Kids & Pediatric Dentistry

Pit & Fissure Sealents

Pits and fissures of the occlusal surfaces of the posterior teeth are more prone to caries development than the smooth surfaces due to their morphological complexity, making dental hygiene more challenging leading to increased plaque accumulation [1]. The enamel in pits and fissures cannot receive the same protection given by fluorides comparing to the enamel in the smooth surfaces [2].

The use of pit and fissure sealants provides a physical barrier that inhibits microorganisms and food particles accumulation, preventing caries initiation, and arresting caries progression [3][4].

Permanent first molars, followed by second molars, show the highest caries prevalence. The management of occlusal caries on permanent molars represents a significant challenge because the onset of caries occurs soon after they erupt into the oral cavity. The effectiveness of pit and fissure sealants relays on their long-term retention [4]

Pediatric Dental Crowns

A dental crown is a restoration that covers or “caps” a tooth, restoring it to its normal size and shape while strengthening and protecting it from further cracking or breakage. Crowns are necessary when a tooth is damaged by decay to the point that a filling is no longer a treatment option. Sometimes when a dentist removes significant tooth decay or performs a nerve treatment, he or she will recommend capping the child’s affected tooth with a crown.

Stainless steel crowns are silver caps that cover the back teeth and preserve more of the tooth structure than other types of crowns. They withstand biting and chewing forces well and rarely chip or break. Stainless steel crowns are often used on young patients who are in active occlusion and require a crown that can adapt to an adjusting and growing mouth.

White crowns are used to strengthen decayed front teeth. They are commonly referred to as strip crowns, made of a composite resin. White crowns that are used on back teeth are made of a porcelain fused to metal material. These crowns are more commonly used on for adult teeth. They are more rigid and work better when a mouth has stopped growing. White crowns are close in color to the natural teeth, so they are more cosmetically pleasing.

Dental crowns for children are generally completed in one visit, and will usually last until they are replaced by adult teeth.

Pediatric Extractions

There are certain occasions when a child will need to have a tooth extracted. The most common causes of tooth extraction for children, include:

Tooth decay is too extensive for restoration. Sometimes there is not a restorative treatment option for a tooth.
Preparation and space management for orthodontic treatment
Baby teeth fail to fall out before permanent teeth come in (this is called an over-retained baby tooth).
Removal of teeth that are chipped or damaged beyond repair by dental disease or dental trauma Our dentists will never recommend extraction if there is a less invasive treatment option. Make sure you understand why extraction is recommended and what the procedure involves for your child.

Baby tooth extraction: what to expect
Dental extractions are a surgical procedure where a dentist or an oral surgeon removes a tooth from the mouth. There are two types of extractions, simple and surgical. A simple extraction involves pulling a baby tooth that is clearly visible in the mouth. Dentists perform a simple extraction with a device called an “elevator,” which loosens the tooth, and then with forceps. These extractions normally will only call for a local anesthetic.

Parents, remember to restrict your child’s eating after surgery until all numbness is gone in order to avoid painful and damaging bites inside the mouth. The other method of extraction is surgical extraction, which is required if the tooth is embedded in the jaw bone (fully impacted), or partially covered by jaw bone (partially impacted). Frequently, a surgical extraction can be performed with a local anesthetic and nitrous oxide. In some cases, IV sedation or general anesthesia will be recommended. Our dentists will work with you to determine the best type of service for your child and will help prepare you and your child for the procedure.

Post extraction, parents need to monitor their child’s behaviors and healing process. Aside from waiting to eat, kids need to avoid drinking from a straw or even spitting vigorously as this could dislodge the blood clot that forms in the dental office right after an extraction. Ice packs can be used in twenty minute intervals to decrease swelling. Over the counter pain medications can be used, but talk to your dentist about recommended dosage and duration.

Your child should continue with a regular oral hygiene routine, but be sure they are extremely careful around the area of the extraction. With proper and gentle care, recovery from an extraction should be very quick.

Preventive Dental Therapy

Preventative dentistry treatments for kids are just as important as preventative dentistry treatments for adults. However, plenty of parents make the mistake of assuming their child’s teeth are in immaculate condition simply because he or she is young.

In reality, youngsters have oral health issues just like adults. In fact, kids are especially prone to cavities as they love to eat candy, drink juice and enjoy other sugary delights.

Here is a look at some of the most important preventative dentistry treatments for kids.
1. Dental Sealants  are a translucent material similar to plastic that a dentist can spread on teeth with ease. Dental sealants remain on the chewing surfaces of teeth to stop cavities from forming and spreading. The dentist usually applies a dental sealant to molars when the patient has especially deep ridges along the chewing surfaces of his or her teeth. If the ridges are not deep, the sealant will not stay in place.

If the sealant becomes loose and traps plaque, the chance of cavities will be that much higher. A mere two minutes per tooth is all that is necessary for the sealant to harden in place. After hardening, the child consumes food without having the food contact the surface of the teeth. This powerful barrier minimizes the chances of childhood cavities.

