clean and reduce discomfort. You can also use an over-the-counter pain reliever (such as Anbesol). This will temporarily numb the area. If the pain doesn’t get better or the sore seems to be getting worse, call your orthodontist.
* Loose spacer — Spacers or separators are rubber rings that are put between your teeth. They are left in place usually for a few days. They open a small space between your teeth so that orthodontic bands will slip onto your teeth easily. Springs or brass wire may be used for this purpose. Sometimes spacers can slip out of position or fall out. If this happens, make an appointment with your orthodontist to have them replaced.

What Your Orthodontist Will Do

Broken brackets, loose bands or wires take time to repair. Sometimes your orthodontist will adjust, reposition or reattach the existing wires or brackets. Sometimes your orthodontist will replace brackets or wires.

If you do not have any discomfort and the problem will not interfere with treatment, the orthodontist may delay repairs until your next regular appointment. In any case, call the office before that regular appointment to make sure that enough time is scheduled to complete the repairs.

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Protecting Your Healthy Smile while Wearing Braces

Oral care throughout orthodontic treatment
Orthodontic treatment is an important investment in your future. Everyone helping with your orthodontic care wants you to have the best results possible. While you are wearing braces, it is essential that you take care of your teeth and gums. This article explains why and how.

More care needed during orthodontics
Have a look in the mirror at your new braces. As you see, the brackets and wires have many nooks and crannies that can trap food and plaque. This means your risk of tooth decay and gum problems may be higher while you are wearing braces.

You need to pay special attention to cleaning your teeth everyday and to your diet. Permanent damage to tooth enamel can occur if the teeth and brackets are not kept clean.

Areas on the enamel surface may begin to lose minerals (the early stage of tooth decay), leaving unsightly white spots. You may also develop inflamed, bleeding gums (gingivitis). Gingivitis and the early stages of tooth decay can be reversed by taking extra care with your cleaning and diet. If left untreated, they can lead to bigger problems that will require treatment and have life-long effects. While you are having orthodontic treatment, you need to continue to have regular check-ups with your family dental professional to ensure little problems don’t become big ones.

Tooth-friendly diet
Dental professionals are increasingly concerned about acidic foods and drinks that can damage tooth enamel when consumed frequently or when sipped over extended periods of time.

The chart below shows you how some common food and drinks stack up against one another. While many high acid foods are healthy for your body, low acid foods are better for your teeth. Remember- during orthodontic treatment, it’s best to choose low acid foods when you sit down to eat.
Less Tooth-Friendly
Foods Drinks
(High Acid) More Tooth-Friendly
Foods Drinks
(Low Acid)
Apples, cherries, oranges, peaches, pears, plums, pineapples, raspberries Bananas, mangoes, melons
Tomatoes, pickles Carrots, cucumbers, lettuce, beets
Soft drinks (regular & diet), sports drinks, fruit drinks Milk, water
Vinaigrette dressings, BBQ sauces, salsas Meat, poultry, seafood,eggs, crackers, soups, pasta

Most of us are well aware that sugary foods and drinks can lead to tooth decay. Starchy foods, such as potato chips, can also stick to teeth for long periods of time and cause tooth decay.

Soda is especially hard on teeth because it not only contains acidic flavor additives, but it also includes 10–12 teaspoons of sugar, which further increases your chance of developing cavities. Studies show that diet sodas are just as damaging as regular sodas at weakening tooth enamel.1

Saliva is your body’s natural defense against tooth decay. You need to give saliva plenty of time to wash away acids that form after eating and drinking. A good rule to follow is to limit eating times each day to 3 meals and 2 snack times. You can drink plenty of water as often as you like! Be aware that bottled water may not contain fluoride.

Braces-friendly diet & habits
There are foods that can loosen, break or bend wires and bands when you are wearing braces.

Avoid hard foods such as nuts and hard cookies. Foods such as apples and carrots should be chopped into small pieces before eating to reduce the stress on your braces. Avoid sticky foods such as caramels, toffees, muesli or fruit bars. No chewing gum! No chewing ice!

Habits such as nail biting, unnatural tongue thrusting, pencil chewing and nervous picking at your wires can also break braces. Be aware of these and make an effort to stop them. Remember that damaged braces mean extra appointments, inconvenience and extended treatment time. If you do break your braces, be sure to make an appointment with your orthodontist immediately. Broken braces are not correcting your teeth!

Care at home
When cleaning your mouth while you are wearing braces, you need to pay special attention not only to your teeth and gums, but also to the brackets and wires.

