If your child has suffered an injury to one or more of the primary incisors you can expect the following reactions: 

The tooth might Change in colour. The tooth (teeth) will probably darken over a period of time, eventually turning quite dark. Usually, the color will be a charcoal gray, although it may be brown or yellow. The tooth will be returning to a color similar to how it appeared before the injury, but not quite as snow white. 

The tooth may also become loose. In this case the bone that supports the tooth has been expanded by the injury, which will make the tooth looser than normal. As the bone returns to the normal position, the tooth should also tighten up again. 

As with any injury, the normal reaction of the injured tissues (in this case, the gums and/or lips) will bleed and/or swell. A cold pack will help decrease the swelling the first day. From 2nd day apply a warm compress on the swollen area.

Fortunately, children do not usually suffer much pain from injuries to teeth. Occasionally there will be pain if the child tries to chew with the injured tooth. The child should have only soft food for a week after the injury.

You should watch for any of the following… 

• Change in any eating or sleeping habits 
• If your child’s normal eating habits change, particularly complaining when biting or chewing. Also note if your child is not sleeping.
• Increased swelling, looseness or pain 
• Gum Boils (This will appear on the gums in the area where the gums and lips meet. Gum boils look like a small blister on the gums.) 

If any of the ‘expected reactions’ become worse, the area should be re-examined by your dentist.

Canker sores (aphthous ulcers) are painful ulcers inside the mouth. They may occur under the tongue or on the inside linings of the cheeks and lips. They usually appear white, gray or pale yellow with a red border.  They are the most common type of mouth ulcer with at least 1 in 5 people developing aphthous mouth ulcers at some stage in their life. Women are affected more often than men.

Canker sores are not contagious and those of simple, small forms can heal within 10-14 days where multiple large sores may take 2 months to heal.

The exact cause of most canker sores is unknown. Stress or tissue injury is thought to be the cause of simple canker sores. Spicy food and citrus or acidic fruits and vegetables (such as lemons, oranges, pineapples, apples, figs, tomatoes, and strawberries) can trigger an outbreak or make the problem worse. Sometimes a sharp tooth surface or ill-fitting dentures might also trigger canker sores. Hormonal changes and sometimes medications seem to be another factor in their development.
Some cases of complex canker sores are caused by an underlying health condition, such as an impaired immune system and gastrointestinal tract disease, such as Celiac disease and Crohn's disease, nutritional deficiency, such as vitamin B-12, zinc, folic acid, or iron. 

Treatments

In most cases, canker sores do not require any treatment. If a person already has an appearance, there are steps that can be taken to help relieve the pain or irritation and speed healing:

• Avoid acidic foods such as citrus fruits, or spicy foods that may aggravate the sore 
• If there is a vitamin deficiency (a doctor can test for this), take supplementation as prescribed
• Brush teeth gently and use a brush with soft bristles. 
• See a dentist if you have badly fitting dentures 
• If you suspect a medication is causing the ulcers, then a change may be advisable
• Use toothpaste and mouthwash that does not contain sodium lauryl sulphate
• For pain, topical medications such as Oragel applied directly on the sore or anti-inflammatory agents can be used in case of sever sores

For many natural remedies, please visit  the following website http://www.drweil.com/drw/u/ART02954/Canker-Sores.html

What causes my teeth to be sensitive? 

Tooth sensitivity occurs when the underlying layer of your teeth - the dentin - becomes exposed. Dentine contains little tunnels (tubules) that link to the nerves on the inside of the tooth. When dentine is exposed, these nerves are easily stimulated resulting in pain, especially to cold drinks, food, and air as well as physical pressure, heat, sweet and sour foods.

There are many factors that may lead to the development of tooth sensitivity such as brushing too hard, recession of the gums, cracked teeth or fillings, teeth grinding, tooth whitening products, acid erosion or cavities.

Toothbrush and/or toothpaste damage may be the most frequent cause of sensitivity of otherwise healthy teeth. Over time, brushing too hard or using a hard-bristled toothbrush can wear down enamel and cause the dentin to be exposed. It can also cause recession of the gums (the gum tissue pulls away from the teeth) where the roots get exposed.

What can dentists do about sensitive teeth? 

Check with your dentist to determine the cause of the sensitivity.

Depending on the cause, your dentist may be able to paint special fluoride varnishes onto the affected teeth. There are also other sensitivity products that can be used.

In cases of extreme sensitivity, your dentist can seal or put bonding around the neck of the tooth, to cover exposed dentine.

