List of subjects on which I would be happy to correspond or send information to people

What are Terror Teeth?

Terror Teeth are removable, extremely fun and frightening monster teeth, custom made from a model of your own teeth. They are made so securely that no adhesive is necessary to keep them in place. They match the color of your teeth and are guaranteed to scare away other people and maybe even yourself. You can become a vampire, a witch, or even a “Billy Bob”. We make them to fit each individual mouth so they are very comfortable and the Gothic vampire teenagers love them.

We have a 5-year-old granddaughter with very bad teeth caused by high fevers as a baby, which the dentist says caused softening of enamel. He recommended calcium supplements along with foods high in calcium. Could Tums antacid, which is high in calcium, be used?

I would imagine that they could, but I hesitate to recommend them for use in a child. A good source to contact in the instance that your pediatrician won’t take a stand on this type of supplementation is your local pharmacist. I’m not sure you really want to introduce the buffer capacity to the child at this stage in her life. Did your dentist mention the use of ingestible or topical flouride ? The topical fluoride will help the teeth already in the child’s mouth; the systemic or ingested fluoride will help the developing adult teeth.

Please also limit the drinking of milk, breast milk or formula before bed and push plain water as the fluid of choice when drinking throughout the day.
Marianne W. Schaefer, D.D.S

My 8 year old child had an abscess on her gum [top]. When it first appeared it caused her pain. We went to the dentist for her 6 month check and I mentioned it to the hygienist. As I was paying, the receptionist told me she needed to come back for an antibiotic for the abscess. Fluid did come out of the abscess before the dentist visit and after that it did not cause her any more pain or discomfort. Does she need antibiotics or has it taken care of itself? She no longer has pain or swelling.

It is difficult to assess the nature of the infection without examining your child. Her abscess could have been a food impaction and the hygienist might have dislodged and cleaned it out. On the other hand, the abscess could have been from a cavity or a filled tooth and it will tend to reappear. I suggest you re-contact your dentist and share your concerns about you child’s dental health. He or she may want to take an x-ray (which is a very good idea) and review the area before prescribing antibiotics.
Marianne W. Schaefer, D.D.S

I recently noticed that our 10 month old child has a pronounced a ridge which runs parallel to the tooth-producing ridge. It is white as if it is also to produce teeth. She has five teeth in the usual places for this age. The roof of her mouth (where here tongue rests) is very restricted in size due to this ridge.

It is possible that you are seeing a normal configuration in your daughter’s oral cavity. There are small ridges on the interior roof of the mouth that have been associated with diction and speech development called rugae. However, not having the privilege of seeing your daughter I will suggest you take her to a pediatric dentist for a quick inspection. I am a true believer in prevention of oral problems and to be on the safe side you might want this type of evaluation.
Marianne W. Schaefer, D.D.S

I have a 6 year old who has a case of extremely bad breath! He brushes his teeth with AquaFresh Kids toothpaste and uses Listerine mouthwash afterwards. He brushes twice a day but it doesn’t work! My husband thinks he has halitosis. Can a child suffer from that too? By the way, it’s no use even when I brush them! Please help me, my son says his classmates tease him about it and I think it’s affecting his self-esteem.

It is interesting to note that adults and children frequently have bad breath that has nothing at all to do with oral hygiene. Oral odors can originate from several sources (nasal/pharyngeal, gastrointestinal, and auditory canal spaces.) If a person experiences upset stomach or constipation, the reflux odors can be detected on their breath. Most of the time buffering the acid, changing the diet and including 8-10 glasses of water in the daily diet is enough to help. When the sinus and pharynx become more mucousal, this odor is the most common among children. You should consult with an ear, nose and throat doctor for your child.
Marianne W. Schaefer, D.D.S

I am trying to find out the origins of the tooth fairy and her original purpose. Can you help? My two daughters and I would love to know. Thank you.

The tooth fairy in her current “American” derivation is a Celtic offshoot. Although many cultures have myths dealing with the loss of teeth (particularly the pediatric ones) the fairy as we’ve come to know her is one of English/Irish derivation. The loss of teeth can be viewed as a frightful thing (some psychologists rank it second to castration as one of the most profound personal fears). The fairy is supposed to leave a barter of gift for the tooth. Some stories have it that the fairy uses the teeth to build his/her kingdom. Others believe that the teeth impart eternal youth or magical powers to the fairy. Hope I’ve given you something to think about.
Marianne W. Schaefer, D.D.S

What is the going rate for baby teeth from the tooth fairy?

I think that you’ll find that the going rate can be as little as a quarter or as much as five dollars (which reflects the average cost of a Beanie Baby).
Hugs and kisses. Marianne W. Schaefer, D.D.S

Does it hurt when baby teeth come out by themselves?

Consider that the small pinches you feel when a baby tooth comes out on its own are really more likely itches when your back needs a scratching or like the pinches when you mommy brushes your lovely hair and ends up pulling on it. Don’t be afraid! Let those teeth out and get ready for the neat-o-bandito prizes the fairy will bring you. Marianne W. Schaefer, D.D.S

What does the tooth fairy look like?

The tooth fairy is one of the oldest and most successful fairies in the history of the “little people” Very few have actually seen her true essence. She may not even be a she – she could be a little male fairy for all we know. She is a shape shifter that allows her to cover her true image with a projected image from your brain or psyche. This is why so many children believe that their parents are really the tooth fairy – she or he fools the child by projecting the parental image upon itself. If you ever lie quietly in your bed and you peer through the side of your eye and see a bright flash of light, you may have indeed caught the tooth fairy in action!! Marianne W. Schaefer, D.D.S

Our 18 month old daughter enjoys playing with her toothbrush. We of course encourage the use of her toothbrush but sometimes she wants to play with several toothbrushes, including ours (her parents). I say this is not healthy because of germs she would be introduced to, especially if she puts them in her mouth. My wife insists there are no health risks. Who is right?

Children receive their first oral bacteria from their mothers/fathers’ mouths. Some cultures allow adults to kiss their children on the lips causing an introduction of “familial” bacteria. Other mothers introduce these bacteria through shared feeding techniques. I don’t encourage bacterial sharing but find that with small children this is frequently impossible to avoid. I would think that unless a serious communicable disease exists in your home (AIDS, hepatitis, tuberculosis) your concerns about your own oral flora are minimal. But why does your child have to have your brushes as well? Shouldn’t you be setting boundaries for him/her that might include your personal hygiene instruments? Marianne W. Schaefer, D.D.S

I have a 5 year old son who unconsciously grinds his teeth at night. His upper and lower center and lateral incisors are flat and I am really concerned about this. Please advise me on prevention and treatment before it creates permanent damage to his teeth.

The grinding of teeth by children is considered a reasonably normal response to the irritation caused by the pressures of the eruption of the other teeth. Many practitioners feel that the child will merely outgrow this habit when they feel more comfortable and they frequently do. Regardless of this fact, there is no known preventive pediatric intervention being practiced currently for grinding or bruxing. Some holistic or homeopathic pediatricians have suggested the use of herbal remedies (such as valerian) as mild sedatives. Before using any such remedy, I suggest you check with your current treater to see if they agree with this type of medication. Most patients don’t realize that herbs are medicines too and must be treated with respect and used in a directed and supervised fashion.
Good Luck, Marianne W. Schaefer, D.D.S

I would like to know when children’s teeth erupt and then when they fall out?

Children’s teeth begin to erupt between 5-8 months starting with lower front incisors and followed by the upper front incisors. The pattern is fairly consistent (lower always followed by upper teeth with the full compliment of baby teeth achieved by the 28th-43rd month). The first adult tooth is typically the first molar appearing in the back of the 6-year old’s mouth behind the other deciduous (or baby teeth) followed again by the pattern at 6-7 of lower incisors. It will continue until the entire adult dentition has entered the mouth close to the child’s 12th-13th year. Hope I’ve helped you. Marianne W. Schaefer, D.D.S

Do you have a tooth fairy?

I was told that I have a special invisible someone who follows me around to aid and protect me in my life’s journey. This little spirit guide is named Ruby according to the patient who channeled and was supposed to have seen her as my personal tooth fairy!
Marianne W. Schaefer, D.D.S

Dear Tooth Fairy: You picked up the teeth my daughter has lost and she wants a refund, the teeth for the money you left, she didn’t want to let them go. If could let her know it is ok for a refund or not, she would like to have her teeth back that she was saving. There was one whole and one broken in half. Her sister took them and put them under her pillow. We would appreciate an answer as soon as possible, you can contact me, the mom, online at ######## for my little Elizabeth I would be grateful.

I am very sorry to report that as I pick up teeth on my journey, I give them to my sprites who put them into immediate use. Your daughter’s were made into a part of our Olympic sized swimming pool, which is now filled with water. If she feels that I didn’t compensate her adequately, please assure her that I will drop something additional off when I fly by soon! Gillian, assistant to the fairy.

Where does the money come from that the tooth fairy gives you after you loose you teeth?

The currency that the fairy uses is collected by her sprites and imps who scour the globe nightly looking for the money behind sofa and chair cushions, Occasionally, they will also find money outside of ATM machines and tollbooths. Marianne W. Schaefer, D.D.S Asst. to the fairy

My daughter will be 7 years old in March (1999) her right upper first molar (permanent) has erupted in an unusual place: near the tonsils/glands (nearer to the throat) away from the normal tooth-bearing bone structure. It looks both frightening and funny. What may have caused this to happen? Is it possible to remove the tooth (surgically) without complications, now or later?

