Allen D. McCorkle, D.D.S 25 South Kent Street Winchester, VA 22601 <MAP> (540) 667-4880 Email Us

Thumb Sucking, Tongue Thrusting, and Mouth Breathing

Oral habits can move teeth into unhealthy positions each as a large overjet (Buck Teeth), a crossbite or an openbite. A behavioral approach at the right age using a calendar, stickers, a reward, and positive encouragement is very effective for helping children learn new habits. An openbite and a large overjet may self correct when the habit is discontinued early. Crossbites will not self correct.

Controlling the habit at the right age will allow the permanent teeth to come into healthier positions and prevent more difficult problems. Thumb sucking is normal until the age of 4 to 5 years. Most children stop on their own. I suggest that no attempt be made to stop this habit until then. At this age a behavioral approach is usually successful. Some children may find an appliance helpful.

Tongue thrusting can be helped with a combination of a behavioral approach and a tongue crib appliance. The appliance is cemented in and is helpful while the incisors reposition, usually 1 or 2 years.

Mouth breathing may be a habit or necessary because of nasal obstruction. Nasal obstruction should be evaluated by a physician.

Habit Behavior Modification:

Helping your child learn to overcome his digit habit is different from most things you will teach him. Reminding your child to atop his habit will just make it worse. It is his problem, not yours, and he will need to want to stop before you can help him. He is in the game, you can be the cheerleader.

After he has decided he would like to learn to stop, select a prize or goal. This does not have to be expensive, just special enough to capture his imagination more than his habit, such as a trip to a museum or camping in the backyard or a special item. Then place a calendar where it will be visible for everybody important. Each 24 hours that your child accomplishes his goal, he receives a mark or sticker on the calendar and LOTS of praise.

If he does not succeed, his behavior is ignored. Instruct everyone who is important to your child to refrain from reminding your child to stop his habit, remember, it is his problem. When he comes to you for his mark, and he has not been successful, share his disappointment and then encourage him to keep trying. You will need to check on your child at bedtime and some during the night.

If there is a time that your child is having a particularly hard time succeeding, ask his permission to try some physical reminder such as bad tasting finger nail polish or wearing a sock over the hand or your moving his hand away from his mouth. Be sure you have his permission. If he. reports that he cannot go to sleep without his habit, tell him that if he wants to use his habit, that will be fine, but remind him that he won't get his sticker, and it will be longer before he gets his prize and he won't be helping his teeth to come in pretty and straight. Then encourage him and tell him that if he will try a little longer, he can go to sleep without his habit and then he will get his sticker and his prize sooner and his teeth will be coming in straighter.

When your child succeeds for 24 hours per day for 14 days in a row, he may have his prize. If your child has not succeeded in two months, just stop this program and we can re-evaluate his habit at the next preventive visit.

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Cause

Decay is an infection of the teeth, so when one tooth decays the infection spreads to other teeth and they decay as well. Decay infection also spreads from parents to their children. For a healthy mouth, first, the teeth must be restored. This gets rid of the infection and eliminates the decay. Second, the infection must be prevented from starting again. Permanent teeth are more likely to stay healthy if the primary teeth are healthy first. No matter how badly your child's decay is now, with good home care and regular preventive visits, you can expect the teeth to stay healthy. His permanent teeth will be healthy, and your child will enjoy a bright, healthy smile.

Decayed Primary Incisors

These may abscess and injure the permanent incisors. These teeth are normally lost at 6 or 7 years. The alternatives are removal, restoration, or arresting the decay.

Removal is necessary if they are badly decayed or abscessed. Early loss of primary incisors, in our experience, causes few problems for children. We would expect your child to be able to learn to eat, talk, and accept their appearance. Eruption of the permanent incisors can be delayed when primary incisors are removed early.

Restoring the incisors is a sure way to preserve full oral function and an esthetic appearance. Tooth colored fillings or stainless steel crowns with tooth colored facings restore decayed or fractured incisors very nicely. They are not quite as strong as natural teeth, so care is needed when chewing hard foods. Stain may appear over time, but thorough daily cleaning prevents this problem. We use the most recent generation of total etch-visible light cure bonded hybrid resin system which lasts and looks nice as long as possible.

Arresting decay may allow you to stop the decay until the teeth are lost naturally or until your child is older and easier to treat. This requires ruthless home care plus frequent home topical fluoride gel. The risk is the decay can get worse resulting in pain and infection which requires removal instead of restoration.

Decayed Molars and Canines

Primary molars and canines are lost naturally at 9 to 12 years of age. When they are lost early or decay, space for the permanent teeth is lost. Then, the permanent teeth may not have enough room to come in well. Treatment alternatives include restoration or removal and space maintenance.