2. Fluoride Treatments are Underrated Preventative Dentistry Treatments for Kids
The application of fluoride to teeth increases their strength. Fluoride bolsters enamel, making it that much easier to combat acid and bacteria that cause decay. Strong teeth are that much less likely to endure decay.

3. Teeth Cleanings
Your child’s teeth need a cleaning at least two times per year. This cleaning is necessary to eliminate plaque and tartar. It is challenging to remove plaque when flossing and brushing on one’s own at home, especially during the early years of life. There is a good chance plaque will stick between your youngster’s teeth. Only the pediatric dentist’s specialized tools will eliminate this plaque and prevent the formation of cavities.

4. Space Maintainers
Space maintainers are specialized dental appliances comprised of plastic or metal. These maintainers are fully customized to suit the nuances of your child’s mouth. Space maintainers are diminutive and perfectly comfortable. Your child will adjust to his or her space maintainer in a few days or less. The space maintainer holds the empty space open after a tooth is lost.

It keeps the remaining teeth perfectly steady to prevent movement until permanent teeth emerge. If you are hesitant to have a pediatric dentist apply a space maintainer, consider the fact that this approach is cheaper and more efficient than attempting to move teeth back to the proper positions with orthodontic treatment.

5. Mouth Guards
Most pediatric dentists recommend kids wear mouth guards. These protective devices can be made in the dental office to suit the distinct shape of your child’s mouth. Such guards are worn when playing sports to protect the teeth and gums against physical contact.

Space Maintainers

What are Space Maintainers?
Space maintainers are orthodontic appliances used in pediatric dentistry. The main function of these devices is to manage premature baby tooth loss. Maintainers also help prevent malocclusions (misalignment of teeth), overcrowding, and other orthodontic conditions.

If a child’s teeth are lost prematurely, space maintainers ensure permanent teeth do not erupt into the empty space. Tooth loss can be due to trauma, disease, overcrowding, or decay.
Causes for Treatment
Children may need space maintenance treatment if they have over-retained baby teeth, early childhood caries that result in tooth loss, or tooth loss that occurs due to trauma:

Early Tooth Loss or Extraction Due to Baby Tooth Decay
Baby teeth easily fall victim to tooth decay, which typically results in extractions. Cavities commonly form on a child’s molars because baby tooth enamel is more fragile than permanent teeth.

Even though baby teeth fall out, it is still crucial to take care of them. If one tooth becomes infected and isn’t treated quickly, the cavity-causing bacteria can spread to other teeth. If a child develops a cavity in his or her baby tooth, a dental restoration is necessary to prevent the spread of cavities, early tooth loss, overcrowding, and misalignment.

Restorative options for baby teeth include amalgam fillings, composite fillings, or stainless steel crowns. Although, if a tooth must be extracted due to severe decay, space maintainers are placed to prevent misalignment or overcrowding as permanent teeth grow in.

Over-Retained Baby Teeth
Space maintainers also prevent orthodontic issues associated with over-retained baby teeth. Over-retained teeth refer to baby teeth that have loosened but then tighten back into the gums, preventing the eruption of permanent teeth.

If the baby teeth are not extracted, dental crowding commonly develops, which is a condition that occurs when there is not enough space for teeth to grow in. Permanent teeth can also begin growing in over the over-retained baby teeth.

Tooth Loss Due to Trauma
Children commonly lose their baby front teeth, including the incisors and canines, prematurely to trauma or decay. During the early stages of life, children are still developing motor skills, so injuries affecting the front teeth in both the upper and lowers jaws are very common.

If your child loses a tooth prematurely due to trauma, space maintainers help prevent misalignment and overcrowding as adult (permanent) teeth grow in.

Types of Space Maintainers
Space maintaining appliances are separated into three categories, including fixed unilateral, fixed bilateral, and removable appliances:

Fixed Unilateral Appliances
Fixed unilateral appliances maintain space on just one side of the mouth. Common appliances include the band and loop maintainer and the distal shoe:

Band and Loop Space Maintainer
One of the most common fixed unilateral appliances is the band and loop space maintainer. They are positioned on one side of the mouth (unilateral). Band and loops maintain space after a child loses their primary (baby) first molars or after the permanent first molar erupts around age 6 or 7.

The appliance has a band that cements to the primary second molar. It also has a loop that contacts the distal surface of the primary canine. The band and loop can also maintain space after the premature loss of a primary second molar.

In order to place the band properly, the permanent first molar must erupt first. This appliance is inexpensive and easy to fabricate but requires upkeep to ensure space is maintained properly.

Distal Shoe
Another fixed unilateral appliance is the distal shoe. Similar to the band and loop, they sit on one side of the mouth (unilateral). Distal shoes maintain space after losing primary second molars and before the permanent first molar erupts around age 6 or 7.

The appliance has a stainless steel wire that extends over the unerupted permanent first molar to help guide it into place as it grows in. Distal shoes can only fit over a single tooth.