Wow!! This is one of those questions that stump all of us including many pathologists. Sometimes developing tooth buds occur in unusual spots (such as when children suffered from cleft lip and palate abnormalities). Tooth buds and residual alveolar ridge material have been found in various parts of the mouth where they are not expected. Please question an oral surgeon as to the course of action. This would be an unusual set of circumstances and you might also bring it to the attention of your local dental school pathology department as well!
Marianne W. Schaefer, D.D.S

My 13 year old son has some white blotches on his teeth and some yellow stains due to high fever, flouride or antibiotics, I’m not sure. His two front teeth were covered with a bonding material about a month ago and they look much better. Eventually he will have to get porcelain bonds on many of his teeth. What is involved in this process and will his teeth eventually look normal and nice? A worried mom.

Don’t be overly concerned. As a wearer of veneers, I am completely satisfied with their longevity and aesthetics they have provided me. When your son is old enough, your dentist will conservatively roughen the outer surface of the teeth and take an impression of those teeth you and your son want covered. You’ll be able to choose the shade of the “covers” and in a week or so they get tried in place and with your permission, bonded. Mine have been in for 10 years without problems but they do have a life expectancy. The new techniques and materials continue to prolong the longevity of these lovely restorations!!
Marianne W. Schaefer, D.D.S

My 9 year old child, who has normal teeth, has had 2 fillings fall out that were only about 22 months old. Now he has a deep cavity in the one, which may need to be extracted, and a small cavity in the other. Is it normal for fillings to fall out after such a short time? I had fillings as a child and none of mine fell out. What do you think?

It is difficult to put a timeline on dental work for children, although just shy of two years is rather short. What material did the dentist use? If he/she used composite or acrylic the life expectancy is considerably shorter. Did the dentist warn the child and you about the effects of sticky candy, as these seem to be a favorite among children and they do seem to have a tendency to sneak them? Please pose these questions to your practitioner and see what they have to say about the length of time. I have found that most treaters really are sincere in wanting to help maintain their patient’s dentition and not just their own pocketbook! Marianne W. Schaefer, D.D.S

My 7 year old daughter recently had a very large cavity filled and has been experiencing discomfort ever since. She now has an abscess. One dentist recommended I have the baby tooth removed because root canals were not effective on children. Another dentist described the root canal procedure that he wished to undertake which entailed removing the current filling and medicating and cleaning the canals. After reading some information about root canals they (the articles) mention removing the diseased nerve tissue. What does the root canal procedure really mean? Cleaning or removing? Also if she does have the nerve removed would she have problems when her second teeth come in? Any advice, help you offer would be greatly appreciated.

A child’s version of a root canal procedure is known as pulpotomy. It is simply done by cleaning (which is also removing) the nerve tissue and placing a variety of medicaments to help mummify tissue and kill bacteria. Following the procedure, calcium cements seal the canals and either a filling or a crown can be placed as a restoration until the permanent tooth pushes the baby tooth out. Pulpotomies are standard and accepted pediatric procedures. The only time an extraction is indicated is when the remaining tooth structure is not sufficient to hold a filling or crown.
Thank you for your question, Marianne W. Schaefer, D.D.S

My son went to the dentist on Tuesday and they had to give him 4 shots of Novocain before they started to work. On Wednesday, yesterday evening he got a really bad upset stomach, vomiting etc. Could he be having a bad reaction to Novocain or did he get the stomach flu?

It is unlikely that he is reacting to the anesthetic in such a delayed fashion. Heart palpitations, dizziness, and vomiting—if they would occur—would most likely manifest themselves within hours of the administration. I think he has the flu. Thank you for your question, Marianne W. Schaefer, D.D.S

What would be an appropriate use of dental sealant with cavity-prone children? Are there any published clinical standards of care pertaining to this?

Dental sealant, like other dental restoration materials, are to be used at the direction of licensed practitioners. The aggressiveness or conservativeness of a particular treater determines the “how”, “when”, “where”, and “why” they might be placed. Personally, I place sealants in the permanent first and second molars of children who: 1. Show a high degree of decay in their primary dentition. 2. Whose permanent teeth are very deeply grooved and catch the tip of my explorer. 3. Whose parents understand that proper hygiene must still be maintained. Thank you for your question, Marianne W. Schaefer, D.D.S

My 7 year-old daughter needs to have her #1 extracted and has been referred to an oral & maxillofacial surgeon. Her original dentist says that the roots of the tooth are fused with her bones. After 1-2 hours of trying to pull the tooth out she referred me elsewhere. I have contacted two different dentists in that field and have been presented with two different options. One suggests sedating my daughter with Ketemine, which will put her out for the surgery. He also mentioned that my daughter would still be out after the surgery and I would need to carry her to the car. The other is totally against sedating a child and would used local anesthetic with nitrous oxide. I have gotten a bunch of views from family and friends on the danger of both options. Please let me know if you have any views that might help me make my decision.

I feel the sedation of an adult or child should be undertaken as a last ditch effort. It holds great risks and I’m sure local anesthetic could remove all semblance of pain. A light medication or nitrous oxide might help alleviate her fears and be far less risky. I recently encountered a child with a similar problem. The extraction nearly did me in as well. He seemed to come through the entire procedure with very little residual concern. If you chose the sedation option, please make sure the procedure is performed by a board-certified oral surgeon or with a board-certified oral surgeon in a hospital setting. Thank you for you question, Marianne W. Schaefer, D.D.S

Hi my name is Chris and I just turned 6 and lost a tooth. I am taking care of my teeth and hope you come to visit me tonight. If you do I sleep in the bottom bunk bed. Thank you so much… Love, Chris.

I must tell you that you have beautiful teeth and that I appreciate you taking such good care of them. The tooth you lost as well as others you are yet to lose will be used to help repair my throne room. Only the cleanest and most nicely shaped teeth end up here. Best wishes, T.T. Fairy

I was told by the dentist that my son had “tongue thrust”. She said he did not have enough room in his mouth for his tongue. His jaw was too small, and would lead to further problems. I believe she said he should have 35mm or room in the back of his jaw (lower) and he only has 31mm.

If your child’s oral condition is such that he is faced with spacial compromise, may I suggest that you may wish to engage a second opinion with a pediatric treater this time. If your dentist already specializes as a pediodontist, you may want to consider that oral changes are usually not initiated any earlier than the age of 8 or 9. Commonly orthodontics, jaw surgery, tooth extraction, or reduction of lingual dimension are not performed until puberty. Please feel free to write me back if you wish for more information.
Marianne W. Schaefer, D.D.S

I lost my two first baby teeth today.
From: Ashlee

We just got your message. Please forgive my delay in corresponding. Congratulations on becoming an adult. The loss of those teeth opens a whole new world to you. Soon you will have your own telephone, your own car, and more clothes than even Barbie. Much love, Marianne W. Schaefer, D.D.S

I need to know how to stop my 5 year old from sucking her fingers? We have tried many things, any other suggestions?

Have you tried using substitution of a desired object (such as a toy)? Have you tried marking the desired appendage with either nail polish, a band aid, or a flavorant to help the child recognize the frequently unconscious habit? Would you consider the placement of a retainer in the mouth of the child to physically alter the thumb sucking habit? These are questions that you ask your general practitioner or pediatric treater.
Marianne W. Schaefer, D.D.S

I have a 9 1/2 month old daughter who has cut seven teeth. However, three of her incisors are in at the bottom and the tops are in, but one of the lower incisors has not yet come in! Could there be something wrong? Isn’t there usually an order? Also, she is grinding her teeth. It’s driving me crazy and can’t be good for her. How do I get her to stop?

It is a God-given grace that we do not remember the pain experienced during tooth eruption. Try, just for a moment to imagine the pressure and the pain your child feels in her mouth as her teeth cut through the tissue coming into position. It is the supposition of most dentists that children grind due to the discomfort that they experience. A hard teether might help her. Don’t worry about the missing tooth just yet.
Marianne W. Schaefer, D.D.S

Hello! I have a three-year-old son who just came down with a canker sore. What treatments are out there for him? Also, is there anything we can do to prevent them? My husband has a problem with them and we never expected our children to come down with canker sores at such a young age.

Cold sores are generally spread via oral contact. Although I am not casting aspersions, perhaps your husband was the person to have gifted your son with this originally. Most cold sores run a 14-day cycle. Some dentists (such as myself) have found that the ingestion of vitamin C on a regular basis and/or garlic supplements taken regularly tend to suppress the problem. When your body is at low ebb and your immune system is compromised (such as during a cold) the lesions could arise again. There are hefty prescription drugs available for adults, but I don’t think that they would be appropriate for your child.
Marianne W. Schaefer, D.D.S

Dear Dr. Schaefer,
Thank you for your reply. I will give my sister your number so she can have Samantha call if she wishes. She has been writing to the tooth fairy since she could write (she just turned 9). She believes that the Sandman is dating the tooth fairy. Cute, huh? Thanks again, Lisa

Thanks for telling me something I already knew (he he he) the tooth fairy is indeed dating the Sandman. They are very busy and they keep the same hours so they don’t always get a chance to meet. The tooth fairy and the Sandman share a common love of baroque music and I have it on good that the tooth fairy got her first kiss from the Sandman on her way to her carriage last Sunday. Pass it on.
Marianne W. Schaefer, D.D.S
Agent of the tooth fairy

My name is Elizabeth. What do you do with the teeth as soon as you get them? Thanks for the $1.00 for my tooth.

