Index of this page

• When should I first bring my child to the dentist?

• Should the parent accompany the child into the operatory?

• Should my child see a children's dentist?

• Why fill baby teeth?

• Baby tooth eruption schedule

• Adult tooth eruption schedule

• How to interpret a child's x-ray

• Why does my child grind her teeth at night?

• What if the baby tooth does not fall out on its own?

• Thumb sucking habits

• Will my child need braces?

• The ugly duckling stage

• Space maintainers

• Why does my child keep getting cavities?

• Children's oral hygiene

  • At what age should a child begin to brush?

  • Should a child floss?

• Is there a difference between the shape of baby teeth and adult teeth?

  • Baby tooth pulpotomy versus an adult tooth pulp cap

• What is a Stainless Steel Crown?

  • Which baby teeth need stainless steel crowns?

  • Can Stainless steel crowns be used on adult teeth?

• fluoride

  • fluorosis

  • Fluoride and adults

• What are topical sealants?

  • How are sealants done?

  • How long do sealants last?

  • Success depends on the child's cooperation

  • What teeth are sealed?

  • What is the oldest a patient can be to have her teeth sealed?

• What is a frenum, and why does the doctor want to clip it?

When should I first bring my child to the dentist?

Having said this, it is very rare to find a general dentist who will do an actual procedure, like a filling or an extraction on a child under the age of three.  If it is absolutely necessary to do a procedure on a very young child, the general dentist usually refers to a pedodontist (a children't dentist) who can sedate him or her, or an oral surgeon who can "sleep" the child.

Should the parent accompany the child into the operatory

The answer we learned in dental school was NO!!  Children always behave better without the parent in sight.

The real answer to this question is: It depends entirely on the child (and the parents).

I have found that in a majority of cases, children do perfectly well with parents in the operatory.  It is the minority of cases that are the most difficult, and the ones in which the parents are best asked to leave for the waiting room.  

The behavior of children in the dental setting depends largely on the child's trust in an authority figure and his or her willingness to surrender control over his own body, even at the expense of minor pain, to an adult he does not know.  Trust is a quality learned at home, on the playground and at school.  Children who have learned that adults trusted by their parents are adults to be trusted by them are more likely to have better experiences at the office than those who have learned to distrust adults in general.  Children who have been trained to expect adults to make good decisions on their behalf are more likely to have better experiences than those who tend to make all their own decisions at home.

In other words, if they run their home using behaviors they know makes their parents do what they want, they will try to do the same at the dental office where such behavior is inappropriate.  Their inability to affect the dentist's behavior in the same way they do their parents scares them, and the "bad experience" escalates from there.  If a parent of one of these children is in the operatory, the child plays to the parent and the behavior only gets worse.

The child's behavior is the variable that cannot be controlled by the dentist directly.  It depends upon the factors discussed above, as well as things such as how much sleep the child got last night, the time of day of the appointment (mornings are always best), recent events in the child's life, and the horror stories told to the child by his friends, siblings, and even his parents. 

All of which brings us back to the vast majority of children who are easily treated in the offices of general dentists.  Having done this as long as I have, I have watched an enormous number of tots grow into young adults, and it's fun to go back and read the initial comments in the records when they first came in. "Apprehensive, but cooperative", "Ran out of the operatory", "Called me disgusting but then cooperated" (I told her I had to agree with her, but I couldn't help it.  I was born that way.)  One child who I had been treating for two years with no problems decided to throw a fit one day and wouldn't let me touch her. She was back the next week and cooperated and has cooperated ever since. She's now married with children of her own, and has almost no cavities in her adult teeth.  

Should I bring my child to a children's specialist?

While I, as a general dentist, treat a vast majority of children who come to my office, I never treat a truly uncooperative child.  The work I do requires delicate movements that can't survive the violence of an uncooperative patient.  I never restrain a child.  If he won't let me do my job, I refer him to a pedodontist (a specialist who deals with children's dentistry exclusively).  Pedodontists have nerves of steel and soundproof operatories.  Actually, that's a half joke, but if they must spend a lot of time doing "behavior modification", they can charge for the service, something which as a general dentist I cannot justify.  

