If a tooth has been knocked clean out of the mouth, it is essential to see a dentist immediately. When a tooth exits the mouth, tissues, nerves, and blood vessels become damaged. If the tooth can be placed back into its socket within an hour, there is a chance the tissues will grow to support the tooth once again.
Here are some steps to take:
- Call our office as soon as possible. After normal office hours please call (703) 861-6020.
- Pick up the tooth by the crown and rinse it under warm water. DO NOT touch the root.
- If possible, place it back into its socket – if not, tuck it into the cheek pouch if you trust that your child will not swallow it.
- If the tooth cannot be placed in the mouth, put the tooth into Save-A-Tooth solution , a cup of milk, saliva, or water as a last resort. It is important to keep the tooth from drying out.
- Get to our office, quickly and safely.
We will try to replace the tooth in its natural socket. In some cases, the tooth will reattach, but if the inner mechanisms of the teeth are seriously damaged, root canal therapy might be necessary.
Usually, a crown or filling comes loose while eating. Once it is out of the mouth, the affected tooth may be sensitive to temperature changes and pressure. Crowns generally become loose because the tooth beneath is decaying. The decay causes shape changes in the teeth – meaning that the crown no longer fits. Crowns can also become loose when a hard, sticky food is being chewed.
If a crown has dropped out of the mouth, make a dental appointment as soon as possible. Keep the crown in a cool, safe place because there is a possibility that we can reinsert it. If the crown is out of the mouth for a long period of time, the teeth may shift or sustain further damage.
Call our office to make an appointment.
DO NOT use any kind of glue to affix the crown.
Place the crown in a plastic bag and bring it with you to the appointment.
We will check the crown to see if it still fits. If it does, it will be reattached to the tooth. Where decay is noted, this will be treated.
Cracked or broken teeth
Teeth are strong, but they are still prone to fractures, cracks, and breaks. Sometimes fractures are fairly painless, but if the crack extends down into the root, it is likely that the pain will be extreme. Fractures, cracks, and breaks can take several different forms, but are generally caused by trauma, grinding, and biting. If a tooth has been fractured or cracked, schedule an appointment as quickly as possible.
Where a segment of tooth has been broken off, here are some steps that can be taken at home:
- Call our office.
- Rinse the tooth fragment and the mouth with lukewarm water. Place the fragment in a zip lock bag and bring it with you to the office.
- Apply gauze to the area for at least ten minutes if there is bleeding.
- Place a cold, damp dishtowel on the cheek to minimize swelling and pain.
- Administer an over the counter pain reliever if necessary.
When a tooth has been dislodged or loosened from its socket by trauma or decay, it might be possible to save it. If the tooth remains in the mouth still attached to the blood vessels and nerves, there is a good chance root canal therapy will not be necessary.
It is important to call our office immediately to make an appointment. In the meantime, use a cold compress and over-the-counter medications to relieve pain. Your dentist may reposition the tooth and add splints to stabilize it if it is a permanent tooth. If the tooth fails to heal, depending on your child’s dentition further treatment may be neccesary.
Toothache is common in children of all ages and rarely occurs without cause. Impacted food can cause discomfort in young children, and can be dislodged using a toothbrush, a clean finger, or dental floss. If pain persists, contact the pediatric dentist. Some common causes of toothache include: tooth fractures, tooth decay, tooth trauma, and teeth eruption.
How you can help:
- Cleanse the area using warm water. Do not medicate or warm the affected tooth or adjacent gum area.
- Check for impacted food and remove it as necessary.
- Apply a cold compress to the affected area to reduce swelling.
- Contact the pediatric dentist to seek advice.
Injured cheek, lip or tongue
If the child’s cheek, lip or tongue is bleeding due to an accidental cut or bite, apply firm direct pressure to the area using a clean cloth or gauze. To reduce swelling, apply ice to the affected areas. If the bleeding becomes uncontrollable, proceed to the Emergency Room or call a medical professional immediately.
If a broken or fractured jaw is suspected, proceed immediately to the Emergency Room. In the meantime, encourage the child not to move the jaw. In the case of a very young child, gently tie a scarf lengthways around the head and jaw to prevent movement.
Head injury/head trauma
If the child has received trauma to the head, proceed immediately to the Emergency Room. Even if consciousness has not been lost, it is important for pediatric doctors to rule out delayed concussion and internal bleeding.
Maintaining the health of primary (baby) teeth is exceptionally important. Although baby teeth will eventually be replaced, they fulfill several crucial functions in the meantime.
Baby teeth aid enunciation and speech production, help a child chew food correctly, maintain space for adult teeth, and prevent the tongue from posturing abnormally in the mouth. When baby teeth are lost prematurely, adjacent teeth shift to fill the gap, causing impacted adult teeth and the potential need for orthodontic treatment. This phenomenon can lead to impacted adult teeth, years of orthodontic treatment, and a poor aesthetic result.
Babies are at risk for tooth decay as soon as the first primary tooth emerges – usually around the age of six months. For this reason, the American Academy of Pediatric Dentistry (AAPD) recommends a “well-baby check up” with a pediatric dentist around the age of twelve months.
What is baby bottle tooth decay?
The term “baby bottle tooth decay” refers to early childhood caries (cavities), which occur in infants and toddlers. Baby bottle tooth decay may affect any or all of the teeth, but is most prevalent in the front teeth on the upper jaw.
If decay becomes too severe, the pediatric dentist may be unable to save the affected tooth. In such cases, the damaged tooth is removed, and a space maintainer may be provided to prevent misalignment of the remaining teeth.
Scheduling regular checkups with a pediatric dentist and implementing a good homecare routine can help prevent baby bottle tooth decay.
How does baby bottle tooth decay start?
Acid-producing bacteria in the oral cavity cause tooth decay. Initially, these bacteria may be transmitted from mother, father, or caregiver to baby through saliva. Every time parents share a spoon with the baby or attempt to clean a pacifier with their mouths, the parental bacteria invade the baby’s mouth.
The most prominent cause of baby bottle tooth decay however, is frequent exposure to sweet liquids. These liquids include breast milk, baby formula, juice, and sweetened water – almost any fluid a parent might fill a baby bottle with.
When sweetened liquids are used as a naptime or bedtime drink, they are a heightened risk because they remain in the mouth for an extended period of time. Oral bacteria feed on the sugar around teeth and emit harmful acids. These acids wear away tooth enamel, resulting in painful cavities and pediatric tooth decay.
Infants who are not receiving an appropriate amount of fluoride are at increased risk for tooth decay. Fluoride works to protect tooth enamel, simultaneously reducing mineral loss and promoting mineral reuptake. Through a series of questionnaires and examinations, the pediatric dentist can determine whether a particular infant needs fluoride supplements or is at high-risk for baby bottle tooth decay.
What can I do at home to prevent baby bottle tooth decay?
