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Services
Exams Dental examinations diagnose diseases of the mouth, such as gum disease, oral cancers, and decay. In addition, regular examinations help to alleviate problems while they are small and before they become expensive or impossible to repair. Dental examinations generally include the following:
We cannot express enough how important it is to see your dentist regularly. Remember, prevention is always better than treatment! Cleanings Professional cleanings (dental prophylaxis) are the foundation for preventing gum disease and tooth decay. During a professional cleaning, your child's dental team will:
Patient Comfort Office Environment Dr. Niloo’s Philosophy Nitrous Oxide Sedation Post-treatment of Extractions Crowns, Spacemaintainers and Other Appliances Fillings and Crowns Lip Biting After Treatment Stomach Aches after Cleanings Office Environment Dr. Niloo's office was designed with children and teens in mind. Kids naturally feel at home in this spacious, bright, and soothing office. Our office is equipped with private rooms for the more apprehensive children as well as open-bay treatment stations for those who are more comfortable. This atmosphere helps children relax and enjoy their dental experience. Dr. Niloo's Philosophy Research has shown that adult dental fears that inhibit patients from seeking treatment are often the result of an unpleasant experience with the dentist as a child. Our goal is not to complete treatment at any cost, but to help your child or teenager become an adult who routinely and comfortably seeks dental care. This often requires extra time with your child, creating diversions for the child through many of our child friendly amenities, or, in some cases, the use of appropriate sedatives. It is very important to discuss with Dr. Niloo any bad experiences or fears your child may have so that she may provide the best possible care for your child. Dr. Niloo and her staff customize each child's visit by carefully assessing his behavior and comfort level at the appointment. Parental accompaniment to the treatment area is encouraged during the first visit. For children to develop independence and form a trusting relationship with the dentist and the dental staff, they are encouraged to complete future visits to the dental chair on their own. The majority of older children and adolescents benefit from independent visits, as this allows open communication between the patient and the dental staff. As adolescence approaches, various topics such as smoking, eating disorders, and drug use and their effects on the mouth can be privately discussed. Some adolescents may not want to discuss these topics with the parent present. Patients under the age of five, special needs patients, and those with a higher level of anxiety have a more positive visit if their appointments are in the morning, when the child is not tired and is more receptive to new experiences and instructions. Appointments later in the day are generally reserved for older patients who have more commitments and activities. Children typically benefit from contact with peers. By grouping appointments based on age, younger patients are comforted by seeing children of the same age in the office, and the same is true for adolescents. Being a mom herself, Dr. Niloo recognizes that parents know their children best. She is open to suggestions from parents while at the same time drawing upon her expertise and experience in working with children when making the decision to have parental participation during the visit. Please note that certain children can form a more trusting relationship with the dental staff if they complete their visit independently and without outside distractions. Nitrous Oxide Dr. Niloo offers nitrous oxide sedation (laughing gas) for the slightly anxious child. Nitrous oxide helps a child who is cooperative but is worried about various aspects of his appointment. It helps make the injections less noticeable and helps to alleviate anxiety about having instruments placed in the mouth as well as the noises that they make. It is important to realize that nitrous oxide requires a certain amount of cooperation from the child. The patient is required to have a plastic nose piece placed over his nose and must breathe through his nose. Nitrous oxide is not effective in children who are too young or too anxious to sit in the chair and have the nose piece placed on their nose. Nitrous oxide is an extremely safe sedation alternative. When your child is breathing nitrous oxide, they are receiving more oxygen than they are getting in room air! When the mask is placed on the patient's nose, it will take one to five minutes for the effects to be seen. Some children become dissociated, as if they are unable to talk, while others become very comfortable and may giggle or tell stories. Occasionally a child will fall asleep, but typically your child will be awake for the entire procedure. After the treatment is completed, the nitrous gas is turned off and your child will breathe 100% oxygen for a few minutes to clear the nitrous from their system. This helps to alleviate dizziness that may occur. Your child will then be placed in a seated position for a few minutes, and then he is released. Some children appear as if they have just woken from a nap. This is normal and will subside shortly. IV Sedation (sleep dentistry) > The Procedure IV sedation is a procedure that allows treatment to be completed on a child who is unable to undergo dental treatment while conscious. Your child's wellbeing is always our