Common Conditions

Bulimia Nervosa

Fourteen out of 100,000 people suffer from bulimia nervosa, which primarily affects adolescent and young adult females. It is an eating and psychiatric compulsive disorder that can lead to serious problems with your child's teeth if left untreated. One-third of those who suffer from bulimia nervosa have a history of anorexia nervosa, and one-third of those who suffer from bulimia nervosa have a history of obesity.

Bulimia nervosa is characterized by periods of normal eating followed by dieting or severe restrictions of food intake, often ending in binge-eating. Binge-eating episodes must occur at least twice a week for three months to be diagnosed as bulimia nervosa. Weight gain is controlled by self-induced vomiting, strict fasting, vigorous exercise, and abuse of laxatives or diuretics.

Repeated episodes of induced vomiting can lead to enamel erosion of all teeth due to the chronic exposure to acid in vomit. Bulimia nervosa, and its accompanying dry mouth from decreased salivary flow and parotid gland dysfunction, also can lead to a dramatic increase in cavities because of excessive carbohydrate intake during binge-eating.

Typically, patients who suffer from bulimia nervosa have small, purplish-red lesions on their palate due to contact with objects used to induce vomiting. Silver fillings often become raised due to erosion of the teeth, and braces and temporary restorations may not stay on the teeth because the acid will dissolve the temporary cement used to keep these materials in place. Teeth may be discolored or look dull from the acid.

Avoid brushing teeth after vomiting, and rinse with water instead. Use a basic rinse, such as baking soda and water; immediately after vomiting to neutralize the acid. Remove plaque by brushing and flossing properly. Chew sugarless gum to increase salivary flow or use artificial saliva. Use fluoride either in toothpastes, rinses or gels to reduce sensitivity of teeth and build resistance to decay from acid.

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Canker Sores

Canker sores (also called aphthous ulcers) occur inside the mouth, on the tongue, inside the lining of the cheeks, on the inner portion of the lips, on the throat or tonsils. There can be one or a number of sores in the mouth. Canker sores are very common and recur often, but their cause is unknown.

Often canker sores are found when a child's immune system is compromised by a virus like the common cold. Also a sensitivity to highly acidic foods or citric fruits can increase the child's risk for these to occur. They start out painful, swollen, and a fiery red color. As they heal the appearance becomes white or gray base and red border. To aid in reducing discomfort and increase healing there are a few options available: avoid spicy and acidic foods, using a prescribed topical ointment or antimicrobial rinse, keeping the child's mouth clear from bacteria with thorough brushing and flossing, using a non-alcohol mouth rise, and or a baking soda paste to coat the lesion. Canker sores usually heal in about a week or two. Over-the-counter topical anesthetics can also provide relief.

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Cold Sores

A cold sore, which is also called fever blister and is caused by the "herpes simplex" virus, is composed of groups of painful, fluid-filled blisters that often erupt around the lips and sometime under the nose or under the chin. Cold sores are usually caused by herpes virus type I and are very contagious.

Cold sores usually heal in about a week. Over-the-counter topical anesthetics can provide temporary relief, and prescription antiviral drugs may reduce these kinds of viral infections.

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Cavities and Tooth Decay

Tooth decay is another name for the disease known as "caries," or cavities. A cavity is the result of your tooth enamel, dentin, or cementum being destroyed over long-term exposure to harmful bacteria.

Many cavities are preventable Tooth decay is promoted by your teeth being frequently exposed to foods rich in carbohydrates (starches and sugars) like soda, candy, ice cream, milk, and cakes. Ironically, even fruits, vegetables, and juices can lead to tooth decay.

When these foods break down in your mouth, they provide food for the bacterial film on your teeth and gums called plaque. The plaque interacts with deposits left on your teeth from sugary and starchy foods to produce acids. These acids break down tooth enamel over time by dissolving, or demineralizing, the mineral structure of your teeth. This leads to tooth decay and weakening the teeth.

Plaque is a film of bacteria that forms on teeth and gums after eating foods that produce acids. These foods may include carbohydrates (starches and sugars), such as candy and cookies, and starchy foods, such as bread, crackers, and cereal.

Tooth decay leads to cavities and occurs when plaque remains on your teeth for an extended period of time, allowing the bacteria to "eat away" at the surfaces of your teeth and gums. Ironically, the areas surrounding restored portions of teeth (where fillings, or amalgams have been placed) are particularly vulnerable to decay and are a breeding ground for bacteria.

In addition to causing cavities, plaque can lead to gum irritation, soreness, and redness. Sometimes, your gums may begin to bleed as a result of plaque accumulation. Long-term, plaque can lead to serious problems. Sometimes, the bacteria can form pockets of disease around tooth structures, eventually destroying the bone beneath the tooth.

In regards to early childhood caries, avoid putting your baby or small child to sleep with a bottle containing anything but water, because juices and milk contain sugars that can be harmful to teeth. When a child sleeps, these liquids "pool" in the mouth and bathe the teeth.

Early childhood caries may occur when sweetened liquids, such as milk, formula, and fruit juice, are given and are left to pool in an infant's mouth for long periods of time. Baby bottle tooth decay can lead to severe cavities in your child's mouth, and destroy the teeth if left untreated.

Avoid allowing your child to fall asleep with a bottle and avoid breast feeding at will after the first baby tooth begins to erupt.

