12121 Richmond Ave. | Suite 326 | Houston, Tx 77082 | 281-870-9270


Anesthesia in early childhood not tied to developmental problems

~Lisa Rapaport

(Reuters Health) - Young children who had surgery under general anesthesia were no more likely than their siblings who weren’t exposed to anesthesia to experience developmental challenges that impair school readiness, a Canadian study found.

Some previous studies suggest that the opposite might be true: that the developing brain might be injured by anesthesia drugs early in life, researchers note in JAMA Pediatrics. But much of that research has been based on studies in animals and in labs, not in children having surgery.

For the current study, researchers examined data on almost 11,000 pairs of siblings, including about 370 pairs with both siblings exposed to surgery under general anesthesia and roughly 2,350 pairs with only one sibling with anesthesia exposure.

While children exposed to anesthesia did appear to have a slightly higher risk of developing physical health issues or challenges in social, emotional or communication skills than their siblings who didn’t have surgery, these differences were too small to rule out the possibility that they were due to chance, once researchers accounted for kids’ age at surgery and other factors that might also impact development.

"The findings of the current study should reassure parents of young children who require anesthesia for surgical procedures," said lead author Dr. James D. O'Leary, an anesthesiologist at the Hospital for Sick Children (SickKids) in Toronto and the University of Toronto.

"However, interpreting the clinical implications of anesthesia-related neurotoxicity is challenging, and more definitive clinical studies providing high-quality evidence of a relationship between exposure to anesthesia and neurological injury are still required to guide treatment decisions," O'Leary said by email.

Most of the kids who had surgery - about 60 percent - were at least two years old at the time of their operations and the majority - almost 80 percent - didn’t have overnight hospital stays.

The most common procedures included operations to fix problems with the ears, mouth and throat, male genital organs or musculoskeletal system.

In the pairs with one sibling who had surgery and one who did not, there was no difference in the proportion of kids who had delays in language and cognitive development, social skills, emotional health and maturity, or communication skills.

The study included all children eligible for public or Catholic schools in Ontario, Canada, from 2004 through 2012.

Researchers examined data from a questionnaire that teachers completed to assess child development before children entered primary school when they were five to six years old.

One drawback of the study is that it wasn’t a controlled experiment designed to prove whether or how exposure to general anesthesia during surgery might directly impact brain development in early childhood. Another limitation is the analysis excluded kids with assessments that pointed to potential behavioral, learning or developmental problems.

Parents of children who need surgery should still be reassured by the results, said Dr. Andrew Davidson of Royal Children’s Hospital and the Murdoch Children’s Research Institute in Melbourne, Australia.

"This study adds to the increasing data that for the vast majority of cases anesthesia does not have an impact on school readiness and this should be added to the fact that we increasingly think in the majority of cases it does not have an impact on cognition and many other aspects of neurodevelopment," Davidson, who wasn't involved in the study, said by email.

But there are still some studies linking anesthesia to some behavioral problems, Davidson cautioned.

"Based on this study and others, parents whose children are healthy should not delay needed procedures that may require anesthesia," said Dr. Lena Sun, chief of pediatric anesthesiology at Morgan Stanley Children's Hospital and a specialist at Columbia University Medical Center in New York City.

"However, research is still needed to identify subgroups of children who may have developmental vulnerability to anesthesia exposure," Sun, who wasn’t involved in the study, said by email.

SOURCE: bit.ly/2PC1tP5 JAMA Pediatrics, online November 5, 2018.
Our Standards:The Thomson Reuters Trust Principles.

September 28, 2016

Teen Topics: Bad Breath

Your mom isn’t constantly nagging you about brushing your teeth just to ruin your life. She actually has a couple of good reasons. Not only is she looking out for the boring things like fighting off cavities and gum disease. It could actually help you out in the dating scene. Here’s a couple things to keep in mind.

Before you talk to that special someone:

Bad Breath
(image via Giphy)

  1. Brush your teeth for two minutes with fluoridated toothpaste.
  2. Floss your teeth.
  3. Brush your tongue gently with your toothbrush until you can clearly see the pink of the tongue. White or yellow tongues are stinky. Alternatively, use a plastic tongue cleaner to gently clean your tongue.
  4. Rinse with an ADA approved mouth rinse.

Wait! I am not at home. What do I do?

Bad Breath
(image via Giphy)

  1. Chew a piece of sugar free gum
  2. Use a breath spray
  3. Dissolve a sugar free breath mint in your mouth

Why is this happening, doc?

