This edition of Ask a Dentist, features Pediatric Dentist Dr. Bobby Raber from Every Kid’s Dentist in Arizona, a member of the Smile Generation family. Take it away Dr. Raber...

One of our Facebook followers, Laura Norton Baez asks: "My son has breathing treatments (xopenex and pulmicort) due to asthma. He is 3 and already has a few cavities. Can the breathing treatments cause damage to his teeth? We brush, floss and gargle! My daughter is 5 and has never had a cavity!"

Dr. Raber replies: "In my experience a lot of kids that take breathing treatments for asthma or anything else do have more complex dental issues. We can’t say for certain that the breathing treatments and related medications are the root of your son’s dental problems though. One likely connection to breathing treatments and dental health is the child’s tendency for mouth breathing. Many children on breathing treatments lack the ability to breathe naturally through their nose, so they instead breathe through the mouth. When a child breathes through their mouth it limits the saliva’s natural protective abilities on our teeth. Mouth breathing can have the same effect as xerostomia, which is a lack of salivary flow. Breathing through the mouth instead of the nose can magnify other issues with the child’s teeth. There is a lot of research that says if you have xerostomia, you have a significantly higher risk for cavities. So it is hard to say for sure that your son’s breathing treatment is directly affecting his dental health but there is some merit to the idea. Either way, keep up the great job of brushing and flossing and he will likely see fewer cavities than he might have otherwise!"

Another concerned mom wants to know: "What are the risks involved with sedation dentistry? My 5 year old needs some dental work and they’ve advised us to use sedation. Can we use laughing gas instead of general anesthesia?"

According to Dr. Raber: "In answering this question is important to clarify the term “sedation” as there is a big difference between general anesthesia and oral conscious sedation. Both are forms of sedation, yet general anesthesia is typically administered through an IV in an operating room, whereas oral conscious sedation is done without an IV and typically performed at the pediatric dental office. With oral conscious sedation or general anesthesia we always run the risk that the child will have some type of reaction or that something could go wrong. That being said, as a doctor and a dad I personally choose to use oral conscious sedation for my own children. The reason I choose this method is that oral conscious sedation leaves all the natural vital mechanisms intact, such as the ability for the child to breathe spontaneously on their own. General anesthesia is a much stronger medication, harder to metabolize, and it forces the body to shut down certain vital mechanisms. Additionally with general anesthesia it is typically the first time the child is being exposed to these medications and allergic reactions are unknown at that time, so the risk is higher for the child. As for the use of nitrous oxide, or laughing gas, I am always willing to try it as an option to see if it will work on the child or not. I will only use nitrous oxide on a child 5 years or older, and always with the parent present so we can determine together weather or not it is an effective method for completing the dental treatment. This way if it is not enough to calm the child, the parent is aware of why we need to opt for the next level of sedation. First and foremost, we decide together what is best for the child."

Finally, Twitter follower Paige asks: "How bad is it when you don’t floss everyday?"

"Not flossing daily is alright as long as you don’t get cavities! That sounds odd for a dentist to say but some people are more prone to cavities, so the importance of daily flossing depends on your individual dental needs," says Dr. Raber. He continues: "For kids, flossing becomes important as soon as any of their teeth touch on the side. Many kids have spaces so you don’t need to floss when there are spaces present. Once those teeth push together and touch, it is very important to floss between the teeth. The enamel on a baby tooth is much more susceptible to cavities since there’s not much there to protect it. I have five kids and two of them have cavities on every single molar, the other three have never had a cavity on their molars! I’m a dentist—we brush and floss their teeth every single night! Needless to say, genetics plays a huge role in dental health. My family is a perfect example of dental genetics, having passed on my cavity-prone teeth to two of my children while my wife has great teeth and passed that on to my other three children. An interesting thing to point out is that all the cavities my children have are between their molars, which is all the more reason why flossing is important."


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