FAQ: Is Laughing Gas Safe for My Child? Nursing and Cavities?

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Kevin Kowalke: Good day everyone welcome the latest edition of the Spread the Love, Banish Fear Show, brought to you by Dr. Saadia Mohammed. My name is Kevin Kowalke, and I have the privilege every week to be the host of this educational filled inspiring show, where I tap into the brilliance and wisdom of Dr. Saadia Mohammed as we discuss what is the best way to create the foundation for your family, to have happy and healthy children.

Dr. Saadia's been in private practice since 1998 as a board certified pediatric dentist, with her practice, Palm Beach Pediatric Dentistry in Boca Raton, Florida. She has a fellowship at Yale New Haven Hospital, while holding many certifications and memberships with countless associations and organizations, all in all, Dr. Saadia is our expert when it comes to nurturing a happy and healthy child. So Dr. Saadia welcome to this show.

Dr. Saadia: Thank you Kevin. Every week I have the pleasure and the honor of having these conversations with you, and I just enjoy putting this information out there.

Kevin Kowalke: Well and I know for a fact that everybody listening does too, because we had such a response from it. So, the one thing that I would like to make everybody aware of, so in case you didn't hear last week's show where we spent the time ... we got really focused on tooth decay, you're gonna want to go back into the archives and go find it and listen to it 'cause these two are gonna tie together very nicely, and if for some reason, you're not able to find it, whatever the case is, just reach out to us and we'll make sure that we can get it supplied to you, because this is gonna be a good one.

I'm very excited to have almost like a part two to where we were talking about tooth decay. So what we did was he had recently pulled your audience to come up with some great questions I believe the majority of us would ask or would love to have answers to. So, let's dedicate today's show to some of the most frequently asked questions and by the way audience, the last question we address is my favorite of them all. So, Dr. Saadia opened my eyes to identifying a potential issue that can cause long term problems. So hang in there with us and I'm very excited to get us started.

So, the first question comes from a mom who lives in the North Central part of Florida, and she wants to know, "Do I really need to fix baby teeth?"

Dr. Saadia: My all time favorite question that all pediatric dentists get asked, we love it. So, the big resounding answer is yes you do because guess what? Cavities, caries whether they're on baby teeth or adult teeth, are a bacterial infection. Would you leave a bacterial infection anywhere else in your child's body? Would you even dream of saying, "Oh yeah, there's a little infection on their toe. Can I just leave it because they're gonna grow out of that tooth? Or grow out of that toe I mean?" No, you would never leave it. And any kind of an infection, especially in the mouth, you're just allowing that bacteria to enter the rest of the body. And guess what, research has actually shown that the most common bacteria that is found in cavities or caries is streptococcus mutans, and it is one of the bacteria that causes heart disease. Just hearing that part, I'm like, there is no way anyone should be leaving untreated baby teeth with cavities. They should not be doing that at all. And the other thing is, the teeth are sitting right next to your brain. There isn't a whole lot of, sort of like a barrier. The top teeth, especially the top front teeth, which are most commonly the subject to an accident in a toddler, in an infant and end up being abscessed.

They are sitting right there, just separated by a thin plate of bone, with a lot of blood vessels. And right about that is your brain. There have been reported cases that the infection has spread to the brain. There have been reported infections, and they're very sad that baby tooth infection, abcess has caused the death of a child because it was left untreated, it caused a huge swelling. The swelling impacted the airway, the airway got compromised and the person passed. So, to answer your question, yes mom, even baby teeth need to be treated, and don't forget, baby teeth need to serve a healthy path for the adult teeth to come in.

They also are there saving the space and the biggest and the most important thing is, you just don't wanna leave any kind of an infection in a child's body active and sitting there. And baby teeth, the molars are there around two and a half, that's when they first appear, this last set of baby molars. And they don't fall out till about 14 years of age in some children. Do you really want an infection sitting actively, and you're knowingly going to leave it in your child's mouth for 12 years?

