Our Pediatric Dentistry Services

Sometimes a child cannot safely be treated with laughing gas or conscious sedation. Technique sensitive dental procedures are difficult to complete on patients that are very young, combative, or have extensive treatment needs. Attempting this type of work without general anesthesia can be very dangerous and traumatizing for the patient. For these kids, we provide the option of general anesthesia. While many parents are nervous about the prospect of having their child asleep for the dental work, you can rest assured that modern techniques allow for an extremely safe anesthesia experience. With the correct provider, general anesthesia is a safe and effective option.

We always utilize a board-certified dental anesthesiologist trained to provide anesthesia services in the dental clinic. This requires a different skillset and preparation when compared to anesthesia provided in a hospital or surgery center. Modern monitoring devices and anesthesia delivery systems are utilized and each anesthetic approach is customized to the needs of each patient. Parents will generally be allowed to accompany their child to the surgical suite. They will be present with their little one as they fall asleep and reunited prior to waking up. The child is usually allowed to breathe anesthetic gases through a mask in order to fall asleep, though sometimes the anesthesiologist may recommend another form of induction. The child will be under the direct supervision of the anesthesiologist and nursing staff throughout their entire visit. A complete complement of emergency management medications and supplies are readily available to the surgical team throughout the course of the appointment. All anesthesia providers are current in Pediatric Advanced Life Support (PALS). If you have any questions about general anesthesia our providers will happily review all aspects of treatment with you.

Oral conscious sedation is a technique used to guide a child’s behavior during dental treatment. Oral medications are administered to the child prior to the appointment to help increase cooperation, reduce anxiety, and decrease the discomfort associated with dental procedures. The appropriate medication and dosage will be determined based on your child’s age, weight, cooperation level, and developmental status. Sedative medications cause most children to become relaxed and drowsy. Unlike general anesthesia or IV sedation, oral sedation is not intended to make the patient unconscious or unresponsive.

Who is a candidate for sedation?

• Patients that have a level of anxiety that prevents good coping skills
• Very young children who are unable to cope
• Patients who require extensive dental treatment
• Special needs children

Is sedation safe?

Sedation can be used safely and effectively when administered by a pediatric dentist who follows the sedation guidelines of the American Academy of Pediatric Dentistry. Your pediatric dentist will discuss sedation options and patient monitoring for the safety and comfort of your child.

Preparing your child for a sedation appointment:

• Do not allow your child to have solid food for at least 6 hours prior to their sedation appointment and only clear liquids for up to 4 hours before the appointment.
• It is necessary that you tell the doctor of any drugs that your child is currently taking (prescription medicines or herbal supplements or vitamins) and any drug reactions and/or change(s) in medical history.
• Please inform the office of any change in your child’s medical condition and/or health. If your child has a fever, ear infection or cold do not bring your child. If your child becomes ill, please contact the office to see if it is necessary to postpone the appointment. We will be more than happy to reschedule.
• Please dress your child in comfortable, loose-fitting clothing.
• Prior to arriving at the office, please make sure that your child has gone to the bathroom as not to interrupt the procedure.
• The child’s parent or legal guardian must remain at the office during the entire procedure.
• Please watch your child while the medication is taking effect. Keep your child in your lap or keep close to you. Do not let them run around the office as they could harm themselves.
• Your child may become excited at first and will act slightly drowsy as the medication begins to take effect.

Aftercare recommendations:

• Your child will need to be monitored very closely and will be drowsy. Keep your child away from areas of potential harm.
• If your child wants to sleep then place them on their side with their chin up.
• You will need to wake your child every hour and encourage them to have something to drink in order to prevent dehydration. In the beginning, it is best to give your child sips of clear liquids to prevent nausea. The first meal should be easily digestible and light.
• If your child vomits, to ensure that they do not inhale the vomit, help them bend over and turn their head to the side.
• Your child may have the tendency to bite/rub their lips, cheeks, and/or tongue after treatment because we use a local anesthetic to numb your child’s mouth during the procedure. Monitor your child carefully to prevent any injury to these areas.

If you have any questions or concerns, please call our office.

Commonly called “laughing gas,” is a breathable gas which is commonly used to relieve children’s pain and anxiety during dental procedures. It is a blend of two gases, oxygen and nitrous oxide, which is given through a small breathing mask placed over the child’s nose. The American Academy of Pediatric Dentistry recognizes this technique as safe, effective, and non-addictive. The mixed gas is easily inhaled with normal breathing and is quickly eliminated from the body. Your child remains fully conscious and maintains all protective reflexes.

