Sedation Dentist serving High Point, Greensboro, Winston-Salem and the Triad area.

Transitioning from Childhood to Puberty

By age two, most of the twenty primary teeth are in place and the child should have been to the dentist at least once for an examination. Fluoride treatments will help’to harden teeth against the ravages of children’s diet and improper oral hygiene. Until about age seven, you should help your child to brush properly.

I recall one parent, whose child had multiple cavities at every visit, telling me, “Dr. Bonnick, I do everything right with this child. I brush her teeth every night myself. She’does not eat candies. We have no candies in the house anymore. My husband and I have decided not to buy’snacks. I just don’t know what to do?

Well Dr. Bonnick, it must be genetic. My whole family has’soft teeth. It runs in the family. This dental thing is getting expensive, and I have three children. They all come here.”

How do you handle it in the morning after they eat breakfast I asked. “When do you brush their teeth in’the morning ?

Dr. Bonnick, we are in a mad rush, always in a mad rush’to get them to school. We are always running late; the kids hold us up. Do you have kids Doesn’t everybody make their kids brush their teeth when they get up Their breath could smell bad. We don’t have time to brush after breakfast because we are rushing to get to school ?”

When they get to school, do’they brush ?

They can’t brush in school. Th e teachers won’t allow them’to brush in school. Aren’t they supposed to brush when’they first get up ?

They should brush after eating to remove left over food so’the bacteria can starve.”?

I don’t know where everyone gets their information, but as an expert in dental health, the rule I would give you is after any meal or snack or drink except water, all of us’should brush our teeth ?

By the way, I know “it is not cool to brush in school but if possible, arrange for your children to brush while they are there. If not, you will be spending your money with me fi xing cavities and your child will start developing her ideas about the dentist from her repeat experiences.”

Dr. Bonnick, they don’t brush when they come home.”They snack. They drink a soda. They eat dinner and then’do homework, or eat dinner then watch TV, and then brush their teeth before going to bed.”

Now, because they brush once before going to bed and brush essentially clean teeth again before eating breakfast,’they are wearing plaque on’their teeth for the rest of the’day until bedtime. This is a prime scenario for cavities and gum disease to develop. This is costing us all in the long run.”

I m not sure what to do. Dr. Bonnick, would you give me a note for the teacher ?

Absolutely! If you have the children brush when they wake up, have them brush again after breakfast, and if’they brush aft er lunch, they’ll be on their way to better oral health. Promise them you will subtract the money for filling their cavities from the money you spend on birthdays, holidays, and vacations. Just kidding! Let’s try better oral hygiene. Dentistry is not meant to be a punishment.”

It is amazing how many well-intentioned parents and’teachers will tell the children to brush their teeth two times per day. The proper way to care for teeth and preserve’them from the destruction of cavities is to brush within’twenty minutes aft er each meal, drink, or snack.

As a dental student, I remember doing research for my’senior project at the University of Maryland DentalSchool with a biochemistry professor. My job was to grow?Streptococcus mutans (the most important bacteria to the creation of cavities in teeth) and study’their adherence’to smooth surfaces in different concentrations of sucrose’similar to concentrations found in nature.

The goal was’to find out how these bacteria stick to the smooth part of teeth and enable other bacteria to stick to the tooth’surface.”I obtained sugar cane juice from the government agency’that quarantined it and found the sucrose concentration’to be around 20 percent. I made up samples of 20 percent,10 percent, 5 percent, and 2.5 percent sucrose by diluting’the sample with distilled water and used control samples of the same concentrations drawn up with pure sucrose(cane sugar) and distilled water.

My hypothesis assumed’that adherence of the bacteria would be less with the natural juice than with pure sucrose. This unpublished’study gave us two results: the bacteria had similar result to adherence between the pure sucrose and sugar cane juice, but surprisingly, the bacteria in the sample showed more adherences in the sample at 2.5 percent than at 20 percent.