The teeth that I collect are placed in a large Jacuzzi tub filled with toothpaste. I allow teeth to soak to sparkly white and then I divide them into 3 categories. There are teeth so badly broken that we use them to make our roads. There are teeth filled with fillings and we use them to make walls of our castle.
Lastly the most perfect teeth are used to make my furniture (especially my throne). Currently, I am building a throne for my soon-to-be husband the Sandman. Where do you think I used your tooth?
The tooth fairy

Dear tooth fairy: I want to keep my tooth.
Hi my son has sent the above to you. He lost a tooth today and he wants to keep it. He thought that if he e-mailed the tooth fairy and asked, she might leave it. The innocence of a child is an amazing thing.

Dear Tyler: Sweetie, if you really want to keep your tooth who am I to take it. More power to you. I am one of the fairy minions and my instructions are to get each and every tooth. I am glad I intercepted you letter ‘cause her royal highness might have insisted that I take it. I just substituted a hamster tooth instead. Please let this be our little secret don’t tell on me or I could lose my job and go back to re-rolling frogs tongues that have lost their elasticity. Many thanks, Gillian (minion to the tooth fairy).

I am 10 years old and I just found out I’ve got my first cavity and my dentist will have to drill it. I’m really nervous!! Is there anything I can do about being nervous?

Your dentist and you are lucky to be living in a century in which we have all kinds of special medicines that will make your tooth sleep through the entire teeny tiny operation. You will feel good, you will feel empowered and if your dentist is nice you leave his/her office with a prize. Please write me back and tell me how it went. Please ask your dentist if your mom or dad can stay with you in the room. Marianne W. Schaefer, D.D.S

I think you used my tooth on your throne. What does your robe look like? What does your castle look like? How many broken teeth are used on the road? I read a book that said this girl saw you and you looked like her mom, then her friend saw his dad. Do you remember that?

In order to protect my appearance, our creator has given me the power to shape shift. In other words, I can take on any appearance necessary for me to complete my tasks. If you look at me directly, you may only see a flash of light. Children who look out of the corner of their eye may see me in one of the images I have chosen appropriate for the moment (mother, father, grandparent, or treasured pet) My castle is large and ivory in color, and at the moment the Sandman and I occupy separate wings. I do have a variety of robes, but my favorite color is purple. My favorite “people thing” to do is to kiss the children I have visited. Unfortunately when I do I leave a bit of my fairy dust behind as evidences by beauty marks or freckles. If you don’t want any more freckles, just tell me and I will resist the urge to leave you a kiss the next time. Gillian, agent for the tooth fairy.

I’m 17 years old and I have never been to the dentist. My mom’s a single parent and my father won’t pay for half of the bills and I feel bad and don’t want to go and have my mom pay for all of it, even though she has a good dental plan from work. But I’m getting into the age where I want my teeth cleaned and I also have a gap, it’s not a big one but it is noticeable, but to have them fixed… Also I’m starting to have a pain in one of my teeth. I’ve asked my mom to take me but she’s always put it off. I asked her if I could get them fixed for my birthday and she said yes, she would give me the money. But I’ve never been there so… 1. I’m scared to death. 2. About how much would it cost to get a gap fixed? 3. How or what way would be best to fix it, braces or filling it in? Thanks a lot for your time.

Thank you for your poignant letter. Misty, you are one of the nicest young people that I’ve met. I think that your mother is very fortunate to have you as her daughter. I am sure that your mother has just put things off because she is very busy trying to earn a living of her own. Sometimes, you can access a dental school, using your mother’s insurance and keeping the cost additionally lower by allowing supervised students to help you. Other times there are other dental resources available that you may not be aware of but which can be accessed through family services or women’s groups. If you wish to write me back, and tell me where you live, I will try to help you further. Please don’t be afraid just continue taking the best care of yourself everyday and your problems will not be monumental. Marianne W. Schaefer, D.D.S

My son had a root canal last year, the dentist broke the bit off and it fell into the canal. We did not retrieve it but filled the tooth, now the filling has fallen out, as a matter of fact all the fillings this dentist has done on our son have fallen out. Should we ask this dentist to re-do all the fillings and retrieve the drill bit, he still asked us to pay for the root canal after losing the bit. What should we do?

Your children are your most prized possessions. Their health and safety are in your hands. If you have any doubts as to the care they are receiving (as you obviously do) it would be much better for you to interview another practitioner and start fresh. Please consider having your children seen by a pediodontist. Request every single x-ray (or copies of such) from your previous treater. Good luck, Marianne W. Schaefer, D.D.S

Are you real? My son, Michael (age 7) and my daughter, Melissa (age 8 1/2) don’t think there’s such thing as a tooth fairy. Also, could you tell them how important it is to brush their teeth thoroughly at least twice a day? I would appreciate your help.

As far as we are concerned, the tooth fairy is very real. Other children continue to write me about their experience with the Fairy. I think it is important for you children to know that the biggest concern is that sometimes the Fairy returns teeth that are dirty or badly broken down. This comes as a tremendous embarrassment to most of the children who write to me asking me to help them with these teeth the Fairy no longer wants to take. I must tell them that there is nothing that I can do, that they must take care of their teeth while they are in their mouths. So must you. Marianne W. Schaefer, D.D.S

My 15 year old son has had two panoramic x-rays within seven months. I was not consulted in either instance. I did not even know they were being taken, as permission was not asked of me. (I was sitting in the office waiting area). He has nothing wrong with his teeth; that is no cavities and I have been told he does not require braces. (He has perfect teeth the dentist told my husband.) Why would they need to take x-rays? When I questioned my son, he said they did not ask him just went about it routinely. He thought I knew about it. Also he said the assistant said something about the first one never turned out correctly. (I repeat, I did not even know about the first one…not until March 19th when my son told me of the second one.) He is really worried about the radiation especially since his grandfather just recently died of cancer. Please let me know how I can get some information on this. He likes his dentist and I do not know whether it is warranted to confront him on this issue based on our emotions about cancer.

Yes, I think you should confront your dentist. Informed consent is a very “hot” issue in the area of malpractice these days. In case of treatment for a minor child, adults must be present or given written permission if not present. In our office, we not only ask the adult but also involve the child as to whether we may perform any procedure no matter how minor. I don’t think that your child was harmed from radiation, but I think that the practitioner needs to improve his communication skills. Your feelings are valid, follow through with them. If you have additional questions about the amount of radiation sustained during x-ray procedure, please contact your local dental school’s radiology department. Marianne W. Schaefer, D.D.S

Why haven’t you taken my tooth yet, because it’s been a week.

As the agent for the Fairy, I can tell you that sometimes things don’t go as planned here at the castle. We try very hard not to let personal problems interfere with the all-important work of retrieving teeth. I shouldn’t even be telling you this but I have to tell someone. The tooth fairy has been dating the Sandman, and they had a very large argument and he left in a huff. The tooth fairy has not been herself since. We’re all sure that with our help and affection we can bring her back to her old self in time. Thank you so much for your correspondence. Gillian, agent for the tooth fairy

Why haven’t you come to get my tooth yet. It’s been a week already.

Again, our deepest sincerest apologies for the Fairy’s delay. Please share your disappointment with your mom and dad. Frequently, a letter from a concerned parent is all that the tooth fairy needs to get off her throne and out into the field. Gillian, agent to the tooth fairy.

My 3 year old daughter fell down and hit her mouth 2 weeks ago. She cried for a few minutes. There was no visible bleeding. My wife noticed a dark coloration (dark reddish/purple) appearing on her gums that started at the top of her gums and streaming down exactly to the vertices where her four upper teeth met. We called her pediatrician and he asked whether the child was in pain. She was not. We thought that it was due to her dosage of iron supplement but he said that it was the correct dosage. The coloration disappeared within the following 4 days. A week ago, my wife noticed that her upper front teeth had a darker coloration. I couldn’t really notice then but today I definitely noticed it, especially on the upper front 2 teeth. We also noticed that we could move one of those teeth with our fingers. What do you recommend?

Please, please, please take your child to a pediatric dentist. She really should have gone immediately after the accident. Let her be examined. It is likely that the nerves in these teeth have been injured and may die. She may require procedures used to treat teeth that experience this kind of trauma.
Marianne W. Schaefer, D.D.S

My 12 year old daughter had a dental accident at age 7 which caused her to have a bonded front tooth. Since losing all her baby teeth & maturing, she now has a gap between her 2 front teeth, which she is extremely conscious about. When I asked our family dentist about having it capped, he stated that he would not do it until she was at least 15 and had gone through puberty. I understand his logic, however, I am dealing with an emotional pre-pubescent daughter who is being teased because of the gap and the fact that the bonded tooth sticks out. What are your feelings? Could I get this repaired now & what would be the potential consequences?

Please consider requesting a procedure that is less permanent involving bonding acrylic materials over the surface of the tooth to stimulate closure of the gap. All of us would realize that this procedure is a “temporary” solution to the problem, which really will be solved by crowning the teeth at a later date. Marianne W. Schaefer, D.D.S

My friend won’t brush his teeth, what should I tell him? Is there a tooth fairy?

What you tell your friend can be summarized in one word: “euwwww”. If they want to know how gross it is, ask them to scratch the surface of their tooth with their fingernail and smell it. The tooth fairy says, “Cleanliness is next to Godliness”. Marianne W. Schaefer, D.D.S

Why can’t my 8 year old see the tooth fairy? He would like to know why only adults are privy to the tooth fairy. By the way he would also like to know what is the going rate for each lost baby tooth?

