Tuesday, December 22, 2009

Why does my child's breath smell?

A parent just asked me this question, and it's one that I hear frequently.  We usually think of bad breath, or halitosis, as an adult problem, but trust me, it's fairly common in kids too.  In adults, bad breath can sometimes be a sign of periodontal or systemic disease.  In children, this is rarely ever the case.  Halitosis in children is often caused by poor oral hygiene.  For these kids, a good cleaning by the hygienist, twice daily brushing of the teeth and tongue, and daily flossing (if their teeth touch) should do the trick.  

But I also commonly see halitosis in kids who have excellent oral hygiene.  In these kids, the culprit is usually the tonsils.  The tonsils are folds of tissue located behind the oral cavity, in the throat, and act as part of our body's immune function.  In between these folds are little pockets called tonsillar crypts.  Food often gets stuck in these crypts, and over time, can start to react with the normal bacteria in our body to produce an unpleasant odor.  You and I can easily remedy this issue by gargling with an over the counter mouth rinse.  Young children have a tough time with this.  You might want to have your child try with warm water first to see if gargling is even possible.  If you decide to use a rinse, make sure it doesn't contain alcohol and supervise them to ensure that they aren't swallowing it.  In my experience, kids under age 6 or 7 usually can't gargle.

Other factors that may contribute to bad breath would include things that trap food such oral appliances (braces, retainers, space maintainers, etc), loose baby teeth, and new teeth growing in.  Seasonal allergies and post nasal drip can also cause halitosis.  Tooth decay, sinusitis, and pharyngitis (throat infections) can also lead to bad breath.  Obviously if your child is experiencing other symptoms, such as fever or a productive cough, a visit to the pediatrician would be indicated.  If not, and you're just not sure what's going on, call your pediatric dentist.  In my practice, I'm happy to have patients stop by for a quick peek.  I welcome the opportunity to say hi, it can help anxious parents sleep better at night, and we don't charge for the quick check.

I hope this was helpful.  Feel free to post any questions or comments, and I'll be happy to respond.  You can also check out my website if you want to get in touch with me.

Happy Holidays! 

Dr. Jeremy Dixon

Wednesday, December 9, 2009

At what age should I make my child's first dental appointment?

This seemed like a natural way to start off our new blog.  It also happens to be a question that we hear all the time in and out of the office.  Unfortunately, when you ask health care providers this question you'll get a wide range of answers.

Currently, a child's first visit to the dentist often happens at around age 3.  This is two years later than recommended by both the American Academy of Pediatrics (AAP) and the American Academy of Pediatric Dentistry (AAPD).  What's with this discrepancy and why are so many doctors and dentists still telling us to bring our kids in at age 3?  Old habits are hard to break!

Over the past decade we've noticed a few trends that have caused us to reevaluate our approach to dentistry.  First, it's becoming more and more apparent that our oral health is closely linked to our overall general health (see the relationship between periodontal disease and heart disease for example).  Second, dental disease is usually preventable, so the old dental paradigm of "drill and fill" oral health is shifting to one focused mainly on the prevention of disease.  Finally, while dental decay rates have decreased in the population at large over the last decade, rates have actually increased in children over the same time period!  Today, almost one out of every three preschool age children will develop dental decay, an increase from about one in four ten years ago!  There seems to be several reasons for this (that we can talk about in future postings) including the drinking of bottled water and the prevalence of refined sugars.

Our goal for the year one visit is to provide patients with a "dental home".  These early visits aren't like the dental visits you and I have, and aren't even like those that our older toddlers and adolescents have.  In our office, during these early visits much of the time is spent talking to parents and caregivers.  We also take a very quick look in the baby's mouth while the baby sits on their parent's lap.  We keep this visit as low stress as possible.  Usually the baby will cry for a few seconds (that's when we get our quick peek!), but then quickly recovers as the look is quick and painless (and there are prizes involved too!).  Dental cleanings and fluoride treatments are very rarely done at this appointment.

Establishing this "dental home" accomplishes three things:

     1.  We can provide parents with a risk assessment for their baby based on their family history, the baby's current diet and hygiene practices, and the current condition of the baby's teeth.

     2.  Using this risk assessment, we can give parents anticipatory guidance.  This means that, based on the visit, we can advise parents as to what they can expect from their baby's dental development.  Also, we can tailor our recommendations to help guide parents and prevent their babies from developing dental disease.

     3.  In our experience, children who have these low stress visits regularly from a young age usually have less dental anxiety as toddlers and adolescents.

We hope this helps all of you young parents out there!  Please don't hesitate to write with any comments and/or questions!  And check out the following sites for more information:



See you soon!

Dr. Jeremy Dixon