My Blog

By Courtney Camp Highsmith, DMD
May 25, 2019
Category: Oral Health
AMinorProcedureCouldMakeBreastfeedingEasierforYouandYourBaby

The American Academy of Pediatrics and other healthcare organizations recommend breastfeeding as the best means for infant feeding. While bottle feeding can supply the nutrition necessary for a baby's healthy development, breastfeeding also provides emotional benefits for both baby and mother.

But there might be an obstacle in a baby's mouth that prevents them from getting a good seal on the mother's breast nipple—a small band of tissue called a frenum. This term describes any tissue that connects a soft part of the mouth like the upper lip or tongue to a more rigid structure like the gums or the floor of the mouth, respectively.

Although a normal part of anatomy, frenums that are too short, thick or inelastic can restrict a baby's lip or tongue movement and prevent an adequate seal while nursing. The baby may adjust by chewing rather than sucking on the nipple. Besides a painful experience for the mother, the baby may still not receive an adequate flow of breast milk.

Bottle-feeding is an option since it may be easier for a baby with abnormal frenums to negotiate during nursing. But the problem might also be alleviated with a minor surgical procedure to snip the frenum tissue and allow more freedom of movement.

Often performed in the office, we would first numb the frenum and surrounding area with a topical anesthetic, sometimes accompanied by injection into the frenum if it's abnormally thick. After the numbing takes effect, we gently expose the tissue and cut it with either surgical scissors or a laser, the latter of which may involve less bleeding and discomfort. The baby should be able to nurse right away.

If you wait later to undergo the procedure, the baby may already have developed compensation habits while nursing. It may then be necessary for a lactation consultant to help you and your baby "re-learn" normal nursing behavior. It's much easier, therefore, to attempt this procedure earlier rather than later to avoid extensive re-training.

While there's little risk, frenum procedures are still minor surgery. You should, therefore, discuss your options completely with your dental provider. Treating an abnormal frenum, though, could be the best way to realize the full benefits of breastfeeding.

If you would like more information on treating tongue or lip ties, please contact us or schedule an appointment for a consultation.

By Courtney Camp Highsmith, DMD
May 15, 2019
Category: Oral Health
HowtoProtectYourChildsMouthfromaSportsInjury

As spring weather heats up, so do a lot of outdoor sports like baseball or soccer. Unfortunately, the chances of sports-related injuries increase as well. Your child’s mouth in particular is a prime target for injury—and you need to be prepared.

First and foremost, players should wear a mouthguard during contact sports to reduce their risk of injury. Mouthguards can absorb much of the force generated during impact—and may make the difference between minor bruising and a fractured or knocked-out tooth.

“Boil and bite” mouthguards available from the local pharmacy or sporting goods store are popular because of their cost and availability. These are softened in hot water before the wearer bites down to create a semi-customized fit. An even better option, though, is a custom mouthguard that is made from a precise impression of your child’s teeth that we take in our office. This type of mouthguard costs more, but it provides greater protection and comfort than one from your corner store.

A mouthguard can significantly reduce the risk of injury but won’t eliminate it entirely. If a dental injury does occur, you need to know what to do. This will depend mainly on the type of injury: If the tooth is chipped but not pushed out of position, you can collect any tooth fragments and see us within 12 hours for an examination and possible repairs. If the tooth has moved or is loose, you should see us even sooner—within 6 hours so we can readjust the tooth and, if needed, splint it until it is securely reattached.

A more serious injury is a tooth that has been knocked completely out of its socket. It can often be saved, but you’ll need to act quickly—optimally, within 5 minutes—by reinserting the tooth in its socket. Although it sounds daunting, it’s really a matter of a few simple steps: First, find the tooth and rinse off any debris with clean water. Holding it by the crown (the visible part you are used to seeing) insert the root end into the empty socket. If your placement isn’t “just right,” don’t worry; we can adjust it later, but it will require some pressure to place it in the socket. Have the person bite down on a piece of gauze or clean cloth to hold the tooth in place. Call us immediately. If you cannot reach us, go to an emergency room.

Quick action and prompt follow-up dental care after a mouth injury increase the chance of a happy outcome. Along with proper mouthguard protection, remembering these pointers will help ensure that your family has an enjoyable sports season this year!

If you would like more information about sports-related dental injuries, please contact us or schedule an appointment for a consultation. To learn more, read the Dear Doctor magazine articles “Athletic Mouthguards” and “The Field-Side Guide to Dental Injuries.”

By Courtney Camp Highsmith, DMD
May 05, 2019
Category: Dental Procedures
Tags: pain management  
YouMayNotNeedaNarcotictoManagePost-DentalWorkPain

There's no doubt treating dental problems can improve your health. But because the mouth is among the most sensitive areas of the body, many dental procedures can be potentially uncomfortable after treatment.

We rely on pain medication to alleviate any dental work discomfort, especially during recuperation. Our arsenal of pain-relieving drugs includes strong opioid narcotics like morphine or oxycodone which have effectively relieved dental pain for decades. But although they work wonders, they're also highly addictive.

We've all been confronted in the last few years with startling headlines about the opioid addiction epidemic sweeping across the country. Annual deaths resulting from opioid addiction number in the tens of thousands, ahead of motor vehicle accident fatalities. Although illegal drugs like heroin account for some, the source for most addiction cases—an estimated 2 million in 2015 alone—is opioid prescriptions.