The tooth fairy is a magical entity that does not wish to be seen in his/her actual form. Perhaps it is due to shyness, perhaps to the fact that the mystery tends to hold children’s interest longer. The going rate for teeth is determined by the loveliness of the tooth and the supply and demand at the castle. Ranges of fees can be as little as a dollar and as much as $5.00.
Marianne W. Schaefer, D.D.S

What does the tooth fairy do with your teeth? (Eric age 6)

The tooth fairy uses the teeth she collects to help build her castle. The building process has been going on for at least 150 years. Most recently, she has added a wing to the castle for her boyfriend, the sandman.
Gillian, Agent for the tooth fairy.

When my daughter was 12 she had a root canal. It hurt her for four years until my dentist recommended an “apicoectomy”:/services-provided/patient-education/#endodontics. (Tooth #30) She just had this surgery done in January. Just this week she had severe pain again and my dentist discovered that her tooth had never been sealed after the surgery and there was still cotton in the tooth. She lost the tooth, of course. Is she too young for a bridge and what are my other options for correcting this. Do you think the surgeon or dentist should be liable to pay for correcting this? I followed this with surgeon 2 times after the surgery and he said the tooth was fine. I was never told that the tooth needed sealed. I would appreciate any advice. Thanks a lot.

I am sorry you had this terrible experience. It would appear that “one hand doesn’t know what the other is doing”. My first piece of advice will be that you need to consider getting a second opinion with an independent dentist. One that will follow up with the work that has been provided for your family. My second piece of advice is that your daughter may want to consider a conservative bridge (such as a bonded bridge or a removable bridge) until she is a little older. Please do not leave the space or the teeth on either side; it will start to shift position. Marianne W. Schaefer, D.D.S

How much does genetics play in the development of a child’s first teeth? Even with no sweets, regular brushing, and good oral hygiene, and no bottle-feeding, he still has decay at age 2. Most dentists I called said that they’d see me if I wanted, but I didn’t need to start checkups until 2 1/2-3yrs. Also, 2months ago I took him to the dentist for a chip in his tooth, and he told me that the discoloring was "genetic"… only to find out from a specialist that there is real decay that has caps are in order, a procedure I’m already scheduled to have. Even with a gum infection 6weeks ago, my pediatrician missed this. I’m devastated over this whole ordeal and would like some feedback on this issue.

The amount of enamel present on both adult and pediatric teeth is a genetic trait. Genetics involving the teeth can be influenced by the ingestion and uptake of fluoride. If your water source was intentionally or unintentionally non-fluoridated your child might be more susceptible to dental caries. If you did not bottle feed your child, I assumed you nursed the child. Sugar is also a large component of breast milk and can cause decay in much the same way as formula when patients nurse their children after they have teeth. Frequently nursing is such a relaxing and nurturing experience that the child may fall asleep during the final nursing of the day. Mothers who lay their children to sleep after nursing without rinsing their mouths are putting them at risk for decay. I hope this information has helped you. Marianne W. Schaefer, D.D.S

I just took my 4year old son to the dentist who put two sterling silver crowns on two of his back teeth. These were pre-formed and not fitted to his teeth. Is this a common practice with children’s dentists? Is this something I should be concerned about?

These crowns are not sterling silver but rather stainless steel. Yes, they are “stock” crowns that come in a box and yes, they do not fit exactly to the child’s teeth, but they serve a temporary purpose and are commonly used. Some dentists will additionally line them in acrylic to insure a better fit.
Marianne W. Schaefer, D.D.S

My 8year old daughter has white spots on her permanent front teeth. What causes this, and how can I treat it.

Some discoloration of this nature is caused by an interruption in the pattern in which enamel formed. Some feel that the cause of these interruptions can usually be related to fevers during childhood. They pose no problem to the tooth. As your daughter matures you can discuss with your dentist the possible bleaching of these teeth to minimize the perception of these white spots.
Marianne W. Schaefer, D.D.S

When my son was an infant, all the literature and “conventional wisdom” seemed to be sure that thumb-sucking would stop by itself long before there was a problem, so don’t bother the kid. Last year, my son 5year old, who was still a confirmed sucker, went to the dentist and found that he had “jaw damage” which apparently went beyond mere both displacement. The dentist advised us to have a fixed habit control appliance. He said that the jaw was surely already damaged and that further damage would insure if the sucking didn’t stop at once. So eventually it stopped but my son still has a cross bite on one side (he’s 6 now). The dentist wants us to get orthodontic work started now because of jaw damage, which must be repaired beyond the tooth placement problems. If this is all such a big deal, why didn’t I run across it in all the “Mommy & Me” classes and information I read? I really need to know if this is for real, because my 3 _ year old daughter sucks her thumb unabatedly and the insurance doesn’t’ cover orthodontics very well…

Chronic and aggressive thumb sucking can lead to skeletal changes. Nursing a child who already has teeth can lead to rampant decay. Both of these are facts that are frequently not addressed by books or other publications on child rearing. Every dentist who identifies an aggressive sucker will attempt to stop a habit, however orthodontics at age six seems a bit aggressive to me. Please get a second opinion from a pediatric dentist and realize that most intervention begins at age 8-10. Marianne W. Schaefer, D.D.S

What are the symptoms of fluoride poisoning at the mild level? I can’t seem to train my two year old twins to not swallow their Crest children’s toothpaste, which they do each time we brush their teeth. Also, should I be using plain water instead of toothpaste at their age?

When placing toothpaste on a toothbrush for a child I always recommend an amount equal in size to on of the “candy dots” that we used to eat as children. I further recommend that parents disperse the toothpaste into bristles with their thumbnail before handling the brush to the child. At age 2, your twins are still too young to brush on their own and should be under yours or their father’s direct supervision. It is unlikely that the children would experience acute symptoms from the ingestion of toothpaste; most manufacturers of toothpaste anticipate the possibility of ingestion. For this reason the amounts of fluoride are relatively innocuous. Long-term ingestion of fluoride can lead to the moteling of enamel (marked discoloration with yellow and orange bands). Marianne W. Schaefer, D.D.S

I have twin boys who will be 8 the end of May. They both have only lost two teeth. Most of their classmates have lost a whole mouth full. Should I be concerned?

Although the average person will lose teeth between ages 5-7 in the anterior area, the delay that your boys are experiencing is not exactly extraordinary. I believe they should have had their dental x-rays by now. In those x-rays you and the dentist should be able to visualize the adult teeth beneath the baby teeth. This should ultimately help to ease some of your concern. Marianne W. Schaefer, D.D.S

My daughter knocked her front teeth against her brother’s head while running around. The left front tooth was bleeding and slightly loose. The dentist said to watch out for discoloration and/or infection (white bump on the gums). Will the tooth “tighten up” on it’s own or is it just going to become looser and looser until it falls out? Does it have to be removed if it turns color? She just turned 3 I hate to see her lose a tooth already. Thank you for your help.

The tooth may discolor but the only time that treatment is absolutely necessary is if a small “whitehead” or “pimple” should occur in the gum right above the tooth. If this whitish bump appears it can be treated with a procedure called pulpotomy and the tooth will remain until the adult tooth pushes it out. The tooth should tighten on its own unless the bone has been broken around it. I hope your dentist took at least one x-ray of the affected area, do check for this. Marianne W. Schaefer, D.D.S

Is there really a tooth fairy?

The spirit of the fairy can never die. He/she has been with us for hundreds of years and as long as there are human beings to help, the fairy will be with us to the end of our days. Usually, the ability to see the fairy disappears after the last baby tooth is lost.

Hope you don’t mind, but my son (almost 7) just received a sports injury to the mouth which sent a permanent, almost fully erupted frontal completely back up into the socket. His dentist suggests we leave it alone to see if it re-emerges, (no antibiotics prescribed yet, unless we see signs of abscessing). I’m in need of a second opinion but I feel I have limited resources in Fayetteville, AR. Are the chances that the tooth will re-erupt greater than the risk of cutting tissue to go in after it? Could the tooth become encapsulated or resorbed? Should he be on an antibiotic? I would appreciate any insight from someone who has followed this type of trauma. Of course I have photos, orthopantomograms (sp?) and the capability to send them electronically.

Normally, your son would have been sent for evaluation to an oral surgeon. The oral surgeon would have assessed the presence of broken frontal bones and probably suggested that the tooth be forcibly extruded in a slow and consistent manner with the use of an orthodontic brace. I still think you should take your son to your local Orthodontist and ask as to whether the tooth should be stabilized in any fashion. Even though the tooth may be held firmly in place at this time, my concern would be that the body responds to this injury by permanently calcifying the tooth in place known as anklosing.
Marianne W. Schaefer, D.D.S

Dear tooth fairy: My tooth came out today. It was my first back teeth. I didn’t expect it to come out so soon. I had my piano exam yesterday.
Lots of love, Irina.

Dear Irina: Congratulations on losing a back tooth. With every back tooth that you lose, you become 20%smarter. By the time grownups lose their wisdom teeth; many have become brilliant scientists just like Albert Einstein and Marie Curie. Don’t be afraid to lose teeth, it is a blessing in disguise.
Gillian, Agent for the Fairy.

What would you tell a child about a tooth fairy? Do they exist or don’t they? What do they look like?

