A chipped tooth can happen to anyone: a child riding a bicycle, a teenager playing basketball, or a grown-up crunching a piece of hard candy. It’s one of the most common dental injuries — and, fortunately, it’s usually one of the easiest to treat. There are several ways a chipped tooth can be treated, depending on how extensive the chip is. But first, there are some things you should do right away.

If possible, save any pieces that broke off the tooth, and bring them with you to our office. If you have pain, take an over-the-counter pain reliever like acetaminophen or ibuprofen; rinsing your mouth in salt water can also help soothe the ache. Next, call our office for an appointment.

Small to Moderate Chips

In many cases, a small to moderate chip can be repaired via a procedure called bonding. Bonding uses tooth-colored substances to replace missing tooth structure. Bonding materials are called “composite resins” because they contain a mixture of plastic and glass, which adds strength and translucency. This composite actually bonds, or becomes one, with the rest of the tooth.

Composite resins can be successfully bonded to most healthy teeth, and they come in a variety of tooth shades for truly lifelike results. When bonding is complete, it may be impossible to distinguish the repaired tooth from its neighbors. Though bonding may not last as long as some other restorations, it also does not require the involvement of a dental laboratory — and, most often, can be done with very minimal drilling of the tooth. It’s a particularly good solution for teens, who often need to wait until their teeth have finished maturing before choosing a more permanent type of dental restoration.

The Bonding Process

Tooth bonding can usually be accomplished in a single visit to the dental office, in a procedure that may take 30 minutes to an hour. First, the surface of the tooth may be altered slightly with a drill to bevel the chipped areas. Next, the tooth to be bonded will be cleaned so it is plaque-free, and “etched” with a gel that opens up tiny pores in the surface. Then, liquid composite resin in a matching shade is painted on in a thin layer, and a special curing light is used to harden this bonding material. Once the first layer is cured, another layer can be painted on and cured. More layers can be built up until the restoration has the necessary thickness; it can then be shaped using a dental drill to give it just the right form, and given a final polishing.

Larger Chips

If a tooth has been severely chipped and has lost a large part of its structure, a more extensive restoration may be needed. In this case, a veneer or a crown restoration (cap) may be recommended. There are several different varieties of veneers and caps, which we will discuss with you. Both veneers and caps usually require the services of a dental laboratory, and will take more than one visit to prepare and place. In some cases where extensive damage has occurred, a root canal procedure may also be necessary to prevent or treat infection in the pulp (inner part) of the tooth.

Dentistry is an art as well as a science; dental crowns offer a perfect example of this. A dental crown or “cap” is a covering that fits over a damaged, decayed or unattractive tooth. It can even replace a tooth entirely as part of dental bridgework.

A crown completely covers a tooth above the gum line. This is in contrast to a dental veneer, which only covers a tooth’s front surface and needs natural tooth structure to support it. Therefore, if a tooth is missing a significant amount of structure above the gum line, a crown would be the restoration of choice.

Crowns strengthen damaged teeth, allowing them to function normally again. When crafted from today’s high-tech porcelains (dental ceramics), crowns are virtually indistinguishable from natural teeth. They can even be designed to improve upon a tooth’s original appearance.

There are other materials besides porcelain that we can use to make dental crowns, depending on what qualities are most important. For durability, cast gold can’t be beat. However, this is not always the most aesthetic choice — especially towards the front of the mouth. Other possibilities include porcelain-fused-to-metal crowns (PFM), which have a metal interior for strength and a porcelain exterior for a more natural appearance, and all-porcelain crowns with zirconia, representing the strongest ceramic. We would be happy to discuss the pros and cons of these various options with you.

Crowning or Capping a Tooth

Crowning or capping a tooth will usually take two to three visits. At the first visit, we will prepare your tooth to receive its new crown. First we will shape it to fit inside the new covering. This will involve some drilling to give the tooth a uniform shape. We will numb the tooth and the surrounding area beforehand. If there is very little tooth structure left to begin with, we may have to build up the tooth with filling material, rather than remove tooth structure, to support the crown.

