At Life Saver Pool Fence, we always aim to help protect children from harm. Our Child Safety Source series typically sits down to interview pool safety experts. Today, we’re doing something a little bit different. Let’s take a quick step away from the water to discuss oral hygiene with dental hygienist, Jessica Cooper.
For a change of pace, this episode will include both an interview and some live demonstrations. As always, our own Eric Lupton is pleased to join Jessica Cooper for an in-depth conversation about her particular area of expertise. Additionally, viewers will learn an awesome new technique to brush and floss a toddler’s teeth. Along the way, Jessica Cooper will be answering all of our viewers questions.
This was a lot of fun and we’re glad that Jessica took the time to join us. You can watch Eric and Jessica’s conversation for Child Safety Source right here:
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Below is a direct transcript of the Child Safety Source interview with Jessica Cooper on August 15th, 2018:
Dad: So, she’s going to teach us how to brush their teeth. Do you brush your teeth right know? How do you do it? How do you do it?
Jessica Cooper: Okay. So, sweetie, remember I showed you this is a brand new toothbrush I got for you? Do you want to hold that? Can you hold it for me? Alright, turn around and give daddy a big, big, hug.
Dad: Sit with me.
Jessica: So, daddy we’re going to do this just like I’ve met you for the first time, we’ve not rehearsed.
Dad: Alright.
Jessica: She wraps her legs around your waist.
Dad: Okay, like that.
Jessica: And then, you put your knees together and give her a nice platform. And we, you and I are knee to knee.
Dad: Okay.
Jessica: And then, Eden, lay your head back.
Dad: Lay back. Here I got you.
Jessica: Woo, very nice. So, Eden is two and a half years old, which should mean that she has all of her primary teeth. And what I’m going to do is go ahead and do the brushing first, in case Eden loses interest. So, one thing you want to do is give your child your undivided attention.
Dad: Sure.
Jessica: Okay, sweetie pie. So, we’re going to tickle your teeth today. And she’s a good patient.
Dad: She’s doing so good, you’re doing very good.
Jessica: So, daddy, hold hands. Eden, hold hands with daddy. Now, say cheese. Oh, my gosh, these teeth are so pretty. So, very light grasps on the tooth brush, so you can control and very gentle strokes; were just removing soft plaque and soft saliva and bacteria from the gum line and brushing their teeth, stimulating circulation and getting them shiny clean. Open big, let’s get the back ones. Ahhh! Now, I am very lucky, because Eden is a super, super, good patient. But if a child didn’t really want to do this, it’s a wonderful comfortable position. And I want to encourage all patients…parents rather to take the tooth brushing out of the bathroom and into the family room.
Dad: Got you… well, that’s good.
Jessica: Doing this on the couch, doing this with Mom and Dad and giving that child your undivided attention, it feels so good and it’s so much nicer than standing in the bathroom. You can also do it in the shower and do it in the bathtub, that all works good too. But standing in the bathroom when it’s hot and the bright lights is not as comfortable. Does that feel good? It does. Give daddy a big hug.
Dad: Good job dude.
Jessica: Okay.
Dad: Okay.
Jessica: That was good, right? Super soft toothbrush, super tiny strokes in this lap to tap position. So, let’s try my special flosser.
Dad: She has a flosser, just like what we have at the house.
Jessica: I’m very, very, lucky today that we have Eden, who it is an excellent helper.
Dad: Well, we floss.
Jessica: She knows this then?
Dad: She knows how to floss, yes.
Jessica: So, being that Eden is two and a half years old, she has all of her primary dentition. Open big, let’s see the back, back. Yeah. Ooh, has she been to do the dentist?
Dad: No, she has not.
Jessica: Okay. So, we’re looking for any discoloration, redness in the gums, white spots on the teeth, all of these may be signs… open big, let’s do the back, back…. that there’s some cavities starting. When Eden reaches age four, the dentist will want to take about one X-ray on each side of her mouth to examine in between the teeth where we can’t see with our eyes to make sure that the teeth are strong. We can also use our string.
Dad: Wait, she’s got to [crosstalk]…
Jessica: … get a hug. Notice how she just gets up on her own when she wants a break, she gets a hug, she gets a pat on the back and now, we get to use the silly string.
Dad: That’s regular floss, want to try it?
Jessica: So, again, what’s great about this position is, dad has a lot of control, child is extremely comfortable, you can see much better than if she were standing up. She’s a little person, I’m not so little anymore, so how would I be able to see real well. Usually in the family room, you’ve got an extra lamp next to the couch. When she’s a little older, she could lay down on the couch, put her head in your lap, the same size that you would sit to read or watch TV.
Dad: Yeah, that’s cool.
Jessica: So, Eden, want to do the top teeth?
Dad: Want to do the top?
Jessica: Okay, let’s do it.
Dad: Let’s do the top and then we’re done.
Jessica: Such a great patient.
Dad: Good job man.
Jessica: You must have a really, really, special grandpa.
Dad: Mhmm.
Jessica: I know he loves you.
Dad: Grandpa is watching.
Jessica: He is, he’s my friend. Okay love. Let’s see your tongue, can I see your tongue? Oh.
Dad: Lay back down, lay back down.
