F.A.Qs for Parents
When should my child start seeing a pediatric dentist?
The American Academy of Pediatric Dentistry recommends that you should schedule your child's first dental appointment once the first tooth has erupted. This usually occurs by 1 year of age. As soon as a child has teeth, those teeth are subject to decay. The primary concern in very young children is "Early Childhood Caries" also known as "baby bottle tooth decay," which can be avoided with early prevention and home care.
Following the first visit, the American Academy of Pediatric Dentistry suggests follow-up visits twice a year for preventative care.
Why should I see a Pediatric Dentist?
While all dentists are trained to see any age patients, a Pediatric Dentist limits his practice exclusively to treating children, ranging from infants to teenagers. After completing a four year dental program, two to three additional years or rigors training is required to specialize as a pediatric dentist. The additional training and hands on experience, including advanced behavior management techniques, prepares pediatric dentists to meet the unique needs of infants, children, and adolescents, including children with special needs. We keep current on the lasted advances in dentistry for children and must complete continuing education courses specific to pediatrics.
What is a board certified Pediatric Dentist?
A board certified Pediatric Dentist or Diplomate of the American Board of Pediatrics Dentistry has become certified through an examination that continuously validates their knowledge, skills, and experience for delivering quality patient outcomes. They provide assurances to the public that a board certified pediatric dentist has successfully completed accredited specialty training. ABPD values a health professional's commitment to lifelong learning. ABPD values candidates' and Diplomates' desire to practice pediatric dentistry at the highest level and their commitment to constantly reevaluate their practices in light of the most recent scientific evidence. ABPD recognizes the value of renewal of certification and continuing education for health professionals.
What is Preventative Care?
Preventative care includes all aspects of care that helps ensure your child's oral health care is taken care of. By establishing a Dental Home and providing proper guidance we can establish good habits and minimize any dental issues your child may have. Preventative care includes: proper brushing and flossing, a balanced diet, addressing harmful habits, fluoride treatments, addressing sports safety, and monitoring growth and development for orthodontics.
When should my child first see a dentist?
The American Academy of Pediatric Dentistry recommends children visit a pediatric dentist within 6 months of their first tooth erupting. While most kids will not require any treatment or dental x-rays at this appointment, it is important in helping establish a Dental Home. We will discuss proper diet, proper tooth brushing techniques, as well as address any harmful habits your child may have. An early dental examination and preventative care will establish a good routine early and prevent problems later on. If your child has no cavities, it is recommended they follow up with a check up at least twice a year or every 6 months.
Can tooth decay be prevented?
Over 40% of American children have cavities by age 6. With proper dental care this number can be greatly reduced. Preventive dentistry begins with the eruption of your first tooth. Cavities are caused by bacteria. For the bacteria to form a cavity three other components are needed: a tooth, sugars/carbohydrates, and time. By addressing any of these areas we can prevent bacteria from organizing into harmful colonies as well as develop healthy dietary habits. Brushing twice a day for at least two minutes will lower if not help eliminate the harmful bacterial colonies (referred to as plaque). Early and routine check up can allow us to address these issues and help avoid unnecessary cavities and dental treatment.
How does my child get the bacteria that causes dental decay?
Tooth decay is caused by harmful bacteria. This bacteria that causes cavities is passed directly to babies from their parents, siblings, or other care givers. It is important to try not sharing straws, spoons, drinks, or anything else that comes in contact with some else’s mouth with your young ones.
Why do I need to fix baby teeth?
While primary or baby teeth will eventually be replaced most are in your child’s mouth until they are teenagers. Establishing proper oral hygiene and preventing decay even in baby teeth is extremely important. Learning good habits as a child will translate to overall health permanent teeth and a healthier lifestyle. Studies show that children with poor oral health have decreased school performance, poor social relationships, and less success later in life. Untreated decay can lead to pain and infection. Children experiencing pain from decayed teeth or infections are distracted and unable to concentrate on schoolwork. In addition, baby teeth allow for proper growth and development by permitting your child to chew and eat properly. Baby teeth are also involved in proper speech. Finally, they help the permanent teeth by saving space for them. A healthy smile can help a child feel good about the way they look and themselves.
When will my baby’s teeth start to erupt?
Normally, babies start to get their first teeth around 6-8 months of age. Of course, this is just a guideline. Some kid’s teeth come in much earlier while others come in later. The lower front teeth are usually the first to erupt followed by the top two. By 3 years of age most children will have all 20 of their baby teeth.
How can I avoid nursing caries or baby bottle caries?