After the tooth is prepared, we will take impressions of your teeth, either digitally or with reliable, putty-like impression materials, and send them to the dental laboratory. There, the impressions will be used to make models of your teeth for the creation of a crown. The models will serve as guides to the highly skilled lab technicians, who will ensure that your new crown is designed to enhance your smile and function well within your bite.

Before you leave the office, we will attach a temporary crown to your tooth to protect it until the permanent crown is ready. At the second visit, your permanent crown will be attached to your tooth with either a resin that hardens when exposed to a special light source, or a type of permanent cement.

Creating a Bridge

Crowns can also be used to create a lifelike replacement for a missing tooth. This is done with bridgework, which spans the space of the missing tooth and requires at least three crowns. Two of those crowns will be placed over healthy teeth on either side of the missing tooth; these healthy teeth are referred to as abutment teeth. The two crowned abutment teeth become supports for a third crown placed in between them; that third crown is referred to as a pontic. If more than one tooth is missing, more crowns will be needed to bridge the gap in between the abutment teeth.

The number of abutment teeth necessary to replace missing teeth is influenced by the number of missing teeth, the size and length of the abutment tooth roots, the amount of bone support each abutment tooth has, as well as where in the mouth the missing tooth is located. For example, if you have three missing teeth, four abutment teeth may be necessary, thereby creating a seven-tooth bridge. Engineering and designing of the bridge requires an understanding of how to replace teeth, as well as the biology of the supporting gum and bone tissue.

Caring for Your Crowns & Bridgework

Crowns and bridgework require the same conscientious care as your natural teeth. Be sure to brush and floss between all of your teeth — restored and natural — every day to reduce the buildup of dental plaque. When you have crowns, it is even more important to maintain your regular schedule of cleanings here at the dental office. Avoid using your teeth as tools (to open packages, for example). If you have a grinding habit, wearing a nightguard would be a good idea to protect your teeth and your investment.

What makes a smile beautiful? That’s a complex question, but some qualities of a lovely smile are immediately identifiable: good tooth color, shape and alignment are a few of the most important ones. If your teeth could use improvement in any of these categories, porcelain veneers could be just what you’re looking for.

You may already know that a veneer is a thin covering over another surface. In dentistry, a veneer is a wafer-thin layer of super-strong porcelain that convincingly substitutes for natural tooth enamel. When bonded to your teeth, veneers can create a natural-looking, beautiful new surface. That’s because dental porcelain, like natural tooth enamel, is translucent and tough. But it doesn’t stain like tooth enamel does.

Recent years have brought remarkable advances in dental porcelain technology. These days, veneers can be made so thin that they can sometimes be bonded directly onto your existing tooth surface. In other cases, a very thin layer of tooth enamel — as thin as the veneer itself — needs to be removed to fit the new porcelain surface and make it look as lifelike as possible. Either way, the results are sure to make you smile.

Versatility of Porcelain Veneers

We can use veneers to improve any of the following characteristics of your teeth:

• Color — Teeth can become stained by the foods and drinks we like, from smoking, and even normal aging. Veneers are available in numerous shades, from the most natural to the brightest Hollywood white.
• Size & Shape — Teeth can become worn down from grinding habits, or may not have the shape or size you want to begin with. For example, some people consider rounder teeth more feminine and squarer teeth more masculine. Veneers can be shaped and sized in whichever way is most flattering to your face.
• Alignment & Spacing — Veneers can be used to close small gaps between teeth or make slight corrections in alignment while improving tooth color and shape.

Limitations of Porcelain Veneers

There are some situations in which veneers would be inappropriate. For example, if you have significantly misaligned teeth or a large gap, we might recommend orthodontics instead of veneers. And if you have lost a lot of tooth structure from decay or trauma (or a particularly severe grinding habit), it might be better to restore your teeth with porcelain crowns that cover the entire tooth.

Creating a New Smile with Porcelain Veneers

The first step in creating a new smile with porcelain veneers is to communicate exactly what you don’t like about your smile as it is now. It’s a great idea to bring in pictures of smiles you do like, as a starting point for discussion. We can show you how veneers would look on your teeth in one of several ways. We can create a model of your teeth and put wax “veneers” on the model; we can even put acrylic (plastic) or tooth-colored filling material directly onto your teeth to demonstrate the effect veneers would have on them.