Pedodontists have special training in dealing with children's dental problems, not just their behavior.  They are better equipped to perform simple interceptive orthodontic procedures on children without referral to an orthodontist.  General dentists refer patients to them all the time for problems peculiar to children, such as developmental difficulties and root canals on adult teeth that have not fully formed.  Some (not all) make use of hospital services to place very young children and others who are unable to cooperate under general anesthesia for doing general dental procedures.  This may be ideal for infants and very young children who must have teeth extracted.  Even though the extraction itself would be very easy for any dentist, the trauma of the procedure on an uncomprehending child could cause a fear of dentistry that could effect her for the rest of her life.  

Why bother to fill baby teeth since they will all fall out anyway?

Nursing bottle syndrome (Early childhood caries).  For details, click on the images.

There are three very good reasons that baby teeth are just as important as adult teeth, and must be just as well protected from disease.  

1. Children need their teeth as much as you do to chew and smile.  If the teeth are allowed to become decayed, that child will suffer pain and an inability to eat properly which can lead to lifelong eating disorders, or at minimum poor nutrition for the time during which the child is unable to eat properly.  Children have social lives too, and the stigma of blackened stumps and bad breath can lead to derision (serious teasing) at school and at play, and could effect the child's social development.  

2. Bad baby teeth usually mean frequent visits to the dentist under very poor circumstances.  The child has not slept well, he is in a bad mood, and the dentist is the last person he really wants to see.  In addition, by the time they are seen, the dentist must usually remove the tooth, which is what the parents expect anyway.  So his visits always amount to painful episodes from which he emerges missing a piece of his body!  This sets the stage for not only bad behavior on succeeding dental visits, but for a person with a lifelong fear of dentists who will probably end up with dentures.  

3. Finally, baby teeth are essential for holding the spaces open so that the adult teeth can come into the correct position when they are finally developed enough to erupt ("erupt" means to come through the gums for the first time).  If certain of the baby teeth are removed before nature intended, the adult teeth that develop earliest will move into inappropriate positions crowding out the space necessary for the eruption of other adult teeth which develop at a later date.  This can lead to not only crooked teeth, but to real functional problems as well.  These involve chewing difficulties, TMJ problems, and pronounced facial asymmetries (this means that one side of the face develops more than the other side due to the differences in the way that the muscles on either side are used in chewing and grinding the teeth.)  A person gets two sets of teeth at different stages of life for very good reasons.  The adult version will not fit into a baby's mouth, yet that child must still be able to chew food.  So while nature gave children a temporary set of teeth in order to fill a space that would otherwise have to remain vacant until age 12, she thought she might give them some extra work to do as well.   

How do baby teeth develop?

The three thumbnail images below show a clear plastic dentaform made by Kilgore International inc.  This dentaform shows the dentition of a child of about three years old.  The deciduous (baby) teeth are fully formed, fully erupted, and in occlusion (which means that the top teeth are in contact with the bottom teeth).  The roots of the baby teeth are clearly visible and approximately anatomically correct.  You can see the adult teeth just beginning to form in the plastic just above and below the roots of the baby teeth.  Click on any of the thumbnails below to see larger versions of all three images and more information on the formation of the adult teeth.

Interpreting a child's panoramic x-ray

Above, you see a panoramic x-ray film of a child about 6 or 7 years old.  You can see the adult teeth forming underneath the baby teeth.  You see that the first molars (we call them the 6's for 6 year molars) have erupted into place behind the last baby teeth in each arch, and so have the lower adult central incisors (you cannot see any lower baby centrals).  But the upper adult central incisors have not yet erupted into position (you can see the upper baby centrals as little "stumps" sitting on top of the adult incisors). The adult second molars (the 12 year molars) are not expected to erupt until age 12.  They are shown here only partly formed behind the fully erupted six year molars.

Why does my child grind her teeth at night?

Upon occasion, parents ask me if it is normal to hear their child grind his or her teeth at night.  The sound can be so loud that it can be quite disconcerting, being audible in neighboring rooms with the doors closed!  The answer is that it IS normal for children under the age of about 13 to grind their teeth at night.  It appears to serve two purposes.  

1. Grinding places pressure on the roots of the baby teeth over the developing adult teeth which stimulates resorption (natural destruction) of the roots of the baby teeth.  This resorption is ultimately responsible for the shedding of the baby teeth when the adult teeth are ready to erupt.  

2. Grinding also helps the adult teeth to erupt into their most stable positions in the dental arches.

What if the baby tooth fails to fall out?