Milk and formula both contain sugars that can lead to decay. Early childhood decay, also known nursing or baby bottle caries, can be prevented by following a few steps:
- Avoid putting your child to sleep with a bottle or while nursing.
- Avoid giving milk in a bottle at night.
- If your baby wakes up to feed at night, gently wipe their gums or teeth with a wet wash cloth or napkin after they finish. Again, the milk should not be used as aid to put them back to sleep.
- Avoid “at-will” feeding once the first teeth have erupted.
- Try and wean your child off the bottle by age 1.
- Visit your pediatric dentist within 6 months of the first tooth erupting.
Dental Check Up
How often should I bring my child to the dentist?
The American Academy of Pediatrics recommends that your child see a dentist every 6 months. Some children with special needs or those at higher risks for cavities may benefit from seeing a pediatric dentist more frequently.
What will the dentist do at the check up appointment?
The pediatric dentist will review your patients medical and dental history. Based on your child's age and previous dental experience, the appropriate x-rays will be taken. The pediatric dentist will examine your child's teeth, gums, and jaw. Any concerns or issues will be addressed and discussed. Your child will also be cleaned and polished followed by a fluoride treatment.
My child doesn't have any cavities, do they really need to have a dental visit every 6 months?
Tooth decay or cavities is not the only reason to see your pediatric dentist. As children grow, their mouth is also growing and developing. The growth and development should also be assessed to identify any orthodontic issues and also monitor the eruption of the teeth. Children's behavior, activity, diet, hygiene, and overall health is constantly changing. Regular visits will allow us to address any concerns before they become a problem. Moreover, baby teeth are relatively small in size. A small cavity left untreated can get fairly large in the course of a year. Waiting until your child is in pain to schedule a dental visit may result in more extensive treatment. Finally, establishing a routine not only allows your child to feel comfortable coming to the dentist and establish good habits, but it also allows us to get to know your unique child and watch them grow.
Do you have digital x-rays?
Yes, our offices uses the latest digital technology. Digital x-rays allow us to greatly decrease the exposer time and minimize the radiation exposure to your child.
Are dental x-rays safe for my child?
Yes. The radiation exposure from dental x-rays is very minimal, especially with new modern digital x-ray technology. With the addition of a lead shield or apron and the highly focused beam of new x-rays, the amount of radiation exposure is almost negligible.
Do we have to take x-rays?
We only take the x-rays that necessary to ensure your child does not have any cavities. Infants often have large gaps between their baby teeth, so sometimes x-rays are not needed. However, as the back molars erupt (usually by age 2), the gaps tend to close. At this time x-rays become needed to diagnose any problems in between the teeth. X-rays will show information that can not be seen just by looking.
How often des the dentist need to take x-rays?
Generally, children should have x-rays taken at their 6 month check up appointment. Their mouths are constantly growing and changing and they are at a higher risk of tooth decay then an adult. However, every child is unique and have specific needs. Sometimes x-rays can be taken less frequently. We will only take the x-rays that are needed to properly evaluate your son or daughter.
Diet and Nutrition
What type of diet should my child follow?
A healthy diet is a balanced diet consisting of: fruits and vegetables, breads and cereals, milk and dairy products, and meat, fish and eggs.
What type of foods cause cavities?
A diet high in certain carbohydrates, such as sugar and starches, provide food for bacteria to thrive. These harmful bacteria then attach the tooth surface resulting in cavities. Foods with starch include breads, crackers, pasta, pretzels, etc. In addition, candies and sweets are not the only things that contain sugar. Fruits, some vegetables, and most milk products contain one or more types of sugar and all sugars can promote tooth decay. Sticky foods (such as dried fruits, raisins, or taffy) are not easily washed away from teeth by water or saliva.
Does my child need to give up all sugars?
No. What is important is a balanced diet and eating in moderation. A food with sugar or starch is safer for teeth when eating during a meal, opposed to frequent snacking. Sticky sugars like raisins or taffy are not easily washed away with water and have the potential to cause more cavities then sugars that are easily washed away. Most importantly, try and minimize the number of snacks the child eats and drink more water. This will allow for saliva and water to wash away the sugars after meals.
What is fluoride and how does it work?
Fluoride is a naturally occurring element. When used in small doses it helps remineralize enamel and prevent tooth decay. It is found naturally in water and many foods. It is also added to toothpastes, mouth washes, and gels. Studies have found it to be a very effective in helping to prevent tooth decay
Is fluoride safe?
