Posts for: January, 2020
One in 700 babies are born each year with a cleft lip, a cleft palate or both. Besides its devastating emotional and social impact, this common birth defect can also jeopardize a child's long-term health. Fortunately, incredible progress has occurred in the last half century repairing cleft defects. Today's children with these birth defects often enter adulthood with a normal appearance and better overall health.
A cleft is a gap in the mouth or face that typically forms during early pregnancy. It often affects the upper lip, the soft and hard palates, the nose or (rarely) the cheek and eye areas. Clefts can form in one or more structures, on one side of the face or on both. Why they form isn't fully understood, but they seem connected to a mother's vitamin deficiencies or to mother-fetus exposure to toxic substances or infections.
Before the 1950s there was little that could be done to repair clefts. That changed with a monumental discovery by Dr. Ralph Millard, a U.S. Navy surgeon stationed in Korea: Reviewing cleft photos, Dr. Millard realized the “missing” tissue wasn't missing—only misplaced. He developed the first technique to utilize this misplaced tissue to repair the cleft.
Today, skilled surgical teams have improved on Dr. Millard's efforts to not only repair the clefts but also restore balance and symmetry to the face. These teams are composed of various oral and dental specialties, including general dentists who care for the patient's teeth and prevent disease during the long repair process.
Cleft repairs are usually done in stages, beginning with initial lip repair around 3-6 months of age and, if necessary, palate repair around 6-12 months. Depending on the nature and degree of the cleft, subsequent surgeries might be needed throughout childhood to “polish” the original repairs, as well as cosmetic dental work like implants, crowns or bridgework.
In addition to the surgical team's skill and artistry, cleft repair also requires courage, strength and perseverance from patients and their parents, and support from extended family and friends. The end result, though, can be truly amazing and well worth the challenging road to get there.
If you would like more information on repairing cleft birth defects, 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 “Cleft Lip & Cleft Palate.”
Keeping your child’s teeth and gums healthy may sometimes seem like “one step forward, two steps back.” You do all the right things like daily brushing and flossing, and keeping sugar consumption to a minimum. But they’re still getting too many cavities.
We can add something else to what you’re already doing to decrease their cavity rate: apply a concentrated fluoride mixture (stronger than what’s found in toothpaste or drinking water) directly to their teeth. Studies have shown that topical fluoride is effective at reducing the risk of new cavities in children at high risk for decay, and may even reverse early decay.
Topical fluoride can be applied as a gel, foam or varnish. The particular method used depends on factors like the child’s age or the preference of the dentist. But any of the three methods can deliver a short-term, high dose of fluoride to the teeth.
As a result, the burst of fluoride strengthens tooth enamel against decay, with plenty of evidence of its effectiveness. As such, the American Dental Association recommends periodic topical fluoride applications for children older than 6, and especially those that appear to be at higher risk for decay.
You might, however, be concerned about the long-term health effects of these stronger concentrations of fluoride. Again, research indicates that the only long-term hazard associated with too much fluoride is a condition called fluorosis, which produces heavy tooth staining. Fluorosis, though, is more of an appearance issue and doesn’t harm the tooth itself. And it can be avoided in the case of topical fluoride by performing the procedure correctly and conservatively.
There’s also a short-term risk of a reaction to the fluoride mixture if the child swallows too much during the procedure, which could cause stomach upset and pain, vomiting or headaches. We can avoid this by using precautions like dental dams and other isolation methods to prevent the child from ingesting it.
Using proper precautions and procedures, topical fluoride is a safe and effective way to give your child added protection against decay. Avoiding this destructive disease can help ensure they’ll enjoy good dental health for the rest of their lives.
If you would like more information on keeping your child’s teeth and gums healthy, 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 “Fluoride Gels Reduce Decay.”
Dental amalgam—also known as “silver fillings”—has been used for nearly a hundred years to treat cavities. There are several reasons why this mixture of metals has been the go-to material among dentists: Malleable when first applied, dental amalgam sets up into a durable dental filling that can take years of biting forces. What’s more, it’s stable and compatible with living tissue.
But there’s been growing concern in recent years about the safety of dental amalgam, with even some wondering if they should have existing fillings replaced. The reason: liquid mercury.
Mercury makes up a good portion of dental amalgam’s base mixture, to which other metals like silver, tin or copper are added to it in powder form. This forms a putty that can be easily worked into a prepared cavity. And despite the heightened awareness of the metal’s toxicity to humans, it’s still used in dental amalgam.
The reason why is that there are various forms of mercury and not all are toxic. The form making headlines is known as methylmercury, a compound created when mercury from the environment fuses with organic molecules. The compound builds up in the living tissues of animals, particularly large ocean fish, which have accumulated high concentrations passed up through their food chain.
That’s not what’s used in dental amalgam. Dentists instead use a non-toxic, elemental form of mercury that when set up becomes locked within the amalgam and cannot leach out. Based on various studies, treating cavities with it poses no health risks to humans.
This also means there’s no medical reason for having an existing silver fillings removed. Doing so, though, could cause more harm than good because it could further weaken the remaining tooth structure.
The most viable reason for not getting a dental amalgam filling is cosmetic: The metallic appearance of amalgam could detract from your smile. There are newer, more life-like filling options available. Your dentist, though, may still recommend dental amalgam for its strength and compatibility, especially for back teeth. It’s entirely safe to accept this recommendation.