We all know it's important to stay hydrated. With so many "grab and go" drinks options out there, it can become confusing to know just which ones are best. Certain branding efforts might make these drinks look more beneficial than they actually are and the effects on your teeth may surprise you. Is VITAMIN WATER good for me? While the name sure sounds appealing, often the vitamins in these drinks are ones you don't need or ones you may start ingesting in excess if you drink vitamin water regularly. Registered dietitian Julia Stanislavskaia says “certain vitamins are readily available in an average diet, and there is no need to supplement those in an average person” and “it’s possible to overdose and get excess amounts of certain vitamins if you drink this water as well.” Along with these unnecessary vitamins, you’re also getting a mouthful of artificial flavours, colors, caffeine in some cases, and lots of sugar. The average bottle of vitamin water (591 ml/20 oz) can contain eight teaspoons of sugar! That's two teaspoons more than the daily intake of free sugars recommended by the World Health Organization. Is FLAVORED WATER good for me? Flavored waters sweetened with artificial flavors often use some form of sugar which can be cavity-causing. While some of these drinks are infused with natural flavors as opposed to artificial, thereby saving from added sugar, these natural flavors often include citric acid which wears away tooth enamel. Similarly, these drinks are carbonated through the use of carbon dioxide, meaning there is acid in each bottle that can wear away your tooth enamel. Are SPORTS DRINKS good for me? Much like with fruit juice, the decaying combination of high acidity and sugar in sports drinks can really do a number on your teeth. With time, regularly consuming sports drinks can soften tooth enamel and lead to erosion over time. In addition, sports drinks often contain caffeine, artificial colors, and flavours. It's also important to keep in mind that sports drinks are designed to replace carbohydrate and electrolyte loss during intense physical activity. These drinks were not designed to be consumed regularly considering the additional ingredients present. It’s best to replenish electrolytes lost during an intense workout or an active lifestyle by drinking water and maintaining a healthy diet or drinking sports drinks in moderation. So...What's the best drink for my teeth? You guessed it: water. We’re lucky enough to have easy access to clean, safe drinking water, so why not enjoy more of it? Water is free from sweeteners, caffeine, calories, and artificial flavors and colors. And, it’s just a tap away! If that's too boring for you, consider adding cucumber, mint, strawberries, or ginger. With limited sugar and acid, these will offer a little kick to keep you interested! Dr. Stephanie Stephan DDS, Dentist in Auburn Hills and Pontiac, Michigan 1590 Baldwin Avenue, Auburn Hills, Michigan 48340 www.thehillsdentalstudio.com

How Often Should You Go to the Dentist? Regular visits are essential to maintain healthy teeth and gums and for oral cancer screenings. Because many factors go into determining your oral health risks, the interval between dental checkups should be determined individually for each patient between every 3 to 12 months. Why Visits are So Important: Your check up appointment is vital for monitoring and removal of plaque or calculus (aka tartar). Areas that are improperly cleaned or missed at home can compound quickly with time. You may think that you're removing all of the plaque but, if you don't, it quickly hardens into calculus which can't be removed with a toothbrush or floss. If that calculus is not removed, the gums become inflamed (gingivitis) and after a few months this inflammation involves the bone leading to bone loss (periodontitis). While gingivitis is reversible, bone loss is not. Periodontal disease is the most common cause of tooth loss among adults. This is why it's so important to have your gums checked regularly by a professional if you want to keep your natural teeth. Check up/cleaning visits assess your oral hygiene methods, levels of attachment around your teeth, identify any early signs of periodontitis, monitor your response to treatments, and much more. Remember, it's easier and cheaper to maintain your health than to regain it. A Breakdown of What is Assessed: Oral Cancer Detection: with regular dental checkups the likelihood of catching oral cancer in time is dramatically higher. Recognizing oral cancer in its early stages is key in treating it successfully and while you may not notice oral abnormalities, your dentist will. Looking for abnormalities only takes your dentist a minute and could mean an extremely serious disease is identified early enough to make a huge difference. Plaque, Tartar, Cavities: there will always be small areas in the mouth that are missed by a regular brushing and flossing. When plaque becomes calculus, it is extremely difficult to get rid of without professional help. Plaque and tartar erode teeth and create cavities. This can be avoided with regular cleanings that take care of plaque and tartar before it becomes destructive. Gum Disease: plaque and tartar buildup not only cause tooth decay but can also erode the mouth’s gum tissues. Tartar buildup causes an infection where the gum is connected to the tooth, making the gum pull away from the tooth (gingivitis). As this progresses, the tissue that attaches gums to the teeth breaks down sometimes causing swelling, bleeding, or soreness in the mouth. After a short time, gum disease causes a breakdown of the bone that holds teeth in place causing tooth loosening or loss. Those with severe gum disease may need to see a specialist requiring more appointments at a higher cost and may even need surgery, extremely deep cleaning, and medication depending on the severity. Keeping Bad Habits in Check: there are many bad habits that can impact your health including chewing ice, biting your nails, clenching your jaw, grinding your teeth, eating particularly sticky or hard sweets, brushing your teeth too hard, drinking coffee and red wine, and of course smoking. At your checkups, your dental professionals can check for any oral damage caused by these or other habits. Being informed about specific destructive habits allows you to change or alter your lifestyle choice to prevent further damage, fix the damage that has already been done, and help your oral health be the best it can be. Finding Problems Under the Surface with X-Rays: x-rays help your dentist to see cavities in-between the teeth which simply cannot be visualized until they are large enough to create a hole in the tooth. They also allow us to see damage to the jawbone from gum disease as well as any bone decay, swelling, cysts, or tumors, all of which are impossible to actually see without x-ray imaging. What Goes On During a Dentist Visit? Checking your teeth for tooth decay is just one part of a thorough dental examination. There are 2 main parts to a regular dental visit – the check up (exam) and the cleaning (prophylaxis or periodontal maintenance). 1. The Dental Cleaning During this part of the dental visit, your dental professional cleans your mouth using these methods: Checking the cleanliness of your teeth and gums, measuring the gums Removing any plaque and tartar by scaling with special tools Polishing your teeth with a gritty paste to remove any surface stains on your teeth Flossing to make sure the areas between your teeth are clean Reviewing recommended brushing and flossing techniques 2. The Exam Your dentist may start off with a head and neck exam to look for any signs of trouble - swelling, redness, or possible signs of cancer: Examining your face and neck Checking your lymph nodes Checking your jaw joints (TMJs) Next, your dentist assesses the state of your teeth and gums by: Looking for visual evidence of tooth decay Examining the gums and the measurements of spaces between your teeth and gums Looking for signs of gum disease Checking for loose teeth Looking at the tissues inside of your mouth Examining your tongue Checking your bite Checking for broken teeth Checking for damaged fillings Looking for changes in the gums covering teeth Evaluating any dental appliance you have Checking the contacts between your teeth Taking X-rays to evaluate cavities that can't be seen visually, check bone levels in between teeth, look for infections, and more Looking for signs of other health issues (diabetes, vitamin deficiencies, etc.) Looking for intra-oral signs of oral cancer (see chart below) Once your examination and cleaning have been performed, we'll tell you about the health of your teeth and gums and then make any additional recommendations. Why Does My Dentist or Hygienist Recommend Frequent Returns? Your recall schedule depends on what your dentist or hygienist sees in your mouth, your oral hygiene at home, and your diet. As mentioned before, recall frequency can be as little as 3 months to as much as 12. For people with bone loss, it's very difficult to reach far down enough on the root or below the gum line with a simple toothbrush; dental tools are needed for this. Studies show that after a professional cleaning, microbial plaque tends to grow back to pre-cleaning levels after about 