Pediatric Dentistry

Dental sealants are specially designed materials which are used to protect children's teeth from cavities. Brushing and flossing alone may not be sufficient to clean up the grooves and fissures of a child's molar teeth. Children, on average, do not have the appropriate ability to sufficiently brush and floss their own teeth until around age seven (7). It is recommended that parents continue helping children brush until they are capable of properly doing it themselves. Just because they're brushing doesn't mean they're brushing well enough to prevent dental cavities. This is where sealants and routine dental checkups become important for children. Dental sealants are basically flowable plastic seals which are placed onto the back teeth to protect them from dental cavities or caries. Dentists, hygienists, or dental assistants normally perform this task during the child's routine dental visit. The teeth are thoroughly cleaned before the application of sealants. Sealants help protect the tooth by inhibiting bacterial growth and providing a smooth surface. The resultant smooth surfaces are much easier to clean and, in turn, decreases the chances for debris to accumulate in the pits and grooves which could then cause cavities. With proper home care and the help of dental sealants, parents can ensure that the child is free from dental decay. The best part is there are no “shots” needed to place sealants!

Space maintainers are custom made appliances for your child's mouth which are used to maintain the space needed for the permanent tooth when it is time for it to come in. Space maintainers hold the empty space left by a prematurely lost tooth by preventing movement, or “shifting,” of the remaining teeth until the permanent tooth takes its natural position in the child's mouth. This treatment is much more affordable and much easier on your child than to move them back later with braces. This does not guarantee that braces can be totally avoided, but it significantly improves the odds for at least the area of the missing tooth in particular. Remember, the permanent or “adult” teeth are larger than the baby teeth so any loss of space can significantly impact the entire side of the mouth where the baby tooth came out too soon.

Why are they important to children's dental care?

Baby teeth usually stay in place until they are "pushed out" by a permanent tooth that takes its place. Unfortunately, some children lose baby teeth too early. A tooth may be knocked out accidentally or removed due to severe dental decay. When this occurs, a space maintainer may be required to help prevent future dental problems. Space maintainers encourage normal development of the jaw bones and muscles, save space for the larger permanent teeth, and help guide them into position.

How can losing a baby tooth too early cause problems for permanent teeth?

Teeth attempt to "fill" any space available to them. If your child loses a baby tooth to early, the remaining baby teeth may tilt, drift, shift, move up or down in order to fill the gap. Adult teeth will do the same thing. When this happens, they fill the space intended for the larger permanent tooth. The permanent tooth can come in crowded, crooked, behind or in front of the other teeth, or it can be completely blocked from coming in at all. This condition, if left untreated, may require extensive and expensive orthodontic treatment which may include braces or even surgery to correct the issue all caused by the premature loss of a baby tooth.

Do space maintainers require any special care?

Yes, they do, and you as a parent can help. Make sure your child avoids hard or sticky foods such as chewing gum, suckers, caramels, popcorn, etc. Teeth should be brushed after each meal, making sure to clean the teeth with bands especially well. Once a day, a fluoride mouthwash should be used to help prevent decalcification of the teeth around the band . Do not try to bend the wire for any reason. Notify our office immediately if the bands come loose or the space maintainer is damaged in any way. If the permanent tooth begins to erupt under the wire, this also needs to be checked because it could be time to remove the space maintainer.

Dental fillings can help restore decayed tooth in children. Remember, a child's “baby teeth” are very important and should not be dismissed. They hold the space for the permanent teeth which are already developing below them. Infections from baby teeth can damage the permanent tooth! If a baby tooth is lost, space maintainers are almost always recommended. Studies show that one of the most common causes of children missing school is due to dental toothaches, and this could almost always have been prevented!

The process of filling a baby tooth typically requires local anesthetic although not always. It may be appropriate to use nitrous oxide or oral sedation to complete the work. Sometimes a referral to a pediatric dentist is required.

Primary, or “baby,” teeth of children should be protected when they are damaged from injury or severely decayed. Sometimes this requires the use of stainless steel crowns. The primary molars are the most commonly protected teeth using stainless steel crowns. Unlike crowns for adult teeth, the placement of stainless steel crowns in children usually happens in a single visit. Local anesthesia is used during the process. It may be necessary to use nitrous oxide or even oral sedation to complete the treatment. Occasionally a referral to a pediatric dentist is required. First the tooth decay is removed and the tooth is prepped to hold the crown. Finally the stainless steel crown is adjusted and then cemented into place. Many times the decayed tooth will also need a pulpotomy prior to fitting and placing the stainless steel crown. A pulpotomy is basically a “baby root canal” that is completed in just a few minutes.

Fluoride is used as a preventive treatment against dental decay and is especially useful for children. Together with dental sealants and routine dental checkups, fluoride treatment can help protect children from tooth decay. Studies show up to a 95% reduction in early childhood caries with the use of fluoride prevention. Fluoride treatment involves the professional application of prescription strength fluoride at the dental office. Highly concentrated fluoride varnish is the commonly used agents and provides the greatest amount of protection. Apart from professional treatment, fluoridated water is also a major source which can help avoid dental caries in children. Almost all cities and towns in the United States use fluoridated water.

