Posts for: April, 2021
Breastfeeding is nature's way of providing complete nourishment to a newborn in their first years of life. It can also have a positive impact on their emerging immune system, as well as provide emotional support and stability. But although nursing comes naturally to an infant, there are circumstances that can make it more difficult.
One example is an abnormality that occurs in one in ten babies known as a tongue tie. A tongue tie involves a small band of tissue called a frenum, which connects the underside of the tongue with the floor of the mouth. The frenum, as well as another connecting the inside of the upper lip with the gums, is a normal part of oral anatomy that helps control movement.
But if the frenum is too short, thick or taut, it could restrict the movement of the tongue or lip. This can interfere with the baby acquiring a good seal on the breast nipple that allows them to draw out milk. Instead, the baby may try to chew on the nipple rather than suck on it, leading to an unpleasant experience for both baby and mother.
But this problem can be solved with a minor surgical procedure called a frenotomy (also frenectomy or frenuplasty). It can be a performed in a dentist's office with just a mild numbing agent applied topically to the mouth area (or injected, in rare cases of a thicker frenum) to deaden it. After a few minutes, the baby's tongue is extended to expose the frenum, which is then snipped with scissors or by laser.
There's very little post-op care required (and virtually none if performed with a laser). But there may be a need for a child to “re-learn” how to breastfeed since the abnormal frenum may have caused them to use their oral muscles in a different way to compensate. A lactation expert may be helpful in rehabilitating the baby's muscles to nurse properly.
A restrictive frenum isn't necessarily a dire situation for an infant—they can continue to feed with a bottle filled with formula or pumped breastmilk. But employing this minor procedure can enable them to gain the other benefits associated with breastfeeding.
If you would like more information on tongue ties and other oral abnormalities in 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 “Tongue Ties, Lip Ties and Breastfeeding.”
Although dental care is our primary focus, we dentists are also on the lookout for other health problems that may manifest in the mouth. That's why we're sometimes the first to suspect a patient may have an eating disorder.
Eating disorders are abnormal dietary patterns that can arise from mental or emotional issues, the most common being anorexia nervosa and bulimia nervosa. Each has different behaviors: Anorexics abnormally restrict their food intake (“self-starvation”), while bulimics typically eat heavily and then induce vomiting (“binge and purge”).
Although bulimics are more likely to binge and purge, anorexics may also induce vomiting. That practice in particular can leave a clue for dentists. While vomiting, powerful stomach acid enters the mouth, which can then soften and erode tooth enamel.
It's the pattern of erosion a dentist may notice more than the erosion itself that may indicate an eating disorder. A person while vomiting normally places their tongue against the back of the lower teeth, which somewhat shields them from acid. The more exposed upper teeth will thus tend to show more erosion than the bottom teeth.
A dentist may also notice other signs of an eating disorder. Enlarged salivary glands or a reddened throat and tongue could indicate the use of fingers or objects to induce vomiting. Lack of oral hygiene can be a sign of anorexia, while signs of over-aggressive brushing or flossing may hint of bulimia.
For the sake of the person's overall well-being, the eating disorder should be addressed through professional counseling and therapy. An excellent starting point is the website nationaleatingdisorders.org, sponsored by the National Eating Disorders Association.
The therapy process can be lengthy, so patients should also take steps to protect their teeth in the interim. One important measure is to rinse out the mouth following purging with a little baking soda mixed with water. This will help neutralize oral acid and reduces the risk of erosion. Proper brushing and flossing and regular dental visits can also help prevent dental disease.
An eating disorder can be traumatic for both patients and their families, and can take time to overcome. Even so, patients can reduce its effect on their dental health.
If you would like more information on eating disorders and dental care, 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 “Bulimia, Anorexia & Oral Health.”
It often begins without you realizing it—spreading ever deeper into the gums and damaging tissue attachments, teeth and supporting bone in its way. In the end, it could cause you to lose your teeth.
This is periodontal (gum) disease, a bacterial infection caused by dental plaque, a thin biofilm that accumulates on tooth surfaces. It in turn triggers chronic inflammation, which can cause the gum attachments to teeth to weaken. Detaching gum ligaments may then produce diseased voids—periodontal pockets—that can widen the gap between the teeth and the gums down to the roots.
There is one primary treatment objective for gum disease: uncover and remove any and all plaque and tartar (hardened plaque). If the infection has advanced no further than surface gum tissues, it may simply be a matter of removing plaque at or just below the gum line with hand instruments called scalers or ultrasonic equipment.
The disease, however, is often discovered in more advanced stages: The initial signs of swollen, reddened or bleeding gums might have been ignored or simply didn't appear. Even so, the objective of plaque and tartar removal remains the same, albeit the procedures may be more invasive.
For example, we may need to surgically access areas deep below the gum line. This involves a procedure called flap surgery, which creates an opening in the gum tissues resembling the flap of an envelope. Once the root or bone is exposed, we can then remove any plaque and/or tartar deposits and perform other actions to boost healing.
Antibiotics or other antibacterial substances might also be needed for stopping an infection in advanced stages. Some like the antibiotic tetracycline can be applied topically to the affected areas to directly stop inflammation and infection; others like mouthrinses with chlorhexidine might be used to fight bacteria for an extended period.
Although effective, treatment for advanced gum disease may need to continue indefinitely. The better approach is to focus on preventing a gum infection through daily brushing and flossing and regular dental cleanings. And at the first sign of problems with your teeth and gums, see us as soon as possible—the earlier in the disease progression that we can begin treatment, the better the outcome.
If you would like more information on preventing and treating gum disease, 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 “Treating Difficult Areas of Periodontal Disease.”