My Blog
By Abraham I. Green, MD, FAAP
June 02, 2020
Category: Child Health
Tags: Autism  
Autism Spectrum Disorder (ASD) is a developmental condition that affects how a person views and interacts with the world around them, including other people. In most cases, differences become apparent by the time your child reaches 24 months. Mainly, parents notice behavioral differences and language delays. If you suspect that your child has ASD, schedule an appointment with your local pediatric office. We work with you to figure out what to do next.
 
Signs of ASD 
Every child with ASD is different. Not everyone will have the same symptoms or experiences. With that in mind, here are some summaries on social, communication, and behavioral differences. 
 
Social Differences
  • Your child doesn’t keep or make eye contact
  • They don’t respond to your facial expressions or smiles
  • Does not reciprocate facial expressions or have the appropriate ones
  • Doesn’t respond to parent’s pointing 
  • Has problems making friends
  • Shows a lack of concern for others
Communication Differences
  • Your child hasn’t spoken by 16 months
  • Repeats or parrots what others say
  • Doesn’t feel the need or want to communicate 
  • Starts missing language and social milestones after 15 months
  • Doesn’t pretend play but does have a good memory for numbers, songs, and letters
Behavioral Differences
  • Has an affinity for routines and schedules and does not like altering them
  • Likes to twirl their fingers, sway, rock, or spin
  • Has strange activities that they enjoy doing repeatedly
  • They are sensitive to sounds, lights, touch, textures, and smells
  • They are more interested in the parts of a toy instead of the whole thing
Common Examples
Don’t feel overwhelmed by the information listed above. As mentioned, a child can have a mixture of any of these behaviors. There are a few other common examples that your pediatrician sees. These give you insight into how a neurotypical child reacts in certain situations versus a child with ASD.  
 
By the age of 12 months, your child should turn their head when they hear their name. A child with ASD won’t respond even if their name is called multiple times.
 
By 18 months, a child with speech delays finds accommodations through gestures, facial expressions, or pointing. Children with ASD find no reason to compensate for speech. 
 
After 24 months, many children enjoy bringing their parents objects or toys to look at or play with. A child with ASD may bring their parent an object but will not play with their parent or respond to their reaction.
HowVeneersRestoredHowieMandelsWinningSmile

You probably wouldn't be surprised to hear that someone playing hockey, racing motocross or duking it out in an ultimate fighter match had a tooth knocked out. But acting in a movie? That's exactly what happened to Howie Mandel, well-known comedian and host of TV's America's Got Talent and Deal or No Deal. And not just any tooth, but one of his upper front teeth—with the other one heavily damaged in the process.

The accident occurred during the 1987 filming of Walk Like a Man in which Mandel played a young man raised by wolves. In one scene, a co-star was supposed to yank a bone from Howie's mouth. The actor, however, pulled the bone a second too early while Howie still had it clamped between his teeth. Mandel says you can see the tooth fly out of his mouth in the movie.

But trooper that he is, Mandel immediately had two crowns placed to restore the damaged teeth and went back to filming. The restoration was a good one, and all was well with his smile for the next few decades.

Until, that is, he began to notice a peculiar discoloration pattern. Years of coffee drinking had stained his other natural teeth, but not the two prosthetic (“false”) crowns in the middle of his smile. The two crowns, bright as ever, stuck out prominently from the rest of his teeth, giving him a distinctive look: “I looked like Bugs Bunny,” Mandel told Dear Doctor—Dentistry & Oral Health magazine.

His dentist, though, had a solution: dental veneers. These thin wafers of porcelain are bonded to the front of teeth to mask slight imperfections like chipping, gaps or discoloration. Veneers are popular way to get an updated and more attractive smile. Each veneer is custom-shaped and color-matched to the individual tooth so that it blends seamlessly with the rest of the teeth.