In some cases, a baby tooth may remain in place even though the adult tooth is erupting beside it.  In this case, the baby tooth MUST come out one way or another or it will interfere with the positioning of the adult tooth.  The image on the right shows an adult premolar that has been forced to erupt out of the normal position it should occupy in the arch because of the presence of an over-retained baby tooth.  If the child cannot or will not remove it herself by wiggling it, then bring her in to see us for an extraction. 

Thumb sucking

Thumb sucking is perfectly normal for infants.  Most children stop sucking their thumb by the age of two.  If he or she does not, parents should try to discourage the habit by the age of four.  Thumb sucking actually places forces on the bone that supports the teeth and causes it to grow outward and upward causing an anterior "open bite" and sometimes a narrow upper arch form.  These deformities are easily diagnosed by any dentist or hygienist.  As a rule, the bony abnormalities will correct themselves when the habit is stopped, as long as it is stopped by about the age of six.  If the habit persists after the age of six, most of the time the only correction is by means of orthodontics (braces).

Dentists deal with this problem by building a simple habit breaking device, but these devices only work if the child truly wants to stop sucking his or her thumb.  By the time children begin to interact with others of their own age, the thumb habit becomes a social liability, and the child really does want to stop, but may need a bit of help.  The appliance acts as a reminder to keep the thumb out of the mouth, and also prevents the child from being able to create a suction between the thumb and the roof of the mouth.  This suction feels good and is an important factor in keeping the habit active.

While removable appliances are available, children have a habit of losing or breaking them.  Most dentists recommend an appliance which is permanently cemented to the upper molars.  They consist of two orthodontic bands for the molars with a thick wire running between them.  Most have a button of smooth plastic which sits in the indentation in the roof of the mouth where the thumb is placed during the sucking habit.

Will my child need braces?

Many times, children come in with congenital deformities (ones that they are born with) or developmental problems (ones that are caused by other factors like thumb sucking or other habits, and some, like crowded teeth that are the result of genetic factors but are not present at birth).  Many of these problems are not apparent to the parents, and require a dental exam to identify them.  Most of the common ones are covered in my section on orthodontics.  Left untreated, these deformities cause the child lots of functional and esthetic problems in the years ahead.  It is essential that all children be examined for orthodontic deformities by about the age of 7 when the most common skeletal deformities can most easily be treated.

The ugly duckling stage

Space Maintainers

If your child loses certain of his baby teeth too early, usually due to decay, it is likely that he will need  orthodontic help to reclaim the space lost due to the forward migration of the six year molars into the space which was reserved for the second premolar.  If a dentist is able to catch this situation before too much migration has taken place, he can build a "space maintainer to keep the first molars from drifting forward.  It might look like the one in the diagram to the right, or it might connect both adult first molars with a wire that lies against the insides of all the front teeth in the arch.

Why do my children keep getting new cavities all the time?

For years, it was never really made clear that "the cavity prone years" as we called them in the years before the health benefits of fluoridation began to kick in, are really just the years when kids discover the wonders of sweet foods and drinks.  High sugar intake throughout the day means lots of tooth decay.  The end of the cavity prone years always coincided with the time when the child began to mature and lose his taste for sugar.  It's as simple as that.  The less sugar, the less decay.  Oral hygiene is certainly important because the germs in plaque are responsible for transforming sugar into the acid that is ultimately responsible for the decay, but without the sugar, the germs have no raw materials to create the acid in the first place .  Please click on the icons below for a thorough understanding of how sugar, germs and hygiene interact to influence the state of health in anyone's mouth, kids included. 

Decay

Hygiene

Nice teeth

Children's oral hygiene

At what age should they start to brush?

Very young children usually want to imitate their parents.  The easiest way to indoctrinate children in brushing is to let them watch you do it on a regular basis and then encourage them to imitate you when they show an interest.  Technique is not important at an early age.  Healthy children are not susceptible to gum disease, and if they are not eating too much sugar, the presence of some plaque left over after their early attempts will do them no harm.  The point is to get them to start to handle the toothbrush at an early age, and to get them used to having one in their mouth.  Parents concerned about their child's oral health may do some of the brushing for them, but it is always best not to make it an unpleasant experience.  Gently done, it can be a bonding experience, especially for moms.  The more comfortable and enjoyable the experience is, the less likely it is that the child will later rebel and begin to associate teeth with unpleasantness.  

