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Children Dentistry

Sealants

Dental sealants act as a barrier to prevent cavities. They are a plastic material usually applied to the chewing surfaces of the back teeth (premolars and molars) where decay occurs most often.

Thorough brushing and flossing help remove food particles and plaque from smooth surfaces of teeth. But toothbrush bristles cannot reach all the way into the depressions and grooves to extract food and plaque. Sealants protect these vulnerable areas by “sealing out” plaque and food.

Sealants are easy for your dentist to apply. The sealant is painted onto the tooth enamel, where it bonds directly to the tooth and hardens. This plastic resin bonds into the depressions and grooves (pits and fissures) of the chewing surfaces of back teeth. The sealant acts as a barrier, protecting enamel from plaque and acids. As long as the sealant remains intact, the tooth surface will be protected from decay. Sealants hold up well under the force of normal chewing and may last several years before a reapplication is needed. During your regular dental visits, your dentist will check the condition of the sealants and reapply them when necessary.

The likelihood of developing pit and fissure decay begins early in life, so children and teenagers are obvious candidates. But adults can benefit from sealants as well.

Fluoride

Fluoride is often called nature’s cavity fighter and for good reason. Fluoride, a naturally-occurring mineral, helps prevent cavities in children and adults by making the outer surface of your teeth (enamel) more resistant to the acid attacks that cause tooth decay.

Before teeth break through the gums, the fluoride taken in from foods, beverages and dietary supplements makes tooth enamel (the hard surface of the tooth) stronger, making it easier to resist tooth decay. This provides what is called a “systemic” benefit.

After teeth erupt, fluoride helps rebuild (remineralize) weakened tooth enamel and reverses early signs of tooth decay. When you brush your teeth with fluoride toothpaste, or use other fluoride dental products, the fluoride is applied to the surface of your teeth. This provides what is called a “topical” benefit.In addition, the fluoride you take in from foods and beverages continues to provide a topical benefit because it becomes part of your saliva, constantly bathing the teeth with tiny amounts of fluoride that help rebuild weakened tooth enamel.

Air Abrasion

Air abrasion is a way to remove decay from a tooth without using a dental drill. It works like a sandblaster removing graffiti from walls. The air abrasion hand piece blows a powerful air stream of tiny aluminum oxide particles out of its tip onto the tooth. The tiny particles bounce off the tooth and blast the decay away.

Air abrasion is most commonly used to prepare teeth for composites, or “white fillings.” Air abrasion also helps to repair cracks and discolored teeth, to prepare teeth for bonding procedures, such as sealants, and for various other procedures. Air abrasion works well to repair chipped, fractured, or worn teeth; to prepare teeth for cosmetic surgery; remove stains and spots; repair old fillings and sealants; and repair broken crowns and bridges.

Your general dentist, who has been trained in restorative dentistry techniques, will perform any procedures that use air-abrasion technology. Ask your dentist if he or she uses air-abrasion equipment and if this technique is right for you.

Fillings

A filling is a way to restore a tooth damaged by decay back to its normal function and shape. When a dentist gives you a filling, he or she first removes the decayed tooth material, cleans the affected area, and then fills the cleaned out cavity with a filling material.

By closing off spaces where bacteria can enter, a filling also helps prevent further decay. Materials used for fillings include a composite resin (tooth-colored fillings), and an amalgam (an alloy of mercury, silver, copper, tin and sometimes zinc).

Pulpotomy

A pulpotomy is when the inflamed pulp chamber, usually on a baby molar, is removed, the area is sterilized, and the chamber is sealed. It is sometimes called a baby tooth root canal, but it’s not really a root canal and it can be done is some cases in permanent teeth. It is a very common procedure in children and has a reasonably good prognosis of success. It’s also fairly easy to do in conjunction with associated procedures.

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 is usually the “tooth ache” you feel. If the inflammation and infection continues without treatment, the tooth will likely eventually abscess. In baby molars, a pulpotomy is used in the process of trying to save and restore the tooth. First, the decay is removed, and then the pulp chamber (the top part, not the root canals) is removed usually with a high-speed bur or spoon excavator. A small cotton ball damp with formocresol is placed to “mummify” the pulp stumps and to sterilize the area. After a couple of minutes, the cotton ball is removed and the opening is sealed usually with a Zinc Oxide and Eugenol material like IRM. IRM is a putty like material that hardens up after a few minutes. After a pulpotomy on a baby molar, it is usually necessary to place a stainless steel crown to restore the tooth.

SSC crown

Stainless steel crowns are metal caps used by dental professionals to repair a decayed baby molar (back tooth) and prevent it decaying further.

They are made to fit the exact size and shape of a child’s molar, and are used to cap teeth with large or deep cavities.

Why use stainless steel crowns?
Stainless steel crowns are used as an alternative to silver and tooth-coloured fillings. These strong metal caps cover the entire tooth and are hard to lose or damage. They have a smooth polished surface which makes them easy to clean and most last four years or more.

Space maintenance

If your child’s tooth has come out too soon because of decay or an accident, it is important to maintain the space to prevent future space loss and dental problems when permanent teeth begin to come in. Without the use of a space maintainer, the teeth that surround the open space can shift, impeding the permanent tooth’s eruption. When that happens, the need for orthodontic treatment may become greater.

TYPES OF SPACE MAINTAINERS

Space maintainers can be made of stainless steel and/or plastic, and can be removable or fixed (cemented to the teeth).

Removable

A removable space maintainer looks much like a retainer with plastic blocks to fill in where the tooth is missing. If your child is older and can reliably follow directions, a removable space maintainer can be a good option.

Fixed

Fixed space maintainers come in many designs.A band-and-loop maintainer is made of stainless steel wire and held in place by a crown or band on the tooth adjacent to the empty space. The wire is attached to the crown or loop and rests against the side of the tooth on the other end of the space.

A lingual arch is used on the lower teeth when the back teeth on both sides of the jaw are lost. A wire is placed on the lingual (tongue) side of the arch and is attached to the tooth in front of the open space on both sides. This prevents the front teeth from shifting backwards into the gap.

In the case of a lost second primary molar prior to the eruption of the first permanent molar, a distal shoe may be recommended. Because the first permanent molar has not come in yet, there is no tooth to hold a band-and-loop space maintainer in place. A distal shoe appliance has a metal wire that is inserted slightly under the gum and will prevent the space from closing.

Sedation

sedation is an advanced technique for delivering sedative medication. It is highly adjustable, and extremely safe when administered by a properly trained professional.

Nitrous Oxide Sedation

Nitrous oxide sedation, commonly referred to as “laughing gas,” has been used by dentists and other physicians for more than a hundred years. This form of mild sedation allows patients to relax while breathing in a combination of nitrogen and oxygen through their nose. Based on patient response and vitals, dosage can be adjusted throughout the procedures for optimal comfort. Patients prefer nitrous oxide sedation because:

There’s no “hang over.” The effects diminish quickly and patients are able to return to their regular routine about 15 minutes after the procedure including driving to and from the office.
It helps reduce sensation for patients who have difficulty becoming numb using only local anesthesia.
The patient remains fully conscious able to speak with the dentist and team, but experiences significantly less anxiety.