(image via Giphy)

  1. Eating certain foods like onions, garlic, and spices
  2. Poor dental hygiene
  3. Dry mouth
  4. Medications
  5. Tobacco use
  6. Infections in your mouth or teeth
  7. Other mouth, nose, and throat conditions
  8. Underlying medical conditions

If bad breath is chronic, then please make an appointment to work out a solution. And if your breath is better, then thank your mom. Hey! She might even stop nagging you… well, at least about brushing your teeth, anyway.

February 23, 2016

No, your baby's fever was not caused by teething

By Nadia Kounang, CNN  

Most important points:

  • Drooling, swollen gums and crankiness are most common teething symptoms
  • Avoid medicating teething babies, doctors say
  • Use cold wash rag to comfort swollen gums

(CNN)It's a laundry list of symptoms that every parent is familiar with -- a cranky baby who's drooling, not eating and not sleeping. It must be teething.

But despite the advice parents might have heard, a new analysis in the journal Pediatrics confirms that high-grade fevers are not a sign of teething. Rather, it might be a sign of another illness, and parents and doctors shouldn't just ignore it.

"If a child has a really high fever, or is in significant discomfort, or won't eat or drink anything for days, that's a red flag for concern," said Dr. Paul Casamassimo, director of the American Academy of Pediatric Dentistry's Pediatric Oral Health and Research and Policy Center.

The analysis didn't completely dismiss a parent's intuition. It found the most common symptoms of teething were swollen gums, drooling and crankiness. Symptoms shouldn't last for more than three to five days, Casamassimo said, but he did acknowledge that it can feel much longer.

"By and large, symptoms are not a chronic thing. They come and go, and the job of the parent is to comfort the child, and keep their finger on the pulse of their child. Is the child eating? Staying hydrated?" Casamassimo said.

The study said teething can lead to a rise in body temperature still below 101 degrees Fahrenheit. Teething, the study said, is also associated with decreased appetite, sleeping problems, diarrhea, rash and vomiting.

Teething through the years

Throughout history, parents, as well as practitioners, have attributed a number of maladies to teething. It was, perhaps, an easy explanation for the ever-changing behavior of an infant and illnesses during children's vulnerable early years.

"Teething infants suffer from itching of the gums, fever, convulsions, diarrhea, especially when they cut their eye teeth," Hippocrates observed in 4th century BC.

For hundreds of years, medical professionals believed that teething caused the deaths of children. When Lucy Jefferson, President Thomas Jefferson's sixth child, died at age in 1784 at age 2 1/2, a letter from the doctor said she "fell a Martyr to the Complicated evils of teething, Worms and Hooping Cough."

The 1842 Registrar General's report of England and Wales attributed 12% of all deaths of children younger than 4 to teething. The 1891 "In Cyclopedia of the Disease of Children," a respected medical text of the time, said "Children that have been strong and healthy up to the period of dentition often droop and die, while the delicate or sickly ones pass through it with apparent impunity."

But as medical care improved, it became increasingly clear that there were other reasons behind infant mortality, and teething was more annoyance than a sickness.

How to manage teething

Still, there are a lot of old beliefs and advice out there for parents with cranky, drooling babies. So, how should they manage teething?

"Just comfort your child and get through it," said Casamassimo. He said a cold rag or teething toy may help with the discomfort.

Infant pain relievers might also be an option, but Casamassimo urged parents to be careful. Regular use can lead to tooth decay, and acetaminophen is a leading cause of liver disease in children. "If you have to keep doing it day after day, " it may be a concern, Casamassimo said.

And stay away from topical anesthetics that contain benzocaine and lidocaine, he said.

Benzocaine can lead to methemoglobinemia, a rare, but serious and sometimes fatal condition, where the amount of oxygen carried through the blood stream is reduced. Children younger than 2 appear to be at particular risk, the U.S. Food and Drug Administration said.

According to the Institute for Safe Medication Practices, lidocaine overdoses have been associated with jitteriness, confusion, vision problems, vomiting, falling asleep too easily, shaking and seizures.

While it can be a trying time, Casamassimo said, teething is normal.

"Every kid is going to have it in slightly different ways," he said. "Pay attention to the symptoms. Ameliorate the symptoms. If things get out of hand, contact you pediatrician."