Baby bottle tooth decay can be prevented. Making regular dental appointments and following the guidelines below will keep each child’s smile bright, beautiful, and free of decay:
- Try not to transmit bacteria to your child via saliva exchange. Rinse pacifiers and toys in clean water, and use a clean spoon for each person eating.
- Clean gums after every feeding with a clean washcloth.
- Use an appropriate toothbrush along with an ADA-approved toothpaste to brush when teeth begin to emerge.
- Use a smear of ADA approved fluoridated tooth paste when the child is under the age of three and a pea-sized amount of fluoridated toothpaste when the child has mastered the art of “spitting out” excess toothpaste. Though fluoride is important for the teeth, too much consumption can result in a condition called fluorosis.
- Do not place sugary drinks in baby bottles or sippy cups. Only fill these containers with water, breast milk, or formula. Encourage the child to use a regular cup (rather than a sippy cup) when the child reaches twelve months old.
- Do not dip pacifiers in sweet liquids (honey, etc.).
- Review your child’s eating habits. Decrease frequent snacking and starchy, sugar-filled snacks and encourage a healthy, nutritious diet.
- Do not allow the child to take a liquid-filled bottle to bed. If the child insists, fill the bottle with water as opposed to a sugary alternative.
- Clean your child’s teeth until he or she can ties his or her shoes and reaches the age of eight. Before this time, children are often unable to reach certain places in the mouth.
- Ask the pediatric dentist to review your child’s fluoride levels.
Bruxism, or the grinding of teeth, is remarkably common in children and adults. For some children, this tooth grinding is limited to daytime hours, but nighttime grinding (during sleep) is most prevalent. Bruxism can lead to a wide range of dental problems, depending on the frequency of the behavior, the intensity of the grinding, and the underlying causes of the grinding.
A wide range of psychological, physiological, and physical factors may lead children to brux. In particular, jaw misalignment (bad bite), stress, and traumatic brain injury are all thought to contribute to bruxism, although grinding can also occur as a side effect of certain medications.
What are some symptoms of bruxism?
In general, parents can usually hear intense grinding – especially when it occurs at nighttime. Subtle daytime jaw clenching and grinding, however, can be difficult to pinpoint. Oftentimes, general symptoms provide clues as to whether or not the child is bruxing, including:
- Frequent complaints of headache
- Injured teeth and gums
- Loud grinding or clicking sounds
- Rhythmic tightening or clenching of the jaw muscles
- Unusual complaints about painful jaw muscles – especially in the morning
- Unusual tooth sensitivity to hot and cold foods
How can bruxism damage my child’s teeth?
Bruxism is characterized by the grinding of the upper jaw against the lower jaw. Especially in cases where there is vigorous grinding, the child may experience moderate to severe jaw discomfort, headaches, and ear pain. Even if the child is completely unaware of nighttime bruxing (and parents are unable to hear it), the condition of the teeth provides your pediatric dentist with important clues.
First, chronic grinders usually show an excessive wear pattern on the teeth. If jaw misalignment is the cause, tooth enamel may be worn down in specific areas. In addition, children who brux are more susceptible to chipped teeth, facial pain, gum injury, and temperature sensitivity. In extreme cases, frequent, harsh grinding can lead to the early onset of temporomandibular joint disorder (TMJ).
What causes bruxism?
Bruxism can be caused by several different factors. Most commonly, “bad bite” or jaw misalignment promotes grinding. Pediatric dentists also notice that children tend to brux more frequently in response to fatigue or life stressors. If the child is going through a particularly stressful exam period or is relocating to a new school for example, nighttime bruxing may either begin or intensify.
Children with certain developmental disorders and brain injuries may be at particular risk for grinding. In such cases, your pediatric dentist may provide a protective nighttime mouthpiece or refer back to the pediatrician for further evaluation. If the onset of bruxing is sudden, current medications need to be evaluated.
How is bruxism treated?
Bruxing usually ceases by the age of six in the majority of children. In the meantime however, your pediatric dentist will continually monitor its effect on the child’s teeth and may provide an interventional strategy.
In general, the cause of the grinding dictates the treatment approach. If the child’s teeth are badly misaligned, your pediatric dentist may take steps to correct this. Some of the available options include: altering the biting surface of teeth with crowns, and beginning occlusal treatment, or referring to an orthodontist.
If bruxing seems to be exacerbated by stress, your pediatric dentist may recommend relaxation classes or professional therapy.
In cases where young teeth are sustaining significant damage, your pediatric dentist may suggest building up dental sealants or a nighttime mouth guard. Mouth guards stop tooth surfaces from grinding against each other, and look similar to a mouthpiece a person might wear during sports. Bite splints or bite plates fulfill the same function and are almost universally successful in preventing grinding damage.
Orthodontic treatment is primarily used to prevent and correct bite irregularities. Genetic factors, the early loss of primary (baby) teeth, and damaging oral habits (such as finger/thumb sucking and developmental problems) can contribute to these irregularities.
Orthodontic irregularities may be present at birth or develop during toddlerhood or early childhood. Crooked teeth hamper self-esteem and make good oral homecare difficult, whereas straight teeth help minimize the risk of tooth decay and childhood periodontal disease.
At each biannual preventative visit, your pediatric dentist monitors your child’s jaw growth and development as well as orthodontic irregularities and, if necessary, implement early intervention strategies. Many children may be referred to the orthodontist by age seven or eight if early intervention is required.
Why does early orthodontic treatment make sense?
Some children display early signs of minor orthodontic irregularities. In such cases, your pediatric dentist might choose to monitor the situation over time without providing intervention. However, for children who display severe orthodontic irregularities, early orthodontic treatment can provide many benefits, including:
- Enhanced self-confidence and aesthetic appearance.
- Increased likelihood of proper jaw growth.
- Increased likelihood of properly aligned and spaced adult teeth.
- Reduced risk of bruxing (grinding of teeth).
- Reduced risk of childhood cavities, periodontal disease, and tooth decay.
- Reduced risk of impacted adult teeth.
- Reduced risk of protracted orthodontic treatments in later years.
- Reduced risk of speech problems.
- Reduced risk of tooth, gum, and jawbone injury.
When can my child begin early orthodontic treatment?
Pediatric dentists recognize three age-related stages of orthodontic treatment. These stages are described below.
Stage 1: Early treatment (2-6 years old)
Early orthodontic treatment aims to guide and regulate the width of both dental arches. The main goal of early treatment is to provide enough space for the permanent teeth to erupt correctly. Good candidates for early treatment include: children who have difficulty biting properly, children who lose baby teeth early, children whose jaws click or grind during movement, bruxers, and children who use the mouth (as opposed to the nose AND mouth) to breathe.
During the early treatment phase, your pediatric dentist works with parents and children to eliminate orthodontically harmful habits, like excessive pacifier use and thumb sucking. The dentist may also provide one of a variety of dental appliances to promote jaw growth, hold space for adult teeth (space maintainers), or to prevent the teeth from shifting into undesired areas.