3 to 4 months. That's the reason that some people are required to return every 3 to 4 months to maintain their oral health. Note: Periodontal disease and tooth loss are associated with an increased risk of oral cancer. What You Should Be Doing In-Between Visits: Be sure to take care of your teeth and gums between regular dental visits. Plaque is always forming on your teeth, but you can manage it by brushing and flossing regularly. Here are some tips for good oral care at home: Brushing properly at least twice daily with a fluoridated toothpaste to disrupt the growth of bacteria and to remove plaque from the gums/below the gumline Flossing daily and/or using interdental brushes (if there is a sufficiently large space between teeth) Using and antiseptic mouthwash to help combat gingivitis, control plaque bacteria, and keep your breath fresh So, Are Dental Checkups Worth the Effort? Dentists and dental professionals are not only concerned with fixing teeth. They professionally clean your teeth, aim to ensure your teeth and gums are healthy, and check for abnormalities that may otherwise go unnoticed and could be a sign of larger health issues. Dental professionals make sure that your bones are strong, and will help you correct any habits that may be sabotaging your oral health, among other things. Skipping dental appointments may not seem like a big deal if you view these appointments as "cleanings only," but they are so much more than that! Oral issues can develop and progress extremely quickly whether or not you notice it. By keeping on top of your dental cleanings and checkups you’re doing yourself a big favour in the long run! A cleaning appointment is also more affordable than getting a filling, so if money’s tight you should make sure not to miss those cleanings. Be true to your teeth, or they'll be false to you! Dr. Stephanie Stephan DDS, Dentist in Auburn Hills and Pontiac, Michigan 1590 Baldwin Avenue, Auburn Hills, Michigan 48340 www.thehillsdentalstudio.com

Thanks to technological advances, dentists and patients today have several choices when it comes to selecting materials to fill cavities. Among the choices are natural tooth-colored materials such as resin-based composite fillings and more traditional dental fillings such as those made of metal amalgam. Keep in mind that there are still other materials for restoring teeth including porcelain, gold inlays, zirconia, CEREC, and others for larger fillings, more damaged teeth, or heavy grinders. These may be better options still, but let's keep it (somewhat) simple for today. What is dental amalgam? Otherwise known as "silver fillings," dental amalgam is made up of mercury, silver, tin, copper, and zinc, of which mercury makes up about 50%. Though the material has mercury, studies have proven this material to be safe and may sometimes be the only viable option. What is resin composite? Otherwise known as "white fillings," resin composite fillings are made of ceramic and plastic compounds. When they were first developed, they weren't strong enough to be used in back teeth. With technological advancements supported by numerous studies, these materials are strong enough to be used in back teeth and can provide many advantages. Which material is best for me? It really depends. Deciding which type of filling to use is best made by considering the size and location of the cavity, your oral hygiene, your cosmetic concerns, cost, and other factors. Ask your dentist to discuss all of the choices available for dental fillings and help you decide which is right for you. What are the advantages and disadvantages of each? Amalgam Advantages: The main 3 are: strength, durability, and easy application Though they don't technically require a dry site, they can be the better option where it is not possible to place a filling without contamination from saliva (though they can be affected by saliva as explained below) They have a long history of strength and durability which means fillings "last" in your mouth longer (though they may just be better at hiding decay and the material strength may not be very kind to your tooth as explained below) Because they're easier for your dentist to place, they don't require any extra training, extra effort, or extra material costs meaning your appointment may be about 10-20 minutes quicker and cost a bit less. (But it's important to consider the long-term costs and disadvantages, if any, before deciding if that extra $50 is actually saving you money or not). Amalgam Disadvantages: Corrosion: Amalgams seal through corrosion which often means a darkened or discolored tooth. In addition, corrosion means increased porosity, loss of strength, release of metallic products into the mouth, and open margins where the tooth and filling meet leading to bacteria leaking underneath and creating cavities we can't see. Perhaps most detrimentally, this corrosion may produce additional lateral stress on the walls of the tooth preparation because by-products of corrosion occupy a larger volume which can lead to the cracks and fractures dentists often see in teeth with old amalgam fillings. More aggressive: amalgam restorations need to be at least 1.5-2 mm thick uniformly meaning if decay is small or only deep in one area of the tooth, good tooth structure will need to be removed simply to make sure the metal is thick enough to withstand forces and be retained in the tooth. Cracks and fractures that can lead to more extensive dental treatments: amalgam restorations expand and contract considerably more than composite restorations. This cyclic dimensional change may consequently contribute to the fatigue of the tooth structure and to cusp fractures. In addition, because of creep and flow, amalgam permanently deforms under pressure. With larger amalgams, these changes can create additional lateral stress on the tooth leading to cracks and fractures. The condensation of amalgam also bends the remaining tooth cusps outwards, and the setting reaction of filling-type amalgams produces a slight expansion, which may also add additional stress and cracks. If a tooth cracks or fractures a crown is often the next step and, if this crack extends to the nerve, a root canal or extraction may be necessary. Harder to see recurrent decay around or underneath fillings: due to the gray staining of the tooth around older amalgam restorations, visual evaluation of decay during your dental exam is more difficult. In addition, the extremely high radiopacity of amalgam on an x-ray makes the diagnosis of secondary caries less accurate than with less-radiopaque composites which often means we can't see cavities until your nerve tells us they're there. Delayed hardening: it takes 8 hours before an amalgam filling reaches 70% of its 1 week strength so the actual hardness of the filling may be decreased if you accidentally chew on your new filling within the first week. Temperature effects: an amalgam filling experiences a decrease in strength by 50% when drinking something hot. Amalgam is also more likely to yield long-term sensitivity with hot or cold air, drinks, or foods than other non-metal fillings. Can still be contaminated: certain amalgam alloys (especially high-copper amalgams) still need to be placed in a dry environment and can experience delayed expansion if wet. This can then lead to significant expansion causing leakage and nerve pressure pain among other issues if saliva-contamination occurs during placement. Marginal breakdown: if not bonded, the restoration pulls away from the tooth leading to leaking, graying of tooth, recurrent decay, and other issues. Galvanic shock: can occur when two amalgam or any metal fillings come in contact or are placed too close together. Essentially, this sets up a "battery" in the mouth and the electrical current stimulates nerve endings in the tooth leading to an uncomfortable feeling. In summary, the biggest disadvantage from a tooth-preservation and economical standpoint is that these fillings require more tooth structure to be removed and their properties often lead to cracks and missing tooth cusps. Because of this, you may be looking at a crown, root canal, or even an extraction in the long-run in a tooth that would have otherwise been treated kinder with a different material. In addition, because of the decay that is often missed underneath these fillings, root canals and crowns are more likely as well as the decay only become obvious when it is larger. Considering these extra costs and appointments, does it really make sense to choose an amalgam filling because it's 10's of minutes or 10's of dollars less? Composite Advantages: The color matches your natural tooth, so they are esthetic and natural-looking They are bonded to your tooth which means that they can restore at least some of your tooth's original fracture resistance once placed in the tooth (which non-bonded fillings can't do) They are more conservative than amalgam meaning you can preserve more of your natural tooth leading to less issues in the long-run with fractures, sensitivity, and total dental work They are completely cured before you leave the office so there's no risk of fracture during a typical amalgam's setting time Being plastic, they are worse conductors than metal fillings meaning less sensitivity to hot or cold