Resin restorations (tooth colored fillings) are effective for most decayed molars. We use the newest generation material which studies show endure longer than previous formulas. We bond the resin to the tooth enamel and dentin surfaces to promote the best seal and to strengthen the tooth.

Stainless Steel Crowns are the only effective restoration for badly decayed primary teeth because you can depend on them to last until the teeth are lost naturally.

Pulp Therapy

Teeth with very deep decay or abscesses must either be removed or treated in order to prevent further damage. The dental pulp is the nerves and blood vessels inside the root of the tooth. There are two types of pulp therapy.

1. Pulpotomy. When the decay goes into the pulp, the infected part is removed and the healthy part is medicated.

2. Pulpectomy. When the tooth has abscesses, the whole pulp is infected and must be cleaned out and filled in with a medication. During treatment the tooth is numb so there is no discomfort.

Remember, decay will only get worse and spread to more teeth if it is not taken care of. Now is the easiest time to treat your child's unhealthy mouth and equip him with a health comfortable smile.

THANK YOU! We want you to ask questions! Email us, or call (540) 667-4880.

Mouth Care Following Treatment

Warn your child to not bite his lip, tongue or cheeks end to not eat until the numbness wears off. which usually takes 1 or 2 hours. For primary tooth removal sites, bite on the gauze pad until normal feeling returns and then begin with a soft diet. The gums may be tender for a few days. Scrub the gums clean. even though uncomfortable or bleeding for the most rapid healing. Children's Tylenol or Aspirin may be helpful though most children do well without. Sensitivity to hot or cold is normal for up to two weeks, if this persists or worsens please call us.

Oral Surgery or Permanent Removal Site Care:

Do all of the above and the following also. No Spitting, rinsing, or sucking from a straw for 24 hours. Keep patient calm and quiet, no active playing. The next day begin warm salt water rinses after every meal and before bedtime for 5 days.

Care of Oral Ulcers:

Drink plenty of fluids. If necessary force milk, fruit juice, blend soup or most any nutritious drink. A nutritious diet aids healing. Mouth rinse can reduce discomfort for meals and oral cleaning. Cepecol or Chloroseptic mouth rinse every two hours is helpful. Glycerin, Gly-Oxide, Zilactin, Kanka or Orabase applied to the ulcers after each meal and bedtime can be soothing if the ulcers are affecting your child's normal activities. Keep the teeth clean with a soft toothbrush. Use children's Tylenol for fever. Ulcers will last 7 to 14 days.

Intermediate Care of Abscessed or Decayed Teeth

No sweets and no snacks until the teeth are treated since they cause discomfort. Keep the teeth and gums clean with a soft tooth brush. If your child has a fever, facial swelling or is unable to eat well, antibiotics should be taken as prescribed. Force a good diet and force nutritious drinks. Call us for persistent fever, swelling or lack of appetite.

Cardiovascular and Heart Defects

Bacteria normally present in the mouth enter the blood stream during eating, tooth brushing, and flossing during dental treatment. Once in the blood stream the bacteria can grow on the defect and cause BACTERIAL ENDOCARDITIS, a very serious illness which can cause death. Healthy teeth and gums which do not bleed when brushed and flossed well, reduce the openings for the bacteria. Antibiotics are recommended before and after dental treatment by the American Heart Association to reduce the chance of getting Bacterial Endocarditis. The first dose is taken one hour prior to the visit. The second and final dose is taken six hours Later. Please call us if your child becomes feverish.

Prevention

Wear a mouth guard for contact sports i.e.: soccer, basketball, football and etc. Always wear a seatbelt.

All Teeth

Call us right away. Tylenol or Aspirin may be given for discomfort. Keep the teeth and gums clean. X-rays are needed to find broken roots and pushed-in teeth and to compare with future x-rays. Watch for a gumboil, drainage, or persistent swelling or looseness. If you notice any of these problems, call the office.

Primary Teeth

Knocked out primary teeth are left out. Displaced primary teeth usually reerupt to the original position. May turn dark and remain dark or return to normal color, either is OK. The unerupted permanent tooth may be damaged. This will remain unknown until the permanent tooth erupts.

Permanent Teeth

Knocked out permanent teeth are replanted as quickly as possible. You should try this yourself before you arrive. If not put the tooth in milk. The tooth will require splinting 7 to 14 days and root canal treatment. Displaced or loosened teeth require splinting for 7 to 14 days and may need root canal treatment. Fractured or broken teeth may not need any treatment but may require medication if the tooth nerves are involved. Broken roots require splinting for 6 to 8 weeks and may need root canal treatment. Darkened permanent teeth usually are abscessed and require root canal treatment. ALL of these injuries require periodic evaluation forever. Problems may arise in the future.

THANK YOU! We want you to ask questions! Email us, or call (540) 667-4880.

We are looking forward to your Healthy Smile.