One topic we are often asked about is finger or thumb sucking and/or pacifier use — a challenge that most parents or caregivers will likely face with at least one of their children. The first and perhaps most important thing to remember is that it is totally normal for babies and young children to suck their fingers, thumb or a pacifier. It only becomes a problem when it continues as the child ages or if you unnecessarily make it a problem.

For most children, the sucking instinct starts in the womb before birth. This fact is evident, as many expectant mothers are shown their child sucking fingers or a thumb during a mid or late-term sonogram. Once the child is born, the habit may continue because it provides the child with a sense of security. Other research indicates that some babies start sucking habits as a way to make contact with, test and learn about their new world outside the womb. It is interesting to note that most children typically tend to stop finger or thumb sucking habits on their own and without much intervention between the ages of two and four. However, for others it can continue much longer. And that is the scenario that parents and caregivers need to be aware of so that they can monitor sucking habits.

Children who suck their thumbs or a pacifier after the age of two have a higher risk of developing some long term negative effects from the habit. This includes but is not limited to upper jaw development issues and “buck” teeth (upper front teeth that protrude forward out of a natural position towards the lips). For this reason, some researchers feel that children should cease thumb or finger sucking and/or pacifier use by 18 months of age. However, the Academy of Pediatric Dentistry recommends that parents and caregivers encourage children to cease this habit by age three.

If you feel your child is at risk due to his/her age and habits, please contact us today to schedule an appointment for your child. After a thorough exam, we can work with you to create a strategy for helping your child overcome finger, thumb or pacifier habits. To learn more about this topic, continue reading the Dear Doctor magazine article “Thumb Sucking in Children.”

1. Xylitol is a kind of sugar.
   True or False
2. Xylitol is made from
   1. Bark of birch trees
   2. Coconut shells
   3. Cottonseed hulls
   4. All of the above
3. Xylitol is a natural “sugar alcohol” similar to other so-called sugar alcohols such as mannitol and sorbitol.
   True or False
4. Xylitol is broken down by decay-causing bacteria to produce acid.
   True or False
5. Decay-causing bacteria are transmitted from a parent to a child through oral contact such as a simple lip-to-lip goodnight kiss.
   True or False
6. Researchers have found no difference in prevention of tooth decay in gum made from xylitol compared to gums containing sorbitol/xylitol and sucrose.
   True or False
7. Other xylitol products such as mints, candy and cookies also seem to decrease the incidence of tooth decay.
   True or False
8. Xylitol products increase salivary flow and allow saliva to neutralize acids in your mouth.
   True or False
9. The only side effect of too much xylitol ingestion is a possible mild laxative effect.
   True or False
10. The target dose of xylitol is one to two teaspoons spread throughout the day.
    True or False

1. True. Xylitol is a kind of sugar that does not contribute to tooth decay.
2. All of the above. It is also found naturally in some fruits and vegetables.
3. True. The others, mannitol and sorbitol, are used as sugarless sweeteners.
4. False. Unlike sucrose (table sugar), xylitol is NOT broken down by bacteria to produce acid. Xylitol also stops saliva from becoming acidic so your mouth becomes an unfriendly environment to acid-producing bacteria.
5. True. However, xylitol inhibits growth and attachment of the bacteria to your teeth, so it also inhibits transmission to your children.
6. False. Systematic use of xylitol chewing gum significantly reduces the relative risk of caries (tooth decay) when compared to chewing gums containing sorbitol/xylitol and sucrose. Xylitol gum also appears to halt the development of tiny cavities when compared to other types of chewing gum.
7. True. Use of these products seems to stop the progression of active decay.
8. True. Xylitol and your saliva combine to re-mineralize (harden) your teeth after an acid attack.
9. True.
10. True. This means two pieces of xylitol gum or two pieces of xylitol candy or mints should be consumed for five minutes four times a day after eating meals or snacks.

Contact us today to schedule an appointment to discuss your questions about xylitol and other methods of preventing tooth decay. You can also learn more by reading the Dear Doctor magazine article “Xylitol in Chewing Gum.”

