Although many dads are not able to be as present in the everyday affairs of their children as they would like, their presence is immeasurable and often helps to dictate the emotional well being of their children.  As we develop from adolescents to teenagers and beyond, fathers provide that sense of security, guidance and mentoring that helps us develop into confident, secure adults. Therefore, we here at L&M Orthodontics want to recognize and honor all of you great fathers out there. As a tribute to all that you do, we are offering $500 off Invisalign treatment during the month of June.  So, if you are a dad, or know a dad, who wants a more youthful, healthy smile, we at L&M Orthodontics would like to help make it a reality. We know how much you do for your families; now do something for yourself and get the smile you always wanted!

One particular set of norms I have been questioned about recently is the eruption patterns of the permanent and baby teeth.  Common questions I get include: “When should my child start losing teeth?” “How many baby/permanent teeth should he/she have?” “Am I too old to still have baby teeth?”  So, in an attempt to break things down, I’m going to address the norms of tooth eruption in this blog.

Let me begin by showing a diagram, and then I will explain it thoroughly.

The upper diagram describes the eruption pattern and exfoliation (when they are lost) pattern for the primary, or baby, teeth.  Most of us know already that we are born without teeth, and live the first 6 months or so of our lives that way.  Then, at around 6 months, the first primary teeth make their appearance into the mouth.  These are normally the lower central incisor teeth, followed by the upper central incisors at around 8 months.  Continuing, we will then, on average, see the upper and lower lateral incisors, upper and lower 1^st molars, upper and lower canines, and finally the lower and upper 2^nd molars before the child turns 3 years of age.   For those of you counting, that finishes us at a grand total of 20 primary teeth.

Now I want to point out that all the times presented in this chart are given as a time span as opposed to as an exact month.  This once again comes back to what I mentioned at the beginning of the blog, that people show variation.  So, if your child is 5 months older than the neighbor’s, and the neighbor’s child has 4 more teeth erupted than yours, should you panic?  No, your children are just demonstrating my point that everyone is different, and most likely this is normal for them.  As dentists, in regards to tooth eruption and loss, we are really just looking for symmetry in the mouth.  What I mean by this is that if you get or lose a tooth on one side of the mouth, I would expect the same tooth on the other side to come in/fall out around the same time.  It’s when this doesn’t happen that red flags go up in my mind, but I’ll discuss this later on.

More pertinent to orthodontics is the next part of the diagram; when the baby teeth are shed, or lost.  From the ages of 3-6, our teeth take a break from change, at least from any changes that we can see in the mouth.  At around 6, however, things begin to take off and we not only lose 8 teeth in rapid succession, but also gain 4 more through eruption. Our first teeth to become loose are normally the same as those that erupted into the mouth first, the lower central incisors.  Also at around 6 years of age, the 1^st permanent molars (also known as the 6 year old molars) will begin to erupt behind the 2^nd primary molars.  These 1^st molars are not replacing any baby teeth, and therefore no teeth are lost as they come in. At around 6 ½ the upper central incisors are lost as the permanent centrals take their place, followed by the lower and then upper lateral incisors between 7 and 8.

At this point there is another pause in tooth loss/eruption that may surprise many parents that have been caught up in the excitement of teeth being lost every few months.  Don’t worry, this is normal.  In fact, we even have a technical name for it in dentistry, the “mixed dentition.” In the mixed dentition, for those who did the math, we now have 12 baby teeth remaining and 12 erupted permanent teeth in the mouth for a grand total of 24 teeth!

At about age 10, we normally start to lose teeth again. At 10, the lower primary canines become loose, followed by the upper and then lower primary1st molars at around 10 ½. Just as an aside, primary molars are replaced by permanent teeth called premolar or bicuspid teeth.  All the other baby teeth are replaced by permanent teeth of the same name.  Permanent molars erupt into the mouth behind the baby teeth, and don’t replace a lost tooth, adding to the total number of teeth we have as adults.  Tooth loss usually concludes between the ages of 11 and 12, with the upper and lower 2^nd primary molars and upper primary canine teeth. Their permanent counterparts, along with the permanent 2^nd molars are normally erupted into the mouth at about 12 years of age.  That leaves us with 28 permanent teeth in the mouth which, barring extraction, will stay that way until the 3^rd molar (wisdom teeth) erupt at around 18 years of age.  That leaves us with a grand total of 32 teeth in the permanent dentition!

If you are still with me after all of that, please take note that these norms covered are averages of normal tooth progression, and not set in stone.  I present them to you as a reference of what may be happening in your child’s mouth.  Remember, there is still that pesky variation from case to case. It is not at all uncommon for me to see a 9 year old without a baby tooth left, or a fifteen year old still holding on to a few stragglers. The actual age teeth come out is not as important as the pattern in which they do. Remember symmetry? Overall, don’t worry, this is most likely what is normal for you.

