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When you're first startled awake in the middle of the night by a loud, gritting sound emanating from your child's room, you may have two questions: how can such a loud racket not be harmful to their teeth? And, how can they sleep through it?

While it sounds earth-shattering, teeth grinding (medically known as bruxism) is a common habit among children. It involves an involuntary grinding, clenching or rubbing of the teeth together, either during the day or during night sleep.

While certain medications or conditions could be factors, it's believed most teeth grinding arises from the immaturity of the part of the neuromuscular system that controls chewing. It's believed to trigger a night episode as the child moves from deeper to lighter stages of sleep toward waking. Older children and adults typically handle these sudden shifts without incident, but a young child's under-developed chewing response may react with grinding.

If a child's teeth are normal and healthy, teeth-grinding typically won't create any lasting damage. But because grinding does generate pressures greater than the teeth normally encounter, it can be harmful to decayed teeth or those with enamel erosion due to high acid from consumption of sports and soda drinks. And it's also a cause for concern if the habit continues into later childhood or adolescence.

To avoid these problems, it's best to keep your child's teeth as healthy as possible by practicing daily brushing and flossing, and regularly seeing a dentist for cleanings, treatments and preventive measures like topical fluoride or sealants. And be sure to limit sugar and acidic foods and drinks in their diet to protect against decay and erosion.

You can also take steps to minimize teeth grinding and its effects. Consult with your physician about any medications they're taking that might contribute to the habit. If there are psychological issues at play, seek therapy to help your child better manage their stress. Your dentist can also fashion a custom night guard worn while they sleep that will prevent their teeth from making solid contact during grinding episodes.

Most importantly, let your dentist know if your child grinds their teeth. Keeping an eye on this potentially harmful habit will help lead to appropriate actions when the time comes.

If you would like more information on teeth grinding, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “When Children Grind Their Teeth: Is the Habit of 'Bruxism' Harmful?


In her decades-long career, renowned actress Kathy Bates has won Golden Globes, Emmys, and many other honors. Bates began acting in her twenties, but didn't achieve national recognition until she won the best actress Oscar for Misery — when she was 42 years old! “I was told early on that because of my physique and my look, I'd probably blossom more in my middle age,” she recently told Dear Doctor magazine. “[That] has certainly been true.” So if there's one lesson we can take from her success, it might be that persistence pays off.

When it comes to her smile, Kathy also recognizes the value of persistence. Now 67, the veteran actress had orthodontic treatment in her 50's to straighten her teeth. Yet she is still conscientious about wearing her retainer. “I wear a retainer every night,” she said. “I got lazy about it once, and then it was very difficult to put the retainer back in. So I was aware that the teeth really do move.”

Indeed they do. In fact, the ability to move teeth is what makes orthodontic treatment work. By applying consistent and gentle forces, the teeth can be shifted into better positions in the smile. That's called the active stage of orthodontic treatment. Once that stage is over, another begins: the retention stage. The purpose of retention is to keep that straightened smile looking as good as it did when the braces came off. And that's where the retainer comes in.

There are several different kinds of retainers, but all have the same purpose: To hold the teeth in their new positions and keep them from shifting back to where they were. We sometimes say teeth have a “memory” — not literally, but in the sense that if left alone, teeth tend to migrate back to their former locations. And if you've worn orthodontic appliances, like braces or aligners, that means right back where you started before treatment.

By holding the teeth in place, retainers help stabilize them in their new positions. They allow new bone and ligaments to re-form and mature around them, and give the gums time to remodel themselves. This process can take months to years to be complete. But you may not need to wear a retainer all the time: Often, removable retainers are worn 24 hours a day at first; later they are worn only at night. We will let you know what's best in your individual situation.

So take a tip from Kathy Bates, star of the hit TV series American Horror Story, and wear your retainer as instructed. That's the best way to keep your straight new smile from changing back to the way it was — and to keep a bad dream from coming true.

If you would like more information about orthodontic retainers, please contact us or schedule an appointment for a consultation. You can learn more about this topic in the Dear Doctor magazine articles “Why Orthodontic Retainers?” and “The Importance of Orthodontic Retainers.” The interview with Kathy Bates appears in the latest issue of Dear Doctor.


Families of children with chronic conditions face many challenges. One that often takes a back seat to other pressing needs is the prevention of tooth decay. But although difficult, it still deserves caregivers’ attention because of the dental disease’s potential long-term impact on oral health.

Chronically ill children are often at higher risk for tooth decay, most commonly due to challenges in practicing effective oral hygiene. Some conditions create severe physical, mental or behavioral impairments in children’s ability to brush and floss: for example, they may have a heightened gag reflex to toothpaste in their mouth or they may not be able to physically perform these tasks on their own.