Here are 8 simple steps for keeping your teeth, gums and braces in great shape:

1. If your orthodontist has fitted you with elastics, remove them before brushing.
2. Using a fluoride toothpaste and a soft, compact toothbrush, place your brush at an angle of 45 degrees against the gums. Gently brush along the gum line where the gums and teeth meet, using a small circular motion on each tooth.
3. Spend about 10 seconds on each tooth before moving onto the next tooth, brushing in a set pattern so that you don’t miss any teeth.
4. Gently brush the braces. Press your toothbrush firmly enough so that the bristles spread into the gaps between the wire and the tooth. Brush in and around all of the brackets and wires. Ensure that you brush under the wires. A battery powered brush may be helpful.
5. Brush both the inside and the outside surfaces of your teeth using a gentle circular motion on each tooth.
6. For the chewing surfaces, use a firm back and forth motion.
7. Spit out excess paste, then closely inspect your teeth and braces in the mirror to check that they are clean and shiny.
8. Replace your elastics in accordance with your orthodontist’s recommendation.

Fluoride and oral care products
Fluoride protection against tooth decay is needed throughout life. However, while you are wearing braces, it is much harder to keep your teeth clean. This can result in higher than normal amounts of plaque accumulation, which can cause cavities.

Using fluoride toothpaste after each meal or at least twice a day is one of the most proven ways to help you stay decay free. Fluoride makes teeth more resistant to the acids produced after eating or drinking and replaces minerals that are lost in the early stages of tooth decay.

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Pregnancy, Oral Health and Your Baby

When you’re pregnant, it seems everyone has advice for you — on what to eat, how to prevent morning sickness, how to keep stretch marks at bay. It’s likely, however, that no one has ever told you how important it is to take care of your oral health.

In fact, some people still believe that the state of your gums and teeth will decline during pregnancy and that there’s nothing you can do about it. The saying goes something like, “You lose a tooth for every baby.”

These beliefs are out of date. It’s true that the hormonal changes of pregnancy cause many women to experience “pregnancy gingivitis” — swelling, bleeding or tenderness in the gums. But you aren’t doomed to have dental problems when you’re pregnant. Keeping your mouth healthy before and during your pregnancy will improve your chances of having a healthy pregnancy and a healthy baby.

Periodontal disease and tooth decay (what dentists call “dental caries”) are the two most common diseases of the mouth. Having either one, or both, can affect your pregnancy or the health of your baby.

Pregnant women with periodontal disease may be at a higher risk of problems such as premature delivery or low birth weight babies. And women with current tooth decay, or a history of extensive tooth decay, are at greater risk of having children who get cavities before the age of 5.

Periodontal Disease and Pregnancy
About 12% of babies are born prematurely in the United States; that’s up from 10% in 1985. Women most at risk for giving birth prematurely are those with a history of premature birth, those carrying multiple fetuses (twins, triplets, etc.), and those with certain abnormalities of the uterus or cervix. But the answers aren’t clear as to why many other infants are born too soon.

In 1996, a study found that women who gave birth before the 37th week of pregnancy tended to have advanced periodontal disease. The same was true of women who had babies weighing less than 2,500 grams (about 5.5 pounds). Women with severe periodontal disease were found to have seven times the risk of giving birth prematurely, or having a baby with a low birth weight, as women who had healthy gums.

The researchers calculated that advanced periodontal disease could be linked to about 18% of premature births in the United States.

Since then, several other studies have found that pregnant women with periodontal disease — either severe or mild — are more likely than other women to give birth early (before 37 weeks of pregnancy), to give birth to babies with a low birth weight, or both. However, other research has not found a link between periodontal disease and these birth outcomes.

Is it possible that periodontal disease can lead to premature births? Research is still teasing out the answers. However, it appears that the body’s attempt to fight the bacteria associated with periodontal disease may induce early labor.

Only a few studies have looked at what happens if pregnant women get treated for periodontal disease. A common treatment is scaling and root planing, which involves a thorough cleaning of the crowns and roots of the teeth. Some studies have found that this treatment can reduce the risk of preterm birth. Other studies have not shown such an effect.

However, the studies have shown that periodontal treatment given during the second trimester of pregnancy is safe for both the mother and the unborn baby.

Periodontal disease also may contribute to preeclampsia. This is a poorly understood and potentially dangerous condition that sharply increases blood pressure. Preeclampsia affects about 5% of pregnant women. The only cure is giving birth, which can put the baby at risk if delivery is premature. For the mother, complications can include stroke, kidney failure and hemorrhage.

So far, a few studies have linked preeclampsia with periodontal disease. More research is needed to discover whether there is a cause-effect relationship.

Dental Caries
Tooth decay is a bacterial infection. Infants aren’t born with the bacteria that cause decay. Most acquire these bacteria from their mothers before their third birthday.

Common ways to transmit these bacteria are kissing, sharing utensils, cleaning off a pacifier with your mouth, or an infant putting his or her hand in your mouth. Mothers with active tooth decay will have more decay-causing bacteria. Therefore, their children are more likely to acquire them early in life, and more likely to get tooth decay.

If you are pregnant and have cavities, you can reduce your child’s risk of developing early tooth decay by improving your own oral health. This can greatly reduce the number of cavity-causing bacteria in your mouth and reduce the chance that you will spread them to your child.

