DENTAL PROCEDURES 101

Jul 28 2015

DENTAL PROCEDURES 101

Does your child have an anterior cross bite (underbite of front teeth)?

In these cases, normally top teeth fit in front of bottom teeth- in a cross bite, the opposite is true.

An anterior cross bite is usually the result of smaller upper jaw, a larger lower jaw, mis-positioned front teeth or a combination of the above. This occurs from a genetic predisposition in jaw size or tooth location.

The importance of correcting a cross bite ensures the best alignment of the permanent teeth and to prevent “functional shifting” where a child postures forward and encourages an asymmetric growth of the jaw or exaggeration of the genetic growth pattern to have more severe underbite/crossbite in the permanent teeth. An incorrect bite can lead to wear spots, a crooked smile and malocclusion if not corrected. Permanent teeth will also likely erupt into cross bite if not corrected. Your doctor will need to discuss best timing to start treatment.

The doctor can typically correct a crossbite using a custom made appliance depending on exactly what needs to be corrected. This appliance is usually removable and treatment can take from 6-12mo on average. There is little to no discomfort experienced during the expansion, however success is heavily dependent on compliance with wearing and caring for appliance.

Will this correction mean I wont need braces for my child in future?

No. Appliance therapy addresses the immediate concern of crossbite and its accompanying issues (recession, esthetics, decay, gingivitis..etc) and makes future orthodontics more predictable and or successful. It does not mean the child will not need braces in the future.

What is Bruxism?

Some children and young adults grind their teeth unconsciously (or clench) at night time or throughout the day. This condition is called Bruxism. Excess pressure and wear and tear can eventually damage the enamel other tooth structures below it. It can also cause issues with the jaw joint (TMJ).

What is a night guard?

A night guard is typically a clear hard or soft custom mouth piece that fits into the child’s mouth and re-distributes the forces of the grinding load off the teeth. Depending on age and temperament a child may or may not be able to wear the night guard successfully. Or, new teeth coming in may require the custom mouth guard to be adjusted or replaced.

Does your child have an anterior cross bite (underbite of front teeth)?

In these cases, normally top teeth fit in front of bottom teeth- in a cross bite, the opposite is true.

An anterior cross bite is usually the result of smaller upper jaw, a larger lower jaw, mis-positioned front teeth or a combination of the above. This occurs from a genetic predisposition in jaw size or tooth location.

The importance of correcting a cross bite ensures the best alignment of the permanent teeth and to prevent “functional shifting” where a child postures forward and encourages an asymmetric growth of the jaw or exaggeration of the genetic growth pattern to have more severe underbite/crossbite in the permanent teeth. An incorrect bite can lead to wear spots, a crooked smile and malocclusion if not corrected. Permanent teeth will also likely erupt into cross bite if not corrected. Your doctor will need to discuss best timing to start treatment.

The doctor can typically correct a crossbite using a custom made appliance depending on exactly what needs to be corrected. This appliance is usually removable and treatment can take from 6-12mo on average. There is little to no discomfort experienced during the expansion, however success is heavily dependent on compliance with wearing and caring for appliance.

Will this correction mean I wont need braces for my child in future?

No. Appliance therapy addresses the immediate concern of crossbite and its accompanying issues (recession, esthetics, decay, gingivitis..etc) and makes future orthodontics more predictable and or successful. It does not mean the child will not need braces in the future.

What are sealants?

Sealants protect the surface of teeth with grooves and pits, specifically the chewing surface of back teeth where most cavities are found. Made of shaded, tooth colored plastic, sealants are applied to the teeth to help keep them cavity-free.

How do sealants work?

Even if your child brushes and flosses carefully, it is difficult- sometimes impossible – to clean the tiny grooves and pits on certain teeth. Toothbrush bristles are just too thick to reach into the pits and fissures. Food and bacteria build up in these depressions, placing your child in danger of tooth decay. Sealants “seal out” food and plaque, thus reducing risk for decay.

How long do sealants last?

Research shows that sealants can last for many years. So your child will be protected throughout most cavity prone years. If your child has a good oral hygiene and avoids biting hard objects like ice cubes, crunchy candy, or sticky foods, sealants will last longer. Kids that grind their teeth can also fracture sealants. Your pediatric dentist can easily replace or repair a lost or damaged sealant- He even has a sealant warranty that guarantees his work!  As long as routine checkups are not missed, we maintain the sealants for your child.