Jessica: Lay back down so I can see real good. Let’s open, ahhh! Ahhh! And check the roof of the mouth, ooh she’s almost upside down. Your tongue is perfect. Good job.
Dad: Alright, you do it.
Jessica: So that’s the lap to lap position for pediatric home care; definitely take the brushing out of the bathroom and take it into the family room.
Interviewer: Awesome. Any other thing you want to tell people?
Jessica: Well. There’s some rules of thumb for a child’s health. First dental visit is actually written to be at first tooth. Most of that is education for the parents to make sure that we just prevent dental
health problems and just check development. She’s two and a half years old, so with the full dentition you would definitely want her to be seeing the dentist every six months. They’re examining now for decay, there are examining for gingivitis and redness, examining for proper home care. We will be applying fluoride in the office to prevent decay and strengthen the teeth. Like I said, at age four, she would start having a checkup X-rays. And that is a ballpark, it depends on the developmental age of the child. So, if I had a very, very, tiny four year old who was very timid in the chair, we might try to wait six months for the X-ray exam. All of this is done by the dentist with the hygienist. There is a fabulous pediatric dentist in Delray Beach that I would highly recommend. That’s okay?
Interviewer: Yeah, go ahead.
Jessica: Okay, Dr. Young, who’s right downtown with a beautiful brand new office. I’ve worked with Dr. Young with some charity events and she was great to work with and the patients and the staff love her. So, if you have any questions at all about where to start, that might be a good place. Even if you don’t live in Delray Beach, I’m sure that they could make a recommendation for someone in your area.
Interviewer: So, my mom was never worried about my temporary teeth, birth because my baby teeth were going to fall out anyways. So, we were never big on brushing before the permanent teeth came in. I’m sure that was terrible advice, right?
Jessica: Well, it’s actually a really good point to you make and I’m trying very hard to train myself not to call the baby, baby teeth, but rather to call them primary teeth because they really are our first teeth. And you’ll see twelve and fourteen year olds that still have them and they’re certainly not babies anymore.
Interviewer: Sure.
Jessica: One of the main reasons that we want to preserve the health of the primary teeth, is because child dental disease is one of the leading causes of illness and missing school for kids.
Interviewer: Really?
Jessica: Yes, it’s actually one of the chief reasons that kids will miss school.
Interviewer: I didn’t know that.
Jessica: So, it is painful, it is upsetting, it’s difficult for the child to recover from a dental experience that was dental treatment. I mean, I remember the first time I got an injection to be numb and I cried and I was a sophomore in college. So, it’s not easy for a young person.
Interviewer: I still cry every time. Yeah, yesterday.
Jessica: Those are tears of joy.
Interviewer: Right, right, yeah.
Jessica: But the other reason to preserve the primary dentition, is of course for eating, for proper speech development and social reasons. I mean, even a young child who’s missing their front teeth or missing back teeth, they have other complications. These teeth also preserved the space for the developing permanent teeth that are going to erupt in that position. So, it’s a little bit unfortunate maybe, that our physiology has our permanent teeth developing behind or more posterior to our primary teeth. We’re going to get those six year molars that are permanent teeth before we’re going to use lose the primary molars. So, if they lose, what we don’t want to call baby teeth anymore, this six year molar can migrate forward into space and then block out the permanent teeth. So, you’re looking at a lot of complications.
So, chewing, talking, smiling are super important but preserving the primary dentition to hold space for the developing permanent teeth is super important.
Interviewer: Nice. Any other urban legends myth, or misconceptions?
Jessica: Urban legends myths
Interviewer: Like that one that we don’t have to care about primary teeth?
Jessica: I don’t personally believe that pregnancy causes tooth loss.
Interviewer: Do people think that?
Jessica: That’s an urban myth; I lost one tooth with every baby. You’ll hear things like that or the baby stole all of the calcium out of my teeth. I personally believe that some of these dental problems that young…
Interviewer: I would imagine that pregnant moms are just distracted by being pregnant and aren’t taking care of their teeth as well.
Jessica: Very good point. I think that they are snacking because of nausea. I think that they’re not maybe able to care for themselves as well during pregnancy.
Interviewer: Morning sickness?
Jessica: Morning sickness…
Interviewer: It’s probably isn’t good for teeth.
Jessica: … when the baby is first born and they’re twenty- four- seven on the baby schedule. I also think that some of the dental problems were starting already in their late teens, early twenty’s and by the time they started having babies, and they had matured enough to cause problems.
Interviewer: Sure, it make sense.
Jessica: So, it’s just chronologically coincidental, but not really a causative relationship.
Interviewer: Cool. Anything else about kids you want to talk about?
Jessica: I do want to talk about fluoride. I definitely believe that fluoride in proper concentrations and proper delivery, helps the health of the teeth. I know that there’s a lot of people that don’t want to give these chemicals to their children and I totally get that as well. And it’s just like a lot of other things that we do in life; it’s a proper balance and a proper application. Children that have fluoride treatments have less decay. So, we’re not talking about doing prescription strength fluoride every single day, but the other twice a year properly applied in scan amounts; the treatment that I would do for a child Eden size would be a quarter of a milliliter on her teeth, once every six months.
