Friday, December 11, 2020

Dental checkups should NOT stop because of COVID

Dental Care 2020 Scroll down for the list of dental practices Covid has complicated so much of our normal lives. Doing a risk/ benefit analysis for daily activities can become so tedious. One of the questions many of my patients have asked me is about routine dental care during the pandemic. The current official recommendation now is that your child should have his or her first dental visit by age one, and this does not change due to COVID. In California, about one third of preschoolers have dental decay. It is much easier to prevent decay in toddlers' teeth than to fill a cavity in a young child. Tooth decay is the most common chronic childhood disease and it can be prevented. I reached out to Dr. Rothman who was my daughters’ beloved dentist (he made them laugh and they actually enjoyed seeing him!) Dr. Rothman has remained a trusted resource for me over the years even though my girls aged out of his practice. It turns out that he was the right person to ask! He actually chaired part of the Covid19 workforce on dental practices. He pointed out that dental practices were among the first to really deal with infection control. They have been using masks, gloves and face shields long before this pandemic. His office worked closely with the California Department of Public Health and Cal Osha when they developed practice guidelines and checklists. Dentist offices might actually be one of the safer places to bring your child. It IS considered an essential visit. Sadly, Dr. Rothman told me that he is seeing a real increase in cavities and gum disease that corresponds with people not going in for their routine dental visits. As parents, we may think, "baby teeth fall out, so we don't need to worry about them." This sounds logical, but unfortunately is not true. Luckily, dental science has found out many new facts about how to prevent dental decay. We now know that bacteria causes tooth decay. This "bad" bacteria can find its way into your babies mouths in many ways. Eating foods high in sugar is one of the most obvious offenders. In order to prevent decay in our adult teeth, baby teeth have to be kept healthy as well. What can you do to keep your child's teeth healthy right from the start? For the youngest babies with brand new teeth you can wipe them off with a soft piece of gauze or a wet washcloth. Not only are you cleaning off the teeth, (breast milk does have sugar) but you are getting the baby used to a routine. Training your child from the start that teeth get brushed is a good way to create good dental habits that will last a lifetime. There are other options besides the standard hand held toothbrush. For very young babies, there are little flavored towelettes specially formulated for wiping baby teeth. Spiffies was the first of these that I was familiar with. Now there are several brands available. You could also consider using a soft finger brush. These fit over your finger and if your baby will let you, this option allows you to get in there and do a nice thorough job. If you use a regular toothbrush, make sure it has soft bristles. Replace the brush when it looks like the bristles are getting worn. It is also a good idea to run all the family toothbrushes through the dishwasher every once in a while. One extra perk about routine dental care is that you might walk out of the dentist's office with a new toothbrush! Younger children will have an easier time handling a toothbrush with a thicker handle. Perhaps you can let your child be in charge for one brushing a day and the parent be in charge of the other; that way you know you are doing a more thorough job at least once a day. Some people use a two toothbrush approach. Toddler gets to hold one, but so do you. Both of you can be in there at the same time. Consider putting a little tune on while you brush. This can act as a timer. Brushing is ideally supposed to last 2 minutes. Do the best you can. A full two minutes might be a goal that is a little unrealistic for many of my patients. Brushing can be a little more fun and interactive nowadays with some fun apps. Sonicare-for-kids-sonic-electric-toothbrush brushdj brushupgame DisneyMagicBrushTimer TinyDentist Chomper chums my-bright-smile Don’t let it be too active, I once had a patient who got a fairly serious mouth injury from doing a little rough housing while brushing his teeth. Make sure your child isn’t running around with a toothbrush in the mouth. The American Dental Association recommends using a tiny amount (just a little dab) of fluoride toothpaste. It is important to note that too much can be harmful so keep the amount as small as a grain of rice. Once kids get to be over two and can spit it out after brushing, you can use a pea sized amount. Xylitol is another recommended ingredient for dental health. It is found in some toothpastes. This natural sweetener is found to help reduce