Stage 2: Mixed dentition (6-12 years old)
The goals of mixed dentition treatments are to realign wayward jaws, to start to correct crossbites, and to begin the process of gently straightening misaligned permanent teeth. Mixed dentition marks a developmental period when the soft and hard tissues are extremely pliable. It may be the optimal time to begin to correct a severe malocclusion.
The dentist may provide the child with a dental appliance. Some appliances (like braces) are fixed and others are removable. Regardless of the appliance, the child will still be able to speak, eat, and chew in a normal fashion. However, children who are fitted with fixed dental appliances should take extra care to clean the entire oral region each day in order to reduce the risk of staining, decay, and later cosmetic damage.
Stage 3: Adolescent dentition (13+ years old)
Adolescent dentition is what springs to most parents’ minds when they think of orthodontic treatment. Some of the main goals of adolescent dentition include straightening the permanent teeth and improving the aesthetic appearance of the smile.
Most commonly during this period, the dentist will provide fixed or removable “braces” to gradually straighten the teeth. Upon completion of the orthodontic treatment, the adolescent may be required to wear a retainer in order to prevent the regression of the teeth to their original alignment.
Mouth guards, also known as sports guards or athletic mouth protectors, are crucial pieces of equipment for any child participating in potentially injurious recreational or sporting activities. Fitting snugly over the upper teeth, mouth guards protect the entire oral region from traumatic injury, preserving both the esthetic appearance and the health of the smile. In addition, mouth guards are sometimes used to prevent tooth damage in children who grind (brux) their teeth at night.
The American Academy of Pediatric Dentistry (AAPD) in particular, advocates for the use of dental mouth guards during any sporting or recreational activity. Most store-bought mouth guards cost fewer than ten dollars, making them a perfect investment for every parent.
How can mouth guards protect my child?
The majority of sporting organizations now require participants to routinely wear mouth guards. Though mouth guards are primarily designed to protect the teeth, they can also vastly reduce the degree of force transmitted from a trauma impact point (jaw) to the central nervous system (base of the brain). In this way, mouth guards help minimize the risk of traumatic brain injury, which is especially important for younger children.
Mouth guards also reduce the prevalence of the following injuries:
- Cheek lesions
- Gum and soft tissue injuries
- Jawbone fractures
- Lip lesions
- Neck injuries
- Tongue lesions
- Tooth fractures
What type of mouth guard should I purchase for my child?
Though there are literally thousands of mouth guard brands, most brands fall into three major categories: stock mouth guards, boil and bite mouth guards, and customized mouth guards.
Some points to consider when choosing a mouth guard include:
- How much money is available to spend?
- How often does the child play sports?
- What kind of sport does the child play? (Basketball and baseball tend to cause the most oral injuries).
In light of these points, here is an overview of the advantages and disadvantages of each type of mouth guard:
Stock mouth guards – These mouth guards can be bought directly off the shelf and immediately fitted into the child’s mouth. The fit is universal (one-size-fits-all), meaning that that the mouth guard doesn’t adjust. Stock mouth guards are very cheap, easy to fit, and quick to locate at sporting goods stores. Pediatric dentists favor this type of mouth guard least, as it provides minimal protection, obstructs proper breathing and speaking, and tends to be uncomfortable.
Boil and bite mouth guards – These mouth guards are usually made from thermoplastic and are easily located at most sporting goods stores. First, the thermoplastic must be immersed in hot water to make it pliable, and then it must be pressed on the child’s teeth to create a custom mold. Boil and bite mouth guards are slightly more expensive than stock mouth guards, but tend to offer more protection, feel more comfortable in the mouth, and allow for easy speech production and breathing.
Customized mouth guards – These mouth guards offer the greatest degree of protection, and are custom-made by the dentist. First, the dentist makes an impression of the child’s teeth using special material, and then the mouth guard is constructed over the mold. Customized mouth guards are more expensive and take longer to fit, but are more comfortable, orthodontically correct, and fully approved by the dentist.
Pacifier and Finger/thumb sucking
For most infants, the sucking of fingers/thumbs and pacifiers is a happy, everyday part of life. Since sucking is a natural, instinctual baby habit, infants derive a sense of comfort, relaxation, and security from using a finger or pacifier as a sucking aid.
Finger/thumb sucking can be a harder habit to break than pacifier use and tends to persist for longer without intervention. Children who continue to suck thumbs or pacifiers after the age of five (and particularly those who continue after permanent teeth begin to emerge) are at high-risk for developing dental complications.
How can finger/thumb sucking and pacifier use damage children’s teeth?
Pacifier and finger/thumb sucking damage can be difficult to assess with the naked eye, and both tend to occur over a prolonged period of time. The risks associated with prolonged finger/thumb sucking and pacifier use may include:
Jaw misalignment – Pacifiers come in a wide range of shapes and sizes, most of which are completely unnatural for the mouth to hold. Over time, pacifiers and thumbs can guide the developing jaws out of correct alignment.
Tooth decay – Many parents attempt to soothe infants by dipping pacifiers in honey, or some other sugary substance. Oral bacteria feed on sugar and emit harmful acids. The acids attack tooth enamel and can lead to pediatric tooth decay and childhood caries.
Roof narrowing – The structures in the mouth are extremely pliable during childhood. Prolonged, repeated exposure to finger/thumb and pacifier sucking actually cause the roof of the mouth to narrow (as if molding around the sucking device). This can cause later problems with developing teeth.
Slanting teeth – Growing teeth can be caused to slant or protrude by finger/thumb and pacifier sucking, leading to poor esthetic results. In addition, thumb sucking and pacifier use in later childhood may increase the need for extensive orthodontic treatments.
Mouth sores – Aggressive sucking (popping sounds when the child sucks) may cause sores or ulcers to develop.
If you do intend to purchase a pacifier:
- Buy a one-piece pacifier to reduce the risk of choking.
- Buy an “orthodontically correct” model.
- Stay with the smallest size available. There is no need to buy larger pacifiers as the infant grows. The goal is for the infant to give up pacifier sucking in his own. A larger pacifier may only prolong its use.
- Do not dip it in honey or any other sugary liquid.
- Rinse with water (as opposed to cleansing with your mouth) to prevent bacterial transmissions.
How can I encourage my child to stop finger/thumb or pacifier sucking?
In most cases, children naturally relinquish the pacifier or finger/thumb over time. As children grow, they develop new ways to self-soothe, relax, and entertain themselves.
Pacifier use should cease prior to age three (preferably by age two). Some suggestions to help encourage the child to cease pacifier use are as follows:
- If your child uses a large pacifier, go back to the smallest size available.
- Limit pacifier use to nap and bedtime.
- Cut a hole or slit at the tip of the pacifier. Many children do not like the hissing sound or the feel of the punctured pacifier.
- Read the book, Pacifiers are Not Forever, to your child.
- Pack the pacifiers to send to the pacifier fairy to give to other babies. It is not recommended to pass them down to a known baby in the family (whether a new baby sibling or cousin) as the child may resent the newborn.