Interviewer: So, barely anything.
Jessica: So, barely anything. And it’s five percent of five thousand parts per million; I mean, what would that be?
Interviewer: .0005…
Jessica: .0005
Interviewer: Yeah.
Jessica: … concentrations, so it’s a very trace amounts, but it’s very helpful.
Interviewer: And what does that do?
Jessica: It re-mineralizes any decalcifications and strengthens the existing enamel.
Interviewer: Got you.
Jessica: One more thing, is that I’m definitely a firm believer in sealant applied. So, sealants are a resin coating…
Interviewer: I think I had that when I was a kid.
Jessica: And you probably did, because you’re a younger person; they were really just kind of being done more regularly in the seventies when I was growing up. Absolutely prevents decay when properly applied in the right timing. So, you want to start looking at around age six for the permanent molars to be erupting in the mouth. Some six year olds can tolerate sealants, some you might wait till they’re seven or eight or nine years old and apply them properly before any staining, before any breakdown of the enamel on a very clean, healthy tooth.
Interviewer: And is there any risk of like a cavity getting caught under that sealant and then it…?
Jessica: Yes, that can happen, that certainly can happen. I still find that in a lot of the places where
I’ve worked, especially when children are at a greater risk for decay, due to maybe less access to care, they’re still applying sealants and sometimes there’s some believe that it can arrest early decay. The ideal thing is taking those children to the dentist when the teeth are erupting and finding that exact right interval to do the sealant properly. Sealants best applied in a dental office of course with two operators, because the tooth has to stay completely dry, there are some sealants now that can be done in a wet environment and that’s a good improvement.
As far as dental and preventive health, fluoride water… so, we talk a lot about fluoridated water for children.
Interviewer: Sure.
Jessica: We are talking about four to six ounces a day of fluoridated water…
Interviewer: Is that like the squish ice you get in school.
Jessica: No, that was a fluoride treatment. So, that was probably a five thousand parts per million liquid.
Interviewer: Got you.
Jessica: Nice, that’s all we had back then, but certainly not as effective as some of the creams and varnishes that we have now.
Interviewer: In the dark ages of ‘1987’ or whatever?
Jessica: Right, in the ‘80s’, when you were young.
Interviewer: [laughing]…. Yes.
Jessica: We had the same thing in the ‘70s’ when I was in elementary school, we were all brought down to the cafeteria and we were asked to swish for a minute and spit out in the garbage can; it was great fun way to get out of class.
Interviewer: Yeah.
Jessica: We’re not really showing now that the liquids and the gels and the foams have enough staying power. They don’t stay on the tooth long enough to be super effective. So, you’re going to find when you visit the dentist that they’re going to be using a sticky formula, we call it a varnish. And that allows the fluoride to have contact time with the tooth, it’s thousands of percentage points more effective. But fluoridated water, so your filtration system in your refrigerator does not remove fluoride.
Interviewer: Oh, cool.
Jessica: Alright, which is a good thing for a dental professional, but those parents that don’t want their children to have that, they would want to have a special filter to remove that fluoride. Four to six ounces a day of optimally fluoridated water for ideal to development; so, tooth development. Florida water is swallowed, it only treats the teeth that we don’t have yet. Okay, it treats the developing teeth systemically.
Interviewer: Got you.
Jessica: So, it’s not going to help my teeth or your teeth, it’s not even going to help Eden’s teeth. It’s going to help her developing teeth.
Interviewer: Interesting.
Jessica: So, up to the age of….
Interviewer: Because it goes into the system and…
Jessica: Fed through the bloodstream.
Interviewer: Got you. Okay.
Jessica: The teeth come in stronger and more resistant to decay.
Interviewer: Wow.
Jessica: So, four to six ounces a day from childhood till maybe thirteen years old, depending on your child’s physiologic development. So, when you talk about birthdays and ages, but it’s really more about your physiologic development, rather than your birthday.
Interviewer: Right. I had no idea, that’s [inaudible 00:14:45].
Jessica: If they’re getting water at school or water at the ballpark or water from a water fountain, they might be getting into a fluoridated water and you don’t really have to worry about getting more. You can buy exactly the right water that you want for your child. So, when you’re talking about an infant who is receiving nutrition from formula, you don’t want to use fluoridated water, because all they’re getting is nutrition from their water and it might be more than they need. So, you’re going to buy nursery water, which is non fluoridated water from the grocery store.
Interviewer: Okay.
Jessica: Alright? After that, if you don’t want your child to drink city water, but you do want them to have fluoridated water, you’re going to buy optimally fluoridated water from the grocery store and you’re going to give them, four to six ounces a day of that water.
Interviewer: That’s really cool.
Jessica: Yeah.
Interviewer: So, I notice you didn’t used toothpaste with Eden today, what’s your…. What do you do about toothpaste at a young age?
Jessica: I think that the thing we want to make sure of with children, and that’s a super good question and I would have never remembered to bring that up. So, thank you for that.
Interviewer: That’s what I’m here for.
Jessica: So, the one thing about toothpaste, is we don’t want to use our toothpaste on our children.
Interviewer: Okay.
