New patients receive a comprehensive examination which includes a growth and development analysis, an exam for cavities, and an evaluation of gums and oral hygiene. A routine oral exam is performed on subsequent visits to determine any changes in dental and health status since the previous visit, to check for cavities, and to monitor growth and dental development. We often explain to the young patients that we are counting their teeth and checking to see how strong they are.
Kids Teeth Cleaning and Fluoride:
When your child comes to our office for a hygiene appointment, the hygienist or doctor will clean and polish your child’s teeth, removing the plaque, calculus (the hard mineral deposits), and stain. The cleaning allows the Pediatric Dentist to better examine your child’s teeth for decay or potential problems. During this part of your child’s visit, the hygienist or doctor will explain the importance of oral hygiene to your child and show them how to clean their teeth properly.
Traditional fluoride treatments are usually gels or foams that are placed on your child’s teeth for a set amount of time and then removed. If this type of fluoride is used, then your child is instructed not to eat or drink for 30 minutes. Fluoride varnish also delivers a topical application of fluoride, just in another way. This type of fluoride is also applied to the surfaces of your child’s teeth, but it is stickier and is not removed.
Advantages of fluoride varnish include:
- easier for your child to tolerate (no trays)
- allows your child to eat and drink immediately after placement
- has been clinically proven to be the most effective professional fluoride treatment available for cavities
- it is safer for your child due to less fluoride ingestion than the gels and foams
Kids Oral Hygiene Instructions:
We try to cater home care instructions to your child’s specific needs and will advise you and your child during the appointment as to the best way to care for your child’s teeth. The Pediatric Dentist and staff will talk to older children and show them how to brush and floss properly. Depending on how well your child is brushing at home, we may recommend products to aid in improved oral hygiene, such as fluoride rinse, handle flossers or a certain type of toothbrush.
X-rays are a vital and necessary part of your child’s checkup. Without them, certain dental conditions can and will be missed. X-rays allow the Pediatric Dentist to diagnose and treat health conditions that cannot be detected during a visual clinical examination. Often, if dental problems are found and treated early, dental care is more comfortable for your child and more affordable for you. In addition, there are more things to look for than just cavities, such as cysts, abscesses, the progress of dental development, and possible future orthodontic concerns of your child.
The American Dental Association and the American Academy of Pediatric Dentistry recommend x-rays and complete examinations every 6 months for children with a high risk for tooth decay. At the first examination, our office may obtain a baseline set of x-rays of your child to determine the current status of your child’s mouth and to check for any hidden problems. If you have previously received x-rays at another office, you may request copies and bring them with you so that we will not have to take the same ones again.
If your child is very young, the Pediatric Dentist may do a complete visual examination first and then advise you if any decay is seen. This can be done because the primary teeth often do not touch, and the dentist can see and feel all of the surfaces the tooth. If decay is visually detected, x-rays will need to be taken to determine the extent of the decay and to determine the correct treatment plan for your child.
Panoramic Radiographs (X-rays):
A Panoramic X-ray is very commonly done on the “initial” visit to the Pediatric Dentist. The panoramic X-ray gives a broad overview of your child’s entire mouth because it shows a picture from ear to ear, producing a complete two dimensional representation of all your child’s teeth.It gives us an overall picture of all your child’s teeth, sinuses, jaw bones, and other hard and soft tissues of his/her head and neck.
The panoramic x-ray is an important part of a thorough dental examination. It is recommended that a panoramic x-ray be taken initially around age six and then periodically to monitor growth and development. Although the panoramic x-ray does not provide as much detail when evaluating the teeth and gums as other dental x-rays, such as bitewings or periapicals, it will pick-up potential problems that the other smaller x-rays cannot. The panoramic x-ray is not intended as a substitute for bitewing or periapical x-rays since these films specifically function to identify decay in its early stage, fractures of specific teeth, or abscesses. By utilizing different types of x-rays available to us, the Pediatric Dentist is able to give you a complete report of your child’s dental health.
Tooth Colored Fillings:
Composite resins (white tooth-colored filling material) are a mixture of powdered glass and plastic resin which harden with exposure to blue light. Advantages of composite resin fillings include much better esthetics, less tooth structure needs to be removed for placement, and less chance of your child’s tooth fracturing because the composite resin filling is bonded to your child’s tooth, actually holding the tooth together, .giving his/her tooth greater strength. Because of the conservative nature of the “drilling” we can often place these without anesthesia (No Shots!).
Kids Stainless Steel Crowns (SSC):
If your child’s tooth has a large cavity, or in some cases trauma that has fractured a tooth, a stainless steel crown may be indicated. An SSC covers the entire tooth and re-establishes proper form and function. To place the SSC, your child’s tooth/teeth are numbed with local anesthesia and all weak tooth structure is removed. The tooth is then prepared for a crown to be placed on it. SSCs are “glued” on with cement that also releases fluoride into the tooth to help it remain strong. Soreness around the crown for a few days is normal and we recommend Motrin or Tylenol as needed. While your child is numb, watch and make sure your child does not chew on their lips, cheeks, or tongue.