November 24, 2015

If a Dental Emergency Happens While You are Traveling

  • Call our office at 281-870-9270 and ask the answering service to page Dr. James.
  • E-mail Dr. James at KidsDentistofHouston@gmail.com.
  • Go to www.mouthhealthy.org on the internet and click on “ADA Find-a-Dentist” to find an ADA member dentist near you.
  • Ask the local hospital or dental society to recommend a dentist. To find a local dental society, go to http://ebusiness.ada.org/mystate.aspx.
  • Ask a hotel concierge or other hotel staff to refer you to a dentist.
  • If you are out of the country, contact the U.S. Embassy. Many embassies and consulates keep lists of local medical and dental staff, which may also be available online at www.usembassy.gov. After clicking on the country you are visiting, medical listings are usually found under the heading “U.S. Citizen Services.”

September 8, 2015

Is It Safe To Go To the Dentist During Pregnancy?

Published on www.mouthhealthy.org

In between trips to the doctor, hospital tours and setting up the nursery, don’t let visiting the dentist fall off your pregnancy to-do list before your baby comes. Getting a checkup during pregnancy is safe and important for your dental health. Not only can you take care of cleanings and procedures like cavity fillings before your baby is born, but your dentist can help you with any pregnancy-related dental symptoms you might be experiencing.

The American Dental Association, the American Congress of Obstetricians and Gynecologists and the American Academy of Pediatrics all encourage women to get dental care while pregnant. “It is a crucial period of time in a woman’s life and maintaining oral health is directly related to good overall health,” says Aharon Hagai, D.M.D.

Here are the most common concerns women have about going to the dentist during pregnancy.

When Do I Tell My Dentist I’m Pregnant?

Even if you only think you might be pregnant, let your dental office know. Tell them how far along you are when you make your appointment. Also let your dentist know about the medications you are taking or if you have received any special advice from your physician. If your pregnancy is high-risk or if you have certain medical conditions, your dentist and your physician may recommend that some treatments be postponed.

How Might Pregnancy Affect My Mouth?

Although many women make it nine months with no dental discomfort, pregnancy can make some conditions worse – or create new ones. Regular checkups and good dental health habits can help keep you and your baby healthy

Pregnancy Gingivitis

Your mouth can be affected by the hormonal changes you will experience during pregnancy. For example, some women develop a condition known as “pregnancy gingivitis,” an inflammation of the gums that can cause swelling and tenderness. Your gums also may bleed a little when you brush or floss. Left untreated, gingivitis can lead to more serious forms of gum disease. Your dentist may recommend more frequent cleanings to prevent this.

Incresed Risk of Tooth Decay

Pregnant women may be more prone to cavities for a number of reasons. If you’re eating more carbohydrates than usual, this can cause decay. Morning sickness can increase the amount of acid your mouth is exposed to, which can eat away at the outer covering of your tooth (enamel).

Brushing twice a day and flossing once can also fall by the wayside during pregnancy for many reasons, including morning sickness, a more sensitive gag reflex, tender gums and exhaustion. It’s especially important to keep up your routine, as poor habits during pregnancy have been associated with premature delivery, intrauterine growth restriction, gestational diabetes and preeclampsia.

Pregnancy Tumors

In some women, overgrowths of tissue called “pregnancy tumors” appear on the gums, most often during the second trimester. It is not cancer but rather just swelling that happens most often between teeth. They may be related to excess plaque. They bleed easily and have a red, raw-looking raspberry-like appearance. They usually disappear after your baby is born, but if you are concerned, talk to your dentist about removing them.

Are the Medications My Dentist May Recommend Safe During Pregnancy?

Be sure your dentist knows what, if any, prescription medications and over-the-counter drugs you are taking. This information will help your dentist determine what type of prescription, if any, to write for you. Your dentist can consult with your physician to choose medications—such as painkillers or antibiotics—you may safely take during the pregnancy. Both your dentist and physician are concerned about you and your baby, so ask them any questions you have about medications they recommend.

What About Local Anesthetics During Pregnancy?

If you’re pregnant and need a filling, root canal or tooth pulled, one thing you don’t have to worry about is the safety of the numbing medications your dentist may use during the procedure. They are, in fact, safe for both you and your baby.

A study in the August 2015 issue of the Journal of the American Dental Association followed a group of pregnant women who had procedures that used anesthetics like lidocaine shots and a group that did not. The study showed these treatments were safe during pregnancy, as they cause no difference in the rate of miscarriages, birth defects, prematurity or weight of the baby. “Our study identified no evidence to show that dental treatment with anesthetics is harmful during pregnancy,” said study author Dr. Hagai. “We aimed to determine if there was a significant risk associated with dental treatment with anesthesia and pregnancy outcomes. We did not find any such risk.”