Jessica: It’s too spicy, they’re going to say spicy, they’re going to say hot, they’re not going to want that in their mouth, it’s too strong for them. But specifically, fluoride toothpaste. Children should start fluoridated toothpaste at age two, even if they don’t spit very well, okay. So, you’re using such as scamp amount on the tooth brush that the benefit to their teeth of using the fluoridated toothpaste far outweighs the risk of them swallowing that toothpaste.
So, why do I even bring it up? Swallowing toothpaste; toothpaste itself is much stronger than fluoridated water and if a child swallows an excessive amount of toothpaste over a period of time, it can negatively impact their developing teeth.
Interviewer: Okay.
Jessica: We don’t want them swallowing toothpaste.
Interviewer: So, if they overdose on fluoride or whatever the minerals/ chemicals are, it goes the other direction?
Jessica: Yeah, I don’t like to use the word “overdose”, but there is a therapeutic effect to ingesting fluoride and then there’s a tipping point at where they may be getting too much. So, we want our child to spit out; but at age two, we want to start using fluoridated toothpaste, even if they’re not trained yet to completely spit. So, in order to do that in the safest way, so that it’s safe and beneficial for the teeth, but we’re not putting the child at risk for excessive fluoride ingestion, we’re going to use a tiny, tiny, trace amount….
Interviewer: I’ve heard people say like the size of a pea, is that right?
Jessica: I think that’s too much. I’m talking about a little smear, a little wipe. And I like to think about putting it down into the bristles a little bit. Because I don’t want that pea to sit on top of the toothbrush and kind of fall off and be swallowed all at one time. So, we’re talking about a little smear….
Interviewer: And then rub it in.
Jessica: And then, I like to think about putting it down into the bristles of the toothbrush.
Interviewer: Like smearing butter on bread.
Jessica: Exactly, exactly. And you’re going to use a child’s toothpaste, so child’s flavor. Prior to age two years old, they have what they refer to sometimes as training toothpastes and these are soft flavors without fluoride.
Interviewer: Okay. And it is literally just to get kids used to toothpaste?
Jessica: It’s literally just to get kids used to toothpaste. Studies show that there’s really no great benefit to toothpaste. It tastes good, it feels soapy, we feel clean and it provides fluoride.
Interviewer: It’s more work, so we feel like we’re getting a better effect?
Jessica: We don’t need it to clean our teeth. We actually don’t need to use to paste to clean the teeth, it’s the mechanical action or what I call mechanical action, but the physical scrubbing of the tooth brush that cleans the teeth, it’s not the toothpaste.
Interviewer: Not the soap, we’ll call it.
Jessica: No. the toothpaste is nice and we like it, there may be other benefits and other ingredients for us adults; desensitizing, the fluoride, the mouthwash flavors and all that stuff that we like. But for children, you want to use non-fluoridated toothpaste up until age two, child’s training toothpaste; after age two, you want to use a child’s appropriate flavor. They have strawberry, they have bubble gum, anything stronger than that, probably most children would consider it hot or spicy. They’re not going to let you brush very long, so you’re going to defeat the purpose but you do want to add fluoride.
Interviewer: The toothpaste making us feel like we’re doing a good job, reminds me of when they started putting… when you needed an egg to do a brownie or cake mix. You know that story?
Jessica: You’ve told me, but I’m happy to hear it again.
Interviewer: Yeah, it started with the cake mix is just water, but people thought it was too easy. So, a self-respecting mom would make cake or brownies where you could just add water and it made a brownie. So, they changed the recipe up, and added a step; we had to crack an egg and put an egg I there. And because it was more work…
Jessica: And more fun….
Interviewer: And more fun, it felt like you were cooking because you had to break an egg open. Those things sold like hot cakes. Pun intended… as opposed to the other was that didn’t.
Jessica: Didn’t really need to be there, but we like it.
Interviewer: Yeah, it feels like you’re cooking it’s more work.
Jessica: Very much like toothpaste, doesn’t really need to be there, but we like it.
Interviewer: Yeah, exactly.
Jessica: Can we switch gears?
Interviewer: Of course.
Jessica: Alright. So, I know Eric your business is pool safety and pool fence.
Interviewer: And child safety in general. Yep.
Jessica: And child safety in general. So, one of the things I really want to bring up, which I’m sure you’re as much or more of an expert on… as I am, is pool safety and dental safety around the pool.
Interviewer: Okay.
Jessica: So, one of the main reasons a child will lose a tooth early, is because the tooth gets knocked out.
Interviewer: Okay.
Jessica: So, we can talk about what to do when the tooth is knocked out. And what to do when the tooth is bump. And what to do when the tooth is chipped. Okay, so where you want to start.
Interviewer: Wherever you want.
Jessica: Well, we can start with the easiest, the most likely thing is the bump.
Interviewer: Okay.
Jessica: Alright, so a child bumping their baby tooth is super, super, common. It can be super scary for the child, it can be uncomfortable and scary for the parents. We do want to have a dental exam, even if it’s a young infant up to whatever age that tooth is bumped. The dentist will want to take an X-ray.
Interviewer: How do you define a bump? Just literally fell down and hit their tooth?
