We have several important goals during your child's first visit to our office. First, we want to introduce your child to staff and the dental setting in as non-threatening a way as possible.
1. To provide pleasant introductions to the dental setting and staff, an overall positive experience for your child.
2. To perform a comprehensive exam and assessment of your child's dental health and needs, both now and future.
3. To obtain radiographs when possible in order to provide important additional diagnostic information.
4. To perform preventive measures such as cleaning, topical fluoride application, oral hygiene instructions and dietary guidance.
5. To provide the parents or guardians a thorough analysis of the child's dental and oral status, including restorative needs, orthodontic treatment needs, and home care recommendations.
6. To provide an assessment of treatment methods that would best serve, given your child's behavior and abilities.
According to guidelines from the American Academy of Pediatric Dentistry (AAPD), your child should be seen by his/her pediatric dentist no later than six months after the eruption of the first tooth. This visit mainly will involve counseling on oral hygiene, habits, and on the effects that diet can have on his/her teeth. It is NOT recommended to wait until age 3 to visit your dentist and as a general rule, the earlier the dental visit, the better the chance of preventing dental problems. Children with healthy teeth chew food easily, learn to speak clearly, and smile with confidence. Start your child now on a lifetime of good dental habits. The AAPD also recommends a dental check-up at least twice a year; however some children that may be at a higher-than-average caries risk may need to be seen more often.
This refers to a tooth or teeth (primary or permanent) that have become "fused" to the bone, preventing it or them from moving "down" with the bone as the jaws grow. This process can affect any teeth in the mouth, but it is more common on primary first molars and teeth that have suffered trauma (typically the incisors). Treatment can vary depending on the degree of severity of the ankylosis (how "sunken into the gums" a tooth may appear). The degree of severity usually will vary depending on how early the process started, and as a general rule, the earlier it starts, the more severe the ankylosis becomes with age. Several considerations must be taken before any treatment is provided, and your dentist will discuss all the risks and benefits of each treatment option.
Trips to the dentist’s office can be a much more simple affair for some patients than others; for many of our patients, help from us to ensure a comfortable and successful treatment is a necessary part of their treatment. General Anesthesia is a great option to be considered by those who may struggle with age, behavior, medical history, or any other variables that makes the dentist office a challenge.
Dr. Smith is experienced and willing to help all patients achieve their happy and healthy smile – when you schedule your appointment, ask us about anesthesia and how it may solve your child’s dental difficulties.
Ectopic canines are generally found in the Buccal Vestibule. Impacted canines may be retrieved with braces, using a surgical approach via a gold chain or straight wire. Tissue covering the tooth is uncovered. A chain or wire is attached to the tooth crown. Tissue is placed back over the tooth leaving the chain or wire coming out of the gum. For the purpose of this illustration a gold chain is used to retrieve the canines. The chain is attached to the tooth crown and the link is attached to a flexible archwire so that the wire is active (bent). Once a month, the wire is reactivated by using the next link up on the chain until the impacted canine erupts enough to attach a regular bracket on the canine. With the regular bracket in place, a more flexible wire is added directly to the bracketed canine. This process will bring the canine into position within the arch by forcing the canine to conform to the straight archwire form. This is a long process taking anywhere from 8-12 months.
In severe cases of enamel fluorosis, the appearance of the teeth is marred by discoloration or brown markings. The enamel may be pitted, rough and hard to clean. In mild cases of fluorosis, the tiny white specks or streaks are often unnoticeable.
Mesiodens is the most common type of 'supernumerary' (extra) tooth. It is typically discovered on routine radiographs taken in young children (3-6 years of age) and is always located in the mid-line between the upper permanent central incisors. The most common complications of all supernumerary teeth (including mesiodens) is delayed or lack of eruption of the adjacent permanent teeth. Only about 25% of mesiodens erupt spontaneously, therefore most of them require surgical management. Treatment of mesiodens is deferred until permanent incisors have at least 2/3 of root development (between ages 7-9), since early treatment can cause damage to the unerupted permanent incisors.
Accidents can happen during any physical activity. A mouth protector can help protect the soft tissues of your tongue, lips and cheek lining. Over-the-counter stock mouth protectors are inexpensive, pre-formed and ready-to-wear. Boil and bite mouth protectors offer a better fit than stock mouth protectors. Softened in water, they are more adaptable to the shape of your mouth. Custom-fitted mouth protectors are made by your dentist for you personally. They are more expensive, but a properly fitted mouth protector will stay in place while you are wearing it, making it easy for you to talk and breathe.
