Question: Are sodium fluoride supplements safe for my two-year-old child?
Answer: Yes, in the correct dosage. Fluoride supplements (drops or tablets) may be prescribed for children when the fluoride content of local drinking water is less than 0.3 parts per million. The recommended daily dosage is 0.25 milligram up to the age of two, 0.5 milligram from age two to three, and 1 milligram from age three to age 14, when the second molars have usually erupted fully. After that, fluoride from toothpaste and fluoride treatments at the dentist’s office provide sufficient protection.
Some years ago, when the recommended dosage for children up to age two was higher (0.5 milligram), there was some concern about mild dental fluorosis—faint white spots on the teeth. But that minor side effect rarely occurs today.
IMPLANT OR BRIDGE?
Question: I have a lower molar that needs to be replaced soon. My dentist has suggested a bridge, and said that bridges have been proved to be reliable. I’m interested in a more modern technique—getting a false tooth supported by a pole implanted in the jawbone. How much research has been done on that?
Answer: Implants have an advantage over bridges, in that they don’t damage adjacent teeth. To install a bridge, the dentist must first file down the adjacent teeth and then crown them. Single-tooth implants have most often been used to replace upper front teeth, a procedure that is usually successful. How-ever, the value of implants in replacing single back teeth has been less thoroughly studied. An implant can be used only if there is enough bone left under the gum to anchor it, and only in locations where the implanting procedure could not damage a nerve or sinus cavity. A dentist performing implants should have gone through a formal educational program in implant techniques.
The cost of implants and bridges can be significant—generally up to $3,000 for a tooth implant and up to $1,500 for a bridge. But some insurers that cover bridges do not cover implants.
Question: My periodontist wants to trim back the gums around six of my teeth, although he says it’s a gamble whether that will stabilize my periodontal disease. Friends have told me to save my money ($600 to $700) because it didn’t work for them. Should I have the surgery ?
Answer: You can’t predict the outcome of your gum surgery from your friends’ experiences. But you should consider surgery only after other measures have failed to stop the progression of the disease. Those measures include a combination of instructed self-care (brushing, flossing, dental rinse) and professional scaling and root planing. It would be wise to get a second opinion before you decide on surgery.
Question: After years of being told to avoid saccharin, I see it’s in many toothpastes. Is it safe?
Answer: Yes. The amount you’d ingest from toothpaste is insignificant.
Question: My dental hygienist told me that I have an unusually heavy buildup of tartar. Since I already floss nightly, she suggested that I try either an antiseptic mouthwash such as Listerine or a toothpaste containing baking soda, or else start flossing twice a day. What should I do?
Answer: There’s no need to floss twice a day, but be sure to use the proper technique when you do floss: Don’t just work the thread between teeth with a sawing motion; curve it around each tooth and sweep it up and down across the broad surfaces.
Since you seem to develop tartar especially quickly, try brushing twice a day with a tartar-control toothpaste. (If you develop a rash around the outside of your mouth, try switching brands.) You should also continue to get periodic professional cleanings.
Listerine can fight plaque, but it doesn’t slow the conversion of plaque to tartar. Toothpastes containing baking soda, or bicarbonate, may actually encourage tartar formation, at least theoretically, by increasing the alkalinity of the mouth.
TIME FOR A CROWN?
Question: At my last checkup, my dentist told me that large silver fillings in two molars were deteriorating and that crowns would be necessary. Couldn’t I just have the fillings replaced?
Answer: Possibly, but that may not be the best solution. The average filling starts deteriorating after about 10 years. When you need a replacement, the tooth must be hollowed out further to accommodate the new filling. But if the old filling is large to begin with, removing more of the tooth could make it vulnerable to fracture from chewing. Often, the wiser choice may be a crown, which is more expensive than a filling but lasts much longer. The tooth is first filed down, and a crown made of porcelain, gold, or plastic is then anchored to the stub.
TOOTHPICKS AND GUM DISEASE
Question: I thought brushing and flossing were enough to prevent gingivitis. But my dentist says I should also use a toothpick,, Is that necessary?
Answer: Brushing and flossing are usually enough for most people. However, a pick can help if your gums are still inflamed or if they bleed during cleanings, both signs of early gum disease. You can use a regular toothpick or a commercial “interdental stimulator,” such as Stim-U-Dent.
Once a day, massage your gums by moving the pick in and out of the spaces between your teeth several times. Your gums may bleed at first, but after a few days the swollen tissues repair themselves to a healthier condition. If bleeding persists, see your dentist.
Question: My children, ages 14 and IS, have no dental problems but were recently advised by a new dentist to have their molars and premolars treated with sealants. What are the appropriate indications for this procedure?
Answer: Sealants are an excellent way to protect children’s first and second permanent molars, even in the absence of current dental problems. The procedure involves applying a soft plastic to the tooth surface to fill in the pits and fissures. This prevents food and bacteria from accumulating in those spaces. The plastic is then hardened with a special light or chemical.
Sealants should be applied soon after the molars appear: at about ages 6 to 7 for the first molai; and ages 12 to 14 for the second. Children with evidence of tooth decay may also benefit from sealants on their premolars, also called bicuspids, which appear at ages 9 to 12.
Question: After a series of X-rays, my dentist recommended removing my 13-year-old son’s upper wisdom teeth at age IS for proper spacing. How seriously should I take this advice?
Answer: This advice stems from the concern that impacted wisdom teeth, or third molars, will tend to push other teeth inward. But long-term studies have now shown that teeth can crowd together whether or not the wisdom teeth have been removed. Crowding, when it occurs, seems to result from a natural tendency of the teeth to move forward, although the exact causes are not clear.
Wisdom teeth should be removed when there is a better reason to do so, such as a painful infection around the teeth. Teeth that are merely impacted will not necessarily become troublesome over time. In addition, teeth that appear to be impacted at age 15 may right themselves in another five or six years. Since wisdom teeth generally don’t reach their final position until the early twenties, it’s too early to tell how your son’s teeth will grow in.
Health handbook introducing you to read the article: DENTAL CARE: DENTAL X-RAYS
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