Jessica: Fell down and hit the coffee table, hit the floor, hit the side of the pool…
Interviewer: And everything looks okay.
Jessica: And cry. Everything can look okay, you could see bleeding at the gum line, you might suspect a tiny chip. Sometimes tiny chips of the edge of the enamel is something we can live with, we don’t need to treat. My experience with an excellent pediatric dentist that I worked with in North Carolina, Dr. Michael [Anglesey]. We really don’t want to be doing a lot of dental treatment on very young children. It’s hard for everyone, it’s especially hard for the parents. But we want to also make sure that if there’s pathology or dental infection going on, that we’re treating that as early as possible. So, it’s always a balance with what’s more likely to cause the child pain or danger.
So, bump the tooth, see the dentist, they’re going to take an X-ray. They’re looking for root fracture up under the gun line, they’re looking for the tooth to have been displaced into a position where it needs to be digitally wiggled back in place, so the child can close their mouth comfortably. I’ve seen this done, the child cries for a minute or two and it’s over and it’s fine.
Interviewer: They’re looking for trauma to the tooth, which causes the nerve to be damaged. We do baby tooth root canals; they’re not like the root canals that you and I would have, but they need to be done on certain patients when we see abscess. That tooth needs to be examined at the time of the accident, usually it’s one month, six months and one year. What should the parents look for in between the dental visit? They’re looking for, I think it’s four, a list of four changing color to the tooth. Doesn’t necessarily mean that the tooth is dying and needs to be treated, sometimes it’s actually a healing response. But a pink, or a brown, or a gray; we’re going to look for a color change.
We’re going to look for the child to become sensitive. You hand the child a Popsicle, they cry and make a face and hand it back to you. Okay, so we’re looking for increased sensitivity to the tooth. We might be looking for a blister or a bubble or a pimple on the gum line. That indicates that there’s an abscess draining there. And the fourth thing, my guess would be redness around the gums. I’m trying to remember the list of four.
So, parents are going to be watching for signs and symptoms. Signs being something that we can observe, symptoms being something the patient reports. “Mommy that hurts my tooth”. We’re going to go back to the dentist at one month, six months and one year and the dentist will assess the frequency of whether they need to take a dental X-ray, watching for the tooth to be changing.
Interviewer: So, that’s a bump, what about a chip?
Jessica: That’s a bump. A chip, again….
Interviewer: Probably a lot of the same…
Jessica: A chip can be something we can live with, it’s certainly the same protocol. Go to the dentist as soon as you can, have a dental X-ray. The chip we’re talking about now, is like if a visible portion of the tooth is broken off. Sometimes that needs to be sealed, sometimes that needs to be restored. Sometimes if dramatic enough on a primary tooth, it might need to be extracted.
Permanent tooth might be somewhat different. We would like to try to possibly re bond that portion; I’ve seen that done. We want to maybe preserve that permanent tooth. We can switch gears to permanent tooth in a moment. Baby tooth being knocked out is not replaced into the mouth, but sometimes it just makes your child look a little bit older. If they’re missing a tooth and they’re six, they might look more like they’re seven and half.
Interviewer: Got you.
Jessica: I have cases in pediatric dentistry, where a child lost their anterior teeth…
Interviewer: Is she leaving?
Jessica: Bye Eden.
Interviewer: Good bye Eden.
Interviewer: Later guys.
Dad: Bye, see you later. Thank you.
Jessica: They do do cemented baby partials, little bridges that go in. This is usually done more because the parents want that.
Interviewer: Right. Just for aesthetics.
Jessica: Children actually do quite fine when they lose a tooth, they do okay. It’s not as common for a back tooth to be knocked out, but if a back tooth is lost, you do want to see the dentist to assess whether or not a space maintainer needs to be done. Again, this has a lot to do with developmental age of the child. But we can switch gears and talk about permanent tooth.
Interviewer: Okay. Are we still talking about chipped? Because we did bumped [crosstalk]….
Jessica: Chipped or broken, may need to be treated.
Interviewer: What about knockout? We’ll do that first.
Jessica: Baby tooth knocked out, is generally not replaced. Let’s take the child to the dentist, we’re going to do palliative care, which is get the child comfortable, make sure that the entirety of the tooth has the lost.
Interviewer: Right, because you could have it like snap off at the base kind of deal?
Jessica: You could have that. You could have a fragment of the root still in place. You could have fracture to the adjacent teeth. So, we might knock out one tooth and have fractured another. So, it’s a dental visit and it’s an X-ray. But that baby tooth is not re-implanted.
Interviewer: Got you.
Jessica: Okay.
Interviewer: Do they put a spacer in sometimes, maybe?
Jessica: For the front that’s not usually done, in the back it would be [inaudible]. It’s a little complicated too if the child loses and usually not knocked out, but might lose a back tooth early. If there’s not a tooth to use for a space maintainer, but this is why you visit the pediatric dentist.
Interviewer: Got you.
Jessica: So, the bigger problem: if we knock out a permanent tooth. So, now we’re talking about a seven year old, an eight year old who has their two front teeth, their Christmas teeth or the laterals and they’ve…
Interviewer: What are the Christmas teeth?
Jessica: All I want for Christmas is my two front teeth.