What is fluoride?

The fluoride ion comes from the element fluorine. Fluoride, either applied topically to erupted teeth, or ingested orally during tooth development helps to prevent tooth decay, strengthen tooth enamel, and reduce the harmful effects of plaque. Fluoride also makes the entire tooth structure more resistant to decay and promotes remineralization which aids in repairing early decay before the damage is even visible.

Where is fluoride found?

Topical fluoride is found in products containing strong concentrations of fluoride and are usually distributed via health professionals. Fluoride may also be found over the counter in toothpastes and mouth rinses. Concentrated fluoridate varnishes and/or gels are either topically applied by a dentist or other oral health professional. Fluoride may also be prescribed as an at-home regimen particularly for persons with a high risk of dental caries or those without fluoridated water. Fluoride is present naturally in low concentration in most drinking water supplies and foods even if it has not be supplemented to higher concentration levels. Fresh water supplies generally contain between 0.01–0.3 ppm. In some locations, the fresh water contains dangerously high levels of fluoride, leading to serious health problems. In addition, all tea leaves contain fluoride; however, mature leaves contain as much as 10 to 20 times the fluoride levels of young leaves from the same plant.

Systemic fluoride may be ingested through public and private water supplies as a dietary supplement. Some bottled water supplies may contain fluoride as well. Make sure to check the label. Once ingested, systemic fluoride is absorbed via the gastrointestinal tract then distributed and deposited throughout the body via the blood supply.

What health risks are associated with fluoride uses?

In general, fluoride consumption is safe. Health risks associated with fluoridation are almost always due to misuse and over concentration. To avoid misuse and over concentration, avoid consuming overly fluoridated substances as this may cause teeth to become discolored, and may cause the enamel of the teeth to look spotted, pitted, or stained—a condition known as dental fluorosis. Avoid swallowing toothpaste and other dental hygiene products such as fluoride mouthwashes. Call the local water department and/or the health department to evaluate the fluoride level in your local drinking reservoir if you have concerns. Children are especially vulnerable to dental fluorosis as their developing teeth are more sensitive to higher fluoride levels. Consult a pediatric dentist or other oral health care professional if you notice changes in the condition of your child's teeth.

Plaque removal is absolutely necessary to prevent tooth decay in children. Research has shown that routine home maintenance of oral hygiene is not sufficient to remove bacterial plaque from the oral cavity of children. Therefore, a professional dental cleaning on a consistent schedule is recommended for children. Children, on average, do not have the ability to sufficiently brush and floss their own teeth until around age seven (7). It is recommended that parents continue helping children brush until they are capable of properly doing it themselves. Just because they're brushing doesn't mean they're brushing well enough to prevent dental cavities.

A pulpotomy is when the inflamed tissues inside the pulp chamber, or "nerve," is removed due to decay that is too large to place a simple filling. The area is sterilized, and the chamber is sealed. It is sometimes called a “baby tooth root canal” because it is usually performed on "baby teeth." It is a very common procedure and has a reasonably high success rate. It is fairly quick and easy to do in conjunction with other procedures. Sometimes nitrous oxide, oral sedation, or a referral to a pediatric dentist may be necessary to complete this procedure.

When a cavity gets really deep, close to the pulp of a tooth, or even into the pulp, the pulpal tissue becomes irritated and inflamed. This will usually cause a toothache. If the inflammation and infection continues without treatment, the tooth will most likely develop into an abscess. In baby molars, a pulpotomy is used in the hopes of trying to save and restore the tooth. First, the outer layers of decay are removed, and then the infected tissue of the pulp chamber is cleaned out. A small amount of medicine is placed inside to cover the pulp stumps and to sterilize the area. After the inside area is cleaned and sterilized, a large filling is placed to seal the tooth and to recreate the shape of the tooth. After a pulpotomy on a baby molar, it is usually necessary to place a stainless steel crown to restore the tooth since the tooth will now be more brittle and susceptible to fracture.

Pulpotomies have a reasonably good prognosis. It may buy some time which helps maintain the space needed for the developing permanent tooth, but it cannot save an already abscessed tooth. It is often surprising at how a seemingly small cavity can be deep enough to reach the pulp in baby teeth. This is often due to the varied anatomy of baby teeth and the rapid progression of decay. Although a very reliable procedure, a tooth with a pulpotomy may continue to have complications and need to be extracted. This is usually due to the remaining pulpal tissue in the root canals becoming necrotic and creating an abscess. This is why it is important to catch cavities early in baby teeth and even more important when considering a pulpotomy for a decayed baby tooth. Time is of the essence!

Remember, baby teeth are important. See our other links regarding space maintainers for more information regarding the premature loss of baby teeth.