Cavities and traumatic injuries are the two main reasons your child’s tooth might require pulp therapy. Pulp therapy is often referred to as a “nerve treatment” or a “baby root canal”. A pulpotomy is a dental procedure that is performed when the decay in a child’s tooth reaches into the pulp (nerve) tissue. The infected part of the nerve tissue within the crown portion of the tooth is removed to prevent further inflammation and spread of disease. Next, a sedative material is placed within the tooth to prevent bacterial growth and to calm the remaining nerve tissue. After the pulpotomy is finished, your child’s tooth is restored with a stainless steel crown (SSC) on the back molar teeth to re-establish normal chewing function and to continue to hold the space until the permanent tooth can take its place. On the upper front teeth, a white esthetic crown can be placed. This procedure is performed in one visit and causes no more discomfort than placing a routine filling. We do this pulpal procedure to hold on to the primary tooth until it is time for it to fall out, but occasionally, the tooth can become abscessed after treatment and if this occurs then an extraction is necessary.
Extractions for Children:
Teeth may need to be extracted, or removed, due to infection, extensive decay, trauma, or over-retention. Over-retention occurs when a baby, or primary, tooth does not fall out on its own and the permanent tooth is already erupting. If your child is in orthodontic treatment, the orthodontist may refer your child to have a tooth/teeth removed for orthodontic reasons.
When an extraction is performed, your child will have local anesthesia to numb the tooth/teeth and tissues prior to removal. After the extraction we recommend Motrin or Tylenol as needed to alleviate pain and a soft diet for the rest of that day. While your child is numb, watch and make sure your child does not chew on their lips, cheeks, or tongue. We will have your child biting on some gauze after the procedure and give you several packs to take home. We ask that you change out the gauze every 15 – 20 minutes until the bleeding stops. That night you may want to put a towel or washcloth over your child’s pillow, as sometimes your child may drool and their saliva can mix with some blood. Most children will be fine to resume normal activity the next day.
Baby, or primary, teeth are just as important as permanent teeth. They are used for chewing, speaking and they hold the space for the permanent tooth. The primary molars in the back of your child’s mouth can remain present until as late as age thirteen. When a baby tooth is removed early due to extensive decay, infection, or trauma, it is important to save enough space for the permanent tooth growing under it to come into your child’s mouth in the correct and best position. Space maintainers allow us to keep that space open for when the permanent tooth is ready to come in. If proper space maintenance is not provided or a space maintainer is lost, teeth around the space will shift, causing the newly erupting permanent tooth to erupt in the wrong place (ectopic eruption) or become impacted. This can lead to increased time in orthodontic treatment, periodontal problems, increased risk of cavities, and possible future removal of a permanent tooth/teeth. Once the new tooth starts to erupt, we will take the spacer out to allow it to grow into the right place. If you notice the permanent tooth under the spacer, please call our office to make an appointment to have to spacer removed.
Nitrous Oxide (Laughing Gas):
A combination of Nitrous Oxide and Oxygen is often used when a child is fearful or nervous to alleviate anxiety and also provide analgesia. It is also useful for those who have a strong gag reflex. Sometimes nitrous oxide is known as “laughing gas” because some patients become so comfortable and relaxed that they will laugh or act silly. Nitrous oxide/oxygen is breathed through a small mask placed over your child’s nose and is safe because your child remains awake, responsive, and breathes on his/her own without assistance. Much more oxygen is given than what we breathe in normal room air and this provides a wide margin for safety. We find that dental treatment is more comfortable and time seems to pass faster for your child if he/she is relaxed, and we can provide optimal treatment because your child will be more able to cooperate.
Nitrous oxide/oxygen analgesia may be beneficial in helping your child if he/she is afraid, uncooperative, or too young to understand dental treatment. It is also very beneficial for very long and complicated dental treatment visits. Since it is important that your child remain calm and still during dental treatment in order to prevent injury to your child or a dental staff member and to receive the highest quality of professional dental care, the Pediatric Dentist may recommend this adjunct to treatment. If your child is having nitrous oxide/oxygen for treatment, we recommend a light meal a few hours before the appointment.
With a very fearful child, a child that is too young to understand and cooperate, or if there is extensive treatment to be done we may recommend conscious sedation. This is the use of medication, most often Versed or Demerol, to obtain a minimally depressed level of consciousness that retains the child’s ability to maintain his/her breathing independently and to respond to verbal commands and physical stimulation while allowing the Pediatric Dentist to give the highest quality of professional dental care.
If your child is a candidate for this technique of behavior management, please expect a longer appointment than usual. Your child will report to the office in the morning on an empty stomach, meaning no food or drink past midnight the night before the appointment. Once at the office, your child will drink the medicine and then once it takes effect, will be escorted to the operatory for treatment. Throughout this visit, your child will be monitored for heart rate, blood pressure, respiration and oxygen levels. If this technique will be useful for the treatment of your child, the Pediatric Dentist will discuss in more detail at your consultation.