- Taking the pacifiers away completely (cold turkey) seems to work best for many families. There may be a few nights of discontent, but children are very resilient and will recover quickly.
It is important to remember that a child has to be ready to stop the habit for it not to seem like a punishment. Some helpful suggestions to help encourage the child to cease finger/thumb sucking are as follows:
- Ask the pediatric dentist to speak with the child about stopping. Often, the message is heard more clearly when delivered by a health professional.
- Buy an appliance to make it difficult for the child to engage in sucking behaviors. Thumb guards and Thumbusters (a piece of cloth worn to cover the thumb) can be helpful.
- Implement a reward system (not a punishment), whereby the child can earn tokens, stickers, or points towards a desirable reward for not finger/thumb sucking.
- Wrap thumbs in soft cloths or mittens at nighttime.
- Discuss with your pediatric dentist the use of bad tasting clear nail polishes for older children (four years of age and older).
The breaking of a habit takes time, patience, and plenty of encouragement!
Thumb Sucking Appliances
The majority of children naturally outgrow their thumb-sucking habit. However, children who continue to finger/thumb suck after the age of six (especially vigorously) when permanent teeth start to erupt risk oral complications. These complications include: narrowed arches, impacted teeth, and misaligned teeth. The “palatal crib” appliance usually stops finger/thumb sucking immediately.
The “crib” is crafted and affixed to the teeth by the pediatric dentist, almost like a barely visible metal retainer. Preventing the finger/thumb from reaching the roof of the mouth reduces gratification – and breaks the habit very quickly. Removable variations of the “crib” are also available, and can be used depending on the age of the child and his or her willingness to cooperate.
Home oral care should begin before the emergence of the first tooth. A cool clean cloth should be gently rubbed along the gums after feeding to remove food particles and bacteria.
Tooth brushing with a small soft toothbrush should begin as soon as the first tooth appears in the mouth. Fluoride-free training/baby toothpastes are generally not recommended as they encourage the child to eat the toothpaste. Flavoring is largely unimportant, so the child can choose whatever type of toothpaste tastes most pleasant. Toothpastes containing peroxide, whitening agents, and baking soda designed for adults are generally not recommended for kids.
Prior to age one, you can use plain tap water to wet the toothbrush prior to brushing. By age one select an American Dental Association (ADA) accepted brand of toothpaste containing fluoride. The ADA logo is clear and present on toothpaste packaging, so be sure to check for it. Use only a smear or rice-sized amount of fluoride toothpaste for children up to age three, and encourage the child to spit out the excess after brushing. Spitting out the toothpaste takes practice, patience, and motivation – especially if the child finds the flavoring tasty. Ingesting tiny amounts of toothpaste is perfectly normal and will cease with time and encouragement. After age three, a pea-sized amount of toothpaste may be used once the child is able to spit out the toothpaste.
Dental fluorosis is not a risk factor for children over the age of eight, but an ADA accepted toothpaste is always the recommended choice for children of any age.
New Patient FAQs
Pediatric dentists are qualified to meet the dental needs of infants, toddlers, school-age children, adolescents, and patients with special needs. Pediatric dentists are required to undertake an additional two or three years of child-specific training after fulfilling dental school requirements.
The American Academy of Pediatric Dentistry (AAPD) recommends that children see a pediatric dentist by age of one (or approximately six months after the emergence of the first primary tooth). Though this might seem early, biannual preventative dental appointments are imperative for excellent oral health.
Parents should take children to see a pediatric dentist for the following reasons:
- To ask questions about new or ongoing issues
- To discover how to begin oral care program in the home
- To find out how to implement oral injury prevention strategies in the home
- To find out whether the child is at risk for developing cavities
- To receive information about extinguishing unwanted oral habits (e.g., finger-sucking, etc.)
- To receive preventative treatments (fluorides and sealants)
- To receive reports about how the child’s teeth and jaws are growing and developing
What does a pediatric dentist do?
Pediatric dentistry offices are colorful, fun, and child-friendly. Dental phobias are often rooted in childhood, so it is essential that the child feel comfortable, safe, and trusting of the dentist from the outset.
The pediatric dentist focuses on several different forms of oral care:
Prevention – Tooth decay is the most prevalent childhood ailment. Fortunately, it is almost completely preventable. Aside from providing advice and guidance relating to home care, the pediatric dentist can apply sealants and fluoride treatments to protect tooth enamel and minimize the risk of cavities.
Early detection – Examinations, X-rays, and computer modeling allow the pediatric dentist to predict future oral problems. Examples include malocclusion (bad bite), attrition due to grinding (bruxism), and jaw irregularities. In some cases, optimal outcomes are best achieved by starting treatment early.
Treatment – Pediatric dentists offer a wide range of treatments. Aside from preventative treatments (fluoride and sealant applications), the pediatric dentist also performs pulp therapy and treats oral trauma. If primary teeth are lost too soon, space maintainers may be provided to ensure the teeth do not become misaligned.
Education – Education is a major part of any pediatric practice. Not only can the pediatric dentist help the child understand the importance of daily oral care, but parents can also get advice on toothpaste selection, diet, finger/thumb-sucking cessation, and a wide range of related topics.
Updates – Pediatric dentists are well informed about the latest advances in the dentistry field. Children who do not see the dentist regularly may miss out on both beneficial information and information about new diagnostic procedures.
Pediatric dentists fulfill many important functions pertaining to the child’s overall oral health and hygiene. They place particular emphasis on the proper maintenance and care of deciduous (baby) teeth, which are instrumental in facilitating good chewing habits, proper speech production, and also hold space for permanent teeth.
Other important functions include:
Education – Pediatric dentists educate the child using models, computer technology, and child-friendly terminology, thus emphasizing the importance of keeping teeth strong and healthy. In addition, they advise parents on disease prevention, trauma prevention, good eating habits, and other aspects of the home hygiene routine.
Monitoring growth – By continuously tracking growth and development, pediatric dentists are able to anticipate dental issues and quickly intervene before they worsen. Also, working towards earlier corrective treatment preserves the child’s self-esteem and fosters a more positive self-image.
Prevention – Helping parents and children establish sound eating and oral care habits reduces the chances of later tooth decay. In addition to providing check ups and dental cleanings, pediatric dentists are also able to apply dental sealants and topical fluoride to young teeth, advise parents on finger and thumb sucking/pacifier/smoking cessation, and provide good demonstrations of brushing and flossing.
Intervention – In some cases, pediatric dentists may discuss the possibility of early oral treatments with parents. In the case of oral injury, malocclusion (bad bite), or bruxism (grinding), space maintainers may be fitted, a nighttime mouth guard may be recommended, or reconstructive treatment may be scheduled.
- Dental Exam
A comprehensive dental exam will be performed by your dentist at your initial dental visit. At regular check-up exams, your dentist and hygienist will perform the following:
- Examination of diagnostic X-rays (radiographs) when age appropriate: Essential for detection of decay, tumors, cysts, and bone loss. X-rays also help determine tooth and root positions.