over time Act more like your natural tooth leading to less cracks and fractures (which often mean more aggressive dental work like a crown or root canal) Composite Disadvantages: Stain with time: in front teeth, this will be more obvious, especially if you eat or drink things that stain teeth more quickly. Often, these extrinsic stains are shallow and can be polished away at your dental appointments. The best esthetic material that doesn't stain will be a porcelain or other indirect and highly polished material. Require a dry site: the material does not work well in areas of the mouth where it is difficult to keep the tooth dry such as in patients with physiological limitations (can't open wide) or some children. However, advances in isolation systems and rubber dams have led to this being a very infrequent problem. Require the right technique and take more time: because they are bonded, they require a few more steps, but often this added time is negligible considering they are cured immediately by the light meaning you don't have to wait at the end of an appointment to check the bite like you do with amalgam. Post-operative sensitivity: you may experience some brief tooth sensitivity following the procedure. Though this is possible with all materials as drilling on the tooth is often the primary issue, this can sometimes be avoided by using lots of water during drilling, a liner for sensitivity, and proper placement techniques. Not as resistant to decay as silver fillings: due to the lack of acid-buffering abilities in the mouth. Because, unlike amalgam, they lack the ability to increase the local pH, this can lead to the outgrowth of more acidogenic/aciduric bacteria in patients who are not diligent about their oral hygiene routine. In short, this means that patients with poor oral hygiene might be better served with an amalgam filling in certain situations if they have no desire to improve their oral hygiene (keeping in mind that the disadvantages of amalgams must still be accounted for). Wear sooner than metal fillings: especially if you have heavy wear from grinding and chewing because they are not as strong. However, if you are clenching or grinding, amalgam may not be a good option also as these forces on the amalgam can cause fractures in your tooth (as explained above). A zirconia or porcelain filling or crown might be best for someone who is that hard on his or her teeth. They’re more expensive than silver fillings: because the material costs more and it takes more time. A Mercedes costs more than a Hyundai for a reason. Your dental plan may not cover them: this is never a good reason to choose one option over another. Your dental plan covers only what your employer asks it to cover, not what is in your best interest. Do your research and decide with your dentist what is best for you and, if money is a factor, realize that the cost difference is not massive and talk about a payment plan if possible. It's interesting to note that many the "disadvantages" of composites often have nothing to do with the material itself but with the practitioner or placement. "Time consuming, technique-sensitive, difficult to polish, and expensive" are often what is read when looking for disadvantages. If you have a doctor skilled in composite placement, these disadvantages become negligible. And, like anything in life, you get what you pay for. The difference in cost between amalgam and composite is typically $50-100 which, considering the advantages and decreased likelihood of future more expensive procedures, should be well worth it. Because they take a little longer and are more technique-sensitive sometimes dentists, used to doing things how they've always done them, don't want to learn the new techniques, take the extra time, or spend money on materials needed to avoid contamination while placing fillings. This should not be the reason you choose a different material that may not be best for you. So...should I replace my amalgam fillings? The short answer: no. Many amalgam fillings are better off left alone if there are no signs of issues or if they don't bother you esthetically. Whenever you replace a filling, you typically have to remove some additional tooth structure, especially if there is decay discovered underneath (though you would want that cleaned out anyway). The more tooth structure you remove, the more likely sensitivity is to occur. However, this sensitivity is often short-term and if signs indicate the amalgam is harming the tooth, this may be the right way to go. Only replace amalgam fillings that your dentist suggests replacing due to reasons listed above or below: Signs of decay or soreness in the tooth or beneath the filling A “void” or margin breakdown between the filling and the tooth The filling can no longer be supported due to a crack in the body of the tooth Recurrent decay under or around the filling You have concerns about the mercury in the filling (though, as mentioned before, are statistically negligible) You have concerns over esthetics and simply desire a more natural looking filling Always ask your dentist for their recommendation. Every case is different, so you'll want a personalized assessment. When it comes to removing old fillings and replacing them with new ones, it is best to be aware of all the options available to you, many of which aren't reviewed in detail in today's blog post. Okay, you've said a lot. What's the final verdict? In summary, when access is limited in the mouth, a procedure needs to be completed as quickly as possible, or dryness is not possible, an amalgam filling may be your best choice. However, new advancements have taken many of these issues completely off of the table. Weighing the advantages and disadvantages, composites and other stronger and cemented materials (such as Emax, Ceramic, Porcelain, and Zirconia) are often better in the long-run than amalgam. Amalgam's biggest benefit is it's strength in a large filling; but with other strong materials are available, these kinder and more esthetic options might be just what you need. With time, things are always improving and advancing. As of now, they are working on how to replace decayed tooth with natural-growing tooth material, so stay tuned for the changes that are inevitable in any field of study that is always improving! Hope that wasn't too confusing! There's a lot to talk about and we've just barely skimmed the surface. As always, ask your dentist to explain what they think is best for you and come to a decision together. Dr. Stephanie Stephan DDS, Dentist in Auburn Hills and Rochester Hills, Michigan 1590 Baldwin Avenue, Auburn Hills, Michigan 48340 www.thehillsdentalstudio.com

For some, their clenching or grinding is evident when they wake up with a sore jaw or headache or notice themselves while driving or studying. For others, the signs may not be so obvious. Other people in the house may tell them that they can hear their teeth grinding from down the hall at night and, still, others have no idea they are grinding until they see their dentist for a check-up. The chewing apparatus system includes the teeth, gums, bones, muscles, and joints. It is intended to be used daily for about the time that it takes to eat three meals (an average of 45 minutes). If you clench during the day or grinding at night you are overusing the system. If this system is being abused for hours during the day or at night in excess of the use during meals, the system will begin to break down. Bruxism vs. ClenchingBruxism is defined as the dynamic grinding of teeth whereas clenching is the static contact of teeth together. When your mouth is naturally closed, your teeth do not contact. It is only when you use your muscles to clench that the teeth are touching. Both of these actions are parafunctional (aka dysfunctional) and can therefore cause damage to the chewing system. Causes The causes of bruxism are not well-understood. It's believed that stress, difficulty sleeping, caffeine, alcohol, smoking, sleep disorders, an abnormal bite, or crooked or missing teeth can be contributing factors. Discomfort from ear infections, allergies, colds, irritation in the mouth, misaligned teeth, and other problems often cause children to grind. Many children grind their teeth throughout childhood and often grow out of the habit once their adult teeth have erupted and their bite has changed. Signs Clenching or grinding can include pain or discomfort in the jaw muscles or joint. It is often concurrent with headaches, toothaches, earaches, or jaw joint pain. Besides causing pain or discomfort, bruxing can do a lot of damage to your teeth over time. Even mild and infrequent grinders often show signs of wear on their teeth and gums that indicate clenching or grinding. Often in heavy grinders, when the jaw is slid from left to right, the worn areas of the teeth fit like pieces of a puzzle. These signs can be evident to you if severe enough, but even mild signs can be evident to your dental professionals. Damage to the teeth include cracks or fractures, chipping, gum recession, wear on the chewing edges, sensitivity in worn areas where dentin or roots are exposed, loose teeth, and others. If you are concerned that you may be clenching or grinding, your dentist can assess your teeth, gums, muscles, and