Some children may be taking medications that inhibit salivary flow as a side effect. Saliva is critical for disease prevention because it both neutralizes mouth acid (which can erode tooth enamel) and is a first line of defense against disease-causing bacteria. And a child’s diet, while designed to support treatment of their chronic condition, may conversely not be the best for supporting their dental health.

It’s best if caregivers and their dentists develop a strategy for decay prevention, which should include the following:

  • Regular dental visits beginning at Age One. Besides monitoring dental health, dental visits also provide cleanings and other preventive measures like topical fluoride or sealants;
  • Brushing and flossing support. Depending on a child’s physical and mental capacities, caregivers (or an older sibling) may need to model brushing and flossing, or perform the tasks for the child;
  • Medication and diet changes. If medications are causing dry mouth, caregivers can speak to their physicians about possible alternatives; likewise, they should see if modifications can be made to their diet to better support dental health.
  • Boosting salivary flow. It’s especially important with children who have dry mouth to drink more water or use aids (like xylitol gum or candies) to boost salivary flow.

Although it requires extra effort and time to give attention to a chronically ill child’s dental health, it’s well worth it. By working to prevent tooth decay early in life, these children will be more likely to enjoy good dental health in the future.

If you would like more information on dental care for children with special needs, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor article “Managing Tooth Decay in Children with Chronic Diseases.”


Due to financial circumstances, people often have a lost tooth restored with a removable partial denture, an effective appliance that restores function and a degree of aesthetic appearance. Later, though, they may want to improve both function and appearance with a dental implant.

If this describes you, you’re making a great choice. Dental implants are the closest technology we have to a natural tooth. But there may be a roadblock to your implant, especially if a long time has passed since your tooth loss—there may not be enough bone at the site to place an implant.

The heart of an implant is a titanium metal post surgically imbedded in the jawbone. The titanium naturally attracts bone cells, which grow and adhere to it to form a solid hold that can support a porcelain crown or other restorations like bridges or dentures. But to achieve a natural appearance it’s important that the implant is placed in the right location. To achieve that requires adequate bone.

But there may not be adequate bone if the tooth has been missing for a while. The forces generated when we chew travel through the teeth to the jawbone, which stimulates bone growth. If that stimulus is absent because of a missing tooth, new bone cells may not replace older ones at a healthy rate and the total bone volume begins to diminish. A denture can’t compensate and, in fact, accelerates bone loss.

But there may be a solution: bone grafting. With this procedure we place a donor bone graft into the area of bone deficiency some time before implant surgery. The graft serves as a scaffold for new bone cells to grow upon. Hopefully, this will produce enough healthy bone to support an implant. If the bone deficiency is minor, we may place the implant and the bone graft at the same time.

If you have experienced bone loss, we must first determine the amount of bone at the missing tooth site and whether grafting is a viable option. Bone grafting postpones your implant, but the delay will be worth the wait if we’re successful. With increased bone volume you’ll be able to obtain a new tooth that’s superior to your current restoration.

If you would like more information on dental implants, please contact us or schedule an appointment for a consultation.


There’s a lot to like about dental implants for replacing missing teeth. Not only are they life-like, but because they replace the root they also function much like a natural tooth. They also have another unique benefit: a track record for long-lasting durability. It’s estimated more than 95% of implants survive at least ten years, with a potential longevity of more than 40 years.

But even with this impressive record, we should still look at the few that didn’t and determine the reasons why they failed. We’ll soon find that a great number of those reasons will have to do with both oral and general health.

For example, implants rely on adequate bone structure for support. Over time bone cells grow and adhere to the implant’s titanium surface to create the durable hold responsible for their longevity. But if conditions like periodontal (gum) disease have damaged the bone, there might not be enough to support an implant.

We may be able to address this inadequacy at the outset with a bone graft to encourage growth, gaining enough perhaps to eventually support an implant. But if bone loss is too extensive, it may be necessary to opt for a different type of restoration.

Slower healing conditions caused by diseases like diabetes, osteoporosis or compromised immune systems can also impact implant success. If healing is impeded after placement surgery the implant may not integrate well with the bone. An infection that existed before surgery or resulted afterward could also have much the same effect.

Oral diseases, especially gum disease, can contribute to later implant failures. Although the implant’s materials won’t be affected by the infection, the surrounding gum tissues and bone can. An infection can quickly develop into a condition known as peri-implantitis that can weaken these supporting structures and cause the implant to loosen and give way. That’s why prompt treatment of gum disease is vital for an affected implant.

The bottom line: maintaining good oral and general health, or improving it, can help keep your implant out of the failure column. Perform daily brushing and flossing (even after you receive your implant) and see your dentist regularly to help stop dental disease. Don’t delay treatment for gum disease or other dental conditions. And seek medical care to bring any systemic diseases like diabetes under control.

If you would like more information on dental implants, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Dental Implants: A Tooth-Replacement Method that Rarely Fails.”

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