Pediatric dentists promote the dental health of children as well as serve as educational resources for parents, from infancy through the teen years. It is recommended that a dental visit should occur within six months after the presence of the first tooth or by a child's first birthday. This is because early oral examination aids in the detection of the early stages of tooth decay. Early detection is essential to maintain oral health, modify aberrant habits, and treat as needed and as simply as possible.
Additionally, parents are given a program of preventative home care (brushing/flossing/fluorides), a caries risk assessment, information on finger, thumb, and pacifier habits, advice on preventing injuries to the mouth and teeth of children, diet counseling, and information on growth and development.
COMMON PEDIATRIC DENTAL PROCEDURES
Stainless Steel Crowns (SSCs)
Tooth Colored Fillings (Composite Resin)
Tooth colored fillings are used to restore front or back teeth or where cosmetic appearance is important. Composites are used to repair fractured teeth and/or areas of decay. The shade of the composite restorative material is matched as closely as possible to the color of the natural teeth.
In general, children need X-rays more often than adults. Their mouths grow and change rapidly. X-rays can often show weaknesses in the tooth structure (such as demineralization) that may not be visible with the naked eye. The American Academy of Pediatric Dentistry recommends X-ray examinations every six months for children with a high risk of tooth decay. Children with a low risk of tooth decay require X-rays less frequently. We use digital radiography which uses approximately 1/4 the radiation of the traditional dental x-rays.
Dental Cleaning (Prophylaxis)
During a dental visit, the dental assistant or hygienist will first review your child’s medical history with you. This is to ensure that Dr. Dunston and his staff is updated on the general health of your child so that we may review any factors that may concern your child’s dental health. Then your child’s mouth will be examined for overall oral health. Next, your child’s teeth will be thoroughly cleaned to remove plaque and calculus (hard tarter deposits), which can cause cavities and gum disease. After the cleaning, fluoride will be applied to the teeth to help protect and strengthen the weak areas against decay. For a healthy child, the American Academy of Pediatric Dentistry recommends a visit to the pediatric dentist at least every six months to evaluate your child’s oral health and development. However, if your child has special needs or is more predisposed to dental caries, the dentist may recommend more frequent visits to more closely manage your child’s oral health.
Cavities form when there is a weakening in the mineral composition of the enamel of your teeth. Fluoride promotes the remineralization of these decalcified spots, therefore helping to prevent cavities. Low level of fluoride is found naturally in some bodies of water. Municipal water supplies are often fluoridated to a specific standard level. Fluoride can also be found in many household products such as toothpaste, mouth rinses, and even some bottled water.
Dr. Dunston will monitor the development of your child’s teeth in order to prescribe the specific amount of fluoride that your child may need. In general, there is a careful balance between too much fluoride and too little fluoride. An excess of fluoride may damage developing teeth leading to fluorosis; while a deficit of fluoride leaves your child’s teeth susceptible to tooth decay. Fluorosis presents in various forms that affect developing permanent teeth by causing white spots to form.
Tooth decay (caries) is a progressive disease that often begins in very young children. Bacteria that normally live in the mouth react with sugars from foods and drinks to create acid that slowly eats away at the enamel of your child’s teeth and can also damage sensitive gum tissue. With the loss of enamel, weak points in the teeth form. These weak areas become cavities– which left alone can lead to irreversible nerve damage and the necessary early extraction of your child’s tooth.
Again, early treatment is the key. As soon as a cavity is identified, your pediatric dentist can repair the tooth using tooth-colored fillings. If the cavity is too deep, a pulpotomy nerve treatment and stainless steel crown or extraction of the tooth may be needed. Effective brushing and flossing, the proper use of fluoride, and a balanced diet can help minimize the amount of decay to help your child have a happy, cavity-free smile!