joints to determine if you are causing damage from this habit. Treatment The habit of grinding or clenching your teeth can be mild or severe, occasional or frequent. If the clenching habit is mild and only occurs during the daytime, it may be worthwhile to look into behavioral modifications to help you consciously quit the habit. If the habit is frequent, severe, or happens when unconscious, you may want to discuss with your dental professional what treatment options are available to you. For children, treatment is generally not warranted because their teeth and jaws change and grow so quickly and most children outgrow this habit by the time all of their adult teeth have erupted (12 years). As baby teeth exfoliate and new teeth erupt, the habit usually does not have the time with a single tooth to create enough damage to require treatment. In addition, treatment is difficult to prescribe for young children considering night guards are not a viable option for a number of reasons. For those whose sleeping disorder is causing the bruxism, a sleep appliance may be beneficial. For others, missing tooth replacement, orthodontic treatment, selective tooth grinding, full mouth reconstruction (in severe cases), diet change, stress reduction, nighttime muscle relaxant, warm compresses, meditation, counseling, and exercise can all help depending on the cause. Most often, the easiest and most immediately effective solution is the fabrication of a night guard appliance. The difference between a night guard and your retainer or bleaching trays is the material and thickness. The thickness of the night guard allows for tooth separation, muscle relaxation, and protection of your teeth. A custom-fit night guard made by your dental team will be less bulky than the boil-and-bite style night guards from the store and will be easier to get used to, but the drugstore version can work in a bind. If you have any more questions, talk to your dental professionals about what signs they may see, and what you can do to protect your teeth and limit the damage done to natural teeth and dental work to prevent further dental appointments, aches, or pains. Dr. Stephanie Stephan DDS, Dentist in Auburn Hills and Rochester Hills, Michigan 1590 Baldwin Avenue, Auburn Hills, Michigan 48340 www.thehillsdentalstudio.com

YES! A thousand times Yes! Why Do Baby Teeth Matter? Baby teeth are very important to your child’s health and development. Baby teeth help your child to chew, speak, and smile. And, just as importantly, they hold the space in the jaws for the permanent teeth that are growing underneath them. If a baby tooth is lost too early, the permanent teeth can drift into the empty space and make it difficult for other adult teeth to find room when it's their turn to come in. This can lead to crooked or crowded teeth as well as poor jaw formation. That's why it's so important to ensure that baby teeth stay healthy in order to allow for healthy development and eruption of the adult teeth. When Do Baby Teeth Come In? There are 20 baby teeth and they are all developed and waiting in their jaws when the baby is born. These teeth typically begin to appear between 6 months and 1 year of age and all teeth have usually erupted by age 3. It is common to note that girls' teeth typically erupt sooner than boys, though every child is different. The order of eruption can be found below: When teeth first start to erupt, sore or tender gums can be a common side effect. Gently rubbing your child's gums with a clean finger or a wet cloth that has been cooled in the freezer can be soothing. Teething rings can also make the tender gums more comfortable. If your child is still cranky and in pain, consult your dentist or physician to see if there is an underlying problem or anything else that you can do to ease the pain. When Should I Start Taking My Child to the Dentist?The ADA recommends your child's first dental visit after the first tooth erupts or by their first birthday. A dental visit at an early age serves many benefits as explained in our other post found here. Your dentist will familiarize your child with the office, take a look around the mouth if your child allows them to, and answers any questions you may have about how to care for your baby's teeth. As soon as a tooth is present, the possibility of decay is present. There are no "age limits" on tooth decay! How to Care for Your Child's Teeth It’s important to care for your baby’s teeth from the start. Here's what to do: You should always clean your baby's gums even before teeth erupt. All you need to do is wipe the gums clean daily with a moist washcloth. As soon as your child's teeth appear, decay can occur. If your child is younger than 3 years: start brushing their teeth as soon as they erupt into the mouth using fluoride toothpaste in an amount no more than a smear or the size of a grain of rice. Brush teeth thoroughly twice per day. If your child is eager to brush themselves, it's good to encourage that behavior. However, they will not be able to adequately clean their teeth at this age. Supervise their brushing to ensure that they use of the appropriate amount of toothpaste and learn the proper technique and then follow up their cleaning with a minute of cleaning their teeth yourself. For children 3 to 6 years of age: use a pea-sized amount of fluoride toothpaste. Brush teeth thoroughly twice per day and supervise their brushing reminding them not to swallow the toothpaste. Until you’re comfortable that your child can brush on his or her own, continue to brush your child's teeth twice a day with a child-size toothbrush and a pea-sized amount of fluoride toothpaste. When your child has two teeth that touch, you should begin flossing between their teeth daily. Floss at least once daily between any teeth that are touching. Your children can start to floss on their own once they are able to tie their own shoelaces (this is a great test of manual dexterity to know when they are ready). If you have questions or concerns, ask your dentist. The sooner your child visits the dentist, the more comfortable they will feel. Brush, brush, brush. (And floss too!) Dr. Stephanie Stephan DDS, Dentist in Auburn Hills and Rochester Hills, Michigan 1590 Baldwin Avenue, Auburn Hills, Michigan 48340 www.thehillsdentalstudio.com

Good question. Let's get into the differences. A general dentist is one that has completed dental school with courses, lessons, and hands-on experience in each of the dental specialties. Sometimes a general dentist will also complete one more year in general dental education as a GPR (General Practice Residency) or AEGD (Advanced Education in General Dentistry). The job of a general dentist is to do a little bit of everything; provided the level of difficulty is within their scope. If it's not, a referral should be made to a specialist. If general dentists weren't able to do anything a specialist is trained to do, then you would only be able to visit your dentist's office for simple fillings and only if you're a middle-aged adult. A dental specialist has completed their general dental studies as well as completing an additional 2-6 years studying in their specialty field. The ADA recognizes 9 dental specialties including: endodontics (root canals), orthodontics and dentofacial orthopedics (braces and Invisalign), oral and maxillofacial surgery (extractions and implants), pediatric dentistry (kids), periodontics (gums), prosthodontics (dentures, full-mouth rehabilitation), dental public health, oral and maxillofacial pathology, and oral and maxillofacial radiology. The job of a specialist is to only do treatments within their specialty, especially the difficult cases. Both general dentists and specialists are required to complete continuing education (CE) courses in order to maintain their licenses. Typically, specialists tend to choose courses in their specific field because the information they learn will be in topics regarding work that they do daily. (It really wouldn't make much sense for an oral surgeon to take a course about Invisalign if they never intend to treat a patient with Invisalign ...but they could if they wanted to!). General dentists tend to choose subjects that appeal to them. Since general dentists are licensed to complete easy to moderate cases in any of the dental specialties, they can choose a course in just about any field of dental studies. In some cases, that can be a little bit about each of the specialties, or they can focus their time in one specialty that interests them. For example, I find root canals and clear aligners like Invisalign interesting, so many of my CE credits are in these subjects. When it comes to knowing who can treat your condition, your general dentist is often a good place to start. A general dentist serves as your gatekeeper to determine what your overall needs are. Typically, this includes a complete exam that involves taking a look at all of your teeth and gums. Once your overall needs are considered, they are then prioritized. If your crooked teeth are bothering you, but you have a tooth with a large cavity approaching your nerve, this should be addressed first. On the other hand, if you're having excruciating pain with one tooth that is infected, smaller cavities can wait. Once your needs are prioritized, each