What is the treatment like?

Your pediatric dentist and his/her staff can apply sealants quickly and comfortably! It only takes one visit. The doctor or his staff clean, isolate, condition, and dry the tooth. The resin-based sealant is painted into the grooves, and then hardened with a blue curing light. It’s that easy!

Which teeth should be sealed? 

The teeth most at risk for decay – and therefore most in need of sealants- are the six year and twelve-year molars. But any tooth with grooves and pits may benefit from the protection of sealants. Baby or adult molars are commonly sealed.

If my child has sealants, are brushing and flossing still important?  

Absolutely! Sealants are only one step in the plan to keep you child cavity-free for a lifetime. Brushing, flossing and regular dental visits are still essential to a bright, healthy smile! Keep in mind cavities that start in between teeth escape the protection of sealants.

Laughing Gas (Nitrous Oxide)

Many children are calm, comfortable and confident in Doctor’s pediatric dental office! Because a pediatric dentist specializes in treating children, he makes them feel special. His/her office is especially designed for children and adolescents! Sometimes, however, a child feels anxious during treatment. Your child may need more support than a gentle, caring manner to feel comfortable. Nitrous Oxide/oxygen is a safe, effective technique that a pediatric dentist may offer to calm a child’s fear of the dental visit.

What is Nitrous Oxide/Oxygen?

Nitrous oxide/oxygen is a blend of two gases – oxygen and nitrous oxide. When inhaled, it is absorbed by the body and has calming effect. It is not a sedative (though we do offer multiple grades of sedation when necessary as well). It has anxiolytic (lessens anxiety) and analgesic (lessens pain) properties. It is very safe. Normal breathing eliminates nitrous oxide from the body very rapidly.

How will my child feel when breathing Nitrous Oxide/Oxygen?

Doctor will give your child the opportunity to choose a “flavor” of air to breathe. Your child will smell this “flavored air” and experience a sense of wellbeing and relaxation. We really want children to have a positive memory of dental care (even when cavities/treatment needs are present).

How safe is nitrous oxide/oxygen?

Very safe, Nitrous oxide/oxygen is perhaps the safest means of anxiolytics in dentistry. It is non-addictive. It is mild, easily taken, and then quickly eliminated by the body. Your child remains fully conscious- keeps all natural reflexes – when breathing nitrous oxide/oxygen. He/she will be fully responsive to commands will communicate with us normally.

Are there any special instructions for nitrous oxide/oxygen?

First, give your child little or no food 4 hours before the dental visit (occasionally, nausea or vomiting occurs when a child has a full stomach). Second, tell your doctor about any respiratory condition that makes breathing through the nose difficult for your child (a common cold, asthma, sinus problems, etc.). It may limit the effectiveness of nitrous oxide/oxygen. Third, tell your doctor of your child is taking any medication on the day of the appointment.

Will nitrous oxide/oxygen work for all children?

Your experienced pediatric dentist knows that all children are not alike! Every service is tailored to your child as an individual. Nitrous oxide/oxygen is not effective for some children, especially those who have severe anxiety, nasal congestion or extensive treatment needs. Most pediatric dentists has comprehensive specialty training and can offer other sedation methods that are right for your child.

Fluoride Varnish

Varnish is the best method for slow release of fluoride over a 24hr period thus giving your pediatric dentist the best technique for strengthening enamel. Application is quicker and easier, and the fluoride varnish does not have the gel taste unpopular with some children.

When your child leaves the clinic, the teeth will be coated with the varnish and will not look bright and shiny as usual after being cleaned and treated with the fluoride gel. They will look nice tomorrow when the varnish has had time to have its maximum effect and has been brushed off.

To retain the varnish on the teeth for as long as possible and to achieve the best result:

Your child should eat a soft, nonabrasive diet for the rest of the day. Teeth should not be flossed and brushed until tomorrow morning, at which time a regular schedule of careful oral hygiene resumes (brushing after breakfast).

What is conscious sedation?

Conscious sedation is a way of using oral medication to relax a child while the child remains consciousness.

Who should be sedated?

Most doctors recommend that only those children with moderate anxiety and limited treatment needs be considered for sedation. Usually these children are young or have trouble managing their anxiety.

Why would a dentist use conscious sedation?