When used properly, studies show fluoride to be very safe and effective. Research has shown drinking fluoridated water has reduced the rate of dental decay by almost 50 percent. Fluoride is safe in very small doses. The amount found in fluoridated water is very minimal and is monitored and regulated making drinking water very safe. That found in toothpaste, on the other hand, is highly concentrated. It is not meant to be swallowed. Proper toothpaste amounts in children should be monitored. Encourage your kids to rinse and spit after brushing. Do not leave toothpaste where young children can reach it.
What toothpaste should my child use?
Your child should use a toothpaste with fluoride and the seal of approval from the American Dental Association. Your pediatric dentist will discus when your child should start using fluoridated tooth paste and techniques for proper brushing.
How much toothpaste should my child use?
The AAPD, currently recommends toddlers use a "smear" of toothpaste once their teeth began to erupt. A "pea sized" amount can be used once they are more comfortable with rinsing and spitting. Children should be supervised to avoid and minimize swallowing of the tooth paste. Ingesting toothpaste can potentially damage developing adult teeth.
What is topical fluoride?
A topical fluoride gel or varnish is high concentration of fluoride carefully applied by the pediatric dentist at your child's check up appointments. It has been documented to be safe and effective in fighting tooth decay. It continues to absorb into the enamel for up to 24 hours. If you have any questions or concerns please speak with your pediatric dentist. In some cases such as medically compromised children, your pediatric dentist may recommend additional fluoride supplements.
What is a sealant?
Sealants are a clear plastic like coating that flow into the grooves on the top or chewing surface of the molars and bond to the teeth.
How do sealants work?
Sealants flow into the microscopic grooves and pits of the teeth. Even with the best brushing, it can be difficult to clean out these tiny grooves. By covering up these grooves with a sealant, a barrier is formed preventing food and cavity causing bacteria from adhering to the tooth; and thus, reducing the risk of a cavity.
Can sealants be placed on all teeth?
No. Sealants follow into the grooves of the chewing surface of the teeth. They are primarily placed on the permanent first, or 6 year molars, and permanent second, or 12 year molars. They are sometimes placed on the permanent premolars if the teeth have deep grooves.
Can Sealants be placed on baby teeth?
While sealants can be placed on baby teeth, the baby molars generally don’t have the same deep grooves that permanent molars have. The pits and crevices are much shallower allowing for them to be more easily cleaned.
How is a sealant placed?
Placing a sealant is a fairly simple non-invasive procedure. The tooth is firs cleaned and isolated to keep it dry. The enamel is then conditioned with a bonding agent or tooth etch. A thin layer of the sealant is then placed over the biting surface and allowed to flow into the grooves. A curing light is then used to harden the sealant and complete the bonding procedure. No local anesthesia is needed to place sealants.
Do sealants last forever?
Sealants can last for a very long time with proper care. If your child practices good oral hygiene and avoids biting on hards objects (such as chewing on ice), a sealant will last much longer. Sealants will slowly break down over time and need to be replaced. We will check on them at your child’s routine appointment.
Does my child still have to brush and floss?
Yes. While sealants help protect bacteria from entering the grooves of the teeth, they do not prevent cavities entirely. In addition, sealants do not protect in between the teeth, a very common area for cavities to form. Brushing, flossing, and a balanced diet are still essential to maintaining healthy teeth and gums.
What is a filling?
When a child has a small cavity, chip or other tooth issue, the tooth can be restored with a filling. A filling is essentially a biocompatible material that is placed in the hole created by the cavity or used to build up a broken tooth.
Are white fillings better then silver fillings?
White fillings and silver or amalgam fillings have both been used in dentistry for a very long time. They each have their advantages and disadvantages. In addition to the cosmetic benefits, the white fillings bond to the tooth and so the preparation for the filling can be kept smaller. They also lack the mercury found in the silver fillings. However, the composite/resin fillings are require the area to be kept very dry to properly bond. While this easy to accomplish in cooperative children, it can be difficult in very young children who are not cooperative. The pediatric dentist can discuss the benefits of each.
Are silver or amalgam fillings dangerous?
Amalgam fillings have been used in dentistry for ages. The are very effective and work well. Unfortunately, they do contain minimal amounts of mercury which has been known to have toxic effects in high doses. While the American Dental Association has found them to be safe and non-toxic, it is best that parents research this and make their own informed decision. The pediatric dentist can definitely go over the advantages and disadvantages.
Does my child need to be numbed up for the filling?