of the treatments required can be evaluated on their own merits whether it is something better treated by a specialist or if it is straightforward enough for treatment in-office with the same people you are familiar with. Your general dentist is trained in each of the recognized specialties. This means that if they have an interest in a particular specialty that you require for treatment (root canals, for example), they can assess the level of difficulty to determine if it is something that they can predictably treat or if they should make a referral to a trusted specialist for you. Often the determining factor of who should treat your tooth/teeth/gums is the level of difficulty. If your crooked teeth include just a few lower teeth, your bite does not need correction, and your general dentist has taken continuing education in orthodontic courses, they may be able to complete your short treatment for you. However, if your general dentist does not have an interest in orthodontics, or if your treatment is not straightforward, a specialist is who you will want to be referred to. Too often patients go straight to a specialist for treatment and the specialist focuses only on the tooth or teeth concerning the patient. An orthodontist or oral surgeon will take a panoramic x-ray to look at the teeth in question but will not take bitewing x-rays to look for decay in between your teeth. This may mean that braces are placed on teeth with cavities and those cavities continue to grow while in treatment until they are too obvious to ignore. Placing fillings can be difficult while you are in full-orthodontic treatment and we may need to interrupt your orthodontic treatment or delay your fillings - which can then require more treatment, such as a root canal. Or, with an oral surgeon, it can mean that your wisdom teeth are removed but the cavities in your remaining teeth continue to grow unmonitored. Similarly, you may go to a root canal specialist because a tooth is causing you so much pain that you want to have the root canal completed, only to find out later that your money would have been better spent on a partial denture and extracting that aching tooth after considering the condition of the other teeth in your mouth. Or you may see a prosthodontist for a partial denture, and if all of your x-rays aren't taken and your gum and bone levels aren't measured and assessed, you may pay to have a partial denture made only to find out that one of the retaining teeth needs to be extracted and now your new partial denture can't sit without rocking. Long story short, see your general dentist first. Have them assess your entire mouth and then, if a treatment they are suggesting is something that a specialist is trained to do (deep cleanings, gum treatments, crowns/bridges, dentures, braces/Invisalign, treatment of children, extractions, root canals, or implants), ask your dentist how comfortable they are providing that treatment for you in their office. If they do not have enough training to feel comfortable, or if you simply want to see a specialist because you want the most qualified person for the job, ask your dentist for a referral. They will be more than happy to send you to whomever you feel most comfortable with. At the end of the day, it's your mouth and your choice and you will have these teeth, hopefully, forever - at least that's the plan! - so don't go cheap on them. And one final, very important note: if you are looking to visit a specialist due to the level of difficulty or the expertise that you are seeking, be careful to ensure that the dentist you are seeing who claims to have a "special interest" in a particular field of study is an actual specialist - i.e. with additional formal training. Some general dentists will, unfortunately, try to falsely give the impression that their continuing education courses in a particular field of study makes them a "specialist." Ensure that you ask the right questions to determine if they are, in fact, the specialist that you are seeking. Best of luck taking care of those teeth! Dr. Stephanie Stephan DDS, Dentist in Auburn Hills and Rochester Hills, Michigan 1590 Baldwin Avenue, Auburn Hills, Michigan 48340 www.thehillsdentalstudio.com

Brushing isn't something that's often taught in schools. It's usually something that you figure out on your own based on lessons from your caregivers, or something your hygienist (hopefully!) reviews with you at your dental hygiene appointments. Unfortunately, not everyone gets the review regularly. Sometimes it's not part of your hygienist's routine, and sometimes they look at your oral hygiene and decide you know what you're doing. But this simple task is often not completed correctly. And some bad brushing habits can be harmful for your teeth. So it's always good to review to make sure that you're giving your teeth the best possible care. According to the American Dental Association, the 8 most common bad brushing habits include: 1. Not replacing your toothbrush soon enough You should aim to replace your toothbrush 3-4 times a year - think about replacing it once every season. The average person visits their dentist every 6 months. So if that's you, and you get a new toothbrush at each visit, you should be looking to replace your toothbrush on your own twice a year. Look to replace it more often than that if you are sick. The bristles do not remove plaque with time and can harbor bacteria, even if they are cleaned regularly. 2. Not brushing for the full 2 minutes (2 times a day!) If you're not brushing long enough, you're not reaching all of the tooth surfaces. The average person brushes for 45 seconds which is not enough time to adequately clean all of the cheek sides, tongue sides, roof of the mouth sides, chewing side, along the gums, and tongue. Those are a lot of surfaces! If you're not sure how long that is, ask Siri to set a timer. 3. Brushing too hard Often this is as a result of not brushing long enough. People often think that if they brush harder, they can brush quicker. Unfortunately, if your toothbrush doesn't touch a surface, it doesn't matter how hard you're brushing. And not only that, but using too much pressure can actually damage your gums leading to gum recession and sensitivity as well as root decay. In addition, aggressive brushing can wear away enamel at a faster rate. You only need a gentle brush for the full 2 minutes. 4. Brushing right after eating Believe it or not, this is not the optimal time to brush. It's actually better to leave the bacteria and food on your teeth for 30 minutes to an hour before brushing. The reason is that your enamel is in a weakened state after eating as the pH in your mouth is now acidic (especially after eating foods containing citric acid, such as oranges, grapefruits and lemons). Brushing while your enamel is weakened can actually cause damage to the tooth structure. So if you're trying to decide if you should brush before or after breakfast on a busy morning, the answer might just be brush before and use a sugar-free gum to remove residual breakfast food if you can't get to a toothbrush again until lunch. 5. Improperly Storing Your Toothbrush Sometimes you may think that storing your toothbrush in a small container or a drawer is safer for it than on the counter. However, storing your toothbrush in a closed container will actually allow bacteria to grow faster. What you want to do is store your toothbrush upright where it is not touching anything and in the open air to allow the air to dry the bristles. If you're concerned about contamination from flushing, always close the toilet lid to keep that bacteria inside and keep your brush as far away as possible from the toilet. 6. Using a HARD toothbrush These kinds of toothbrushes should either be used to clean tile grout or given to an enemy. While hard toothbrushes may feel like they're cleaning your teeth better (and, therefore, you can brush for less time), they can cause the same problems we mentioned before with brushing too hard. A soft toothbrush is usually best. 7. Brushing the wrong way If you're just placing your brush perpendicular to your tooth surface, you're likely brush the part of the tooth that is least likely to get decay and skipping the area by the gums that is more likely to get decay. How you want to brush is to place your toothbrush at a 45 degree angle to your gums. Then, gently move back and forth in short (tooth-wide) strokes. Next, brush the outer surfaces, the inner surfaces, and the chewing surfaces of the teeth. Finally, To clean the inside surfaces of the front teeth, tilt the brush vertically and make several up-and-down strokes. 8. Using a brush that's not best for you Both manual and electric toothbrushes, if used the right way, are effective at keeping your mouth healthy. Try different styles until you find one that you like the best. It may be one with thin, tall bristles, one with a small brush-head that fits better, or an electric brush that helps with your arthritis. The best kind of toothbrush is the one that gets used! Dr. Stephanie Stephan DDS, Dentist in Auburn Hills and Rochester Hills, Michigan 1590 Baldwin Avenue, Auburn Hills, Michigan 48340 www.thehillsdentalstudio.com