Should children floss?  

Flossing requires manual dexterity that very few children possess.  Again, children do not generally have to worry about gum disease, and decay is more a matter of the frequency of sugar exposure.  Also, children's teeth tend to be widely spaced and brushing alone does an adequate job of cleaning.  I feel that making flossing an issue is more likely to cause a child to rebel against the whole process of oral hygiene.  Flossing is helpful in preventing decay between teeth too, but that is more easily controlled by limiting sugary foods and drinks (especially between meal juices, Kool Aid, Fruit Rollups and candy).  

Is there a difference between baby teeth and adult teeth besides size?

Yes, there IS a difference in both anatomy and physiology.  The first thing to notice in the diagram at the right is the relative difference in size of the various parts that make up the two types of teeth.  The baby tooth (on the left) has a bigger nerve relative to the size of the rest of the tooth than the adult tooth.  That means that decay in any part of a baby tooth has less distance to travel to get to the nerve than in an adult tooth.  When we repair decay in either type of tooth, we always make the cavity preparation larger than the original extent of the decay in order to make the filling mechanically stable, which means that we are more likely to strike the nerve in a baby tooth when restoring it.

This does not mean that it will hurt the child because the child has already been anesthetized.  However, the difference in physiology between baby teeth and adult teeth means that special precautions must be taken if the nerve in a baby tooth is struck in the course of removing decay.  

The baby tooth pulpotomy

When the nerve in an adult tooth is exposed during the course of removal of decay, the nerve can often be saved provided that the decay has not caused it to become too inflamed.  This is done simply by stopping the bleeding and covering the exposed nerve with a cement containing calcium hydroxide.  This is known as a pulp cap.  (If the nerve has been too badly affected by the decay, it frequently swells up, and due to the confined space in which it lives, the tissue becomes so tight that blood can no longer flow inside the nerve of the tooth.  When this happens, the first symptom may be severe pain.  In order to relieve the pain, and the abscess that may follow later, the dentist must either remove the tooth or perform a root canal procedure.)

In a baby tooth, pulp caps never work.  The nerve will not survive, eventually causing an abscess.  In order to prevent this problem, the dentist will usually try to save the tooth using a procedure called a pulpotomy.  In this procedure, the top part of the nerve (the part in the pulp chamber) is removed and the remainder of the nerve in the root canals is treated with a cotton pellet soaked in formocresol  which is a medical fixative intended to fix, or "tan" (as leather is tanned) the living nerve that remains in the root canals.  This treatment turns most of the remainder of the nerve into "leather" and it becomes inert and unlikely to hurt or cause a future abscess.  Finally, some temporary filling material is mixed up using formocresol  and this is placed in the pulp chamber and used as a base under a regular filling. Recently, dentists have been using a solution of  16% ferric sulfate instead of formocresol.  (FS Hemostatic by Premier is a retraction cord solution found in many dental offices which works well.)  This procedure keeps the remainder of the nerve (in the canals) alive, and, in combination with a filling of ZOE (zinc oxide and eugenol), has been shown to relieve a toothache in a deciduous tooth with a live nerve.  Ferric sulfate pulpotomies have been shown to have the same clinical success as formocresol pulpotomies.  Ferric sulfate has the added benefit of stopping bleeding form the pulp. Note for dental students:  Formocresol  pulpotomies only work if the pulp is alive and bleeding when exposed.  They will not work if the tooth, or any of its canals is already abscessed.  The reason for this is that the purpose of the pulpotomy is to fix, or "tan" the coronal portions of the living tissues in the canals.  This relieves pain, but a secondary purpose is to allow any unfixed portions apical to the canal orifices to remain alive.  The fixed portions of the tissue in the canals remain biologically inert and act a bit like gutta percha, keeping the toxic FC from perking out of the apex into the tissues beyond the tooth and causing a chemical abscess.  Also, formocresol can be applied to the pulp chamber only if all bleeding from the remaining tissue in the canals has been stopped with pressure from a cotton pellet.  If the chamber is closed with a canal still bleeding, the pulpotomy will cause an abscess.  In that case, it would be best to use a solution of ferric sulfate or aluminum chloride (Hemodent) to stop the bleeding first.

What is a stainless steel crown?

