WHAT IF MY CHILD NEEDS BRACES?

The pediatric dentist is specially trained to intercept and treat malocclusions (bad bites) in children. Many malocclusions can be recognized in the 2-3 year old child. That is not to say that the malocclusion should be treated at that time, because the 2-3 year old child is rarely cooperative enough for orthodontic treatment to be undertaken. However, early orthodontic intervention can often reduce or eliminate more severe orthodontic problems later. At each visit the pediatric dentist should evaluate your child’s jaw growth and development to be sure they are developing normally. The pediatric dentist will be concerned about early tooth loss, the development of habits such as bruxism and digit sucking and their effect on growth and development. The pediatric dentist may recommend intervention to correct growth and developmental problems.

MY CHILD NEEDS AN EXTRACTION – WHAT IS THAT?

An extraction is the complete removal of a primary or permanent tooth. Extractions can be surgical or non-surgical depending on the difficulty of the extraction, the amount of tooth structure remaining, whether or not the tooth is impacted or erupted, and whether it has straight or curved roots. We do most extractions in our office believing that as a pediatric dental office we are best suited to remove/treat the teeth of children. However, difficult extractions may be referred to an Oral Surgeon (someone who specializes in difficult or surgical extractions). Although most extractions are atraumatic, we use nitrous oxide analgesia, local anesthesia and/or sedation dentistry to make sure your child’s experience is a pleasant as possible.

There are many reasons why your child might require an extraction. These include:

The tooth may be badly decayed and not be able to be saved,
The tooth may be abscessed (infected),
The tooth may be blocking the eruption of a permanent tooth,
The tooth may be ankylosed,
The tooth may be impacted,
Your orthodontist may request extractions for proper orthodontic treatment.

Depending upon the reason for the extraction and the age of your child, we may recommend the placement of a space maintainer.

WHAT IS A SPACE MAINTAINER?

When a child prematurely loses a primary tooth, teeth on either side of the lost tooth may drift or shift and cause a loss of space or other complications. A space maintainer is a dental appliance designed to hold the space of the lost tooth until such time as the permanent tooth replacing the lost tooth has erupted or until orthodontic treatment can be instituted. Space maintainers come in different sizes, shapes and materials.

HOW LONG WILL MY CHILD’S FILLINGS LAST?

We would like to tell you that your child’s fillings will last forever, or at least until they lose the tooth with the filing, but we cannot. Unfortunately nothing lasts forever and nothing that the dentist does is as good as the original undamaged tooth. Fillings replace tooth structures lost as a result of dental decay and help maintain tooth health, structure and function. But they are never as good as the original tooth. Here is a breakdown of our success rate with various dental materials.

Stainless steel crowns (SSC) – Stainless steel crowns are the restoration of choice for a child’s tooth that is badly decayed, broken down or has had root canal therapy (pulpotomy or pulpectomy). A SSC covers the entire crown of the tooth and protects the tooth from breakage. SSC’s are designed to last until the primary (baby) tooth is lost or, if placed on a permanent tooth, until the child has matured enough that a more permanent type of restoration (porcelain crown) can be placed. SSCs placed in our office generally last until your child loses the tooth that the stainless steel crown has been placed upon. Failure rates for stainless steel crowns are less than 1% per year, in Dr. Auerbach’s treatment experience.

Composite restorations (tooth colored or white fillings) – This is a tooth colored material bonded to the tooth after decay is removed. Composite is used for esthetic and restorative reasons. Composite has several components and is the material of choice for a front tooth or in a circumstance where esthetics may be a consideration. It may also be placed in posterior teeth. The newer composite materials are strong and resist wear, but not as well as normal tooth structure. The placement of composite is technique sensitive and therefore requires more chair time than amalgam restorations. Composites placed on posterior primary teeth will generally last 5 -7 years or until the primary tooth is lost. Those placed on anterior primary teeth undergo a higher failure rate but most will last until the primary tooth is lost. Composites placed on permanent teeth will generally last 5-7 years. In Dr. Auerbach’s treatment experience, composites fail at a 2-4% yearly rate.

Amalgams – this is the silver mercury based material used for over 150 years in dentistry. We do not do this type of restoration but the success rate for amalgam is at least as good as that for composites.

Composite faced/veneered anterior crowns – these are placed over the tooth and are comprised of stainless steel crowns having a facing or veneer of a composite type of material covering the front part of the tooth for increased esthetics. They are placed on anterior teeth. They require greater tooth removal than other types of anterior restorations and may require a root canal be completed as well. These have about a 25% failure rate per year wherein the facing or veneer/ shears off or the entire crown is lost.

Composite faced/veneered posterior crowns – these are tooth colored crowns placed on posterior teeth and have an approximately 100% failure rate per year wherein the composite facing/veneer will chip off leave the underlying stainless steel crown exposed. Due to the extremely high failure rate of this type of restoration we do not perform this procedure in our office.