Dentists and other healthcare providers are seeking ways to address this problem. One way is to re-examine the use of opioids for pain management and to find alternative means that might reduce the number of narcotic prescriptions.

This has led to new approaches in dentistry regarding pain relief. In a trend that's been underway for several years, we've found managing post-discomfort for many procedures can be done effectively with non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin, acetaminophen or ibuprofen. They don't share the addictive quality of narcotics and are regarded as safer when taken as directed.

There's also been a recent modification with using NSAIDs. Dentists have found that alternating the use of ibuprofen and acetaminophen often amplifies the pain relief found using only one at a time. By doing so, we may further reduce the need for narcotics for more procedures.

The trend now in dentistry is to look first to NSAIDs to manage pain and discomfort after dental work. Narcotics may still be used, but only in a secondary role when absolutely needed. With less narcotic prescriptions thanks to these new pain management protocols, we can reduce the risk of a dangerous addiction.

If you would like more information on managing pain during and after dental work, please contact us or schedule an appointment for a consultation.

By Courtney Camp Highsmith, DMD
April 25, 2019
Category: Dental Procedures
CrazyLittleThingCalledHyperdontia

The movie Bohemian Rhapsody celebrates the iconic rock band Queen and its legendary lead vocalist, Freddie Mercury. But when we see pictures of the flamboyant singer, many fans both old and new may wonder—what made Freddie’s toothy smile look the way it did? Here’s the answer: The singer was born with four extra teeth at the back of his mouth, which caused his front teeth to be pushed forward, giving him a noticeable overbite.

The presence of extra teeth—more than 20 primary (baby) teeth or 32 adult teeth—is a relatively rare condition called hyperdontia. Sometimes this condition causes no trouble, and an extra tooth (or two) isn’t even recognized until the person has an oral examination. In other situations, hyperdontia can create problems in the mouth such as crowding, malocclusion (bad bite) and periodontal disease. That’s when treatment may be recommended.

Exactly what kind of treatment is needed? There’s a different answer for each individual, but in many cases the problem can be successfully resolved with tooth extraction (removal) and orthodontic treatment (such as braces). Some people may be concerned about having teeth removed, whether it’s for this problem or another issue. But in skilled hands, this procedure is routine and relatively painless.

Teeth aren’t set rigidly in the jawbone like posts in cement—they are actually held in place dynamically by a fibrous membrane called the periodontal ligament. With careful manipulation of the tooth, these fibers can be dislodged and the tooth can be easily extracted. Of course, you won’t feel this happening because extraction is done under anesthesia (often via a numbing shot). In addition, you may be given a sedative or anti-anxiety medication to help you relax during the procedure.

After extraction, some bone grafting material may be placed in the tooth socket and gauze may be applied to control bleeding; sutures (stitches) are sometimes used as well. You’ll receive instructions on medication and post-extraction care before you go home. While you will probably feel discomfort in the area right after the procedure, in a week or so the healing process will be well underway.

Sometimes, dental problems like hyperdontia need immediate treatment because they can negatively affect your overall health; at other times, the issue may be mainly cosmetic. Freddie Mercury declined treatment because he was afraid dental work might interfere with his vocal range. But the decision to change the way your smile looks is up to you; after an examination, we can help you determine what treatment options are appropriate for your own situation.

If you have questions about tooth extraction or orthodontics, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Simple Tooth Extraction” and “The Magic of Orthodontics.”

By Courtney Camp Highsmith, DMD
April 15, 2019
Category: Dental Procedures
Tags: root resorption  
CatchRootResorptionEarlyforBestChancesofSavingYourTooth

As your dental provider, we're always alert for signs of tooth decay or periodontal (gum) disease, the two leading causes of tooth loss. But we're also watching for less common conditions that could be just as devastating.

Root resorption falls into this latter category: it occurs when a tooth's root structure begins to break down and dissolve (or resorb).  It's a normal process in primary ("baby") teeth to allow them to loosen and give way when permanent teeth are ready to erupt.

It's not normal, though, for permanent teeth. Something internally or—more commonly—externally causes the root structure to break down. External resorption usually occurs at the neck-like or cervical area of a tooth around the gum line. Known as external cervical resorption (ECR), it can first appear as small, pinkish spots on the enamel. These spots contain abnormal cells that cause the actual damage to the root.

We don't fully understand how root resorption occurs, but we have identified certain factors that favor its development. For example, it may develop if a person has experienced too much force against the teeth during orthodontic treatment. Injury to the periodontal ligaments, teeth-grinding habits or some dental procedures like internal bleaching may also contribute to later root resorption.

Early diagnosis is a major part of effective treatment for root resorption. Because it's usually painless and easily overlooked, resorption is often too difficult to detect in its early stages without x-rays—a good reason for regular dental exams. Beginning spots or lesions are usually small enough to surgically remove the tissue cells causing the damage and then filled with a tooth-colored filling material. If it has advanced further, we may also need to perform a root canal treatment.

At some point, the damage from root resorption can be too great, in which case it might be best to remove the tooth and replace it with a dental implant or similar restoration. That's why catching root resorption early through regular dental exams can give you the edge for saving your tooth.

If you would like more information on diagnosing and treating root resorption, 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 “Root Resorption: An Unusual Phenomenon.”





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