top priority. In order to provide an increased level of comfort and safety, Dr. Niloo works with an anesthesiologist to perform the sedation while she completes the dental treatment. IV sedation is a very safe procedure for healthy children. However, there are more risks associated with this procedure. Thus it is important to have a frank discussion with Dr. Niloo about your child's health history prior to the appointment. On the day of the appointment your child should arrive to our office with an empty stomach [ see instructions below ]. The anesthesiologist will then review your child's health and treatment needs. Dr. Niloo will again explain the planned procedure and answer any additional questions you may have that day. You may hold your child while the anesthesiologist gives your child an injection in the arm to begin the sedation procedure. This is all your child will remember about this appointment, and some children do not even remember the injection because of the amnesic properties of the medication. This will relax your child in about 10 minutes. Your child will then have an IV placed, and the anesthesiologist will sedate them in order for the dentist to begin treatment. If it was not possible to obtain x-rays previously, x-rays will be taken, and an assistant will advise you of the results and review any changes in the treatment plan. We will periodically update you on your child's progress while you wait in the waiting room. After dental treatment is complete, the anesthesia will be reversed and your child will begin to wake up. Some children are very sleepy when they wake up, some cry and are agitated, and some get the shivers. Remember, your child has a lot of medication in her system and may be very confused while waking up. The anesthesiologist will give you post-operative care instructions and will allow you to go home when your child is alert and responsive enough. Do not hesitate to call our office if you have questions or concerns after the visit. Eating and Drinking Before the IV Sedation Appointment Your child should have nothing to eat for 6 hours before the sedation appointment. Avoid solid food and milk. Clear liquids (water, apple juice, grape juice, clear sodas, and clear Jello without fruit or whip cream) are allowed up to three hours prior to the appointment. These instructions are extremely important to the health and safety of your child. Clothing Your child should wear a short-sleeved shirt. You may bring a small blanket. Please bring diapers or pull-ups if applicable and an extra change of clothes. Remove all jewelry, watches, and hair ornaments. Medication Do not stop taking any medications before consulting your doctor and anesthesiologist. Health Status If your child develops a fever, cold, runny nose, a productive cough, or an acute asthma attack within 2 days prior to the scheduled appointment, please call our office. Eating and Drinking After the Appointment As instructed by the anesthesiologist, start by giving your child water or apple juice no earlier than two hours after leaving the office. You may wet their lips with water if they are thirsty before two hours have passed. Feeding your child too quickly, or feeding them heavy foods immediately after sedation, will likely result in vomiting. If your child can tolerate liquids, move to soft foods such as yogurt, pudding, etc. Gradually increase to normal foods as they are able to tolerate it. Children's Tylenol or Motrin can be given for pain and low-grade fever. Please notify us if your child develops a temperature higher than 100.5 F or if vomiting continues for more than eight hours. Sleeping Your child will likely go home and take a nap after sedation. This is normal. Place them on their side. Do not leave your child unattended or place anything (such as gauze) in their mouth while they are sleeping. Activity After the procedure, your child will be drowsy and have poor balance and coordination for up to 6-8 hours. It is best that your child rest for the remainder of the day. Watching TV/videos and reading at home are excellent ideas. Your child may resume normal activity or go back to school the day after their appointment if he feels able. Some children may not feel up to normal play and may seem "hung over" from the medications. Encourage clear liquids to help clear the medication from their system. Remember that your child is not as awake as they think they are. Avoid swimming, biking, playing outdoors, and other vigorous activities for the remainder of the day. Oral Hygiene > The day of the procedure, your child may experience some tenderness. Do not brush or floss your child's teeth in the area of an extraction. The next morning you can gently brush your child's teeth. Brushing is very beneficial because clean teeth allow the gums to heal much faster. Post-Treatment of Extractions Bleeding Most of the bleeding should have subsided by the time you have left the office. It is important to keep pressure on the extraction area for about one hour after the appointment. This can be done with the gauze provided to you when you leave the office. If the site begins to bleed again, have the child bite on a wet tea bag for an additional 20 minutes. Swelling Swelling after an extraction is most likely due to your child biting the area that was anesthetized without realizing it. Place ice bags around the area if this is occurring on the day of extraction, or provide warm compresses if it is in the days after. If the swelling is rapidly progressing and the child has a fever, call us as soon as possible. Crowns, Space Maintainers and Other Appliances