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By Vincent M. Immordino, D.M.D., P.A. & Thomas J. Burns, Jr., D.D.S., P.A.
October 20, 2020
Category: Oral Health
KeepYourChildsFluorideIntakeataSafebutEffectiveLevel

Fluoride is an important part of your child's dental development. But if children take in too much of this important mineral, they could experience enamel fluorosis, a condition in which teeth become discolored with dark streaking or mottling.

That's why it's important to keep fluoride levels within safe bounds, especially for children under the age of 9. To do that, here's a look at the most common sources for fluoride your child may take in and how you can moderate them.

Toothpaste. Fluoridated toothpaste is an effective way for your child to receive the benefits of fluoride. But to make sure they're not getting too much, apply only a smear of toothpaste to the brush for infants. When they get a little older you can increase that to a pea-sized amount on the end of the brush. You should also train your child not to swallow toothpaste.

Drinking water. Most water systems add tiny amounts of fluoride to drinking water. To find out how much your water provider adds visit “My Water's Fluoride” online. If it's more than the government's recommendation of 0.70 parts of fluoride per million parts of water, you may want ask your dentist if you should limit your child's consumption of fluoridated drinking water.

Infant formula. Many parents choose bottle-feeding their baby with infant formula rather than breastfeed. If you use the powdered form and mix it with tap water that's fluoridated, your baby could be ingesting more of the mineral. If breastfeeding isn't an option, try using the premixed formula, which normally contains lower levels of fluoride. If you use powdered formula, mix it with bottled water labeled “de-ionized,” “purified,” “demineralized” or “distilled.”

It might seem like the better strategy for preventing fluorosis is to avoid fluoride altogether. But that can increase the risk of tooth decay, a far more destructive outcome for your child's teeth than the appearance problems caused by fluorosis. The better way is to consult with your dentist on keeping your child's intake within recognized limits to safely receive fluoride's benefits of stronger, healthier teeth.

If you would like more information on fluoride and your baby's dental health, 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 “Tooth Development and Infant Formula.”

By Vincent M. Immordino, D.M.D., P.A. & Thomas J. Burns, Jr., D.D.S., P.A.
October 10, 2020
Category: Oral Health
Tags: oral hygiene   oral health  
4WaysYouCanBetterManageDentalCareforaChildwithDownSyndrome

Madeline Stuart, acclaimed fashion model; Chris Burke, successful actor; Collette Divitto, founder of Collettey's Cookies. Each of them is accomplished in their own right—and each has Down syndrome. In October, Down Syndrome Awareness Month recognizes the achievements of people with Down syndrome overcoming incredible challenges. One such challenge, keeping their dental health on track, is something they and their families face every day.

Down syndrome, also known as trisomy 21, is a genetic disorder that happens when the body's cells contain an extra copy of chromosome number 21. This can cause a wide range of physical, intellectual and developmental impairments that, among other things, can contribute to dental disease and other oral health concerns.

But oral problems can be minimized, especially during childhood. Here are four ways to better manage dental care for a child with Down syndrome.

Begin dental visits early. Down syndrome patients can have physical challenges that could result in delayed tooth eruption, undersized teeth or smaller jaws that contribute to poor bite development and greater risk of tooth decay and periodontal (gum) disease. To stay ahead of any developing issues, you should begin regular visits to the dentist no later than the child's first birthday.

Be aware of dental anxiety. Some children with Down syndrome experience significant anxiety about the clinical aspects of their care. We strive to provide a comfortable, caring environment for all patients, including those with special needs. A variety of relaxation techniques as well as sedation options may help to reduce anxiety.

Coordinate medical and dental care. Medical problems can affect dental care. Be sure, then, to keep us informed about your child's health issues. For example, heart defects are more common among those with Down syndrome, and dental patients with heart conditions may need to be treated with antibiotics before certain dental procedures to minimize the chances of infection.

Make daily hygiene easier. Daily brushing and flossing are important for everyone's dental health, but they can be difficult for someone with Down syndrome. In some cases, you may have to assist or even perform these tasks for your child. You can make oral hygiene easier by choosing toothbrushes that fit your child's level of physical ability or using special flossing devices.

The physical disabilities of those with Down syndrome fall along a wide spectrum, with some individuals needing more help than others. Tailoring their dental care to their specific needs and capabilities can help keep your child's teeth and gums healthy for the long term.

If you would like more information about providing dental care for children with disabilities, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine articles “Managing Tooth Decay in Children With Chronic Diseases” and “Dentistry & Oral Health for Children.”

By Vincent M. Immordino, D.M.D., P.A. & Thomas J. Burns, Jr., D.D.S., P.A.
September 30, 2020
Category: Dental Procedures
ThisOrthodonticDeviceCouldReducetheNeedforFutureBraces

Each year, millions of children and teenagers wear braces or clear aligners to straighten a crooked smile. But there may be a way to treat some of these bite problems and avoid braces—by intercepting the problem at an earlier age.

This can often be done if the bite problem stems from abnormal jaw development rather than misaligned teeth. An example of this occurs when the upper jaw growth outpaces the lower jaw, causing the upper teeth to protrude beyond the lower teeth. Aside from the effect on appearance, protruding front upper teeth may extend beyond the protection of the lip and be more prone to injury.

A device called a Herbst appliance could prevent this from happening. The top of the device has two hinged metal tubes that connect to elastic bands bonded to the back teeth on both sides of the upper jaw. The bottom also has tubes affixed in the same way to the bottom teeth, except they're slightly smaller and fit within the upper tubes.