Can I Get a Dental X-Ray While Pregnant?

About half of the women in the anesthetic JADA study had X-rays taken while they were pregnant, which were also found to be safe. It’s possible you’ll need an X-ray if you suffer a dental emergency or if there is a need to diagnose a dental problem. Although, radiation from dental X-rays is extremely low, your dentist or hygienist will cover you with a leaded apron that minimizes exposure to the abdomen. Your dental office will also cover your throat with a leaded collar to protect your thyroid from radiation.

June 19, 2015

By Dentagama.com 

Nail biting or onychophagia is a compulsive stress relieving habit that can cause pathological changes if it persists for a long period of time. Often people indulge in this habit out of sheer boredom or when they are deeply engrossed in something. Though more prevalent among children and teenagers, it often extends to adulthood. It is mostly regarded as a nervous habit that is unsanitary and harmful for general health. However, few people pay attention to the effect it has on dental health.

    Negative Effects of nail biting on oral health

  1. Chipped/fractured teeth

    Though nails are more brittle than teeth, hard chewing of nails can chip a tooth edge. The primary reason is that when you bite your nails, the repetitive and forceful hitting of the upper and lower teeth leads to chipping. In some cases, it may also lead to more advanced teeth fractures. The repetitive motion the teeth get engaged in also wear the teeth down quickly.

  2. Orthodontic treatment interference

    The nail biting habit is particularly damaging in people wearing braces. This is because the teeth are already under steady pressure and the additional force generated on teeth due to nail biting may lead to root resorption. It can have a detrimental effect on the orthodontic treatment.

  3. Create gaps in between front teeth

    This is likely to occur only when children are habituated to nail biting from a very young age. As teeth are not strong at a young age, this habit leads to gaps between the front teeth. Nonetheless, this condition may only arise for kids who continuously bite their nails between the teeth.

  4. Temporomandibular joint disorder (TMD)

    Persistent nail biting is often accompanied by pain in the temporomandibular joint and tenderness in facial muscles. This is probably due to the repetitive force applied during chewing nails.

  5. Introduction of bacteria in the mouth

    The insides of the nails often harbor germs that get introduced in the oral cavity, thereby increasing the chances of infection. In rare cases, if a small snipped off nail remains in the mouth or between the teeth, it can lead to inflammation of the gums or even gum abscess.

    Treatment for nail biting

    Nail biting is often observed in conjunction with other oral habits such as bruxing. Though occasional biting of nails is not a matter of concern, chewing of the nails that persists till adulthood cannot be ignored. For compulsive nail chewers treatment becomes imperative due to a risk for damaging teeth and the skin around the nails. The treatment needs to address the cause as well as employ habit reversal techniques.

  • Often with children, it is advised to apply nail polish with a bitter taste over the nails. This serves as a deterrent to the child. Another advice is to cover the fingers with a glove which again serves as a reminder. However, these methods are likely to work only if the child is motivated to give up the habit.
  • For adults, opting for periodic manicure or keeping nails short or trimmed may also help to control the urge to chew nails.
  • Since nail biting is often an outcome of boredom, finding means to keep the hands busy is another option. One can use drawing, writing, playing a musical instrument and so on to keep the fingers occupied.
  • It is worthwhile to have regular dental checkups to deal with the dental repercussions.

December 22, 2014

By Dan Bruce, DDS; diplomate, abdsm 

Airway trauma, brain damage, or death. Six months ago I found myself sitting in a presurgical room reading over these risk factors on the informed consent. My son was lying in his bed innocently watching cartoons. My wife and I decided to have an adenoidectomy performed to help facilitate his nasal breathing. At five years old, my son had a vague idea about what was going to happen next. Fortunately, he trusts mom and dad completely and knows it will help him breathe better. As a health-care provider, it is easier to tell the parents the minute risks associated with anesthesia and surgery. As a parent, that decision becomes a whole lot more difficult.

Signs and symptoms

My son's symptoms included mouth breathing, halitosis in the morning, excessive movements while sleeping, and occasional mild snoring. He is a very smart and insightful boy, but at times he had trouble concentrating on tasks. (After coaching his soccer team, I found this is a very common occurrence with all 5-year-old boys.) Another pertinent dental finding was a tight lingual frenum that restricted the movement of his tongue. I thought that a child needed his or her frenum released if there was trouble nursing, but this was never a problem with him, so I did not address it. My son did have some difficulty saying certain letter sounds that required the tongue to come up against the front teeth; for example, "L," "6," and "R."