Here are some important steps you can take:

* See a dentist for treatment of all untreated cavities.
* Brush and floss daily.
* Use products, such as chewing gum and mints, that contain xylitol.

Research has shown that pregnant women and new mothers who use products that contain xylitol can reduce the number of decay-causing bacteria in their mouths. You need to use the products every day for months for them to work, but this is another way to reduce the risk of tooth decay in your young children.

Before You Become Pregnant
If you are planning to get pregnant, visit your dentist for an exam. This way, you can receive any necessary treatment before you become pregnant.

A dental visit before pregnancy will reduce your risk of having a dental emergency during pregnancy and give you a chance to schedule dental visits during your pregnancy.

Visiting the Dentist During Pregnancy
Many women steer clear of the dentist during pregnancy, believing that certain practices might be harmful to the fetus. But dental care during pregnancy is an important part of keeping you, and your baby, healthy. Having a healthy mouth during pregnancy may reduce the risk of delivering a premature or low birth weight baby.

Because of the hormonal changes that occur during pregnancy, the chance of developing “pregnancy gingivitis” and periodontal disease increases. This is because during pregnancy the immune system may work differently than usual and alter the way the body reacts to the bacteria that cause gum disease. Cleaning the tooth surfaces often helps to relieve the symptoms of “pregnancy gingivitis” and improves overall oral heath.

If scaling and root planing to treat periodontal disease is necessary during pregnancy, the American Academy of Periodontology recommends scheduling it early in the second trimester.

While no research has shown that treatment during pregnancy is dangerous, dentists recommend scheduling non-urgent care for the second trimester or early in the third trimester of pregnancy.

The second trimester is considered best because during the first trimester, the fetus’s organ systems are developing. Also, during the first trimester the fetus is more likely to be affected by things that the expectant mother is exposed to such as medications, chemicals, caffeine, alcohol and tobacco.

The third trimester presents other possible risks. In the last half of the third trimester, the uterus becomes sensitive to external influences, such as whether the expectant mother becomes stressed or develops an infection. These situations can lead to an increased risk of premature delivery.

In some women who are in their second and third trimester of pregnancy, the growing uterus will put pressure on a large blood vessel called the inferior vena cava. This can cause a decrease in blood circulation. This problem has been reported in as many as 8% of all pregnancies. Women with this condition can experience an increase in heart rate and a light-headed feeling.

A dentist who treats a woman with this condition should make sure that she can get in a comfortable position during the dental procedure. It’s also a good idea to limit the length of the visit.

Regardless of the trimester, urgent dental treatment should not wait. Examples of urgent dental problems include a broken tooth, an infection or another problem that causes pain.

It is best to avoid using any medications during pregnancy. In situations where they are absolutely necessary, common dental medications can be used. They should be used in the smallest amounts possible to achieve results.

X-rays should be avoided during pregnancy. However, if they are needed to treat a dental emergency your dentist will take steps to protect you and your baby. He or she will cover you with a lead apron and will take the minimum number of X-rays needed to provide diagnostic information.

If you are pregnant and have bleeding gums, swollen gums, gum pain or a toothache, visit your dentist so he or she can diagnose the problem. When you visit, be sure to tell your dentist that you are pregnant.

Local anesthetics and nitrous oxide sedation should be used with caution during pregnancy.

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How Pregnancy Affects Your Oral Health

Pregnancy affects nearly every aspect of a woman’s life, including her oral health. You may think of your oral health as just one more thing to worry about, but taking care of your mouth and teeth is important during pregnancy.

What are the special oral health concerns of pregnant women?

Pregnancy Gingivitis
Most women notice changes in their gums during pregnancy. Some women notice that their gums look redder and bleed when they brush their teeth. And some women have severe swelling and bleeding.

All of these changes are referred to as “pregnancy gingivitis.” They can start as early as the second month. The condition tends to peak around the eighth month and then taper off after the baby is born.

Pregnancy gingivitis is most common in the front of the mouth. The symptoms are the same as those for gingivitis, but some of the causes are different. Increased hormone levels may be partly responsible for pregnancy gingivitis. During pregnancy, the level of progesterone in your body can be 10 times higher than normal. This may enhance growth of certain bacteria that cause gingivitis. Also, your immune system may work differently during pregnancy. This could change the way your body reacts to the bacteria that cause gingivitis.

To minimize the effects of pregnancy gingivitis, practice good oral hygiene: Brush twice a day, for at least two minutes each time. Floss every day. Using an antimicrobial mouth rinse also may help you control your gum infection. Some dentists suggest using rinses that don’t contain alcohol, but it is not clear whether alcohol-based rinses have a negative effect on pregnancy.

