Posts for category: Dental Procedures
While pediatric dentistry has made great strides in making young patients’ dental visit experiences more relaxing, some children and teenagers still have difficulty with anxiety. Their anxiety in turn can make necessary care much harder to provide.
For difficult cases, many dental providers for children now incorporate a technique known as conscious sedation to help ease anxiety. With this technique, they’re able to perform procedures like cavity-filling or tooth-extraction that are more difficult with an anxiety-prone patient.
While general anesthesia creates a total loss of consciousness, conscious sedation uses precise medications to suppress consciousness at different levels ranging from light to deep suppression, and create a relaxed state for the patient. A child under sedation can still breathe normally and respond to certain stimuli, including touch and verbal commands. For only a light or minimal effect, a dentist normally administers the sedation drug as a pill the child takes orally. For deeper sedation, the medication is most likely delivered through a vein (intravenously).
Sedation reduces fear and anxiety but not necessarily pain, so it’s often accompanied by some type of anesthesia, either a local anesthetic delivered by injection to the procedure site or with a nitrous oxide/oxygen gas combination that’s inhaled through a mask worn by the patient.
Even though the child isn’t completely unconscious, one of the dentist’s staff will monitor vital signs (heart and respiration rates, blood pressure and blood oxygen level) throughout the procedure. This continues even after the treatment is over until the child’s vital signs return to pre-sedation levels. Once released, they will need a ride home and should rest for the remainder of the day. They can then return to school and resume other normal activities the next day.
With the advent of newer and safer drugs, conscious sedation is becoming a more widespread technique in both medicine and dentistry. Using it to ease a child’s anxiety increases the chances they’ll receive all the dental care they need without unpleasant memories of their visit that could follow them into later life.
If you would like more information on the role of conscious sedation for children, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Sedation Dentistry for Kids.”
Have you heard about dental sealants? These preventive treatments have been available for many decades, and more and more children are taking advantage of them. The National Institutes of Health (NIH) estimates that around 30% of kids from 6 to 11 years of age have had sealants applied to their molars (back teeth). Sealants are designed to reduce the incidence of cavities by filling in or eliminating the pits or crevices found in all molars, where decay-causing bacteria can hide and your brush can't reach. But do they really work?
Now, the research is in, and the answer is clear — YES!
Two major studies, each of which reviewed the results of thousands of patients over several years, recently came to the same conclusion: Dental sealants are effective at reducing cavities, and their benefits can last for four years (or more) after application. In general, the studies showed that kids who didn't get sealants were twice, three times, or even more likely to get cavities, compared to kids treated with sealants.
Sealants themselves are protective coatings made of plastic resins or glass-like materials. They are applied in liquid form, and then hardened by a special light. When “painted on” to the chewing surface of a molar, sealants fill in the tiny crevices, or “pits and fissures,” that are found there. Uneven tooth surfaces form a perfect breeding ground for the bacteria that cause tooth decay; worse yet, the bristles of a tooth brush can't usually reach them. That's what makes these areas highly susceptible to tooth decay.
Applying sealants is a quick and painless procedure that doesn't require any numbing shots or drilling. Many kids start getting sealants when the first permanent molars come in, around age 5 to 7; they may have more sealant treatments when additional molars emerge, between the ages of 11 and 14.
Sealants are recommended by the American Dental Association and the American Academy of Pediatric Dentistry, and have only a modest cost per tooth. On the other hand, having a cavity filled generally costs substantially more, and may result in more trouble (and expense) down the line — so sealants can make sense economically, as well as preventively. This is especially true for those at high risk for tooth decay.
If you have questions about dental sealants, please contact us or schedule a consultation. You can read more in the Dear Doctor magazine article “Sealants for Children,” and “Top 10 Oral Health Tips for Children.”
When you think orthodontics, you may instantly picture braces or clear aligners worn by teenagers or adults. But there’s more to orthodontics than correcting fully developed malocclusions (poor bites). It’s also possible to intervene and potentially reduce a malocclusion’s future severity and cost well beforehand.
Known as interceptive orthodontics, these treatments help guide jaw growth in children while mouth structures are still developing and more pliable. But timing is critical: waiting until late childhood or puberty could be too late.
For example, we can influence an upper jaw developing too narrowly (which can cause erupting teeth to crowd each other) with an expander appliance placed in the roof of the mouth. The expander exerts slight, outward pressure on the upper jaw bones. Because the bones haven’t yet fused as they will later, the pressure maintains a gap between them that fills with additional bone that eventually widens the jaw.
