Martha Ann Keels, DDS, PhD
Dylan S. Hamilton, DMD, MS
Erica A. Brecher, DMD, MS
Pediatric Dental Specialists
2711 N. Duke Street
Durham, NC 27704
A baby tooth usually stays in until a permanent tooth underneath pushes it out to take its place. Unfortunately, some children lose a baby tooth too soon. A tooth might be knocked out by trauma or removed due to dental disease. When a tooth is lost too early, we may recommend a space maintainer to prevent future space loss problems.
Baby teeth are important to your child’s present and future dental health! They encourage normal development of the jaw bones and muscles. They save space for permanent teeth and guide them into position. Remember some baby teeth are not replaced with adult teeth until a child is 12 or 14 years old!
Space maintainers hold open the empty space left by a lost tooth. They steady the remaining teeth and prevent movement until the permanent tooth takes its position in the jaw.
It is more affordable – and easier on your child – to keep the normal positions with a space maintainer than to later move them back in place by orthodontic treatment.
If a baby tooth is lost too soon, the teeth beside it may drift or tilt into the empty space. Teeth in the other jaw may move up or down to also fill the gap. When adjacent teeth shift into the empty space, there is no room for the future permanent tooth to erupt into. If left untreated, the condition may require extensive orthodontic treatment.
What special care do space maintainers need?
Our pediatric dentists have four rules for space maintainer care:
- Avoid sticky candy,
- Do not tug or push on the space maintainer with your fingers or tongue,
- Keep it clean with conscientious brushing, and
- Continue regular dental visits.
Posterior crossbite is a reverse bite in the back teeth on one or both sides of the mouth. Normally top teeth fit on the outside of the bottom teeth – in a crossbite, the opposite is true.
A posterior crossbite is usually the result of constriction of the top jaw. Constriction usually occurs from an active thumb habit, although there are many cases in which a cross bite is from an unknown origin.
The importance of correcting a crossbite ensures proper alignment and bite of the teeth. An incorrect bite can lead to wear spots, a crooked smile, and malocclusion. If not corrected the permanent teeth will also likely erupt into a cross bite.
Expansion of the upper jaw is needed to correct the crossbite. An appliance called a quad helix can slowly expand the upper jaw to correct the crossbite. Two bands with a small wire are fit on the back molars. This appliance is glued in and cannot be removed by the patient. Usually the crossbite is corrected in approximately 6-8 months with a 4-6 month retention time afterwards. There is no discomfort experienced during this expansion.
The purpose of the quad helix (QH) is to stimulate the upper teeth and jaw to grow wider. This creates more room for the permanent teeth and shapes the upper dental arch to more closely match the patient's lower dental arch.
The device is not removable and you will not need to adjust it. Since it fits behind the teeth, it is not very visible. Most patients require between 3 and 5 days to become accustomed to the QH device. After these days of initial adjustment, most patients forget that the appliance is in their mouth. As well, the first 3 to 5 days of wear usually result in some alteration in speech. If the patient will speak slowly, speech will become normal within 3 to 5 days. Although the QH works slowly and gently, some discomfort is to be expected. Ibuprofen (Advil), Tylenol or similar analgesics will be all that is necessary. It is an excellent idea to take the proper dose of medication before discomfort starts. Another point of information is that many patients have the habit of pressing their tongue against the QH wire. This will create a groove in the tongue. Although this is not harmful, it may make the tongue sore.
Patients must not play with the wire or pick at it. Hard or sticky candy such as Gummy Bears, Skittles, or Star Burst will bend the wire resulting in discomfort and added expense. Carrots, apples, steak, pizza, or similar foods, should be cut into small pieces before being chewed. Teeth should be brushed and flossed in the usual manner.
Remember, if you only wear the headgear 11 hours per day, then you're missing 3 hours each day. That means you’re losing 21 hours every week. At that rate, we'll never get your teeth corrected. Remember, patients who consistently get in their 14 hours everyday achieve excellent results in the shortest time.
If you get home from school at 4:00p.m and wear your headgear until 6:00p.m that's 2 hours. Put it back on at 7:00p.m and wear it all night until the next morning at 7:00a.m. Well, that's it- 14 hours. Getting more than 14 hours per day on the weekends will certainly help you reach your goal faster.