Fixed Bilateral Appliances
The second category of space maintainers includes fixed bilateral appliances. Bilateral space maintainers are placed after teeth are lost on both sides of the mouth. Common types include the transpalatal arch, lingual arch, and Nance arch.

Transpalatal Arch (TPA)
The transpalatal arch (TPA) is a bilateral appliance that maintains space after teeth in the upper jaw are missing on both sides. The TPA consists of a thin 36-mil palatal wire that extends above the palate (roof of the mouth) and connects the banded primary molars on both sides.

The appliance allows for the proper eruption of the permanent molars in the maxillary dental arch (upper jaw).

Lingual Holding Arch (Upper and Lower)
A lingual holding arch is a bilateral appliance that connects two primary molars in the upper or lower jaws. The appliance creates space in the mandibular (lower) or maxillary (upper) dental arch. This aids in the proper eruption of permanent molars.

Nance Arch (Upper Only)
The Nance arch incorporates an acrylic button that rests on the palatal rugae (roof of the mouth). The appliance can only sit in the upper dental arch because of this feature. The Nance arch prevents the misalignment of permanent molars and maintains overall dental arch length.

Removable Partial Dentures
Removable partial dentures maintain space after baby teeth are lost prematurely. The appliance is similar to the lingual arch but has artificial teeth attached to it.

Removable dentures are typically necessary if more than one tooth is missing on either side of the mouth. They may also be placed for esthetic reasons, rather than to prevent space loss, especially when anterior (front) teeth are missing.

After your child becomes an adult, they can keep using the partial denture or replace the device with dental implants.

Kids & Pediatric Root Canal Treatment

Root canal treatment is a safe and effective way to stop many kinds of tooth pain, and to keep a tooth from being lost due to decay or injury. But if a root canal is recommended for your young child, you may wonder why: Isn’t that baby tooth going to fall out in a few years anyway?

That’s true — the primary (baby) teeth typically are shed between the ages of 6 and 12 years. Yet there are some good reasons for trying to save baby teeth for as long as possible with root canal treatment, rather than simply extracting any that are damaged by trauma or infection.

For one, primary teeth have the same functions as adult teeth — and a missing tooth at any age can cause problems with speech and eating. Baby teeth also have another important role: They serve as guides for the proper placement of the permanent teeth. Without primary teeth to guide them in, permanent teeth tend to emerge in a crooked fashion, often becoming tilted or crowded because of inadequate space. This can result in bite problems that may require extensive orthodontic treatment later.

Saving The Tooth Is Always Best
Root canal treatment for children.
Unlike its hard outer surface, the soft pulp inside the tooth is rich in blood vessels and nerves. Problems in this area are often signaled by tooth sensitivity and pain. When we find these symptoms during an examination, we generally use radiographs (x-rays) to confirm that the pulp is diseased, or dying. That’s when we need to take action, before an abscess or further infection can develop.

In severe cases, the tooth may need to be removed, and a space maintainer installed to fill the gap. But many times, space maintainers don’t fully restore the tooth’s functionality. Plus, they are susceptible to coming loose and must be monitored constantly. If possible, we prefer to use treatment methods such as:

Indirect pulp treatment. If pulp damage is minimal, it’s possible to remove most of the decay (but not the pulp), apply an antibiotic, and then seal the tooth up again; that’s referred to as an “indirect” treatment.
Pulpotomy. Alternatively, if decay is limited to the upper portion of the pulp, we may recommend a “pulpotomy.” This involves removing the damaged part of the pulp, stabilizing the remaining healthy portion, and then disinfecting and sealing the tooth. This “partial” root canal is a time-tested technique that’s successful in many cases.
Pulpectomy. If pulp tissue is infected through the entire tooth structure, a pulpectomy may be needed. Here, we remove all pulp tissue, disinfect and shape the canals, then fill and seal them with inert material. Afterwards, the crown (visible part) of the tooth will be restored. This resembles traditional root canal therapy, with a crucial difference: The sealant we use in children is capable of being dissolved by the body. That way, when it’s time for a permanent tooth to erupt, the baby tooth’s roots can be naturally absorbed and tooth development can proceed normally.
Preparing for Your Child’s Root Canal Treatment
As you probably already know, most of the legends you may have heard about root canal therapy simply aren’t true. In fact, the procedure generally causes little discomfort, but is quite successful in relieving tooth pain! We are adept at using anesthesia to block the sensation of pain, and experienced in calming the fears of young ones. While it’s understandable that you may be nervous, it will help if you don’t let your child pick up on your own anxiety. A calming voice and a gentle touch can do much to relieve stress.

After a thorough examination, we will recommend the best options for your child’s treatment. The procedures are routinely done right here in our office. Afterwards, we will give you complete follow-up instructions, and schedule a return visit. A root canal is nothing to fear: Think of it as a treatment that may save your child from some tooth pain now, and potentially a lot of corrective dental work later on