Interviewer: Okay, yeah, I’ve never heard that.
Jessica: That was their Christmas teeth.
Interviewer: That’s funny.
Jessica: So, I saw a patient just yesterday who spent all day, the day before at the skateboard park but then broke his front tooth and intruded it in a simple like at home playing around with my friends- accident. So, this can happen. When we knock out a tooth in its entirety; so, the tooth is displaced… let’s start with the tooth is displaced, it’s not in the right position. If you can grab the tooth and wiggle it back into the proper position, do that, do that as quickly as you can. If you can’t, get the patient to the dentist as quickly as you can. At this point, we’re not saying look in the Yellow Pages and establish with the new pediatric dentist for your ongoing continuing care, we’re talking about get that patient to the nearest dentist that can see them within thirty minutes.
Interviewer: Wow. Okay.
Jessica: Yeah. Let’s say the tooth is I your hand or on the ground or in your patients hand. The tooth is gently washed off, it is not scrubbed.
Interviewer: Just rinse it off.
Jessica: You don’t want to scrub the exterior of the tooth and the cells that are on the outside of that room. Rinse it off gently in water, stick it back in. stick the tooth back in. So, you’re re-implanting that tooth into its socket as quickly as you can.
Interviewer: Right on.
Jessica: Sometimes we don’t want to do this, we can’t do this, we have a crying child, we don’t know what to do. Next best thing: put that tooth into the child’s mouth, just between the tooth and gum if you can. So, it’s the right temperature and it’s the right environment and it’s going to keep the tooth hydrated and it’s in their own saliva.
Interviewer: Much like chipmunk it back in…
Jessica: Chipmunk it back into the child’s mouth. Child’s hysterical, doesn’t want to do that, can’t do that, don’t feel comfortable doing that. In the mother’s mouth.
Interviewer: Okay.
Jessica: Don’t feel comfortable, don’t want to do that that sounds disgusting, I can’t do that, I’m crying too. In a glass of milk.
Interviewer: Okay. Why milk?
Jessica: I don’t know why, probably proper ph.
Interviewer: Calcium the whole thing?
Jessica: My guess would be proper ph.
Interviewer: Okay.
Jessica: That’s a good question. I’m probably right that it’s proper ph. but we can look it up.
Interviewer: It white like a tooth, I don’t know.
Jessica: I don’t…
Interviewer: It feels right.
Jessica: And rush that tooth and the patient directly to the dentist for re-implantation. We don’t have to go into great detail about what the dentist will do, but the tooth is stabilized.
Interviewer: I would never thought to put it back in or definitely not to chipmunk it. That’s kind of cool. Right, just jam it in there?
Jessica: Yeah. The child is going to recover much faster than mom and dad to that trauma. But the dentist… there’s a series and a protocol for treatment if the tooth is stabilized in position, you’re hoping that the body just welcomes it home and it becomes stable. That stabilization is usually a wire and bracket that can’t stay there, that has to be monitored and it has to come off in a couple of weeks. So, that’s something that the dentist will help you with and that’s… again, I’m not a pediatric dentist or a specialist in that area, but I did sleep at a Holiday Inn Express last night.
Interviewer: [Laughing]
Jessica: Now, actually, I’ve assisted with these traumas and it’s really important that there’s a lot of follow up with the patient.
Interviewer: Perfect. So, what do you recommend for kids with loose teeth? You know, primary teeth that are getting ready to come out. Should they wiggle them loose or should they let them come out on their own, should we yank them, what’s the correct thing to do?
Jessica: I think the correct thing is it depends on the tooth and it depends on the parent and the child…
Interviewer: I kind of miss having loosed teeth by the way, I really enjoyed it as a kid.
Jessica: Oh, my gosh.
Interviewer: Wiggling out of my teeth and it was one of the joys of my life. And I’m sad I’ll never get to do that again.
Jessica: So, it’s clear that you and I are what keeps the earth on its balance on the axis.
Interviewer: Oh, you were not a fan?
Jessica: Because nobody was getting near me when I had loose teeth as a child. You weren’t going to look at it, you sure weren’t going to check it; just let me check it real quick and you weren’t going to touch it…
Interviewer: Well, I didn’t want other people doing it, but I liked twirling it around, like tongue, like rocking it back and forward and when it got really loosed, you could spin it and move it. Like I loved everything about it, like I’m really am upset that I’ll never get to experience that again.
Jessica: The teeth that you’re describing, I call it E.T.W. So, encourage to wiggle, we definitely want the child wiggling that tooth, pushing on that tooth, getting that tooth out.
Interviewer: I was doing the right thing then.
Jessica: You were doing the right thing. So, we definitely encourage the child to wiggle; these teeth do need to come out, there’s a lot of bacteria that’s trapped under there, the developing tooth wants to come in. We don’t want that bacteria being held against the developing tooth. I do see children though, that it’s not time for the tooth to come out. They see their friends losing teeth and they want to lose teeth, so they start to wiggle their teeth. So, it’s just appropriate, again, we’re assuming that parents are going to be taking their children to the dentist every six months and taking them to the dentist whenever they see something developing and they’re not sure.
Interviewer: Starting at what age?