The lower tubes sliding within the upper tubes produces slight pressure against the lower jaw to ease it forward. This gradually influences the lower jaw to grow at a pace equal with the upper jaw to decrease the chances of poor bite development. Unlike other corrective methods, the Herbst appliance fixed in place and out of the way won't interfere with sports or other physical activities.

An installed Herbst appliance may change a patient's sensations during swallowing, eating or speaking, but most children adapt to the changes within a few days. And, because the device can create challenges for keeping the back teeth clean, many dentists recommend adding a fluoride rinse to daily brushing and flossing as an added boost against tooth decay.

The Herbst appliance is most effective during the period of most rapid physical growth between the ages of 11 and 14, but if the teeth are already beginning to protrude it can be undertaken as early as 8 or 9. Either way, this important orthodontic tool could help address a complicated bite problem and reduce the need for more costly orthodontic treatment later on.

If you would like more information on early interventions for poor bites, 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 “The Herbst Appliance.”

By Vincent M. Immordino, D.M.D., P.A. & Thomas J. Burns, Jr., D.D.S., P.A.
September 20, 2020
Category: Dental Procedures
Tags: celebrity smiles   veneers  
HowVeneersRestoredHowieMandelsWinningSmile

You probably wouldn't be surprised to hear that someone playing hockey, racing motocross or duking it out in an ultimate fighter match had a tooth knocked out. But acting in a movie? That's exactly what happened to Howie Mandel, well-known comedian and host of TV's America's Got Talent and Deal or No Deal. And not just any tooth, but one of his upper front teeth—with the other one heavily damaged in the process.

The accident occurred during the 1987 filming of Walk Like a Man in which Mandel played a young man raised by wolves. In one scene, a co-star was supposed to yank a bone from Howie's mouth. The actor, however, pulled the bone a second too early while Howie still had it clamped between his teeth. Mandel says you can see the tooth fly out of his mouth in the movie.

But trooper that he is, Mandel immediately had two crowns placed to restore the damaged teeth and went back to filming. The restoration was a good one, and all was well with his smile for the next few decades.

Until, that is, he began to notice a peculiar discoloration pattern. Years of coffee drinking had stained his other natural teeth, but not the two prosthetic (“false”) crowns in the middle of his smile. The two crowns, bright as ever, stuck out prominently from the rest of his teeth, giving him a distinctive look: “I looked like Bugs Bunny,” Mandel told Dear Doctor—Dentistry & Oral Health magazine.

His dentist, though, had a solution: dental veneers. These thin wafers of porcelain are bonded to the front of teeth to mask slight imperfections like chipping, gaps or discoloration. Veneers are popular way to get an updated and more attractive smile. Each veneer is custom-shaped and color-matched to the individual tooth so that it blends seamlessly with the rest of the teeth.

One caveat, though: most veneers can look bulky if placed directly on the teeth. To accommodate this, traditional veneers require that some of the enamel be removed from your tooth so that the veneer does not add bulk when it is placed over the front-facing side of your tooth. This permanently alters the tooth and requires it have a restoration from then on.

In many instances, however, a “minimal prep” or “no-prep” veneer may be possible, where, as the names suggest, very little or even none of the tooth's surface needs to be reduced before the veneer is placed. The type of veneer that is recommended for you will depend on the condition of your enamel and the particular flaw you wish to correct.

Many dental patients opt for veneers because they can be used in a variety of cosmetic situations, including upgrades to previous dental work as Howie Mandel experienced. So if slight imperfections are putting a damper on your smile, veneers could be the answer.

If you would like more information about veneers and other cosmetic dental enhancements, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine articles “Porcelain Veneers” and “Porcelain Dental Crowns.”

By Vincent M. Immordino, D.M.D., P.A. & Thomas J. Burns, Jr., D.D.S., P.A.
September 10, 2020
Category: Oral Health
Tags: dry socket  
HowtoAvoidThisPainfulConditionAfterToothExtraction

Dentists and oral surgeons remove millions of teeth every year, most without any adverse aftereffects. But about 2% of patients experience a dry socket, a condition that, although not dangerous to health, can be quite painful.

Also known as alveolar osteitis, a dry socket occurs when the blood clot that normally forms right after extraction doesn't form or becomes lost later. The clot serves as a barrier for the underlying bone and nerves during the healing process; without it these tissues can become irritated from contact with air, food or fluids.

Dry sockets (which usually occur in the back, lower molars) are fortunately rare, mainly in patients over 25, smokers or women using oral contraceptives. Patients also have a higher risk of developing a dry socket if they attempt certain activities too soon after tooth extraction like vigorous chewing or brushing that may dislodge the protective clot.

You can reduce your chances of a dry socket after a tooth extraction with a few simple guidelines. Unless advised otherwise by your dentist, avoid brushing the day after extraction and gently rinse the mouth instead. It also helps to avoid hot liquids and eat softer foods for a few days. If you smoke, you should avoid smoking during this time and use a nicotine patch if necessary.

Over the next few days, you should remain alert for any signs of a dry socket, often a dull, throbbing pain that radiates outward toward the ears, and a bad taste or mouth odor. A prompt visit to the dentist will help alleviate these symptoms, often in just a few minutes.

To treat it, a dentist will typically irrigate the socket and apply a medicated dressing, which you would need to change every other day for up to a week. After that, you'll leave the dressing in place for a while as you heal.

A dry socket doesn't interfere with the healing process: Your extraction site will heal whether or not you have one. But prevention and treatment for a dry socket will help ensure your healing after an extracted tooth is much less uncomfortable.

If you would like more information on dry socket after tooth extraction, 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 “Dry Socket.”





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