Usually the child will need to have local anesthesia placed to do the fillings. Sometimes very small fillings can be done without numbing up child. However, our goal is to make sure your child is comfortable during the treatment and does not experience any pain.
How long do fillings last?
Dental fillings can last a very long time if taken care of. You child will still need to brush and floss on a regularly. If not, the child can get recurrent decay or a new cavity below the filling. Sometimes, as a child's mouth grows their bite changes and they sometimes start biting directly on the filling. This can cause fillings to crack and need to be redone. The pediatric dentist will evaluate the fillings at your child's regular check up appointments.
What is a crown?
A crown is restoration that is placed on a tooth where a filling would be to large to work. Also called a cap, it covers the entire tooth. Your child's tooth is still underneath the tooth.
Why does my child need a crown?
If the decay is very extensive a filling will not work. If the filling is more then half the size of the tooth there is a very high chance it or the tooth will break with normal biting forces. For this reason, it is better to place a crown on top of the tooth. Usually, if your child needs a pulpotomy or a baby root canal, the tooth is best restored with a crown.
Are the crowns white or silver?
Both silver and white crowns are available. They both work equally well. Unlike silver fillings, silver crowns are made of stainless steel and non-toxic. Cosmetics is really the primary difference between the two.
Does the crown need to be taken out later?
No. The crown is cemented on top of the baby tooth. With proper care the tooth with the crown will fall out just as a normal baby tooth would.
How do I take care of the crown?
A tooth with a crown should be cared for like a tooth without one. Brushing twice a day and daily flossing will ensure the crown doesn't accumulate any plaque and maintain the health of the gums around the crown.
Will my child be soar after the crown?
The crowns do extend slightly below the gums. Some kids will experience mild irritation of their gums for 1-2 days as the gums heal. With good brushing, the gums will heal quickly around the crown and your child should not feel any discomfort after that. For the first day, there may be slight bleeding and swelling around the crown. Your child should still brush normally in the area. If they are soar, over the counter pain medications (Tylenol or Motrin) can be given.
What is a pulpotomy?
A pulpotomy is sometimes referred to as a “baby root canal.” Sometimes due to severe decay, dental trauma, or pain, pulp therapy or a pulpotomy is needed. During a pulpotomy the pulp chamber, which contains the nerves and blood vessels of the baby tooth, is cleaned out. A biocompatible material is placed in center of the tooth previously occupied by the pulp. The tooth is then restored.
When does my child need a pulpotomy?
Some signs your child may need a pulpotomy are pain at night, pain on biting, constant pain or bleeding from the tooth due to truama. A thorough examination by the pediatric dentist will determine if pulpotomy will be the best form of treatment.
Is it painful?
No. Once the child is numb, a pulpotomy is a very quick procedure and your child should not have any discomfort during it.
How does taking out the nerve of the baby tooth affect the adult tooth?
The adult tooth is a separate tooth with its own nerve and blood supply. A pulpotomy on a baby tooth will have no effect on the nerve of the adult tooth. Afterwards, the baby tooth will fall out normally.
It is better just to pull the baby tooth out?
Every case is different. The pediatric dentist will evaluate the X-rays and symptoms and determine what the best treatment options are. Posterior or back teeth can stay in your child’s mouth into their teens. It is important to try to persevere the teeth if possible for eating, proper growth, and to maintain the arch length or space.
What is an extraction?
An extraction is when the pediatric dentist removes the tooth.
Why does my child need their tooth taken out if it will fall out on its own?
Sometimes due to pain, trauma, extensive decay or infection a tooth will need to be taken out before it is ready to fall out on it own. By looking at the x-ray the pediatric dentist will be able to determine if the tooth can be restored or if an extraction is the best treatment route.
Are extraction painful?
Every procedure is different. Due to short roots, most baby teeth come out fairly quickly and effortlessly. Some children experience very mild discomfort for one or two days. Over the counter pain medication (Tylenol or Motrin) is usually provides enough relief if they are uncomfortable. Children don’t get dry socket and the bleeding generally stops within 10-15 minutes with pressure.
My child lost their front teeth, can we replace them?
The upper front adult teeth normally come in between 6-8 years of age. For children who lose their baby teeth early, either due to trauma or decay, a pediatric partial can be made to replace the missing teeth. These fake teeth look very natural and most kids tolerate them well.
Does my child need a pedo partial?
The primary function of a pedo partial is cosmetic. Having a nice smile and teeth "like all their friends" can go along way in making feel comfortable and good about themselves. It will also help with proper speech development.
Do they come in and out?