Functional appliances like the Herbst appliance influence muscle and bone development in the jaws to eventually reshape and reposition them. The Herbst appliance utilizes a set of metal hinges connected to the top and bottom jaws; when the patient opens and closes their jaws the hinges encourage the lower jaw to move (and eventually grow) forward. If successful, it could help a patient avoid more invasive treatments like tooth extraction or jaw surgery.
Some interceptive objectives are quite simple in comparison like preserving the space created by a prematurely lost primary tooth. If a child loses a primary tooth before the incoming permanent tooth is ready to erupt, the nearby teeth can drift into the empty space. Without enough room, the permanent tooth could erupt out of position. We can hold the space with a simple loop device known as a space maintainer: usually made of acrylic or metal, the device fits between adjacent teeth and prevents them from drifting into the space until the permanent tooth is ready to come in.
Interceptive orthodontics can have a positive impact on your child’s jaw development, now and in the future. For these techniques to be effective, though, they must begin early, so be sure your child has a complete orthodontic evaluation beginning around age 7. You may be able to head off future bite problems before they happen.
When does dental care begin for a child? In the truest sense, before they're born. Although the first teeth won't erupt until months after birth, they're already forming in the baby's jaw while still in the womb.
During the prenatal period a baby's dental health depends on the mother's health and diet, especially consuming foods rich in calcium and other minerals and nutrients. Once the baby is born, the next dental milestone is the first appearance of primary teeth in the mouth. That's when you can begin brushing with just a smear of toothpaste on a toothbrush.
Perhaps, though, the most important step occurs around their first birthday. This is the recommended time for you to bring them to visit our office for the first time.
By then, many of their primary teeth have already come in. Even though they'll eventually lose these to make way for their permanent set, it's still important to take care of them. A primary tooth lost prematurely could cause the permanent tooth to come in improperly. Saving it by preventing and treating tooth decay with fluoride applications and sealants, fillings or even a modified root canal treatment could stop a bad bite and costly orthodontic treatment down the road.
Regular trips to the dentist benefit you as a caregiver as much as they do your child. We're your best source for information about dental health and development, including concerns like teething and thumb sucking. We'll also keep you informed on your child's growth process as their teeth, jaws and facial structure develop.
Beginning regular dental visits at age one will also help make your child comfortable with seeing the dentist, more readily than if you wait until they're older. It's an unfortunate fact that many people don't seek out the clinical dental care they need because of anxiety over visiting the dentist. Starting early, not only will your child be getting the best in dental care, they'll be developing a habit that can continue to benefit their oral health the rest of their lives.
If you would like more information on your child's dental care, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Age One Dental Visit.”
Protecting a child's primary (“baby”) teeth from tooth decay should be a top priority. If one is lost prematurely due to decay, it could cause the permanent tooth to misalign when it comes in.
The basic prevention strategy for every child is daily brushing and flossing and regular dental visits. But children at higher risk for decay may need more: Â additional fluoride applied to teeth enamel during office visits.
This natural mineral has been shown to strengthen enamel, teeth's protective layer against decay, especially during its early development. Enamel is composed of calcium and phosphate minerals interwoven to form a crystalline structure called hydroxyapatite. Fluoride joins with this structure and changes it to fluorapatite, which is more resistant to mouth acid than the original structure.
We mostly receive fluoride through fluoridated drinking water and dental care products like toothpaste. Topical fluoride takes it a step further with a stronger dose than found in either of these sources. It can be applied with a foam, varnish or gel using an isolation tray (foam or gel) or painted onto the enamel (varnish or gel).
But does topical fluoride effectively reduce the occurrence of decay? Research indicates yes: a recent review of 28 studies involving over 9,000 children found an average 28% reduction in decayed teeth in children who underwent topical fluoride treatments.
There is, though, one potential side effect: children who swallow the fluoride substance can become sick and experience headache, stomach pain or vomiting. This can be avoided with proper precautions when applying it; the American Dental Association also recommends using only varnish for children younger than 6 years. It's also recommended that children receiving gel or foam not eat or drink at least thirty minutes after the treatment (those who receive the varnish aren't restricted in this way).
Topical fluoride is most effective as part of an overall prevention strategy. Besides daily hygiene and regular dental visits, you can also help reduce your child's decay risk by limiting the amount of sugar in their diet. Sealants, which are applied to the nooks and grooves of teeth where plaque can build up, may also help.