Screening for pediatric sleep apnea

Kids can show different signs and symptoms of sleep-related breathing disorders compared to adults. For example, the Apnea-Hypopnea Index (AHI) threshold for adults to be diagnosed with sleep apnea is five events per hour. For kids, as few as one event per hour is generally a concern and may warrant treatment. In addition, kids can show drastically different signs of sleep disturbances compared to adults. There are several good screening tools for pediatric sleep disorders. For example, the BEARS questionnaire is a simple, effective screening tool for many sleep disorders in a primary care medical setting.1

BEARS stands for: 
B = Bedtime Issues 
E = Excessive Daytime Sleepiness 
A = Night Awakenings 
R = Regularity and Duration of Sleep 
S = Snoring

Two things to note: Excessively sleepy children can present as either lethargic or hyperactive. A number of studies have linked ADHD symptoms to sleep-related breathing disorders.2,3 Also, any snoring or difficulty breathing in a young child is a red flag and would warrant referral.

In addition to screening questions, oral signs of a sleep disorder may include obstructive tonsils, mouth breathing, venous pooling under the eyes, and a high, narrow palate. If a pediatric sleep disorder is suspected, then referral to a sleep specialist is indicated.

Treatment of pediatric sleep apnea most often consists of removal of the adenoids and/or tonsils. Sometimes rapid palatal expansion is also used. If this is the case, myofunctional therapy may be helpful in maintaining the space gained through expansion (see below).

Effects of mouth breathing and incorrect tongue posture

Even if a child does not have sleep apnea, sleep and breathing habits can have a profound impact on the growth and development of the face and airway. We know that the position and strength of the oral musculature can have dramatic effects on the growth and development of the arches and facial structure. When a person breathes through the mouth, the tongue cannot sit up on the roof of the mouth and expand the arches laterally and anteriorly. The results can be seen in the photo below of a 4-year-old patient who is a chronic mouth breather. The primary teeth should have spacing between them. In this case, the teeth have collapsed inward due to perioral muscle pressure and a lack of outward tongue pressure. The tongue is not exerting outward pressure because it is between the occlusal surfaces of the teeth to facilitate mouth breathing. Also note the dry, cracked lips and swollen gingival margins that result from mouth breathing. 

Example of results from mouth breathing

Studies by Harvold on primates more than 30 years ago showed that different types of malocclusions were generated from induced chronic nasal obstruction.4 Different tongue postures can also create different types of malocclusions. This is important to assess even in cases of what looks like "genetic malocclusion." Even if a certain phenotype is passed down from parent to child, the cause of this phenotype may be from a shared behavior such as mouth breathing or a shared gene expression resulting from a certain stimulus.


For patients who have a habitual mouth-breathing habit, the first step is to determine how significantly the nose is obstructed and why. For my son, the pediatric sleep specialist did not think a sleep study was warranted before assessing the patency of the nasal airway. Therefore, we visited an ENT who performed a nasoendoscopy. This procedure involved spraying an anesthetic in the nose and using a fiber-optic camera to view the nasal passages, airway, tonsils, and adenoid tissue. The ENT felt the first line of treatment was to try nasal saline rinses and a nasal steroid spray. We tried this diligently for about six weeks in addition to elimination of common food allergens in his diet. Unfortunately, my son would get nosebleeds from nasal steroids and rinses, and dietary modifications did not help.

Our next recommendation was to remove the adenoid tissue obstructing the airway. It was not a decision to take lightly for many reasons, but we felt an adenoidectomy would help immensely in the short and long term. There can be a variety of reasons for nasal obstruction, one common one being a deviated septum, so it is important to ensure that a physical obstruction is not blocking the nose. Other alternative therapies to help open the nasal airway and/or shrink the tonsils, which may or may not help, are: treatment for food or environmental allergens, cranial osteothapy to aid in the flow of lymphatic fluid, or nasal strips such as Breathe Right strips. For some patients/parents, these options may be worth exploring before surgery is considered. If the nasal passage is partially open, constant nasal breathing can facilitate further opening.

Next steps

Ultimately we decided to have his adenoid tissue removed. After my son recovered from his surgery, we noticed a significant decrease in nighttime movements and much more peaceful sleep. He was able to sleep most of the night with his mouth closed. He is showing improvement in school. Plus, I felt better because I knew he was getting more oxygen to his brain during sleep.

