I have noticed that my son has bleeding gums from poor brushing. He has braces and has a year of treatment remaining. His orthodontist seems concerned. Should I should end treatment and try later when my son's oral hygiene improves?

It is a difficult decision for me to discontinue active treatment due to poor dental hygiene. I want to get you the finished result as does the parent and child. At my office, my team and I would have frank conversation with you about your son's poor home care. My recommendation could be to continue treatment but leave the wires out for two to four weeks for better cleaning. I would place your son on an antimicrobial mouth rinse to help reduce bacteria levels and high fluoride prescription toothpaste to help prevent white spots. If these measures fail to get the gingivitis under control, then I would recommend temporarily suspending active treatment by removing braces.

My teeth are sensitive to hot and cold sensations. What causes this problem?

Tooth sensitivity can be caused by a number of reasons. Some of the more common culprits are cavities, cracked teeth, broken fillings, grinding your teeth, and receding gums. Everyone has microscopic tubules in their enamel that connect with the nerve of a tooth. If these tubules are exposed, temperature changes from eating hot or cold foods are transmitted more easily too the nerve. If your sensitivity is from a cracked tooth or grinding, then the changes in pressure on the tooth are causing your sensitivity. If your sensitivity does not go away after a few days, you can call 1-800-4Braces for a free consultation to discuss this problem.

Question: My baby just got his first tooth. Can he get cavities?

Dr. Herman's Answer: Yes, cavities can develop in your baby's teeth. For this reason, you should limit the time teeth are exposed to liquid containing sugar. Juice, formula and milk all contain sugar and can encourage the development of cavities. You should never put your child to bed with a bottle or “sippy cup” that is filled with any liquids containing sugar—only warm water is acceptable. This applies to pacifiers as well and I would strongly advise against dipping your child’s pacifier in honey or any sweetener. You may have the urge to reward your child with sweets, but remember that high-levels of sugar exposure at a young age can be disastrous to your child’s oral health.

Question: Why do you check for cavities at every orthodontic appointment? How do you determine if a tooth has a cavity?

Dr. Herman's Answer: I check for cavities at every orthodontic appointment because healthy teeth and gums are necessary for successful orthodontic treatments. I want my patients to have great results—that’s why I take the extra time to check for cavities. I use the "International Caries Detection and Assessment System." This system is based on visual inspection of a tooth and involves checking color, translucency, and dental hardness. When doing a 6 month dental exam, I also use X-ray images to assess for cavities. If a patient does have a cavity we discuss treatment options as well as ways to improve at home care to prevent future cavities.

Q: I expected that you would monitor the progress of the straightening of my daughter’s teeth. What surprises me is the emphasis you and your staff place on monitoring the health of her teeth and gums. Aren’t you just her orthodontist?

Dr. Herman’s Answer: Yes, but I was a dentist for 8 years before I did a residency to become an orthodontist. The biggest problem any orthodontist has while straightening teeth are issues with gum and dental disease. I put the patient first in making it convenient for each patient to obtain exam and hygiene services. This means you can have exam and hygiene services at the office of your dentist or at my office. While your daughter is under my care my goal is no new gum disease or cavities. However, if you want to help me to accomplish that goal is up to you.

Q: My child has braces and I was told to reduce his number of sugar exposures. What does that mean?

Dr. Herman's Answer: Studies show that there is a strong relationship between cavities and exposure to refined sugars in snacks and sugar filled beverages. Soda, juices and sports drinks high in sugar are the main culprits for causing cavities. If your child can have these beverages reduced or if he or she is willing to drink a sugar free variety, you will do a lot to reduce risk of cavities. Candy, cake, cookies and so on are high in sugar but they don’t appear to cause cavities nearly as much as the sugar containing beverages. Coke like sodas and some juices also contain acids that contribute to the cavity process. Limit sugar beverages and you will significantly reduce his risk to cavities.