Neal, Leonard, and Sorensen Implant, Facial, and Oral Surgery

Baby Teeth

My child has no teeth, he is 9 months old. Is there a problem that I should get checked out? I worry about this because he has been so early at all the other developmental stages.

Dana Martin – Indiana

For an infant, the mouth is an exquisitely sensitive portal connecting the world around him to his developing mind and body. He uses his mouth to meet his mother, to sate his constant hunger, to comfort himself between feedings, and to explore objects in the widening world around him. When hard teeth begin protruding into this soft, sensitive orifice, it is a major event in the life of an infant.

Many parents worry about the timing of the appearance of their children’s teeth. While the average time for the appearance of the first teeth is between five and seven months of age, there is a wide normal variation of timing. The teeth might come in as early as one month of age, or they might wait until a child is almost one-and-a-half-years old. Anywhere in this range can be normal.

Generally lower teeth come in before upper teeth, and generally girls’ teeth erupt earlier than those of boys (much like with everything else). Delayed eruption of all teeth may be the result of a nutritional problem, such as rickets, or a systemic condition, such as hypopituitarism or hypothyroidism.

Natal teeth or teeth present at birth are found in about one out of two thousand newborn infants. These are often extra teeth, but this should be confirmed radiographically before any attempt is made to remove them. Natal teeth may cause pain to the infant, poor feeding, and, if the baby is nursing, maternal discomfort. Natal teeth may also cause damage or even amputation of the tip of the newborn’s tongue due to strong sucking behavior. Early appearance of all teeth may indicate a hormonal problem such as hyperthyroidism.

The following tables outline the normal ranges for teeth to erupt and to shed:

Eruption of Primary or Deciduous Teeth


  Upper Lower
Central incisors 6-8 months 5-7 months
Lateral incisors 8-11 months 7-10 months
Cuspids (canines) 16-20 months 16-20 months
First molars 10-16 months 10-16 months
Second molars 20-30 months 20-30 months


Shedding of Primary or Deciduous Teeth


  Upper Lower
Central incisors 7-8 years 6-7 years
Lateral incisors 8-9 years 7-8 years
Cuspids (canines) 11-12 years 9-11 years
First molars 10-11 years 10-12 years
Second molars 10-12 years 11-13 years


Eruption of Permanent Teeth


  Upper Lower
Central incisors 7-8 years 6-7 years
Lateral incisors 8-9 years 7-8 years
Cuspids (canines) 11-12 years 9-11 years
First premolars (bicuspids) 10-11 years 10-12-years
Second premolars (bicuspids) 10-12 years 11-13 years
First molars 6-7 years 6-7 years
Second molars 12-13 years 12-13 years
Third molars (wisdom teeth) 17-22 years 17-22 years

(Adapted from chart prepared by PK Losch, Harvard School of Dental Medicine, from Nelson’s Textbook of Pediatrics.)

If a permanent tooth becomes visible before the primary tooth above it has fallen out, generally the primary tooth should be extracted.

I hope that gives you enough to chew on!

Have you ever seen “Harry” Tongue? He’s NOT the new neighbor on the block!!

Hairy tongue, also known as black tongue, is a gentle condition of elongation and staining of the fingerlike projections (papillae) on the tongue surface. This condition may be caused by overgrowth of a bacteria or yeast that produces a colored substance. Hairy tongue can occur at any age. Hairy tongue is rarely symptomatic, although overgrowth of Candida albicans may consequence in glossopyrosis. Medications that commonly cause hairy tongue comprise antibiotics, anti-psychotics, anti-depressants, and anti-cholinergic agents.

Contributory factors for hairy tongue are many and contain tobacco use and coffee or tea drinking. These factors account for the various colors related with the condition. Tongue problems include pain, swelling, or a change in how the tongue looks. The prevalence of hairy tongue varies broadly, from 8.3% in children and young adults to 57% in persons who are addicted to drugs and incarcerated. Hairy tongue has been reported with greater frequency in males.