Kevin Kowalke: That's a great point that you make Dr. Saadia, I don't even know that I can say anything to back that up, anymore than what you just said. I love to hear it, and I believe what ends up happening is we think as just normal human beings that don't understand the science behind everything that you do from a dental standpoint as well as biology within our own bodies. [inaudible 00:06:36] just think, well those teeth aren't gonna be there permanently anyways, and so as we're doing an okay job, everything's fine, but the way that you described it, about how that can have the disease, and how that just impacts and the amount of time. 'Cause let's face it, every child is a little bit different, we figure out how long they have their teeth and those kind of things. My goodness, of course none of us would wanna in our children's mouths, so I hope that all of our listeners take that to heart and had a big eye opening there just in case you maybe thought something different or were told something different, which listen, we understand and that stuff happens, and that's why you're so smart for listening in on these shows that we do with Dr. Saadia who has so much brilliance and wisdom to share with all of us.

So Dr. Saadia, thank you for that, and I'd love to then go on to-

Dr. Saadia: Can I ask something Kevin?

Kevin Kowalke: Yeah absolutely.

Dr. Saadia: Sorry to interrupt but as you were speaking, it just occurred to me why that misconception is about the baby teeth. Because people always focus on the front teeth and their baby loses their front teeth. The bottom front teeth typically the first, and that happens as early as four and a half, but on average is six. So people just automatically focus on that and they believe that, "Oh, it's only gonna be a couple of years before the teeth fall out." So, that's where the big misinformation or the miss arises from. People think, "Oh, the teeth are gonna fall out around four or six years of age," whereas they forget about the molars. Because they're all the way in the back of the mouth and nobody really worries about them, it's not the cute smile or anything, and those are the ones that normally get the big cavities, and nobody's looking at them, because everyone's looking at the front. And, they're forgotten in the back, and that's where it's really important to remember, molars serve a lot longer life span in the child's mouth.

Kevin Kowalke: I love it and thank you for interjecting that. And it makes total sense, and again, it's not that people are doing it intentionally of course, it's just like you described. It's our perception and so thank you for giving a lot of clarification to that and to create the importance of all of the teeth, and not just the ones that we're seeing on a day to day regular basis. So, that's great. Again, another writer downer, really important piece of information for all of us to not only affect our lives and our kids and that, but everybody we know. So this gives you some really good talking points and you can sound so smart at dinner parties or whatever the case is. And Dr. Saadia's happy to let you have all the credit, right Dr. Saadia?

Dr. Saadia: Absolutely, have the credit, take the credit. Kevin Kowalke: I love it. But please everybody listening, encourage others to listen and subscribe to this podcast. I'm telling you, they will thank you for it. So, let's get onto the next question and by far, one of the most popular from the responses that we received all over the country, and I know that we talk about this on a regular basis, so I love the fact that we get a chance to influence some new people who haven't heard this before, but does nursing a baby cause cavities?

Dr. Saadia: Oh, goodness. You know that's one of my favorite things and how passionate about ... I am about breastfeeding babies, and how I am such a big supporter of the World Health Organization's agenda to say, nurse for the first 1000 days 'cause those are so important. So, the resounding answer to that is no. Nursing is not the problem. Nursing is actually very healthy. But again, I'm gonna refer back to our last podcast because caries as I'd mentioned before is an pH imbalance, which causes the cavities.

So, what happens with children who are nursing, and the parents who get accused of saying, "It's the nursing that caused the cavities." There is something that is causing the pH imbalance of the biofilm. And most commonly it is the tethered oral tissue, also commonly known as a lip or a tongue tie, resulting in improper latch of the baby. So instead of the child latching on correctly, and the milk being deposit towards the back of the mouth and going right into them, they're actually kind of just nibbling on the top, and the tethered oral tissue doesn't allow them to latch on properly.

And the milk pools around their top front teeth and their top back teeth because those are tied, the lip and tongue tie will go together and because the lip is restricted, it's a beautiful ripe environment for that sugary milk to sit around, drop the pH and there you have it, a perfect recipe for causing cavities.

Kevin Kowalke: I love it, and I know it's one your favorites. And it's become one of mine too Dr. Saadia because I don't believe that people truly understand or have been given the full story behind how important breast feeding and as you know, my wife and I, that's our intention for our baby girl who we're about to see here in 10 weeks or so, which we're super excited about and you have given us such an education on this topic in particular, where we feel confident with our choice and how we're gonna raise our baby, and so we can't thank you enough and I appreciate sharing the answer to that again, because that question will always come up. We have new moms all the time right Dr. Saadia?