That was not the end of his treatment, though. My son still had a tight lingual frenum, which limited his ability to place his tongue on the roof of his mouth during rest. This resulted in underdeveloped arches and less room for the tongue. He also still had some trouble saying certain letter sounds, such as "L," "6," and "R."

Example of a tight lingual frenum restricting movement of the tongue: 
Example of a tight lingual frenum

The treatment for these symptoms included myofunctional therapy and a lingual frenulectomy. A myofunctional therapist is typically a speech pathologist or hygienist who has undergone additional training to help correct issues related to mouth breathing, tongue posture, and tongue habits. A listing of myofunctional therapists can be found at www.myoacademy.net, which is the website for the Academy of Orofacial Myofunctional Therapy. There seem to be a lack of trained myofunctional therapists - we need more!

We started my son on some myofunctional exercises to help strengthen and stretch his tongue prior to the frenulectomy. We then used a laser to release the frenum. Oftentimes this needs to extend deep into the fibrous tissue in order to get the necessary functional benefit. Due to the highly vascular nature of the tongue, this is a procedure to be careful with. Directly after the release of his frenum, we did some stretching exercises to help ensure the frenum did not reattach. Again, the degree of tongue-tie can vary. A posteriorly tight frenum can present problems and requires a more technique-sensitive frenulectomy.

The main goals of treatment are threefold: lips together when not speaking or eating, tongue on the roof of the mouth, and breathing through the nose. When in doubt as to whether or not a frenum needs to be released, talk to the myofunctional therapist. These goals (in addition to developing a correct swallowing pattern) are accomplished through training exercises of the tongue, lip, and other oral muscles.

At this time, we are in the myofunctional therapy stage. Training is difficult and time-consuming, but we are making progress. It takes a strong commitment from the whole family to support my son to do his therapy.

What to do now

At a minimum, I think every dentist should be able to spot pediatric sleep-related breathing disorder symptoms, mouth breathing, and a tight lingual frenum. As mentioned above, children should not snore habitually! Snoring alone has been linked to poor academic performance and an increase in ADHD symptoms,5 among other problems. Early detection and treatment can make a huge change for these kids and save significant amounts of medical and dental treatment in the future. Also, the earlier mouth breathing or poor tongue posture is assessed and corrected, the more likely the patient will have better arch development.

The financial impact

There are many questions this article is not meant to answer. For example, what is the etiology of adenotonsillar hypertrophy? If a tight lingual frenum creates so many problems, why does it occur? I encourage you to find the answers to these questions and more. The answers will help dentistry integrate more with medicine and will improve the lives of our patients.

I am very proud of the quality and longevity of my restorative dentistry, but in the current business environment, patients want more. When you screen for obstructive sleep apnea and sleep disturbances in your practice, you can differentiate yourself. My only warning is that some patients do not think they have a problem and do not want to hear a solution to something they do not perceive as a problem. Know your patients, know the science, and make education the primary goal. There is an exciting new concept in the dental field called "airway centric dentistry." Children and adults will sacrifice teeth, gums, and joints to be able to breathe. Keeping this concept in mind will greatly improve the diagnostic and treatment skills of the dental clinician in all areas of dentistry.

Acknowledgement: I would like to thank Dr. Steve Carstensen and Dr. Barry Raphael for enlightening me on some of the concepts presented in this article. Thank you for being progressive leaders in the profession!

July 23, 2014

Question: "My son has been teething and seems to be in a lot of pain. What can I do to reduce the pain? When should his first appointment be to the dentist?”

A: Teething pain is very common and a normal part of child development. The obvious signs of teething are swollen gums, emergence of new teeth, excessive drooling, increased desire to chew things, and increase incidents of placing objects and fingers in the mouth. Most teething pain can be recognized with increased fussiness while eating and difficulty to fall asleep or stay asleep.

Common remedies for teething pain are giving the infant “teething rings.” These are objects that the child can chew on to relieve some of the discomfort associated with teething. They come in many varieties. I prefer the teething rings that come with liquid inside them. We advise parents to put the rings in the refrigerator to cool the liquid to provide extra relief to the child.

We also advise parents to wet a clean wash cloth and then place that in the refrigerator. Some children prefer the size and texture of a wash cloth to the teething rings.

The last thing we advise is the use of Tylenol to alleviate severe discomfort. Please follow the instructions on the bottle as they pertain to your child’s specific age and weight. I would suggest giving Tylenol to help with discomfort about an hour before bedtime.