- Oral cancer screening: Check the face, neck, lips, tongue, throat, tissues, and gums for any signs of oral cancer.
- Gum disease evaluation: Check the gums and bone around the teeth for any signs of periodontal disease.
- Examination of tooth decay: All tooth surfaces will be checked for decay with special dental instruments.
- Examination of existing restorations: Check current fillings, crowns, space maintainers, appliances, etc.
2. Professional Dental Cleaning
Professional dental cleanings are usually performed on children starting at age 3. The cleaning appointment will include the following:
- Removal of calculus (tartar): Calculus is hardened plaque that has been left on the tooth for some time and is now firmly attached to the tooth surface. Calculus forms above and below the gum line and can only be removed with special dental instruments.
- Removal of plaque: Plaque is a sticky, almost invisible film that forms on the teeth. It is a growing colony of living bacteria, food debris, and saliva. The bacteria produce toxins that inflame the gums. This inflammation is the start of periodontal disease.
- Teeth polishing: Remove stain and plaque that is not otherwise removed during tooth brushing and scaling.
A childhood fear of the dentist is very common and something our specially trained staff encounter on a daily basis. We recognize that there are many fears that play a part in such anxiety.
Here is a list of some of the most common dental fears:
- Fear of embarrassment about the condition of teeth
- Fear of gagging
- Fear of injections
- Fear of loss of control
- Fear of pain
- Fear of the dentist as a person
- Fear of the dental tools
- Fear of separation from parents
Sometimes your child may just be tired which makes it more challenging for him or her to undergo a dental procedure. We recommended appointments earlier in the day for younger children before they become fatigued. Even adolescents have a more favorable experience earlier in the day.
How can one overcome dental anxiety?
Dental anxiety and fear can become completely overwhelming. It is estimated that as many as 35 million people do not visit the dental office at all because they are too afraid. Receiving regular dental check-ups and cleanings is incredibly important for your child’s dental health. Having regular routine check-ups is the easiest way to maintain excellent oral hygiene and reduce the need for more complex treatments.
Here are some tips to help reduce dental fear and anxiety:
Encourage your child to talk to us – Though it can be hard to talk about irrational fears with a stranger, we can take extra precautions during visits if fears and anxiety are communicated.
Bring a portable music player – Music acts as a relaxant and also drowns out any fear-producing noises. Listening to calming music throughout the appointment will help to reduce anxiety.
Bring a favorite show or movie – Our office provides numerous children’s movies for your child to watch during longer dental visits. If your child prefers, bring a favorite and familiar DVD for us to play for your child during his or her visit.
Agree on a signal – Many children are afraid that the dentist will not know they are in significant pain during the appointment and will continue with the procedure regardless. The best way to solve this problem is to agree on a “stop” hand signal. Both the dentist and your child can easily understand signals like raising the hand.
Ask for a mirror – Not being able to see what is happening can increase anxiety and make the imagination run wild. Watching the procedure can help keep reality at the forefront of the mind.
Sedation – If there is no other way to cope, sedation offers an excellent option for many people. There are several types of sedation, but the general premise behind them is the same: the patient regains their faculties after treatment is complete.
Ask about alternatives – Advances in technology mean that dental microsurgery is now an option. Lasers can be used to prepare teeth for fillings, and remove staining. Discuss all the options with us and decide on one that is effective and produces minimal anxiety.
Pediatric dentists have experience in working with children of all ages. Pediatric dental offices are generally colorful, child-friendly, and boast a selection of games, toys, and educational tools. Pediatric dentists (and all dental staff) aim to make the child feel as welcome as possible during all visits.
There are several things parents can do to make the first visit enjoyable. Some helpful tips are listed below:
Take another adult along for the visit – Sometimes infants and toddlers become fussy when having their mouths examined. Having another adult along to soothe the infant or toddler allows the parent to ask questions and to attend to any advice the dentist may have.
Leave other children at home – Other children can distract the parent and cause the younger child to fuss. Leaving other children at home (when possible) makes the first visit less stressful for all concerned. We understand that this is not always possible. Our team is ready and willing to play and take care of your children while the parents are tending to the one being examined and treated.
Avoid language that may be scary for children – Pediatric dentists and staff are trained to avoid the use of language that can scare the child, like “drills,” “needles,” “injections,” and “bleeding.” It is imperative for parents to use positive language when speaking about dental treatment with their child.
Provide positive explanations – It is important to explain the purposes of the dental visit in a positive way. Explaining that the dentist “helps keep teeth healthy” is far better than explaining that the dentist “is checking for tooth decay and might have to drill the tooth if decay is found.”
Explain what will happen – Anxiety can be vastly reduced if the child knows what to expect. Age-appropriate books about visiting the dentist can be very helpful in making the visit seem fun. Here is a list of parent and dentist-approved books:
- The Berenstain Bears Visit the Dentist– by Stan and Jan Berenstain
- Show Me Your Smile: A Visit to the Dentist – Part of the “Dora the Explorer” Series
- Going to the Dentist – by Anne Civardi
- Elmo Visits the Dentist – Part of the “Sesame Street” Series
What will happen during the first visit?
There are several goals for the first dental visit. First, the pediatric dentist and the child need to get properly acquainted. Second, the dentist needs to monitor tooth and jaw development to get an idea of the child’s overall health history. Third, the dentist needs to evaluate the health of the existing teeth and gums. Finally, the dentist aims to answer questions and advise parents on how to implement a good oral care regimen.
The following sequence of events is typical of an initial “well checkup”:
- The dental team will greet the child and parents.
- The child/family health history will be reviewed (this may include questionnaires).
- The pediatric dentist will address parental questions and concerns.
- More questions may be asked, generally pertaining to the child’s oral habits, pacifier use, general development, tooth alignment, tooth development, and diet.
- The dentist will provide advice on good oral care, how to prevent oral injury, fluoride intake, and sippy cup use.
- The child’s teeth will be examined. Generally, the dentist and parent sit facing each other. The infant or toddler is positioned so that his or her head is cradled in the dentist’s lap. This position allows the infant to look at the parent during the examination. Children older than three are encouraged to sit in the dental chair if they feel comfortable, and the parent may sit next to them in a regular chair.
- Good brushing and flossing demonstrations may be provided.
- The state of the child’s oral health will be described in detail, and specific recommendations will be made. Recommendations usually relate to oral habits, appropriate toothpastes and toothbrushes for the child, orthodontically correct pacifiers, and diet.
- The dentist may detail which teeth may appear in the following months.
- The dentist will outline an appointment schedule and describe what will happen during the next appointment.
Cavity-causing (cariogenic) bacteria can be transmitted from the mother, father, or caregiver to the child. This transmission happens via the sharing of eating utensils and the “cleaning” of pacifiers in the adult’s mouth. Parents should endeavor to use different eating utensils from their infants and to rinse pacifiers with warm water as opposed to sucking them.