Discomfort After Cementation Expect some discomfort after the treatment; this is usually due to gum irritation. The discomfort should resolve in two to three days. Children's Motrin or Tylenol and a soft diet during this time will help ease any discomfort. Coming Loose If the crown or appliance is very loose and can be easily removed from the mouth, take the appliance out and place in a plastic bag. If it is slightly loose, leave it in the mouth. In either case, call our office as soon as possible for an appointment to have the appliance re-cemented. Teeth Are Coming In If the adult teeth are starting to erupt where the prematurely lost baby tooth was located, please make an appointment to have your child evaluated for the removal of the space maintainer. Fillings and Crowns Pain It is normal for your child to have some soreness in the area where treatment was completed. Children's Tylenol or Motrin should alleviate the pain. If your child is still having difficulties after a day or two, please call our office for a follow-up appointment. If the pain is severe, not alleviated by pain medications, or swelling occurs, please call our office as soon as possible to discuss the situation with the doctor. Swelling If your child experiences swelling after treatment, it is likely due to lip, cheek, or tongue biting in the anesthetized area. However, if you do not see teeth marks in the area and the swelling is increasing, please call our office as soon as possible. Lip Biting After Treatment Often children will bite themselves in the area they were anesthetized without realizing it. The area can become quite swollen and painful. Your child will need to remain on a soft diet until the area heals to avoid further injury. Give your child Children's Motrin or Tylenol as needed for the pain. Stomach Aches After Cleanings During your child's dental cleaning, fluoride was placed on the teeth to help strengthen the enamel. Fluoride can be irritating to the stomach if swallowed. Our dental team takes every precaution to ensure that the fluoride treatment is properly applied and promptly removed. If you think your child may have swallowed a small amount of fluoride during treatment, you can give your child a glass of milk to help neutralize the fluoride. Dr. Niloo is available 24 hours a day for dental emergencies. After normal business hours you may call her on her cell phone at (703) 861-6020. If she goes out of town, she makes arrangements with other local pediatric dentists to assist her patients in emergency situations. The office voicemail will have the name and number of the pediatric dentist who is covering call. First Aid for Dental Emergencies Please keep our office number and the above emergency number available and convenient. Most hospitals and emergency centers do not have a dentist on call. Unless you suspect a jaw fracture or severe injury to other parts of the body, contact Dr. Niloo first. What should I do if my child has a toothache? If your child is experiencing pain, please make an appointment to have the tooth evaluated. Children's Tylenol or Motrin can be given to temporarily alleviate the pain. Do not give the child aspirin or place aspirin on the teeth. What should I do when a baby tooth is knocked out? Do not attempt to reinsert the tooth. Contact Dr. Niloo as soon as possible. What should I do when a permanent tooth is knocked out? Find the tooth. If it is coated with dirt, gravel, etc., then rinse it gently in cool water. (Do not scrub it or clean it with soap - just use water!) If possible, replace the tooth in the socket and hold it there with clean gauze or a wash cloth. If you cannot put the tooth back in the socket, place the tooth in a clean container with milk or water. If there is no container available and no concern about the child swallowing the tooth, place the tooth to the side of the mouth to keep it moist. Come to our office immediately. (Call the emergency number if it is after hours.) The faster you act, the better your chances are of saving the tooth. What do I do when a tooth is chipped or fractured? Contact our office immediately. Quick action can save the tooth, prevent infection, and reduce the need for extensive dental treatment. Rinse the mouth with water and apply cold compresses to reduce swelling. If you can find the broken tooth fragment, bring it with you. What do I do if my child receives a severe blow to the head or a jaw fracture occurs? Go immediately to the emergency room of your local hospital. A blow to the head can be life threatening. What do I do if my child bites or cuts his tongue, lip, or cheek? Apply ice to the bruised or affected area. If there is bleeding, apply firm but gentle pressure with a clean gauze or cloth. The mouth is a very vascular area. If heavy bleeding does not stop after one hour or it cannot be controlled by simple pressure with a wet tea bag, contact our office. What do I do when my child's braces or wires are broken? If a broken appliance can be removed easily, take it out. If it cannot, cover the sharp or protruding portion with dental wax, cotton balls, gauze, or chewing gum. If a wire is stuck in the gums, cheek, or tongue, do not remove it. Contact our office or the orthodontist who placed the appliance. Loose or broken appliances that do not bother the child usually do not require emergency attention. How can I prevent dental injuries? Reduce injury to teeth, lips, and cheeks by having your child wear mouth guards while playing sports or other activities where there may be some risk for injury. Our office can make a custom-fitted mouth guard for this purpose.