No. The fake teeth are attached to wire that is attached to two orthodontic bands. These custom fit bands are cemented to their back molars. Most kids adapt to them quickly and hardly notice anything different. While the partial can come off if your child eats really sticky foods or treats, they normally stay in quite securely.
How is the partial made?
The partials are made at a dental laboratory. An impression of your child's mouth will be taken. The models will be sent to the lab and about 2 weeks later it will be ready to be placed in your child's mouth.
How long will my child need to wear them?
The adult teeth normally erupt between 6-8 years of age. By looking at the x-rays, the pediatric dentist can get a rough idea of when the teeth will come out. At each routine check up, an x-ray will be taken to see the position of the adult teeth. When the teeth are close to coming in the partial will be removed.
When do I need a space maintainer?
Normally baby teeth are pushed out as the adult teeth erupt. Sometimes, a baby tooth is lost too early. It can be be lost due to trauma or sometimes pulled out by the dentist due to infection or severe decay. When a primary tooth is lost prematurely, the pediatric dentist may recommend putting a space maintainer in your child's mouth. The space maintainer will prevent the tooth around the empty space from drifting or tilting forward. It will hold, or maintain, the space so the adult tooth can erupt properly and in the right spot. This will help prevent crowding and more extensive orthodontic needs.
What is a space maintainer?
There are different types of space maintainers. The most common type is small, custom fit bad that is fit to the tooth behind the empty space. Another small wire or band will extend to the tooth in front of the gap. There are also other kids which your pediatric dentist can discuss with you. They are fairly small and unobtrusive. Most kids adjust to them quickly and hardly notice they are there.
How do I take care of a space maintainer?
For the most part care for a space maintainer is not too different then routine care. The child should continue routine brushing and flossing. A little extra time spent brushing around the band will help prevent any gingival inflammation. Sticky sweets and gums should be avoided. The child should also try and avoid pulling on it with their fingers or playing it with their tongue. Finally, continue with your routine dental check ups. When the adult tooth is close to erupting the pediatric dentist will remove the space maintainer.
My spacer came off, what should I do?
If your child's spacer comes off do not throw it away, rinse it with water and put it in a container to bring to your pediatric dentist. Call your pediatric dental office to make and appointment to have it reset. While not an emergency, it is best not to wait too long before having it replaced. Waiting too long may result in the teeth moving and the spacer will not longer fit properly.
When does my child need to see the orthodontist?
Every child's growth is different. Your child's dental development will be monitored by their pediatric dentist at each check up appointment. We will evaluate your child's occlusion, crowding, bite problems, and jaw discrepancy. If needed with can intervene with minor early orthodontic care to help guide the teeth or even refer your child for a complete orthodontic evaluation. While many kids with minor crowding can wait until most of the adult teeth have erupted, some children will require braces or treatment a little earlier.
My child still has baby teeth, why do they need braces or early orthodontics?
Early orthodontics, sometimes called phase I, can benefit your child in many ways. In addition, to enhancing your child's smile and appearance, starting early can provide a guide or space for erupting teeth. This can help prevent crossbites from developing, sometimes prevent the need for extractions later, and help simplify complete orthodontic care when they are older. Straight teeth are also easier to keep clean, thus helping to prevent cavities and gum problems. Some problems, such as uneven jaw growth, are more easily corrected while your child is young and their growth more easily influenced. If not treated early, some issues can only be corrected by jaw surgery later in life.
Does early orthodontics mean full braces?
No. Early orthodontics can be something as simple as wearing a retainer to correct a single tooth cross bite. Other children will benefit more from fixed braces. The pediatric dentist can discuss the different options that would be best for your child.
Why are my child's teeth crowded?
Crowding is often inherited. If the child has a small jaw and relatively larger teeth, they will have crowding. Sometimes, early loss of baby teeth or habits (prolonged pacifier or digit sucking) can influence the shape of the jaw and also create orthodontic needs.
What should my child do to take care of their teeth with braces or an appliance?
Your child should maintain their normal brushing and flossing habits. If your child has braces, extra brushing after meals will help prevent gum disease. With a removable appliance, your child should remove and brush it on a daily basis.
Are the appliances or braces uncomfortable? Can they eat everything?
With any orthodontic appliance or braces, there will be some getting used to it. Most children adapt quickly and hardly notice it is there after a few days. With some appliances, speech may be altered for a few days. As for diet, your child should avoid sticky foods (gum, taffy, some sticky candies) and large hard foods (such as peanuts or chewing ice). Aside from this, there is not much that needs to avoided in terms of diet. Your child will be able to participate in normal activities and sports. If your child plays in sports in which they may get hit in the mouth, it may be advisable to have a mouth guard made. This can be discussed with your pediatric dentist.