If you grind your teeth, ask your dentist about the possibility of having a mouth guard made to wear at night.

What can I do about sensitive teeth? To prevent further damage, brush your teeth gently and avoid abrasive toothpaste.

Desensitizing agents such as Sensodyne tooth paste work by blocking off the dentinal tubules, so that the nerves don’t get stimulated. They work a lot better by gently massaging the paste or gel into the sore spot with a finger. Do not rinse it off. It may take several weeks before the desired effect is achieved. When sensitivity has subsided then it can be used as regular tooth paste.

Using fluoride containing mouthwash also can help. Use it just before bed and do not rinse.

Over the years of my practice I have been asked many questions by many parents. The next issues will bring up some of these questions.

My Daughter never eats any candy - How can she have so many cavities?

Many people do not realize other factors in the foods that their child eats can cause cavities. Even naturally-occurring sugars (for example Juices and dried fruits) can cause decay. Additionally, the frequency of eating or snacking, and the physical properties of the foods also affect the development of tooth decay

Eating Frequency

Each time your child eats, the mouth environment becomes more acidic, which is optimal for tooth decay to occur. Over a few hours, the acidic conditions in the mouth neutralize, which halts the tooth decay cycle. If your child is constantly snacking or having sweet drinks (pop, fruit juice,) throughout the day, there is not enough time for the mouth to neutralize, and it constantly is in the perfect condition for tooth decay to form.

A good rule of thumb is to finish off a meal or snack with water to flush the mouth and start the neutralization process.

Oral hygiene also plays an important role in potential for developing cavities. Make sure your child brushes his or her teeth after breakfast and before bed time. Children up to age 8 need assistance at least once a day with their tooth brushing and flossing.

A few of my child patients have admitted to me that they have a snack before bedtime after they have brushed their teeth. It is very important to brush after the snack and not to have any food in the mouth before bedtime. Night time is the time that the bacteria have a very high chance to grow, especially if they have food to feast on.

**Be sure to check out LULU Brush Time on our Kids page to help encourage your child to brush regularly.

Over the years of practice I have been asked many questions by my senior patients. The next issues will bring up some of these questions.

As a senior, do I really need to be concerned about cavities any more, All my teeth are already filled why would I get more cavities?

Actually as we age the environment in our mouth changes which make cavities more likely and frequent.

For example, the gums begin to recede in older adults, exposing the tooth root surface to decay. Dentin is much more susceptible to cavities.  New decay often occurs around the edges of older fillings as well.

Dry mouth, resulting from the natural aging process and certain medications and diseases, can lead to more tooth decay as well. Without an adequate amount of saliva, food particles can't be washed away and the acids produced by bacteria can't be neutralized.

Lowered dexterity in some older adults can be a cause for less effective tooth brushing which results in increased bacteria in the mouth. The more bad bacteria in the mouth the more risk for developing cavities.  This is all preventable.

Here are some tips to how to avoid cavities

•  Brush your teeth gently, at least twice a day, with fluoride toothpaste. Pay special attention to the gum line. If you have a hard time holding the toothbrush because of arthritis or another condition, try sliding a bicycle grip or foam tube over the handle.  Also consider purchasing electric toothbrushes because they are easier to use if you have problems with dexterity.

•  Floss or use interdental  brushes at least once every day, to clean between teeth. Interdental brushes come in different sizes and are available at most pharmacies. When choosing a brush size, be sure that it goes in and out between the teeth easily.

 •  Avoid frequent snacking on sugary or starchy foods. These foods feed the bacteria that cause tooth decay. This includes rice, potatoes, bread, fruits, and vegetables. It’s not the amount of carbs you eat that causes tooth decay, but the length of time your teeth are exposed to them. If you eat a lot of carbs for lunch, that’s one big exposure. But if you spend the day sipping sugary drinks, that’s continuous exposure -- and much more unhealthy for your teeth.

•  Rinse your mouth with water as often as possible, preferably after every meal.

The temporomandibular joint (TMJ) is the hinge joint that connects the lower jaw to the temporal bone of the skull, which is immediately in front of the ear on each side of your head. 

TMJ disorders (TMD)

The cause of TMD is not always clear, we know that the symptoms arise from problems with the muscles of the jaw or with the parts of the joint itself. Common symptoms include…

• Pain or tenderness in jaw joint area and in or around the ear when you chew, speak, or open your mouth wide. May occur on one or both sides.
• Jaws that lock in the open or closed-mouth position
• Clicking, popping, or grating sounds in the jaw joint when opening or closing the mouth
• Difficulty chewing or a sudden uncomfortable bite
• Limited ability to open wide

Because many other conditions can cause similar symptoms to TMD – including a toothache, sinus problems, arthritis, or gum disease – your dentist will conduct a careful patient history and physical examination to determine the cause of your symptoms.

