On Call with Dr. Martha Miqueo, DDS, Pediatric and Adolescent Dentistry, Orthodontics and friend to Pedimedica!

Dr. Miqueo is a leading authority in pediatric dentistry and orthodontics and is president of Vizstara Dental for Children and Orthodontics. Dr. Miqueo is also on staff as Attending Pediatric dentist at Hackensack University Medical Center, where she covers oral trauma and dental emergencies. Dr. Miqueo is an expert in the management of patients with cleft lip and palate, as well as the application of the laser technique for both soft and hard tissue.

Dr. Miqueo loves children and has three of her own. She feels that being a parent has made her a better practitioner because she is more understanding of parental anxieties towards treatment of their children.

The American Academy of Pediatric Dentistry recommends that infants see the dentist for their first dental exam within 6 months of getting his/her first tooth or by their first birthda., but Dr. Miqueo believes that good oral health begins at birth!

Good Oral health Begins at Infancy

Babies are born with their primary (first) set of teeth formed underneath the gums. These teeth do not usually start to grow into the mouth until the child is six to eight months old. By age three, all 20 primary teeth should be in the mouth. A child's primary (first) set of teeth is very important. These teeth help a child eat and speak. They hold space for the permanent teeth and are very important for the child’s self image.

Around the age of six, a child's mouth will begin to grow to make space for the permanent teeth. Each baby tooth will be replaced by a permanent tooth. The permanent teeth begin to come into the mouth between the age of five and six and will continue to about age twenty one, when the third molars erupt.

It is important for children to develop good oral health habits at an early age. Practicing healthy habits can prevent or reduce tooth decay (cavities) in infants and children. Dr. Miqueo is happy to provide Pedimedica parents with answers to frequently asked question regarding children’s oral health as well as suggestion to implement good hygiene and preventative care.

FAQ’s

When should I select a “Dental Home” for my child?

It is important to select a dental home early so that you can prevent problems from developing rather than treating them. The American Academy of Pediatric Dentistry recommends that you see a pediatric dentist by the age of 1.

What should I look for when selecting a dentist?

Check listings for practitioners in your area. Call and make an appointment to meet them even before your baby is born. Ask questions and inform yourself of preventive practices that are established before the teeth grow into the mouth.

Is it important to go to a Pediatric dentist or can I take my child to our family’s general dentist?

Your child should see a pediatric dentist, just like your child sees a pediatrician. A pediatric dentist has 2– 3 years of training beyond dental school. It is very important that your child feels comfortable and has a pleasant first experience.

How often does my child need to see the dentist? Is there a schedule of visits like there is with my pediatrician?

Your child should visit the dentist 2 times a year to receive an examination, cleaning, and fluoride treatment.

How do I know when my child needs to see an orthodontist?

It is recommended that a child see an orthodontist between the ages of 7-9, depending on the child’s dental age. Sometimes problems such as impacted canines can be prevented if detected early.

I heard it is important to brush my baby’s gums. Is that true, and why?

YES! It is important to brush the baby’s gums. That cleans the mouth and soothes the gums. It helps when teething and trains the baby for when it is time to start using a toothbrush.

Is there a difference between breast fed babies and bottle fed babies in regards to the child’s oral health?

In regards to oral health, neither the breast or the bottle should be used as pacifiers. Babies should be fed and detached. You want to set these habits early so that as the teeth start to grow in they are protected. When milk pools in the mouth for long periods of time and is exposed to bacteria, cavities can develop.

Tips on implementing good oral health from birth-adulthood:

Learn how to take care of your baby’s mouth while you are pregnant.

Find a Pediatric Dentist early on before a problem develops.

Visit your Pediatric Dentist twice a year for check-ups.

See an Orthodontist when your child is between the ages of 7-9.

For more information on regarding questions you may have on your child’s oral health you can contact Dr. Miqueo at Vizstara dental, 201-816-4000 or visit her website at http://www.vizstara.com/.

On Call with Dr. Taneja

Fun outdoor kids’ activities such a as swimming can also bring earaches!
Dr. Taneja would like to share some useful information on how to treat and prevent what is commonly called “Swimmers Ear”.

Swimmers Ear (otitis externa)

Symptoms:
Patient has intense pain when the ear is touched or pulled. Currently swimming pain when the tab of the earlobe overlying the ear canal is pushed in the ear feels plugged up and drainage is clear white, foul smelling or bloody.

Cause:
Swimmer's ear is an infection of the skin lining the ear canal. It is caused by excessive moisture in the ear canal from swimming. When water gets trapped in the ear canal it alters the acidic environment of the canal and allows bacteria to invade the canal. The most common bacteria responsible for outer ear infections are staphlococcus aureus and pseudomonas aerginosa.
Children are more likely to get swimmer's ear from swimming pools than from lakes. The chlorine in the pool kills the good bacteria in the ear canal, and harmful bacteria tend to take over.

Treatment:
Over-the-counter drops temporarily control the pain, but are not strong enough to cure the infection.Antibiotic drops are needed to cure the infection. You should also apply heat to the ear for some relief and take over the counter ibuprofen.

Expected Course:
With treatment, symptoms should be better in 3 days.

Prevention:
The key to prevention is keeping the ear canals dry when your child is not swimming. After swimming get all the water out of the ear canals by turning the head to the side and pulling the earlobe in different directions so the water runs out. If recurrences are a problem, rinse the ear canals with rubbing alcohol for 1 minute each time he/she finishes swimming. This is not a cure, this is only for prevention.

