For many parents, the image of an infant intently absorbed in sucking a pacifier — or her own thumb — is one of the cherished memories of babyhood. But if this habit goes on for too long, it can cause problems with the child's bite. Want to know what the potential predicaments are, when you should be concerned about the behavior, and what you can do? Read on!

Thumb sucking is a natural, comforting behavior of humans (and some other primates) related to nursing. It usually goes away on its own by the time the permanent teeth are coming in. But it can be a hard habit to break — and if it becomes a persistent behavior, the consequences may include a problem called an “open bite.”

In a normal bite, the top teeth slightly overlap the bottom teeth. When the thumb (or any other object) constantly rests between the upper and lower teeth, however, the pressure it exerts may prevent the teeth from fully erupting (coming out from the gums into the mouth) and alter the shape and development of the upper and lower jawbone. This result is a gap between the upper and lower teeth.

The same problem may also be caused by prolonging the “infantile swallowing pattern,” a forward-thrusting position of the tongue which, like thumb sucking, normally begins to cease around age four. That's when it is replaced by the adult swallowing pattern, where the tongue is held behind the teeth, against the roof on the mouth. Researchers believe that most open bites result from the failure to change from the infantile to the adult swallowing pattern.

When should you be concerned about the thumb sucking habit? If the behavior continues much past toddlerhood, or if the sucking is particularly active, you may wish to have us evaluate your child's bite. The American Academy of Pediatric Dentistry recommends having the habit stop by age 3. Persistent thumb sucking can actually push the teeth forward and change the growth patterns of the jaw, creating more difficult problems.

There are several methods for controlling the behavior and correcting problems with the bite. One is an appliance called a “tongue crib.” This thin metal device is placed behind the upper and lower incisors. It discourages thumb sucking, while at the same time helping to keep the tongue from inserting itself between the upper and lower teeth. Eliminating these unhelpful habits is essential to allow the teeth to erupt into proper position and to allow for the normal development of the jawbones.

Recent research has also shown that individualized exercise routines called orofacial myofunctional therapy (OMT) can be highly effective in preventing open bite relapses. These exercises are designed to retrain muscles in the face, tongue and lips, and can help to create good chewing and swallowing patterns.

If you would like more information about thumb sucking or children's bite problems, please contact us or schedule an appointment for a consultation. You can also learn more about these issues by reading the Dear Doctor magazine article “How Thumb Sucking Affects The Bite.”

For years the main approach to treating tooth decay (or caries) could best be described as “drill and fill” — remove the decayed tooth material and fill the resulting cavity. But a new approach has come to prominence that addresses not only the results of decay, but seeks to identify and treat the underlying conditions that caused the decay in the first place, and may continue to infect other teeth.

This approach is known as Caries Management By Risk Assessment or CAMBRA. Rather than a “One Size Fits All” approach, CAMBRA individualizes treatment and prevention options by first assessing your own individual risk for tooth decay.

We base this assessment on what might be called the Caries Balance. On one side are factors that increase your risk of tooth decay, easily remembered by the acronym BAD: Bad bacteria that produces acid; Absence of healthy, functional saliva that neutralizes the effects of acid; and Dietary habits that are heavy with sugars, acids and between meal snacking. On the other side are protective factors that reduce your risk, known as SAFE — Saliva and sealants that protect the surfaces of teeth; Antimicrobials that help rid the mouth of bad bacteria; Fluoride, which strengthens teeth against de-mineralization caused by acid; and an Effective diet.

The assessment first involves a survey of questions about your hygiene habits, dental history and lifestyle: Do you brush twice and floss once daily? Do you live in a fluoridated area or use fluoride mouth rinse? Do you smoke? Have you had frequent cavities in the past? These and other questions, along with a complete dental exam and acid level testing, can give us a more accurate understanding of your risk and how best to incorporate treatment that reduces it even further.

Using CAMBRA, you and our dental team develop a true partnership that actually transforms your dental health from simply treating existing caries, to preventing future occurrences.

If you would like more information on the CAMBRA approach to caries prevention, 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 Decay: How to assess your risk.”

Everyone knows Vanna White as the elegant co-host of the popular game show Wheel of Fortune. But here's one thing you may not know: White is listed in the Guinness Book of World Records as television's most frequent clapper, with an average of 720 claps per show — that's over 28,000 per season! And here's something else: the star with the megawatt smile wore braces as a kid, and she's not too shy to talk about it.

“I only had to wear them for a year and it was a good experience for me,” she told an interviewer for Dear Doctor magazine. But when it was time for her son to get them, White noticed something different. “We used to have those silver bands that went all the way around each tooth, and they don't have that anymore. It is fascinating to see how far they have come.”