I can only speak from knowledge and whether you wish to share this knowledge with your child is your own decision. The tooth fairy exists for all children and adults who wish to maintain a youthful outlook on life. It is a charming and comforting thought to know that something as precious as a tooth will be cherished by someone or something. The loss of a tooth is a frightening thing. I think that it is very sad that some children might not be able to have a lovely mythology to help them through this unusual time. I explain to most children that we really do not know if the tooth fairy is male or female. The tooth fairy for the most part is an invisible entity that can be seen by children who still have at least one pediatric tooth left. The fairy most often seen is a glint of light in the night, is a shape shifter that can take on the appearance of a family member or cherished pet. The fairy uses the finest teeth to line her palace. Those that have filings, or are decayed are used to pave her roads. This usually encourages better hygiene, as each child is hopeful that its tooth might be used to actually build her throne. Marianne W. Schaefer, D.D.S

I discovered my son has a couple of very small white spots on two of his front teeth. I know its fluorosis. He is a terrible brusher. Sometimes he didn’t brush at all so I had him using a fluoride rinse, in conjunction with brushing. Obviously that was the cause so we have discontinued use of the rinse and I am monitoring his brushing more carefully. I am concerned. The teeth don’t look bad but I wonder if the spots will fade at all, and I’m hopeful that it won’t be too noticeable. I feel terrible. Any suggestions?

Typically, flourosis is marked by yellow to orange danding rather than white spots. What your describing is more typical of hypo or hyper calcification (in which the amount of calcium is altered due to genetic factors or due to high fevers in interrupting the pattern of calcium precipitation. I don’t think you need to worry if your child has been seen by a dentist your trust. I’m sure that as a young adult there will be many things that can be done to change the appearance of the teeth should you and your child choose to do so. Marianne W. Schaefer, D.D.S

My 8 year old daughter had her front teeth knocked out, I immediately replaced the tooth in the socket. She was seen by the dentist who splinted the tooth, the dentist that had seen my daughter was an associate of her regular dentist and had recommended a wait and see treatment with the possible need for a root canal if the tooth should die. Her regular dentist called the next day and feels that the root canal, should be performed in the next 10-14 days, without waiting to see if the tooth will survive. I am confused as to the best treatment option.

Unfortunately there is not part answer here (six of one- half dozen of another). They could both be right. It is unlikely that the nerve of the tooth will survive the assault, however there is no danger at this time in waiting for things to “settle” down a bit and allow some time to pass before evaluating the situation. If you really feel compelled to establish a definitive opinion, why not ask your general dentist for a referral to an endodontist (root canal specialist) and see what he or she thinks.

1. When is the right age for a child to have braces put in? 2. I had my 2 upper front teeth crowned a few years ago. Although my dentist says that my gums are healthy and there is no infection my gums (specially the top front one) smells. What could it be?

In our country the typical age for children to begin Orthodontics or braces was at the onset of puberty (due to the relative ease in which bones were thought to move and change at this time). These days, children are starting the process at younger and younger ages than before. Typically you can expect a child to be in braces anywhere from the age of 9 to adulthood.

If you detect an odor it usually is either indicative of decaying food or bacterial build up due to dental decay. Please have your dentist check you again soon!
Marianne W. Schaefer, D.D.S

First of all allow me to say that I enjoyed your homepage thoroughly, and I do indeed share your obsession about Halloween and the macabre. My question concerns Children’s dental health care issue in the broadest sense. I am working on a report in which I need to detail the importance of Dental health care for children. What are the specific implications of no or minimal dental care for children? What type of health problems and social problems could lead to? Your input in this matte would be greatly appreciated. In addition, if you happen to be aware of any specific resources. Thank you for any help you can offer.

Children’s dental health is very important. Pediatric teeth help to guide the adult teeth into place. Without them mastication is difficult at best, children are establishing their sense of themselves in the world and their self esteem at an early age. Without an appropriate smile they feel embarrassed and self-conscious. Pediatric caries or decay is just as painful as the adult version, if not so- more. Children are unaware of the true source of their pain and are easily frightened by the frequently escalating quality of the dental pain. Only a fraction of all the children in the U.S. are ever seen for dental checkups. It is estimated that only about half of the U.S. school population has a means of teaching or presenting dental hygiene issues. Many parents are just ignorant and at risk as their children, facing limited resources and phobias. If you like, you may write me back, and I will be happy to put you in touch with a lady dentist who works closely with children and family services in Cook County, IL. She is a forensic dentist like myself, and I will be able to give you her name and phone number next week. Please consider writing me after May 25th for this information. Marianne W. Schaefer, D.D.S

I’m eight years old and I have lost several teeth. I want to know if you are making my teeth fall out or is it something else? I would like to have another loose tooth soon because it has been a long time since I lost one. I have lost about 8 front teeth.

It is a known fact that at one time, the tooth fairy did have the power to help children lose their teeth that were causing them pain in an effort to ease their suffering. Before there were dentists the tooth fairy could use this power for adults and children both. However, one of her minions misused the power in a vengeful way, and the fairy can only wait to collect teeth at this current time. The loss of a great number of teeth usually signifies that you are growing up faster than some of your friends. Do you feel smarter or more grown up all of a sudden? You should. Gillian, Agent for the Fairy

My 5 year old daughter needs a crown on one of her jaw teeth. As you know crowns are very expensive and out of my financial picture right now. Is there some kind of treatment that would be easier on my pocketbook as I don’t have $500?

Please, consider having your daughter seen by a pediatric dentist, either privately or in conjunction with dental school. Please ask your pediatric dentist to suggest alternatives to a crown. One of these alternatives might be extraction of the tooth with placement of a space maintainer until a time that adult tooth would erupt or until a time that you and your daughter could afford a prosthetic. Also, please take the initiative to make sure she has proper preventive care so that you don’t have to face this type of situation again.
Marianne W. Schaefer, D.D.S

How much money do you give us per tooth? Is it more for the bigger teeth?

The tooth fairy awards more money when teeth are cared for (clean, shiny, & nice smelling). The next time you think you might like to skip brushing just remember that the tooth fairy might be using your less than pristine tooth in some dark, dank corner of the castle allowing you only a pittance of a return. If you supply her with wonderful clean teeth, they are used to build her throne and sometimes rather than money, she will leave jewels or jewelry in its place. Marianne W. Schaefer, D.D.S

My 7 year old son is about to lose his first two teeth. I have no idea of the going rate of baby teeth these days. Can you offer any suggestion on how much we should “leave” for him?

We tell most of our children that the tooth fairy decides how much to leave for each tooth based upon the condition of the tooth she finds. Furthermore, the teeth that are unsightly, dirty, or stinky are consigned to be used in building the tooth fairy’s dungeon. The tooth fairy is a good soul but she is currently housing only two people in her dungeon, the first is a “cavity creep” and the second is the Sandman who ended their long time romance. The actual going rate is different from region. Sometimes the fairies leave prizes instead such as jewels and stick-on tattoos. Marianne W. Schaefer, D.D.S

At what age should children start brushing their teeth, or should parents start when they are toddlers? What can elementary teachers do to encourage dental health, by this, which areas should be taught?

From the time children are bathing and have teeth present in their mouths, parents should incorporate tooth brushing or tooth wiping during bath time. The presence of the parent in the child’s mouth at a young age will make it easier for them to help the child brush later, and for other dental professionals to be able to offer an examination to the child. School children should be allowed to brush their teeth after their noon meal. If this is not something that can be done, all children should be encouraged to complete their lunch hour with a glass of water to reduce the presence of oral acids. Children may go unsupervised after brushing after a parent is satisfied that the child is spending at least a minute completing this chore. Marianne W. Schaefer, D.D.S

My 7 year old daughter has been sucking her thumb since a baby. Her upper front teeth are now protruding and it’s affecting her appearance. What can be done to break this habit?

Please, take your daughter to a pediatric dentist. Allow this dentist to evaluate your child, for a maxillary crib (a type of appliance that disallows the placement of fingers in the mouth). It is important that you take an active stance in following up with a dentist for this type of problem.
Marianne W. Schaefer, D.D.S

Where does the tooth fairy live? What does the tooth fairy do with all the baby teeth? What color is the tooth fairy’s hair? Does the tooth fairy have long or short nails?

Interesting questions. I would be happy to answer as best I can. The tooth fairy has used teeth from her many years of scavenging to build a castle in which she lives with a variety of electric friends, and her on-again, off-again consort, the Sandman. She uses the teeth to build walls, floors, roadways, and swimming pools and yes—even furniture. Her throne is made from the finest, cleanest of the teeth she has collected. She tried to change her shape to protect her anonymity but in her relaxed and most private moments she chooses to look like this: very, very blond hair, short hair, blue eyes, very femininely shaped, tiny pink lips sparkled with glitter, long pink nails rounded at the tip.
Gillian, Assistant of the fairy

My daughter’s permanent teeth are coming in. She has lost two teeth but in one section her tooth is growing in and has broken the gum line but her baby tooth is not loose yet. Is there anything we can do or should do?

Sometimes adult teeth erupt behind the baby teeth requiring the extraction of the baby tooth. Normally, the tongue and speech patterns of the child will help to reposition the adult tooth into its normal alignment. If you have any additional concerns, please ask your dentist when you see him/her for the extraction of the baby tooth. Marianne W. Schaefer, D.D.S

My two and one-half year old daughter was diagnosed with facial decay of her four front teeth. The dentist has referred to us to a periodontist and I’m wondering what the cause of this? What should we change? She drinks lots of juice (always 100% juice) and never takes it to bed with her. I feel terrible about this and I am also anxious to know what the treatment is like? Thank you for any information you can give us.

