DENTAL EMERGENCIES

We have a pediatric dentist on call at all times for consultation regarding dental emergencies. Call the office at 215-855-4092 or click on Dental Emergencies.

Braces

It is never too early to keep an eye on your child’s oral development. Your child’s pediatric orthodontist can identify malocclusion, crowded or crooked teeth or bite problems, and actively intervene to guide the teeth as they emerge in the mouth. Early orthodontic treatment can prevent more extensive treatment later.

Malocclusion is often inherited. Orthodontic problems also are caused by dental injuries, the early loss of primary teeth or such habits as thumb sucking, fingernail biting or lip biting. The orthodontist may be able to help your child avoid oral habits that could create orthodontic problems.

Early orthodontics can enhance your child’s smile, but the benefits far surpass appearance. Pediatric orthodontics can straighten crooked teeth, guide erupting teeth into position, correct bite problems, and even prevent the need for tooth extractions. Straight teeth are easier to keep clean and less susceptible to tooth decay and gum disease.

Different orthodontic appliances work in different ways to benefit your child’s dental health. Some are fixed; others are removable. Your pediatric orthodontist will explain which appliance is best for your child, what the treatment can do and how long it will take.

As with any dental treatment, the more a child cooperates, the better the results. First, careful brushing and flossing keep the appliance and your child’s oral health in top shape (removable appliances should be brushed each time the teeth are brushed). Second, regular dental check-ups, besides orthodontic appointments, protect your child from tooth decay and gum disease. (It is sometimes beneficial to increase the frequency of dental cleanings). Third, prompt contact with your pediatric orthodontist when an appliance breaks will keep orthodontic treatment on-time and on-track.

Your child will be able to eat a normal diet except for sticky foods like gums and caramels, and hard foods like peanuts, ice chips and popcorn. Some appliances alter speech, but most children adapt quickly and speak clearly within a day or two. Generally, children can safely run, jump, swim and play with an orthodontic appliance. However, these activities should be reviewed with the orthodontist.

Bleaching – Zoom!® Tooth Whitening System

We recognize that the desire for dental whitening among teenage patients has increased. A negative self-image due to a discolored tooth or teeth can have serious consequences on adolescents and could be considered an appropriate indication for bleaching.

Dental Whitening may be accomplished by using either professional or at-home bleaching modalities. The advantages of the Zoom!® Tooth Whitening System include:

• An initial professional examination to help identify the causes of discoloration and any clinical concerns with treatment;
• Professional control including soft tissue protection;
• Better patient compliance;
• A decreased incidence of sensitivity; and
• Rapid and stable results.

A whiter, brighter smile is beautiful – it can help a person feel better about themselves and make a memorable impression.

The more common side effects associated with bleaching vital teeth are tooth sensitivity and soft tissue irritation.

DENTAL CLEANING AND SCALING

Microbial plaque is the primary factor in the development of cavities and periodontal disease. Although it may be possible to remove most plaque using mechanical oral hygiene aids, many patients do not have the motivation or skill to maintain a plaque-free state for extended periods of time. The indications for a professional cleaning and scaling include:

• The removal of plaque, stain, and calculus;
• The elimination of factors that influence the build-up and retention of plaque;
• Demonstration of proper oral hygiene methods to the patient and caregiver;
• Facilitation of a thorough clinical examination; And, the introduction of dental procedures to the child.

An individualized preventive plan increases the probability of good oral health by demonstrating proper oral hygiene methods and techniques and removing plaque, stain, calculus, and the factors that influence their build-up.

EXTRACTIONS

Surgery performed on pediatric patients involves a number of special considerations unique to this population:

• Prior to surgery a review of the child’s medical history is done. It may also be necessary to obtain a medical consultation to prevent emergency situations from developing.
• It is usually necessary to obtain one or more x-rays.
• Special attention is given to the social, emotional, and psychological status of the pediatric patient prior to any surgery.
• Loss of teeth or bone fractures due to trauma in the head and neck area can adversely affect growth and development.
• Dental infections may involve more than one tooth in children and are usually due to dental decay. Prompt treatment of infection is important and antibiotics are frequently prescribed.

RESTORATION OF DENTAL DECAY

The objectives of restorative treatment are to repair or limit the damage from dental decay, protect and preserve tooth structure, re-establish adequate function, restore esthetics where applicable, and provide ease in maintaining good oral hygiene. The restoration of primary teeth differs from the restoration of permanent teeth due in part to the shape of the teeth.