Conscious sedation aids in calming a child so that he or she can accept dental treatment in a more relaxed state. This can prevent injury to the patient and provide a better environment for delivering quality dental care. Keep in mind it’s hard and dangerous to do dentistry on a moving child.

What medications are used?

The typical pediatric denitst has training and experience with many different agents that are used for conscious sedation, from inhalation agents (laughing gas) to medicines that are drunk from a cup such as Versed, Vistaril, Demerol, Chloral Hydrate, etc. None of these sedatives should render the child unconscious. Your doctor will base his/her recommendation of medications to be used based in the child’s age, level of anxiety, amount of dental work that needs to be completed and length of appointment.

Is sedation safe? 

The typical pediatric dentist has had 2 years of advanced training to administer, monitor and manage sedated patients. He or she also exceeds the standard of care in their monitoring and emergency equipment. Many doctors are also trained and certified in pediatric advanced life support. We don’t recommend treatment on kids with many cavities this way as there are better options to consider with anesthesia.

What are athletic mouth protectors?

Athletic mouth protectors, or mouth guards, are made of soft plastic. Your doctor adapts them to fit comfortably to the shape of your upper teeth.

Why are mouth guards important?

Mouth guards hold top priority as part of a proper sports outfit/equipment. They protect not just the teeth, but lips, cheeks and tongue. They help protect children from such head and neck injuries as concussions and jaw fractures. Increasingly, organized sports are requiring mouth guards to prevent injury to their athletes. Research shows that most oral injuries occur when athletes are not wearing their mouth protection.

When should you wear a mouth guard?

Doctor recommends your child wear a mouth guard whenever they are in an activity with a risk of falls or head contact with other players or equipment. This includes football, rollerblading, and even gymnastics. We usually think of football and hockey as the most dangerous to teeth but nearly half of sports-related mouth injuries occur in basketball and baseball.

How do I choose a mouth guard?

Any mouth guard works better than no mouth guard! Choose one that is comfortable to wear. If a mouth guard feels bulky or interferes with speech, it will be left in the locker room. You can buy mouth guards in sports stores that are pre-formed or “boil-to-fit”. Different types and brands vary in terms of comfort, protection and cost. Alternatively, Doctor can make customized mouth guards. They cost a bit more, but are more comfortable and more effective in preventing injuries. Doctor can advise you on what type of mouth guard is best for you.

What is Monitored Anesthesia Care (MAC)?

MAC provides a way of effectively completing dental care while a child is unaware and safe.

Who should receive MAC?

Children with severe anxiety and/or extensive/complex dental treatment needs are candidates for MAC. Usually these children are young or have compromised health issues and helping them control their anxiety is not possible using other methods.

Is MAC safe?

YES! In addition to ensure the best possible care of your child, Doctor requests that all of his MAC cases be covered by a specialist dental anesthesiologist. They are responsible for delivering the anesthesia, closely monitoring the vital of the child, and medical care of the child. Many precautions are taken to provide safety for the child during anesthesia. Patients are monitored closely during the procedure by anesthesia personnel who are trained to manage complications. Doctor will gladly discuss any additional questions you have about the benefits and risks involved with anesthesia and why it is recommended for your child’s treatment.

Special considerations associated with the MAC appointment:

Your child’s procedure will be done on an “outpatient” basis. This means they will have their procedure in the morning and be allowed to go home after a short recovery period the same morning.

A physical examination may be required prior to a this appointment to complete dental care. The anesthesiologist will ask for this physical examination if indicated to get information to ensure the safety of your child.

  • Prior to surgery: minimal discussion to your child about the appointment may reduce anxiety. Explain they are “going to go to sleep when their teeth are being fixed.”
  • Eating and drinking: it is important NOT to have a meal the night before general anesthesia. You will be informed about food and fluid intake guidelines prior to the appointment.
  • Changes in your child’s health: if your child is sick or running a fever, contact your dental office immediately! It may be necessary to arrange another appointment.
  • How long will it take? Most offices can not accurately guess how long a child’s appointment will take as very often the extent of treatment needs is only apparent once the visit has started. As an estimate, many quality dental providers will need 30-40 minutes per quadrant that has treatment needs. If a child also has front teeth than need treatment, that would be an additional “quadrant”. Majority of dental rehabilitation cases are between 1-3 hours in duration.
  • How much does it cost? The fees for anesthesia services may not be related to your dental provider. Many anesthesiolgists have their own fees that commonly range from $500-$1000 per hour. You should contact your provider directly to get fees.
  • After Surgery: Usually, children are tired following general anesthesia. You may wish to return home with minimal activity planned for your child until the next day. After that, you can usually return to routine schedule.

