Just about the time when a woman starts to wonder if she might be pregnant, around 6 weeks into the pregnancy, primary teeth, (aka baby) teeth begin to form.  Incredibly, by the 10th week, the permanent teeth begin to form. Developing teeth form into four lobes, which can be thought of as four balls of clay that blend together over time to create the classic tooth shapes that we are familiar with.  Think of the shape of a molar.  If you look straight down onto the biting surface of a molar, you will notice a four-leaf clover outline.  This shape is due to the melding of the four spherical developmental lobes.

The crown of a tooth develops first and begins to erupt (break through the gums) before the roots are fully formed.  Primary teeth (aka “baby teeth” or “milk teeth”) typically erupt around age 6 months, starting with the lower front central incisors.  If a baby is early to get his first primary teeth, he will stay on that schedule and will be early with the following eruptions and exfoliation (loss of) primary teeth.  The same is true of late eruption.  Usually, all primary teeth have erupted by age 3 years and the first baby teeth are lost during kindgergarten.  As the permanent teeth make their way to the surface, the roots of the baby teeth resorb away, leaving nothing but tiny crowns attached to the gum tissue.  Sometimes the baby tooth’s root does not resorb, in which case, the dentist will wiggle it out to make way for the permanant tooth.

I am still surprised today to sometimes hear adults comment that baby teeth are not important and therefore do not need to be cleaned, restored, and maintained until the permanent teeth erupt. The opposite is true.  First, consider the fact that baby teeth have nerves.  Ouch!  Poor oral hygiene, poor diet, and lack of dental care can not only lead to painful cavities, but also to infection. Infection is so commonly treated with antibiotics that the public has come to believe that antibiotics cure infections, but in the mouth, an infection treated only with antibiotics will only easy pain and swelling temporarily.  In addition to antibiotics, the source of the infection must be removed.  Often, this is achieved with root canal therapy or extraction. The baby teeth act as an alignment guide for permanent teeth, so premature loss of baby teeth leads to tipping and malalignment as well as increased risk of decay, gum disease and fracture. Baby teeth are important!

From kindergarten through puberty, a child is in the state of mixed dentition, during which they simultaneously lose baby teeth and gain permanent teeth.  It’s sometimes called the Ugly Duckling Phase, but I think it’s adorable.  During these growth years, a dentist evaluates the size and shape of the jaws.  Ideally, the upper teeth slightly overlap the lower teeth in a tiny overbite.  In case of an underbite at anytime, the dentist will make note and, depending on the child’s age, may refer to an orthodontist for early intervention.  During growth, pressure can be applied on the jaws to encourage or slow growth.  This was traditionally achieved with headgear but today it is more common to use intra-oral hardware that is cemented into place temporarily.  The main goal is to eliminate jaw size/shape discrepancies.  If this is not done during growth, surgery is required as an adult.

As we age, teeth begin to show wear on the biting surfaces.  Older populations often have worn through the lighter outer enamel layer to expose the darker dentin layer.  Also, our the jaw bones that support our teeth tend to exhibit bone loss over time.  As the bone levels drop, the gum tissue levels will follow, resulting in the “long in the tooth” look.  One benefit of ageing is that as we age, the inner root canal of a tooth tends to become occluded, resulting in less sensitivity.  Ah, a benefit to ageing!  With a healthy diet, good oral hygiene, and regular dental visits, it really can be a sweet life for your teeth.

Smiles,

Dr. Cook

As a general dentist, I am often asked by new parents, or parents of toddlers, when their baby should have their first dental visit. No one expects “6 months” to be the answer. Here is an excerpt from the American Academy of Pediatric Dentistry website regarding the first visit: “The AAPD recommends that the child be seen by a pediatric or general dentist at the time the first tooth comes into the mouth, and no later than the child’s first birthday,” AAPD national spokesperson Dr. Indru Punwani said. Our office offers two dentists, myself and Dr. Erika Smart, both trained at the University of Washington School of Dentistry, both trained in the oral examination of infants. The first teeth typically erupt around age 6months, although this is a rule of thumb. Some baby teeth erupt (break through the gums) earlier or later. The first eruption sets the schedule for losing baby teeth and eruption of permanant teeth. At the first examination of an infant, the dentist and the parent sit facing each other, “knee-to-knee” with the parent holding the child facing them and the baby’s legs around the parent’s waist. The parent then supports the baby’s back and leans them backward toward the dentist until the baby is laying on their back looking up at the dentist. In this position, the dentist can get a good luck at the baby’s mouth and yes, the baby usually does cry. This helps the dentist get a look, which doesn’t take long. Constant contact between parent and baby is a comfort to both parent and baby. After the quick exam, the baby can sit up again and is rewarded with a new toothbrush. During the visit, the dentist educates the parent about oral bacteria, how cavities are caused, healthy versus cavity-causing snacking, oral hygeine, teething, thumb-sucking, etc. One piece of advice that surprises many parents is that many common snacks are cariogenic (cavity-causing). Examples: dry cereal, fish crackers. Any grain product is a simple carbohydrate that is broken down into glucose in our mouths feeds our oral bacteria. The bacteria eat the glucose, metabolize it, store it, excrete their sticky, acidic waste product called plaque. The acidic plaque sticks to teeth and essentially eats holes through the enamel (hard outer layer) over time. Today, parents want so much to protect their children from everything. I see it all the time. They are happy to have this conversation with the dentist, avoid cariogenic snacks, and introduce their babies to the dentist in a comfortable way. In our office, children are not forced to do anything that they are afraid of, parents are always welcome in the treatment area, and children are encouraged to smell and touch everything. It takes very few visits for the little ones to feel comfortable sitting in the big chair, wearing the sunglasses, and getting their teeth counted. Mom and Dad are happy, Baby is happy, Dentist is happy.

Smiles,

Dr. Cook

Dentistry is changing and I am hopeful that it is changing for the better. Before Tweets, blogs, and virtual likes, before “friend” was a verb, dentists often worked alone and went home to their familes where they maintained some anonymity. They also promoted their businesses mostly with phone book listings or other ads in print. Remember Steve Martin in “The Jerk” rejoicing when he finally saw his name in print?

Change can be overwhelming, uncomfortable, and awkward. But the internet connects the typical sole proprieter dentist to his or her peers, profession, and patients in a way that should give relief and support. It’s a relief to be able to research medical conditions, side effects, drug interactions and the latest research on anything. With instant access to our peers and professional organizations, the lone wolf dentist has a world-wide pack of support.

Dentists can now engage and share in a more personal manner. In dentistry, a personal connection can go a long way in breaking down a patient’s old anxieties. Dentists must consider that careful balance between presenting the professional appearance and letting their guard down in exposing their personal lives. “Every third Facebook post should be of a personal nature,” I was once advised. In a light-hearted moment, I recently posted a picture of myself wearing a set of BillyBob teeth, which I thought was hilarious. I did make some personal connections and I believe that by showing the non-dentist side of me, that I am, in a small way, promoting the newer, gentler approach of dentistry.

Developing an online presence is overwhelming, but I am excited about building connections and growing my practice. Writing this early blog entry was a bit uncomfortable. It sounds a little awkward, but the blog, like my practice, is a work in progress.

Smiles,

Dr. Cook