One caveat, though: most veneers can look bulky if placed directly on the teeth. To accommodate this, traditional veneers require that some of the enamel be removed from your tooth so that the veneer does not add bulk when it is placed over the front-facing side of your tooth. This permanently alters the tooth and requires it have a restoration from then on.

In many instances, however, a “minimal prep” or “no-prep” veneer may be possible, where, as the names suggest, very little or even none of the tooth's surface needs to be reduced before the veneer is placed. The type of veneer that is recommended for you will depend on the condition of your enamel and the particular flaw you wish to correct.

Many dental patients opt for veneers because they can be used in a variety of cosmetic situations, including upgrades to previous dental work as Howie Mandel experienced. So if slight imperfections are putting a damper on your smile, veneers could be the answer.

If you would like more information about veneers and other cosmetic dental enhancements, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine articles “Porcelain Veneers” and “Porcelain Dental Crowns.”

3ThingsYouShouldDotoProtectYourTeethLaterinLife

Entering your “sunset” years doesn't mean you're washed up—you still have a lot to offer the world. That's why the theme for this May's Older Americans Month (sponsored by the Administration for Community Living) is “Make Your Mark.” And to really make that difference, you'll have to maintain your health—including protecting your teeth from loss.

Once upon a time, it was considered the norm for older adults to experience tooth loss and the resulting consequences on their overall well-being. Today, though, not only can advanced restorations lessen the impact of lost teeth, it's also more likely that you can keep your teeth intact for the rest of your life.

To give your teeth their best chance for survival in your later years, here are 3 things you can do to promote their continuing health.

Brush and floss every day. Ridding your teeth of disease-causing plaque on a daily basis is important at any age, but perhaps even more so as you get older. However, hand weakness caused by arthritis or another health condition can make it more difficult to brush and floss. It may help to use a larger-handled toothbrush or an electric toothbrush, and a threading device may help with flossing. If manual flossing is still too difficult, you can try a water flosser that emits a water stream to loosen and flush plaque away.

Relieve chronic dry mouth. Older adults are more prone to chronic dry mouth because of increased use of medications, many of which interfere with saliva flow. It's more than an unpleasant feeling: Deprived of the protective properties of saliva, your mouth is at increased risk of dental disease. If dry mouth is a problem for you, speak with your doctor about alternatives to any saliva-inhibiting medications you're taking. Also, drink more water and use saliva boosters to promote better saliva flow.

Keep up dental visits. Regular dental visits become even more important as you age. Dental cleanings are especially necessary, particularly if you have dental work that can interfere with plaque removal during brushing and flossing. Disease monitoring and screening are more in-depth for older adults who are more prone to tooth decay, gum disease and oral cancer. And if you wear dentures, you should have them checked regularly for fit and overall condition.

If you've already enjoyed decades of dedicated dental care, you need only stay the course. But even if you haven't, adopting new dental care habits now can boost your teeth's health and longevity. To get started, make an appointment with us: We'll assess your current dental health and offer a care strategy for keeping your teeth healthy through the next exciting season of your life.

If you would like more information about dental care for older adults, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine articles “Aging & Dental Health” and “Understanding Aging Makes Beauty Timeless.”

By Abraham I. Green, MD, FAAP
May 18, 2020
Category: Child Health
Tags: Tonsillitis  
TonsillitisEveryone is born with two tonsils. These are lymph nodes located right in the back of the throat. They help out the immune system by housing important white blood cells. Even so, the tonsils themselves can become infected, which is known as tonsillitis. The tonsils swell up, causing pain and discomfort. Children between the ages of five and eleven experience it the most. You need to bring your child in to see a pediatrician right away. Tonsillitis is commonly caused by streptococcus pyogenes also known as strep throat. 
 
The Basics of Tonsillitis
 
Your tonsils work by trapping dangerous viruses and bacteria within. As mentioned before, this can lead them to become infected. Infections are easily transferred between children, with tonsillitis being caused by strep, adenovirus, the flu, and Epstein-Barr virus (mono).
 