Almost everyone feels that their teeth are not as white as they should be. With the toilet-bowl-white standards brought about by "Hollywood smiles," people are becoming increasingly interested in tooth whitening. Whitening your teeth is one of the fastest and easiest ways to improve your smile, but what option is best for you? The best way to decide what treatment to move forward with is to have a discussion with your dentist. Every mouth, just like every body, is different and what worked best for your friend or neighbor may not work best for you. Your dentist can assess the cause of your discoloration, what restorations you currently have in your mouth that will be affected by treatment, and what other factors in your mouth need consideration. For example, if you have a thinner biotype or receded gums, the chemicals in certain bleaching agents may irritate your gums and cause further recession. Your exposed roots may also experience more severe sensitivity since the nerve endings are exposed unlike they are in your enamel. What Causes Tooth Discoloration? Many things including age, but to put it simply: Extrinsic causes include things that stain your enamel: smoking, coffee, wine, dark pops, dark teas, and other foods or drinks. Intrinsic causes include things that discolor your dentin: excessive fluoride exposure as a child, tetracycline use by a pregnant mother or young child, trauma as a child, trauma in a permanent tooth, or a developmental issue. What is important to figure out before deciding which whitening method is right for you is the cause of your discoloration. Some discolorations are better treated with dental work or intrinsic bleaching, for example. What Are My Options? Professional In-Office Whitening: This is the quickest, and most expensive, treatment option. But, time is money. If you are looking to achieve dramatic results in one session, then this will allow you to do just that. This method uses the highest concentration of hydrogen peroxide or carbamide peroxide to whiten and precautions are taken to protect your gums and nerves. Professional Take-Home Trays: This includes custom trays that are made for you in your dental office that allow you to whiten during the day or overnight. This option also allows you to touch up your tooth color later if they begin to discolor again. This option has a healthy balance of cost and efficacy. It uses a lower level of hydrogen peroxide than in-office whitening, so it takes a little longer, but it is effective, safe, and less expensive. Drugstore Options: Whitening Strips: this treatment takes longer than professional treatments, but will whiten with time. If not applied correctly, gum irritation and sensitivity can occur. Whitening Toothpaste or Gel: this treatment takes longer than professional treatments, and is not as quick as whitening strips. Gels also tend to work better than toothpastes and are not as abrasive. If not used correctly, you can damage your enamel or cause your existing dental work to lose its shine. Whitening Pen: this treatment is portable and can work well for refreshing the effects of a different whitening method. The serum in these pens does tend to dissolve with time, so you may need to continually purchase new pens to notice any visible changes. Whitening Mouthwash: this treatment has the lowest concentration of whitening agents and can take several months before any kind of changes are noticed. This may work best for maintaining a whiter smile. Off-The-Beaten-Path Options: This includes "DIY" treatments such as using baking soda, hydrogen peroxide on a brush, activated charcoal, lemon rinds, oil-pulling, etc. While some of these treatments cause no harm and little change, others can actually be harmful for you. Baking soda can be too abrasive and remove enamel, hydrogen peroxide can dull the shine of your enamel or restorations, activated charcoal and lemon acids can lead to enamel erosion, and oil-pulling takes time with limited actual results. Which Option Is Right For Me? All of the different options will likely work to whiten your teeth. The question is how much time and money are you willing to invest? Like anything in life, time is money. If you are looking to whiten your smile for this weekend's events, then the drugstore options simply won't work quickly enough. If you are looking for the most economical choice, then a drugstore treatment may be best for you. Read the "Food for Thought" section below before settling on an option. Is it Safe? If you are following the instructions given to you by your dental office or as listed on the product you have chosen to use, then whitening is safe. However, if you overuse whitening products, or use alternative treatments you can cause damage to your teeth. Using treatments more aggressively than recommended may cause your enamel to demineralize which can actually weaken your enamel. What About Sensitivity? The sensitivity cause by whitening agents is typically temporary and decreases with time. The best treatment for sensitive teeth while whitening is to decrease the frequency of which you are using these agents and to incorporate a sensitivity toothpaste into your routine. This toothpastes contain ingredients such as potassium nitrate or strontium chloride, which block the tunnels to your nerve thereby decreasing the tooth's sensitivity. Also important to keep in mind: if you have existing fillings - especially ones on your front teeth - whitening may cause even more sensitivity. Is Whitening Safe For Kids? Generally, it is best not to start any whitening regimen until age 16 or older. The younger you are, the larger the nerves are in your teeth. This means that your teeth are more likely to become sensitive and there is a chance that you could cause damage to your nerves. What Else Can I Do To Keep My Teeth White? Maintaining excellent oral hygiene will help to maintain a bright smile. Brush at least twice daily - preferably after meals or staining drinks - and floss at least once daily. Schedule regular appointments with your dentist to ensure healthy teeth and gums and to remove surface stains and yellow tartar that cannot be removed with your toothbrush or floss. If you have drinks or foods that stain your teeth and can't get to a toothbrush, follow up with a glass of water and try to limit discoloration-causing foods and drinks. Final Food for Thought: If you have any existing dental work in your front teeth, whether it be fillings, veneers, or crowns, it's important to have your dentist take a look before beginning any whitening treatment. The color of your teeth will be affected by the whitening product, but dental materials will not change color - they may, however, lose their surface luster. So if there are fillings that currently blend in with your teeth, when your teeth are whiter these fillings will need replacement with a new color. Also, if you are planning on having dental work done on your front teeth, you will want to consider if you are happy with your existing color before having treatment completed. If you are not happy with the color of your teeth, figure out which whitening method you are going to use, follow the instructions, and then give your teeth a break from the whitening for two weeks to allow the color to bounce back slightly. Once the color has settled, and if you are happy with it, then your dentist can pick the shade of your restorations to match the shade of your teeth that you are now happy with. If you have any concerns about existing work on your front teeth, ask your dentist if this is something that you should be concerned about. Keep smiling bright! Dr. Stephanie Stephan DDS, Dentist in Auburn Hills and Rochester Hills, Michigan 1590 Baldwin Avenue, Auburn Hills, Michigan 48340 www.thehillsdentalstudio.com

The ADA recommends bringing your child to the dentist by their first tooth or their first birthday. This may seem "too young" for a child to be in the dentist's office, but the fact is that the more often your child visits the dentist and has pleasant visits, the more likely they are to view future dental visits positively. You want this, trust me. We like to take things slowly so that we make visits as positive as possible and that we don't scare your child, but we can only do that if we start early. According to a 2014 study by the AAPD, ~60% of children in the U.S. will have tooth decay by age 5. And the NIDCR reports that ~28% of children in the U.S. ages 2 to 5 develop at least one cavity. If the first time your child visits the dentist is for tooth pain at age 5, how can we expect them to feel comfortable when they return for a check-up and cleaning?  