There are many questions you should ask your pedodontist (not periodontist). Some of these might include inquiries as to the possibility of genetic enamel defects, as well as the absence of fluoride in your water source. While nursing is the best means of feeding your baby, many dentists feel that nursing after the eruption of teeth (particularly before children are laid down to sleep) is one of the most prominent reasons of anterior decay. Please discuss this with your child’s new specialist. Marianne W. Schaefer, D.D.S

I have a four year old who has eight cavities. Three of those are very bad and in need of pulpotomy and crowns. I am having a hard time understanding why we need to place a crown on a baby tooth that will only fall out in two years anyway. I always had my baby teeth pulled out when I was a child and I turned out just fine. My son, trust me, is very scared and will be traumatized by this whole experience. I don’t want him to be terrified of the dentist. Please help. Alice.

Ultimately, the choice as to how to approach your or your child’s dental treatments are your own. The dentist is obligated to inform and educate you as to your treatment options. Dentists are able to do wonderful things for people these days and the standard of treatment that this dentist may have tried to present to you reflects the best or perhaps the most optimal care available. Teeth are supposed to be maintained in the mouth until the “grown-up” teeth push them out. This is accepted as an optimal choice in that the adult teeth need guidance and are less likely to erupt in a manner requiring expensive orthodontic intervention later. If you think that your dentist is too “heavy handed” with his/her diagnosis, please get your x-rays and take your child for a second opinion. If the second opinion is in agreement with your original dentist, please take the time to become educated in the proper maintenance of your child’s health so that this will not reoccur. Marianne W. Schaefer, D.D.S

What does the tooth fairy do with the teeth?

The tooth fairy loves teeth so much and her collection has grown so vast that she has employed many master builders who have helped her use the teeth to make a beautiful kingdom. Everything from the throne to the roads and the sidewalks and the rose garden are made out of teeth. In the winter when the light of the night is particularly dark, many hundred and hundreds of the teeth are used as little light up lanterns dotting the night sky.
Gillian, Agent of the tooth fairy

Do you have any idea what could cause dark vertical ridges to appear on my daughter’s teeth? She has been in Poland for one week, dealing with substandard nutrition… also, she is taking Monodox twice a day for severe acne. Do you have any idea what is going on and more importantly, what to do?

I am sure that most dental authorities would agree that a week of malnutrition would have absolutely no impact to the teeth. Your daughter’s gums might begin to bleed, but the teeth themselves would be unaffected. Tetracycline (an antibiotic) has been known to stain teeth while they are developing. While I think the antibiotic is unlikely to cause vertical ridges in completely formed teeth, might I suggest you check with your pharmacist about this phenomenon. Marianne W. Schaefer, D.D.S

I have a 2 year old that has some decay on the two top center teeth. I’m at a loss on how this happened. I have brushed her teeth since she was breast fed for almost 2 years I thought breast-feeding was helpful. She never had a bottle. Is there anyway I can stop the decay? I’m just sick about it. Is she destined to have silver teeth until they fall out at 6 years?

All things that are natural are not necessarily good in excess. In nature, animals wean their young from suckling when their “milk” teeth come in. While nursing is a lovely, nurturing moment shared by the child and mother, any mother who allows their child to drift off to sleep following their nursing is putting the child at risk for decay. Breast milk contains sugar, surprise, surprise. If your child has not been additionally exposed to fluoridated water, the enamel of their adult and baby teeth will be additionally less resistant to decay. I cannot tell you the extent of your child’s decay, having not met her. If your dentist feels that she should wear crowns then she should wear crowns.
Marianne Schaeffer

We have a ten-year-old daughter. X-rays show a missing permanent tooth, which will require orthodontic work in the future. Is this common? There are no heredity issues of which we are aware to cause this. My mother seems to believe that this is mankind’s way of evolving into a higher species. Since we are no longer the “hunter gatherer” people our distant ancestors were and have become used to eating softer, prepared foods, our jaw structure is slowly changing to a smaller frame. We basically do not need all the teeth we presently have. Is she nuts, or is there anything to this theory of hers? Thank you.

While I do have a psychology degree, I hesitate to diagnose your mother. Perhaps she should concentrate her efforts in the additional study of anthropology before posing additional theory. While the absence of room for third molars or “wisdom teeth” appears to have greatly diminished in Caucasian peoples, and this is indeed an evolutionary occurrence, I don’t think her granddaughter is reflective of this type of process. Missing teeth is very common. Marianne W. Schaefer, D.D.S

In the past year, how many visits has the tooth fairy made to children who have lost their teeth? If the tooth fairy loses a tooth, will she always get a visit from a fellow tooth fairy?

It is difficult to say just how many teeth are taken by the tooth fairy. Obviously, it is several thousand per day. However, the Internal Revenue Service levied a tooth tax some 45 years ago. The tooth fairy found the tax too hard to pay and still have enough money to buy gifts for the children. She also feels the tax is unfair, since the vast majority of adults don’t believe in her, therefore, the actual number of teeth far exceeds those kept in the castle. For your information fairies are immortal and they do not lose their teeth.
Gillian, Agent for the fairy

I have a problem with my 2.5 year old daughter’s teeth. She seems to have developed black spots on them, small ones, close to the tops around the gums, despite the fact that we carefully brush her teeth every night, and avoid giving her sweets late in the afternoon or in the evening. My dentist says it is nothing to worry about, but I do worry. And even just for the nicer smile. Is there something that we can do to remove the spots?

If you are dissatisfied with the diagnosis your dentist has given you, please consider taking your child to a specialist called a pedodontist, who treats only children. If both doctors assure you that there is nothing wrong, then please do stop worrying. Your dissatisfaction with your child’s smile, while understandable, can be translated into rejection by the child. Marianne W. Schaefer, D.D.S

How many teeth would a year old child be expected to have? What kind of “table food” would such a child be expected to eat?

Children in this bracket can have between 4 and 6 teeth on average. Soft foods are still advised. Chunks of food that can be choked on (especially grapes) are very, very dangerous. My office manager, Gale just recently saw a product (available at Target), which allows you to place chunks of fruits, etc. in what relates to a “mesh bag” on a giant “pacifier” like object that lets them chew on it and hold it not allowing the “chunks” to create difficulty for the child. Marianne W. Schaefer, D.D.S

I have had a root canal done, will I still have sensitivity to hot foods and drinks and how long does it take for a root canal to completely heal?

A root canal or any dental procedure should be viewed as a "micro-surgery’ which should be accompanied, postoperatively, by some discomfort. The typical discomfort that accompanies root canal is pain unsolicited by specific stimulus. Occasionally there can also be pain to the pressure of chewing. You see, in theory there is no longer a nerve inside that tooth that can detect thermal changes. However if there were an extra root unseen by your dentist, there could still be nerve tissue remaining. Please return to your dentist with your frank and honest evaluation. Allow them to decide if there could still be an unseen canal or perhaps another adjacent tooth that is symptomatic. Marianne W. Schaefer, D.D.S

My dentist just diagnosed me with pulp stones. I would like to learn more about this before I start the very involved treatment plan he recommends. He did not have any printed information to give me. Can you provide me with more information or direct me where to look?

Pulp stones can frequently be a benign condition in which calcium deposits accumulate with the chamber of the tooth. There is no definite documentation for their accumulation other than to note that they seem to increase in number in correlation to the age of the dental pulp and or previous sustained injury (due to presence of decay or repair of decay). Sometimes they result in a pulpitis or injury to the nerve requiring root canal treatment. For more information may I suggest that you contact a local endodontist (root canal specialist) and have them evaluate your situation. Marianne W. Schaefer, D.D.S

I’m pleased to inform you that my root canal was quick and painless. And while the rubber dam was uncomfortable, I have to say that the novocaine shot into my upper palate (interior) was the worst! The endodontist told me to expect a sting, but that was putting it mildly. All the horror stories I heard about root canals were I suppose true in the past, but today they are not any worse than having a cavity filled. Thanks for your speedy reply.

I’m sure by now you have discovered that if a competent practitioner performs a root canal, the result will be painless and, in general a good experience. Please let me know what you thought the most difficult part of frequently the wearing of the rubber dam. Marianne W. Schaefer, D.D.S

How painful are root canals ? Also, what can be used other than gold after a root canal to keep the cost down? I have to confess I haven’t been to a dentist for a long time because I hate it (stemming from my childhood), but for a while now I have been having problems. Most recently I broke a tooth around a filling, so I have made an appointment. What can I say to the dentist that will let them know what a chicken I am and what about medications to help me relax? I really appreciate the opportunity to be able to ask a dentist about my concerns. Thank you.

If a competent practitioner performs a root canal there should be virtually no pain associated with the treatment while you are at the office. Occasionally, patients feel discomfort following the procedure, however, your doctor should be able to medicate you appropriately to help you eliminate this problem. You can have restorative materials used such as stainless steel to help reduce some of your costs or allow a dental school to provide you service. If you have a conventional treater, they may suggest a common sedative to help you relax. If you prefer to use an herbal one, you can contact a holistic treater. Marianne W. Schaefer, D.D.S

I wanted to know if there is any substance to the rumor about root canals (that can make you sick, that the instrument that is used to fill the space drilled out can cause infections.) Also want to know if the alternatives present more or less problems?