Jessica: Start, actually at first tooth. First tooth and as I said, that’s a lot about parents dental health education. It might sound crazy to take the child to the dentist at first tooth and for sure there is people that are going to hear that and say, that’s wrong, that’s not right. It was age three, up until very recently it was age one, now it’s first tooth.
Interviewer: Got you.
Jessica: We’re seeing an increase in childhood dental decay.
Interviewer: Soon it’s going to be within twenty minutes of delivery, right from the moment.
Jessica: [laughing] I just say, first tooth, take a picture, call grandma, take them to the dentist. This is about education. So, we’re going to be talking to our parents about proper brushing, wiping the gums with as a soft wet washcloth gently or with a gauze, stimulating blood flow, cleaning the bacteria off of gums. We’re going to be talking about, what’s in the baby bottle, when do they have the baby bottle and not having a baby bottle at bedtime. We’re going to be talking about [inaudible 00:32:38], paci and sippy cup. What age it’s time to break those habits for the child. Why we want to break those habits for the child; it can definitely affect their dental development, the shape of their jaw and cause future problems. So, age two would be the age at which you want to start weaning off the pacifier.
A thumb is a big challenge for parents; why? Because I always have it with me and you just want to do a lot of encouragement with the child to break that thumb habit as well around age two.
Interviewer: So, what can happen with the thumb?
Jessica: The sucking of the thumb and the pacifier can actually change the shape of the jaws. It’s a lot of vacuum and a lot of pressure, so it brings the sides in and narrows them that can lead to problems with their bite. It can also cause what we call open bite or that sort of vaulted circular when we bite together, we have an open circle in the front. That’s a very difficult thing to fix with orthodontics in the future.
If you can get the child to stop the thumb and the pacifier or the finger sucking habit, most of the cases the proper forces of lip and tongue pressure will allow the jaw to just kind of roll back into its proper position. I’ve seen it work very, very, well. I’ve also seen it not work. So, it’s a difficult thing to correct with orthodontics alone in the future, if that open bite persists.
Interviewer: Perfect. Anything else?
Jessica: Well, I don’t know we could just talk forever about teeth and kids and safety, but I think that the really important thing is to realize that kids are going to bump their teeth, they’re going to knock them, and they’re going to chip them. It’s super important that where even with the baby teeth, we’re not just saying, oh that’s a baby tooth, it’s fine. We want to check and make sure that that root tip was completely lost with the tooth, that there’s no fracture to the jaw bone around the teeth or the other teeth. Continue to follow up whatever your dentist recommends, but it’s usually one month, six months and one year. We want to watch for those changes at home; color change, pimple on the gums, redness and the patient reporting sensitivity.
If a permanent tooth is knocked out, time is of the essence. That tooth needs to be re-implanted, I think it’s within the hour.
Interviewer: That’s crazy.
Jessica: Into the patient’s mouth ideal, into the mom’s mouth or into a glass of milk and bring the patient and the tooth and mom go directly to the dentist.
Interviewer: What about dad’s mouth? Is dad’s mouth okay or only mom?
Jessica: You know, I think dad’s mouth is okay.
Interviewer: It’s okay?
Jessica: It’s okay.
Interviewer: You’re sure.
Jessica: Yeah.
Interviewer: Okay.
Jessica: Yeah.
Interviewer: Maybe brother and sibling?
Jessica: I mean, well you know, if the brother is willing to do it.
Interviewer: Will any mouths do?
Jessica: I guess any mouth would do. Yeah, any mouth would do.
Interviewer: Fair enough, okay.
Jessica: It’s the right temperature, the right environment, but the child’s mouth is the best. Milk is probably going to be the best choice. I think we’ve actually and again, I’d have to check. I think we’ve actually had somebody put it in saline, like salt water… into the office, but I would just do water at that point. If I didn’t have milk and I didn’t have a mouth, I would probably just do water.
Interviewer: But hopefully you have a mouth with you.
Jessica: Don’t want the teeth to dry out and you don’t want to rub them, you want to gently rinse them and stick it right back in on site if you can.
Interviewer: That’s awesome. I want to see that happen in my lifetime.
Jessica: [Laughing]. I don’t want to see that happen in my lifetime.
Interviewer: I do, [inaudible 00:35:51].
Jessica: You can probably YouTube it.
Interviewer: I want someone tooth to fall out, so I can tell them like, “hey, you got to stick it back in”. And they’re looking at me like I’m out of my mind. And then when they say no, I’m like alright then just chipmunk it by the cheek there.
Jessica: That’s exactly right.
Interviewer: And they’re like, “oh”. And I’m going to show them the video, like “look”.
Jessica: That is exactly right.
Interviewer: Yes. Jessica Cooper said this is what you do. The renowned, legendary Jessica Cooper. Fantastic.
Jessica: I don’t know how long you usually do the podcast for, but…
Interviewer: No, we’re good.
Jessica: Orthodontic evaluation at age seven. Why age seven? We’re not putting braces on the teeth at that age. You are looking for the potential for future problems. You’re taking a panoramic radiograph, where you can see all of the developing teeth, you’re looking to see that those teeth are developing bilaterally at the same rate in a proper position for ideal eruption.