This is a common benign lesion in children and adolescents that results from the rupture of the excretory ducts (very small tubes) that deliver saliva to the top tissues of the lips. More than 75% of mucocele are located on the lower lip and their size and color may vary, however, they tend to be relatively painless for the most part. Most of the time, patients report that these "bumps" grow until they burst spontaneously, leaving small ulcers that heal within a few days. This does not mean the lesion is gone, as they often tend to re-appear weeks or months later. Most dentists will recommend surgical treatment for these lesions.
These are two common problems in children that have their origin in discrepancies between the size of the jaws (top and bottom), or discrepancies between the size of the teeth and the amount of space available.
1. A posterior cross bite can appear at an early age, and depending on its cause (malpositioned teeth or misaligned jaws) treatment may be warranted early. It can involve one or both sides of the molar area and in some cases in can cause a "shift" of the bite. Many appliances are available for treating this condition and your dentist will discuss in detail the risks and benefits of treating a posterior cross bite.
2. Anterior open bites refer to a condition in which the top and bottom front teeth are not in contact (they do not touch each other when the patient bites). The origins of open bites can be traced to habits that patients have or had in the past, and occasionally to discrepancies between the sizes of the jaws. Since most open bites in children are associated to an existing habit, treatment usually addresses the habit itself and is most effective when done at an early age. Many appliances are available for treating this condition and your dentist will discuss in detail the risks and benefits of treating an open bite in children.
Baby teeth that have large caries (cavities) and some degree of pain occasionally require that the 'coronal' (top) portion of that tooth's nerve be removed before a filling or a crown (preferably) is placed. The main goal of this procedure is to preserve the baby tooth, since baby teeth help to maintain adequate room for the permanent teeth. Pulpotomies have published success rates that range from 60% to 90% and represent a good and reliable way to save a badly decayed baby tooth.
This is a relatively uncommon benign cyst in children and adolescents that appears in the floor of the mouth as a result of blockage of the salivary duct located under the tongue. Just like other mucous retention cysts (formed by pooled saliva), Ranulas tend to be relatively painless; however most of them will require surgical treatment. Your dentist will refer you to an oral surgeon for evaluation and treatment.
Strip crowns, also known as 'white crowns', is an alternative to placing crowns on primary incisors (top baby teeth) with large caries. Because these teeth are fixed using the same material that is used to place 'white fillings', this procedure is very technique sensitive and may not be an option for young children. With proper case selection, these 'fillings' may last for at least two to three years. Stainless steel crowns with 'white' facings (the front part is white) are also available, in the event that strip crowns are not an option. Your dentist will be happy to discuss all options available for aesthetic restorations on primary teeth.
Please feel free to read the most frequently asked questions that are asked about pediatric dentistry.
What is oral sedation?
A conscious oral sedation is a procedure in which a child is given an oral medication that causes a depressed level of consciousness. Our academy (AAPD) has clearly defined the indications for this procedure, and these are as follows:
A) Preschool children who cannot understand or cooperate for definitive treatment.
B) Patients requiring dental care who cannot cooperate due to a lack of psychological or emotional maturity.
C) Patients requiring dental treatment, and who cannot cooperate due to a cognitive, physical or medical disability.
D) Patients who require dental care but are fearful and anxious, and cannot cooperate for treatment.
As with any procedure in which a child's conscious state is altered, there are some risks involved.
The main risks (serious complications) associated with conscious sedation include, but are not limited to: aspiration, respiratory arrest, cardiac arrest, and death. Because your child will be partially awake, local dental anesthesia (a lidocaine shot) is still needed, and this may limit the extent of work that we can provide.
Sedation dentistry is also an option in cases of accidents or trauma, but in these situations, the decision to administer the medication must take into consideration the risk of aspiration (breathing vomit into the lungs) and any head trauma that may have occurred.
If your child is a candidate for a conscious sedation, please make sure you follow the instructions provided by your pediatric dentist.
Can you do all the work at once with a Sedation?
In cases with extensive decay, we are limited by the maximum dosage of local anesthetic that we can use. As a rule we also consider your child's comfort after he/she leaves the clinic, in order to determine how much local anesthetic we can use.
Very young children are at high risk of biting their lips or chewing on the inside part of their cheeks after they receive local anesthetic (a lidocaine shot). This usually happens because of their natural curiosity they try to feel the area or areas that are numb.
