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19847 Century Blvd, Lobby B, Ste 215, Germantown, MD 20874

Germantown Orthodontist : Germantown Orthodontics : Germantown Invisalign : Germantown Braces : Germantown Pediatric Dentist : Germantown Pediatric Dentistry : Germantown Kids Dentist : Germantown Childrens Dentist : Dr Echandy : Dr Robles

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General Topics

Abcessed Tooth

An abscess is a pocket of infection located at either the end of the root or along the lateral surface of the root. A periapical (root tip) abscess is usually caused by a deep cavity or trauma to the tooth that has caused nerve damage. The treatment for a periapically abscessed tooth will require either PULP THERAPY or an EXTRACTION. A lateral abscess is usually related to periodontitis (gum disease). An abscessed tooth is usually painful but may only be detected on an x-ray and treated before the patient experiences discomfort. Left untreated an abscess may compromise the immune system and in extreme cases may become life-threatening.


Some individuals have specific allergies to certain medications or materials. You will be asked about any specific allergies your child may have on the new-patient questionnaire. Be sure to let us know prior to treatment if your child has allergies to any of the following: Antibiotics, Dental Anesthetics, Latex.


An ankylosed tooth is a tooth that appears to be out of line with neighboring teeth. This condition can occur in both primary (baby) teeth and permanent teeth and can occur at any stage of development or eruption. The cause of this condition is uncertain. The diagnosis is based on examination and x-ray.


One serious form of decay among infants and young children is baby bottle tooth decay. The cause of this condition is frequent and long exposure of the teeth to liquids that contain sugar, including milk/breast milk, formula, fruit juice, and soft drinks. While the child is asleep the sugary liquid is not completely swallowed and pools around the front teeth, and the bacteria living in every baby’s mouth converts the sugars to acid which causes cavities. Baby bottle tooth decay (early childhood cavities) can also affect the teeth of a toddler who is allowed to drink sugary beverages from a bottle or sippy cup frequently throughout the day.


• Clean your child’s teeth after each feeding by wiping the teeth and gums with a damp washcloth or gauze pad.

• Never allow your child to fall asleep with a bottle that contains milk, formula, fruit juices or any other sweetened liquids.

• Never allow your child to carry around a bottle or sippy cup filled with milk, formula, fruit juices or any sweetened liquids for long periods of time as a pacifier. If your child needs comfort or is thirsty give him plain water.

• Make sure your child gets the fluoride needed to prevent cavities.

• Schedule your child’s dental appointment by his first birthday.


In most cases bad breath is caused by the bacteria in the mouth and on the tongue. It can also be an indication of gum disease. Possible causes:
• Untreated Cavities
• Gum Disease
• Inadequate oral hygiene (not brushing and flossing daily)
• Odor causing foods
• Sinus or respiratory infections
• Mouth breathing
• Some medical disorders or medications
• Use of tobacco products


Cavities begin when the plaque (bacteria) on the teeth combine with sugars and carbohydrates of food particles left on and in between the teeth to produce acid. The acidity then begins to weaken the hard enamel shell around the teeth causing demineralization. If left unchecked a cavity (hole) will develop in the enamel which will rapidly spread to the softer dentin which lies under the enamel. If the cavity is diagnosed in time, usually a restoration (filling) will correct the problem. A very large cavity may require a crown (cap). However, if not treated a cavity can spread into the pulp (nerve) and cause an abscess requiring pulp therapy, root canal therapy or extraction.


Good oral hygiene. Brushing at least twice a day and daily flossing removes bacteria and food particles that combine to create cavities. For infants the use of a wet gauze or washcloth can be used instead of a brush.

Brushing the teeth after your child takes vitamins or syrupy medicines

Healthy eating habits. A well balanced diet is essential to the development of strong teeth and healthy soft tissue of the mouth. Children should eat a variety of foods from the five major food groups. Many inappropriate snacks that children are given to eat can lead to cavities. Snacking on sugary foods or beverages will promote tooth decay.


Tooth grinding is a common occurrence in both children and adults. It often occurs at night and can be heard by a parent while the child sleeps. Sometimes a parent may notice wear to the teeth (teeth getting shorter). Reasons for grinding may include stress, erupting teeth, or pressure to the inner ear at night. Usually, childhood bruxism does not require any treatment. If there are signs of excessive wear to the permanent teeth, a night guard may be needed.


The most common form of gum disease in children is gingivitis. It starts when plaque and tartar are not removed regularly through proper brushing and flossing. The bacteria in the plaque causes an infection in the gingiva (gums) called gingivitis. If untreated, the infection spreads to the tissue and bone that hold your teeth in place, a condition called periodontitis. The usual signs of gingivitis include red, swollen and/or sore gums. Early intervention and treatment will prevent the gingivitis from becoming periodontitis.


Thumb sucking by infants and young children is a natural reflex. It often makes them feel secure and content and may induce drowsiness making them fall asleep. It also provides a sense of security at difficult periods. Prolonged thumb sucking or pacifier sucking beyond the eruption of the permanent teeth can interfere with the proper growth of the mouth and the alignment of the teeth. The problems that can occur as a result of thumb sucking or a pacifier depends upon the duration, intensity, and frequency of the habit. The most common developmental problem caused by prolonged thumb sucking and pacifier use is the development of an anterior open – bite. The open- bite can lead to a secondary tongue thrust with associated speech defects. Pacifiers should be discontinued as early as possible depending on the age and maturity of the child. Recommendations can be made to help stop both habits.


Tooth brushing is the most important first step in preventing cavities. Teeth need to be cleaned from the time they appear. Just like bathing and hair-washing, cleaning the teeth is a part of a child’s general hygienic needs and it must be managed by the parents until a child is capable of doing it himself. Initially, the front teeth of a baby can be cleaned with a wash cloth or gauze pad after every meal. No toothpaste is necessary. When back teeth start erupting, a small soft bristle brush should be used by a parent with a small amount of training toothpaste to clean the teeth. Because infants are not old enough to rinse, the use of fluoride toothpaste should be avoided so that a child does not ingest excessive fluoride. There are many child-oriented brushes to choose from that can make brushing fun. As a child grows, the use of a small amount of fluoride toothpaste will strengthen tooth enamel and help prevent cavities. Our Smile Team provides instructions on proper brushing and flossing techniques. Teeth should be brushed twice-a-day or after every meal.


There are two forms of tooth discoloration. Exogenous (surface staining) can be caused by frequent drinking of coffee, sodas, or tea, inadequate oral hygiene, some antibiotics, and use of tobacco products. A professional cleaning by a dentist can remedy exogenous tooth discoloration. In extreme cases, bleaching might be necessary.

The other form of tooth discoloration is endogenous (from within the tooth). This occurs if a tooth has been injured. Sometimes the nerve will gradually “die” and the tooth will become dark. A root canal treatment can sometimes cause a tooth to darken. Endogenous discoloration can be remedied by bonding, veneers, or crowns.


Tongue thrusting occurs when a child places his tongue against his front teeth before, and during, the act of swallowing. Normally, the tongue should be placed on the roof of the mouth behind the front teeth. The tongue placed against the teeth develops the upper arch faster than the lower arch, protruding the front teeth. Tongue thrusting may also occur when a persistent pacifier or tongue habit forces an open – bite (when the top teeth don’t vertically overlap the bottom teeth).

Tongue thrusting can often be associated with speech impediments.


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Patient Testimonials

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I don’t have to hide my smile anymore!
I love my smile more and more everyday! Thank you Dr. Robles!

- Jennifer


19847 Century Blvd, Lobby B, Ste 215
Germantown, MD 20874