During a dental visit, the dental assistant will first review your child’s medical history with you. This is to ensure that dentist and the staff is updated on the general health of your child so that we may review any factors that may concern your child’s dental health. Then your child’s mouth will be examined for overall oral health. Next, your child’s teeth will be thoroughly cleaned to remove plaque and calculus (hard tarter deposits), which can cause cavities and gum disease. After the cleaning, fluoride will be applied to the teeth to help protect and strengthen the weak areas against decay. For a healthy child, the American Academy of Pediatric Dentistry recommends a visit to the pediatric dentist at least every six months to evaluate your child’s oral health and development. However, if your child has special needs or is more predisposed to dental caries, the dentist may recommend more frequent visits to more closely manage your child’s oral health.
In general, children need X-rays more often than adults. Their mouths grow and change rapidly. X-rays can often show weaknesses in the tooth structure (such as demineralization) that may not be visible with the naked eye. The American Academy of Pediatric Dentistry recommends X-ray examinations every six months for children with a high risk of tooth decay. Children with a low risk of tooth decay require X-rays less frequently. We use digital radiography which uses approximately 1/4 the radiation of the traditional dental x-rays.
Cavities form when there is a weakening in the mineral composition of the enamel of your teeth. Fluoride promotes the remineralization of these decalcified spots, therefore helping to prevent cavities. Low level of fluoride is found naturally in some bodies of water. Municipal water supplies are often fluoridated to a specific standard level. Fluoride can also be found in many household products such as toothpaste, mouth rinses, and even some bottled water.
Sealants are thin, white plastic coatings that are applied to the tops or chewing surfaces of back teeth and are highly effective in preventing tooth decay. The naturally occurring pits and grooves on the chewing surfaces of teeth can often collect plaque. These small grooves and cracks are the most susceptible to cavities in children and teens and benefit the least from topical fluoride. Sealants and fluoride work together to help prevent tooth decay. On average, sealants last for 5 to 10 years with proper maintenance. At every dental check-up, the dentist will check that the sealants are intact. In order to prolong the life of your child’s sealants, avoid crunchy foods and avoid chewing on ice and hard candy (i.e. Jolly Ranchers, Lifesavers, etc).
Silver Diamine Fluoride (SDF)
Silver Diamine Fluoride is a clinically applied treatment that controls active dental caries and aids in preventing further progression of the disease. SDF has a dual mechanism of action resulting from the combination of its ingredients. The silver component acts as an anti-microbial agent killing bacteria and preventing the formation of new biofilm, while the fluoride acts to prevent further demineralization of tooth structure. Application of SDF is simple and noninvasive. Initially, the teeth are brushed without paste and rinsed. The carious teeth are isolated, kept dry, and all excess debris is removed. A microbrush is dipped in a drop of SDF and placed on the lesion(s) for two minutes. Then, excess SDF is removed. The only reported side effect has been staining of the tooth at the site of SDF application which is a common occurrence.
Composite Resin (Tooth Colored Fillings)
Tooth colored fillings are used to restore front or back teeth or where cosmetic appearance is important. Composites are used to repair fractured teeth and/or areas of decay. The shade of the composite restorative material is matched as closely as possible to the color of the natural teeth.
Extractions (Tooth Removal)
Extractions are done only as a last resort in the case of severe tooth decay. If a primary molar is removed prematurely, a space maintainer will be placed. Some extractions are needed for orthodontic reasons to help facilitate tooth alignment when crowded teeth are present. Primary teeth are essential in maintaining the correct spacing in your child’s jaw for the permanent teeth.
Space maintainers are used when a primary tooth has been prematurely lost (or extracted) to hold space for the developing permanent tooth. If space is not maintained, teeth on either side of the extraction site can drift into the space and prevent the permanent tooth from erupting into its proper position. The space maintainer will be removed from your child’s mouth once his/her permanent tooth replacing the extracted tooth comes in.
Pulpotomy (Baby Root Canal)
Pulp therapy (pulpotomy) is the treatment of infected nerves and blood vessels in teeth. Pulp therapy generally becomes necessary for two reasons: either as a result of extensive tooth decay (dental cavities) or as the result of tooth injury. Failure to provide the necessary pulp therapy could result in your child experiencing pain, infection, swelling, or loss of the tooth. Many cavities may be so deep that they extend to the nerve, often causing pain and discomfort. When this happens, the infected part of the nerve must be removed. The remaining healthy nerve will be left intact and medicated. The purpose of a pulpotomy is to extend the life of the baby tooth, thereby avoiding the need for extraction and a space maintainer, until the eruption of the permanent tooth. In other words, the tooth can be preserved for chewing food and maintaining proper space for permanent teeth, as well as helping your child to preserve a healthy, happy smile.
Stainless Stain Crown (SSCs)
Stainless steel crowns are used to restore back teeth that are too badly decayed to hold white fillings. When tooth decay on back teeth has been left untreated, teeth may have extensive damage to the enamel, dentin and sometimes the nerve (pulp). In such cases, tooth-colored fillings are not a viable option, and stainless steel crowns necessary. These prefabricated sliver-colored crowns are fit; then cemented onto the primary (baby) teeth to prevent further damage until these teeth are naturally lost.
Local anesthesia is often required to restore (place a filling) or extract (remove /wiggle) a tooth. This technique involves injecting a numbing anesthetic via a small needle into the gum tissue near the tooth that needs to be fixed. This treatment option works well for the very cooperative child that doesn’t mind getting an injection. For younger children who are afraid of needles, this option should be used in conjunction with nitrous oxide. Young children are often unpredictable and can become restless and fearful without warning. For a variety of reasons, some children may become frightened (ie. noise from the dental drill (tooth whistle) or from the strange sensation of their numb tooth, teeth or tongue).
Nitrous Oxide Sedation
This type of sedation is effective with children who may have slight anxiety but are willing to have the treatment performed. It is effective for children who have limited work that needs to be done. This gas is most helpful with minor fillings and surgeries for slightly anxious children. Children who are uncooperative/pre-cooperative or who are unwilling to follow instructions (eg. breath through your nose) etc. this technique will not be successful. Nitrous Oxide is a very safe sedative gas inhaled by your child while wearing a mask on their nose (like a clown nose). The maximum relaxing effect is reached by breathing the sweet smelling air through their nose. It is important that your child understands that throughout the procedure, they will need to breath through their nose and avoid mouth breathing. After breathing the gas, your child typically feels relaxed and less anxious. Nitrous oxide DOES NOT put your child to sleep. At the end of the procedure, we will turn off the nitrous oxide and place our child on oxygen only. Once your child is on 100% oxygen, they will have no residual effects from the nitrous oxide gas. Nitrous oxide is one of the safest drugs that we have in anesthesia and dentistry.
All of your child’s dental treatment can be completed in one visit under general anesthesia in our office. Your child is completely asleep and unaware of any treatment being performed. General Anesthesia is sometimes necessary for children that are unable, by either age or maturity level, to cooperate during dental treatment. This is a wonderful option for an infant, a very anxious child, children who require major dental treatment, children with strong gag reflexes, children who have had negative dental experiences, children who have sound or smell aversions and children who are medically compromised or have special needs. Children treated with general anesthesia must have a recent physical examination by a pediatrician and speak with the anesthesiologist prior to their treatment.