You’re looking for jaw discrepancies, so you can you can use Mother Nature’s help and apply a little pressure and tease that development into the right direction. You’re trying to stave off excessive surgical treatments later if you can. But age seven; do I think that you can have that evaluation at your dentist? Yes I do. But we’re looking for baby teeth to have excess spacing.
Interviewer: Primary teeth.
Jessica: Yes, primary teeth.
Interviewer: Not baby teeth. I was told….
Jessica: I’m working on it.
Interviewer: …that baby is the wrong terminology. The correct terminology…
Jessica: Thank you so much.
Interviewer: …. Ms. Cooper, is primary teeth.
Jessica: You’re exactly right. Because again…
Interviewer: Thank you.
Jessica: … we’re going to keep these teeth to sometimes age fourteen. I’ve seen ten year olds with a full adult dentition, I’ve seen fourteen year olds that had primary teeth still. So, it’s a chronological development. What were we talking about? Orthodontic [inaudible 00:37:39].
Interviewer: Before I corrected you, yes.
Jessica: Orthodontic eval. You do want to see excess spacing in your child’s primary dentition; lots and lots of space in between the teeth. If your child has perfectly lined up, perfectly straight teeth…
Interviewer: That’s not good.
Jessica: …some people would call that moderate to severely crowded.
Interviewer: Oh, wow.
Jessica: If their baby teeth are crooked, it’s severe crowding. So, we want to see a large open excess space, ideally. It doesn’t mean the child’s going to have you know tremendous dental problems, but it would mean that you’d be taking them to the orthodontist at that age seven and not waiting.
Interviewer: Interesting.
Jessica: So, you’re looking for things like excessive over jet or the top teeth are way out in front of the lower teeth. Ideally they’re going to be in this relationship. You’re looking for teeth that are crossed over and not spaced widely together, you’re looking for under bite. You’re looking for cross bite, when the six year old molars come in.
What’s cross bite? The upper teeth are inset to the lower teeth. So, cross bite and you’re looking for that… what the textbook calls “socially debilitating malocclusion”. What is that? That is my child won’t smile, my child’s getting teased. These are indications for early adult or early orthodontic intervention.
Interviewer: Got you.
Jessica: Again, studies show that you do when you need to do. Get in, get out, get the braces off and then you reevaluate for tooth position at the age thirteen or whenever they have all their permanent teeth.
Interviewer: When people normally start getting braces?
Jessica: When people normally start getting braces. We call that a phase one and a phase two. I feel it’s super, super, important. I would almost say that a phase one is more important than a phase two, because you’re talking about growth and development, versus perfect tooth alignment and perfect rotations for a perfect smile.
Interviewer: Yeah, it make sense. And you know, I had braces for four years, from age like twelve to I guess almost sixteen and they didn’t do much. So, maybe if I started earlier, it may have had a better result.
Jessica: It’s possible. But we don’t know and we miss that window. I have a good friend whose child is ten years old and I’m strongly encouraging him that we want to get that child to the orthodontist if appliance therapy or any sort of therapy needs to be done. We’re trying to take advantage of growth and we’re also trying to do this while everything is still soft and gushy before all those bones fuse and we don’t have as much opportunity to use forces to grow that bone into the right dimensions.
Interviewer: So, I’m guessing appliance therapy means that it has some kind of braces and not a refrigerator?
Jessica: Yes. Some sort of bending and brackets and rubber bands in the mouth.
Interviewer: Got you.
Jessica: There’s some things that… I mean, I’ve seen children do incredibly well with removable appliances that need to be done. And you need a special kind of patient and a special kind of parent to do that. It requires diligence, but it’s amazing and thrilling when it works properly. I saw a young girl change her shape from a convex profile with an under bite and she was able to use… we banded the back teeth. She had some rubber bands and maybe some bands in the front and it’s called a face mask and she put that on when she got home from school and where it all afternoon and slept at it. And she was able to help to advance her maxilla; she looked like a different child in about a nine month period. It was great.
Interviewer: That’s cool.
Jessica: Fantastic.
Interviewer: That’s awesome.
Jessica: Yeah.
Interviewer: Perfect. Alright, anything else you to wrap up with?
Jessica: Brush, floss and see your dentist twice a year.
Interviewer: [Chuckles]. That will work. Perfect. Thank you so much.
Jessica: Thank you so much.
Interviewer: Awesome. Alright, love you guys. Ooh, good. Sweet.
Jessica: How long was that?
Interviewer: I have no idea. [Inaudible 00:41:43].
Jessica: It was…
Interviewer: [inaudible 00:41:45]. Probably about an hour. Forty- five minutes?
Jessica: You said you want to do an hour right?
Interviewer: Yeah, forty-five minutes, we’re perfect, yeah. We’re right in the ball park.
Jessica: Want to brush your teeth?
Interviewer: Sure.
Jessica: Alright.
Interviewer: You can do that.
Jessica: Well, as long as you’re happy with it.
Interviewer: Yeah, it was great, it was awesome. The beginning was super cool, Eden was super cooperative, she was very nice.
Jessica: So, lucky.
Interviewer: And he was worried.
Jessica: But if we…if she hadn’t been….