We're glad she noticed! In fact, orthodontic appliances have advanced a good deal in the past decade or so. Instead of using metal bands, brackets holding the wire part of braces are now typically attached directly to the teeth with a dental adhesive. For an even less obtrusive look, ask about using colorless brackets instead of metal ones — that way, the only part that's clearly visible is the thin wire itself. And in some situations, braces can be placed on the lingual (tongue) side of the teeth, making them all but invisible.

Another type of nearly invisible appliance is the clear orthodontic aligner. The aligner system consists of a series of precision-made transparent “trays” that fit over the teeth. Each tray is worn for a few weeks, and each moves your teeth by a small amount; together, they can help correct mild to moderate orthodontic problems. And the best part — they're really hard to notice! That makes them perfect for both adults concerned about a “professional” look, and image-conscious teens.

So if you're a TV star — or if you'd just like to have a brighter and better smile — it's never too late to get started! If you would like more information about orthodontics, please contact us for a consultation. You can learn more in the Dear Doctor magazine articles “The Magic of Orthodontics” and “Clear Orthodontic Aligners.”

Research has shown that periodontal (gum) disease can affect the health of your whole body. Evidence suggests a relationship between severe gum disease and cardiovascular disease (“cardio” – heart; “vascular” – blood vessel), conditions that lead to heart attacks and strokes. There is also a relationship between gum disease and pregnancy; mothers with severe gum disease have a higher incidence of pre-term delivery and low birth-weight babies. To understand gum disease, you may find the following facts helpful. How many are you aware of?

1. Periodontal disease — Any disease that affects the areas around the teeth. The word comes from the Latin “peri” meaning around and Greek “odont” meaning tooth. Periodontal disease, or gum disease as it is commonly called, is really a group of diseases with the same outcome: destruction of the periodontal tissues, loss of supporting bone and ultimately the loss of your teeth.
2. Dental plaque (Biofilms) — A bacterial film that forms on teeth at the gum line, and the reason we brush and floss. Its daily removal is necessary to keep your teeth and gums healthy. A biofilm is a biological film comprised of colonies of living organisms that are generally specific to a particular eco-system. Plaque is one type of biofilm.
3. Gingivitis (“gingiva” – gum; “itis” – inflammation) — A response of the gum tissues to plaque biofilm that is left undisturbed (due to ineffective, or inadequate oral hygiene). It is the first stage of periodontal disease.
4. Pocket formation — Just like a pocket on your clothing, pocket formation is the result of separation of the gum tissues from their normally healthy tight attachment to a tooth. Pocketing allows the introduction of bacteria, which perpetuate gum disease.
5. Abscess — A collection of pus that forms within diseased periodontal tissues. It is experienced as pain, swelling, and discharge of pus from the gum tissues and is an advanced sign of periodontal disease.

Important Tip — Bleeding Gums when brushing teeth or flossing is not normal. It is a warning sign of early gum disease that you should bring to the attention of our office.

Contact us today to schedule an appointment to discuss your questions about periodontal disease. You can also learn more by reading the Dear Doctor magazine article “Understanding Gum (Periodontal) Disease.”

Treating bad breath is big business. Just check your local drug store or supermarket and you'll find a mind-numbing array of mints, gums, mouthwashes, sprays, strips and other products that promise to sweeten your breath and make you (or your mouth at least) irresistible. But most of these products only mask halitosis (from the Latin “halitus” – exhalation, and Greek “osis” – disease) and some even contain ingredients, like sugar, that contribute to tooth decay and gum disease. In most cases, for enduring, healthful results, nothing beats a trusty toothbrush, toothpaste and floss, used faithfully and correctly, along with periodic dental checks and cleanings.

Oral bacteria are the number one reason for noxious breath. More than 600 types inhabit our mouth, and some of them emit awful odors — predominantly volatile sulfur compounds characterized by a “rotten egg” smell) — as they consume remnants of food trapped in our mouth. Brushing and flossing regularly, especially after eating, can dislodge food trapped between teeth (interdental) and under the gums (subgingival), depriving microbes of a ready-made meal. It also disrupts the buildup of sticky plaque (microbial “biofilms”) where odor-causing germs can flourish.

When cleaning your mouth, pay special attention to the back of the tongue. It is the primary location for generating halitosis because it is drier and less efficiently cleansed by saliva and normal oral activity than the front. Our office can instruct you on proper oral hygiene including the gentle use of a tongue scraper or brush.

Sometimes more involved periodontal techniques such as scaling and root planing (deep cleaning) are called for; antibiotics may be useful in targeting the offending microbes. If tooth decay and/or periodontal (or gum) disease is contributing to halitosis appropriate treatment is necessary.

