Read to learn more about Pediatric Dental Topics:

Preventive Dentistry

Will Preventive Dentistry benefit my child?

Yes! Your child will benefit from the preventive approach recommended for all children – effective brushing and flossing, moderate snacking and adequate fluoride intake.  Home care takes just a few minutes a day and prevents needless dental problems. Regular professional cleanings and fluoride treatments by our staff and doctors are also very beneficial.  In addition to regular cleanings, sealants on the biting surfaces of your child’s teeth are highly recommended to protect against decay because this area is where four out of five cavities occur in children.

Sealants

What are sealants?

Sealants protect the surfaces of teeth with  grooves and pits, especially the surfaces of back teeth where most cavities are found.  Made of shaded, tooth color plastic, sealants are applied to the teeth to help keep

them cavity-free.

How do sealants work?

Even if your child brushes his/her teeth and flosses carefully, it is difficult – sometimes impossible – to clean the tiny grooves and pits on certain teeth.  Toothbrush bristles are just too thick to reach into the pits and fissures.  Food and bacteria build up in these depressions placing your child in danger of decay.  Sealants “seal out” food and plaque reducing the risk of decay.

How long do sealants last?

Research shows that sealants can last for many years.  So, your child will be protected throughout the most cavity prone years.  If your child has good oral hygiene and does not chew on hard objects like ice cubes, crunchy candy or sticky foods, sealants will last even longer.

What is the treatment like?

Our doctors can apply a sealant quickly and comfortably!  It is only one visit.  We condition the tooth and then dry the tooth, paint the sealant on, then harden it with a blue light.  It’s that easy!

Which teeth should be sealed?

The teeth most at risk for decay - and therefore most in need of sealants – are the six- year molars and twelve-year molars.  But any tooth with groves or pits may benefit form the protection of sealants.

If my child has sealants, are brushing and flossing still important?

Absolutely!  Sealants are only one step in the protection against decay, therefore they aid in keeping your child cavity – free for a lifetime.  Brushing, flossing, and regular dental visits are essential to a bright healthy smile!

Fluoride

We are offering an improved method of decay prevention to our patients. We are using a varnish to apply fluoride to children's teeth. The fluoride varnish has a longer working time than the traditional  fluoride gels or foam applications.  To keep the varnish on the teeth for as long as possible:

** Avoid drinking or eating for ten minutes after placement of the varnish.

** Your child should eat a soft, nonabrasive diet for the rest of the day.

** Teeth should not be flossed and brushed until tomorrow morning, at which time a regular schedule of careful oral hygiene should be resumed.

What is enamel fluorosis?

A child may face the condition called enamel fluorosis if he or she gets too much fluoride during the years of tooth development (while they are growing in the jawbones).  Too much fluoride can result in defects in the tooth enamel.  It is shown as white, yellow or brown splotches, streaks or lines, usually on the front teeth.

Why is enamel fluorosis a concern?

In severe cases of enamel fluorosis, the appearance of the teeth are marred by discolorations or brown markings.  The enamel may be pitted, rough, and hard to clean therefore setting those teeth up for increased risk of decay.  In mild cases of fluorosis the tiny white specks or streaks are often unnoticeable.

How does a child get enamel fluorosis?

By swallowing too much fluoride for the child’s size and weight during the years of tooth development (while they are growing in the jawbones).

This can happen in different ways:

• A child may take more of a fluoride supplement than the optimum amount they need (sometimes pediatricians do not take a thorough fluoride history and over prescribe supplements!).

• The child may take a fluoride supplement when there is already an optimal amount of fluoride in their drinking water.

• Some children simply like the taste of fluoridated toothpaste. They may use too much toothpaste, and then swallow it instead of spitting it out.

Please monitor your child’s use of fluoridated toothpaste.  For children ages 6 months to 3 use a grain of rice size of toothpaste. Beginning at age 3, use a pea-size amount of toothpaste applied to the toothbrush.

Should I avoid fluorides all together for my child?

NO! Fluoride prevents tooth decay.  It is an important part of helping your child to have a healthy smile for a lifetime.  Getting enough – but not too much – fluoride can be accomplished with the help of our practice.

Can enamel fluorosis be treated?