Strip or resin anterior crowns – similar to composite faced crowns in that the entire tooth is covered by the restoration but in this type of restoration the entire crown is made of a composite material. There is no metal substrate. These can be placed on either anterior or posterior teeth. Those placed on posterior teeth have a very high failure rate approaching 100%. Those placed on anterior teeth are very esthetic but have approximately a 20% yearly failure rate. Additionally, as your child grows, the margin of the strip crown (that part of the crown at or just below the gum tissue) may start to show and/or flake off.

You can increase the longevity of your child’s restorations by following good oral hygiene and by eating a well balanced diet and by returning for periodic dental evaluations, cleanings and the administration of fluorides.

WHAT IS BONDING?

Bonding is a procedure where tooth colored material (composite) is used to esthetically treat a tooth. One of the more common uses of bonding is to close a gap between the front teeth or to repair a fracture on a front tooth.

WHAT IS A DENTAL CLEANING OR PROPHYLAXIS?

The buildup of plaque and calculus (tartar) on the teeth and in the mouth causes bad breath, cavities and gum (gingival) problems. While many can properly clean their teeth and prevent the buildup of these harmful materials, the pediatric patient often needs help in maintaining a clean mouth. The pediatric dentist will generally want to examine your child at least twice yearly for their “check-up”. Part of this check-up will include a dental cleaning (prophylaxis). During the prophylaxis your child’s teeth will be flossed and then cleaned with a special fluoride containing toothpaste and/or special hand instruments or an ultrasonic cleaner to remove all plaque and calculus. After this has been completed a fluoride gel or varnish may be applied. Oral hygiene instructions will be reviewed. This is all done in an effort to teach your child good oral hygiene habits and to reduce their incidence of decay.

WHAT IS A PULPOTOMY?

A pulpotomy is a partial root canal on a primary tooth. Both primary and permanent teeth are living (the “nerve”) with the nerve of the tooth extending from the root or roots of the tooth into the crown (the crown is that part of the tooth you see in the mouth). In a pulpotomy procedure the top part of the nerve of the tooth, that part in the crown of the tooth is removed. A pulpotomy is often required when decay and bacteria are very near to the nerve or when removal of the decay and bacteria causes the nerve of the tooth to be exposed. After removing that part of the nerve that is in the crown, a medication may be placed over the nerve stumps to protect the remaining nerve. With very few exceptions, any tooth that has had a pulpotomy done on it should be protected with crown. On posterior primary teeth a stainless steel crown is generally used. On occasion a pulpotomy may be performed on an incompletely formed permanent tooth in an attempt to allow the roots of the tooth to continue to form.

WHAT IS A PULPECTOMY?

A pulpectomy is the formal term for a complete root canal, whether done on a primary tooth or a permanent tooth. In a pulpectomy procedure, the complete nerve of the tooth is removed using small instruments called reamers or files. The canals of the teeth (where the nerve was in the root or roots of the tooth) are cleaned and a material is placed into the canals to prevent fluid or other material from entering the canal. Teeth having a pulpectomy performed on them should be protected with a crown. Primary teeth can have complete root canals done on them but the material placed into their canals should be resorbable so that as the root of the tooth is resorbed by the permanent tooth, the material is also resorbed.

WHAT IS TOOTH WHITENING OR BLEACHING?

Tooth bleaching or whitening is a process by which the color of a stained or discolored tooth is changed to a lighter, more esthetic shade. Bleaching or whitening requires the use of a mild acid that dissolves or bleaches some of the substrate of the tooth from the tooth. Over-the- counter whitening or bleaching products are safe and effective but are somewhat limited in the amount of whitening they can achieve. They are much less expensive than dental administered bleaching. In our office, if your child is unhappy with the color of their teeth we will generally recommend the use of an over-the-counter product to see if that product can help your child achieve the lightness desired. If the over-the-counter product is not effective we can make custom bleaching trays for your child to use.

WHAT IS A FRENECTOMY?

A frenum is a piece of tissue that connects the muscles of the lips and checks to the gums and tissues of the mouth. There are several frenums present in your child’s mouth, the most noticeable ones being the frenum that attaches between or near the upper front two teeth (the labial frenum) and the one that holds the tongue down to the floor of the mouth (the lingual frenum). Occasionally the frenums attach too high and cause gum rescession, spacing between teeth or a tongue tied situation. A frenectomy is a surgical procedure in which part or all of the problematic frenum is removed or repositioned in order to return a healthy situation to the mouth. The vast majority of frenums need no treatment and surgical treatment of a frenum done in a young individual may cause orthodontic problems later; however a severely tongue tied child should have their frenum released at the earliest age practical. To determine whether a lingual frenum need be treated you should determine whether the frenum is causing gum rescession or interferes with speech. If the frenum does not cause either of these two problems, in most cases, the frenum need not be surgically treated.

 

 

 

 

 

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