Baby Root Canal

Your pediatric dentist may have recommended the treatment option of removing the unhealthy part of the nerve in your child’s tooth to allow the remaining tissues to heal without infection. This procedure is in some ways similar to a root canal in an adult. It is called a pulpotomy.

Baby teeth respond well to the removal of the diseased part of the dental pulp (nerve) while leaving the healthy portion intact. The cavity is removed from the tooth in addition to the portion of the pulp that has been infected by the bacteria of the cavity. A disinfectant is placed in the top of the remaining pulp, the tooth is sealed and a crown (silver cap for back teeth and white cap for front teeth) is placed over the tooth. This allows the tooth to stay vital (alive) in the mouth and minimizes risk of further fracture of enamel.

What are the advantages and disadvantages of pulpotomies?

The obvious is that the tooth is maintained in service and holds the space for the developing permanent tooth below it. The disadvantages are teeth that receive nerve treatments likely require a crown to be placed on the tooth to provide adequate strength. Occasionally, the bacteria invade the nerve completely and a pulpotomy fails and the tooth must be removed, but the risk is low.

Are there alternatives?

Alternatives include removal of the tooth (with the diseased nerve) and placement of a space maintainer, which allows the room to be “held open” for the permanent tooth to erupt between the ages of 7-12 years old.

What are the cost differences?

Although the cost for a pulpotomy and crown are moderate, they are similar in price for the removal of the tooth and space maintainer. Remember that the cost of either treatment likely ensures that the space for the erupting permanent tooth will be held over the next few years to minimize expensive orthodontic issues from shifting teeth.

What is the result of non-treatment?

Usually the patient will experience continued and increased pain and/or infection. There is also a risk of damage to the underlying permanent tooth below the infected primary (baby) tooth. Ignored nerve infection will usually result in an abscess and require removal of the tooth.

Why do children lose their baby teeth?

A baby tooth usually stays until a permanent tooth underneath pushes it out and takes its place. Unfortunately, some children lose a baby tooth too soon. A tooth might be knocked out accidentally or removed because of dental disease or removed for orthodontic issues. When a tooth is lost too early, your pediatric dentist may recommend a space maintainer to prevent future space loss and dental problems.

Why all the fuss? Baby teeth fall out eventually on their own!

Baby teeth are important to your child’s present and future dental health! They encourage normal development of the jaw bones and muscles. They save space for the permanent teeth and guide them into position. Remember: some baby teeth are not replaced with adult teeth until a child is 12 years or older!

What are space maintainers?

Space maintainers hold open the empty space left by a lost or extracted tooth. They steady the remaining teeth, preventing movement until the permanent tooth takes its natural position in the jaw. It’s more affordable- and easier on your child- to keep teeth in normal position in the jaw, than to move them back in place with orthodontic treatment later.

How does a lost baby tooth cause problems for permanent teeth? 

If a baby tooth is lost too soon, the teeth beside it may tilt or drift into the empty space. Teeth in the other jaw may move up or down to fill the gap. When adjacent teeth shift into an empty space, they created a lack of space in the jaw for the permanent teeth, so, permanent teeth are crowded and come in crooked. If left untreated, the condition may exacerbate the normal growth and development of the jaws.

?

In certain cases where a child has mild-moderate crowding, it may be recommended to “borrow” space from the areas where there is extra room and give it to the areas where there is crowding.

How and from where do we borrow space?

The most common area where we have crowding is lower front incisors. We borrow space by extracting the canines next to the crowding. A space maintainer is then used to “hold space” and we let nature align the crowded teeth into better position.

Will space management mean I wont need braces for my child in future?

No. Space management addresses the immediate concern of crowding and its accompanying issues (recession, esthetics, decay, gingivitis..etc) and makes future orthodontics more predictable and or successful. It does not mean the child will not need braces in the future.

What are space maintainers?

Space maintainers hold open the empty space left by a lost or extracted tooth. They steady the remaining teeth, preventing movement until the permanent tooth takes its natural position in the jaw. It’s more affordable & easier on your child to keep teeth in the right position, than to move them back in place with orthodontic treatment later.

What special care do space maintainers need?

