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TreatingaChildsToothInjuryMayRequireSpecialConsideration

Often as children grow older, their participation in sports or similar activities increases. While generally encouraged, this greater activity does increase injury risk, especially to the mouth.

In fact, the late childhood to early adulthood demographic is the most prone portion of the population to incur dental injuries. To complicate matters, their dental development is often incomplete, posing a number of treatment obstacles for an injured tooth.

For example, the primary means for preserving an injured adult tooth is a root canal treatment: damaged or diseased tissue within the pulp, the tooth’s innermost layer, is removed and the empty chamber and root canals filled and sealed to prevent infection. But while a fully matured tooth can function without the nerves and blood vessels of the pulp, a developing tooth needs these tissues for continued tooth formation. Otherwise, tooth development can stall and cause problems later on.

The most common solution for younger teeth is to remove any damaged tooth structure without disturbing the pulp if at all possible followed by a filling. That’s contingent, though, on whether we find the pulp unexposed or undamaged—if it is, we’ll try to remove only damaged or diseased pulp tissue and leave as much healthy tissue intact as possible. To aid with healing and tissue re-growth, we may also place medicinal stimulators between the pulp and the filling.

Jaw development may also pose a challenge if the injured tooth is too far gone and must be removed. Our best choice is to replace it with a dental implant; but if we install the implant while the jaw is still growing, it may eventually appear out of place with the rest of the teeth. It’s best to postpone an implant until full jaw maturity in early adulthood.

In the meantime we could provide a temporary solution like a removable partial denture or a modified bonded bridge that won’t permanently alter nearby teeth. These methods can adequately restore the function and appearance of missing teeth until the jaw is mature enough for an implant.

While injuries with young permanent teeth do pose extra challenges, we have effective ways to address them. With the right approach, the outcome can be just as successful as with a mature tooth.

If you would like more information on dental care in the formative years, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Saving New Permanent Teeth after Injury.”

By Dr. Rosanne M. Palermo
August 09, 2018
Category: Dental Procedures
WhattodoifYourChildhasaToothache

When your child says they have a toothache, should you see your dentist? In most cases, the answer is yes.

And for good reason: their “toothache” could be a sign of a serious condition like tooth decay or a localized area of infection called an abscess, which could adversely affect their long-term dental health. The best way to know for sure –and to know what treatment will be necessary—is through a dental exam.

So, how quickly should you make the appointment? You can usually wait until morning if the pain has persisted for a day or through the night—most toothaches don’t constitute an emergency. One exception, though, is if the child has accompanying fever or facial swelling: in those cases you should call your dentist immediately or, if unavailable, visit an emergency room.

In the meantime, you can do a little detective work to share with the dentist at the appointment. Ask your child exactly where in their mouth they feel the pain and if they remember when it started. Look at that part of the mouth—you may be able to see brown spots on the teeth or obvious cavities indicative of decay, or reddened, swollen gums caused by an abscess. Also ask them if they remember getting hit in the mouth, which may mean their pain is the result of trauma and not disease.

You can also look for one other possible cause: a piece of candy, popcorn or other hard object wedged between the teeth putting painful pressure on the gums. Try gently flossing the teeth to see if anything dislodges. If so, the pain may alleviate quickly if the wedged object was the cause.

Speaking of pain, you can try to ease it before the dental appointment with ibuprofen or acetaminophen in appropriate doses for the child’s age. A chilled cloth or ice pack (no direct ice on skin) applied to the outside of the jaw may also help.

Seeing the dentist for any tooth pain is always a good idea. By paying prompt attention to this particular “call for help” from the body could stop a painful situation from getting worse.

If you would like more information on dental care for children, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “A Child’s Toothache: Have a Dental Exam to Figure out the Real Cause.”

By Dr. Rosanne M. Palermo
July 30, 2018
Category: Oral Health
Tags: oral hygiene   braces  
StopWhiteSpotsBeforeTheyAppearWhileWearingBraces

Braces can be a long, involved process, but gaining a more attractive smile and better oral health is worth it. Sometimes, though, braces can produce unintended short-term consequences.

Brace brackets and wires do the work of moving teeth to better positions. They can, however, hinder the wearer's hygiene efforts to remove plaque, a thin film of bacteria and food particles, from tooth surfaces. Plaque buildup increases the risk of dental disease and other ill effects.

One such effect while you're wearing braces is the formation of tiny spots that look pale and chalky on otherwise smooth and polished enamel. These are white spot lesions (WSLs), where acid has remained for too long on the tooth enamel. They occur because acid-producing bacteria escape removal during brushing and flossing due to the braces hardware.

We want to try to prevent WSLs while wearing braces, and not just because they're unattractive. You're actually looking at enamel erosion, which could lead to cavity development at those weakened spots.

Although difficult for you as a braces wearer, daily brushing and flossing is crucial to WSL prevention. You'll need to take more time to be sure you're reaching all around the wires and brackets. You can improve your effectiveness with special brushes for braces and floss threaders or water irrigators. You can also help keep acid levels low by cutting back on acidic foods and beverages, especially sodas, coffee or spicy foods.