Early (Interceptive) Orthodontic Care
It's never too early to keep an eye on your child's oral development. Dr. Dunston can identify malocclusion (crowded or crooked teeth) or bite problems and actively intervene to guide the teeth as they emerge in the mouth. Interceptive orthodontic treatment can prevent more extensive treatment later. Dr. Dunston checks the progress of your child’s bite and jaw development with routine dental examinations. This early assessment of your child’s teeth may prevent extensive orthodontic work in his/her future.
Extractions (Tooth Removal)
Extractions are done only as a last resort in the case of severe tooth decay. If a primary molar is removed prematurely, a space maintainer will be placed. Some extractions are needed for orthodontic reasons to help facilitate tooth alignment when crowded teeth are present. Primary teeth are essential in maintaining the correct spacing in your child’s jaw for the permanent teeth.
Pulp Treatment (Pulpotomy)
Pulp therapy (pulpotomy) is the treatment of infected nerves and blood vessels in teeth. Pulp therapy generally becomes necessary for two reasons: either as a result of extensive tooth decay (dental cavities) or as the result of tooth injury. Failure to provide the necessary pulp therapy could result in your child experiencing pain, infection, swelling, or loss of the tooth.
Many cavities may be so deep that they extend to the nerve, often causing pain and discomfort. When this happens, the infected part of the nerve must be removed. The remaining healthy nerve will be left intact and medicated. The purpose of a pulpotomy is to extend the life of the baby tooth, thereby avoiding the need for extraction and a space maintainer, until the eruption of the permanent tooth. In other words, the tooth can be preserved for chewing food and maintaining proper space for permanent teeth, as well as helping your child to preserve a healthy, happy smile.
Sealants are thin, white plastic coatings that are applied to the tops or chewing surfaces of back teeth and are highly effective in preventing tooth decay. The naturally occurring pits and grooves on the chewing surfaces of teeth can often collect plaque. These small grooves and cracks are the most susceptible to cavities in children and teens and benefit the least from topical fluoride. Sealants and fluoride work together to help prevent tooth decay. On average, sealants last for 5 to 10 years with proper maintenance. At every dental check-up, the dentist will check that the sealants are intact. In order to prolong the life of your child’s sealants, avoid crunchy foods and avoid chewing on ice and hard candy.
Space maintainers are used when a primary tooth has been prematurely lost (or extracted) to hold space for the developing permanent tooth. If space is not maintained, teeth on either side of the extraction site can drift into the space and prevent the permanent tooth from erupting into its proper position. The space maintainer will be removed from your child’s mouth once his/her permanent tooth replacing the extracted tooth comes in.
Root Canal Treatment
Also, called complete Pulpectomy, it involves complete removal of all the pulp tissue because it is infected. The main objective of pulp therapy in the primary dentition is to retain every primary tooth as a fully functional component in the dental arch to allow for proper mastication, phonation, swallowing, preservation of the space required for eruption of permanent teeth and prevention of detrimental psychological effects due to tooth loss. If a child has tooth pain, particularly if there has been accompanying swelling of the gum tissues or cheek, this will need to be managed first. A small opening is drilled in the biting surface of the tooth to drain infection and/or a course of antibiotics is given. This will set the stage for the removal of infected tissue from the root canal/s completely. This procedure resembles traditional root canal treatment, with removal of all the infected tissue from the root canals; disinfecting, cleaning, shaping and filling the canals to seal them.
The sealant material must be absorbable so that the body can absorb the roots normally, allowing the primary tooth to be lost and replaced by its permanent successor. The materials most commonly used are zinc oxide/eugenol paste, or iodoform paste and calcium hydroxide. Some researchers have reported a mixture of calcium hydroxide and iodoform as nearly perfect — it is easy to apply, absorbs at a slightly faster rate than the roots, is non-toxic to successor teeth and is radio-opaque, which means it is visible on radiographs (x-rays).
Upon completion of root canal treatment for primary teeth, the restoration of choice for a back tooth is a stainless-steel crown and, for a front tooth, a composite tooth-colored resin.