Question: “When should his first appointment be to the dentist?"

A: A child should be seen by the dentist within 6 months after the eruption of the first tooth. The first visit’s purpose is to establish a dental home for your child. Also, the first visit will provide an opportunity for the parent to learn about proper oral hygiene practices, prevention of decay, oral habits such as pacifier use and discontinuation, normal growth and development, use of fluoride, and trauma prevention. The dentist will provide a through oral examination at explain any specific findings at this visit as well.

August 30, 2013

Question: "What kind of sedation would you recommend for a 3 year old getting extensive dental work?”

I am a board certified pediatric dentist. In our office in most situations, I use an oral conscious sedation for this type of procedure. Parents usually choose oral conscious sedation because there are fewer medical risks than IV sedation and the cost of an oral sedation is significantly less than IV sedation. But in some cases, IV sedation is the best option. Each case is different because each child and practitioner are different.

May 26, 2013

Question: “My son is getting pulpotomy and crowns. Our dentist is planning IV sedation. Is there anything I should be concerned about re: side effects, short or long term?

I know this process is stressful. I am glad you are doing some research before such a large procedure. IV sedation is a type of anesthesia that will put your child into a deep sleep during his dental procedure. The anesthesiologist will administer medications directly into his blood stream to manage his consciousness and pain level. Unlike general anesthesia, during IV sedation, your son should be breathing on his own and not using a ventilator.

There are side effects to IV sedation depending on the health of your child. I am going to assume your son is healthy and has no known heart, lung, liver, or bleeding disorders. If he has any health complications, you should be wary of IV sedation in a non-hospital setting and seek advice from your physician or anesthesiologist.

If he is healthy, then in the short term you should expect the following side effects: soreness in the site of the IV administration, dizziness, nausea for 24 to 48 hours, grumpiness, drowsiness, and possible constipation. If your child spikes a fever or is unable to awake from sleep, then please contact the anesthesiologist or 911 immediately. The last 2 side effects are indicative of a serious medical condition and require immediate assistance.

Also, there is always a chance your son may be allergic to the medications given. If he develops a rash or trouble breathing after the procedure, then please contact the anesthesiologist and 911 immediately.

Long term effets from a normal IV sedation are usually minimal.

March 10, 2013 – Teeth Grinding, Part 3

Question: “What should we do if our child grinds his teeth?”

A: If the child is under the age of 11 and only has mild to moderate wear on the teeth, then no treatment is necessary except regular checkups at our office every six months.

If the child is under the age of 11 and has severe wear on the teeth, then a customized treatment program based on the causes of the wear will have to be tailored to the child. Some examples of treatment include a custom mouth guard, tooth colored fillings, or consult with a physician.

If the child is over the age of 11 and exhibits moderate grinding of the teeth, then I may recommend braces to first correct the alignment of the teeth followed by a hard night guard to be worn while sleeping.

The type of treatment really depends on the severity of the wear on the teeth, age of the child, and the cause of the habit.

If we can identify and treat bruxism in adolescence, then we can prevent a host of problems in adulthood. Long term complications of untreated grinding of the teeth may include breaking teeth, muscle dysfunction, TMJ pain, headache, and migraines.

In my opinion, prevention is always better than the cure.

January 9, 2013 – Teeth Grinding, Part 2

Question: Why do children grind their teeth?

A: This answer will discuss why children grind their teeth. Why adults and teenagers grind their teeth is a different and more complex subject that will need to be discussed with the dentist.

No scientific study clearly explains why children develop this tendency. It may be a single cause such as the eruption of new teeth or it could be multiple causes. Other reported causes are improper alignment of upper and lower teeth, an earache or even stress, perhaps due to frustration or tension at home or some change in routine.

Some kids who are hyperactive also experience bruxism. And sometimes kids with other medical conditions (such as cerebral palsy) or on certain medications can develop bruxism.

I have observed that children who have trouble with nasal congestion due to allergies, sinus infections, or enlarged adenoids will often grind their teeth to help them breathe better while sleeping.

If your child grinds their teeth and snores regularly, then please let me know as that could be a sign of a sleep disorder.

The next blog entry will answer the question, “What do we need to do about it?”

November 14, 2012 – Teeth Grinding, Part 1

Question: What should I do about my child grinding his teeth?