Once we have agreed on a plan, we will prepare your teeth by removing a small amount of enamel, if this step is necessary. Molds of your teeth will be taken and used by a skilled dental laboratory to create your veneers, and you will receive a temporary set of veneers to wear during the few weeks it will take to create your permanent veneers. We will be in touch with the laboratory throughout the fabrication process to make sure the finished product is just what we’ve envisioned. When the veneers come back from the lab, they will be cemented onto your teeth.

Caring for Your Veneers

Just like the teeth nature gave you, teeth restored with veneers need gentle brushing and flossing every day. This will remove dental plaque and ensure good gum tissue health around the veneers. Regular checkups at the dental office will remain as important as always to your oral and general health. And keep in mind that as tough as veneers are, they may not be able to withstand forces that come from using your teeth as tools (to open packages, for example) or biting into very hard foods like candy apples — which isn’t good for your natural teeth, either! And if you grind or clench your teeth at night, we might advise you to get a custom-made nightguard to protect your veneers.

f you have been told you need root canal treatment, you may be feeling a bit nervous. Not to worry — treating root canal problems is a routine part of dentistry that can relieve certain kinds of tooth pain and help your teeth last longer. As you learn more about this beneficial procedure, you will understand why it’s needed — and how it will leave you in far better shape than you were when you came in to the dental office! Here are some answers to frequently asked questions.

What is a root canal?

Dentists use the term “root canal” in referring to the tiny, narrow passageways that branch from a central, hollow space in your tooth (called the pulp chamber) down to the ends of the tooth roots. The term can also be used as a shorthand for “root canal treatment” — that is, the procedure used to save the tooth if the soft tissue deep inside of it (called pulp) becomes acutely inflamed or infected.

Why do I need root canal treatment?

If tooth pulp becomes acutely inflamed or infected because of decay or injury, we need to remove that tissue in order to save the tooth and stop the infection from spreading. As an adult, you don’t actually need the pulp — its primary use is to aid in tooth development during childhood.

Is there an alternative?

We could remove the whole tooth, but it’s always better to try to save it — especially since root canal treatment is routine and has a very high success rate (over 90%). Saving the tooth can prevent other troubles from occurring later on; these could include bite problems from teeth shifting position, difficulty eating, and loss of jawbone volume and density.

Is root canal treatment painful?

The procedure normally causes no more discomfort that a filling would. Root canal treatment may have a bad reputation, but it is undeserved; in this case it’s the disease that’s to blame and not the cure. In other words, the infections that make the treatment necessary in the first place are often painful because they are inflaming tissue that has lots of nerves and therefore is very sensitive. Root canal treatment actually relieves this pain!

What will happen during the procedure?

After numbing the area, we will make a tiny hole in the crown (top) of your tooth to access the pulp chamber and canals. After we remove the diseased tissue, we will disinfect the chamber and the canal(s) all the way to the root end(s). Teeth in the front of the mouth have one root and generally one canal; back teeth have two or three roots and generally three or four canals. We will fill those canals and the pulp chamber with an inert, biocompatible material, and seal it with adhesive cement. The access hole will receive a temporary filling.

What will happen afterwards?

Your tooth may feel sensitive for a few days, but any discomfort can usually be relieved with over-the-counter pain medication or anti-inflammatories like ibuprofen. You will be instructed to avoid chewing on that tooth until it receives its permanent filling, which can be placed a few days later. Depending on how damaged the tooth was to begin with, it may need a full-coverage crown. We will discuss your options with you.

How can I avoid the need for root canal treatment in the future?

Keep your teeth decay-free by brushing and flossing every day. Eat a healthy diet low in sugar and avoid acidic beverages such as soda. Come in to the dental office regularly for professional cleanings and exams. And if you’re active in sports, consider ordering a custom-made mouthguard to protect your teeth from injury.

Root canal treatment — also called endodontics (“endo” – inside, “dont” – tooth) — is a set of specialized procedures designed to treat problems of the soft pulp (nerve) tissue inside the tooth. While some mistakenly think of it as an unusually painful treatment, in most cases the procedure is no more uncomfortable than getting a filling. It’s actually one of the most effective ways of relieving some kinds of tooth pain.

