Lest we be accused of not being afraid of wading into controversial topics, a recent article in the Wall Street Journal caught our eye. Not that it had anything to do with dentistry per say, but the title “Can You Sleep Train Your Baby At 2 Months” was tantalizing none the less.
The article centered on the sleep philosophy of a prominent pediatric group in Tribeca (that would be a neighborhood in the center of the universe, otherwise known as Manhattan) which advocated ‘ferberizing’ infants at 2 months of age so as to improve their nightly sleeping habits.
The Ferber method, or Feberization, is a technique invented by Dr. Ferber who promoted the idea of letting babies ‘cry it out’ and develop the ability to self-soothe and fall asleep on their own.
The basic idea is to leave the baby in the room, leave, and return at progressively increasing intervals to comfort the crying baby (without picking him or her up). With each night, these intervals increase until the baby is asleep. Dr. Ferber felt that by age 6 months of age, this technique is appropriate as most babies are capable of sleeping through the night by that age and don’t need night feeding.
The WSJ article profiled a practice that goes one step further, and their recommendation is to sleep train babies at age 2 months. Of course, in the interest of a balanced informed article, both advocates and detractors of this method discussed the pluses and minuses of sleep training at so young an age. This is a highly emotionally charged issue with both sides accusing the other of being absolutely wrong. I suspect this debate will go on for the foreseeable future.
So why was this article on how to put your baby to sleep of interest to a pediatric dentist? Simply put, we face a similar conundrum on a daily basis at our practice and that is the issue of pacifier use. Pacifiers certainly have their place in soothing very young infants, and parents (myself included) would be quick to say that they work well in getting that fussy baby of yours to calm down, even fall asleep. However, pacifiers do become a problem when used for too long, especially once baby teeth start growing in. Long term use of a pacifier can cause significant malocclusion, specifically distorting the position of the front teeth, causing large overbites, failure of the front teeth to be able to close, and even impeding in the widening of the palate – all ingredients for orthodontics at an early age.
Most children be getting weaned off the pacifier starting by age 2, and our recommendations is that they stop by age 4. Anything beyond can cause the developmental problems listed above.
The takeaway from the WSJ article for this pediatric dentist is that one CAN train your child be it to fall asleep or stop using the pacifier. The basic technique(similar to that of Dr. Ferber) is that of being consistent and over time decrease the amount of time your child is allowed to use the pacifier. Our thought is that the earlier one starts (or if you never start at all!), the easier the pacifier removal will be. Clearly if some parents can train their 2 month old to sleep through the night, pacifier removal should be a cinch!
We’re always on the lookout for the latest in dentistry, and this newish entry to the world of burgeoning oral health products caught our eye. Developed by an orthodontist, it is a patented disclosing toothpaste (Plaque HD) which is designed to help patients with braces to brush better.
One of the greatest challenges when it comes to braces (especially the traditional metal ones) is brushing. Food and plaque tends to build up very easily, causing significant gingivitis to the point where the gums can grow over the braces and cover one’s teeth completely. This can also lead to extremely significant cavities, the cost of repair approaching the cost of the braces themselves. We’re talking thousands of dollars. Gulp!
But how does one know that you are doing an adequate job? For our younger patients who don’t brush well, we give out disclosing tablets (there are also mouth rinses). These tablets, which are chewed after an initial round of brushing, get incorporated into plaque that hasn’t been brushed off, turning these areas pink. Hence, one can actually see the areas that are being missed, and can go back and brush the pink off. Aside from a great educational tool, it is great fun for the kids to see their teeth turn pink.
Plaque HD incorporates this disclosing agent in their fluoride cavity preventing toothpaste. Instead of pink, it turns teeth green in areas that haven’t been brushed well (ie. plaque is accumulating) and serves as a visual cue for patients to go back and brush in those areas. The benefit of this toothpaste is that it’s a one step process – simply brush, look for green areas and then brush again until removed.
This is a fabulous idea that is a long time coming. It’s applications are not limited only to patients with braces but can be used by anybody who brushes poorly. It is a vast improvement from the traditional disclosing tablet route which is more labor intensive, messy and takes more time. The toothpaste retails for $21 (direct to consumer) which may seem like a lot, but keep in mind that even one small white composite filling costs significantly more. Think of the toothpaste as an investment for not only a beautiful smile, but a healthy one. We think this is a win-win for all.