A frenectomy (or frenotomy) is a procedure used to correct a congenital condition where the tongue frenum (the connective tissue between the tongue and the bottom of the mouth) or upper lip frenum (the connective tissue between the lip and the gum) is very tight. When the tongue frenum is too tight it is commonly called tongue tie (or ankyloglossia). When the lip frenum is too tight it is commonly called a lip tie. Both can cause restrictions of movement of the tongue or lip, preventing normal positioning during breastfeeding and/or speaking. A tight tongue or lip frenum may also be related to dental decay, spacing, other speech difficulties, and/or digestive problems.

Tongue or lip ties can cause difficulties with breastfeeding. Tongue and lip-ties are relatively common — they can affect anywhere from 5-10% of the population. Your lactation consultant, doula, and/or doctor will look at your baby’s tongue and/or lip to determine if they have a tie. If your baby has a tie and you are having pain with breastfeeding, your practitioner may refer you for an infant frenectomy. At your dental visit, the severity of the lip and/or tongue tie will be assessed. A frenectomy may help improve symptoms, decrease breastfeeding pain, and/or improve your infant’s latch.

How does a tight frenulum affect a baby’s ability to breastfeed?

In order to get milk from the breast, the baby must move his tongue in a wave motion to draw the nipple and areola into his/her mouth and then press them against the roof of his/her mouth. If the tongue is tied, the baby is unable to make the wave motion, he/she may instead compress the breast tissue which can cause nipple pain or damage. It is always good to be evaluated by a healthcare provider if you think your baby may have a tongue-tie.

How does a lip-tie affect a baby’s ability to breastfeed?

A lip-tie affects a baby’s ability to latch onto the breast and achieve a good seal because the movement of the upper lip is restricted. The baby’s upper lip is unable to flange and so only the nipple goes into the mouth. Therefore a lip-tie can also cause pain or nipple damage during breastfeeding.

Can you describe the frenectomy procedure? Is it painful for the baby?

The procedure is relatively painless. The baby is crying mostly because he is being held. The baby is put on the breast immediately following the procedure. Overall the procedure is simple and safe with a very small risk of infection. A lot of times the mother will notice an immediate improvement in the latch. The earlier the procedure is done, the less time it will take the baby to nurse effectively.

Why am I just hearing more about lip-ties and tongue-ties now?

In the past, doctors preferred the “wait and see approach”. Also, the rate of breastfeeding was not as high as it is now. The majority of babies used to be bottle feed.

What are the treatment options?

Traditional treatments for baby tongue-tie consists of “clipping and/or cutting” which then results in bleeding and a lot of undue stress to the parents. We work with lasers and are able to provide a laser frenectomy. This causes little or no bleeding, very little pain, and very little risk of infection. The healing is instantaneous for infants.

Dental crowns are sometimes referred to as “caps.” There are many types of dental crowns ranging from stainless steel (metal), partial metal and resin, ceramic /porcelain (white) crowns. Pediatric crowns are prefabricated full coverage restorations/caps cemented to the prepared tooth. The process for placing a crown involves preparing the tooth by removing the decay and shaping the tooth to allow room for a crown. The crown is then cemented to the existing prepared tooth. This does not affect the eruption of permanent teeth.

When is this indicated?

• A broken tooth from trauma – often a traumatic tooth injury will leave little remaining tooth structure and a crown is indicated to restore the tooth.
• Extensive decay on a tooth – if the decay on a tooth is extensive, a filling will not hold up and a crown may be indicated.

What are the benefits:

• Esthetics, promoting positive self- image
• Strength and Durability
• Biocompatibility with gum tissue
• No metal
• Maintenance of form and function of the teeth

Also called white fillings or composite fillings are restorations that mimic the natural appearance of tooth structure. In addition to restoring teeth that have been fractured or decayed, tooth-colored fillings may also be used cosmetically to change the size, color, and shape of teeth. Composites are a mixture of glass or quartz filler that provide good durability and resistance to possible fractures when daily moderate chewing pressures are used. They can be generally used on front teeth or molars.

Composites are “bonded” or adhered in a cavity. This allows the dentist to make a more conservative repair of the tooth, meaning less tooth structure is removed when the dentist prepares it. This may result in a smaller filling than that of a metal (amalgam) filling.

It generally takes longer to place a composite filling than it does for a metal filling. That’s because composite fillings require the tooth to be kept clean and dry while the cavity is being filled.

It is a process used to lighten or whiten your teeth by applying a product to them externally or internally and may be accomplished by using either professional or at-home modalities.

Advantages of in-office whitening or whitening products dispensed and monitored by a dental professional include:

• An initial examination to help identify causes of discoloration, help address concerns with treatment and manage post-op expectations
• Professional control and soft-tissue protection
• Patient compliance
• Rapid results

The AAPD recognizes that the desire for dental whitening in pediatric and adolescent patients has increased. A negative self-image due to discolored teeth can have serious consequences on adolescents and could be considered an indication for bleaching. Due to a difference in thickness of the enamel, primary teeth are commonly whiter than baby teeth; therefore, bleaching teeth when both primary and permanent teeth are present could result in a mismatched dental appearance. A pediatric dentist should be consulted prior to whitening.

