Common Problems

Canker Sores

Canker sores (aphthous ulcers) are usually small sores inside the mouth with a white or gray base surrounded by a red border. Generally, the ulcerations last one to two weeks and often recur. 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 are 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 two-three weeks. You should consult your dentist for any prolonged symptoms or if your child is not maintaining adequate nutrition and hydration due to the sores.

Enamel Irregularities

Sometimes the calcification process of young teeth can be interrupted resulting in enamel that is rough, or discolored. 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 treatment, 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. Please visit our Enamel Irregularities page for more information and clinical pictures.

Gum Disease

Gingivitis, or gum disease, is the inflammation of the gum tissue often caused by plaque accumulation over time which can progress into tooth loss and bone damage. In the early stage of gingivitis, gums can bleed easily and become red and swollen. As the disease progresses into periodontitis, teeth may fall out 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. One indicator of gum disease is consistent bad breath or a bad taste in the mouth.

Orthodontic Problems

A bite that does not meet properly (a malocclusion) can be inherited, or some types may be acquired. Some causes of malocclusion include missing or extra teeth, crowded teeth or misaligned jaws. Accidents or developmental issues, such as finger- or 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.

Tooth Decay

Group of kidsCavities 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 the 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 between-meal 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, veggie sticks and real 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 (brush teeth after feeds), juice and sweetened drinks (all contain sugars), mom/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. Limit frequency of 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, 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 (colas, coffee, sport) 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. Grinding that effects permanent teeth can cause dental or muscular pain and is often corrected 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.