Be sure to have your dentist check the health of your gums while you are pregnant. Pregnancy gingivitis usually can be treated with a professional cleaning. This can be done at any time during your pregnancy, but preferably during the second trimester. More aggressive treatments, such as periodontal surgery, should be postponed until after delivery.

Pregnancy Granuloma (Pyogenic Granuloma or Pregnancy Tumor)
A pregnancy granuloma is a growth on the gums that occurs in 2% to 10% of pregnant women. It is also known as a pyogenic granuloma or pregnancy tumor. Pregnancy tumors are misnamed. They are not actually tumors and are not cancerous. They are not even dangerous, although they can cause discomfort.

Pregnancy granulomas usually develop in the second trimester. They are red nodules, typically found near the upper gum line, but can also be found elsewhere in the mouth. These growths bleed easily and can form an ulcer or crust over. Pregnancy granulomas usually are attached to the gum or mucous membrane by a narrow stalk of tissue.

The exact cause of pregnancy granulomas is unknown, although poor oral hygiene is a primary factor. Trauma, hormones, viruses and blood vessel malformations have also been suspected as co-factors. Women with these growths usually have widespread pregnancy gingivitis.

Pregnancy granulomas will disappear after your baby is born. If a growth interferes with speaking or eating, you may need to have it removed before you give birth. However, about half the time, the growth will come back after it has been removed.

Tooth Erosion
In women with severe morning sickness, frequent vomiting can erode the enamel on the back of the front teeth. If you are vomiting frequently, contact your dental office for information on how to prevent enamel erosion.

Dry Mouth
Many pregnant women complain of dry mouth. You can combat dry mouth by drinking plenty of water and by using sugarless hard candies or gum to stimulate saliva secretion and keep your mouth moist.

Excessive Saliva
Less commonly, pregnant women feel they have too much saliva in their mouths. This condition occurs very early in a pregnancy. It disappears by the end of the first trimester. It may be associated with nausea.

I’ve heard that pregnant women lose a tooth for every child. Is that true?

No. This is a myth. People used to think that a developing fetus who did not get enough calcium would absorb it from the mother’s teeth. This is not the case. If you practice good brushing and flossing habits, you are no more likely to get cavities or lose teeth during your pregnancy than at any other time.

How should I take care of my teeth and mouth while I’m pregnant?

Eat a well-balanced, nutritious diet with plenty of protein, calcium and vitamins A, C and D. Brush your teeth twice a day for at least two minutes each time. Use fluoride toothpaste. Floss at least once a day. Using an antibacterial mouthwash can help destroy bacteria that contribute to gingivitis. Using an antibacterial mouthwash can help destroy bacteria that contribute to gingivitis. Some dentists suggest using a mouthwash that doesn’t contain alcohol, but it is not clear whether alcohol-based mouthwashes have a negative effect on pregnancy. Use as directed.

Is it safe to visit the dentist while I’m pregnant?

The second trimester is the best time to receive routine dental care. If possible, major procedures, reconstruction and surgery should be avoided until after the baby is born.

Try to avoid dental visits during the first trimester and the last half of the third trimester. During the first trimester, the fetus’s organ systems are developing, and the fetus is highly sensitive to influences from the environment. In the last half of the third trimester, there is some risk of premature delivery because the uterus is sensitive to external influences. Also, at the end of your pregnancy, it can be uncomfortable to sit in a dentist’s chair. After about 20 weeks’ gestation, pregnant women should not lie on their backs for long periods of time because this can put pressure on large blood vessels and cause changes in circulation.

What should I do about emergency dental treatment while pregnant?

You should receive treatment if it is necessary to ease your pain, prevent infection or decrease stress on you and your fetus. Your dentist should consult with your obstetrician or midwife if there are questions about the safety of medicines or anesthesia.

Is it safe to get dental X-rays while I’m pregnant?

Advances in technology have made dental X-rays much safer. Studies have shown that using a lead apron will protect you and your fetus from radiation. However, most dentists do not recommend dental X-rays if you are pregnant or think you may be pregnant. X-rays usually are taken if they are needed for diagnosis or treatment that cannot wait until after the baby is born.

Can I take dental medications while pregnant?

Ideally, you should not take any medicines during pregnancy, especially during your first trimester. However, sometimes this is simply not possible because the benefits of a medicine outweigh the risks related to its use. Most common dental medicines can be used during pregnancy. However, some — such as sedatives and certain antibiotics — should be avoided.

The U.S. Food and Drug Administration classifies many prescription drugs at different levels of risk to the fetus. There are five categories: A, B, C, D and X. Pregnancy Category A drugs are the safest. Pregnancy Category X drugs are known to be harmful to the fetus.

Always talk to your dentist about any medicines he or she prescribes during your pregnancy.

Can I take dental medications while nursing?

The amount of drug excreted into breast milk is usually about 1% to 2% of the dose you take. So it is highly unlikely that any dental medicines will affect your baby.