There are four big consideration for space maintainers’ care:

  1. Avoiding sticky sweets or chewing gum.
  2. Not tugging or pushing in the space on the space maintainer with fingers or tongue.
  3. Keeping the appliance clean with conscientious brushing.
  4. Continued regular dental visits.

What is Ankylosis?

Ankylosis is a dental condition in which the roots of a primary tooth loses its normal attachment to the bone (small ligaments) and becomes fused directly to the jaw. The cause of this is mostly not known, but it is seen fairly often, particularly in lower primary molars.

Will it cause problems?

There are three potential problems that can occur. Because the ankylosed tooth is fused to the bone, it will no longer erupt normally and will appear submerged. This can lead to malpositioning of the teeth on either side of it and excessive eruption of the opposing tooth in the opposite dental arch may occur. Of greater concern, however, is the disruption of the usual way that primary teeth lose their roots (dissolving away during the growth of the permanent tooth in the bone). About half the time the growth of the permanent tooth will be blocked by the ankylosed tooth because the roots will not dissolve.

What must be done?

If the adjacent teeth shift extensively or the permanent tooth is blocked from erupting, the ankylosed tooth must be surgically removed (extracted) by your pediatric doctor or sometimes an oral surgeon. The timing of this dependent upon the development of the permanent tooth and can best be determined by regular follow up and x-ray examination of the area.

What is Interceptive Orthodontics?

As a child grows and matures, many indications become apparent to the dentist that your child’s teeth may not be developing in a normal position or may have improper biting relationships. In certain cases, your doctor may suggest to you that a limited orthodontic treatment be done before the stage where all permanent teeth have come in.

Interceptive orthodontic treatment (commonly referred to as Phase I) allows minor tooth movement during an early development time in your child’s life. Commonly, braces are attached only to the limited number of permanent teeth erupted (usually the front 4 incisors and the back permanent molars).

What are the benefits and limitations of phase I orthodontics?

Benefits: Minor preventive orthodontic procedures can often prevent major problems from developing later. Discomfort is reduced, and the end results may be achieved quicker and be better.

Limitations: Cost to the family and inconvenience of appliance in the mouth of a young child.

Occasionally the result of the interceptive procedure cannot be predicted totally before it is accomplished. The risks are the same as for full orthodontic therapy, but usually to a lesser degree.

Are there alternatives?

Waiting to see if your child’s dentition (jaws and teeth) improve spontaneously without orthodontic therapy is an alternative, but indicators of the development of orthodontic problems are quite clear. Waiting is not an alternative without its own predictable risk.

How much does Interceptive orthodontics cost?

The costs are lower for Interceptive orthodontics than for full orthodontic therapy because Interceptive therapy is usually much less comprehensive. Some trained pediatric dentists offers Interceptive orthodontics to patients who meet the criteria. Your dental office should discuss the difference in fees depending on the complexity of the patient’s individual needs.

What is the result of non- treatment?

If the choice by the parent is non-treatment (or to wait), your child will eventually need full Interceptive orthodontic treatment, which will cost more than the Interceptive care. Also the treatment is likely to be more difficult because early problems were not corrected or decreased in severity. Again, most children who have interceptive orthodontic WILL need a second phase of treatment later in life.

Are oral habits bad for the teeth and jaws?

The most common oral habits include pacifier and thumb sucking. Most children stop sucking on thumbs, pacifiers or other objects on their own between two and three years of age. In most of these cases, no major harm is done to their teeth or jaws. However, some children repeatedly suck on a finger, pacifier or other object over long periods of time. In these children, the front teeth may tip toward the lip or not come in properly. Also the shape and from of the jaw bones can change.

Are pacifiers a safer habit for the teeth than thumbs or fingers?

Thumb, finger and pacified sucking all affect the teeth essentially the same way. However, a pacifier habit is often easier to break. Also, children have a decrease incidence of Sudden Infant Death Syndrome (SIDS) when using a pacifier until age 12mo, after which point all habits are discouraged.

When should I worry about a sucking habit?

Your pediatric dentist should carefully watch the way your child’s teeth come in and jaws develop, keeping the sucking habit in mind at all times. For most children other than simple positive re-enforcement techniques, we do not intervene with treatment until later in life when permanent teeth are closer to coming in. Research suggests the longer a child continues their habit (beyond age 2yr old), the less likely we are to get spontaneous correction.