Common Mistakes:Don't use earplugs of any kind for prevention or treatment, as they jam ear wax back into the ear canal and wax buildup traps water behind it and increases the risk of swimmer's ear.
When to call the doctor:Call our office if the symptoms are not cleared in 3 days a fever occurs the ear becomes severely painful and/or if lymph node behind the earlobe becomes swollen and tender.

On Call with Dr. Kraut

With the spring season well underway many parents are wondering if their child could be suffering from seasonal allergies and how should they best treat it. Dr Kraut answers the most common questions parents ask regarding this topic.

How do I know if my child is suffering from seasonal allergies and what’s the best way to treat it?

If your child seems to having a stuffy or runny nose with clear drainage, sneezing, itchy eyes and nose, throat clearing and a cough this time of year, chances are seasonal allergies could be the cause. If symptoms increase after being outside, that should give you another hint. Also, children suffering from allergies generally do not run fevers.


What is rose fever?

Rose fever is the name commonly given to people who have allergic symptoms this time of year. People mistakenly thought that symptoms were due to the roses that were blooming. Actually, allergic symptoms in the spring are caused by tree and grass pollens.


What happens if allergies go untreated?

Children whose allergies are not treated can go on to develop ear and sinus problems. Fluid in the ear can affect hearing, sinus pressure can cause headaches, nasal congestion very often interferes with sleep which can lead to behavioral and school issues. In some cases, untreated nasal allergies can develop into allergic asthma.

What is the best treatment for seasonal allergies?

There is no one best treatment. Depending on symptoms, your child might benefit from antihistamines, eye drops and or nose sprays. There are many prescription and over-the-counter preparations available and it can get very confusing! Consultation with your doctor is the best place to start. In all cases, if you suspect your child might have allergies, keep your windows closed and use your air-conditioning. Also, make sure your child showers and washes his/her hair every night.


Should I start medication before the onset of seasonal allergies?

Yes, the ideal time to start medication is before symptoms start.


What do I do if my child doesn’t improve from the medications?

If they don't improve, check with your doctor to see if you are using the appropriate medications. An allergy consult might be recommended.


When should I get my child tested for allergies?

Allergists can help diagnose exactly what your child is allergic to so you and s/he will be better prepared next year. They use detailed histories, physical exams, skin tests and other tests to help determine what the best course of therapy should be. They can help choose those medications that will be of benefit to your child. Under some circumstances, immunotherapy (or allergy shots) might be recommended.

On Call with Dr. Kolsky

“My teenager has been unusually tired lately and is now experiencing and a very sore throat. Could my child have mono?”

Dr. Kolsky answers the most frequently asked questions on this topic

"Infectious Mononucleosis or “Mono” as it is called by most people is a viral infection characterized by the triad of fever, tonsillitis or pharyngitis and swollen glands.. It is an extremely common cause of “sore throat” and is usually caused by the virus specifically known as Epstein-Barr virus (EBV).

Many, if not most children, have a sub-clinical infection (i.e. they either don’t know that they are ill or they have a very mild sore throat). By age 18 years, it is estimated that about 80% of the world’s population has had EBV infection, and that by age 40 years, 90-95% of adults have had it.”

How is Mono Diagnosed?

EBV infection during early childhood is often sub-clinical (i.e. no apparent symptoms). During adolescence thru adult years, the incidence of symptomatic infection rises, with the peak incidence in the 15-24 year age group. The typical features in this age group include the above mentioned fever, sore throat, swollen glands, and also fatigue.

Blood work reveals elevation of a certain type of white blood cell called atypical lymphocytes. Other lab data that support the diagnosis include the “Mono spot test” and measurement of specific EBV antibodies. Sometimes, especially during the 1st week of the illness, the Mono spot test can be negative, and needs to be repeated in week 2 or 3 if symptoms of Mono persist.

Rarely Mono is caused by a different agent other than EBV. This includes cytomegalovirus, toxoplasmosis, and human herpes virus.


How is Mono spread?

After developing infectious mono, the virus can be transmitted from the saliva for many weeks.

Although the virus spreads primarily through saliva, it is NOT a very contagious illness. The virus can persist in the mouths of patients for as long as 18 months following recovery from the illness. This may explain why only a small number of patients with Mono recall any previous contact with an infected individual. Also spread within a family is UNCOMMON, again demonstrating that it is NOT a particularly contagious illness.

What is the treatment of Mono?

The most important part of treatment is supportive care and there are NO specific medications to cure Mono.

Acetaminophen or Ibuprofen is recommended for the treatment of fever, sore throat, and general malaise. Giving plenty of fluids and proper nutrition are also important. Plenty of rest helps the symptoms, BUT absolute bed rest is NOT necessary.

There are times when steroids are used, especially if the patient is having great difficulty swallowing fluids and is at risk of becoming dehydrated. Steroids are also used if the patient is experiencing breathing problems from the enlarged tonsils.


Does Mono Have Complications?

Most patients have an unremarkable recovery and are back to regular activities within a few weeks after the illness. Sports are often delayed for a period of time (usually 4 weeks) and for contact sports a bit longer (4-8 weeks).

Possible complications from Mono include:

Anemia which is a low red blood cell count

Low platelet count (thrombocytopenia)

Airway obstruction from markedly swollen tonsils

Rupture of spleen, especially in those athletes who return to contact sports too soon after the illness