Parents should also adhere to the following guidelines to enhance infant oral health:
- Brush – Using a soft-bristled toothbrush and plain tap water, start brushing your infant’s teeth as soon as they begin to erupt in the mouth. This should be done twice daily, preferable after breakfast and before bed. When the child turns one, a tiny smear of ADA approved fluoridated toothpaste (the size of a grain of rice) may be used.
- Floss – As soon as two adjacent teeth appear in the infant’s mouth, cavities can form between the teeth. Ask the pediatric dentist for advice on the best way to floss the infant’s teeth. Floss picks may be used on younger children.
- Pacifier use – Pacifiers are a soothing tool for infants. If you decide to purchase a pacifier, choose an orthodontically correct model (you can ask the pediatric dentist for recommendations). Be sure not to dip pacifiers in honey or any other sweet liquid. It is best to limit pacifier use to nap and bedtime and to stop its use by age 2.
- Use drinking glasses – Baby bottles and sippy cups are largely responsible for infant and toddler tooth decay. Both permit a small amount of liquid to repeatedly enter the mouth. Consequently, sugary liquid (milk, soda, juice, formula, breast milk or sweetened water) is constantly swilling around in the infant’s mouth, fostering bacterial growth and expediting tooth decay. Only offer water in sippy cups, and discontinue their use after the infant’s first birthday.
- Visit the pediatric dentist – Around the age of one, the infant should visit a pediatric dentist for a “well baby” appointment. The pediatric dentist will examine tooth and jaw development, and provide strategies for future oral care.
- Wipe gums – The infant is at risk for early cavities as soon as the first tooth emerges. For young infants, wipe the gums with a damp cloth after every feeding. This reduces oral bacteria and minimizes the risk of early cavities.
Dental X-rays are essential, preventative, diagnostic tools that provide valuable information not visible during a regular dental exam. Dentists use this information to safely and accurately detect hidden dental abnormalities and complete an accurate treatment plan. Without X-rays, problem areas may go undetected.
Dental X-rays may reveal:
- Abscesses or cysts
- Bone loss
- Cancerous and non-cancerous tumors
- Decay between the teeth
- Developmental abnormalities
- Poor tooth and root positions
- Problems inside a tooth or below the gum line
- Missing or extra teeth
Detecting and treating dental problems at an early stage can save you time, money, your child unnecessary discomfort, and your child’s teeth.
Are dental X-rays safe?
We are all exposed to natural radiation in our environment.
Dental x-rays produce a low level of radiation and are considered safe. At Children’s Dentistry of Oakton, we take necessary precautions to limit the patient’s exposure to radiation when taking dental X-rays. These precautions include using lead apron shields to protect the body and using modern, digital sensors that cut down the amount of radiation and the exposure time of each x-ray.
How often should dental X-rays be taken?
The need for dental X-rays depends on each patient’s individual dental health needs. The dentist will recommend necessary x-rays based on the review of your medical and dental history, dental exam, signs and symptoms, age consideration, and risk for disease.
Bitewing x-rays (x-rays of top and bottom teeth biting together) are taken at recall (check-up) visits and are generally recommended once a year to detect new dental problems. If monitoring areas of concern they may be taken at the following 6 month recall appointment.
The panoramic x-ray (the wrap around x-ray of the top and bottom jaw) is typically taken between the ages of 6 to 8 when the teeth begin to erupt. It may be taken again in adolescence by the orthodontist, and then again in the late teens to monitor wisdom teeth eruption.
Fluoride is the most effective agent available to help prevent tooth decay. It is a mineral that is naturally present in varying amounts in almost all foods and water supplies. The benefits of fluoride have been well known for over 50 years and are supported by many health and professional organizations. There is a lot of misleading information about fluoride out there, therefore, it is important to discuss all your concerns with Dr. Niloo and her team.
Fluoride works in two ways:
Topical fluoride strengthens the teeth once they have erupted by seeping into the outer surface of the tooth enamel, making the teeth more resistant to decay. We gain topical fluoride by using fluoride containing dental products such as toothpaste, mouth rinses, and gels. Dentists and dental hygienists generally recommend that children have a professional application of fluoride twice a year during dental check-ups.
Systemic fluoride strengthens the teeth that have erupted as well as those that are developing under the gums. We gain systemic fluoride from most foods and our community water supplies. It is also available as a supplement in drop or gel form and can be prescribed by your dentist or physician. Generally, fluoride drops are recommended for infants, and tablets are best suited for children up through the teen years. It is very important to monitor the amounts of fluoride a child ingests. If too much fluoride is consumed while the teeth are developing, a condition called fluorosis (white spots on the teeth) may result.
Although most people receive fluoride from food and water, sometimes it is not enough to help prevent decay. Your dentist or dental hygienist may recommend the use of home and/or professional fluoride treatments for the following reasons:
- Deep pits and fissures on the chewing surfaces of teeth
- Exposed and sensitive root surfaces
- Fair to poor oral hygiene habits which have caused weak spots (decalcification) on the teeth
- Frequent sugar and carbohydrate intake
- Inadequate exposure to fluoride
- Inadequate saliva flow due to medical conditions, medical treatments or medications
- Recent history of dental decay
Fluoride alone will not prevent tooth decay! It is important to brush at least twice a day, floss regularly, eat balanced meals, reduce sugary snacks, and visit your dentist on a regular basis.
Though most parents primarily think of brushing and flossing when they hear the words “oral care,” good preventative care includes many more factors, such as:
Diet – Parents should provide children with a nourishing, well-balanced diet. Very sugary diets should be modified and continuous snacking should be discouraged. Oral bacteria ingest leftover sugar particles in the child’s mouth after each helping of food, emitting harmful acids that erode tooth enamel. Space out snacks when possible, and provide the child with non-sugary alternatives like celery sticks, carrot sticks, and low-fat yogurt.
Oral habits – Though pacifier use and finger/thumb sucking generally cease over time, both can cause the teeth to misalign. If the child must use a pacifier, choose an “orthodontically” correct model. This will minimize the risk of developmental problems like narrow roof arches and crowding. The pediatric dentist can suggest a strategy (or provide a dental appliance) for finger/thumb sucking cessation.
General oral hygiene – Sometimes, parents clean pacifiers and teething toys by sucking on them. Parents may also share eating utensils with the child. By performing these acts, parents transfer harmful oral bacteria to their child, increasing the risk of early cavities and tooth decay. Instead, rinse toys and pacifiers with warm water, and avoid spoon-sharing whenever possible.
Sippy cup use – Sippy cups are an excellent transitional aid when transferring from a baby bottle to an adult drinking glass. However, sippy cups filled with milk, breast milk, soda, juice, and sweetened water cause small amounts of sugary fluid to continually swill around young teeth – meaning acid continually attacks tooth enamel. Sippy cup use should be terminated between the ages of twelve and fourteen months or as soon as the child has the motor skills to hold a drinking glass.