Today, there are a wide variety of materials available to restore teeth. They are, however, not all appropriate for every situation. The proper choice of a restorative material may depend upon the developmental status of the dentition, how cavity prone the child is, the patient’s oral hygiene, the likelihood of timely recall visits and the child’s ability to cooperate for treatment.

Some of the materials used in restoring teeth include pit and fissure sealants, resin-based composites (white), amalgam (metal), stainless steel crowns, bridges and removable appliances. Esthetics and the improved tooth-color restorative materials have led to a decrease in the use of dental amalgam.

FISSURE SEALANTS

Sealants protect the grooved and pitted surfaces of the teeth, especially the chewing surfaces of the back teeth where most cavities in children are found. Made of clear or shaded plastic, sealants are applied to the teeth to help keep them cavity-free. Even if your child brushes and flosses carefully, it is difficult, sometimes impossible, to clean the tiny grooves and pits on certain teeth. Food and bacteria build up in these crevices, placing your child in danger of tooth decay. Sealants “seal out” food and plaque, thus reducing the risk of decay.

Sealants can last for several years if properly cared for. Therefore, your child will be protected throughout most cavity-prone years. If your child has good oral hygiene and avoids biting hard objects, sealants will last longer. The pediatric dentist will check the sealants during dental visits and recommend re-application or repair when necessary.

How is it done? The tooth is first cleaned. It is then conditioned and dried. The sealant is then flowed onto the grooves of the tooth and hardened with a special light. Your child will be able to eat right after the appointment.

FLUORIDE TREATMENTS

Fluoride is a safe and effective adjunct in reducing the risk of dental decay and reversing enamel demineralization, a condition which can lead to dental decay. The adjustment of the fluoride level in community water supplies to optimal concentration is the most beneficial and inexpensive method of reducing the occurrence of cavities. When fluoridation of drinking water is impossible, effective systemic fluoridation can be achieved through the intake of daily fluoride supplements.

Significant cavity-preventing benefits can be achieved by the use of fluoride-containing preparations such as toothpastes, gels, and rinses, especially in areas without water fluoridation. Clinical trials have confirmed the anticaries effect of professional topical fluoride treatments, including 5% neutral sodium fluoride varnish. Fluoride varnishes can prevent or reverse enamel demineralization.

HOSPITAL DENTISTRY UNDER GENERAL ANESTHESIA

Sometimes the only safe way to provide dental care for infants, children, adolescents, or persons with special health care needs is in the hospital, under general anesthesia, and under the auspices of an anesthesiologist. We often treat patients who present special challenges related to age, behavior, medical status, developmental disabilities, intellectual limitations, or special needs. Dental decay, periodontal diseases, and other oral conditions, if left untreated, can lead to pain, infection, and loss of function. These undesirable outcomes can adversely affect learning, communication, nutrition, and other activities necessary for normal growth and development

To address these challenges and meet these treatment needs effectively, pediatric dentists have developed and employ a variety of management techniques, including accessing anesthesia services and the provision of dental care in the hospital setting with general anesthesia.

IN-OFFICE SEDATION

Sedation is a technique to guide a child’s behavior during dental treatment. Medications are used to help increase cooperation and to reduce anxiety or discomfort associated with dental procedures. Sedative medications cause most children to become relaxed and drowsy. Unlike general anesthesia, sedation is not intended to make a patient unconscious or unresponsive.

Sedation may be indicated for children who have a level of anxiety that prevents good coping skills, those who are very young and do not understand how to cope in a cooperative fashion, or those requiring extensive dental treatment. Sedation can also be helpful for some patients who have special needs.

If we feel sedation is indicated, we will discuss sedation options and patient monitoring for the safety and comfort of your child, as well as instructions to be followed before and after the appointment.

SPORTS GUARDS

Increased competitiveness has resulted in a significant number of dental and facial injuries which represent a high percentage of the total injuries experienced in youth sports. All sporting activities have an associated risk of orofacial injuries due to falls, collisions, and contact with hard surfaces. The National Youth Sports Safety Foundation in 2005 estimated the cost to treat an avulsed permanent tooth and provide follow-up care is between $5,000 and $20,000 over a lifetime. Even with a mouthguard in place, up to 25% of dental injuries can still occur.

Helmets, facemasks, and mouthguards have been shown to reduce both the frequency and severity of dental and facial trauma. A mouthguard is constructed to help protect the lips and intraoral tissues from bruising and laceration, to protect the teeth from crown fractures, root fractures, luxations, and avulsions, to protect the jaw from fracture and dislocations, and to provide support.