Once fluoride is part of the tooth enamel, it can not be taken out.  But the appearance of the teeth affected by the fluorosis can be greatly improved by a variety of treatments that our practice offers from bleaching to white fillings.  If your child suffers from severe fluorosis, our practice will educate you and your child about the various techniques and choose the best procedure to help enhance your child’s smile and their self-confidence.

Questions About General Anesthesia

Who should receive general anesthesia?

Children with severe anxiety and /or the inability to relax are candidates for anesthesia.  Usually, these children are young or have compromised health issues, helping them control their anxiety is not possible using

other methods.

Is general anesthesia safe?

YES! In addition, to ensure the best possible care of your child, the pediatric dentists request that all of their general anesthesia cases be covered by pediatric medical anesthesiologist.  The anesthesiologist is the doctor who is responsible for delivering the general anesthesia, monitoring and medical care of your child while he/she is unconscious.  Many precautions are taken to provide safety for the child during general anesthesia by anesthesia personal who are highly trained to manage complications.  We will discuss the benefits and risks involved with general anesthesia and why it is recommended for your child’s treatment.

What special considerations are associated with the general anesthesia appointment?

Most of the time, your child’s surgery will be done on an “outpatient” basis.  This means they will have their surgery in the morning and be allowed to go home in the afternoon.

 Physical examination- The doctors will advise you about any evaluation appointments that may be requested.

Prior to surgery –Minimal discussion to your child about the appointment will reduce the anxiety. Explain they are “going to go to sleep and when they wake up their teeth will be fixed.”

EATING AND DRINKING - It is IMPORTANT NOT to have a meal or snack past 12:00am before anesthesia. You will be informed about food and fluid intake guidelines at the time of the pre- op appointment.

Changes in your child’s health – If your child is sick or running a fever the day or night before the actually surgery appointment PLEASE CALL OUR OFFICE IMMEDIATELY! It may be necessary to arrange another appointment.

Usually, children are tired following general anesthesia. You may wish to return home with minimal activity planned for the remainder of the day.  The next day can return to their normal everyday routine.

Crowns - White and Stainless Steel

Please avoid sticky candy (i.e.,Skittles, Starburst, Gummies, etc.) as repeated chewing on sticky candy may loosen the cement that is holding the crown on the tooth.

If the silver crown comes off, then the tooth will have to be anesthetized (numbing shot) in order to place a new crown. We would like to avoid this if at all possible. If the crown should come off, then please save it and call our office as soon as possible.

Nerve Treatments- pulp treatments (pulpotomy)

If the nerve is infected, baby teeth respond well to the removal of a diseased part of the dental pulp while leaving the healthy portion intact.  The cavity is removed from the tooth in addition to the portion of the pulp that has been infected by the bacterial growth from the cavity.  A disinfectant is placed on top of the remaining pulp, the tooth is sealed and a crown (white or silver cap) is placed over the tooth.  This allows the tooth to stay vital (alive) within the mouth.

What are the advantages and disadvantages of pulpotomies?

The obvious benefit is that the tooth is maintained in service and holds the space for the developing permanent tooth below it.  The disadvantages are the teeth that have had nerve treatments are likely to require a crown (white or silver cap) to be placed on the tooth to provide adequate strength.  Occasionally, the bacterium invades the nerve completely and the pulpotomy fails and the tooth must be removed, but the risk is low.

Are there alternatives?

Alternatives include removal of the tooth (with the diseased nerve) and the placement of a space maintainer, which will hold space for the permanent tooth to erupt between ages 10 – 12 years old.

What is the result of no treatment?

Usually the patient will experience continued and increased pain and infection and also the risk of damage to the underlying permanent tooth below the infectious (baby) tooth. Ignored nerve infection will usually result in an abscess and require removal

of the tooth.

Bruxism

Dental Manifestations:

- Grinding of baby teeth or adult teeth

- Usually occurs at night

- Results in mild to severe wear of front and back teeth

- Very common in young children with baby teeth

- Usually decreases by age 7-8 years old and is eliminated
after the eruption of the permanent teeth  at 12 years.

What happens in severe cases?

1. You can develop tooth sensitivity once the enamel covering is gone-uncommon in baby teeth.

2. The nerve can be exposed- OUCH! May require extraction.

Suggested Treatment

- Young children up to 8 years old usually require no treatment. Parents may have to purchase earplugs!

- Older children may require a mouth guard at night to protect their permanent teeth.

- Our doctors will monitor your child's occlusal wear and recommend any treatment if needed.