Brushing – Children’s teeth should be brushed a minimum of two times per day using a soft bristled brush and a smear (ages one to three) or pea-sized amount of toothpaste (ages three and up when the child is able to spit effectively). Parents should help with the brushing process until the child reaches the age of eight and is capable of reaching all areas of the mouth. Parents should opt for ADA approved fluoride toothpaste. For babies, parents should rub the gum area with a clean cloth after each feeding.
Flossing – Cavities and tooth decay form more easily between teeth. Therefore, the child is at risk for between-teeth cavities wherever two teeth grow adjacent to each other. The pediatric dentist can help demonstrate correct head positioning during the flossing process and suggest tips for making flossing more fun.
Fluoride – Fluoride helps prevent mineral loss and simultaneously promotes the remineralization of tooth enamel. Too much fluoride can result in fluorosis, a condition where white specks appear on the permanent teeth, and too little can result in tooth decay. It is important to get the fluoride balance correct. The pediatric dentist can evaluate how much the child is currently receiving and prescribe supplements if necessary.
A sealant is a thin, plastic coating applied to the chewing surface of molars, premolars and any deep grooves (called pits and fissures) of teeth. Many cases of dental decay begins in these deep grooves where food debris, plaque, and cavity causing bacteria can be harbored. Teeth with these conditions are hard to clean and are very susceptible to decay. A sealant protects the tooth by sealing deep grooves, creating a smooth, easy to clean surface.
Sealants can protect teeth from decay for many years, but need to be checked for wear and chipping at regular dental visits.
Reasons for sealants:
- Children and teenagers– As soon as the six-year molars (the first permanent back teeth) appear or any time throughout the cavity prone years.
- Baby teeth– Occasionally done if teeth have deep grooves or depressions and child is cavity prone.
What do sealants involve?
Sealants are easily applied by your dentist or dental team members and the process takes only a couple of minutes per tooth.
The teeth to be sealed are thoroughly cleaned and then surrounded with a silicone isolator or cotton to keep the area dry. A special solution is applied to the enamel surface to help the sealant bond to the teeth. The teeth are then rinsed and dried. Sealant material is carefully painted onto the enamel surface to cover the deep grooves or depressions. A curing light is used to harden the sealant material.
Proper home care, a balanced diet, not crushing ice with the teeth or eating sticky, hard foods, and regular dental visits will aid in the life of your new sealants.
Panoramic X-rays are wraparound photographs of the face and teeth. They offer a view that would otherwise be invisible to the naked eye. The panoramic X-ray provides the dentist with an ear-to-ear two-dimensional view of both the upper and lower jaw. X-rays in general, expose hidden structures, such as unerupted teeth, reveal preliminary signs of cavities, and also show fractures and bone loss.
Panoramic X-rays are extraoral and simple to perform. Usually, dental X-rays involve the film or sensor being placed inside the mouth, but panoramic film is hidden inside a mechanism that rotates around the outside of the head. Our office uses a digital panoramic machine with the sensor outside of the mouth.
Unlike bitewing X-rays that need to be taken every few years, panoramic X-rays are generally only taken on an as-needed basis. A panoramic X-ray is not conducted to give a detailed view of each tooth, but rather to provide a better view of the sinus areas, nasal areas and mandibular nerve. Panoramic X-rays are preferable to bitewing X-rays when a patient is in extreme pain, and when a sinus problem is suspected to have caused dental problems.
Panoramic X-rays are extremely versatile in dentistry, and are used to:
- Assess patients with an extreme gag reflex
- Evaluate the TMJ
- Expose cysts, tumors, and abnormalities
- Diagnose missing or extra teeth
- Evaluate the growth and development of the jaw bone for orthodontic purposes
- Expose impacted teeth
- Expose jawbone fractures
- Plan treatment (full and partial dentures, braces and implants)
- Reveal gum disease and large cavities
How are panoramic X-rays taken?
The Panorex equipment consists of a rotating arm that holds the X-ray generator, and a moving film attachment/sensor that holds the pictures. The head is positioned between these two devices. The X-ray generator moves around the head taking pictures as orthogonally as possible. The positioning of the head and body is what determines how sharp, clear and useful the X-rays will be to the dentist. The pictures are magnified by as much as 30% to ensure that even the minutest detail will be noted.
Panoramic X-rays are an important diagnostic tool and are also valuable for planning future treatment. We recommend your child’s first panoramic x-ray between the ages of 6 to 8 when the teeth begin to erupt.
The incidence of tooth decay has significantly diminished over the years due to the use of fluorides and an increase in patient awareness and access to routine preventive dental care. However, teeth are still susceptible to decay, infection, and breakage and sometimes need to be restored back to health. Snacking and lack of optimal oral hygiene may still result in cavities. Through improved techniques and modern technology, we are now able to offer more options for restoring a tooth back to its normal shape, appearance and function.
Should your child’s teeth ever require a restorative treatment, you can rest assured knowing we will always discuss with you the available options, and recommend what we believe to be the most comfortable and least invasive treatment. Providing your child with excellent care is our number one priority.
Reasons for restorative dentistry:
- Enhance your child’s smile
- Improve or correct an improper bite
- Prevent the loss of a tooth and to preserve space for permanent teeth
- Relieve dental pain
- Repair damaged and decayed teeth
- Restore normal eating and chewing
Remember to give your teeth the attention they need today!
The overwhelming fear of dental appointments can be a common cause of anxiety for parent and child. Many people visualize a drill-wielding person in a white coat just waiting to cause pain and remove teeth. The reality, however, is very different. The comfort, relaxation, and happiness of the patient are the primary focus of our dental practice. Our team members will do whatever they can to reduce anxiety, allay fears, and provide painless, quick treatments.
Recent technological advancements have meant that in many cases, dentists can provide treatment using lasers without much discomfort, in most cases, not needing any injections. There are also a wide variety of safe anesthetics available to eliminate pain and reduce anxiety during routine appointments.
A composite (tooth colored) filling is used to repair a tooth that is affected by decay, cracks, fractures, etc. The decayed or affected portion of the tooth will be removed and then filled with a composite filling.
There are different types of filling materials available, each with their own advantages and disadvantages. You and your dentist can discuss the best options for restoring your teeth. Composite fillings, along with silver amalgam fillings, are the most widely used today. Because composite fillings are tooth colored, they can be closely matched to the color of existing teeth, and are more aesthetically suited for use in front teeth or more visible areas of the mouth. Our office does not provide amalgam fillings.
As with most dental restorations, composite fillings are not permanent and may someday have to be replaced. They are very durable and will last many years, giving you a long lasting, beautiful smile.
Reasons for composite fillings:
- Chipped teeth
- Closing space between two teeth
- Cracked or broken teeth
- Decayed teeth
- Worn teeth
How are composite fillings placed?