Is it ok for my child to use a pacifier?
Pacifiers or even finger sucking is normal for babies. Not only does it provide security but it is means for them to interact with the world. Most children by the age of two will naturally stop. It is only with prolonged pacifier use or digit sucking that we start to see dental problems.
When should I be concerned my child is using the pacifier or sucking their thumb too much?
Most children will stop these habits on there on. If the habits persists past the age of 2, it may start to effect the shape of their jaw or position of their teeth. If your child is consistently engaging in the habit throughout the day or night after age 2, your pediatric dentist can discuss ways to help break the habit and discuss how it is affecting their development.
How will a pacifier or finger habit effect my child's teeth?
Overuse of a pacifier or finger sucking habit will cause the upper jaw or palate to become narrow. The upper front teeth will start to tip forward. Normally, when i child bites down the upper teeth will overlap the bottom teeth. A prolonged habit will result in what is known as an "open bite". When your child bites together there will be a space between their upper and lower front teeth.
Is there anything to help my child stop the habit?
For those children that are unable to stop the habit on their own, your pediatric dentist can discuss techniques to help break the habit or even recommend a habit appliance with interferes with the habit. While your child may not like it, a pacifier can be taken away. It is best to try and reinforce positivity and explain why they don't need. It should not be made out as punishment that the pacifier is being taken away. A digit habit is much more difficult habit to break. Again, your pediatric dentist can discuss ways to try and eliminate this habit.
Are pacifiers better then thumb/finger habits?
Overuse of the pacifier or finger/thumb habits will have the same results. However, a pacifier habit is generally much easier to break as it can be taken away.
Can my pediatric dentist make something to help my child stop sucking their thumb/fingers?
Yes, a habit appliance can be made to help break the habit. These appliances, however, are intended for older children who understand the harmful results of the habit and want to stop.
Athletic Mouth Guard
What is a mouth guard?
An athletic mouth guard protects your child's teeth while playing sports. A preformed mouth guard can be purchased at a sports story or a fitted made of soft plastic by the pediatric dentist. They fit comfortably to the shape of the top teeth.
Why should my child wear a sports guard?
Mouth guards are an important part of sports equipment and sports safety. They protect the teeth, gums, tongue and cheek. Most oral injuries, include chipping or losing teeth, can be prevented with the use of a mouth guard.
When should my child use a mouth guard?
Your child should use a mouth guard when playing any contact sport or participating in an activity that may pose a risk to their face or teeth. Some of these sports include football, basketball, soccer, hockey, skateboarding, and many more. Mouth guards are important even in those sports we don't traditionally think of as contact sports.
What is the best mouth guard?
The best mouth guard is one your child will wear. It should fit comfortably and not be bulky. For some kids a pre-made or "boil to fit" will work adequately. Other kids will be more likely to wear a custom fitted mouth guard made by the pediatric dentist. These tend to be more comfortable.
My child grinds his teeth is this ok?
Teeth grinding in children is very common and normal. Most children grow out of by the time they are 6-7 years old. Very rarely do children experience tooth sensitivity from worn dentition. For a very small number of children the grinding may be a result of obstructive sleep disorders in which case some appliance therapy would be recommended. Most young children do not need any treatment. If the habit persists past the age of 7, the grinding may be a result of occlusion or bite issues. This can be evaluated by the pediatric dentist. Stress can also start to play a role in the older children.
Does my child need a night guard?
A night guard is not recommend for children. In fact, it may be more harmful by restricting the growth of your child’s jaw. As mentioned, most children grow out of it without any intervention. If your child has been diagnosed with sleep apnea their grinding may be a symptom of their obstructive sleep disorder. For these children an night time appliance to help influence the growth of the jaw may be needed. The pediatric dentist will be able to evaluate this and determine the proper course of treatment.
The grinding is so loud, I am worried my child will break their teeth?
This is very unlikely to happen and not something that should be of concern.
What can I do to help stop the grinding at night?
For the younger kids (under 6) it can sometimes help to make sure they are calm and relaxed prior to going to bed. Kids who are hyper prior to bed time tend to grind a little more. If the grinding is a result of airway issues or a jaw discrepancy, an orthodontic appliance will help.
What is a frenectomy?
A frenectomy is a minor procedure in which the frenulum, a small fold of tissue that prevents the lip or tongue from overly extending, is surgically altered or modified.