Remember that foul breath is just a symptom of some underlying condition. If diligent oral care at home doesn't do the trick, our office can help you get to the root of the problem and determine the appropriate therapy.

If you would like more information about halitosis and ways to prevent or treat it, 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 “Bad Breath.”

Nobody wants “halitosis,” commonly known as bad breath. Americans spend an estimated $3 billion per year on breath freshening products like candies, chewing gum and sprays, but that really just masks the problem. Bad breath is clearly a major concern. Treating bad breath effectively means understanding and treating what causes it.

And The Top Ten Main Causes of Bad Breath Are:

1. You just woke up — because saliva flow is reduced during the night, it is normal to wake up with a dry mouth and “morning breath.”
2. It was something you ate — garlic, onions, coffee, alcohol, spicy foods and more — are common causes — luckily they are temporary. Brushing, flossing and mouthrinses may help.
3. It was because you didn't eat — fasting can result in bad breath. In hunger, especially starvation, a person's breath may actually smell like nail polish remover (acetone). This comes from ketones that are produced as the body metabolizes fat for energy production.
4. “Xerostomia,” literally dry mouth — from plain old dehydration, and certainly many medications can cause dry mouth leading to bad breath. Drinking sufficient quantities of water is helpful and important.
5. Smoker's breath — If you are a smoker, the telltale odor lingers — for days and weeks. Try quitting for multiple health benefits.
6. Ineffective oral hygiene — buildup of food remnants and bacteria on and between your teeth and gums is a prominent cause of bad breath.
7. Bacterial accumulation on the back of your tongue — large numbers of bacteria accumulating in the nooks and crannies, where they may give off volatile sulfur compounds (VSCs), which have an odor reminiscent of rotten eggs.
8. You may have tooth decay or periodontal (gum) disease — one of the main causes of bad breath is gum disease. Studies have shown that the more VSCs a person has on their breath, the more likely it is that they have gum disease. Openly decayed teeth can also be a cause of bad breath.
9. You may have a problem with your nose or tonsils — Nasal odors exhaled from the nose and mouth may be a result of sinus infections, foreign bodies, or infections of your tonsils.
10. Serious health conditions — like diabetes, lung disease and cancer can also be systemic (general body causes of bad breath) that do not emanate from the mouth.

Because some of these problems are serious and need treatment, don't just try to cosmetically camouflage bad breath. Make every effort to remove the film of bacteria (plaque) from your teeth and gums every day; if this does not cure your bad breath, contact us for an assessment, diagnosis, and treatment.

Contact us today to schedule an appointment or to discuss your questions about bad breath. You can also learn more by reading the Dear Doctor magazine article “Bad Breath: More than just embarrassing.”

Let's say you happen to be sitting on a plane next to supermodel Bar Refaeli, who was recently voted #1 on Maxim magazine's Hot 100 list. You're a little nervous, but you want to make a good impression. What's the first thing she's going to look at? Your expensive suit? Your sculpted torso? How about — your smile!

“Teeth are the first thing I look at,” explained the glamorous cover girl in a Maxim interview. “A nice smile with beautiful teeth is the most attractive thing.”

We wholeheartedly agree. But, of course, not everyone is lucky enough to be born with a perfect set of teeth. What to do then?

“Let's just say that with today's orthodontists, I don't understand why people wouldn't fix them,” Refaeli stated. Need we say more?

The Israeli supermodel, who has appeared in several Sports Illustrated swimsuit issues, knows what she's talking about. Refaeli started modeling as a young child, but had to put her career on hold for a few years while she got braces. When they came off, at age 11, she began her steady climb to the top of the modeling business.

Plenty of aspiring actors and models — as well as regular folks — get braces as children. But if you're serious about improving your smile, it's never too late to have orthodontic treatment. For adults, there are many options available in addition to the standard metal appliances.

Colorless ceramic braces offer a less noticeable way to correct misaligned teeth. Made of high-tech materials that resist staining, their translucent appearance blends so well with the look of your natural teeth that it can be hard to tell you're wearing them.

Clear aligners are an alternative to braces that are worn 20-22 hours per day. They consist of a series of precision-made, transparent “trays” that gradually straighten your teeth over a period of time. Best of all, you can remove them for special occasions — like meeting a supermodel.

Which type of orthodontic treatment is best for you? Why not come in for a consultation and find out! Working together, we can evaluate your situation and develop an effective, individualized treatment plan that fits your lifestyle.

If you have questions about orthodontic treatment, please contact us or schedule an appointment for a consultation. You can learn more in the Dear Doctor magazine article “Orthodontics For The Older Adult.”