Common Causes

• Grinding or clenching the teeth, which puts a lot of pressure on the joint
• Dislocation of the soft cushion or disc between the ball and socket
• Presence of osteoarthritis or rheumatoid arthritis in the TMJ
• Stress, which can cause a person to tighten facial and jaw muscles or clench the teeth
• Trauma to the jaw, TMJ or muscles of the head and neck – such as from a heavy blow or whiplash – can cause TMD.
• Habitual gum chewing or fingernail biting

Treatments

Jaw rest: It can be beneficial to keep the teeth apart as much as possible. Avoid eating hard, chewy, or crunchy foods such as harder raw vegetables, nuts or foods that require opening the mouth widely. Pre-chopping or blending these foods can allow for their consumption

Heat and ice therapy: These assist in reducing muscle tension and spasm. However, immediately after an injury to the TMJ, treatment with cold pack applications is best.

Medications: Anti-inflammatory medications such as ibuprofen, naproxen , or steroids can help control inflammation. Muscle relaxants, such as diazepam aids in decreasing muscle spasm.

The treatment of chronic TMD can involve Physical therapy, Stress management, Occlusal therapy (a custom-made acrylic appliance such as a mouth guard) or Corrective Dental Therapy. Surgery is used only in extreme cases as a last resort.

Our mouths are full of bacteria. These bacteria, along with mucus and other particles, constantly form a sticky “plaque” on teeth. Plaque that has not been removed can harden and form “tartar”.

The longer plaque and tartar are on teeth, the more harmful they become. The bacteria will eventually cause inflammation of the gums that is called “gingivitis.” Gingivitis is a mild form of gum disease.

If gingivitis is not treated the infection breaks down the gum tissue that attaches to the teeth. Gingivitis has then advanced to periodontitis where bacterial toxins from the plaque and the body’s natural response to infection start to break down the bone and connective tissue that hold teeth in place. If periodontitis is not treated, the bones, gums, and tissue that support the teeth are destroyed. The teeth may eventually become loose and have to be removed.

The following are some of the warning signs of periodontal disease:

• Bad breath or bad taste that won't go away
• Red or swollen gums
• Tender or bleeding gums
• Loose teeth
• Gums that have pulled away from your teeth
• Any change in the way your teeth fit together when you bite

There are few factors that increase the risk for periodontal disease such as poor oral hygiene, smoking and diabetes.

Prevention and treatment Gingivitis can be controlled and treated with good oral hygiene and regular professional cleaning. More severe forms of periodontal disease can also be treated successfully but may require more extensive treatment. Such treatment might include deep cleaning of the tooth root surfaces below the gums and sometimes corrective surgery.

To help prevent or control periodontal diseases, it is important to:

1. Brush and floss every day to remove the bacteria that cause gum disease.
2. See your dentist at least once a year for checkups, or more frequently if you have any of the warning signs or risk factors mentioned above.

It is important to know that once your child has teeth, he/she is susceptible to tooth decay and that early childhood caries (tooth decay) is avoidable. Decay is associated with food and liquids high in sugar, bathing the teeth for extended periods of time. Bacteria in our mouth consume the sugar to create an acid that damages the enamel of a tooth. The longer and more often food is left in the mouth, the greater chance of developing ECC. Mother's milk, formula, cow's milk and fruit juice all contain sugars in quantities which promote ECC.

Babies may get decay from going to bed with a bottle of milk, formula or juice. Unrestricted at-will breast-feeding at night may increase the risk of tooth decay as well.

Primary teeth are very important for a child's development. Some primary (or baby) teeth will be in your child's mouth until age 12.  If teeth are not cared for, your child's ability to chew food properly will be compromised which can limit his or her ability to meet their dietary requirements.

If primary teeth fall out prematurely due to lack of care or treatment, general growth and development are compromised. The presence of teeth helps to guide proper growth and development of a child's head and neck.  Primary teeth also guide the permanent teeth into a better position which may help to eliminate the need and expense of orthodontic intervention later in life.