Where is my child’s frenulum?
In the mouth there are two frenulums: 1) the lingual frenulum found under the tongue and 2) the labial frenum or frenulum found in the lip.
My child is tongue tied, what do I need to do?
There are different ways to evaluate if your child is tongue tied, or has ankyloglossia, and needs treatment. Your pediatric dentist can quickly evaluate if treatment is needed and discuss the options. Children who are tongue tied usually are unable to extend their tongue, pronounce certain sounds, and unable to lick their top lip. In these kids a lingual frenectomy is needed. The tissue underneath the tongue is modified to allow your child to extend their tongue normally.
My child has a gap between their top teeth. Do they need a frenectomy?
A low attachment of the upper labial frenectomy can often cause a gap between the two front teeth. The proper time to evaluate this is when your child is between 8-10 years old. It is often done in conjunction with orthodontics. Again, the pediatric dentist will be able to evaluate whether the gap is due to the frenum or just their normal development and tooth arrangement.
Is a frenecomy difficult?
Both an labial and lingual frenectomy are fairly straightforward and minor procedures. It is a surgical procedure that requires some cutting so some patients may experience minor discomfort for a few days afterwards. Generally, over the counter pain medication is sufficient. Healing occurs quickly and most children function normally within a few days. Frenectomies can be done by both a scalpel as well as a laser depending on the situation. The pediatric dentist can go over the various options available. In a few cases, the frenum will reattach to its original position and the procedure will have to be done again.
Nitrous Oxide (laughing gas)
What is nitrous oxide?
Nitrous oxide, more commonly known as laughing gas, is blend of oxygen and nitrous oxide. It is administered to your child through a snug rubber mask that covers their nose. It provides a calming sensation to anxious children who need a little bit more to help them feel relaxed. It is also extremely helpful in those kids with a severe gag reflex. Some patients feel it has a mild “numbing” effect and they are less aware of the treatment (sounds, sights, etc.) taking place, by raising the pain threshold.
Is nitrous oxide safe?
Yes, it is extremely safe. Most anesthesiologist would consider it one of the safest types of sedation. It is well tolerated and nonaddictive. It takes effect very quickly and it is similarly eliminated from the body very rapidly. It is non-allergic and the effects are easily reversible by simply turning it off and administering 100% oxygen for a few minutes. Your child will remain fully awake, maintain their reflexes, and be able to communicate. After the procedure, the effects will have worn off by the time your child leaves the office.
Are there any instructions before and after?
Nitrous oxide can make some people feel a little nausea. It is best if your child does not eat at least an hour prior to the dental appointment. If the nitrous oxide is to be combined with another sedation agent then this time might be longer. If your child is congested or unable to breathe from their nose, let your pediatric dentist know. This will prevent the nitrous oxide from working. Your child will be given 100% oxygen after the treatment is completed to allow the nitrous oxide to clear from their system. However, they may still feel dizzy for few minutes when standing up. This normally passes after a few minutes.
My child is hysterical, will nitrous oxide work?
Probably not. Nitrous oxide, while very effective, is one of the mildest forms of sedation. In order for it to work your child needs to tolerate wearing the soft rubber nose and then breathe from their mouth. Children who are crying, talking a lot, or hysterical tend to breath from their mouth making the laughing gas ineffective. Your pediatric dentist can go over other options available for your child if nitrous oxide is not enough.
What is oral sedation?
Oral conscious sedation is a behavior management technique that uses medication to help calm an extremely nervous or anxious child. The medication is usually given in a liquid/syrup that your child will drink prior to treatment. Conscious sedation is helpful in children who have a high level of anxiety or are very young and they don't respond to other behavior management techniques.
Is oral sedation safe?
Oral sedation is very safe. Prior to administering the sedation your child's medical history will be reviewed. The dosage is based on your child's weight with a high margin of safety. Your child's vital signs will be monitored during treatment. The potential side effects and post sedation care will be discussed.
What medications are used?
There different medications that are used, each with different advantages and uses. The pediatric dentist will discuss what options are best suited for your child and their treatment.
How effective is oral sedation?
Oral sedation can be very effective. Along with the oral medication, nitrous oxide is also administered to enhance the effects. It also has a mild amnesic effect so your child may not remember their visit. Unfortunately, oral sedation does not work on every child. Extremely apprehensive or hysterical children may require IV sedation or general anesthesia to complete treatment in a safe and no traumatic manner.
What do I need to do before the appointment to prepare my child?