A: Grinding of the teeth is a common question that gets asked in our pediatric dental office by numerous parents. Most parents are referring to either the involuntary or habitual grinding of the teeth. Sometimes it occurs when the child is awake, but most often the grinding, or bruxism, happens while the child is sleeping. There are three questions that parents will ask regarding this topic:

  1. Is this bad?
  2. Why does it happen?
  3. What do we need to do about it?

In this blog entry, I will answer the first question, “Is grinding of the teeth bad?” In subsequent blog entries, I will answer the other two questions.

So, is grinding of the teeth bad? It depends on the age of the child and the severity of the wear on the teeth. It is very common for children under the age of 11 to grind their teeth. If the child is under the age of 11 and has mild to moderate wear on the teeth, then very little long term damage will be done to the teeth and no treatment is usually necessary. At your child’s next exam, I can help you determine the severity of the wear on the teeth.

Children that are 11 years of age and older typically have more permanent teeth than baby teeth. Grinding of teeth in this age group can be very harmful to the teeth, joints, and muscles of the head and neck. If your child has mostly permanent teeth and grinds habitually, you need to discuss this with the dentist. Treatment may be required.

Sometimes, I see patients that are under the age of 11 and have severe wear of the teeth. This situation also may require treatment. Severe wear of the teeth presents as very small teeth that are very flat across. If you feel that your child’s teeth appear to be growing smaller and smaller, please let us know.

The next blog entry will answer the question, “Why does this happen?”

November 1, 2012 – Questions about our practice

It is hard to pick a health care provider for children. I thought I would help by listing questions that are often asked of me by our patients. I hope the answers below give you some insights into our philosophy on dentistry.

Q: What got you into this specific medical field? 
A: Most people who are afraid of the dentist are afraid because of a bad dental experience in childhood. I really enjoy working with children and have set up a practice that makes going to the dentist as fun and gentle as dentistry can be. I hope to instill in my patients a love and understanding of optimal oral health and a great relationship with their dentist.

Q: What landed you in your city, and what is it that you like about the neighborhood? 
A: I grew up in Houston. I attended elementary, middle, and high school here. I have a large extended family and a close church community that have supported me all my life. Houston is home and I would never live anywhere else.

Q: Do you belong to any professional associations? 
A: I am the past president of the Houston Academy of Pediatric Dentistry. I serve on the Board of Directors of the Greater Houston Dental Society and the Texas Association of Pediatric Dentistry. I am also actively involved with the American Dental Association and member of the American Academy of Pediatric Dentistry.

Q: What year did you begin practicing? 
A: I graduated from dental school in 2001 and began working at the University of Texas Health Science Center in the Pediatric Dentistry Department. I moved to Houston in 2003 and started working in West Houston with Dr. Sheryl Hunter Griffith. In 2004, she opened a second location in Katy, TX. In 2013, I decided to commute less and be closer to my family by spending all my time at our Houston location.

Q: What investments in your practice equipment and facilities have you made? 
A: The office is continually updated with the best technology. We have video games and TVs in the waiting room. There are mounted ipads in the treatment rooms. We have TVs mounted above each patient station. The office has nitrous oxide and the latest in sedation monitoring equipment. And of course, we have digital x-rays and tooth colored fillings.

Q: What procedures do you feel your practice excels in above others? 
A: We specialize in seeing young children, teens, and children with special health care needs. The whole office and staff is set up only to see these patients and make their visits pleasant and fun.

Q: What HMO or PPO providers are you in network with? Do you offer financing? 
A: We accept PPO insurance and are in-network providers for Cigna Radius PPO and Delta Dental Premier. We offer financing through Care Credit.

Q: Do you accept any government programs or discount cards? 
A: Not currently.

Q: What are the most challenging parts of your everyday practice? 
A: We are always striving to give patients excellent customer service within the confines of a stress inducing industry. The most challenging part of our day involves convincing a child who has been scared by another dentist that we can help them in a comfortable and gentle way.

Q: What are the best moments that make it worthwhile? 
A: Definitely when the children thank you for helping them get out of pain and then say "and it didn't even hurt."

October 22, 2012 - Welcome

Welcome to our new website and the inaugural blog entry. I believe communication and the sharing of information are two of the best ways to serve our patients. Unfortunately, for many of us, in our day-to-day lives, it can be challenging to stay on top of the latest happenings in health care, not to mention dental care. Therefore, I have decided to start a blog in hopes of keeping you abreast of current happenings in the pediatric dental world and increasing awareness of the importance of dental health and education in our children.

Thank you for your time, and as always, I look forward to working with you in the future. Should you ever have dental questions or needs, please don’t hesitate to call or email the office.


Back to Top