When a back baby tooth is severely effected with decay, but the nerve has not yet been touched, we sometimes place a prefabricated "tin can" which is made out of stainless steel and shaped and sized to fit baby teeth.  This allows us to remove just the decay without having to get any closer to the nerve than absolutely necessary.  If we can avoid touching the nerve during a restoration, we can usually avoid having to do the pulpotomy described above.  These prefab crowns are relatively inexpensive and fairly quick to place, and because of the nature of baby tooth enamel, are more permanent than a regular filling would be.  Large fillings in baby teeth do not stand up very well to long term wear.   Stainless steel crowns are frequently placed on teeth that have had pulpotomies as well, because by the time a baby tooth needs a pulpotomy, the damage to the crown is so severe that only a stainless steel crown is likely to remain intact for the life of the tooth.

Which baby teeth need crowns and which may be safely filled?

Fillings are adequate for back baby teeth if the decay is not too extensive or too close to the nerve.  They are not adequate for teeth which have large or multiple fillings, have decay so close to the nerve that removal of all the decay would expose the nerve, or for any baby tooth in which the nerve has been removed (see pulpotomy).  

Stainless steel crowns can be used on virtually any baby tooth, but are best reserved for situations in which the finished filling will take up more than half of the baby tooth, the decay is very close to the nerve, and or if the nerve has been removed.  It is possible to place a stainless steel crown over a baby tooth leaving a small amount of decay in place to avoid killing the nerve.  The decay generally stops once the crown is placed.  Large fillings on baby teeth do not work well because of the nature of the anatomy of the teeth and also because children tend to grind their teeth naturally, and large fillings may not be adequately retained under this type of stress.  It is always best to place a stainless steel crown on all baby teeth which have had pulpotomies because these teeth tend to be brittle and are likely to break, especially in childrens' mouths since they tend to grind their teeth mercilessly.

Can stainless steel (prefabricated) crowns be used on adult teeth?

Although a stainless steel crown can be placed on a back adult tooth as well, we generally avoid doing this because the margins (edges) of the prefabricated crowns do not fit the neck of the tooth tightly, and the result is plaque retention and gum irritation leading to periodontal destruction (gum disease) around that tooth.  Children do not have this problem because of their incredible resistance to disease, and because the baby tooth will fall out naturally before the child is old enough to develop the problem.  For more on prefabricated crowns and adult teeth click here.

Fluoride and children

I have written an entire page on the advantages, disadvantages and controversy surrounding fluoride (along with a rather amusing letter from an antifluoridationist).  In general, fluoride is a well accepted fact of life in American dentistry.  We use it in toothpastes, mouth rinses, topical applications, for desensitizing teeth, remineralizing decay, and as a dietary supplement for children.  

Topically applied fluoride creates a coating of decay resistant armor which lasts for several days on the surface of the teeth, and penetrates into decayed areas of teeth to help remineralize them.  (Fluoride binds with decayed tooth structure and encourages it to recombine with calcium in the saliva to begin the process of hardening the decay.)  We recommend it in all the toothpaste you buy so everyone in the family can enjoy this protection.  

We also recommend that children under the age of 12 receive daily doses of fluoride in tablet form, or in the municipal water supply.  This form of fluoride is incorporated into the actual structure of the teeth that are developing at that time, and imparts some lifelong protection against decay.

One word of caution however.  Very young children often mistake the toothpaste placed on their toothbrushes for candy and will actually eat it.  The amount of fluoride in toothpaste vastly exceeds the amount recommended for internal consumption, and the child may get too much of a good thing.  Excess fluoride in the diet of children with developing teeth can cause fluorosis of the teeth.  This causes orange, brown and white spots in the enamel of the adult teeth which are forming at the time of the overdose.  We recommend that you supervise the use of fluoride containing toothpastes by young children, or that they use non fluoride containing toothpaste until they are old enough to understand that toothpaste is not candy.

When children come in for an exam and cleaning, it is routine for us to use a fluoride tray application which contains prescription strength fluoride for longer lasting protection, and in order to help stop decay already present.  Adults do not receive this service even though it would benefit them also. The reluctance of the profession to provide fluoride treatments to adults probably stems mostly from the perception by the general public that fluoride is only for children. 

