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The wisdom teeth are the last of the permanent molars to emerge from the gums. This can occur as early as age 17 or as late as 21. Though some teens and young adults experience a completely normal tooth eruption with ideally aligned molars that pose no health threat, this is not the case for everyone.

According to the American Association of Oral and Maxillofacial Surgeons (AAOMS), wisdom teeth must meet specific criteria to avoid a required extraction. These guidelines include:

• Completely erupted and non-impacted
• Completely functional
• Painless
• Free of decay
• Disease-free
• Capable of being properly cleaned

If one or more of your child’s wisdom teeth do not meet these conditions, we recommend scheduling an appointment with Drs. Hutcheson, Train, Goodall, Lewis; an extraction may be necessary.

Impacted wisdom teeth

One of the most common reasons for extracting a wisdom tooth is due to impaction. An impacted wisdom tooth is one that has not erupted and will not fully erupt from the gums. Usually this occurs because there is not enough room for the tooth to emerge. Impaction can be painful and can also lead to infection if left untreated. According to the AAOMS, roughly 90 percent of the teen and adult population has at least one impacted tooth. Extracting an impacted wisdom tooth early can help prevent future complications, such as periodontal disease, infections, and damage to neighboring teeth.

Extracting fully erupted wisdom teeth

Even if your child’s wisdom teeth are fully erupted, Drs. Hutcheson, Train, Goodall, Lewis and our team at Children's Dental Specialists may recommend removing them as a preventive measure. Fully-erupted third molars often interfere with a healthy bite. This can lead to problems with tooth and jaw alignment and may also contribute to the development of headaches. Your child’s wisdom teeth may also be more prone to tooth decay and gum disease, because their location in the back of the mouth makes them more difficult to reach for brushing and flossing.

To learn more about wisdom teeth, or to schedule an appointment with Drs. Hutcheson, Train, Goodall, Lewis, please give us a call at our convenient Richardson or Carrollton office!

It seems like the ads are everywhere these days—repair your enamel and reverse tooth decay with a tube of toothpaste! Are these claims too good to be true? Let’s dive into the science of tooth decay—how decay develops and how (and if!) it can be reversed.

Teeth can stand up to the powerful pressures of biting and chewing because over 95% of our enamel is made up of minerals. Calcium and phosphate ions in our teeth bond to form a crystal structure called hydroxyapatite. Because of the strength of this crystalline design, tooth enamel is the hardest substance in our bodies, even stronger than our bones. 

But bones, like most other parts of our bodies, are living tissue, which means that they can create new cells to replace old or damaged cells. Tooth enamel can’t regenerate new cells to repair itself. This means that when a cavity has made a hole in the tooth, the enamel can’t grow back. And, while enamel structure is very strong, it’s also vulnerable to damage—specifically, damage from acids. 

Our teeth are exposed to acids throughout the day, whether they are acids created by plaque bacteria or the acidic foods and drinks we consume. Acids dissolve mineral bonds, stripping calcium and phosphate minerals from the enamel and leaving weak spots in the tooth surface. This process is called demineralization. Demineralization is the first stage of tooth decay.

The good news? Our bodies are designed with a built-in defense mechanism to prevent demineralization from causing lasting damage. All through the day, saliva helps wash away acids in the mouth and bathes our teeth with new calcium and phosphate ions. These ions bond with the calcium and phosphate in our enamel, restoring enamel strength. This protective repair process is called remineralization. 

Now for the bad news. In the tug of war between demineralization and remineralization, saliva can only do so much. If your diet is heavy with acids, if you don’t brush away acid-producing plaque bacteria regularly, if you eat a lot of the sugars and starches which feed plaque bacteria, the remineralizing effects of saliva can’t keep up with the demineralizing effects of acids.