I was just out in Scottsdale, Arizona attending a continuing education course sponsored by the American Academy of Pediatric Dentistry. For those of you not in the know, continuing education courses are a required part of remaining board certified, and a fantastic way of keeping up to date with the latest advances in pediatric dentistry. Typically, one chooses a course based on your level of interest in the subject matter (laser dentistry, orthodontics, conscious sedation, behavior management), but oftentimes the location of the course is also important. Some of us like to stick close to home but others prefer traveling to places that we wouldn’t otherwise get an opportunity to visit. Either ways, it’s a win win.
One of the courses taught at this most recent conference was given by a fella by the name of Andrew Sonis, D.M.D. Andy happens to be a dual trained pediatric dentist and orthodontist, and was for decades, a member of the faculty at the Department of Dentistry at Boston Children’s Hospital. So he knows his stuff. He was also my research adviser (“Acquisition of Mutans Streptococci and Caries Prevalence in Pediatric Sickle Cell Anemia Patients Receiving Long-term Antibiotic Therapy” – look it up, it’s a great read!) He gave a fantastic overview of orthodontics including treatment recommendations for our younger patients, but by far, the best part of his talk was when he showed us a picture of Tom Cruise.
Now Tom Cruise probably has one of the most famous smiles in show business. His face has graced many a movie poster (Top Gun! Mission Impossible! The Color of Money! Risky Business) and he is fodder for the paparazzi. I’ve spent many a wasted hour gazing at his face on the cover of People magazine while waiting in the grocery line. He’s got a smile that many of us wished we have.
One of the golden pillars of orthodontics is that symmetry is essential. Orthodontists do their best to ensure that a patient’s smile is symmetrical because a skewed smile simply doesn’t look right. In fact, one of the goals in orthodontics is to ensure that a patient’s upper dental midline is coincident with the facial midline. Huh?!!! In English, this means that if you drew a line down the center of a person’s face (ie. over the middle of the nose), this line should line up with a line drawn between the upper two central incisors (the large front teeth in the middle). Look at yourself in the mirror – most people have this symmetrical smile.
Not Tom Cruise. His upper dental midline is significantly shifted over to the left side of his face. This is hard to tell in most of his pictures as they are taken at an angle, but for photos that are straight on, this abnormality becomes quite obvious. I must admit, ever since I found this out, I’ve been unhealthily obsessed with looking at Tom’s teeth. It’s not too clear to me how it is that Tom’s upper midline came to be – most orthodontics would have addressed this issue.
So what’s the takeaway from this? Well clearly, the fact that Tom’s midline is not coincident hasn’t hurt his acting career. Also, I need to keep current with celebrity gossip as given the number of articles on this issue (try google searching “Tom Cruise Teeth”), I may be the last person on Earth to find out about his midline discrepency.
Put this in the category of “A REALLY BAD IDEA” – home orthodontics.
The internet is truly incredible. If one had told an individual back in the early 70’s or even 80’s that you could access all of humanity’s knowledge from a device that could be carried in the back of one’s pocket you would have been called a hopeless fool or dreamer. The fact that information is so easily available to anybody who has access to a smartphone is simply astounding.
The downside of the internet, is that these days anybody who would like to pose as an expert, can do so if they have an interesting website, youtube post, facebook page, twitter feed or vine video. It used to be that one had to graduate from High School, attend 4 years of college, 4 years of dental school, then 2-3 more years of specialization at a post-doctoral program, and decades of professional practice, before one would feel comfortable calling oneself an expert in the field of dentistry. Apparently, these days, the bar is much lower.
I recently came across this website http://www.teethgap.com/ which sells ‘elastic bands’ that can be used to close spaces between one’s front teeth. The website is professional looking with pictures of white coated ‘clinicians’ (interestingly enough some are wearing stethoscopes, something not typically used by dentists), impressive phrases like “FDA Approved”, “Made by Orthodontist” and “100% guarantee”. At the risk of being completely wrong, even the management team looks a little suspicious in the sense that they are all really good looking, and the photos appear to be stock photos culled from a internet photo distribution site. If the management team is legit, my apologies and congratulations on a very photogenic team.
The website claims that through the power of simple elastic (‘Non-Latex too!) bands placed around teeth, that one can easily, simply and cheaply close gaps between teeth. The video shows before and after pictures.
There are also dozens of video testimonials on youtube from individuals who have tried this technique at home and who swear that it works (Here’s one – https://www.youtube.com/watch?v=HpZKF72qvW8). What is scary is that this particular video has gotten over 200,000 views. What is even worse is that a video from an actual orthodontist showing how one should close spaces garnered 2000 views.