Topical Sealants

Adult molars (the large back teeth), as everyone knows, have deep grooves on their biting surfaces.  Because of their depth, sticky sweet foods like raisins, fruit rollups and of course candy may get stuck in them and remains there for 30 or 40 minutes after the treat is finished.  The enamel at the bottom of these grooves also tends to be very thin.  Thus, they are often the first places decay forms in the teeth.  For many years, before the advent of fluoride as a public health measure, many people lost their back teeth before they reached adulthood simply because these grooves were so susceptible to decay.  Even after the widespread use of fluoride in drinking water became common, the top surfaces of the back teeth tended to get decay and needed fillings.

With the discovery of the process of dental bonding, it became possible to apply a permanent plastic layer to the top of the back teeth to "waterproof" them and seal out germs and sugar.  This service became known (appropriately) as dental sealants.

How dental sealants are done

The chewing surfaces of the teeth to be sealed are first cleaned with pumice which looks a bit like fine beach sand.  This buffs the surface of the enamel and prepares it for the process of bonding

With the teeth kept dry using cotton rolls, or sometimes a rubber dam, a gel containing dilute phosphoric acid is applied to the buffed biting surface of the tooth.  This is allowed to remain on the enamel for about 15 to 30 seconds, and is then washed off.  After drying the tooth, the surface looks chalky white which is evidence of the microscopic hills and valleys caused by etching the surface.

The liquid resin (plastic) sealant is applied over the etched enamel.  The resin flows into the etched mountains and valleys and then pools in the grooves in the top of the tooth.  A bright light is then shined on this liquid plastic, and it hardens into a glasslike coating over the surface of the tooth.  

A more up-to-date procedure replaces the resin sealant with a glass ionomer formulation which adheres to the teeth without the phosphoric acid etching technique necessary if the sealant is an acrylic resin or a coposite.  In addition, g``lass ionomer has the property of releasing fluoride into the tooth structure, which means that these sealants prevent decay both by preventing sugar and bacteria from making contact with the tooth enamel, and by strengthening the surrounding enamel with fluoride.

How long do sealants last? 

I have placed sealants on children's teeth when they were 12 years old, and many have remained on the teeth as the patient grew into their early 20's.  The success of the sealants depends mostly on the cooperation of the child when the sealants were done.

The success of dental sealants depends on cooperation of the child during the procedure!

For a sealant to be successful for a long time, the child MUST be able to understand what the dentist is trying to do and be willing to keep the mouth open and the teeth dry for the duration of the procedure.  If the teeth get wet between the time the acid gel is washed off, and the time the final cure is done with the light, the sealant will either not adhere to the etched surface, or may only partially adhere.  Sealants fail all the time because they are attempted on children who are too immature to cooperate.

What teeth are usually sealed?

Generally, only adult back teeth are sealed.  Baby teeth have enamel which does not etch particularly well, and generally, children under the age of 6 are too young to cooperate in the process.  All adult back teeth can benefit.  This includes 8 premolars, and 8 molars per patient.  Unfortunately, insurance companies frequently will not pay for sealants on premolars.  Whether the service is paid by insurance or not, it is still money well spent.

What is the oldest a patient can be to have his teeth sealed?

The placement of sealants on the back teeth causes the teeth to bite differently.  Children adapt to the new bite with ease, but adults do not.  If sealants are placed on an adult's teeth, that patient will usually begin to grind their teeth together causing headaches, neckaches,  ear aches, sore teeth, and teeth sensitive to cold.  In short, sealing adult teeth can cause all the symptoms of TMJ.  As a rule of thumb, I generally never recommend sealing teeth on anyone over the age of 17 unless they are undergoing adult orthodontics.

What is a frenum (or frenulum), and why does the dentist want to clip it?

The term "frenum" (or frenulum) is from the Latin term which means "little bridle".  It is a small fold of tissue that secures, or restricts the motion of a mobile organ in the body.  In the mouth, you can see and feel three of them.  One attaches the upper lip to the gums, and if you stick your tongue hard into the fold between your upper lip and the two central incisors, it feels like a tiny tight string stretched between the lip and the gums.  Another one is in a similar position between the lower lip and gums, and the third one is under the tongue attaching the underside of the tongue to the floor of the mouth.  It is easily seen when you lift your tongue backwards and up to the roof of the mouth.  In most cases, these little cords are considered normal anatomy and are simply ignored.  Upon occasion, however, these little pieces of tissue can cause problems, in which case they can easily be "snipped" (released) by a dentist without causing any other problems.  Their status in the body is a bit like that of the appendix.  They are ignored most of the time, but removed when they they cause a problem.