Dr. Saadia: Oh yes, and that's a big one, and I love it because the more we can spread the message, and I'm so happy you and your wife are going to be doing the right thing, and you're making that choice for breastfeeding. So, one of the things that I'd like to add to that question is, yes I did say that nursing doesn't cause the cavities, what happens is the pooling of the milk that causes it. So, "If so, so what?" is always my attitude. Well, the first thing to do is make sure that you have a practitioner or a professional that knows how to examine for tethered oral tissue, and will help identify that and release them is they need to be released. And also, the other thing is, if you're in the place where you're like, "I really don't know, but I feel through my own research that there is tethered oral tissue, but no one can help me." The minimum you can do is wipe the mouth with xylitol wipes after nursing, because what that will do is it will not allow the bacteria to metabolize. 'Cause xylitol is like a five carbon sugar alcohol, and it is used in certain oral products, which are of a higher grade, and the reason xylitol's used, it doesn't allow the bacteria to metabolize it like sugar.

And what happens is because the bacteria can't metabolize, the bacteria start to die. In addition, what it does because it is sweet, it increases salivary flow in the mouth. And when you increase the salivary flow, you increase the chances of returning the pH back to normal and providing more minerals for remineralization. So a simple xylitol wipe after nursing every time the child's nursing will help out. And tethered oral tissues as we've spoken about previously, I just get so passionate about it, so I just have to talk about it a little bit more. Children are frequent nurses, so it goes back to my whole thing of, the more frequently they're ingesting, the more they're pooling, the more they demineralizing and risking more sites of cavities.

So, identify and correct the tethered oral tissue and wipe the mouth down after every nursing, just a great habit to get into with any child, whether there is tethered oral tissue or not. Good habit to do, good habit to establish.

Kevin Kowalke: I love it, and that's what we are working towards, to have everybody get into these good habits, so that we give our children the best opportunity to live a really amazing and happy life. And it all starts with the health, and we all know that moms and dads are concerned about it, so thank you for adding that because that is an important thing for everybody to also know, and I hope everyone is taking notes here, we got really good stuff, as you can tell. So the next question is a good one, and very smart of a mom and dad. Dads, congratulations, I love when I see dads engaging on this, 'cause it's not just moms' responsibility, it's both of our responsibilities, all the way from South West Florida ask you this question, "Why does one sibling have issues with tooth decay, cavities, while another maybe does not?"

Dr. Saadia: That one is again such a classic question, I'm so proud of these parents for recognizing and asking that question because a lot of times the child just gets blamed. "Oh, you don't brush well." Whereas their poor little things are like, "I actually brush better than the other." So every single person that gets cavity, they are many different factors that play into it. And as I'm going to bring back again my last podcast that we had spoken about what caries actually is, it's a pH imbalance of the biofilm.

So anything, which causes the biofilm, which is the little bacteria that sit around our mouth and just ... that's normal flora. Sit around our mouth, if there is more of an acidic environment, if that is created it will increase the chances of that person getting cavities. Well what creates a decrease in the pH? Lots of things. You can be eating acidic foods and drinking acidic things, that will cause it. You could be having asthma, and the medication could dry your mouth out, and the saliva can't wash it away.

And that will create more of an acidic environment. Some steroids that children are on, that will create more of an acidic environment. Some children ... again going back to the tethered oral tissue, if there is tethered oral tissue, especially the buckles, we all have seven frenums, so the buckles, a lot of times the children won't necessarily self cleanse themselves. If you and I have food, and they get stuck up in our cheek area, we're gonna take our tongue and clean it out. Well, if there's tethered oral tissue, one, they can't. Two, they don't even think about it as children, and that food will sit there.

And sometimes it's not even sweets, but it is a carb, and the initial digestion process starts to happen in the mouth. You break a carb down, you turn it into sugar. If that sugar sits around, you get more of an acidic environment, that's when the bacteria thrives, because the bacteria that causes cavities love acid. So now you've got the perfect recipe for more cavities. So one child could have tethered oral tissue, one could not. One could have asthma, one could not. You could have a child who is simply just a happier child, a happier child will usually exhibit less cavities than the unhappy or more anxious child.