The Academy of Sports Dentistry recommends the use of a properly fitted mouthguard; encourages the use of a custom fabricated mouthguard made over a dental cast and delivered under the supervision of a dentist; and supports a mandate for the use of a properly fitted mouthguard in all collision and contact sports.

NITROUS OXIDE

Sometimes a child may feel anxious before and during treatment. Your child may need more support than a gentle, caring manner to feel comfortable. Nitrous oxide is a safe, effective agent used to calm a child’s fear of the dental visit and enhance effective communication. Additionally, it works well for children whose gag reflex interferes with dental treatment.

Nitrous oxide is not used alone. It is combined with oxygen. A fitted mask is placed over the nose and, as the patient breathes normally, uptake occurs through the lungs. At the end of treatment, it is eliminated after a short period of breathing oxygen and has no lingering effects.

Nitrous oxide also raises the pain threshold and it sometimes makes it seem as if time is passing more quickly. It is well tolerated and is very safe. Your child remains fully conscious, keeps all natural reflexes, and will be capable of responding to a question or request.

A child should have little or no food within the two hours prior to the appointment as occasionally, nausea or vomiting may occur when a child is on a full stomach.

SPACE MAINTAINERS

There are many types of space maintainers. Some are on one side of the mouth and others are on both sides. Some are fixed or cemented in place on the teeth, and others are removable appliances. Each of these types has its indications and contraindications.

Space maintenance is most commonly indicated when a primary molar is prematurely lost due to infection or trauma. It is usually not required for missing anterior teeth. However, there are exceptions, as when esthetics or speech development is a concern.

The band and loop space maintainer is the most commonly used. It is fixed and located on just one side of the mouth.

Judicious space maintenance benefits the child patient and may prevent future alignment and orthodontic problems.

SPECIAL NEEDS PATIENTS

Some special children are very susceptible to tooth decay, gum disease and oral trauma. Others require medications or a diet which is detrimental to dental health. Still other children have physical difficulty with effective dental habits at home. The good news is dental disease is preventable. If dental care is started early and followed conscientiously, every child can enjoy a healthy smile.

A first dental visit by the first birthday will start your child on a lifetime of good dental health. The pediatric dentist will take a full medical history, gently examine your child’s teeth and gums, then plan preventive care designed for your child’s needs. And, yes, your child will benefit from the preventive approach recommended for all children – effective brushing, flossing, moderate snacking and adequate fluoride. Homecare takes just minutes a day and prevents needless dental problems. Regular professional cleanings and fluoride treatments are also very beneficial. Sealants can prevent tooth decay on the chewing surfaces of molars where four out of five cavities in children occur.

Pediatric dentists have two or more years of advanced training beyond dental school. Their education as specialists focuses on care for children with special needs. In addition, our office is designed to be physically accessible for special patients with curb cuts, elevator, wide doorways and hallways and a large bathroom.

If a child needs extensive treatment the pediatric dentist may provide in-office sedation or general anesthesia in a local hospital. Your pediatric dentist has comprehensive training in behavior management, sedation and anesthesia techniques. He or she will discuss the benefits, limits and risks of such an approach if it is recommended.

STATE OF THE ART STERILIZATION

We recognize patient safety as an essential component of quality oral health care for infants, children, adolescents and those with special health needs. We are in compliance or exceed infection control guidelines of the federal government for dental health care settings in order to prevent disease transmission from patient to care provider, from care provider to patient, and from patient to patient.

We have routine state inspection of all our radiological equipment and have developed emergency and fire safety protocols, and have annual inspections by township officials.

We also have ongoing quality improvement strategies by the routine assessment of risk, adverse events, and mistakes with a plan for reduction and improvement in patient safety and satisfaction.

All of our staff are licensed by the appropriate state licensing board after fulfilling their educational and examination requirements. They have many years of experience and are required to take continuing education related to their practice, which includes being informed of advances in sterilization and infection control techniques.

X-RAYS: INTRAORAL AND PANORAMIC

Radiographs are valuable aids in the oral health care of infants, children, adolescents, and persons with special needs. They are used to diagnose oral diseases and to monitor dentofacial development and the progress of therapy.

We recognize that there may be clinical circumstances for which a radiograph is indicated, but a diagnostic image cannot be obtained. For instance, the patient may be unable to cooperate or the dentist may be working in a hospital which does not have intraoral radiographic capabilities.

Our practice utilizes every effort to minimize a child’s exposure to radiation such as the use of lead aprons, thyroid collars, high-speed film and beam collimation. We follow the guidelines of the American Dental Association and the American Academy of Pediatric Dentistry.