Creating a dental crown that looks good and wears well is not an easy achievement. It is the result of good communication you, the patient, have with us, your dental professionals, and that we have with the dental lab that manufactures the crown. In addition, it reflects the quality of work done by us and by the lab technician.

What is a dental crown?
A crown is a dental restoration that surrounds the remains of a damaged tooth or is attached to a dental implant so that it resembles a natural tooth as it extends above the gum line. The choice of materials and appearance of the crown depend upon many factors. One is the location of the crown. If it is in the back part of your jaw, strength and wear will be a major factor. If it is in the front, a life-like appearance will be important.

What goes into making a good-looking and functional crown?
Options for crown materials include porcelain, gold, porcelain fused to metal (called PFM) and some newer materials such as “pressed-ceramic” restorations and computer-milled-ceramics.

You as the patient can have a say in choosing the crown's color and appearance. Before it is cemented into its final position, make sure you are happy with the feel and appearance of your new crown.

Gold is often chosen for crowns on back teeth because of its superior wear qualities. Gold crowns have been known to last more than 50 years. They also cause minimal wear to the teeth that they touch on the opposing jaw.

Crowns made of porcelain (a glass-like substance fired in an oven at a high temperature) look good but may be too brittle to stand the wear and forces given to back teeth. Like glass, they can fracture under pressure. But because of their lifelike appearance they make a good choice for visible front teeth.

PFM (porcelain-fused-to-metal crowns) are a good combination of the best of gold and porcelain, but they sometimes lose the stains applied to make them look natural, and occasionally they fracture away from the metal.

A provisional crown can help you make sure you are getting a crown with the qualities you want. With the provisional crown all the details are worked out ahead of time, and you get a chance to try them out to make sure the crown looks good and that you can eat and talk normally. After you give your approval on the provisional crown, the final crown will be made to match it, in longer-lasting and better quality components.

Contact us today to schedule an appointment to discuss your questions about crowns and other dental restorations. You can also learn more by reading the Dear Doctor magazine article “Gold or Porcelain Crowns.”

Time to tune up the brightness on your teeth? Here are six modern methods of whitening and brightening your smile.

• In-office “power” bleaching under the supervision of my staff and me is recommended if your teeth are badly stained, or if you are about to have veneers or crowns made. It's quick, safe, and effective. Gels containing high concentrations of bleach are applied to your teeth in our office, often with the enhancement by heat and light to make them act faster. Results show teeth becoming up to ten shades lighter in about an hour.
• “Take home” whitening solutions and trays are designed to fit your mouth and can also be provided by my office. The technique is easy to perform and is less expensive than in-office power whitening system, although it takes longer to see the same results. General recommendations are for 30 minute applications twice a day. You can usually see a change after two to four sessions. This requires patience, because it is important not to exceed recommended exposure in order to avoid damage to your teeth, gums, and the inside skin of your mouth. After two weeks of use, teeth can be expected to be about eight shades lighter.
• Whitening strips look like clear Band-Aids that are applied to the tooth surfaces. They should be worn twice a day for 30 minutes each time, for seven days. On average, they claim to lighten teeth more than three shades. They take about two weeks to work at 30 minutes per day.
• “Paint on” or “Brush on” whitening formulas are also available. These are gels that are painted onto the teeth every night at bedtime, for two weeks. Some claim that this line of home whitening can whiten teeth two to five shades. These gels may make your mouth feel goopy, but they are relatively inexpensive. Some gels come with a small brush to scrub them onto the teeth.
• Over-the-counter “mouth-tray” whiteners use mouth trays that are not designed for your particular mouth, so they may not fit well and may be messy or uncomfortable. They are filled with gel and worn 45 minutes a day for one week. On average, teeth become two shades whiter.
• Whitening gum is a relatively new product. It requires chewing two pieces for at least 20 minutes, four times a day, to see an effect.

Contact us today to schedule an appointment to discuss your questions about tooth bleaching. You can also learn more by reading the Dear Doctor magazine article “Teeth Whitening.”