For these and other reasons it is unlikely that we could work on all of your child's teeth at once. An exception to this rule would be a child that is taken to the operating room.
What is a General Anesthesia appointment and how safe is it?
The use of general anesthesia for dental work in children is sometimes necessary in order to provide safe, efficient, and predictable care.
The general anesthetic is given to your child by a specialist (anesthesiologist) and ONLY after the child has been thoroughly screened by a physician.
Our academy (AAPD) recognizes the need for general anesthesia in certain situations where challenges relating to the child's age, behavior, medical conditions, developmental disabilities, intellectual limitations, or special treatment needs may warrant it.
Pediatric dentists are, by virtue of training and experience, qualified to recognize the indications for such an approach and to render such care. Your pediatric dentist and his staff will discuss all the necessary steps that must be taken in order to promptly and safely complete your child's dental treatment after this treatment option has been chosen.
Like any procedure in which a child's conscious state is altered, there are some risks involved. The main risks (serious complications) associated with an oral sedation include, but are not limited to: Allergic reaction, respiratory arrest, cardiac arrest, and death.
Statistically, the chances of a serious complication are similar to those of being involved in a life threatening motor vehicle accident.
Please make sure you fully understand as a parent or legal guardian all the risks involved with this procedure. Also review the instructions that you must follow the day before the procedure.
Will you need to give my child a shot to do the dental work?
This is the one of the most commonly asked questions that we get from our patient's parents. We try to minimize the discomfort of the injection by placing a gel that works as a local anesthetic to numb the tissue were the injection will be administered.
Profound local anesthesia is usually obtained five to ten minutes after the injection, depending on the area of the mouth where the anesthetic was placed. We always check to confirm that the area is numb before we begin to work. In cases of localized infection or trauma (like broken teeth) it is very difficult to obtain profound anesthesia, however we do have other means of supplementing the anesthetic (like conjoined use of nitrous-oxide gas, medications, or conscious sedation).
Younger children, particularly pre-schoolers may interpret the feeling of numbness as pain, and therefore cry. Please follow the postoperative instructions that we give you, in order to minimize complications such as lip biting.
My child's teeth have stains on them, are these cavities?
When a baby-tooth changes color, it can mean many things. Baby teeth can and do normally change in color, particularly close to the time that they become loose, however, this change is minimal and should not be confused with a carious lesion (cavity).
The best way to determine if your child has a stain or a true cavity is to take him or her to a pediatric dentist.
Caries is an infectious disease; it progresses if left untreated, and usually is associated with pain (especially when the "cavities" are large). Teeth with cavities typically assume a darker (brown) discoloration, and depending on the extent, may exhibit loss of tooth structure.
Teeth that have been previously "bumped" may also change in color. Traumatized baby teeth can assume a yellow or a dark discoloration, which may or may-not be associated with pain.
Other less common causes of changes in color may be: Fluorosis, food staining (particularly tea or colas), systemic disease (hepatitis), etc.
My child is getting shark teeth what can I do?
One of our most common consults occurs when children around the age of 7 begin to lose their lower front teeth. Many of our parents become overly worried about this phenomenon. It is VERY NORMAL for permanent lower incisors (front teeth) to erupt behind their predecessors (baby teeth), however if a baby tooth is not loose by the time half of the permanent incisor has erupted, it may be necessary to pull it.
My child has crooked teeth, will he or she need braces?
Crooked or crowded teeth are very common in the growing patient. Even patients that get braces may develop a minor degree of crooked (crowded) teeth, particularly in the front teeth of the jaws, as they grow old.
The first step in determining the need for treatment is what we call an orthodontic consult. During this appointment we may obtain special records and special x-rays of your child's jaw. This information will allow us to make a decision based on predicted growth patterns that your child may show later. In orthodontic terms we refer to this as Early Treatment.
Early treatment refers to ANY orthodontic (braces) or orthopedic appliances (like Headgear) treatment that begins when the child is in primary dentition, or in early mixed dentition (when the first permanent teeth begin to erupt).
Early treatment has been proven to be effective despite objections by some people in the orthodontic community.
The AAPD recognizes that early diagnosis and successful treatment of developing malocclusions can have both short-term and long-term benefits, while achieving the goal of occlusal harmony, function, and facial esthetics.
Always know that you are welcome to ask us anything you want to know about your child's dental health or any other questions you may have.
We're here to help!