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Gingivitis and Gum Disease

Periodontal disease is a condition in which the structures that support the teeth, including the gums and bone surrounding each tooth, become infected and begin to break down. Periodontal disease (also known as "periodontitis") can be influenced by the body's response to infection caused by the bacteria in plaque. Poor oral hygiene in children could set the stage later on for gum disease - the major cause of tooth loss in adults. It is most often caused by bacteria.

In the early stage of gum disease, called gingivitis, the gums can become red, swollen and easily bleed. At this stage, the disease is still reversible and can usually be eliminated by daily brushing and flossing.

Like some diseases, gum disease isn't painful until it reaches a more critical stage, in which treatment options narrow. If it goes unchecked, inflammation begins to allow surrounding bone to demineralize and dissolve. As the bone dissolves around the teeth in the more advanced stages of gum disease, called periodontitis, the gums and bone that support the teeth can become seriously damaged. The teeth can become loose, fall out, or have to be removed.

Early symptoms of gum disease:

  • Gums that bleed when you brush your teeth
  • Red, swollen or tender gums
  • Gums that have pulled away from the teeth
  • Persistent bad breath
  • Pus between your teeth and gums
  • Loose teeth
  • A change in the way your teeth fit together when you bite

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Teeth Grinding (Bruxism)

Teeth grinding (also called bruxism) is often viewed as a harmless, though annoying habit commonly seen in young, developing children.

Though this can cause jaw problems in adults, children don't often present the same symptoms or conditions. It is especially common in preschoolers and children developing their first permanent molars. Tooth grinding can be induced by stress, congestion, development, and also be a subconscious reaction to growth. However, the real cause is still unknown because children who don't present any of the above can still grind their teeth. There is no treatment recommended or required for tooth grinders in the primary dentition. We do continue to monitor the wear on the the enamel surfaces.

If signs of bruxism are noted in the mixed or permanent dentition such as wear of the teeth or popping sounds or pain when you open and close your mouth, therapy is suggested. This usually involves the use of a nightguard worn while sleeping.

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When babies are teething, usually between the ages of four months and 2.5 years, they often have sore and tender gums. The pain usually can be soothed by gently rubbing the baby's gums with a clean finger, a small, cool spoon or a wet gauze. A clean teething ring for the baby to chew on also may be helpful.

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Impacted Teeth/Wisdom Teeth

Our office must examine your child's mouth and X-rays to determine if the teeth are impacted or will not grow in properly. Impacted teeth may cause problems that can lead to infection, adjacent tooth resorption, gum disease, cysts, or tumors.

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Jaw Disorders/TMD

The temporomandibular joint (TMJ) connects the lower jaw, called the mandible, to the temporal bone at the side of the head. Because these joints are flexible, the jaw can move smoothly up and down and side to side, enabling us to talk, chew and yawn. Muscles attached to and surrounding the jaw joint control its position and movement.

When we open our mouths, condyles, or the rounded ends of the lower jaw, glide effortlessly along the joint socket of the temporal bone. A soft disc lies between the condyle and the temporal bone to ensure smooth motion. This disc absorbs shocks to the temporomandibular joint from chewing and other movements.

Temporomandibular (jaw) disorders, also called "TMD" or "TMJ syndrome," are a general class of health problems associated with the jaw. TMD may occur when the jaw twists during opening, closing, or side-motion movements. These movements affect the jaw joint and the muscles that control chewing.

TMD is not just one disorder, but a group of conditions, often painful, that affect the jaw joint (temporomandibular joint, or TMJ) and the muscles that control chewing. Although researchers don't yet know how many people actually have TMD, the disorders appear to affect about twice as many women as men, according to the National Institute of Dental and Craniofacial Research.

Fortunately for most people, jaw joint or jaw muscle pain is usually not a sign of a more serious problem. Pain and discomfort from TMD is temporary and sporadic, and can come in waves or "cycles."

Only a small percentage of people with TMD pain develop significant, long-term symptoms, according to National Institute of Dental and Craniofacial Research.

Temporomandibular disorders fall into three main categories:

  • Myofascial pain, the most common form of TMD, which is discomfort, or pain in the muscles that control jaw function and the neck and shoulder muscles
  • Internal derangement of the joint, dislocated jaw or disc, or injury to the condyle
  • Degenerative joint disease, such as osteoarthritis or rheumatoid arthritis in the jaw joint
  • Severe injury to the jaw or TMJ can cause the problem. Arthritis in the jaw joint may also follow an injury. Orthodontic treatment, such as braces and the use of headgear, has also been blamed for some forms of TMD, but studies now show that this is unlikely, according to National Institute of Dental and Craniofacial Research.

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Pacifier/Thumb/Finger Sucking


The large majority of children suck their thumbs or fingers as infants, and most grow out of it by the age of four, without causing any permanent damage to their teeth. If your child continues sucking after the age of 3, or if he sucks aggressively, let us know and we can check to see if any problems have arisen from the habit.

The large majority of children suck their thumbs or fingers as infants, and most grow out of it by the age of four, without causing any permanent damage to their teeth. If your child continues sucking after the age of 3, or if he sucks aggressively, let us know and we can check to see if any problems may arise from the habit.

Pacifier Use

As newborns get older, sucking serves many purposes. It often makes them feel comforted, secure, and happy. The soothing effect can calm nerves and anxiety especially when separated from a parent and for sleep purposes. Pacifier habits can eventually cause an open bite where the top and bottom front teeth don't come into occlusion. It is an easier habit to break when compared to a thumb or finger habit. We recommend to try and eliminate this habit before the child's 3rd birthday. This will allow the teeth to drift back into their natural position.

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