A root canal procedure becomes necessary when infection or inflammation develops in the pulp tissue of the tooth. Pulp tissue consists of blood vessels, connective tissue and nerve cells — which explains why a problem here may cause you to feel intense pain. In time, the pain may go away… at least temporarily. Without treatment, however, the infection won’t. It can lead to a dental abscess, and may even contribute to systemic problems in other parts of the body.

Root Canal Treatment Is Your Friend

We’ve all heard the gag: “I’d rather have a root canal…” This comedy line, comparing the procedure to something truly undesirable, may be funny — but putting off needed endodontic treatment is no joke. The idea that a root canal procedure invariably comes with complications and pain is a shopworn myth. It’s certainly true that infection or inflammation in the tooth’s pulp can be excruciatingly painful. But you should remember that having a root canal results in eliminating this acute pain and is not the cause of the pain.

Need another reason not to delay root canal treatment? How about this: A natural tooth that’s saved via root canal treatment and restoration helps you avoid the problems that commonly occur when teeth must be removed. These include unwanted tooth migration or shifting, which can lead to difficulties in chewing; the need for bridgework or dental implants, which may be costly and complicated; and even the eventual loss of bone structure from the area of the missing tooth.

Causes of Root Canal Problems

Root canal problems stem from infection and inflammation of the tooth’s pulp tissue. One potential cause of infection is deep tooth decay. Untreated dental cavities eventually allow bacteria to work their way down to the center of the tooth, where they may infect the pulp tissue. Another path by which bacteria may come into contact with pulp is via chipped or cracked teeth. Any opening in the protective enamel coating has the potential to allow bacteria access to the tooth’s pulp.

Trauma to the tooth — the kind that might result from a sports injury or automobile accident, for example — is also a major cause of pulp tissue damage. In this case, it’s essential to seek treatment immediately, both to try and save the tooth, and to prevent future problems.

In some cases, extensive dental work itself may cause damage to the pulp tissue that will need to be treated via a root canal. Having multiple fillings or restorations on the same tooth increases the chances of this type of injury. Occasionally, common procedures like crown preparation or orthodontics may eventually lead to root canal problems.

What to Expect During Root Canal Therapy

If an examination shows that you do need root canal therapy, don’t worry — it’s one of the most routine and effective procedures in the arsenal of dental treatments and can often be accomplished in just one visit.

The root canal process generally begins the same way as a filling does, and with no greater discomfort: an anesthetic is administered to numb the tooth and the surrounding area. For many patients, the worst is already over.

Next, a small opening is made in the surface of the affected tooth to give access to the pulp chamber and root canals. Tiny instruments are used, sometimes with the aid of a microscope, to remove the dead and dying pulp tissue from inside these narrow passageways. The chamber and empty canals are then cleaned, disinfected, and prepared to receive a filling of inert, biocompatible material. Finally, adhesive cement is used to seal the opening in the tooth, preventing future infection.

Following root canal treatment, your tooth may feel some sensitivity or tenderness for a few days. Over-the-counter pain relievers like ibuprofen are generally effective in relieving discomfort, but prescription medications may also be given if needed. During this period, it may help to avoid biting hard on the affected tooth. All of these symptoms, however, should be temporary.

To further protect the tooth and restore it to full function, it’s usually necessary to have a crown or other restoration placed on it. Restorations can take many forms, from traditional gold crowns to tooth replicas made of high-tech tooth-colored material. In any case, you will have made an investment in preserving your dental health for years to come.

Signs and Symptoms of Root Canal Problems

How do you know when you need a root canal? Sometimes, it’s painfully obvious. If you feel constant and severe pain and pressure in your mouth, or noticeable swelling and extreme sensitivity in your gums, then it’s clear you need to come in for evaluation and treatment right away. Another telltale symptom of pulp tissue damage is sharp pain when you bite down on food. Lingering pain after eating hot or cold foods is also an indication of potential trouble. If you notice any of these symptoms, please come in for an examination.

