19 March 2009

Breaking even again

On the one hand, I hied me off to the dentist today with suspicious eagerness for someone who suspected herself to be in for some unpleasant tartar-scraping (and YES, Dr. H, if you’re reading this, I know that flossing more than a couple times a week would eliminate some of this…I’m working on it, ’kay? :P). Why the spring in my step as I set off? My fellow mothers, you’ve doubtless already guessed: I was going all by my very own self. I calculated that I’d get at least 10 minutes of reading in the waiting room and another 20 or 30 minutes of lying quietly in a relatively comfy chair.

In my previous lives, I always dreaded dentist visits (sorry again, Dr. H! Nothing personal; mostly due to some early traumatic experiences). Now I wonder: why only every 6 months? Is there a way I could convince the insurance company to cover more frequent visits? In short, I’d rather spend an hour in a muzak-ed room having wicked-looking instruments wielded upon me by a fiendishly enthusiastic hygenist than in the company of my own children. Shame on me.

Bring it on, buddy--and take your time.

On the other hand, as I listened to the nice young hygienist (who happens to be D.I.N.K.) describe how her 40-minute commute gives her some needed “me time” and how their dogs (with the expected comparison to kids) get muddy when they play outside, I actually felt a little sad for her. Used to be I’d hear something like that and just feel sorry for me. :P Baby steps, people…baby steps.


Pam said...

RM, I am SO with you on this, and despite all the unpleasant work I've had done on my own teeth already, I have always strangely enjoyed going to the dentist. It's of course been even better now that I have actually had so many visits go by with no cavities to drill and fill!

Maybe I just love that freshly cleaned feeling THAT much, since it lasts a day or two at least, unlike whatever vain attempt I make to keep a corner of my home clean for an hour.

And yes the quiet time is nice, too.

Oh, and for the record, I have faithfully brushed and flossed every night for a very long time, but my crowded palate has given me grief anyway.

I am so glad I am thinking outside the box for our kids... we are able to give them a better start than what I had with a nifty appliance called the T4K.

I've been meaning to ask the good doctor about that...

Sarah D said...

I went to the dentist today too.
My dentist does not employ assistants really. He does everything including flossing and cleaning. He doesn't overbook, so I was literally in the office for no more than 15 minutes. I then hightailed it to the park to walk, since I still had some "alloted time off" left.

Clean teeth rock!

What does DINK stand for?

Reb. Mary said...

DINK: Dual Income No Kids

Rebekah said...

Hey, I was just at the dentist too! I also thoroughly enjoyed riding my bike there and back. Great, great afternoon . . . although I never know if I have any cavities because they won't do an x-ray when I'm pregnant or nursing--HA!

Gauntlets said...

I'm due for the dentist, big time. Though I've always regarded the experience as something akin to the Death of Ivan Ilyich . . .

Erich Heidenreich, DDS said...

All homeschool mothers with more than two kids LOVE to come to my office alone. They say it is only second to going to the hair stylist.

Unfortunately, there are also those mothers who think my staff is there to baby-sit their kids while they get their teeth cleaned or worked on. Some even bring toys and sit them on the floor in my treatment room and then expect me to be able to do my work while their child is climbing all over them and asking questions ... that is, if they're not playing with my equipment or running up and down the hallways. I have plenty of experience dealing with kids climbing all over, but I don't recommend it during dental visits.

Another interesting dental fact is that I have occasionally had mothers tell me that a severe toothache (always an infected tooth in need of a root canal) is worse than childbirth. In my experience observing both, it certainly appears that severe dental pain is second only to the pain of severe burns!!!

Moral of the story? FLOSS daily! ;-)


I honestly had never heard of the T4K appliance. However, after reading what I found with Google, I have to say that the principle of this system seems quite sound. I just don't know the success rate, and since I have had no experience with it in practice, I can't say whether I'd recommend it.

