Common Problems

Canker Sores

Common problems such as, canker sores (aphthous ulcers) are lesions inside the mouth with a white or gray base surrounded by a red border. Generally, the ulcerations last one to two weeks. The sores are not contagious. Presently, there is no known cause or cure of these ulcers. They are thought to be caused by an immune system reaction. Many factors can trigger a reaction, such as viruses, bacterial infections, food sensitivities/allergy, nutritional deficiencies, mechanical trauma, medications, stress, and hormonal changes. Aphthous ulcers may also be hereditary. Rarely aphthous ulcers can associated with other systemic diseases.

Sodium lauryl sulfate (SLS) is an ingredient in toothpaste that may also trigger ulcer formation. People who are sensitive to SLS may find using SLS-free toothpastes to be beneficial.

There is no known cure for these ulcers. Palliative treatment is recommended, which includes soft, cool foods and avoidance of hot and spicy foods. The ulcers typically resolve in 1-2 weeks. You should consult your dentist for any prolonged symptoms, frequent ulcerations, or if your child is not maintaining adequate nutrition and hydration due to the sores.

Enamel Irregularities

When the calcification process of developing teeth is disrupted, it can result in enamel that is rough or discolored in appearance. Common causes of enamel irregularities are high fevers during infancy, trauma, malnutrition, certain antibiotics during tooth development, and certain medical conditions. Often these irregular areas on teeth are more prone to decay and need to be monitored closely. We may recommend prescription topical fluoride gel, sealants, restorations, or a combination of these to better protect these teeth. On rare occasions, the tooth defects are extensive enough to need nerve treatment and crown coverage.

Gum Disease

Gingivitis, or gum disease, is the inflammation of the gum tissue often caused by plaque accumulation.  Over time, if left untreated, gingivitis can progress to periodontitis, which is when the inflammation process affects bone health and can result in bone and tooth loss. In the early stage of gingivitis, gums can bleed easily and become red and swollen. As the disease progresses into periodontitis, teeth may become loose or need to be removed by a dentist due to bone damage. Gum disease is highly preventable and can usually be avoided by daily brushing and flossing. 

Orthodontic Problems

When teeth that do not align properly it’s called a malocclusion. A malocclusion can be inherited (genetic), or acquired (ie: thumb, finger, pacifier habits). A malocclusion can be caused by extra teeth, crowded teeth or misaligned jaws. Accidents or developmental issues, such as finger/thumb-sucking over an extended period of time may cause malocclusions. Pediatric dentists are trained to diagnose orthodontic problems early and refer the pediatric patient for an orthodontic evaluation as needed.

Thumb & Pacifier Habits

Sucking on fingers, pacifiers, or other objects when children are young is completely normal and can provide a sense of security. Most children naturally outgrow this habit between 2 and 4 years old. Thumb and pacifier sucking habits that go on for a long period of time can create teeth alignment or bite problems. If the habit continues while the permanent teeth erupt, we can assist you in helping the child break the habit with behavioral modification techniques. If that proves unsuccessful, we may suggest an orthodontic-type appliance to help your child break the habit. Most children stop these habits on their own.

Tooth Decay

Cavities are the most common chronic disease of childhood – five times more prevalent than asthma! Cavities are a disease process mediated by oral bacteria. Cavities are caused by bacteria in the mouth that digest sugars and produce acids. The bacteria, acid, food debris, and saliva combine to form plaque, which clings to teeth. The acids in plaque dissolve the enamel surface of the teeth, creating holes called cavities. The sugars responsible for cavities are fermentable carbohydrates – sucrose, fructose, and glucose. Limit exposure to sugars by having your child eat three meals a day and two healthy snacks. Try to eliminate “grazing” (eating between meals) and limit foods and snacks containing fermentable carbohydrates.

BAD FOODS: Gummy vitamins, fruit snacks, fruit roll-ups, dried fruits, and fermentable carbohydrates such as chips pretzels, crackers, and cookies. Try to limit these snacks as much as possible.

GOOD FOODS: Natural cheeses (string cheese, mozzarella), plain yogurt, vegetables and fruit.

There are many factors that can place your child at risk for cavities. These include special health care needs, medications (may contain sugar, can decrease salivary flow), reflux (GERD), asthma, grazers (frequent snacking and drinking), breastfeeding once eating solid foods (brush teeth after feeds), juice and sweetened drinks (all contain sugars), parent/primary caregiver’s cavity history.

There are many things you can do to help prevent cavities. Do not place juice or flavored milk in a sippy cup or bottle. Never take any liquids to bed except plain water. Do not offer your child juice or limit the exposure to juice to 1 cup a day at mealtime only. Cutting juice with water only decreases the calories; it does not decrease cavity risk. Caregivers can transfer cavity-causing bacteria to children – thus, it’s important to minimize saliva-sharing behavior and schedule routine dental visits for caregivers. Keep your child’s diet as healthy as possible, and limit the frequency of exposure to fermentable carbohydrates. Brush teeth at least twice a day – after breakfast and before bed. Once the spaces between the teeth close, it’s time to start flossing. We recommend using fluoride toothpaste twice a day.

Tooth Erosion

Tooth erosion occurs when acidic chemicals wear away a tooth’s enamel covering. The acid from various candies, drinks (soda, coffee, sport drinks) or gastric reflux softens the enamel which can then be easily abraded away by grinding, chewing and tooth brushing. The thinning of enamel can expose the underlying dentin and cause tooth sensitivity or even expose the tooth’s nerve. To minimize the effects of the acid, it helps to decrease your exposure to acidic drinks and/or use a straw. Do not brush teeth right after consuming acidic foods. Use a prescription fluoride toothpaste or rinse to help reverse enamel softening. If the erosion is severe, we would recommend ruling out Gastroesophageal Reflux Disorder (GERD) as a possible cause by referring to a pediatric GI specialist.

Tooth Grinding

Grinding, also known as bruxism, can be a habitual involuntary habit. Grinding is considered a normal developmental stage of childhood. Many children tend to grow out of this habit and do not grow into adults who grind. Grinding can wear away primary and permanent teeth enamel. Grinding that effects permanent teeth or causing muscular pain can be treated with a nightguard.


Chestnut Dental has 24-hour emergency coverage. If a tooth has been fractured, knocked out, displaced or loosened after an injury, please call us right away.

At Chestnut Dental, we work together to ensure children’s overall dental health, prevent future issues, and strive to make our patients comfortable. Should you have questions during your child’s appointment, we’ll be able to address them and provide appropriate consultations. If you’re ready for your child to visit us, contact our offices in NeedhamFranklin, and Bedford today!