However, to minimize risk, take any medicines just after your baby has nursed. Then, try to avoid nursing for at least four hours or as long as you can. This will minimize the amount of drug that enters your breast milk. Most drugs reach their maximum concentration in milk one or two hours after you take them.

Your dentist may want to discuss medicine options with your physician and/or your child’s pediatrician.

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Anesthesia During Pregnancy

If you are pregnant or think you might be pregnant, tell your dentist during your visit.

During the first trimester, it is best to avoid any dental treatment that’s not essential. After that point, discuss your anesthesia options with your dentist and your obstetrician or midwife. They can help to decide on the safest choice for you.

Local Anesthetics

Sometimes a dentist will give you a shot to numb part of your mouth. This is called a local anesthetic. Pregnant women can receive some local anesthetics for necessary treatment. But most dentists say it’s best to have dental treatment before pregnancy or postpone treatment that’s not essential.

Nursing women can receive normal doses of local anesthetics. This does not affect the baby.

If possible, pregnant women should avoid local anesthetics that contain epinephrine. If it accidentally enters a blood vessel, it could reduce the blood supply to the placenta. It also could cause spasms in blood vessels. Spasms could affect the arteries that supply the uterus.


Sedation makes you drowsy and less anxious. Pregnant women should avoid nitrous oxide, particularly during the first trimester. There are many other options to reduce dental anxiety. Examples include listening to music or acupuncture. Women who are pregnant or could be pregnant should not be given diazepam or similar drugs.

General Anesthesia

General anesthesia causes you to become unconscious. The effects of general anesthesia on a pregnant woman and her fetus vary. It depends on the drugs used. In most cases, pregnant women should avoid general anesthesia. If you are pregnant or believe you may be pregnant, tell your dentist or oral surgeon.

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Oral Health Through Pregnancy

Follow these steps for a healthy mouth.

* Have a Dental Checkup.
Get your teeth cleaned and checked. Be sure to get any needed dental work done. The germs that cause cavities can be passed on to your baby after it is born.
* Brush Twice a Day
Brush at least twice a day with fluoride toothpaste. Use a soft toothbrush. Be sure to put the bristles of the toothbrush where the teeth and gums meet. This is where gum disease starts.
* Floss daily.
Floss daily to clean between the teeth where a toothbrush can’t reach.
* Limit the Number of Times You Eat Sweet or Starchy Snacks Each Day.
Sweet or starchy snacks can cause “acid attacks” on your teeth. Drink fewer sugary drinks and eat fewer sweets. Soda and sweets may cause cavities. Eat more fruits and vegetables.
* Seek Prenatal Care.
Follow the advice of your health care professional. This is important for your health and the health of your baby.
* Get Adequate Calcium.
You need calcium for your baby’s teeth and bones. Calcium can be found in milk, cheese, dried beans, and leafy green vegetables.

0-6 months
Babies need healthy teeth to eat, talk, and smile. Here are three ways to protect your baby’s smile.

* Check Out Fluoride.
Fluoride prevents cavities and makes teeth stronger. Ask your dentist or doctor if your water has the right amount of fluoride in it to help prevent cavities. If your water does not have fluoride in it, or if you use bottled water for drinking or cooking, your dentist or doctor may prescribe fluoride supplements for baby.
* Avoid Putting Baby to Bed with a Bottle.
Putting a bottle in bed with baby can cause lots of cavities. If you breast-feed, avoid letting baby nurse continuously. Any liquid except water – even milk and juice – can cause cavities. If you think your baby needs to suck on something while sleeping, try a pacifier or a bottle with only water in it.

Take Care of Your Own Oral Health, Too.
New research shows that you can pass on cavity-causing germs once the baby has teeth. This can happen by sharing and/or tasting the baby’s food or letting baby stick her fingers in your mouth. Having unfilled cavities also means there is more chance to transmit these germs, so any cavities should be filled as soon as possible!

Preventing Early Childhood Cavities
Early Childhood Cavities is a serious dental disease. The result of this disease is cavities, pain, infection, early tooth loss, speech problems, and loss of self esteem.

Early Childhood Cavities is preventable. Here are a few tips:

* Avoid putting baby to bed with a bottle or letting baby nurse continuously
* The only liquid that will not harm your baby’s teeth is water
* According to the American Public Health Association, baby should be weaned by age 12-14 months

6-18 months
Here are four ways to protect baby’s smile.

* When baby is between 6 to 12 months, begin using a sippee cup.
As soon as baby begins reaching for your jewelry and holding toys, it is time to introduce the sippee cup. It may be messy at first, but keep at it. Baby will love learning this new skill!
* Avoid letting baby walk around with a bottle.
Prolonged exposure to the bottle can lead to a serious condition known as “Early Childhood Cavities.”
* Clean baby’s teeth daily.
When the baby teeth begin to erupt at about 6 months, you should clean baby’s teeth every day with a soft, damp, baby toothbrush. The best position will probably be for you to sit down and hold baby in your arms. You can also sit on the floor and lay baby’s head in your lap. Check baby’s teeth for cavities. Lift baby’s lip and look at the teeth. If you see brown spots or chalky white spots, call your dentist.
* Visit the dentist.
Once baby reaches his/her first birthday, it’s time to take baby for the first dental visit!