And that anxious may be a mouth breather, the mouth breathing will dry the mouth out, it will again promote more cavities. You could have a child whose just constantly not wanting to drink anything but juice. Juice, even if it is 100% natural fruit juice is usually acidic. You keep sipping juice throughout the day, you've got an environment that is going to promote more cavities. You should drink water when you are thirsty. You could drink a little bit of juice during a mealtime because during mealtimes, you will get more salivary production and salivary flow, and that will help neutralize acidity from juices.

But, during the day, as a thirst quencher, water. So, there's just a whole host of lists that people ignore and they ... well why is one child getting cavities and not the other? Look, listen, feel, lean in a little bit. What is really the difference between the two children? And you'll recognize, of course the basics of brushing and flossing are a given. You have to brush at least two times a day for two minutes. A lot of children aren't doing that. They just don't have the time, they're too busy playing digital games, and that's another big one. Who is spending more time on digital games and media? Most of these children have a very different personality beside the ones that are in their little digital games.

They get very intense, very focused. Some of these children are waking up at 4AM just so they can play three hours of games before they go to school. Guess what, they're gonna have more cavities.

Kevin Kowalke: This is all fascinating, and such great lists. And it's one of the things how I would summarize all this because you gave so much good information there, is I would say to everybody listening, let's get an appointment scheduled with Dr. Saadia and her team so that she can take care of you and go through all of this to really make sure that you're doing the best job that you can, 'cause we all know mom, dads out there listening, want to do that. And so, but it was really great Dr. Saadia for you to share so many different things for people to now just take a step back, observe their children and see if any of those ... they can check symbols off a list, so then maybe we're gonna get to a point where we can finally understand here's why this is happening, here's why that is happening.

So, thank you that's just wonderful information. Another question that actually many moms and dads had referenced in our responses, and this one is from all over. We're talking outside of Florida, the whole deal. They wanna know, what is nitrous oxide and is it safe?

Dr. Saadia: So, to very simply answer that question, when I first saw that question, I was kind of a little taken aback, because I was like, "Really? People don't know what nitrous oxide is?" But of course, I live in my world. And I don't really live in everyone else's world so to explain what is nitrous oxide, nitrous oxide is also known as laughing gas. It's N2O2 cause people confuse that and they think, "Oh no, this is something bad." No. Nitrous oxide's been around for many years, it is a mild sedative and it is administered in dental offices along with oxygen, because get all worried thinking, "Oh nitrous oxide is terrible and it's bad," or whatever.

The truth is, the way the administrating is happening these days, you cannot ... there's a fail safe system, and you cannot administer nitrous oxide without any oxygen. And as long as you have oxygen, you are in good shape. In addition, nitrous oxide is something that you breathe in, you inhale. So it's not something that you can just push onto someone. You're breathing it, and they have to have that voluntary, "Okay, I'm gonna breathe it in, I'm gonna breathe it out." It's a very safe gas that we use to remove some of the anxiety that a lot of our little and our older patients have in relationship to dentistry.

And all it does, it just sedates them a little bit, relieves their anxiety, and it also matters how someone uses it. It needs to be introduced slowly, increased to a level that is optimum for the patient. And there are some misconceptions around that too, 'cause people say, "Oh it's by the body weight." It's actually by the lung size, not so much the body weight because it is a gas. And it is administered by a flow meter, meaning how much of the gas is flowing out. So you don't wanna have too much flowing out so the person feel's like, "Oh there's a rush of air coming into their nose."

So it's a very gentle administering system, and we use it all the time in our office, and that is about the only thing we use. And I stress that because a lot of the mishaps that people hear about on the news and that makes them nervous was a combination strategy that was used for those children. They were being administered something as an oral sedative in addition to nitrous oxide. Or they were getting an IV sedation in addition with nitrous oxide. None of those mishaps that you have heard about in the news were exclusively nitrous oxide. Because just nitrous oxide alone, they're breathing nitrous oxide and oxygen. So as long as you've got oxygen, you're golden.