What can I do to stop my child’s habit?

Most children stop sucking habits on their own, but some children need the help of their parents. When your child is old enough to understand the possible results of a sucking habit, your pediatric specialist can encourage your child to stop. You can also assist by carefully discussing what happens to their teeth if your child doesn’t stop. This advice coupled with the support from parents, helps most children quit. Be VERY mindful of not pushing the child too much, too early as that may delay their readiness to quit.

What is enamel fluorosis?

A child may have the condition called enamel fluorosis if he or she gets too much fluoride during certain years of the tooth development (while they are growing in the jawbone). Too much fluoride can result in minor defects in tooth enamel. It shows up as white, yellow or brown splotches, streaks or lines, usually on the front teeth.

Why is enamel fluorosis a concern?

It usually is not a significant issue other than its esthetic concerns. In severe cases of enamel fluorosis, the appearance of the teeth is marred by discoloration or brown markings. The enamel may be pitted, rough, and hard to clean, therefore setting those teeth up for increased risk of decay. In mild cases of fluorosis, the tiny white specks or streaks are often unnoticeable.

Can enamel fluorosis be treated?

Once fluoride is part of the tooth enamel, it can’t be taken out. But the appearance of teeth affected by fluorosis can be greatly improved by a variety of treatments Doctor provides. If your child suffers from severe enamel fluorosis, Doctor can tell you about dental techniques that enhance your child’s smile and self-confidence!

How does a child get enamel fluorosis?

By swallowing too much fluoride for the child’s weight during the years of tooth development (while they are gowning in the jawbones). This can happen in several different ways:

  • A child may take more fluoride of a fluoride supplement than the optimum amount they need (sometimes pediatricians do not take a thorough fluoride history and over prescribe!)
  • The child may take a fluoride supplement when there is already an optimal amount of fluoride in the drinking water.
  • Some children simply like the taste of fluoridated toothpaste. They may use too much toothpaste, and then swallow it instead of spitting it out.

How can enamel fluorosis be prevented?

First, your dentist can determine the appropriate fluoride supplementation, if any, that should be given. Depending on your state and water sources, your dentist may choose to test the level of fluoride in your child’s source of drinking water. After he/she knows how much fluoride your child’s needs, fluoride supplement use can be considered. Second, monitor your child’s use of fluoridated toothpaste. A grain of rice-sized for infant and a pea-sized amount for older kids placed on the brush is plenty for the fluoride protection. Teach your child to spit out the toothpaste.

Should I avoid fluorides all together for my child?

NO! Fluoride prevents tooth decay. It’s an important part of helping your child keep a healthy smile for a lifetime. Getting enough, but not too much, fluoride can be easily accomplished with the help of professionals.

What is Enamel Hypoplasia (EH)?

Enamel hypoplasia (EH) is a defect in tooth enamel that results in poor quality and/or quantity of enamel as a tooth is developing. The defect can be a small discoloration of defect in the tooth, or it can affect the whole tooth. The discoloration can range from white, to yellow, to brown in color and often gives the tooth a rough or pitted appearance. EH can affect a single tooth or multiple teeth. EH can cause teeth to be hypersensitive to chewing or hot and cold sensations. These teeth are often of cosmetic concern, and are often more susceptible to dental cavities.

What causes enamel hypoplasia (EH)?

Although no one specific cause is available for EH, environmental and genetic factors have been shown to be associated with it. Over 100 related causes have been linked to EH. Among the most common is difficulty during the mother’s births, poor pre- and post-natal nutrition, including deficiencies in vitamin A, C, D and Calcium/Phosphate deficiencies, or a notable syndrome. Other causes are fever producing illnesses (otitis media, RSV, etc.), especially during the first year of life. Unfortunately, the cause of EH in a child is often difficult to determine.

So, how is enamel hypoplasia dealt with?

Treatment options vary depending on the severity and the symptoms. Treatment can range from sealants, to small bonded fillings, to crowns, and at times extractions of the offending teeth. These teeth may also be more difficult to anesthetize (“get numb”). Laughing gas or liquid medicines used in conjunction with restoring these teeth may be necessary. Although Doctor recommends that all patients have thorough exams twice a year, patients with EH surely need to be seen with this frequency due to often rapid breakdown their teeth experience. To help prevent EH from causing more severe issues, many pediatric dentists feel a pro-active home prevention program is also warranted. Toothpastes with higher fluoride content, fluoride rinses, and diet counseling to reduce the amounts of acids and sugars all become part of this plan.