18-24 months
These are three important ways to protect your toddler’s smile.


Limit the number of times toddler eats snacks each day.
Avoid giving your child soda pop, sweets, and starchy foods like chips and crackers. These snacks can cause cavities.

Avoid constant snacking. Every time your child eats a sweet or starchy food, there is an “acid attack” on the teeth. The more “acid attacks,” the more cavities. If you decide to offer a sweet or starchy food, give it at mealtimes.

Caution; According to the American Academy of Pediatrics, your child should not be using the bottle now.
Bottle feeding for long periods of time or while sleeping can lead to tooth decay. This decay can cause pain and infection and also ruin your child’s beautiful smile!

Snack List for Healthy Teeth
Love your children by giving them teeth-healthy snacks.
* Fruit
* Vegetables
* Sandwiches
* Cereal with milk
* Cheese
* Yogurt
* Milk
* Juice without added sugar

Limit snacking to 2-3 times per day.

Brush at least twice a day.
Brush toddler’s teeth after breakfast and before bedtime. Use a soft, child-sized toothbrush to clean the teeth and gums. If your child knows how to spit out after brushing, use a “pea-sized” dab of fluoride toothpaste on the toothbrush.

Your child can begin to practice brushing his or her own teeth, but you will need to help. When your child is done brushing, then you should finish the job. Most young children don’t brush well until they are about 6 years old.

Remember – the dentist is your partner!
After the first checkup at age 1, your child should visit the dentist regularly.

Before you go, you may want to play dentist with your child. Use a flashlight and mirror and count each other’s teeth. Read books to your child about going to the dentist.

Remind your child what will happen during the dental visit. You might say “The dentist wants to see you again – and maybe take a picture of your teeth!” Keep the message positive.

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Pregnancy Prenatal Care and Oral Health

Can Oral Health Have an Effect on Pregnancy?
Growing evidence suggests a link between gum disease and premature, underweight births. Pregnant women who have gum disease may be more likely to have a baby that is born too early and too small.

More research is needed to confirm how gum disease affects pregnancy outcomes. But it appears that gum disease triggers increased levels of biological fluids that induce labor. Data also suggests that when gum disease worsens during pregnancy, there’s a higher risk of having a premature baby.

What Can I Do to Ensure I Have a Healthy Pregnancy?
The best advice to women considering pregnancy is to visit their dentist for a checkup and to treat any oral problems before becoming pregnant.

During your pregnancy, your teeth and gums need special attention. Regular brushing and flossing, eating a balanced diet and visiting your dentist regularly will help reduce dental problems that accompany pregnancy.

What Oral Problems Might Develop During My Pregnancy?
Studies show that many pregnant women experience pregnancy gingivitis — when dental plaque builds up on the teeth and irritates the gums. Symptoms include red, inflamed and bleeding gums.

Pregnancy gingivitis occurs more frequently during pregnancy because the increased level of hormones exaggerates the way gums react to the irritants in plaque. However, it’s still plaque — not hormones — that is the major cause of gingivitis.

Keeping your teeth clean, especially near the gumline, will help dramatically reduce or even prevent gingivitis during your pregnancy. And substituting sweets with more wholesome foods such as cheese, fresh fruits or vegetables is better for your teeth.

What Can I Expect When I Visit My Dentist During My Pregnancy?
First, be sure to let your dentist know you’re pregnant when you schedule your appointment. It’s best to schedule your dental visit during the fourth to sixth month of your pregnancy. This is because the first three months of pregnancy are thought to be of greatest importance in your child’s development. During the last trimester, stresses associated with dental visits can increase the incidence of prenatal complications.

Typically, X-rays, dental anesthetics, pain medications and antibiotics (especially tetracycline) are not prescribed during the first trimester, unless it’s absolutely necessary. During the last three months of pregnancy, sitting for long periods of time in the dental chair can become uncomfortable. And there is evidence that pregnant women can be more prone to gagging. Your dentist, however, is prepared for this situation.

If you need to schedule an emergency visit, let the office know about your pregnancy before you arrive. Discuss any stresses, past miscarriages and drugs you are taking as these can all have an influence on how your dentist attends your needs. Your dentist may also want to consult with your physician before any treatment is started.

If you have any doubts or concerns, insist that your dentist and physician discuss your particular needs. If your dentist prescribes medication, do not exceed the prescribed dosage. This includes aspirin.

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Flouride Treatments and Supplements

What Is It?