Kevin Kowalke: Alright, I love it, and thank you for explaining that, it makes a lot more sense. You have a way of giving this information so that people can really understand it, and that's one of the nice comments that we get on a regular basis. So, I appreciate you doing that because it has been in the news and to give people some peace of mind and also to know what to look out for, and how it can be administered safely. So thank you for that and alright. So Dr. Saadia here we go, we got the final question. Now this one is coming from a grandmother in your area of Boca Raton, and she has some concern for her daughters' child. Gosh you just gotta love grandparents, I just love how much they're so vested in these kids. And she would love for you to talk about grinding teeth, and specifically what she was getting was, how can you know that if this is actually happening, and what is the easiest way to recognize it, so then they can try and do something about it.

Dr. Saadia: Yes, I'm loving this one too because it is such a common question that comes up in my practice also. And they'll be like, "Oh my child is grinding." So, the first question you asked me was how you recognize it? Well most commonly, the parents will come to me and they say they hear the child grinding, and it sounds like rocks. And I will look in the mouth and I'll be like, "Okay, I get it." But they're really not wearing down their teeth. So as a dentist, I am not concerned, but I would like to be aware of it and I would like you to identify what potential reasons this child is grinding.

And it can be a number of different issues. It could be ... again, it goes to something is out of balance. Grinding is not normal, so something's out of balance. In this day and age, sometimes if something as simple as something stressing this kid out, somewhere there is ... they're having jostles in school, there's some kind of stress in their life, which is being expressed as grinding during night time. There could be an airway problem, they could have allergies. They could have tummy problems, they could have some reflux issues and that's all causing them to grind.

They could have my all time favorite, tethered oral tissue, which is affecting both the airway because sometimes the tongue because it is tied, it will fall back into the airway and compromise their airway. And sometimes it will actually cause reflux issues too. So, that could be one of the reasons for grinding. So, identify one, what is the reason? Digging in a little bit deeper to see, are any of these factors the reason why this child is grinding? And then, addressing the underlying cause because as a dentist, one of the simplest things we can do, but that's just a bandaid fix for the children who are really wearing their teeth down, is make them a soft night guard.

So basically they're grinding on their night guard and not grinding away their teeth. But the most important thing is to really identify, what is causing the grinding. And it's a really good one that a lot of times gets missed. They're playing a lot of digital games at night before they go to bed. They need the turn off those digital things, relax. They need to make sure they're drinking lots of water before they go to bed. They need to make sure they are sleeping in the right position, 'cause they might not be sleeping in the right position, they might be all cramped up.

And that's how they're trying to position their airway, to grinding. Their body's trying to compensate say, "Okay, I need more air." And they're grinding through their teeth, just to posture their bottom jaw a little bit more forward and get more air.

Kevin Kowalke: This is all really good to be able to pay attention to again. Once again, Dr. Saadia bringing us some really good information that can help us to identify when there could be some problems here, so I just wanna thank grandma from Boca Raton for bringing in that question, which I promised all of you was gonna be a good one. And I was really excited to get a chance to hear Dr. Saadia explain all of that, so as usual, I know I tell you this all the time, so I hope you never take it for granted, but Dr. Saadia you did an amazing job and you shared wonderful information, important information.

And listeners, I encourage you to share this with others and to talk about it, and let's get this and let's expand the reach of people who get to learn all of this really important thing, and we get to spread the love and banish the fear, right Dr. Saadia?

Dr. Saadia: Yes, spread the love, banish the fear, be in gratitude. I love it, let's spread this information out there.

Kevin Kowalke: I love it too, well Dr. Saadia, thank you so much for being here again today, and thanks for all of you who take the time to listen to this and who do something with it and who are taking care of your family and taking care of your friends who have families as well, and so thanks for again for listening in on the latest edition of Spread the Love, Banish Fear brought to you by Dr. Saadia. And I always end, if you wanna talk to Dr. Saadia and her team, come on you guys know, they're brilliant, they can really help you with this and they have your best interest at heart and on top of their mind.

You can tell how much Dr. Saadia cares, so it's not that she's brilliant, but she cares, and those are the kind of people. Someone like her and her team are the type of people you want to be caring for your children. So give them a call, 561-477-3535, again 561-477-3535. Dr. Saadia, thanks again for being here, and until next time everyone, make it a great day.