Composite fillings are usually placed in one appointment. The dentist will remove decay as needed. The space will then be thoroughly cleaned and carefully prepared before the new filling is placed. If the decay was near the nerve of the tooth, a special medication will be applied for added protection. The composite filling will then be precisely placed, shaped, and polished, restoring your tooth to its original shape and function.
It is normal to experience sensitivity to hot and cold when composite fillings are first placed, however this will subside shortly after your tooth acclimates to the new filling.
Good oral hygiene practices, eating habits, and regular dental visits will aid in the life of your new fillings.
Sedation Dentistry for Children
Dental sedation is intended to reduce the child’s anxiety and discomfort during dental visits. In some cases, the child may become drowsy or less active while sedated, but this will quickly desist after the procedure is completed.
When is sedation used?
Very young children are often unable to keep still long enough for the pediatric dentist to perform high-precision procedures safely. Sedation makes the visit less stressful for both children and adults and vastly reduces the risk of injury. Some children struggle to manage anxiety during dental appointments. Sedation helps them to relax, cope, and feel happier about treatment. Sedation is particularly useful for children with special needs. It prevents spontaneous movement, and guides cooperative behavior. Having positive dental experiences as children enables them to continue routine dental visits as adults without any negative memories.
What are the most common types of sedation?
Most pediatric dentists have several sedation options available, and each one comes with its own particular benefits. The dentist will assess the medical history of the child, the expected extent and duration of the procedure, and the child’s comfort level before recommending a method of sedation.
Conscious sedation allows children to continually communicate, follow instructions, and cooperate during the procedure. The methods of sedation are described below:
Nitrous oxide – The pediatric dentist may recommend nitrous oxide (also known as “laughing gas”) for children who have a strong gag reflex or exhibit particular signs of nervousness or anxiety. Nitrous oxide is delivered via a mask, which is placed over the child’s nose. Nitrous oxide is always combined with oxygen – meaning that the child can comfortably breathe in through the nose and out through the mouth.
Laughing gas relaxes children extremely quickly, and can produce happy, euphoric behavior. It is also quick acting, painless to deliver, and wears off within a matter of minutes. Before removing the mask completely, the pediatric dentist delivers regular oxygen for several minutes, to ensure the nitrous oxide is eliminated from the child’s body. On rare occasions, nitrous oxide may cause nausea. For this reason, most pediatric dentists suggest minimal food intake prior to the appointment.
IV (intravenous) Sedation
The dentist may recommend IV sedation if your child has special needs, is unable to complete the restorative treatment under nitrous oxide or has and extensive amount of work. This is done at the dental office on a particular day with a board certified anesthesiologist.
What about general anesthesia?
General anesthesia (which puts the child in a deep sleep), is recommended when:
- A procedure cannot otherwise be performed safely.
- The child has a condition which makes it medically necessary.
- The child needs oral surgery.
General anesthetic requires more intensive preparation before the treatment, the procedure is often done at a surgical center or hospital and it has a longer period of recovery after the treatment. Conscious sedation or IV sedation is usually favored wherever possible.
Sometimes, primary (baby) teeth are lost prematurely due to trauma or decay. Adjacent teeth tend to shift to fill the space, causing spacing and alignment problems for permanent (adult) teeth. Space maintainers are inserted as placeholders until the permanent teeth are ready to erupt. There are two main types of space maintainer:
- Fixed space maintainers – Depending on the position of the missing tooth and the condition of the surrounding teeth, the pediatric dentist may place a “band and loop,” a “crown and loop,” or a “distal shoe” type of space maintainer to fill the empty gap. If multiple teeth are missing, a “lower lingual holding arch” in the lower arch or a “Nance appliance” in the upper arch may be placed. All space maintainers fulfill the same function; just the nature of the attachment to the adjacent teeth differs. Fixed space maintainers are usually made of metal and are highly durable.
- Removable space maintainers – Removable spacers are rarely used with young children. Working a little like orthodontic retainers, special plastic parts fit into the empty slot to prevent the “drifting” of adjacent teeth.
The “pulp” or nerve of a tooth cannot be seen with the naked eye. Pulp is found at the center of each tooth, and is comprised of nerves, tissue, and many blood vessels, which work to channel vital nutrients and oxygen. There are several ways in which pulp can be damaged. Most commonly in children, tooth decay or traumatic injury lead to painful pulp exposure and inflammation.
Pediatric pulp therapy is known by other names, including: root canal, pulpotomy, pulpectomy, and nerve treatment. The primary goal of pulp therapy is to treat, restore, and save the affected tooth.
Pediatric dentists perform pulp therapy on both primary (baby) teeth and permanent teeth. Though primary teeth are eventually shed, they are needed for speech production, proper chewing, and to guide the proper alignment and spacing of permanent teeth.
What are the signs of pulp injury and infection?
Inflamed or injured pulp is exceptionally painful. Even if the source of the pain isn’t visible, it will quickly become obvious that the child needs to see the pediatric dentist.
Here are some of the other signs to look for:
- Constant unexplained pain.
- Nighttime pain.
- Sensitivity to warm and cool food temperatures.
- Swelling or redness around the affected tooth.
- Unexpected looseness or mobility of the affected tooth.
When should a child undergo pulp therapy?
The pediatric dentist assesses the age of the child, the positioning of the tooth, and the general health of the child before making a recommendation to extract the tooth or to save it via pulp therapy.
Some of the undesirable consequences of prematurely extracted/missing teeth are listed below:
- Arch length may shorten.
- In the case of primary tooth loss, permanent teeth may lack sufficient space to emerge.
- Opposing teeth may grow in a protruding or undesirable way.
- Premolars may become painfully impacted.
- Remaining teeth may “move” to fill the gap.
- The tongue may posture abnormally.
How is pulp therapy performed?
Initially, the pediatric dentist will perform visual examinations and evaluate X-rays of the affected areas. The amount and location of pulp damage dictates the nature of the treatment. Pediatric pulpotomy and pulpectomy procedures are among the most common performed.
Pulpotomy – If the pulp root remains unaffected by injury or decay, meaning that the problem is isolated in the pulp tip, the pediatric dentist may leave the healthy part alone and only remove the affected pulp and surrounding tooth decay. The resulting gap is then filled with a biocompatible, therapeutic material, which prevents infection and soothes the pulp root. Most commonly, a crown is placed on the tooth after treatment. The crown strengthens the tooth structure, minimizing the risk of future fractures.
A pulpotomy can be performed as a standalone treatment on baby teeth and growing permanent teeth, or as the initial step in a full root canal treatment.
Pulpectomy – In the case of severe tooth decay or trauma, the entire tooth pulp (including the root canals) may be irreversibly affected. In these circumstances, the pediatric dentist must remove the pulp, cleanse the root canals, and then pack the area with biocompatible material. In general, reabsorbable material is used to fill primary teeth, and non-reabsorbable material is used to fill permanent teeth. Either way, the final treatment step is to place a crown on the tooth to add strength and provide structural support. The crown can be disguised with a natural-colored covering, if the child prefers.