• The labial frenums
  • The maxillary labial frenum  is the cord between the upper lip and gums. 

    

    In little children, the maxillary labial frenum is often attached between the two central teeth.  In most cases, this attachment migrates away from the teeth as the child approaches the age of 8 or 9. 

    Children generally have a large space between their central incisors during the "ugly duckling" years, but by the time the adult canine teeth are fully erupted, between the ages of 11 and 12, the space should close.  In some cases, however, the labial frenum retains its high attachment between the teeth, and this can cause the central incisors to permanently retain the space (diastema) between them, as shown in the image above.  If this happens, the dentist or orthodontist will often recommend that the child see an oral surgeon to resect (snip) the frenum.  This will usually prevent the formation of an adult diastema.

     

    • If either parent has a permanent space between his or her front teeth, (in other words, if a space between the front teeth runs in the family), a high frenum that does not regress by age 8 or 9, should be resected to avoid a permanent diastema in the adult.
    • If neither parent has a space, then they may wish to wait until the child's adult canines are fully erupted before making the decision.  Alternatively, they can have it released just to be safe.
    • Note: A high frenum that does not cause a permanent diastema may have other negative consequences for the adult.   A high frenum in an adult can create a periodontal (gum) defect.  This happens because the constant movement of the lip can tug at the gingival attachment to the teeth creating a mechanical defect that can lead to loss of one or both central incisors as the patient ages.

       

  • The mandibular labial frenum is the cord between the lower gums and the lower lip.  A high attachment of this frenum rarely causes spaces between the lower incisors.  It can, however, cause periodontal defects in the adult, and some dentists recommend releasing them in children (about age 9) to avoid this (possible) scenario. 
  • Traumatic injury to either of these frena frequently happens during a blow to the face.  This will usually tear the frenum causing lots of bleeding, but little long term damage.  A torn labial frenum is rarely sutured by emergency personnel since it is considered a trivial injury.  Unfortunately, torn labial frena are often, but not always associated with child abuse.  Regarding abuse, "Current literature does not support the diagnosis of abuse based on a torn labial frenum in isolation. The intra-oral hard and soft tissue should be examined in all suspected abuse cases, and a dental opinion sought where abnormalities are found."

     

• The lingual frenum

  

   

  • The lingual frenum attaches the underside of the tongue to the floor of the mouth.  In most cases, it is long and stretchy enough to allow ample movement of the tongue, but sometimes, it is so short that it binds the tongue firmly to the floor of the mouth causing speech impediments and feeding difficulties in infants.  This condition is called ankyloglossia (tongue-tied). 

    Ankyloglossia compliments of Bechara Ghorayeb, MD

    When a dentist discovers this, he or she will generally refer the patient to an oral surgeon to release the frenum.  The procedure is known as a lingual frenectomy.  This procedure is done at virtually any age.  In very young children, it is best performed under general anesthesia.  In older patients it is a simple procedure performed using local anesthesia.

What causes decay?

Oral Hygiene techniques

The three factors that cause dental disease

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 You are always welcome to email me using the email button above.  I have written a separate page for you here.

Patients
Please make your questions short and precise.  Avoid rambling, multiple questionnaires. 

Remember that I cannot diagnose something I cannot see. I probably won't be able to tell you what that sore in your mouth is.  See a dentist.

referrals to a dentist near you
This is a new page,  and will grow as more dentists come on board.

Please do not inquire about fees. (See this page instead.).

I DO appreciate your help in correcting typos and broken links.
 

No dental insurance?
 What is dental
  insurance and how
  does it work?

Are your fillings
killing you?
 Is mercury ruining your
 life??

Is Fluoride poison?
 Should it be illegal?

Do Root Canals cause
multiple sclerosis or
other diseases?
 Click here to find out.

Are dentures better
than real teeth?
 Should you have all your
 teeth pulled and get
 false teeth?

Bad breath?
 What is causing your bad
 breath, and how can you
 treat it?

Cure your dry mouth for
Free
 Click here to find out how.
 

Copyright 2000 by Doctor Martin S. Spiller, DMD
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