If your child arrives for their first visit and is diagnosed with numerous areas of decay, sometimes the best option is to put your child to sleep at the hospital and complete all of their necessary treatment in one visit. If your general dentist or pedodontist is comfortable working on your child with or without nitrous and can break up the treatment into multiple appointments, then this is usually the preferred option. However, children get tired and restless after multiple visits and at some point may even refuse treatment. So the only option may become a hospital visit. This may actually be easier for your child than multiple visits and it can hit the "reset" button for their next dental appointment which, if habits change, can be a simple check-up. It's great to have a reset, but not so great when you start thinking about booking your child an operation in the hospital. Why not just leave the cavities? Well, I'll go deeper into that in another blog but - put simply - the cavity will eventually get infected and/or painful and, in some cases, the infection can become fatal. At some point, your child will be in pain or the tooth will be infected and you'll have no other option but to seek treatment. Imagine how fun that visit will be for your child. Now imagine, instead, that your child comes in for a visit at age one. They're probably too young to allow the dentist to take a look inside, but some actually do! Even if they don't, they now know what the office looks like, as well as the inside of the dental operatory. They get to go for "a ride" on the cool dental chair, play with some buttons, and take home a sticker or a prize. And you get to talk with the dentist about the best way to care for your child's teeth, when to stop using a bottle or pacifier, what kinds of foods to include in the diet, when to use fluoridated toothpaste, how much toothpaste to use, and the list goes on. The appointment is as important for you as it is for them. Prevention is key! If you don't know how best to care for your child's teeth, your child can't receive the best care. Why should I care if my child likes going to the dentist? Let me count the ways... pain infection (can be fatal) malnutrition trouble concentrating in school missing school due to pain or appointments abscesses affecting the development of adult teeth early tooth loss leading to space loss and more lengthy and expensive orthodontic treatment (that may not have been necessary otherwise) dark spots and holes visible when smiling and/or speaking and the list goes on... I'm sure you can think of a dozen other reasons that are good for your child. Now let's think selfishly for a second. Is it fun for you to take time off of work to drag your child to a dental appointment as they kick and scream the whole way? Is it fun for you to do that time and again until everything is finally restored? Is it fun for you to repeat yourself over and over every night about the importance of brushing and flossing? I think we all get where I'm going with this. What should I tell my child about the appointment? Now that we have all of that other vital information out of the way, we can get to the main point of this blog: If you've never been somewhere, you don't know what to expect. You rely on people you trust who have been there to let you know how to feel about where you're going. If they say nothing, you may be fine or you may be nervous because you don't know what to expect. If they only say positive things, you go wherever they take you and you are excited to be there. I can't stress enough the importance of speaking positively to your child. Your child will mimic your feelings. If you're scared, they will sense that and become scared too. Tell them... ...about how easy and cool their visit is going to be. That the dentist is just going to take a look inside their mouth and count their teeth so that they know how many they have. Stimulate the conversation by asking them how many teeth they think that they have. Tell them that the dentist might brush their teeth just like they do at home and maybe even use some cool and different toothbrush that tickles their teeth. Tell them that they'll get vitamins painted on their teeth to make them nice and strong! Tell them anything but negative things! We don't use the word "needle" around kids because we hide it, use topical gel, and inject slowly so that a needle from the dentist doesn't feel like they needle they remember from the pediatrician's office. If you use the word needle, then your child will associate it with shots at the doctor, and the experience for them with us really isn't the same. The doctor doesn't use topical gel or nitrous gas. Every dentist has their own tricks. We say the tooth is going to go to sleep with the sleepy juice, warn them about a potential "mosquito bite," have them close their eyes, and move slowly. The majority of the kids have no idea for years that they ever had a shot with us! I'm not kidding. The only ones who even know that needles exist in our office are the ones who were told so by their parents, relatives, or friends. Prepare them... ...by playing dentist at home. Go over the appointment I described above and let them "practice" at home so that they feel prepared. Children, like adults, are more relaxed when they are prepared. ...by reading children's books about dental appointments that help with the preparation. Most characters have a book about their visit to the dentist and some even have videos online. Some favorite books include Doctor DeSoto by William Steig, Just Going to the Dentist by Mercer Mayer, and Dora Goes to the Dentist by Random House and Robert Roper. The Bernstein Bears and Curious George have their own books too. ...by being a good role model and choosing positive behaviors yourself. If you show your children at home the importance of keeping their mouths clean, and model that by keeping yours clean, they are much more likely to listen to your direction. Make "brushing time" fun, play a video, sing a song, do what you can to make brushing at home fun. That way, when you prepare your child for the appointment you can say things like "the dentist will get to see how clean your teeth are and what a good job you do." Kids love positive reinforcement. ...by getting them excited by being excited yourself (fake it if you have to). Set aside a special outfit, talk about how different and cool everything in the office is, set them up for a treat after the appointment, etc. If you're bringing your child at a young age, there's really nothing to be scared about. If they're coming in excited, they're going to have a great time and - often - they can't wait to come back again! Just remember that negative words like "hurt, painful, needle..." - even if they are accompanied with words like "only, little bit, or small" - only serve to make your child nervous and uncomfortable. Better word choices include "funny, tingly, ticklish, and sleepy juice." If you have any questions about what to say to your child or what their first experience will be like, just ask your dentist. We always want to make dental appointments as easy as possible. So many of our young patients have no fear and have had numerous fillings placed! We have broken the "fear of the dentist" cycle with so many kids, let your dentist or pedodontist do that for you and your family too! Dr. Stephanie Stephan DDS, Dentist in Auburn Hills and Rochester Hills, Michigan 1590 Baldwin Avenue, Auburn Hills, Michigan 48340 www.thehillsdentalstudio.com

This is never a great position to find yourself. You or your child had a bad fall/was playing a sport/had one too many... and you find yourself with a tooth (or part of one) in your hand. Is this a dental emergency? Who do you call? What should you do? Baby (Primary) Tooth: Under the age of ~12 (or if you have a retained baby tooth), there's a good chance that the tooth that has been injured is a baby tooth. Sometimes it's easy for you to tell, sometimes it's not. It's important to make that distinction because what you do when trauma occurs can be different for a baby tooth. This chart may help you make that distinction: Now, if it is a baby tooth read on. If not, skip to the next section. Is it an IMMEDIATE emergency? Typically, with a baby tooth, most trauma cases are not emergencies in the sense that you need to get in to see your dentist RIGHT AWAY. Treatment will be the same if the dentist sees them at midnight or in two days, and children are generally upset or in pain and won't let the dentist perform any treatment or even take a look in some cases. Who do I call? Your general dentist, or if your child is seeing a pediatric specialist, will be your best bet. Give your dentist a call and set up an appointment to see them soon. You definitely want someone to take a look at the area, likely take a radiograph (x-ray), and possibly recommend or perform treatment. If there are any teeth knocked out, or pieces broken, bring those with you to the appointment whenever possible. What do I do? That depends on what happened. Find your case below... If the tooth was hit and is Not Moving and often not missing any pieces: We call this concussion if the tooth was hit but is not moving, not out of position, and there's no bleeding. You should see your dentist who will likely take a radiograph for a baseline image and monitor the tooth. Future issues such as nerve damage or nerve death are possible and your dentist will know how to deal with these. We call this lateral luxation if the tooth was hit but is not mobile though it is out of position. You should see your dentist who will likely take a radiograph for a baseline image, closely monitor the tooth, and possibly recommend trying to move it back in position likely with anesthesia, allowing the tooth to naturally reposition, adjusting the bite, or extracting the baby tooth early...it all depends. Future issues such as nerve damage or death as well as infection are possible and your dentist will know how to deal with these. If