Peroxide-containing whiteners or bleaching agents improve the appearance by changing the tooth’s intrinsic color. The professional-use products usually range from 10 percent carbamide peroxide (equivalent to about 3% hydrogen peroxide) to 38% carbamide peroxide (equivalent to 13% hydrogen peroxide). Carbamide peroxide is the most commonly used active ingredient in dentist-dispensed tooth-bleaching products for home-use. In-office bleaching products commonly require a protective barrier to protect the gums. Home-use bleaching products contain lower concentrations of hydrogen peroxide or carbamide peroxide.

Sealants are protective coatings placed on the biting surfaces of molar (primary and permanent) teeth to prevent cavities. Sealants act as a shield for the tooth protecting it from food, plaque, bacteria, and acids that in combination cause cavities. Research shows that sealants reduce the risk of cavity formation by ~80%. Investing in early prevention decreases future costs associated with fillings and/or crowns.

How long do sealants last?

In most cases, sealants last 2-3 years. Therefore, your child should be protected throughout this time. By avoiding biting hard objects and focusing on proper hygiene, sealants will last even longer. If, however, a sealant breaks down, it can be easily replaced.

Digital x-rays are performed quickly and safely to minimize radiation exposure. The amount of radiation delivered by contemporary equipment is extremely small. Depending on the child’s age, he/she can sit alone or on his/her parent’s lap. Digital x-rays require substantially less radiation than traditional x-rays and soft lead vests protect even further from radiation. The intra-oral sensors are smaller and rounded in comparison to the traditional films, thereby improving patient comfort. Furthermore, the sensors are directly connected to the computer by a fiber optic wire that allows the x-ray image to be captured immediately. The entire process is non-invasive, painless, and generally very quick.

What are the benefits of digital x-rays for kids?

• Less radiation than traditional x-rays
• Decreased time spent in obtaining x-rays
• Smaller and more comfortable intra-oral sensor (film)
• X-rays are digitized (high definition) and therefore can be enhanced, magnified, and transmitted electronically
• Provide a better chance of obtaining x-rays at an earlier age to prevent/diagnose cavities

How often should a child have dental X-rays?

In general, children need x-rays more often than adults. Their mouths grow and change rapidly, and they are more susceptible to tooth decay than adults. The American Academy of Pediatric Dentistry recommends x-ray examinations every six months to detect cavities developing between the teeth. However, the needs and tooth development of each child are different and may necessitate different frequencies for x-rays.

Fluoride is a compound that contains fluorine, a natural element. Small amounts of fluoride used on a frequent basis helps prevent tooth decay. In areas where fluoride does not occur naturally, it may be added to community water supplies. Research shows community water fluoridation has lowered decay rates by over 50%, which means that fewer children grow up with cavities. Fluoride can be found as an active ingredient in many dental products such as toothpaste, mouth rinses, gels, and varnish.
How does fluoride works?

Fluoride inhibits loss of minerals from tooth enamel and promotes remineralization (strengthens weak areas of enamel and initial stages of cavities). Fluoride also inhibits bacterial growth which prevents acid production of the bacteria that causes cavities. Risk for decay is further reduced when fluoride is used in combination with a healthy diet and proper dental hygiene.

Potential sources of fluoride:

• Too much fluoridated toothpaste at an early age
• The inappropriate use of fluoride supplements.
• Hidden sources of fluoride in the child’s diet.
• Excessive and inappropriate intake of fluoride supplements may also contribute to fluorosis.

Fluoride supplements including drops and tablets, as well as fluoride fortified vitamins should not be given to infants younger than six months of age. After that time, fluoride supplements should only be given to children upon the recommendation of your pediatrician or pediatric dentist and only after all of the sources of ingested fluoride have been accounted.

Certain foods contain high levels of fluoride, especially powdered concentrate infant formula, soy-based infant formula, infant dry cereals, creamed spinach, and infant chicken products. Please read the label or contact the manufacturer. Some beverages also contain high levels of fluoride, especially decaffeinated teas, white grape juices, and juice drinks manufactured in fluoridated cities.

Parents can take the following steps to decrease the risk of fluorosis in their children’s teeth:

• Place only a drop of children’s toothpaste on the brush when brushing, a smear layer (under 3 years old) or a pea-sized (3 years and older)
• Account for all of the sources of ingested fluoride before requesting fluoride supplements from your child’s physician or pediatric dentist.
• Avoid giving any fluoride-containing supplements to infants until they are at least 6 months old.
• Obtain fluoride level test results for your drinking water before giving fluoride supplements to your child (check with local water utilities).