The first visible sign of demineralization is often a white spot on the tooth where minerals have been stripped from enamel. Studies have shown that enamel-strengthening toothpaste can be effective in this very first stage of tooth decay. Toothpastes which advertise enamel repair generally contain one or more of these ingredients:

• Calcium Phosphate
• Hydroxyapatite
• Fluoride 

Toothpastes with calcium phosphate or hydroxyapatite contain calcium and phosphate minerals, the building blocks of tooth enamel. Studies have suggested that these minerals can replace the calcium and phosphate ions stripped from enamel. These toothpastes may or may not contain fluoride, which is something you should discuss with your dentist before deciding on a specific toothpaste.

Fluoride toothpastes remineralize enamel—and more! Fluoride ions are attracted to the tooth’s surface, and, when fluoride ions join with the calcium and phosphate ions there, they form fluorapatite. Fluorapatite crystals are larger, stronger, and more resistant to acids than hydroxyapatite crystals. And, once bonded with tooth enamel, fluoride attracts the calcium and phosphate ions in saliva to remineralize the teeth more quickly. 

Why consider enamel-repair toothpaste? 

Once enamel is gone, it’s gone for good. If excess demineralization isn’t treated, a weak spot on the tooth surface will continue to erode, growing bigger and deeper until it becomes a hole in the enamel. This is a cavity, and your dentist will need to treat and repair your tooth to prevent the cavity from growing and potentially exposing the tooth’s pulp to bacteria and infection. 

If you wear braces, you want to be especially careful about excess demineralization. Because it can be hard to brush and floss effectively with braces, white spots and discolored patches are a common concern for those with braces, especially on the enamel around brackets.  

Talk to Drs. Hutcheson, Train, Goodall, Lewis at our Richardson or Carrollton office about which toothpastes can help restore a healthy balance between the ongoing cycles of demineralization and remineralization when you have braces. While tooth-repair toothpaste can’t fix cavities, these products can often strengthen demineralized enamel and reverse this earliest stage of tooth decay.

While you make sure your family is getting the best care possible, with regular dental checkups and cleanings at our Richardson or Carrollton office, there is one family member that might be hiding under the bed when it’s time for tooth care. Periodontal disease is the most common clinical condition affecting adult cats—and it is completely preventable!

Periodontal disease starts when the bacteria in your pet’s mouth form plaque. The plaque can harden into tartar, and, if plaque and tartar spread under the gum line, can be responsible for a number of serious problems. Tooth loss, tissue damage, bone loss, and infection can be the result of periodontal disease. Professional dental treatment is important if your cat is suffering from periodontal disease, and your vet can describe the options available to you.

But, like with humans, prevention is the best way to assure these problems never develop, and there are several methods for avoiding plaque and tartar build-up.

Brushing: Yes, there are toothbrushes and toothpastes specifically designed for your cat! If a toothbrush is not working for you or your pet, there are cat-sized finger brushes available as well. Daily brushing is most effective, but try for at least several times each week. The process of introducing brushing should be a slow and gentle one, and seafood and poultry flavored pastes make the process more palatable. (Human toothpaste is not good for your cat due to its abrasiveness, and swallowing the foam might pose a danger to your pet.)

Anti-plaque rinses and gels: If despite your gentle persistence your cat simply will not cooperate with brushing, there are other options! Rinses and gels containing Chlorhexidine are effective and do not usually pose a problem for pets—although they might not take to the flavor. Rinses can be squirted inside each cheek or gels can be applied to the teeth with a toothbrush or finger brush. Talk to your vet to find the safest and most effective products.

Diet: Whether they use a particular shape and texture to simulate brushing or an anti-tartar ingredient, several pet foods claim to reduce the accumulation of plaque and tartar. Your vet is the best resource for nutritional suggestions to make sure your cat’s dental and physical diet is as healthy as it can be.

Whether you try brushing, rinses, gels or a tooth-friendly diet, patience and a gentle touch are the best way to introduce dental hygiene. Talk to your vet at your cat’s next checkup, and find out what you can do to keep your feline friend healthy and happy. An ounce of prevention might be worth a pound of purr!