Molar Incisor Hypoplasia/Hypo mineralization (MIH)

A distinct pattern of EH is called MIH. Those with this condition have both molars (back teeth) and incisors (front teeth) effected with this condition to varying degree. Its treatment depends on severity of each individual tooth in question and your pediatric dentist will make recommendations accordingly.

Comparing your options for materials in dental restorations

When your child needs dental treatment such as fillings, it is rare that only a single option is available for treatment. The parents’ basic knowledge of the different materials and options in dentistry could benefit the doctor, parent, and ultimately the child. Here, we simplify the cons and pros of the major dental materials.

Bonding to enamel and dentin

Adhesives that micromechanically bond to tooth structure (dentin/enamel) are very commonly used with tooth colored fillings in pediatric dentistry. This filling material is commonly called Resin or Composite (it is essentially a plastic restoration). It can be used to partially (filling) or fully (crown) cover CERTAIN teeth. In pediatric dentistry, large (for example 3 surface) fillings may not be good candidates for composite fillings.

The pros include: Very esthetic. Typically less healthy tooth structure needs to be removed. Works well with other resins (like sealants).

The cons include: More costly to patient. More technique sensitive (takes longer and child’s perfect behavior is more important). Not as strong as silver fillings or crowns.

Amalgam filling

Amalgam is considered one of dentistry’s most time tested material. Like most dental materials in use now, it has undergone several generations of development and improvement. Today’s amalgam is comprised of several different alloys mixed chair-side to give the ideal outcome. Though certain practices do not use this material, professional organizations including the American Dental Association and American Academy of Pediatric Dentistry have published guidelines and research that support its judicious use. The major area of concern to many remains the presence of mercury, which is a known carcinogen, in all amalgams. However, many quality scientific studies have failed to find support that mercury in amalgam has such effects in humans.

The pros include: Less cost effective. Strong, (though not necessarily strong enough in certain cases).

The cons include: Mercury concerns by some. Esthetic concerns. Typically requires more healthy tooth structure removal than composite. Does not bond well with other resins such as sealants.

Crowns

The use of crowns in children is much different than in adults. Porcelain is rarely ever used in the United States for primary teeth. By far, the most common crown used for molars are called Stainless Steel Crowns (SSC). They are preformed crowns made of a mixture of metals that give it a typical stainless steel shine. They come in many different sizes and your pediatric dentist will select and modify the best fit for the specific tooth. The crown gets cemented to help retention. These crowns are very time tested with excellent compatibility with the oral tissues. Other options used on front teeth include Resin Crowns and SSCs W/ Veneered facings.

The pros of SSC crowns: Full coverage protection against caries on all surfaces of teeth. Less technique sensitive than fillings. Great long term durability.
The cons of SSC crowns: Lack of esthetics. Can require recementation. More costly than fillings.

The pros of resin crowns: Esthetic; Full cover protection on all surfaces of teeth.

The cons of resin crowns: NOT used on back teeth (molars). Can stain or break, more costly than fillings.

The pros of SSC with veneer: More esthetic than SSC.

The cons of SSC with veneer: More healthy tooth structure removed compared to SSC (at times may force dentist to do an otherwise unnecessary nerve treatment). Veneers can break off.

Is my child “tongue-tied” and what’s a “laser frenectomy”?

Frenum is the name given to a tissue that attaches to an organ and prevents it from moving too far. In the mouth, we commonly see one just above the two upper front teeth (labial frenum), and one connecting the tongue to the floor of the mouth (lingual frenum). These structures may cause issues if they are too thick, too short, or just poorly positioned. The labial frenum most commonly requires treatment in conjunction with orthodontic care, such as addressing an exaggerated space between the upper front teeth. The lingual frenum is most commonly released to deal with a “tongue-tied” child who may have problems latching during breastfeeding, developing speech, and/or, having gingival health issues later in life. Other frenum related issues include discomfort of the gums, especially while brushing, formation of cavities from trapped plaque, recession of the gums due to the constant pull by the frenum, and esthetic and functional problems from an anomalous frenum.

What are my options for treatment?