Fluoride is a mineral that is naturally present to some degree in both fresh and salt water sources. Its major dental benefit is that it is readily incorporated into the teeth’s mineral structure, thereby making them stronger and more decay-resistant. Fluoride can even reverse tiny cavities that are starting to form. Less tooth decay means you have a better chance of avoiding significant dental treatments — and keeping your natural teeth for life.

The great majority of toothpastes sold today contain fluoride, because it’s an effective, easy and inexpensive way to prevent tooth decay and promote oral health. Because of its proven health benefits, fluoride is often added to municipal water supplies to bring them to the current recommended level of 0.70 parts per million. In fact, the federal Centers for Disease Control and Prevention recently named community water fluoridation as one of the most significant public health achievements of the 20th century.

Making Fluoride Available to the Teeth

Fluoride can be delivered to teeth in two ways: topically (on the surface) and systemically (through the body). The first method helps people of all ages; the latter is only beneficial in childhood while the permanent teeth are forming beneath the gum line — up to about age 9.

Fluoride ingested in drinking water can reach teeth both ways. When swallowed, it travels through the body and becomes incorporated into developing teeth; it also stays in the mouth throughout the day in a very low concentration. Toothpaste and mouthwashes provide higher concentrations over shorter periods of time. Fluoride can also be applied directly to the teeth at the dental office; children who get their water from unfluoridated sources may be prescribed a fluoride supplement in the form of pills or drops.

How Much Do You Need?

The amount of fluoride you need varies according to your particular risk for decay, which is determined by many factors: your body’s own biochemistry, your diet, the amount of fluoride you come into contact with daily, and the effort you put into your own oral hygiene. If you maintain an effective daily routine of brushing and flossing, and avoid sugary and/or acidic foods and beverages, your decay risk will likely be low. If you are lax about oral hygiene, drink soda and snack throughout the day, your risk will be much higher.

Poor oral hygiene and constant intake of sweets make an ideal environment for decay-causing bacteria, which need sugar to thrive. In the process of digesting that sugar, they create tooth-eroding acids as a byproduct. And if you drink beverages that are already acidic — soda, sports drinks, energy drinks, even some fruit juices — you are applying those tooth-destroying acids directly to your teeth without using bacteria as a middleman. In that case, you might benefit from fluoride treatments here at the dental office and/or regular use of a fluoride mouthrinse.

However, there is such a thing as too much fluoride — particularly when it comes to children. If developing teeth absorb too much fluoride, they can become permanently stained or even pitted — a condition referred to as enamel fluorosis. It is not dangerous, but may require cosmetic dental work. That’s why young children should not be allowed to swallow fluoride toothpaste. Adults who take in excessive fluoride throughout their lifetimes may become more prone to bone fractures or tenderness, a condition known as skeletal fluorosis. Severe forms of enamel or skeletal fluorosis are not common in the United States. Still, given that excessive doses of fluoride could cause problems, it’s best to consult us on the most appropriate products for you and your child to use.

Maintaining good oral health has many rewards: A sparkling smile, fresh breath, and healthy gums. But recent scientific evidence suggests that it may have an even greater benefit to your overall health: Specifically, it could potentially reduce your risk for a number of systemic (whole-body) diseases, including cardiovascular disease (CVD), diabetes, and rheumatoid arthritis — even premature birth.

Periodontal (gum) disease is estimated to affect nearly half of all Americans, and is the major cause of adult tooth loss. Numerous studies have shown that patients with severe periodontal disease are at increased risk for developing cardiovascular disease. Periodontitis may also increase the chance that diabetes will develop or progress, and research suggests an association between gum disease and adverse pregnancy outcomes as well.

Inflammation: Friend and Foe

What’s the link between diseases of the mouth — like gum disease — and those of the body? They are connected by the body’s natural reaction to harmful stimuli, which we call the inflammatory response. Often characterized by pain, redness and swelling, inflammation is a process by which your immune system responds to damage or disease in your tissues. Inflammation can help the body heal — or, if it becomes chronic, it can lead to more serious problems.