Trying home orthodontics is a terrible idea. Aside from the fact that it doesn’t work (I can guarantee you that the space will return), using rubber bands for the express purpose of closing spaces is dangerous. There have been many reported cases of these bands slipping under the gums, getting lodged in by the roots of the teeth, and in cases where they are not removed, lead to bone destruction, infection and eventual loss of the teeth.
There is a consumer alert posted on the website of the American Association of Orthodontists which cautions consumers to “please be wary of any suggestions to move teeth with rubber bands, dental floss or other objects ordered on the Internet.” We would agree with this advice.
And for your dental health, don’t believe everything you read or see on the internet. Except for us of course.
It can be said that while one cannot have a dental practice without a dentist, most dentists would not be able to practice dentistry without a dental assistant. In our practice, that is certainly the case, since our dental assistants play a crucial role in our ability to provide comfortable, pleasant and comprehensive care to our patients. From ensuring that all of our instruments are properly sterilized, to taking a x-rays, to explaining treatment to our youngest of patients, our dental assistants are involved in every aspect of patient care.
Here are excerpts from a recent interview with Kris, the Lead Assistant of our orthodontic department and all around fabulous assistant:
What made you go into dental assisting?
While in High School, I began working as a receptionist for my own dentist. I really enjoyed working there and this motivated me to apply to become a dental assistant at SouthEastern Technical Institute. This was a 9 month long program. After completion, I sat for the dental boards and after passing these examinations, became a Certified Dental Assistant.
How did you end up at Dentistry For Children, P.C.?
I started my career 25 years ago, as a dental assistant at a general dentist’s office. We saw mostly adult patients, and while it was interesting, I didn’t feel especially challenged. One day, while chatting with one of my patients, he happened to mention that his daughter worked for a pediatric dentist by the name of Dr. Eli Schneider. That very day, I got a call back from Dr. Schneider, asking if I would be interested in coming in for an interview. I jumped at the opportunity, and after a 2 hour interview, was hired on the spot. It was the best decision I ever made!
If it were not for Dr. Schneider, I would be an ex-dental assistant, working as a manager at McDonalds (which is the second job I held while a general dentistry assistant).
What’s the best part about being a pediatric/orthodontic dental assistant?
I LOVE working with children. They are amazing and say the funniest things – teenagers are especially hilarious (though admittedly, they are not my own teenagers). I love sharing my knowledge of dentistry and braces with both our patients and their parents. I’ve learned that when kids are scared or nervous, showing them and spending time explaining procedures helps them overcome their fears. It makes me feel victorious when we win them over.
In orthodontics, it is incredibly rewarding to see the smile on patient’s faces when we take their braces off and they see their straight teeth for the first time. It’s simply awesome.
I also volunteer my time. With the doctors at my practice, I’ve helped with dental screenings at local schools where we identify children with untreated cavities and help ensure that they are treated. I’ve also spent time treating children who are unable to receive routine dental care. You should see the smile on these kids’ faces.
What’s your normal day like?
There is no ‘normal’ day in pediatric dentistry and orthodontics. Besides being the lead assistant in orthodontics, I assist our pediatric dentists in both our main practice, and also at our local hospital, where we treat children with significant dental needs under general anesthesia. Working in a hospital environment is quite different from our office, and I like the change in pace. In the office, I set up patient trays, sterilize our instruments, take radiographs, assist our hygienists, check the schedule to make sure patient appointments are correct, order supplies, write up lab slips, communicate with our vendors, talk to patients and/or parents on the phone, coordinate emergency appointments, assist our doctors chairside….phew! There are so many things that need to be done. However, most importantly, we have fun with our young patients!
Any advice for those thinking of becoming a dental assistant?
If you like working and educating people, and don’t mind teeth, dental assisting is a great profession. If you do decide to become a dental assistant, make sure you attend an accredited 9 month program, at the end of which you can become certified. I maintain my certification by attending continuing education classes and conferences.
Any final words?
I’m so happy with my profession. Thinking back to how I got started in the field, it’s amazing how one person (thanks Dr. Schneider!) can open a door for you and change your whole life.
The kids are back at school (mostly) and we’ve been on a little summer blogging hiatus. But we’re back! Some of us have been super busy over the summer, including our friend Mariah (who happens to be the daughter of our fantastic assistant Kris!) who recently got her braces on. Just in time to be styling them at school. She was super psyched to get them on, showing that getting your braces on is as easy as pie. So for anybody nervous about getting your braces put on, no worries – Mariah’s smile is proof positive that it is easy and painless. By the way, we love her T-Shirt.