(The bacteria glued themselves to a smooth surface easier at a lower concentration of sugar.)?Application of this knowledge to the mouth shows us’that activity of the bacteria is not that high at higher’sugar concentrations, but as sugar in the mouth becomes more diluted with time, it promotes more adherences of Streptoccocus mutans. So if you had a fruit or some juice with sucrose and you did not brush right away, the lower concentration of sucrose (dilution) would make the bacteria more active (with time, bacteria sticks to teeth better) and cause more holes in your teeth.

Many parents are health-conscious, and sometimes it works to the detriment of’their children. Some refuse to have their children drink fl uoridated water, and instead’they use bottled or filtered water. These children not only lose the benefit of the hardening properties of fluoride when their teeth are developing, but they should use topical fluoride more often at a time when they are more likely’to have dental cavities.

At approximately six years of age, the first permanent teeth’start appearing in the mouth, and it is very important to have them sealed to protect them from cavities at a point when children are not very good at cleaning their teeth.”The baby teeth are often partially covered with gum tissue, and because it hurts to brush, some children neglect the proper cleansing of the area.

The first large back tooth is called the first molar. This is one of the most important’teeth for stabilizing the bite, and it usually appears when’the child is six years old. It is the most important back tooth, and it represents the “sweet spot for chewing.

This is the tooth that is most often filled, extracted, or in need of root canal treatment because it is one of the first permanent teeth that appears in the child’s mouth. Loss of the fi rst molar is a common reason for posterior bite collapse (back teeth don’t fit together well, so’the bite is not as efficient as it could be), and if it is lost, immediate replacement with an implant is of extreme importance.

The bone grows with the eruption of the adult teeth and because of this continual growing as a child continues’to grow it is not a good idea to place an implant in the growing patient. Until the end of the “growth spurt, bone’development could change the relationship of the crown of the tooth with’the developing bone.

If a first molar or any primary tooth is lost early, your child should be evaluated for a’space maintainer (a device to maintain the’space for an erupting tooth, prosthesis, or implant).

The mixed dentition stage is a confusing time for most parents. The primary teeth are being lost as permanent’teeth are erupting into place and the child is going’through a growth spurt. Puberty gingivitis is common as hormonal changes as well as poor flossing habits (non-flossing) by children promote excessive plaque buildup.

Lack of flossing leads to more cavities between the teeth,’so teeth that may be sealed on top can still have cavities’through the sides. Root canal treatments, as well as large fillings, are common during this time.

Orthodontic treatments are started during this transitional’time for many reasons. Growth spurts can be used to correct malocclusions, and loss of teeth allows’the orthodontist to move teeth into more ideal positions.

There are generally three classifications of occlusion (the way teeth come together). Class one occlusion is one in which the relationship of the upper and lower teeth is ideal. The upper teeth should be on the cheek side of the lower teeth and the teeth relate properly.

Class two occlusion is a relationship where the upper jaw and teeth stick out too far from the lower teeth and the relationship is one of a protruding upper jaw. In a class three occlusion, the lower teeth stick out ahead of the upper teeth and give the appearance of a’strong jaw. An overjet is not an abnormal condition, but when the’distance between the upper and lower front teeth is so far apart that it makes incising (biting) difficult or it stresses’the lower jaw to move extremely forward in order to touch’the upper jaw, the overbite should be treated.

An overbite is the measurement of the upper front teeth closure over’the lower. When an overbite is extreme, the lower teeth’sometimes hit into the upper gum near the roof of the mouth. This should be corrected.

A crossbite can exist with one or more teeth when the relationship of the upper’teeth is on the tongue side of the lower teeth. A slight overlap (degree) may not be harmful, but your dentist can determine whether it should be evaluated or not. A crossbite left untreated could result in facial deformities and improper development of one or both jawbones.

The major challenge during the mixed dentition stage is’to get the child to brush after every meal and floss once or twice per day. The environment and parents attitudes’set the tone for early-adulthood habits and determine how much it will cost for dental care in the future.


Chapter 5: Problems of Early Adulthood