Pediatric Dentistry

Instructions after a filling or extraction

Only liquids until the mouth and teeth wake up (about 1 ½-2 hrs), to prevent your child from biting their lips, cheeks or tongue. Ice cream is considered a liquid and is a great treat after an apt., especially since it has calcium. Do not let your child bite, pinch, or play with their lips, or tongue. If your child bites themselves, it will be very painful, may swell and get secondarily infected. You will usually notice this up to 24hrs after the appointment. Call the office, they may need an antibiotic prescribed if they get secondarily infected.

Extractions

Bite on gauze given for 20-30 minutes
Do not eat anything until the numbness wears off
Soft diet for a few days, ice cream, applesauce, pasta, yogurt are good choices
You should expect blood tinged saliva for next 24 hrs
If there is excessive bleeding please call the office for an evaluation
Give over the counter medication(what you normally give for fever) for pain when you get home
If resorbable sutures were placed they will dissolve in about a week
Do not drink through a straw, use a cup for 24 hrs
Do not spit for 24 hrs

Brush your teeth as normal but avoid the extraction area until it is feeling better.

Brushing and flossing instructions

Children do not develop the fine motor skills to do a good job brushing and flossing until age 6 or 7. That is why we recommend that the parent brush and floss the teeth for the child until this age. You should let your child brush by themselves first to learn how and then be sure to go over it. Teeth should be brushed twice a day in the morning after breakfast and the last thing right before bedtime. Bedtime is the most important because cavities are made at night. Flossing can be done once a day.

The scrubbing technique

Brush the teeth at the junction of the teeth and gum line - this is where all the food collects
Hold the bristles towards the teeth and gums
Move the brush back and forth vigorously with short strokes - just like when you clean anything else
Make sure you brush all the front, top, and inside surfaces of the teeth
Brush your tongue at the end - it has a lot of bacteria on it

Thumbsucking and pacifier Use

Thumb, finger sucking and pacifier use is a normal sucking reflex that infants use to help calm themselves. Children usually give up sucking habits by the age of three or four. If a child continues past the age when their adult teeth erupt, they may develop a malformed jaw condition called an anterior open bite, and it can affect speech. A child may need a habit breaker appliance and orthodontics to correct this.
Breaking the habit:

Wait till the time is right (low stress)- a child must be ready to give it up or therapy will fail
Motivate your child- show examples of what can happen to their teeth
Use a reward system- positive reinforcement and small incentives (punishment techniques usually backfire)

Tooth eruption

The baby teeth first to come into the mouth are the two bottom front teeth. You will notice this when your infant is about 6-8 months old. Next will follow the four upper front teeth and the rest will appear periodically in pairs along the sides of the jaw until your child is about 2 ½ years old. By 2 ½ years old your child will have all 20 baby teeth. Usually at around age 6 your child will start to get their permanent adult teeth. The 6 year adult molars, lower and upper front teeth will appear first. But some children will start to get their adult teeth as early as 5 years and as late as 8 years. It is important to bring your child in for regular dental check ups so that we can evaluate the eruption and catch any problems when they are easily corrected.

Some problems that can occur with tooth eruption that can be prevented are over-retained baby teeth causing the adult teeth to come in crooked. Over-retained baby teeth causing the adult teeth underneath to be impacted. Prematurely loosing baby teeth due to over-crowding. Adult teeth coming in crooked due to over-crowding, and congenitally missing teeth.

Baby bottle tooth decay

Early childhood caries is usually due to diet and poor oral hygiene. It became known as baby bottle decay because putting your child to sleep with a bottle or breast is a prime cause of it. It is usually seen in infants and children as young as 18 months old, and usually the four upper front teeth are affected and so broken down they need to be extracted. This is why we recommend brushing your child's teeth at least twice a day, once in the morning after breakfast and once in the evening, before bedtime. When your child goes to sleep we do not recommend anything but water in the bottle or sippy cup.

Mouth guards

Athletic mouth protectors are a must for any child participating in such sports as hockey, soccer, karate, football, basketball, baseball and skateboarding, as well as many other sports. They protect the teeth, lips, cheeks, tongue and jaw bones. Most injuries occur to the mouth and head area when a child is not wearing a mouth guard.

Choose a mouth guard that feels comfortable to your child. There are many options of mouth guards. Most guards are found in athletic stores. These vary in comfort, protection as well as cost. The least expensive tend to be the least effective in preventing injuries.

Customized mouth guards can be provided through our practice. They tend to be more expensive but are much more comfortable and shock absorbent. Remember your child's jaws are still growing so mouth guards should be replaced each season so that they fit well and offer the most protection.

Gum disease

Most Children with poor oral home care suffer from gingivitis. This is an infection of the gum tissues caused by poor brushing. It can cause the gums to be red, inflamed and to bleed easily. It is an infection which left alone can spread to the bone surrounding the teeth, causing tooth loss called periodontitis.

Most children who have gums which bleed when brushing stop brushing. Children who's gums bleed when brushing should actually be brushing more often and doing a better job. By brushing you are removing the bacteria which causes gingivitis, massaging and strengthening the gums, to toughen them up and keeping them healthy.

Some medical conditions in children can cause an exacerbation of gingivitis and periodontal disease such as puberty, poorly controlled diabetes, and Down's syndrome.

Adolescent oral care

There is evidence to suggest that gingivitis and periodontitis increases in the teenage years. This is due to a lack of motivation in brushing and flossing on the part of the teen. Children who have instilled in them a good oral home care routine from a very early age are more likely to have good oral hygiene during the teen years.

Be a good role model for your child during these years by brushing and flossing regularly yourself. Emphasize the importance of good oral hygiene by scheduling regular dental visits for your child. At these appointments we will review oral hygiene with your child. Studies have shown that children who receive regular dental visits are more motivated to practice good oral hygiene at home.

Orthodontics

As pediatric dentists we monitor the growth and development of your child's teeth and jaws, at every visit. We are trained to correct minor orthodontic problems which can prevent major orthodontic treatment in the future. When appropriate we recommend a referral to an orthodontist to address problems. Some problems a child might have are tooth crowding, jaw growth discrepancies, impacted adult teeth.

The results of orthodontic treatment can be dramatic- a beautiful smile, improved dental health, and self-esteem.

Sedation

Mild sedation

Nitrous Oxide(laughing gas) is an anti-anxiety medication, which you inhale through a nasal hood. It is best for an older child who wants to co-operate but is anxious and having a hard time. The child must be able to keep it on their nose and breathe through their nose. It does not put a child to sleep, but simply relaxes them. It also has pain relief (analgesic) properties, and helps to reduce the gag reflex for children with strong gag reflexes. Best of all it is one of the safest drugs, as soon as you turn it off it leaves your body in a few minutes.

Conscious sedation

Conscious sedation is also for children who are anxious. There are many different types of medicines that you can give orally 1 hour or so prior to the procedure. Sometimes it is used in conjunction with Nitrous Oxide. It works best on older children who want to cooperate but are finding it difficult, and need a little bit more sedation than Nitrous Oxide can offer. It does not put a child to sleep.

Deep sedation

Deep sedation is done in a hospital setting with a licensed anesthesiologist, or in a licensed Oral Surgeon's office for ambulatory surgery (such as for extractions). The child is given general anesthesia either through an IV or inhalational. This is usually done for an anxious child who needs multiple extractions, an extensive amount of treatment, or has medical issues that prevent them from being treated in a traditional dental clinic setting.