Gum disease (periodontitis), CVD, diabetes and rheumatoid arthritis are all associated with the same type of inflammatory response. Studies have found that moderate to severe periodontitis tends to increase the level of systemic inflammation — a condition that may smolder in the background, awaiting the right conditions to flare into a more serious disease. It has also been shown that the same strains of bacteria that are found in inflamed gum tissue may also appear in the arterial plaques of individuals suffering from CVD.

How Does It Work?

While there is intriguing evidence of a link between gum disease and other systemic diseases, further studies will be needed to prove whether one causes the other. At present, however, several mechanisms have been proposed to explain how the connection works. One suggestion is that oral bacteria themselves may enter the bloodstream, form into clumps, and trigger systemic inflammation. The inflammatory response can cause swelling of cells and tissues, which narrow the arteries and increase the risk of blood clots.

Another possibility is that byproducts of oral bacteria released into the bloodstream could trigger the production of substances called CRPs (C-reactive proteins) in the liver. These proteins tend to inflame blood vessels and promote the formation of clots, possibly leading to clogged arteries, heart disease and stroke. Elevated CRP levels, according to some studies, are a stronger predictor of heart attack than cholesterol levels.

What You Can Do

Since chronic inflammation is a systemic problem, the best way to begin controlling it is via a whole-body approach. Maintaining a healthy weight, getting moderate exercise (and, if you use tobacco, quitting the habit) will help with this. So will bringing untreated inflammatory diseases, such as periodontitis, under control.

We have a number of effective treatments for periodontal disease, including nonsurgical procedures such as root cleaning and the local application of antimicrobials. For more serious conditions, conventional or laser gum surgery is an option. Finally, to keep your gums healthy between office visits, we can help you develop an effective oral hygiene routine you can practice at home.

Although it’s too early to say that periodontal disease causes heart disease or other systemic conditions, they seem to have a connection. And while we can’t change genetics, we can control external factors like excess weight, tobacco use… and gum disease. Maintaining good oral hygiene is the best way to avoid periodontal problems. But if problems occur, don’t wait: The sooner we begin treatment, the better your chances for controlling gum disease — and perhaps systemic diseases too.

Teeth can last a lifetime if you take care of them right — and the best time to start is just as soon as they begin appearing. By establishing good oral hygiene routines for your children right from the start, you’ll give them the best chance of keeping their teeth healthy — forever.

Tooth decay, the major cause of dental trouble that can eventually lead to tooth loss, is actually an infectious disease caused by bacteria. If it takes hold, it can form a cavity in the enamel and then progress deeper into the tooth — causing discomfort, difficulty eating and speaking, and a need for fillings or root canal treatment. The good news is that tooth decay (also called caries) is completely preventable.

The primary route to good dental health is plaque removal. Plaque is the sticky, whitish film that builds up on teeth in the absence of effective oral hygiene. Decay-causing bacteria thrive in plaque, where they break down any sugar that lingers in the mouth. In the process, they produce acid byproducts that erode teeth. This is how a cavity begins. What are the most effective techniques for plaque removal and decay prevention? That depends on the age of your child.

Babies

Babies can develop a form of tooth decay known as early childhood caries. This occurs when they are allowed to go to sleep with a bottle that’s filled with anything but water. The sugars in formula, milk (even breast milk) and juice can pool around the teeth and feed decay-causing bacteria. When it comes to bedtime soothing, a pacifier or bottle filled with water is safer for developing teeth — that is, until about age 3. At that point, sucking habits should be gently discouraged to prevent orthodontic problems from developing later on.

Brush your baby’s first teeth gently with a small, soft-bristled toothbrush, using just a thin smear of fluoride toothpaste, at least once a day at bedtime. Before a tooth is fully erupted, you can use a water-soaked gauze pad to clean around the tooth and gums.

Bring your child in to see us by age 1. We can demonstrate proper hygiene techniques; look for signs of early decay; and recommend fluoride supplementation if needed.

Children

Starting at age 2, you can begin teaching your child to brush with a children’s toothbrush and no more than a pea-sized amount of fluoride toothpaste. But remember, children will need help with this important task until about age 6, when they have the fine motor skills to do an effective job themselves.