Let me try to dispel this vicious rumor! When root canals are performed by properly trained practitioners, (skilled general dentists/endodontists), they are highly successful means of treating an infected nerve. Root canals fail for a variety of reasons. Sometimes the skill of the practitioner is not sufficient for them to see a hidden anatomy (thereby missing an extra canal that can continue to infect). Sometimes, the teeth that are being treated are really fractured, and the fracture itself, which cannot be seen, causes failure. Sometimes cysts can form at the base of the root in response to an infection that has been there chronically for a long time. That cyst might have to be removed in addition to the initial root canal procedure to effect appropriate healing. There is truth to the rumor that some materials commonly used in Europe can be detrimental to the soft tissue. Sargenti paste, as it is known in this country, contains materials that have been proven to be toxic if they should leach into surrounding tissues. Most dentists in the U.S. have opted not to use this substance.
Marianne W. Schaefer, D.D.S

How obvious is it from an x-ray that you need a root canal ? Is this something that is quite apparent or is it a judgment call? Can some of the symptoms that make a dentist decide you need root canal be caused by deep fillings instead? I have a tooth that is sensitive when the dentist taps on it or when he sprays water on it, but it doesn’t bother me when I chew on something like taffy although I get a twinge sometimes from using dental floss. I have a tooth on the other side that is sensitive also but he filled that one six months ago and I find it hard to believe it would need a root canal also. My dentist likes to fix every little (and big) thing he possibly can. If it doesn’t need filling it needs replacing, not root canal?

My philosophy is if it isn’t broken, don’t fix it! In other words, I’m a very conservative treater. While most of my patients appreciate this philosophy, many of my colleagues might feel that I am not anticipating or addressing problems before they serve as an irritant. Sometimes you can visualize the abscess of the tooth on an x-ray. However, most dentists will diagnose and subsequently recommend root canal treatment only after they have seen evidence on an x-ray, have demonstrated the non-vitality of a tooth through a series of tests, and finally, taken the patient’s complaints of continued discomfort to heart. Marianne W. Schaefer, D.D.S

I am a 24 year old female. I underwent root canal surgery on my right upper second incisor 15 months ago. My crown fell out while eating a bagel 5 months ago without any pain. My dentist fixed it. Now since the last 25 days I’m having pain in the same tooth on percussion. My dentist didn’t find anything in the x-ray and thought it was gingivitis and put me on oral penicillin and chlorhexidine gluconate mouthwash for 8 days. Pain was still the same, in fact now more localized on pressing the skin near and just below right external nare. It gives me right-sided frontal headache also. On taking Vicks inhalation little nasal mucus and my pain decreases. Yesterday I went to another doctor for this persisting severe pain. He didn’t examine me but just from history and tooth x-ray told me that I have little collection of pus (infection) deep into my root canal. I being a doctor could see his finding as correct. Now he put me on cap. Cephalexin b.d for ten days and then he tends to do syringing of pus/removing my crown and scooping deep inside the root plus re-doing of my root canal. He says it’s difficult to cure it with antibiotics. Am I going on the right track? What do you think has happened to me? Will all this lead to costly and lengthy and painful procedures? My crown is so snuggly fitted, will he be able to remove it intact or will he have to break it? In that case I’ll have one more expense for new a crown.

Normally in the United States, an infection at the tip of the root in curetted through a minor surgery involving only the tip of the root of the offending tooth. By doing this many of us are able to avoid having to replace the original crown and bridge work. Most of our patients see this “apicoectomy”:/services-provided/patient-education/#endodontics as the more conservative approach to the problem. Please allow as endodontist (root canal specialist) to provide your future services. Marianne W. Schaefer, D.D.S

Is it a standard procedure for a dentist to explain the facts of a root canal before he starts ? Should a dentist have told me he left a meisial file in my tooth and could have he sent me to another dentist before filling it, so they could remove the file? What is the standard procedure that a dentist should take before he does a root canal? (Should there be any type of informed consent?)

One of the most debated areas in the malpractice arena today centers around informed consent. Yes, the dentist should discuss every procedure before beginning. Yes, the dentist should reveal any and all likely complications of the procedure as well as its benefits. Yes, the dentist should alert the patient to any aspect of the procedure that has not gone as expected. Lastly, the patient and the dentist should decide together whether or not a specialist should be consulted when a less-than-desired result is achieved.
Marianne W. Schaefer, D.D.S

My tooth filling fell out last night, previously I have had a dentist tell me I need a root canal. But I have no pain on that tooth, nor does cold or hot food bother me, there is no swelling either. The last dentist said, “If you have no pain” don’t get a root canal. I have an appointment tomorrow, and I know I’m going to hear the root canal question. If I have none of the signs of a root canal, does it mean I don’t need one?

What I really think you need right now is a second opinion. If there were any sign of infection at the tip of the root of the tooth, the root canal would not be out of the question (even if the tooth is asymptomatic). Please allow a second practitioner to check the tooth with an x-ray, and see if they agree with the previous diagnosis.
Marianne W. Schaefer, D.D.S

I had an apico done on tooth #14 about a year ago. A small pimple has now appeared near the site. I’ve been told that the apico should now be done again or opt to loose the tooth. If I have another apico done could this problem happen again? And, is it a possibility that the silver-based (oral surgeon’s description) material filling the root is being rejected by my body?

I think an honest surgeon or endodontist will tell you that each time an apico fails, there is less chance of success with each re-treatment. You may even wish to consider an independent second opinion at this time. Please do proceed with some kind of treatment, do not leave a possible area of infection untreated. Please consider using a surgeon or endodontist for the source of your second opinion. Marianne W. Schaefer, D.D.S

Two weeks ago I had a molar prepped for a crown. The tooth has a temp on it now. Prior to the work on my tooth it never gave me any trouble, it had a lot of fillings. Now the tooth hurts all day and is sensitive to cold. This happened to another tooth three years ago and required a root canal. Is this normal or is my dentist doing the procedure wrong? Will the tooth stop hurting or is another root canal inevitable?

It is not standard for every tooth prepared for a crown to ache and require root canal. Most effective practitioners should have the ability to anticipate the responsibility of root canal and prepare the patient as well. You may have a treater who either is not a good communicator or who has not anticipated your needs properly. Please feel free to express your concern to them. There are means by which an aggravated nerve can be sedated with various abundant cements. Please ask your dentist about this as well.
Marianne W. Schaefer, D.D.S

I had a tooth pulled and the dentist left some root in. The dentist stated that the root was fused to the sinus cavity and either he could try to get it out and possible rupture the cavity or leave the root in. I chose to leave the root in. What complication could I have from my decision?

You will have little chance of complication, however every so often the retained root tip will encapsulate and form a cyst, which could affect the health of your sinus cavity and ultimately your health as well. I think a better option would have been for the general dentist to allow an oral surgeon to help you make that choice. Oral surgeons are trained in additional skills in either a four or six year program beyond their dental training. They are the experts here and if they suggest leaving the tip you could feel confident with that choice! Marianne W. Schaefer, D.D.S

Are a root canal and crown advisable in an 88 year old male with osteoporosis?

I would imagine that if your practitioner felt the root canal should be performed to extend the life of a tooth, and you felt that keeping or maintaining the tooth would bring health and happiness to the individual who required the service, age should never be a consideration. I think the only consideration that should be made is in regards to the health of an individual. Marianne W. Schaefer, D.D.S

About nine years ago I bit into a potato skin and there was a rock in it. I ended up having two root canals on teeth #30 and #31. Now in my mid-thirties I had an abscess on #30 and it was re-rooted they said #31 had an inside fracture and #31 was pulled. There is a concern about tooth #30 and they will watch to make sure the bone is healing. I am a severe asthmatic and am wondering what I can do if I lose #30 and if not what can I do with the space left from #31 pulled. I am devastated. It would be easier to take if I had not taken care of my teeth. But thanks to eating out I am minus one and maybe two teeth.

The loss of a most posterior molar is difficult to accept indeed. The replacement of the missing tooth is not easy. A cantilever bridge that hangs from the healthy teeth in front of the space puts a great deal of stress on these natural supporters of the bridge. Most dentists won’t do cantilever bridges anymore. I think you may have heard about implants. Or you have not; you may wish to inquire with your general dentist as to whether or not you are a candidate for one. Because your asthma is so severe you will want to alert the general dentist or surgeon about this when considering an implant. In the future, may I suggest mashed potatoes—they’re Oprah’s favorite. Marianne W. Schaefer, D.D.S

I need to have several root canals done and other work done on my teeth. If I elect to have all the work done at one time will I have too much pain afterwards? I am to the point where I have a really hard time eating and need this work done very soon but I don’t want to have to back and forth to the dentist for a year or two like my husband had to do. What do you recommend I do? I don’t think there is a tooth my mouth that doesn’t need something done to it.

Only you can determine the amount of work you will allow to perform. Every person has their own sets of needs and wishes to be filled. It is not unusual to have a patient want to avoid prolonged treatments and extensive work. Sometimes the individual is not up to it psychologically or financially. A good place to start would be to have your dentist present you with several treatment plan options (beginning with the most ideal and extending or including the most simplistic.) After you and they have reviewed these, you might decide to get a second opinion. Taking the time to iron out your plan before you begin will help you speed through the work with confidence and inner peace. Marianne W. Schaefer, D.D.S

My first molar became pressure sensitive (but not hot/cold sensitive) in January and I had a root canal done. I suffered post-operative infection and had a course of clindamyacin that cleared it up. Three weeks ago the same tooth again became pressure sensitive (more to back and forth motion than chewing) and I am having a great deal of pressure in my face above the tooth. The tooth had an existing crown before the root canal was done. The endodontist said it was trauma that would go away, however after two weeks and lots of “Motrin” I went to a regular dentist who said the x-ray showed some infection at the palatial root and put me back on clindamycin. I am on the fifth day of the drugs with no improvement. I have no dental insurance and this experimentation is stressing my budget considerably. Any ideas?