If you give your child a bottle at bedtime, stopping all at once will not be easy. Here are some tips:

1. Put plain water in the bottle.

2. If your child gets upset, do not give up. Comfort the child and keep on trying

3. If this does not work, try watering down your child's bottle over a week or two, until there is only plain water left.

Once your child has teeth, lift his or her lips once a month and check the teeth. Look for chalky white spots or lines on the teeth specifically along gum line of the front teeth. Darkened areas on teeth can also be a sign of tooth decay. If you see any signs, go to the dentist right away. Early childhood tooth decay must be treated quickly.

Parents and caregivers should start oral hygiene practices as soon as a baby is born by using damp gauze to wipe the mouth and gums pads after feedings. Once teeth start to erupt, introduce tooth brushing with a very soft toothbrush made for children. 

The Canadian Dental Association recommends the assessment of infants, by a dentist, within 6 months of the eruption of the first tooth or by one year of age. The goal is to have your child visit the dentist before there is a problem with his or her teeth.

How to treat and deal with Dry mouth
Dry mouth or known clinically as Xerostomia, may be much more common than most people think. Over 6 million Canadians experience dry mouth and many may not know it. Xerostomia can be painful with reported serious affects to quality of life. It tends to manifest mostly at night, especially in mouth-breathers. Dryness may cause chapped or cracked lips or cause a persistent cough, a burning tongue or throat, periodontitis, ulcers, sores, and inflamed soft tissue can all be results of oral dryness.
Patients will usually complain of soreness in the mouth, impaired taste, difficult or painful eating - especially dry or spicy food - and waking up regularly during the night. Without a sufficient quantity of saliva to wash food particles off teeth, neutralize acids in the mouth and battle the bacteria population, a person may frequently develop multiple cavities – especially around the gum line.

Causes of Dry Mouth
Drugs: An average of 1 in 5 patients are affected by dry mouth, especially women, seniors, and those using any of 400 commonly-prescribed drugs that list dry mouth as a side effect, including blood pressure medications, antihistamines, antidepressants, diuretics and many others.
Cancer Treatment: Xerostomia has been ranked as the third most distressing symptom of therapy for head and neck cancer. Surgery, radiotherapy and chemotherapy can all cause dry mouth symptoms, and sometimes the effects are permanent. Radiotherapy causes the most damage to the salivary glands. In the first week after radiotherapy saliva flow reduces by 95%, and ceases almost entirely within five weeks. Two thirds of radiotherapy patients who survive three years are still suffering from Xerostomia.
Disease: Dry mouth can be a symptom of several diseases, and is often seen alongside other reduced secretions such as dry skin, dry eyes, blurred vision and vaginal itching. Sjögren's Syndrome - a disease where the body's immune systems attacks salivary glands and tear ducts is one of the greatest causes. Other diseases known to trigger include rheumatoid arthritis, systemic lupus erythromatosis and sarcoidosis.
Diabetes is another common cause of dry mouth and hypo-salivation. This could be due to the body excreting water through increased urination, or from some underlying metabolic or hormonal problem.

What to Do
If the dryness is due to drugs, it may be possible for your doctor to advise you to stop or reduce their intake, or switch to another “less drying” medication. Recent studies have shown that drugs such as Pilocarpine (Salagen™) can decrease your sensation of oral dryness. Since people with dry mouth often develop fungal infections such as oral candidiasis, they may require topical antifungal treatment such as rinses and dissolving tablets. Dentures often harbor fungal infections, so they should be soaked daily in chlorhexidine. If the dryness is due to a specific disease, proper treatment of the disease will decrease the intensity of your oral symptoms.
The dentist can be helpful to obtain a proper diagnosis of dry mouth. The diagnosis will help in developing a plan for management and treatment. A low-sugar diet and daily use of antimicrobial rinses can help. Select a mouthwash that doesn't contain alcohol as they will only cause further mouth dryness. One great product to help relieve dry mouth symptoms is biotène product which is divided into two categories: moisturizing relief products and hygiene products. A person with dry mouth should see a dentist at least 3 times a year and have him/her routinely check for evidence of early decay.

Drink water more frequently throughout the day, especially while eating and rinse with water as often as possible. Chewing Xylitol gum can help stimulate salivary flow and combat cavity. Xylitol is considered to be a safe sugar substitute unlike many synthetic sweeteners. Also watch your intake of carbohydrates, like bread and pasta and cookies, etc. which tend to hang around in the mouth. Avoid or decrease intake of caffeine-containing drinks and foods. Do not smoke and avoid or decrease intake of alcohol and spicy, salty or very acidic foods.