the tooth was hit and Is Moving and often not missing any pieces: We call this subluxation if the tooth was hit and is moving, possibly with bleeding. You should see your dentist who will likely take a radiograph for a baseline image and monitor the tooth. Future issues such as nerve damage or death are possible and your dentist will know how to deal with these. We call this root fracture if the tooth was hit and it looks like the tooth is moving. This time, though, it's moving because the root is fractured. You should see your dentist who will likely take a radiograph and likely recommend repositioning and splinting for a few weeks followed by close monitoring. Future issues such as nerve damage or death as well as infection are possible and your dentist will know how to deal with these. We call this alveolar fracture if the tooth was hit and it looks like the tooth and the bone around it are moving. This time, though, it's moving because the jaw bone is fractured. You should see your dentist who will likely take a radiograph and likely recommend repositioning and splinting for a few weeks followed by close monitoring. Future issues such as nerve damage or death as well as infection are possible and your dentist will know how to deal with these. If the tooth was hit and is Knocked In or Out of the Gum: We call this extrusion if the tooth was hit and is moving out of position and it looks like the tooth is going to fall out. You should see your dentist who will likely take a radiograph for a baseline image, closely monitor the tooth, and possibly recommend trying to move it back in position, allowing the tooth to naturally reposition, or extracting the baby tooth early. Future issues such as nerve damage or death as well as infection are possible and your dentist will know how to deal with these. We call this intrusion if the tooth was hit and it looks like the tooth has moved into the bone. You should see your dentist who will likely take a radiograph for a baseline image and either recommend allowing the tooth to naturally reposition and closely monitoring or extracting the baby tooth early so as not to cause further damage to the adult tooth. Future issues such as nerve damage or death as well as infection are possible and your dentist will know how to deal with these. If the tooth was Knocked OUT: We call this avulsion if the tooth was hit and is knocked out of the mouth. You should see your dentist who may take a radiograph for a baseline image or to make sure the tooth isn't lodged in the bone (especially if you can't find the tooth) and likely recommend palliative care if needed and monitoring especially for any problems with the adult tooth. Future issues such as problems with the adult tooth are possible and your dentist will know how to deal with these. IT IS IMPORTANT TO NOTE THAT, UNLIKE IN AN ADULT TOOTH, YOU SHOULD NOT TRY TO REIMPLANT THE TOOTH IN THE MOUTH. A baby tooth that is knocked out should stay out. If the tooth is chipped or part of it is broken: We call this fracture if part of the tooth is missing. Whether it's a small chip or a big chip where the nerve is exposed, or the crown of the tooth is gone and the root is left, you should see your dentist. The larger the chip or fracture, the more urgent it is to see them right away. Your dentist may take a radiograph and then recommend treatment that can range from something as small as smoothing and monitoring the tooth to a filling or to something as major as a partial baby root canal and build-up to an extraction. It really depends on how big the chip is, what parts are broken, and if the nerve is involved. You'll want your dentist to check this out. IMPORTANT TO NOTE: Teeth that are chipped or broken can also have further root or bone issues, one issue noted above does not mean there aren't other issues as well. You should also keep an eye out for discoloration of the tooth which could mean nerve damage or death, as well as for an abscess (a "pimple" on the gums) by the traumatized tooth and let your doctor know right away if you notice these changes or your child complains of sensitivity or pain. You should also note that baby tooth trauma can sometimes affect the developing adult tooth underneath it, so other issues may be noticed when the adult tooth erupts. Adult (Permanent) Tooth: If you, or your child, are/is over the age of 5 or 6, there's a chance that the tooth that has been hit, broken, or fallen out is an adult tooth. Is it an emergency? Typically, with an adult tooth, minor trauma cases are not emergencies in the sense that you need to get in to see your dentist RIGHT AWAY. However, typically, timing is more important so you should schedule to see your dentist as soon as possible, even if that is in a day or two. Emergencies requiring treatment as soon as the trauma occurs include: a tooth that has been knocked out or a chipped tooth where the nerve is exposed - timing here is critical! Who do I call? Your general dentist will be your best bet. You definitely want someone to take a look at the area, likely take a radiograph (x-ray), and possibly recommend or perform treatment. If it is an emergency and you can't get a hold of your dentist quickly enough, call an office that is open or has an emergency line and go see them for your trauma care. Follow up with your dentist after. What do I do? That depends on what happened. Find your case below... IMPORTANT TO NOTE: In an adult, radiographs are generally always taken because, unlike some kids, you can sit still enough for them. They are important in making decisions long-term and determining if there have been any changes during follow-up appointments. If the tooth was hit and is Not Moving and often not missing any pieces: Concussion - similar to above. See your dentist within a few days to closely monitor. Lateral luxation - similar to above. See your dentist soon! See your dentist who will take a radiograph and likely recommend trying to move it back in position likely with anesthesia and stabilize with a flexible splint for a few weeks. If the tooth was hit and Is Moving and often not missing any pieces: Subluxation - similar to above. See your dentist who will take a radiograph and possibly recommend a flexible splint for a few weeks. Root fracture - similar to above. See your dentist soon! Repositioning and splinting for a few weeks to a few months is common. The options and prognoses of this fracture depend on where the fracture is on the root. Long-term this may mean root canal therapy or even extraction. Alveolar fracture - similar to above. See your dentist soon! Repositioning and splinting for a few weeks followed by close monitoring. Long-term this may mean root canal therapy or even extraction. If the tooth was hit and is Knocked In or Out of the Gum: Extrusion - same as above. You should see your dentist soon who will likely take a radiograph for a baseline image, reposition the tooth, and stabilize it with a flexible splint for a few weeks. Root canal treatment is often needed as is regular follow-up. Intrusion - same as above. Depending on the age of the patient's tooth, either passive eruption or orthodontic/surgical repositioning stabilized with a flexible splint are recommended. You should see your dentist soon. Root canal treatment is often needed as is regular follow-up.  If the tooth was Knocked OUT: Avulsion - same as above. THIS IS THE TRUEST DENTAL EMERGENCY. You should try to see your dentist - or any dentist available - WITHIN 60 MINUTES for the best long-term prognosis. If you really can't get to your dentist or an emergency dentist within an hour or two, if it's just not possible, be aware that your treatment plan may be different. Your treatment depends on when you are able to see the dentist and what your situation looks like. WHAT YOU CAN DO TO HELP YOUR TOOTH SURVIVE BEING KNOCKED OUT: IMPORTANT TO NOTE: avoid storing your tooth in water! If you can't find milk, saline, or Hank's Balanced Salt Solution, use your spit or store the tooth in your cheek until you can see your dentist. If the tooth is chipped or part of it is broken: Fracture - same as above. Whether it's a small chip or a big chip where the nerve is exposed, or the crown of the tooth is gone and the root is left, you should see your dentist. The larger the chip or fracture, the more urgent it is to see them right away. Your dentist will take a radiograph (maybe not if the chip is really small) and then recommend treatment that can range from something as small as smoothing and monitoring the tooth to a filling or to something as major as a root canal and build-up with a gingivectomy to surgical or orthodontic extrusion to an extraction. It really depends on how big the chip is, what parts are broken, and if the nerve is involved. You'll want your dentist to check this out. If your chip is relatively large in size, bring it to your dental appointment. Sometimes that piece can be reattached and often is the nicest looking option in terms of replacement. If you have any further questions, ask your family dentist, they are always happy to help - especially in cases of trauma! Stay safe out there! Dr. Stephanie Stephan DDS, Dentist in Auburn Hills and Rochester Hills, Michigan 1590 Baldwin Avenue, Auburn Hills, Michigan 48340 www.thehillsdentalstudio.com