Fluoride is a naturally occurring element that strengthens teeth. In doing this, it can help to prevent tooth decay. Experts say the best way to prevent tooth decay is to use several sources of fluoride.

Fluoride is found naturally in water sources in small amounts. Some foods, such as meat, fish, eggs and tea, contain fluoride. It also is added to water in some areas. Many toothpastes, rinses and professional treatments contain fluoride. Prescription fluoride tablets are available for children who do not get fluoride in their water.

What It’s Used For

Enamel is the outer layer of the crown of a tooth (the visible part). It is made of closely packed mineral crystals. Every day, the enamel loses and gains minerals. The loss of minerals is called demineralization. Gaining new minerals is called remineralization. These two processes balance each other.

Demineralization begins with the type of bacteria that cause plaque on your teeth. These bacteria feed on sugar in your mouth and produce acids. The acids dissolve the crystals in your teeth. Remineralization builds the enamel back up. In this process, minerals such as fluoride, calcium and phosphate are deposited inside the enamel. Too much loss of minerals without enough repair of the enamel leads to tooth decay.

Fluoride strengthens teeth by helping to speed remineralization. It also helps to stop bacteria from making acids. Teeth can absorb fluoride in two ways. One way is through the small doses that children swallow in food, supplements and fluoridated water. This fluoride enters the bloodstream and becomes part of the permanent teeth as they develop. The teeth become stronger, so it is harder for acids to destroy the enamel.

Fluoride also can enter teeth directly in the mouth. This occurs in several ways:

* When you get a fluoride treatment at the dental office
* When you brush with fluoride toothpaste or use a fluoride rinse
* When fluoridated water washes over your teeth as you drink

Fluoride treatments commonly are given to children as their teeth are developing. If your child has a history of cavities or is at high risk of decay, he or she should use additional fluoride. This promotes remineralization of the teeth. Many children get fluoride treatments every six months. The treatments provide extra protection against cavities, even if children already drink fluoridated water.

Fluoride mouth rinses also can help children with a history of cavities or a high risk of decay. These rinses are recommended for children over age 6. You can find them in the mouthwash section of most stores. Prescription fluoride rinses and gels that provide a higher level of fluoride also are available.

Fluoride supplements generally are reserved for children between the ages of 6 months and 16 years who don’t drink fluoridated water. These are available as liquids for younger children and tablets for older children. Either your pediatrician or your dentist can prescribe them.

Fluoride treatments help all teeth. They help to prevent decay in both children and adults. Anyone who is at risk of dental decay is a good candidate for fluoride treatments.

Factors that increase the risk of tooth decay include:

* A history of cavities
* Infrequent dental visits
* Poor brushing habits
* Poor diet habits, especially frequent snacking

Many common medicines can cause the mouth to be dry. Examples include antihistamines and medicines for high blood pressure, anxiety and depression. Without enough saliva, tooth decay gets worse quickly.


Before you have an in-office fluoride treatment, your teeth should be clean. Your dentist may need to polish away stains. If you use fluoride rinses or gels at home, first brush your teeth thoroughly and floss them. It’s a good idea to use fluoride products at night before bedtime. When you are sleeping, they are less likely to be washed or rinsed away.

How It’s Done

The fluoride treatments you receive in a dental office have more fluoride than over-the-counter fluoride mouthwash or toothpaste. They are used for both children and adults. Dental-office treatments also are different chemically and stay on the teeth longer.

There are two common types of professionally applied fluorides. Acidulated phosphate fluoride (APF) is acidic; neutral sodium fluoride is not. Neutral sodium fluoride usually is used for people who have dry mouth (xerostomia) or who have tooth-colored fillings, crowns or bridges. An acidic fluoride may irritate a mouth that is dry. It also can create small pits in composite fillings.

Fluoride is applied as a gel, foam or varnish during a dental appointment. The teeth are dried so the fluoride doesn’t become diluted. Fluoride can be applied by using a tray that looks like a mouth guard for one to four minutes. Fluoride also can be painted directly on the teeth. It comes in a variety of flavors, but it should never be swallowed.

Fluoride supplements are usually used in children. They are taken in small quantities. The daily dose ranges from 0.25 to 1 milligram. The amount is based on the child’s age and the amount of fluoride in the water he or she drinks.

Dentists do not prescribe more than 264 milligrams of fluoride tablets at a time. That’s because the toxic dose of fluoride for a 2-year-old child weighing 22 pounds is 320 milligrams. To avoid any chance of overdose, do not stock up on fluoride tablets. If you have any questions regarding fluoride risks, talk to your dentist or physician.

Everyone should use fluoridated toothpaste. Be careful with young children. They are more likely to swallow the toothpaste than to spit it out. Use only a pea-sized amount of toothpaste when they brush. Encourage them to spit out as much as possible. Avoid flavored toothpastes that may encourage swallowing.


Don’t eat, drink or smoke for at least 30 minutes after a professional fluoride treatment. This helps to increase the fluoride’s contact with the teeth.