Myofunctional factors (i.e. improper muscle forces in the mouth) do play an important part in developing the alignment of the teeth. Proper jaw growth and tooth eruption can only occur if the muscles of the tongue, lips, and cheeks are doing their job right. The tongue, in particular, is a very powerful muscle and can exert a tremendous orthodontic force on teeth.

I have seen ever-increasing cases of tongue thrusts in my practice over the past 20 years. There are many things that can be blamed for myofunctional problems, but I personally believe baby bottles and sippy cups are the biggest. Even with orthodontic nipples, the tongue is trained into a lower, forward posture. Nursing provides a better posture from which to transition to the adult swallow. I believe nursing on-demand for the first year also reduces the incidence of thumb sucking. Thumb sucking and clothing sucking tends to go hand-in-hand with tongue thrusting.

Once a child begins to transition to solid foods at about a year, the child should also begin drinking out of a cup with no sippy-lid. There will be more spills, but we're used to that anyway, right? Our family's temptation toward sippy cups has entirely been the prevention of spills.

Sippy cups and baby bottles lend themselves too well to letting children carry around drinks with them, sucking on them over long periods of time. A toddler walking around with a bottle hanging out of his mouth is one of my biggest pet peeves. Not only does this greatly encourage improper tongue positions, it also can cause buck teeth and open bites all by itself.

The extended use of Sippy cups and baby bottles also tends to increase decay problems. When the drink being carried around in the bottle or sippy cup contains ANY amount of sugar (even milk has sugar - lactose) this drastically increases the risk of decay.

Between meals, WATER ONLY! Have a plastic cup (no lid!) for each kid next to the sink that they can grab and get a drink of water any time they want.

Remember this factoid if you want to prevent cavities: It isn't the amount of sugar or even the concentration of sugar that gets in your mouth that matters most - it's the frequency. The bacteria that cause decay don't need much sugar to survive and cause decay. They simply need to be fed frequently. Every time they are fed, they produce decay-causing acid for one half hour. One sip of milk or one M&M eaten every half hour throughout the day will cause tremendous decay problems. However, a full one-pound bag of M&Ms eaten all at once at mealtime is just fine as far as the teeth are concerned. It's the frequency, not the amount.

Back to swallowing... A normal adult swallow begins with the tongue on the roof of the mouth, about at the first ridge you can feel on the hard palate. The tongue "cups", forming a bolus of food in the center which is then pushed toward the throat. This is the best way to initiate the next and most important part of swallowing - the peristaltic action of the throat which sequentially contracts the muscles of the esophagus toward the stomach.

An infantile swallow (pushing the tongue forward and then creating suction in the back of the mouth to suck the food into the throat) is not as effective at initiating the swallow reflex in the esophagus. The peristalsis stalls half-way down, and the food gets stuck.

Tongue thrusters often need to re-initiate the swallow reflex more than once to get the food to go all the way down. For this reason, tongue thrusters have a difficult time swallowing pills, and also have more incidents of choking during meals. Meat can be a particular challenge, especially steak.

Even without bottles or sippy cups, the transition to an adult swallow can be delayed. Half of kindergarten-age children still have a retained infantile swallow. However, if an adult swallow has not been attained by eight years of age, I generally refer to a myofunctional therapist. Good therapists are hard to come by, but can be found. Self-treatment is virtually always unsuccessful. You can't just tell yourself to swallow right. Some muscles need to be strengthened by some weird exercises in order to even be able to do it. You need to be given exercises unique to your tongue thrusting habit, and have monthly re-examinations to fine tune your new swallow habit. It takes about six months of active therapy to correct, and another six months of conscious exercise to make it permanent. Even then, relapse is possible if the patient is not consciously checking his habit now and then. After a few years with no relapse, the habit is usually permanently fixed.

Pam said...

Yes, yes, I have gotten how the 'sugar bugs' work. I only wish someone had explained that to me back when I saved/savored my candy; it likely contributed to my problems.