Your pediatrician is highly qualified in treating tonsillitis. That is because almost all cases are found in children. During puberty, the tonsils shrink in size. This makes it much harder for them to become infected. You need to seek medical intervention right away. Infections can become life-threatening if not treated, leading to diseases like rheumatic fever. An even more serious complication is a peritonsillar abscess. The infection spreads beyond the tonsils and swells up the neck and chest tissues. This can block and stop your child’s airways. 
 
Signs of Tonsillitis in Children
 
In children under the age of two that have problems communicating what is wrong, symptoms manifest in the form of excessive drooling, refusing food or bottles, and fussiness. Expect these symptoms in older children: 
  • Sore throat
  • Noticeably bigger tonsils
  • Fever
  • Pain or problems with swallowing
  • Yellow or white patches coating the throat and tonsils
  • Swollen lymph nodes in the neck
  • Foul breath
  • Stiff neck
  • Headaches
  • A scratchy or rough voice
  • Stomach pain
Diagnosing Tonsillitis
 
Your pediatrician won’t have any trouble diagnosing your child with tonsillitis. They will first start by asking for a brief history of when your child started feeling sick. The next step is performing a physical exam. The pediatrician will look in the throat, nose, and ears. If strep is suspected, a nurse takes a swab of the throat. A blood test will also be drawn to identify what bacteria or virus is responsible.
 
If strep or another bacteria is responsible for your child’s tonsillitis, antibiotics are prescribed. It’s important that your child finishes the whole dose. This guarantees that the entire infection is gone.
InTheseUncertainTimesWeStillCareAboutYourDentalHealth

During this year's National Public Health Week in April, health issues like vaping and the opioid crisis are taking a back seat to what is front and center on everyone's mind: the novel coronavirus (COVID-19). This highly contagious viral infection is upending business as usual for most of the world in a way unlike anything we've experienced. Nothing is “normal” right now, including dental care.

As with other aspects of daily life, you can expect disruptions in dental care because of COVID-19, especially involving routine visits. But with that said, we're working hard to ensure your teeth and gums aren't overlooked during this global crisis. We are here for you, so please call us for any questions you may have, and especially if you are experiencing dental pain.

If you do need to visit the dentist for treatment, you might be concerned about potentially exposing yourself or others to COVID-19. Like every business that interacts with the public and especially all healthcare providers, dental offices are implementing extra precautions during this time to protect both patients and staff against infection.

This isn't something new: The dental profession as a whole has strict protocols for preventing infection that have been in place for several years. Infection control is a top priority for dentists at all times, not just during outbreaks like COVID-19. Here are some of the things we do—and are expanding because of the novel coronavirus—to keep you safe during dental appointments.

Barrier protection. Dental providers routinely use disposable items like gloves, face masks or eyewear to prevent disease spread during procedures that involve close contact with patients. For extra precautions with COVID-19, we're adding more of this type of barrier protection.

Sterilization and waste disposal. Instruments and equipment that we use repeatedly are thoroughly sterilized to remove all microorganisms, including coronavirus, from their surfaces. For disposable items used during treatment, we keep these separate from common waste and dispose of them according to strict protocols for handling bio-medical waste.

Disinfection. Even though the main pathway for spreading COVID-19 is through respiratory droplets in the air, we're continually disinfecting office and treatment surfaces that the virus might potentially contaminate. In doing so, we're using substances recommended by the U.S. Centers for Disease Control (CDC). By the way, you can find a list of such products at //www.americanchemistry.com/Novel-Coronavirus-Fighting-Products-List.pdf.

These are uncertain times for all of us. But while we're cooperating with social distancing and other measures to slow the spread of COVID-19, we're still here partnering with you to keep your family's teeth and gums healthy.

If you would like more information about special dental precautions during this time, don't hesitate to contact us. To learn more, read the Dear Doctor magazine article “Infection Control in the Dental Office.”





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