That depends on 4 factors:
1. How consistently you get that 14 hours
2. How much correction needs to be done
3. How fast your face is growing
4. What your individual treatment response is
your compliance of 14 hours every day. If you
can wear it to school (even if you get an additional 3 hours of wear at school in the morning) and get more than 14 hours 14 hours, you'll finish that much sooner. Average treatment time is 12-14 months of full time (14 hours per day) wear.
You'll change to wearing it during sleep only. This helps stabilize the results. Gradually, you'll decrease the amount of time you’re wearing it until you stop.
Patients must not play with the headgear. Hard, sticky, or brittle foods such as Jolly Ranchers Gummy Bears, Now or Laters, Skittles, Taffy, gum, eye Poppers or ice will loosen or destroy the molar bands that the headgear attaches to. This will result in discomfort and added expense. These types of foods and snacks must not be put in your child's mouth at all! Carrots, apples, steak, pizza, or similar foods should be cut into small pieces before being chewed. Teeth should be brushed and flossed in the usual manner.
If a band does come loose, carefully try to remove it from your tooth. Place the band in an envelope and bring it with you when you come to the office. If the band will not come off, but stays in place on the tooth, stop wearing the headgear, then call us for an appointment to re-cement the band. Please call us early in the day so that we can arrange for you to be seen. True emergency is when something is loose or broken and you can't fix it and can't eat. If something like that were to happen, call the office at 919-220-1416. Remember always bring your headgear to every appointment!
As a child grows and matures, many indications become apparent to we that your child’s teeth are not developing or growing into normal position and their biting relationships between upper and lower arch may need help to become aligned.
Interceptive orthodontic treatment (commonly referred to as Phase I) allows tooth movement during an early developmental time in your child’s life. Braces are attached only to a limited number of permanent teeth erupted (usually the incisors and the back permanent molars).
Benefits: minor preventive orthodontic procedures can often prevent major problems from developing later. Discomfort is reduced, and time and money are often saved.
Limitations: cost to the family and inconvenience are present early in a child’s life. Occasionally the results of the interceptive procedure cannot be predicted totally until it is accomplished. The risks are the same as for full orthodontic therapy, but to a lesser degree.
The costs are lower for Interceptive Orthodontics than for full orthodontics because the interceptive therapy is usually much less comprehensive. We will offer Interceptive Orthodontics to patients who meet the criteria, and then discuss fees based on the level of complexity of each individual case.
If the choice by the parent is non-treatment (or to wait), your child will eventually need full orthodontic treatment, which will cost more than interceptive care. The treatment will most likely be more difficult because early problems were not corrected or have not decreased in severity.
Care Of Orthodontic Appliances
We believe strongly in patient and parent education. It is the responsibility of the parents and the patient to know what is required for successful orthodontic treatment. We hope your child will have support, encouragement and supervision from home to be certain that our instructions are followed carefully.
1. Avoid hard foods such as ice, candy, popcorn, peanuts, corn on the cob and pizza crust. Fruits and vegetables, such as apples and carrots, should be cut into small pieces and chewed with back teeth. Biting into hard foods may bend wires, loosen bands or brackets. Damage to the braces will prolong treatment time.
2. Avoid sticky foods such as snickers bars, gummy bears or tootsie rolls. These foods can also bend wires, loosen bands and brackets.
3. Brush immediately after every meal and before bedtime. Orthodontic appliances make tooth brushing more difficult. Therefore, special attention to oral hygiene must be given to avoid Cavities and Gingivitis. We will demonstrate proper oral hygiene techniques after the placement of the appliances and reinforce these instructions at each appointment.
4. Floss the teeth at least once per day. The evening is usually the best time to floss because it takes ten to fifteen minutes to brush and floss thoroughly.
5. Rinse with a fluoride mouth rinse daily to reduce the risk of Cavities during orthodontic treatment. We suggest using ACT or any over-the-counter fluoride mouth rinse.
6. Maintain your six month check-ups. While we check the teeth at every orthodontic appointment, a thorough examination and cleaning is needed twice a year.
If the suggestions are followed routinely, your child's orthodontic treatment will proceed smoothly and will result in a pleasing smile and a healthy mouth. If you have any questions about the care of your child's orthodontic appliances, please do not hesitate to ask our doctors.