If your child is scheduled for oral sedation they will need to come to the appointment on an empty stomach. No food or dairy for at least 4 hours prior. No water or clear liquids for 2 hours prior. Your pediatric dentist will discuss if they prefer a longer fasting period. If your child is sick, congested, or has a fever it is best to call and reschedule the appointment.
What should I be careful of after the appointment?
Your child will only be dismissed from the office when the pediatric dentist feels they are ready. Afterwards, they may be drowsy for a few hours. Your child will not be able to go to school after and should remain indoors limiting physical activity. Watching a movie or reading is perfect. If your child wants to sleep it is perfectly safe. They should be supervised for the next 2-3 hours to avoid injury. Your child will likely also be numb from any dental treatment, so the appropriate post op instructions should be followed. Most children are back to normal in 3-4 hours.
IV Sedation/General Anesthesia
What is IV Sedation?
During IV sedation or general anesthesia your child is essential "asleep" for the treatment. Medication is administered through an IV and your child is kept in a state of unconsciousness so he is unaware of the dental treatment and unable to move. A medical or dental anesthesiologist will administer and closely monitor your child while the pediatric dentist completes the treatment.
Why is it better for my child to have their work done under IV Sedation?
Some children are extremely apprehensive, uncooperative, too young to reason with or understand instructions, have extensive treatment, or have special needs. In order to safely complete treatment in a positive and non-traumatic manner IV sedation or general anesthesia is sometimes required.
Is this done in a hospital or in the office?
IV Sedation is often done in office or out patient surgical center. When in office, the anesthesiologist will bring all his monitoring equipment to the office. This often allows treatment to be completed in a comfortable, familiar and convenient location. Sometimes due to medical concerns, it is better the child be treated in a hospital setting. The pediatric dentist will discuss what is best for your child.
Is it safe?
Yes. While there are some risks associated with IV sedation or general anesthesia, all safety precautions are taken to ensure everything goes smoothly. The anesthesia is administered by dedicated and highly trained medical or dental anesthesiologist. Your child's vital signs will be continuously monitored throughout the treatment and until they are ready to be discharged. Complications are very rare. Your pediatric dentist as well as the anesthesiologist can discuss the risks and benefits.
What do I need to do before the appointment?
Your child's medical history will be reviewed by the dentist and anesthesiologist. A physical evaluation by their pediatrician is generally also needed. The anesthesiologist will let you know how long prior your child must be fasting. It is extremely important that you follow these instructions. If your child eats or drinks anything the case will need to be rescheduled. If your child has been sick, has a cough or fever prior within 2 weeks prior to the appointment please call the office to discuss whether the appointment needs to be rescheduled.
What will me child be like after?
Your child will be dismissed by the anesthesiologist only after they are awake and stable. Most kids are groggy or tired for the remainder of the day. It is best they stay at home and avoid outdoor activities. Watching a movie is perfect. The pediatric dentist and anesthesiologist will discuss what foods can be eating. Most children are back to normal by evening time.
What should I do if my child’s adult tooth gets knocked out?
Find the tooth and gently rinse it in cool water. DO NOT scrub it or use soap. If you are able to, place the tooth back into the socket and hold it in place with clean napkin or wash cloth. If you are unable to put in back in the socket, place it in a clean container or cup in milk or saliva. Call your pediatric dentist ASAP. When a tooth is knocked out, time is critical. The longer it takes to replant the tooth, the chances of being able to save the tooth will diminish.
What should I do if my child’s baby tooth is knocked out?
Baby teeth should not be put back in the child’s mouth. Rinse the child’s mouth out with warm water and apply pressure if there is any bleeding. Call the dental office and bring your child in as soon as possible. While that tooth can not be replaced, we want to make sure that no other intra-oral trauma needs to be addressed.
My child chipped their tooth?
Call your pediatric dentist as soon as possible. The quicker the problem is addressed, the greater the chance of infection, pain or other extensive treatment can be minimized. Rinse the mouth with water and apply gentle pressure if their is any bleeding or swelling present. Try and avoid biting on hard foods with those teeth until they can be evaluated.
My child hit their head or jaw and can’t open?
The child should immediately taken to the ER or local hospital. A severe blow to the head or jaw can be life threatening. In addition, a broken jaw will require surgical intervention.
Should my child wear a mouth guard?
Yes. If you child participates in activities involving a risk of falls, collisions, or contacts with hard surfaces an oral mouth guard can help prevent dental injury. A soft preformed mouth guard can be purchased from the store or a more comfortable, fitted mouth guard can be fabricated by our office.