Even if you develop WSLs we can treat them effectively, especially if caught early. One way is by aiding enamel re-mineralization through saliva stimulation (the mouth's acid neutralizer) or applying fluoride to the teeth to strengthen enamel. We can also use caries infiltration, a technique that injects tooth-colored resin below the surface of the lesion. This strengthens the weakened enamel and gives the area the appearance of translucence like normal enamel.

While you're wearing braces, focus diligently on keeping your teeth clean of plaque and keep up your regular cleaning visits with us. If you notice any unusual discolorations or abnormalities, see us as soon as possible. Stopping WSLs from developing will help ensure your teeth are healthy and attractive after the braces come off.

If you would like more information on dental care with braces, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “White Spots on Teeth during Orthodontic Treatment.”

By Dr. Rosanne M. Palermo
July 20, 2018
Category: Oral Health
Tags: celebrity smiles   retainer  
MargotRobbieKnowsAGreatSmileIsWorthProtecting

On the big screen, Australian-born actress Margot Robbie may be best known for playing devil-may-care anti-heroes—like Suicide Squad member Harley Quinn and notorious figure skater Tonya Harding. But recently, a discussion of her role in Peter Rabbit proved that in real life, she’s making healthier choices. When asked whether it was hard to voice a character with a speech impediment, she revealed that she wears retainers in her mouth at night, which gives her a noticeable lisp.

“I actually have two retainers,” she explained, “one for my bottom teeth which is for grinding my teeth, and one for my top teeth which is just so my teeth don't move.”

Clearly Robbie is serious about protecting her dazzling smile. And she has good reasons for wearing both of those retainers. So first, let’s talk about retainers for teeth grinding.

Also called bruxism, teeth grinding affects around 10 percent of adults at one time or another, and is often associated with stress. If you wake up with headaches, sore teeth or irritated gums, or your sleeping partner complains of grinding noises at night, you may be suffering from nighttime teeth grinding without even being aware of it.

A type of retainer called an occlusal guard is frequently recommended to alleviate the symptoms of bruxism. Typically made of plastic, this appliance fits comfortably over your teeth and prevents them from being damaged when they rub against each other. In combination with stress reduction techniques and other conservative treatments, it’s often the best way to manage teeth grinding.

Orthodontic retainers are also well-established treatment devices. While appliances like braces or aligners cause teeth to move into better positions, retainers are designed to keep teeth from moving—helping them to stay in those positions. After active orthodontic treatment, a period of retention is needed to allow the bite to stabilize. Otherwise, the teeth can drift right back to their old locations, undoing the time and effort of orthodontic treatment.

So Robbie has the right idea there too. However, for those who don’t relish the idea of wearing a plastic appliance, it’s often possible to bond a wire retainer to the back surfaces of the teeth, where it’s invisible. No matter which kind you choose, wearing a retainer can help keep your smile looking great for many years to come.

If you have questions about teeth grinding or orthodontic retainers, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Teeth Grinding” and “The Importance of Orthodontic Retainers.”

By DR. ROSANNE M. PALERMO
July 19, 2018
Category: Dental Procedures

Since they were first developed in the 1970s, modern dental implants have grown in popularity as a tooth replacement method. It is a dental implantsrevolutionary treatment that is helping about 500,000 patients per year according to the American Academy of Implant Dentistry. This procedure can be performed by Dr. Rosanne Palermo, a family dentist in Erie, PA. Learn more about dental implants, and how they can help rebuild your smile.

Dental Implants Replace Missing Teeth
The part of your tooth that shows above the gum line is only the crown. Below the gum  line  there is a root that is firmly entrenched in your bone tissue. A dental implant replaces that root and integrates with healthy bone tissue so that a new crown can be installed. Unlike a removable denture, the implant cannot be removed and is indistinguishable from your other teeth.

Building a Dental Implant
A dental implant is made of a small titanium rod that looks very similar to a screw. The titanium material is biocompatible, which makes it ideal for combining with the bone tissue in a process called osseointegration. Once it is firmly in place, which may take a few months, your Erie, PA, family dentist will add an abutment device, which will support a dental crown.

Implant Benefits
After tooth loss, you may assume that your only option is to wear a denture device that could slip out at any time. But when you have an implant you don’t have to worry about slippage or embarrassing situations. Once your dental implant is installed, you’ll soon forget that you even have one because the titanium part is hidden. It’s just like having a new tooth and modern crowns look very natural. Having an implant will help your bone tissue stay healthy and viable. When you take good care of your teeth and gums, the implant could be a part of your mouth for a lifetime. 

Your Dental Implant Consultation
It’s important that you have a dentist check your teeth soon after tooth loss if you want to be considered for a dental implant. Call (814) 833-3001 today to schedule an appointment with Dr. Rosanne Palermo at her Erie, PA, family dentist office.





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