Orthodontists do everything they can to save teeth, but sometimes, a tooth is so damaged by accident, injury, infection, or decay that extraction is the only option. Or perhaps your child’s wisdom teeth are starting to come in—and starting to cause problems. Or, when this is the healthiest alternative, an extraction might be necessary for orthodontic reasons.

While there are several possible reasons an extraction might be necessary, one thing is true for any extraction: you want to make sure that your child is as comfortable as possible and heals as quickly as possible after the procedure.

Aftercare and recovery time isn’t exactly the same for every extraction. Whether your child’s tooth is a baby tooth or a permanent one, whether it’s a single tooth or several, whether it’s erupted or impacted, whether a local anesthetic or sedation is recommended—these factors and more can make a difference in recovery time.

Drs. Hutcheson, Train, Goodall, Lewis will provide you with clear, specific instructions for helping your child to a speedy recovery after an extraction. We’d also like to offer you some general aftercare ideas to make sure your child is as comfortable as possible while recovering.

• Bleeding

Some bleeding is normal after an extraction. Follow your dentist or oral surgeon’s instructions carefully to minimize bleeding at the extraction site. Your child will probably need to keep a gauze pack in place for as long as directed to reduce bleeding and to help a clot form. If bleeding is heavier than expected or goes on longer than expected, call our Richardson or Carrollton office.

• Swelling

Swelling is a normal response to extractions. Your dentist might suggest cold compresses to help reduce swelling immediately after the extraction. If you don’t have an ice pack, ask whether a bag of frozen peas or corn can substitute.

With any cold compress, it’s important to protect your child’s skin from injury. Follow your dentist’s suggestions for application and be sure not to exceed the time limits recommended. And don’t apply a compress directly to your child’s face—wrap a towel or cloth around the bag or pack to protect the skin.

• Careful Cleaning

The area around the extraction shouldn’t be disturbed or touched. The blood clot that forms after an extraction protects the area from irritation and infection caused by food particles and bacteria. If a clot is dislodged accidentally, it can lead to a condition called dry socket, which can be very painful.

This means no brushing near the extraction site, and no heavy rinsing or spitting for as long as directed. If your child is younger, you might need to help with brushing over the days following to make sure those sturdy bristles don’t get close to the extraction site before it’s healed.

• Soothing Foods

Have a supply of your child’s favorite comfort foods handy while healing, such as cream soups, mashed potatoes, scrambled eggs, gelatin, yogurt, and smoothies. Hot and cold foods can be irritating, so stick to cool or lukewarm foods for the first few days. Encourage your child to drink lots of liquids, but nothing carbonated. And do wait until any numbness wears off before giving your child chewable foods to avoid biting tongue or cheeks.

Remove spicy favorites from the menu, which can be irritating, as well as chewy, crunchy, or jagged foods like crackers, since tiny, sharp bits of food can make their way inside the site. Remind your child to chew on the side of the mouth opposite from the extraction site. And, since suction is an all-too-easy way to dislodge the clot over the extraction site, no straws!

• Schedule Recovery Time

Make sure your child rests and takes it easy after the procedure. Exercise, lifting, even bending over can dislodge a protective clot, so re-schedule any physically demanding sports and activities until your child is given the dental all clear.

• Medication

If your child has been given a prescription for pain medication or antibiotics, follow the instructions as directed. Drs. Hutcheson, Train, Goodall, Lewis might recommend age-appropriate over the counter pain relievers to have on hand. For severe or continuing pain, call your orthodontist or oral surgeon right away.

• Coordinate Dental Schedules

Orthodontic extractions, if needed, will be scheduled into your child’s orthodontic treatment plan. Treatment can begin or resume when the extraction site has healed.

If an emergency extraction is necessary, call our Richardson or Carrollton office so we can be aware of the situation and can coordinate with your child’s dentist or oral surgeon to keep treatment on track as much as possible.

An extraction can be worrying for both patient and parent, so talk to your orthodontist for the best ways to make this experience a positive one for your child before, during, and after treatment.