The treatment of hairy tongue is variable. Practice good oral hygiene for hairy tongue and black tongue. Be sure to eat a well-balanced diet. Antihistamines can help relieve a swollen tongue caused by allergies. Surgical removal of the papillae by using electrodesiccation, carbon dioxide laser, or even scissors is the treatment of last resort when less complicated therapies prove ineffective. Topical application of retinoids has been used with some success.

Keratolytic agents are effective but may be irritating. Gently brush the tongue with a toothbrush twice daily. Maintain good oral hygiene with regular tooth brushing. Minimize mouthwash use and avoid smoking or chewing tobacco. Eat more foods with fiber (fruits and vegetables); sucking on pieces of fresh pineapple may also be helpful. You should avoid the food or drug that causes the tongue swelling. Therapy may be needed to improve speech and swallowing ability.

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Oral Cancer

Oral cancer is cancer of the mouth,head, and neck. It most commonly involves the tissue of the lips or tongue. It may also occur on the floor of mouth, roof of mouth, gums, and the cheek lining. Most look very similar under a microscope and are called squamous cell carcinomas. These are cancerous and spread very quickly.

Smoking and other tobacco product use are the cause of 70-80 percent of oral cancers. Heavy alcohol use could also increase the risk for oral cancer. Other factors include chronic irritation, human papilloma virus, and poor dental and oral hygiene. Some oral cancers begin as a white plaque or as a mouth ulcer.

Visual symptoms include a sore, lump, or ulcer. Other symptoms include chewing problems, pain with swallowing, abnormal taste in mouth and speech difficulties.

Tests used to confirm the diagnosis inlude a biopsy and microscopic examination of the area.

Treatment is usually a sugery to remove the tumor. Surgery combined with radiation therapy and chemotherapy may be necessary for larger tumors or if the cancer has spread to the lymph nodes in the neck.

Approximately half of people diagnosed will live more than 5 years after being diagnosed. If found early, before it has spread to other tissues the cure rate is nearly 90%.  Unfortunately 25% of people with oral cancer die because of delayed diagnosis and treatment.

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Kisses may spread cavities to your baby.

It’s true. Kissing, sharing utensils or any other action that transfers saliva from you to your baby puts them at risk for cavities. The cavity causing bacteria, otherwise known as Streptococcus mutans is harmful to the soft enamel of a baby’s teeth making them prone to decay and other oral hygiene problems as your child grows. 
Mothers don’t be afraid to kiss your babies. Only people with active tooth decay can spread Streptococcus mutans bacteria and there are several things that can be done to improve both you and your child’s oral health.
To read the full article found on MSNBC and find out what you can do to prevent the spread of this cavity causing bacteria click the link below:

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Tongue-Tied ?

Ankyloglossia or a persistent lingual frenulum is a congenital persistence of tissue which binds the tongue to the floor of the mouth.  When severe, the frenulum should be cut to mobilize the tongue.

A doctor can diagnose this condition during a physical exam. The exam will show that the tongue tissue is attached too far forward.

Surgery is seldom necessary but if it is needed, it involves cutting the abnormally placed tissue. If the child has a mild case of tongue tie, the surgery may be done in the doctor’s office. More severe cases are done in a hospital operating room. A surgical reconstruction procedure called a z-plasty closure may be required to prevent scar tissue formation.

The complications are rare, but recurrence of tongue tie, tongue swelling, bleeding, infection, and damage to the ducts of the salivary glands may occur.

If you are concerned that your child may have tongue tie, have your health care provider examine it during a routine well-baby examination.

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Firsthand Experience… and I work here!

After 27 years in the Dental Biz (orthodontics & general dentistry & oral surgery), I am now experiencing “up close & personal” what modern oral surgery and dentistry have to offer a 50-something midlife mama who has lost multiple teeth just over the last three years due to fracture, dry mouth-induced decay, and heredity.

I am in the process of getting implants and crowns to restore the function and appearance of my teeth.  I am excited about this adventure! My bite will be back to normal, the crowns will be bright and natural-looking, and I won’t have to worry about the boneloss and shrinkage that caused people my age in generations past look old before their time. This mama is NOT goin’ there anytime soon!