That being said, sometimes things don’t go according to plan.  Like I mentioned earlier, losing a tooth without losing the same tooth on the other side of the mouth soon after sends up a red flag for me as an orthodontist.  Other common problems include teeth prematurely lost to trauma or decay, or a tooth that has been lost more than three months ago without a permanent replacement coming in.  These signs could mean many things, such as missing or malformed permanent teeth, lack of spacing necessary for permanent tooth eruption, ankylosed teeth (the tooth is fused to the bone), or permanent teeth erupting away from where it should be, just to name a few.  Luckily, these are all conditions that we look for during an initial orthodontic evaluation. Treating these orthodontic problems is ideally done while the child is young. We recommend a child be screened by an orthodontist at around age 7. Because the permanent teeth haven’t yet erupted completely, it’s possible to evaluate the relationship of the teeth to each other and to act on any potential problems at the earliest stage. Any correction that is needed can be addressed at this point, and make future orthodontic treatment easier and more expedient.

Memorial Day, originally called Decoration Day, is a day of remembrance for those who have died in our nation’s service. In our celebration this weekend, we are observing an American ritual dating back to May 30, 1868, when General John Logan, in his General Order No. 11, ordered flowers placed on the graves of Union and Confederate soldiers at Arlington National Cemetery. Since then the observance has changed, but I feel it is important that we all still take a moment in recognition of those that died to keep our country the amazing place it is today.

On a lighter note, Memorial Day is also the unofficial start of summer.  To all of you reading this entry, let me wish you and/or your children an easy finish to the school year and an awesome summer season.  What about you? What are you up to this Memorial Day weekend? Whether you are headed out of town, visiting family and friends, or just relaxing around the house, we’d love to hear about it!  I’m sure we’re all looking forward to some fun in the sun!  Be safe, and we’ll see you at your next appointment!

Everyone at L&M Orthodontics wants to say thank you to all of our wonderful patients for entrusting us to give you that beautiful “Star Smile” that you have always wanted. It is truly a pleasure and a blessing for us to not only to share in the special moment when  your magical new smile is revealed,  but we also appreciate the friendship that we have been able to establish with our patients along the way.  To honor you, our patients, we are having a Patient Appreciation Water Ice Day (Free water ice for our patients and friends of our patients) during the dates and times listed below.  Whether you have an appointment on those dates or not, we hope you can stop by and let us thank you.

Glenside Office: Friday 5/31 2pm-5pm
Doylestown Office: Wednesday 6/5 2pm-5pm

In honor of all the wonderful mothers, L&M Orthodontics is offering $500 off of Invisalign treatment during the month of May. Shout out to all the moms, you are amazing. Being a mother is the hardest job on earth! Moms are often tirelessly contributing in the work force, supporting their spouses, parents, siblings and in-laws, acting as the provider to provide for their children’s needs, and creating a happy home. Most importantly, though, moms gave birth to everyone of us and helped mold each and everyone of us into the people we are today.
So often in the orthodontic profession, we witness moms sacrificing their dental health and opportunity to improve their smile in order to provide orthodontic treatment for their children. In doing so, these wonderful women miss out on the well-being and self confidence that comes with a beautiful new smile. If you are mom, or know a mom, who wants to improve their smile, we at L&M Orthodontics would like to help by making Invisalign treatment a reality.

For those of you that don’t know, a mouth guard is a removable appliance made from a soft and flexible plastic, which is adapted to comfortably fit and protect your teeth. There are multiple variations, including the preformed (ready to wear) variety, boil and bite type, or custom-made mouth guards.  As can be expected, they come in all different design, colorations, and of course, prices.

Mouth guards hold top priority as sports equipment, even for those of us that aren’t in braces. During physical activities, a blow to the face could chip or fracture teeth, as well as damage your braces and other fixed orthodontic appliances. In more severe cases, trauma can affect not only the teeth, but also the lips, cheeks, tongue, and other oral structures.

Research shows that most injury to the oral environment occurs when athletes are not wearing mouth protection. Taking this into consideration, most organized sports have begun to require mouth guards to prevent injury to their athletes. Mouth guards help to protect your teeth from the blunt force of impact, and in most instances can prevent damage from occurring. Additionally to protecting the teeth, they aid in limiting the occurrence of concussions and jaw fractures. For those of us with braces, a mouth guard also provides a barrier between your appliances and your cheek or lips, limiting the risk of soft tissue injuries. Our recommendation is that a mouth guard should be worn whenever participating in an activity with a risk contact with other players, equipment, or the surrounding environment. This includes, and is not limited to, football, baseball, basketball, soccer, hockey, skateboarding, gymnastics, etc.

So, which mouth guard is right for you? A mouth guard should cover both the fronts and surfaces of your teeth fully.  You have many options out there, so make sure to choose one that is comfortable to you, and allows for easy breathing and wear.  For people with braces, you may opt to choose a mouth guard with coverage for the top and bottom teeth, since the braces can cut up both your upper and lower lips.  Also, while in braces, the ready to wear variety is preferred, since both boil and bite and custom mouth guards form to the current position of the teeth, and will inhibit our planned tooth movement (or will not fit after the braces move your teeth).  Any mouth guard is better than no mouth guard, so choose a mouth guard that feels right to you. If you have any further questions, Dr. Lee and I will be happy to advise you on what type of mouth guard is best in your situation.

That being said, the next time you’re in for an appointment, let our staff know if you’re planning to play any sports. We have orthodontically compatible mouth guards available for our patients, and we make custom mouth guards in the office. For those of you participating in summer sports, keep an eye on our Facebook page for our custom mouth guard event in June. And for everyone, make sure to wear a mouth guard!