It’s also extremely important to start encouraging healthy dietary habits at this time. Your child will have less plaque buildup and decay if you place limits on soda and sugary snack consumption. As a parent, you can model this behavior to instill it in your child. After all, monkey see, monkey do! Any sugary treats that are allowed should come at mealtimes, not in between. This will ensure your child is not creating favorable conditions for oral bacteria to grow around the clock.

At your child’s regular, twice-yearly dental checkups and cleanings, we can apply topical fluoride to strengthen tooth enamel and make it more resistant to erosion and decay. If necessary, we can also apply dental sealants to the back teeth (molars) to prevent food particles and bacteria from building up in the tiny grooves where a toothbrush can’t reach.

Teens

At this point, your children have the primary responsibility for maintaining their day-to-day dental health — but you can continue to help them make good dietary and behavioral choices. These include drinking plenty of water and avoiding soda, sports drinks and energy drinks, all of which are highly acidic; avoiding tobacco and alcohol; and continuing to visit our office regularly for cleanings and exams. This is particularly important if your teen wears braces, which can make it more difficult to keep teeth clean.

Remember, we are always here to answer questions and to help your child continue to develop good oral hygiene habits that will last a lifetime.

Fluoride, a naturally occurring mineral, is essential for proper tooth development and the prevention of tooth decay. In communities throughout the United States, tooth decay may still be a significant problem — but it is far less prevalent than it would have been, if not for the fluoridation of public water supplies. That’s why the major associations of pediatric dentists and doctors support water fluoridation to the current recommended levels of 0.70 parts per million (ppm). It’s also why the federal Centers for Disease Control and Prevention (CDC) has called fluoridated water one of the most significant health achievements of the 20th century.

Of course, not everyone has access to fluoridated water. That’s one reason why we sometimes recommend a fluoride supplement for your child and/or the use of toothpastes and other products that contain this important mineral. Because it is possible for children to get too much fluoride, it is best to consult with us on the use of any fluoride-containing product.

How Fluoride Helps

The protective outer layer of teeth, called enamel, is often subject to attacks from acids. These can come directly from acidic foods and beverages, such as sodas and citrus fruits — or sometimes through a middleman: the decay-causing bacteria already in the mouth that create acid from sugar. These bacteria congregate in dental plaque and feed on sugar that is not cleansed from your child’s mouth. In metabolizing (breaking down) sugar, the bacteria produce acids that can eat through tooth enamel. This is how cavities are formed. When fluoride is present, it becomes part of the crystalline structure of tooth enamel, hardening it and making it more resistant to acid attack. Fluoride can even help repair small cavities that are already forming.

Delivering Fluoride to the Teeth

Fluoride ingested by children in drinking water or supplements can be taken up by their developing permanent teeth. Once a tooth has erupted, it can be strengthened by fluoride topically (on the surface). Using a fluoride-containing toothpaste is one way to make sure your children’s teeth receive helpful fluoride exposure daily. We recommend using only a pea-sized amount for children ages 2-6 and just a tiny smear for kids under two. Fluoride should not be used on children younger than six months. A very beneficial way to deliver fluoride to the teeth is with topical fluoride applications right here at the dental office. We can paint it right onto your child’s freshly cleaned teeth and let it sit for a few minutes for maximum effectiveness.

How Much Is Too Much?

Teeth that are over-exposed to fluoride as they are forming beneath the gum line can develop a condition called enamel fluorosis, which is characterized by a streaked or mottled appearance. Mild fluorosis takes the form of white spots that are hard to see. In more severe cases (which are rare), the discoloration can be darker, with a pitted texture. The condition is not harmful, but may eventually require cosmetic dental treatment. Tooth decay, on the other hand, is harmful to your child’s health and can also be quite painful in severe cases.

The risk for fluorosis ends by the time a child is about 9 and all the permanent teeth have fully formed. Until then, we would be happy to discuss with you how much fluoride your child needs and in what form. Since fluoride use is cumulative, we need to take into account all the sources your child comes in contact with — including powdered infant formula mixed with fluoridated tap water — along with sugar consumption and other risk factors for decay, to make the appropriate recommendation. But while caution is advised, it would be a mistake to forgo the benefits that this important mineral can bring to your child’s teeth — and his or her overall health.