Please see a new endodontist or oral surgeon and ask them to review the tooth and offer an opinion as to whether it could be fractured or not. If the tooth is not fractured then ask one of them to appraise you of the risks and benefits of a procedure called “apicoectomy”:/services-provided/patient-education/#endodontics. This is a surgical procedure designed to remove the tip of the offending root and its subsequent infection. Marianne W. Schaefer, D.D.S

Just 36 months ago, my general dentist performed a root canal on my upper left first molar (#14). He told me yesterday that the “MB root” had to be ‘re-treated" and he referred me to an endodontist. How is a tooth re-treated? Is it commonplace for a properly performed root canal to require a “re-treatment” just 36 months after its completion?

Re-treats can happen but most of us don’t want them to and hate when it happens. The idea behind this is to try to provide the best solution and eliminate the problem on the first try. Anatomy of the teeth is as diverse as the size and shape of different people. The re-treat of this root could be required for a variety of reasons. One reason could be an extra canal or small root extension that could not be seen at the time that the service was delivered. While I choose to let an endodontist treat all molar teeth for this reason, your dentist may have felt qualified to attempt the first root canal. I don’t think this makes him a bad practitioner. I am glad he referred you to a specialist for the second attempt. The re-treatment procedure will be very similar to the original. Marianne W. Schaefer, D.D.S

Is it possible to completely disinfect the root canal before sealing it permanently? If metal post is put in a root canal for support won’t it corrode or react with the tooth?

Some dentists feel that complete sterilization of the canal is possible. Because a person’s mouth is filled with bacteria, I do not believe that this is the case. However, I believe that successful root canals reflect a treatment in which “pathogens” bacteria that are commonly found within the environment are eliminated. A post is usually made of a non-corrosive metal and sealed within the structure of the tooth in the absence of moisture.
Marianne W. Schaefer, D.D.S

I have had a root canal done on main chewing tooth on my bottom row of teeth. It has been a few weeks since my dentist filled up the tooth. My gums have now gotten puffy and sore under the tooth that was worked on for many visits. Do you think that means the root canal didn’t take? Has it become an abscess?

Your dentist should consider referring you to an endodontist or root canal specialist, for a second opinion. When root canals do not respond and continue to weep fluid or swell, there is a possibility of an existing cyst or a fracture in the treated tooth. You cannot continue to nurse an infection but should allow review as soon as possible. Marianne W. Schaefer, D.D.S

I had a root canal some time ago and a few months ago an x-ray showed what looked like a small abscess or something there. My new dentist said it could be developing or healing. In an x-ray yesterday the x-ray was the same. My dentist then said that the bone might just never have healed after the abscess that necessitated the root canal, and she said she’d probably in time need to go in there through the underside of the jaw and irritate the area to try to cause some re-growth. Obviously, I’d prefer to avoid that contingency! My dentist suggested that bone re-growth might be helped by comfrey but I’ve heard it’s not safe. Is it safe? And if not, are there any other measures I could take to try to encourage the bone re-growth healing so as to avoid the procedure?

At this point, I would like to suggest that you ask your dentist to send you and all the available x-rays to an endodontist for a second opinion. An endodontist is a root canal specialist and they can help you and your doctor to accurately determine whether or not there has been any measure of re-growth. If a cyst is halting the healing process, the endodontist can easily manipulate the removal of this tissue to hasten the healing process through a procedure called an “apicoectomy”:/services-provided/patient-education/#endodontics. Marianne W. Schaefer, D.D.S

I have been told by an endodontist that he may not be able to do a root canal on a first molar because of calcification that formed during the time the tooth was crowned (12 years ago). I don’t have any pain or an abscess and the x-ray does not show decay. If he can’t do the root canal he will put the temporary crown back on and I will have to have the tooth extracted by another dentist. Are there new procedures, or special instruments that would allow an endodontist to open even calcified or narrowed canals? In my professional life I can’t afford to be without a tooth near the front of my mouth, but I also can’t afford the replacement options. Any alternatives that you can suggest?

Correct me if I’m wrong, but did you not just tell me that your tooth, though badly calcified and endodontically untreatable is currently asymptomatic (without pain)? If this were true, what would be the harm in inquiring whether the tooth can remain untreated but with a permanent crown? The only risk you might be accepting would be the loss of the money involved in crowning the tooth should you eventually lose it. If the endodontist was unable to open your canals I am sure you would not be able to find another dentist or a product that would reverse the situation. Please ask your dentist if one additional alternative to your treatment plan might be to retain this tooth as long as you can. Marianne W. Schaefer, D.D.S

I have been to a general dentist 12 times for one bicuspid root canal. After the root canal, I was given a 4 day supply of penicillin to combat possible infection. Shortly after the procedure, I developed above the tooth a swelling that was tender to the touch. I have since been put back on penicillin for a 24 day period. The swelling did subside somewhat; however, there was still a bit of swelling (it is kind of hard) and tenderness. I was then put on “chodamycin” (sp?) for two 4 day periods and still the lump and tenderness persists. (Never mind the terrible diarrhea it gave me.) Am I battling an infection? Could I have other damage? Am I in danger of losing the tooth? Could I possibly be endangering the rest of the teeth? I am supposed to go back this Friday for another visit. Please help! Thanks.

Sorry for the delay in correspondence. You may have already attended to this problem. I was going to suggest that you allow your dentist to refer you to an endodontist (root canal specialist). It is likely that the tooth has an irreparable fracture or a non-healing cyst at its apex. An extraction might be in your future, please do get a second opinion. Marianne W. Schaefer, D.D.S

I came from the dentist today and she did an “emergency pulpotomy” What did she do to my tooth?

I assumed that your dentist performed a pulpectomy. A pulpectomy is basically a procedure in which the nerve or "pulp’ of a tooth is mummified. The agent or agents that are placed into the canal space are also anti-bacterial agents and help to offset the chance of abscess. Ultimately, the patients must proceed by either choosing to root canal the tooth or extract it. Most dentists will inform their patient that while they are unlikely to experience pain for a period of time, not to forget to make more concrete decisions about the treatment best suited for this tooth.

I had a root canal done about 3 years ago. Two days ago I started suffering from immense pain throughout my lower jaw all the way to my ear. I called my dentist and he wasn’t there but left the name of another dentist for emergencies. I went to him and he said that the root canal has to be re-done and prescribed “Tylenol” w/codeine #3 and penicillin. I went to the dentist who had done the root canal and he is in the process of re-doing it. My question is this: is it normal that a root canal has to be re-done after only three years? And what would cause this?

Dentists do not plan to redo their dental work only years later. If the original root canal had to be re-worked, a variety of reasons could have necessitated this. There could have been unseen canals that remained unfilled. There could have been excess material extruding from the original fill. A cyst could have formed. A fracture could have occurred. These are just a few of the many possibilities. If you like your practitioner please ask them to discuss the reason that they think this particular root canal did not succeed.
Marianne W. Schaefer, D.D.S

I am about to have a root canal. This is my first one and I am sure that the endodontist is extremely capable, and that is just an every day procedure for him, however, I am very nervous. My biggest concern is that any time I have had any procedure that included numbing the area, I always end up feeling it because I tend to metabolize the anesthetic very quickly and more is injected which never seems to help, it only leaves my jaw very sore afterwards. I explain this to every dentist and specialist I have seen, but they all seem to think their methods are different and that I will not experience any discomfort. Any suggestions would be helpful at this point. Thank you for your time.

You are correct to be concerned. A tooth with a restoration that is high can become irritated to the point that the resultant damage to the nerve tissue is irreversible, sometimes requiring a root canal to bring peace to the patient. I hate to use a pun but I think that you should “bite the bullet” and return to your dentist who sounds genuine in his concern. Please pursue this with the original treater if you choose, with a new dentist who might have a fresh outlook on the case. Marianne W. Schaefer, D.D.S.

I am confused. My former dentist would have me get a root canal if I had decay under a crown. My new dentist wants me to have a new crown instead of a root canal.

It sounds as if your new dentist is taking a more conservative approach to prescribing your care. Either way, the dentist should warn you that the necessity for a root canal couldn’t be determined 100% prior to the beginning of the dental work. Sometimes, things that would appear to be simple have a way of cannonballing into much more. Marianne W. Schaefer, D.D.S.

What is this? I wake up, early in the morning with a low-voltage, high-current kind of increasing pain in the front tooth. I know that if I just lift my head onto the pillow, the pain disappears leaving just an afterglow of temperature sensitivity in the tooth. The pain normally only comes when my body is horizontal, and my head is lifted to the right. Lifting the head onto the pillow also changes the curvature of the neck. X-ray is normal, tooth should be fine. What is wrong?

My experience with this question, which others have actually asked, the sensation you are experiencing is due to an increase in the blood pressure to your head and neck. Somehow by standing upright patients will experience a cessation or decrease in the symptoms they have been experiencing upon reclining. You may want to confer with an endodontist (root canal specialist) and see if indeed the nerve of the tooth is hyperemic. Good luck, Marianne W. Schaefer, D.D.S.