The treatment of a poorly attached frenum is called a frenectomy. While historically, a scalpel and sutures were required for surgical release, new technology has made the procedure very quick with excellent results are easily tolerated by young children as well as adults. Frenectomies can now be done with the soft tissue lasers, commonly without any post treatment bleeding, any sutures, and virtually no post treatment down time. life, prior to development of issues commonly associated with the disturbances caused by a pulling frenum. A dentist who is trained to diagnose and render the best treatment options should evaluate each individual child.

Options when a child needs sedation:

My Child needs help to be comfortable during dental treatment, what options do I have?
It’s never easy making the decision to have your child sedated for a procedure. It’s important that parents do their homework in advance and develop a comfort level with their child’s provider. We’ve seen it time and time again when a parent has “decided not to decide” and typically caries continue to progress, requiring more invasive procedures.

If developing that comfort level means getting a second opinion, then we can help with that. Parents frequently wonder “what are my options?” Here are the more common routes of helping children have comfortable and safe treatment:

1- Nitrous Oxide:

Also called laughing gas. This method is mostly useful for the older child who has some minimal anxiety and will be able to be coached through the procedure. The child MUST be calm enough to breathe through her/his nose. If not, the dentist will get more of the gas than your child. This procedure is known for its safety (only commonly reported issue is possible nausea).

2- Conscious Sedation:

This is also referred to as Oral Sedation. Here, the child is given an oral dose of one or more sedative drugs. There are many different medications and combinations of medications that your doctor may use based on the degree of sedation required and the child’s weight. This is done in the dental office and the procedure generally requires a healthy child. The child’s tonsil sizes (and airway) are amongst many factors that need to be evaluated to ensure a safe procedure. Some medications used have amnesic effects. This method requires rigid NPO (nothing by mouth) guidelines to be followed and insufficient and or paradoxical reactions (opposite of expected sedation) could occur in a minority (but significant) percent of children. Oral sedation works in 3 out of 4 kids and the other 25% will need to be aborted and scheduled for Monitored Anesthesia Care.

3- Monitored Anesthesia Care (MAC):

Here, an anesthesiologist is brought along to start an IV that allows quick and direct access of medications to your child’s blood stream. This is the common choice for children that are youngest, most anxious, and or have extensive treatment needs. While with increased depth of sedation, the chances of an adverse reaction increases, many consider this option the “gentlest and most predictable” option. The cost tends to be similar or oral sedation if more than 1-2 oral sedation visits are needed. However, since all treatment is done is one sitting (in oppose to as many as 4-5 visit with Conscious Sedation), once the cost of missing work is calculated into the picture, IV sedation may be more cost effective.

4- General Anesthesia (GA) in Operating Room:

In rare cases, we schedule children who need treatment in a hospital operating room (the terminology used often is General Anesthesia). This will commonly increase the costs drastically, and the child will be in a deeper sedation to allow intubation. We commonly avoid this treatment route unless it for a severely medically compromised child and the medical benefits can be used to cover the significant hospital bill.

In short, there are several options and each have pros and cons that require careful consideration. Please advise your dental professional for more information and consult a licensed practitioner before proceeding with any of the options discussed.

Why do children lose their baby teeth?

A baby tooth usually stays until a permanent tooth underneath pushes it out and takes its place. Unfortunately, some children lose a baby tooth too soon. A tooth might be knocked out accidentally or removed because of dental disease or removed for orthodontic issues. When a tooth is lost too early, your pediatric dentist may recommend a space maintainer to prevent future space loss and dental problems.

Why all the fuss? Baby teeth fall out eventually on their own!

Baby teeth are important to your child’s present and future dental health! They encourage normal development of the jaw bones and muscles. They save space for the permanent teeth and guide them into position. Remember: some baby teeth are not replaced with adult teeth until a child is 12 years or older!

What are space maintainers?

Space maintainers hold open the empty space left by a lost or extracted tooth. They steady the remaining teeth, preventing movement until the permanent tooth takes its natural position in the jaw. It’s more affordable- and easier on your child- to keep teeth in normal position in the jaw, than to move them back in place with orthodontic treatment later.

How does a lost baby tooth cause problems for permanent teeth? 

If a baby tooth is lost too soon, the teeth beside it may tilt or drift into the empty space. Teeth in the other jaw may move up or down to fill the gap. When adjacent teeth shift into an empty space, they created a lack of space in the jaw for the permanent teeth, so, permanent teeth are crowded and come in crooked. If left untreated, the condition may exacerbate the normal growth and development of the jaws.

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