Congratulations, your teeth are finally out of jail. The retainers that you'll be receiving are designed to retain (or hold) your teeth in their finished position. Unless instructed otherwise, you must wear the retainers every night while sleeping. Always bring your retainers with you when you visit the office.
Hawley retainers are colored plastic and wire retainers. Unless instructed otherwise, you must wear these retainers every night while sleeping. If you spend the night at a friend’s house, it's best to leave your retainers at home. Not wearing them for 1 night is o.k. but skipping 3 nights in a row is not o.k. At first your retainers may feel tight against your teeth. After a few weeks of wear they'll loosen up. Unless your teeth are actually being moved with the retainers, they won't feel very tight. When the retainers are not in your mouth, keep them in the protective case given to you. Never wrap your retainers in a napkin, never put them in your pocket or purse without the protective case, and never put them on a lunch tray. Keep your retainers clean by brushing them daily with water and tooth paste or soap. Be careful. New retainers are very costly. Always bring your retainers with you when you visit the office.
Please be absolutely certain that these are picked-up at the office tomorrow and worn each and every night, 7 nights per week while sleeping. The patient does not need to be present to pick-up these retainers.
The retainer(s) you'll receive are clear, thin plastic and will cover all of your teeth. This type of retainer is called a vacuum formed retainer and it's very easy to slip these retainers over your teeth. If you are receiving upper and lower vacuum formed retainers, there's only one way that they'll fit. The top retainer will not fit on the bottom teeth.
The retainer should be cleaned with cool water and a toothbrush. The plastic is very heat sensitive. If it is placed in hot water or exposed to any high temperatures (like in a hot car) the plastic will melt and the retainer will be ruined. This will mean crooked teeth and added expense which will upset everybody.
When not in your mouth, be certain that your retainer is kept in its protective case. Never wrap retainers in a napkin or paper towel. If you go to spend the night with a friend, it's o.k. to not wear your retainers for 1 night. Skipping 3 nights in a row is a bad idea. Caution: if a dog gets the retainer it will be destroyed. This could lead to bad feelings about the dog and I'm sure you like your dog- so, let's keep it that way.
Always bring your retainers with you when you have an appointment.
If you have any questions you can reach us at 919-220-1416.
Athletic mouth protectors, or mouth guards, are made of soft plastic. We will take an impression of your child’s teeth and design a guard that will fit tightly and comfortably to your child’s upper teeth.
Mouth guards are top priority when participating in any sport. They protect not just the teeth but also the lips, cheeks, and tongue. They help protect children from such head neck injuries as concussions and jaw fractures. Increasingly, organized sports are requiring mouth guards to prevent injury to their athletes. Research shows that most oral injuries occur when athletes are not wearing mouth protection.
Our practice recommends that your child wear a mouth guard whenever you are in an activity where there is a risk of falls or head contact with other players or equipment. This includes baseball, basketball, soccer, hockey, skateboarding, roller blading, lacrosse, field hockey, and even gymnastics. Normally people would think that football and hockey are the sports that would propose the most danger to teeth, but in reality nearly half of sports-related mouth injuries occur in basketball and baseball.
Any mouth guard works better than no mouth guard! Choose one that is comfortable to wear for an extend length of time. If a mouth guard feels bulky or interferes with speech, it will be left in the bedroom or locker room to collect dust. You can buy mouth guards in sports stores that are preformed or boiled to fit. Different types and brands vary in terms of comfort, protection, and cost. Our office can make a customized mouth guard as well. This type of guard cost a little bit more, but is the most comfortable and provides the best protection against injuries. If there is ever a need for sports mouth guards ask us and we will advise the best type for you.
Helpful Pediatric Dentistry Info:
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Our mission is to provide the best comprehensive dental care for your infant, child and adolescent in a friendly, safe and state-of-the-art environment.
We want your child to develop a positive attitude toward dental health and learn the necessary skills to maintain a cavity-free smile for a lifetime.
As parents, we welcome you to stay with your child for all dental appointments. We encourage your involvement in your child’s dental care. We strive to educate you and your child about achieving and maintaining good oral health.
If a problem does develop, we will offer you all treatment options and work with you to determine the best treatment plan and most compassionate approach for your child.
We consider it a privilege to treat your child.
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