Wow, all that swallowing stuff makes so much sense. So what, if any, is the recommended pacifier? I've used gerber nuks for those babies who even used them. They seem to do a better job IMO because the 'stem', if you will, of the bulb of the pacifier is narrower.

As for the T4K, we have been driving 3 1/2 hours for the appointments with the dentist who uses this orthodontic appliance. It is less expensive and more gentle than braces, and so far we have been very pleased with the results. I wish more dentists would get into this so folks like us wouldn't have to drive so far to do it. Ours is in Noblesville, IN.

I'd be happy to expound on our experience if anyone is interested.

And this same dentist told us that while brushing and flossing is of course fine to do, the BIGGEST part of preventing decay is to "swish and swallow" within 15 minutes after eating. Meaning swish some water around to rinse the mouth, then swallow. This maintenance between brushing keeps the bacteria from being fed.

One more habit to add to the list... :oP

Erich Heidenreich, DDS said...

If a pacifier is used, Nuk is probably the most recommended by dentists. I'm not sure. It's what I've leaned toward. However, personally, I encourage my wife not to give any pacifiers to our kids. And, if she does, to only use them when "necessary". A pacifier is better than a thumb. At least you can take the pacifier away some day. :-P

Melrose said...

wow, very educational! :)

Reb. Mary said...

In your life, you have doubtless said many things. Even just on this blog, you have left many comments worthy of note. But this one surpasses them all: >>a full one-pound bag of M&Ms eaten all at once at mealtime is just fine<<
AH, the joy of shameless excerpting for one's own purposes. Thank you, thank you.
And in return, I shall floss tonight. Right after the one-pound bag of M&Ms :D

Erich Heidenreich, DDS said...

Ah, yes, but of course you know the shame is that you left out the ellipsis, the three little dots that would alert the reader of your intentional omission of an important clarifying phrase contained in the original text.

"...as far as the teeth are concerned."

Now, go floss as your penitence! ;-)

Marie said...

So, what should we pregnant Mommies to do when we need to eat every hour or so for the first few months? I can hardly get to the cupboard that often, much less run to the bathroom and brush my teeth! What's a momma to do?

Erich Heidenreich, DDS said...

Good question, Marie.

My answer: Rinse and spit with an over-the-counter fluoride rinse once daily, preferably right after brushing at bedtime. Do not drink or rinse after this if possible.

Fluoride strengthens the enamel, making it more resistant to the demineralizing action of the acid that decay-causing bacteria produce.

As Pam already mentioned, it can also help to rinse with water after snacking. However, it is an error to think this will stop all decay activity from frequent snacking. Even if you could be successful at removing all the remaining carbohydrates from your mouth after eating, the bacteria in your mouth have been fed and will produce acid for 1/2 hour. Even brushing will not eliminate the problem, as there are deep grooves and other hiding places for these microscopic bacteria. A single toothbrush bristle looks like a tree compared to these grooves. The mouth simply can't be sterilized.

Compared to this decay question, a much more important dental issue during pregnancy is oral hygiene. I'm sure many of you moms have noticed that your gums may be more sensitive and bleed more easily during pregnancy. What you may not know, however, is the danger gingivitis and gum disease in your mouth can be to your baby's life. Rather than write another marathon comment, here is a relatively good fact sheet I found.

Lauriinnc said...

Oh thank you Dr H! Nice dental lesson.

While getting a filling at times has caused me great anxiety, depending on where it is, I love how my dentist takes care of me.

I have some kids (including #1) with no cavities, and then some with lots and the "Baby#9" got a crown when he was 18 months old :( THAT was a very sad day. I discovered the huge cavity myself. He LOVES candy and apparently has soft teeth. boo hoo.

Next comes braces for two or three of them. yippee. NOT

Marie said...

I never knew the link between gingivitis and possible pre-term labor, but it makes sense! Thanks for the tips!

Rev. Robert Franck said...

Busy pastors with large families at home also like to go to the dentist.

I get to sit in a chair, lean back, and nobody expects me to do anything for an hour.

My appointment is tomorrow at 11.