bacteria and strengthen tooth enamel. It is important to use a toothpaste that is non abrasive: Most kids' brands are specially formulated to be gentle. Some adult ones are fine. Some toothpastes will have the abrasive rating noted on the package but it isn’t always easy to find. Ideally try to brush twice a day and floss once a day (for teeth that are touching.) Pay attention to habits that may or may not be good for your teeth. Children who are “grazers” tend to have more cavities than those who eat less frequently. Saliva neutralizes the acids in the mouth and actually ‘washes’ the teeth, but it needs about 2 hours in between meals to work. If someone is constantly eating, the saliva isn’t getting a chance to do its job. Foods that are high in carbohydrates and sugar are not healthy for our teeth or general health. A daily intake of 60 grams of carbs or higher more than doubles your chance of getting caries (and all that sugar can lead to type II diabetes in kids!) FINDING A DENTIST Find a dentist that treats very young children and bring your child to his or her first appointment when the first teeth erupt - no later than by age one. During the visit, the dentist will check your child for dental decay and talk to you about cleaning your baby's teeth. They might also talk to you about proper nutrition for keeping baby teeth healthy. If you have any concerns about the manner in which the teeth are erupting, having a dentist who is familiar with your child will be very useful. Another important thing to think about is that having a dentist can come in very handy if you happen to have any dental emergencies. Kids have accidents! It is not unusual for me to get calls about chipped or loose teeth after a fall. I usually suggest that they contact their dentist on those occasions, and the folks that already have one are way ahead of the game. If there is a dental emergency, early intervention can be the difference between saving the tooth or losing it. Some parents avoid taking children to the dentist to save money, yet studies show that the dental costs for children who have their first dental visit before the age of one are 40 percent lower in the first five years of life than for those who do not see a dentist before their first birthday. Consider this when deciding whether or not to add your child to your dental plan (if you are lucky enough to have one.) When I was working at Noe Valley Pediatrics, I compiled a list of popular practices based on patient feedback. Full disclosure, this list is from my 2018 post. There are lots of great practices that are not on my radar. We are fortunate to have lots of excellent choices in our city. If someone is conveniently located or is on your insurance plan that is certainly worth consideration. Many of them have updated their websites to reflect their COVID precautions. If the practice has not posted their protocols, it is very reasonable to call and ask. David Rothman 415-333-6811 is over on Ocean avenue near Stonestown. He was my kids' dentist and they loved him. He is an excellent dentist with a wonderful sense of humor. His office is able to do procedures under general anesthesiology in the office if needed. He remains my "go to" guy if I have any tooth related questions Bergen James, Doris Lin-Song and Jennifer Yu 415-668-3500 Claudia Masouredis 415-753-2777 Dorothy Pang 415-681-8500 is on Taraval and 18th in the Sunset. Dr. Pang is affiliated with the UCSF dental school. If someone needs a dental procedure under anesthesiology she can do this at UCSF rather than in the office. Raymond Katz 415-751-7900 This practice is at 5233 Geary. Han Pediatric Dentistry 415-681-3220 Dr. James Han’s office is at 1530 Noriega Street. Dr Han is also on staff at CPMC and attends any dental emergencies at the ER there. He can perform general anesthesia cases in the OR there as well. Dr. Charles Spitz and Dr. Tyler Davis 650-375-8300 Peninsula Pediatric Dentistry and Orthodontics. If you are looking for a practice down on the peninsula, this great practice is located in San Mateo. Dr. Davis works with Dr. Spitz, who used to have a practice in the Mission. They are located in the Mills Medical Arts building on the corner of South San Mateo Drive and 2nd Avenue in downtown San Mateo. "We are a preventative practice first and foremost. We believe the best dental care is personalized to meet the individual needs and preferences of each child we see. We work hard to get to know our patients and their families. We're always willing to listen, to discuss options and to answer your questions." Anne Lee DDS 650-873-5212 Kid Smiles 415-681-5437 There are some low cost options available as well. If you need assistance in finding a dentist, or low-cost children's health insurance in San Francisco, please call the Women and Children's Health Referral Line @ 1-800-300-9950. Low Cost Dentist options

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