So stay tuned for future episodes of Corinne Gets a New Bite! And feel free to ask me personally how I feel about the process :).

🙂 Corinne Nicole Spranger, Treatment Coordinator, Kirkland Office

Xylitol helps prevent cavities

Chewing gum, eating candy with Xylitol can actually help prevent cavities.
What is great about this natural sweetner is that made from the bark of white birch trees, corn cobs and many fruits and vegetables. It has a low glycemic index of 7.0, so it is a good sweetner for people with diabetes. But too much can have a laxitive effect. It is good to start slow. The “all Xylitol” Gum has about 1 gram per piece & “all Xylitol” mints about 1/2 gram. Work up to a target of 6-12 grams per day. It is good to rinse your mouth after eating & either chew gum or use a mint with Xylitol.
Cavities/Dental caries is a bacterial infection on the teeth, specifically the biofilm on the teeth. When it becomes infected the biofilm becomes acid-producing, (low ph), 7.0 is neutral, which can then cause the cavities.
Simply by adding 6-10grams a day to your diet can actually kill the Streptococcus mutans bacteria, which is one of the main know bacteria to cause tooth decay.
The University of Washington had a Xylitol gum chewing study a couple of years ago & it was proven to stop the production of bacteria that caused cavities, my husband was in that study. The gum was tasty & the mints with Xylitol were quite good.

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Can flossing actually add years to your life?

I know you’re thinking, yeah, yeah, my dentist and hygienist are always nagging me to floss more.   Is it just so their job will be easier, or is it really that big of a deal?

I did a little research, and studies show that people who floss daily, actually live an average of 6.4 years longer than people who only floss the day before their dental appointment (yes, I’m talking about you.)

Flossing not only reduces your risk of gum disease, but heart disease, too.  So, it turns out that my husband’s new year’s resolution to floss everyday isn’t so weird after all.  I’ve gotta go buy some more floss.

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Post Operative Care Instructions Following Oral Surgery

proper care following oral surgery procedures will hasten recovery and prevent complications.


Minimize strenuous activities for 24—72 hours after surgery.


Remove the gauze from mouth 1 hour after getting home and before drinking or

eating. A small amount of bleeding is normal on the first day and night.


After surgery, liquids are acceptable when desired. Allow for the numbness to

cease before beginning solid foods. The day after surgery, eat as desired and

tolerated. Encourage clear fluid intake, initially, then progress to soft foods.

Smoking, spitting and usage of straws will increase the risk of painful osteitis or

dry sockets, which will delay healing.


It is normal to have swelling of the face after surgery. Use ice packs (ice in

plastic Ziploc bags covered with a towel) for 3 days after surgery. It is important

to place the ice pack on the outside of the face, alternating sides, 15 minutes on

15 minutes off. On the fourth day after surgery, switch to a warm moist towel

compress. Usually the largest amount of swelling occurs on the third day after



Tomorrow rinse mouth gently every 3-4 hours (especially

after meals) using 1/4 teaspoon of salt or baking soda to a glass of warm water.

Continue rinses for several days. Teeth may be brushed the day after surgery,

stay one tooth away from surgery sites. Toothpaste may be used but avoid

mouthwashes containing alcohol.


Small bone fragments may work through the gums during healing. These are not

roots. Please contact the office to have your surgeon evaluate them if they occur.


Pain medications and antibiotics can cause nausea. Take medications with an

adequate amount of soft food to help prevent nausea. Classic Coke and clear

carbonated liquids are helpful in preventing nausea. If nausea still continues,

discontinue narcotic pain medications. Substitute with Ibuprofen. Discontinue

antibiotics only if your surgeon recommends this.


Use narcotic pain prescription only if needed. Substitute or use in conjunction

with 600 mg of Ibuprofen every 6 hours


Dissolvable sutures will dissolve on their own in 7-10 days. Sutures may

become loose, irritating or may come out. This is usually not significant. Any

questions or concerns please feel free to contact the office.


Numbness from the injection site should wear off in 2-8 hours after

surgery. If any symptoms occur which you feel are unusual or are concerning

you, please call at once.

 Neal Oral and Maxiofacial Surgery