Sealants Sealants are not permanent. They generally last about five years with normal wear, but can wear or chip away earlier in certain instances if the child grinds his teeth or chews ice. Also, sealants do not prevent decay between teeth or the onset of gum disease, so regular home care and dental visits are important. Alternatives There are no appropriate alternatives to sealants. If a tooth has decay, it will need a filling or other restoration.
Composite fillings are more than just attractive. They require minimal tooth preparation, in other words less healthy tooth structure is removed to restore the tooth. Also, a sealant can be placed over the remaining exposed grooves of the tooth to minimize the risk of decay on another area of the tooth. Silver FillingsUntil stronger composite materials were created, silver fillings were more commonly placed. Silver amalgam is a good material; our office uses composite material. White fillings The initial investment in a composite filling is higher than that for a silver filling. Even though the extra cost of white fillings is minimal, some insurance companies do not cover this extra cost. Silver fillingsThe obvious disadvantage is the color. Also, people have various beliefs about the metal contents in silver fillings, as they do contain a small amount of mercury. Another disadvantage is that more tooth structure needs to be removed to retain a silver filling.
When decay has reached the nerve, or pulp, of the baby tooth, a pulpotomy is needed. Like adult root canals, the dentist will access the nerve chamber of the tooth and remove some of the nerve of the tooth. Unlike adult root canals, this is a very short procedure, as only part of the pulp needs to be removed, and does not require the time consuming filing of adult root canals. Advantages If the tooth has been symptomatic this procedure will likely alleviate the pain. Also, it allows for the tooth to be preserved until it is ready to fall out naturally. Alternatives The only alternative to a pulpotomy is extraction of the tooth coupled with the placement of a space maintainer. However, if it is possible to save the baby tooth, a pulpotomy is the best treatment because it preserves the appropriate spacing for the adult dentition.
Crowns (Caps)
Decay is removed and cleaned from the tooth before the crown is placed over it. Unlike adult crowns, where the crown is made to fit the tooth and requires at least two appointments, crowns on baby teeth are placed in one visit Advantages Since the entire tooth is covered, a crown is the most desirable restoration for severely broken down teeth. Crowns are stronger than fillings and protect and strengthen the remaining tooth structure. Crowns offers the best chance for keeping a nerve-treated tooth until it is ready to naturally exfoliate.
Crowns are excellent restorations and have few disadvantages. Most children's crowns are silver in color and, therefore, may be noticeable. Our office does provide a white alternative, which is a stainless steel crown with a white coating bonded to the tooth. These crowns are more costly than the silver crowns, and the white coating can chip, exposing the silver color underneath.
Typically there are no good alternatives to crowns. If the tooth has sustained enough damage to require a crown, then the best treatment for the tooth is to receive the crown. Placing a filling on a tooth that should have a crown likely will result in fracture, recurrent decay, and loss of that tooth.
If a baby tooth is prematurely lost due to an accident or severe decay and/or abscess, the space should be saved for the future eruption of the permanent teeth. A space maintainer is a combination of bands and wires designed to hold the remaining teeth in a position that will allow the future permanent tooth to erupt in the proper location. A space maintainer is typically placed where a back tooth is lost. Space loss does not usually occur when front teeth are lost, therefore space maintainers are usually not recommended for front teeth. Advantages Disadvantages Your child will need to wear the appliance until the permanent tooth erupts. If not kept clean, decay can occur under the bands. Alternatives If a space maintainer is not placed, the teeth will shift into the open area, making it difficult, or in some cases impossible, for the permanent tooth to erupt. This requires orthodontics to remedy the situation.
Orthodontics
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