Eruption Chart - When Teeth Come In

Children’s teeth begin forming before birth. As early as 4 months, the first primary (or baby) teeth to erupt through the gums are the lower central incisors, followed closely by the upper central incisors. Although all 20 primary teeth usually appear by age 3, the pace and order of their eruption varies.

Permanent teeth begin appearing around age 6, starting with the first molars and lower central incisors. This process continues until approximately age 21.

Adults have 28 permanent teeth, or up to 32 including the third molars (or wisdom teeth).

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Dental Habits- THUMB, FINGER AND PACIFIER HABITS

Are these habits bad for the teeth and jaws?

Most children stop sucking on thumbs, pacifiers, and other objects on their own normally between the ages of two or three years old, and in most cases no harm is done to their teeth or jaws.  However the children who repeatedly suck on their fingers, pacifier or other objects over a long period of time tend to make their upper front teeth tip outward toward their top lip and in some case make their adult teeth not erupt properly.

When should I worry about a sucking habit?

We will carefully watch the way your child’s teeth come in and how the jaws are developing with the sucking habit in mind at all times.  For most children there is no need to worry about the sucking habit until their permanent front teeth are ready to come in, but the habit should be gently discouraged by the age of four. Positive reinforcement and rewarding for not sucking is one of the most successful techniques for habit cessation.

What can I do to stop my child’s habit?

Most children stop sucking habits on their own, but some children need the help of their parents.  When your child is old enough to understand the possible results of the habit, we will begin to encourage your child to stop, as well as talk about what happens to the teeth if your child does not stop.  This advice, coupled with support of their parents, helps most children quit.

Are pacifiers a safer habit for the teeth than thumbs or fingers?

Thumb, finger and pacifier sucking all affect the teeth essentially the same way however, a pacifier habit is often easier to break.

Dental Care For Your Special Needs Child

Do special needs children have unique dental needs?

Most do.  Our practice has found that some special needs children are more susceptible to tooth decay, gum disease; oral trauma and heavy tartar build up.  Others require medication or diets that are detrimental to good dental health.  Still other children have physical difficulty with effective dental habits at home.  The good news is that poor dental health is preventable if dental care is started early and followed conscientiously, every child can enjoy a beautiful healthy smile.

How can I prevent dental problems for my special needs child?

A first dental visit by the first birthday will start you child on a lifetime of good dental health.  We will take a full medical history, gently examine you’re your child’s teeth and gums, and then plan preventive care designed for your child’s needs.

Are your doctors and staff prepared to care for special needs children?

Absolutely!  Dr. Keels has 3 years of advanced training beyond dental school and their education has a specialized focus on care for children with special needs. In addition, our office is universally designed to assist children and parents who may have additional needs.

Will my child need special care during dental treatment?

Some children need more support than a gentle, caring manner to feel comfortable during treatment.  Protective stabilization or mild sedation may benefit your child.  If your child needs extensive dental treatment, we may suggest providing care in the hospital under general anesthesia.  Our pediatric dentists have comprehensive education in behavior management and anesthesia techniques.  All of our doctors have Pediatric Advanced Life-Saving (PALS) certification and speciality licensure from the North Carolina Dental State Board to provide sedation for children. They will select a technique based on the specific health of your child, and then discuss the benefits, limits, and risks.

GE Reflux (Gastroesophageal Reflux Nickname “GERD”)

Dental Manifestations

- Enamel erosion from the stomach acid washing over the teeth

- Tooth sensitivity can develop once the enamel covering is gone*

- Acid reflux can make untreated cavities worse

- In severe cases the nerve can be exposed * OUCH!

What can I do to slow down or stop the GE Reflux?

Suggest dietary changes to help reduce  acid erosion

- Avoid sour candies (skittles, gummies, war heads, nerds, etc)

- Avoid fried foods and acid drinks (Orange juice with pulp)

- Avoid over eating (super sizing)

- Don not lay down for 2 hours after eating

- Place a 2x4 under the head of the bed

Your Pediatrician may recommend

- Zantac, Prilosec, Prevacid or Reglan Referral to a Pediatric GI Specialist

What are the long-term effects?

- If untreated, GE Reflux can cause irreversible loss of tooth structure

What are the long-term medical risks?

- If untreated, GE reflux can predispose you to esophageal (throat) problems in adulthood