As with other compounds, fluoride is safe and effective when used properly. However, it can be hazardous at high doses. All water-fluoridation systems are checked daily to maintain safe fluoride levels. Parents should supervise the use of all fluoride products, including toothpaste, in the home. Keep fluoride tablets stored safely away from young children.

Toxic fluoride doses are based on weight. For instance, a toxic dose of fluoride for an 8-year-old child weighing 45 pounds is 655 milligrams. In comparison, an 8-ounce glass of water with 1 part per million of fluoride contains 0.25 milligrams of fluoride. A small dab of toothpaste contains 0.24 milligrams of fluoride. Since these fluoride products are used in such small amounts, it is very difficult to receive toxic doses in a home setting.

When used properly, fluoride is safe and effective. Young children, in particular, should be supervised during in-office treatments and when using fluoride products at home. If they swallow too much fluoride, young children may become nauseous. Also, too much fluoride can cause spots to form on the enamel of any developing teeth. The spots will be visible when these teeth come into the mouth. Discuss these concerns with your dental professional. He or she can recommend which fluoride products are appropriate for you.

When To Call a Professional

It is important that you talk to your dentist or dental hygienist about any fluoride products you are using. Your dentist or hygienist can consider all sources of supplemental fluoride and determine which are best for you or your child.

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What Is It?

Your permanent teeth form under your gums in the jawbone during early childhood. They appear in your mouth after the primary or “baby” teeth are lost. The crowns of nearly all of the permanent teeth are fully formed by the time you are about 8 years old. The exception is the wisdom teeth, which form in young adulthood. The crown is the part of a tooth you can see in your mouth.

Consuming too much fluoride while the teeth are being formed can lead to fluorosis. This condition causes white or brown discoloration or spots on the enamel, or tooth surface. The effects can range from minor color changes to surface irregularities of the teeth. Fluorosis does not develop after teeth have erupted into the mouth.

Fluorosis is a cosmetic condition, not a disease. Often, it is so mild that only a dental professional can detect it. Most cases of fluorosis result from young children taking fluoride supplements or swallowing fluoride toothpaste when the water they drink is already fluoridated.


Teeth affected by mild fluorosis may show no changes or changes visible only to a dental professional. Mild to moderate fluorosis produces white lines, streaks or spots. In more severe fluorosis, the teeth can become pitted and have brown, gray or black spots. The enamel also may have an unusual shape.


Your dentist and dental hygienist will ask about your child’s fluoride intake. This will help to determine if the discoloration seen is a result of fluorosis. They also will ask about past and present medical conditions or disabilities that may affect your child’s teeth. Your dentist will examine your child’s teeth and gums and take X-rays to make sure the teeth have no other defects or cavities.

Other conditions may look like fluorosis. Developmental defects and problems with the skull or bones of the face can disrupt the enamel or dentin of the teeth. In addition, high fevers or trauma (such as a fall that injures a tooth) in infants or young children may discolor teeth. Young children can get cavities in their primary teeth, so any tooth discoloration should be checked at the dental office.

Expected Duration

The spots and stains left by fluorosis are permanent. They may darken over time.


If you have a child under 6, put only a small pea-sized amount of toothpaste on his or her toothbrush. Encourage your child to spit rather than swallow after brushing. Avoid toothpastes with flavors that may encourage swallowing. Keep all fluoride-containing products out of the reach of young children. These include toothpastes and mouthwashes.

Adding fluoride to drinking water is one of the great preventive disease programs of the 20th century. Children should take fluoride supplements only if the water they drink does not contain enough fluoride. If your child is taking fluoride supplements now, check the amount of fluoride in your water. If you are on a public water supply, call your supplier to ask about the fluoride level. You can also have your dentist check a sample of your water. Then discuss with your dentist or pediatrician whether your child needs fluoride supplements.

Some foods and drinks contain fluoride. For example, many fruit juices and soft drinks contain fluoride at levels similar to fluoridated water. Some bottled waters now have added fluoride. All of this can add up. It is important to know how much fluoride your child consumes.


Remember that fluorosis affects only the appearance of teeth. It does not result in cavities. As a result, most of the treatment for fluorosis consists of masking the stain.

Many cases of fluorosis are minor enough not to need treatment. Sometimes fluorosis occurs only on the back teeth, where it can’t be seen. More serious cases and cases involving the front teeth can be treated by removing the surface-stained areas through tooth whitening or other procedures. Severe cases of fluorosis can be covered with bonding, crowns or veneers.

When To Call a Professional

If you notice white streaks or spots on your child’s teeth or notice that one or more teeth are discolored, contact your dental office.


Teeth affected by fluorosis are not diseased. Fluorosis will not result in cavities or other dental problems. Concerns about appearance can be addressed with whitening to remove surface stains and veneers or other procedures to cover the discoloration.

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