Fillings
There are different kinds of fillings used to restore teeth after decay is removed:
Composites
Advances in modern dental materials and techniques increasingly offer new ways to create more pleasing, natural-looking smiles. Researchers are continuing their decades-long work developing aesthetic materials, such as ceramic and plastic compounds that mimic the appearance of natural teeth. As a result, dentists and patients today have several choices when it comes to selecting materials used to repair missing, worn, damaged or decayed teeth.
Composite resins are tooth-colored materials that are used both as fillings and to repair defects in the teeth. Because they are tooth-colored, it is difficult to distinguish them from natural teeth. Composites are often used on the front teeth where a natural appearance is important. They can be used on the back teeth as well depending on the location and extent of the tooth decay.
Cements
Ionomers – Glass ionomers are tooth-colored materials made of a mixture of acrylic acids and fine glass powders that are used to fill cavities, particularly those on the root surfaces of teeth. Glass ionomers can release a small amount of fluoride that help patients who are at high risk for decay. Glass ionomers are primarily used as small fillings in areas that need not withstand heavy chewing pressure. Because they have a low resistance to fracture, glass ionomers are mostly used in small nonload-bearing fillings (those between the teeth) or on the roots of teeth. Resin ionomers also are made from glass filler with acrylic acids and acrylic resin. They also are used for nonload-bearing fillings (between the teeth) and they have low to moderate resistance to fracture. Ionomers experience high wear when placed on chewing surfaces. Both glass and resin ionomers mimic natural tooth color but lack the natural translucency of enamel. Both types are well tolerated by patients with only rare occurrences of allergic response.
Porcelain (ceramic) dental materials
All-porcelain (ceramic) dental materials include porcelain, ceramic or glasslike fillings and crowns. They are used as inlays, onlays, crowns, and aesthetic veneers. A veneer is a very thin shell of porcelain that can replace or cover part of the enamel of the tooth. All-porcelain (ceramic) restorations are particularly desirable because their color and translucency mimic natural tooth enamel. All-porcelain restorations require a minimum of two visits and possibly more. Their strength depends on an adequate thickness of porcelain and the ability to be bonded to the underlying tooth. They are highly resistant to wear but the porcelain can quickly wear opposing teeth if the porcelain surface becomes rough.
Root canal treatment (RCT)
The pulp of a tooth is the inner central core of the tooth. The pulp contains nerves, blood vessels, connective tissue and reparative cells. The purpose of pulp therapy in Pediatric Dentistry is to maintain the vitality of the affected tooth (so the tooth is not lost).
Dental caries (cavities) and traumatic injury are the main reasons for a tooth to require pulp therapy. Pulp therapy is often referred to as a “nerve treatment”, “children’s root canal”, “pulpectomy” or “pulpotomy”. The two common forms of pulp therapy in children’s teeth are the pulpotomy and pulpectomy.
A pulpotomy removes the diseased pulp tissue within the crown portion of the tooth. Next, an agent is placed to prevent bacterial growth and to calm the remaining nerve tissue. This is followed by a final restoration (usually a stainless steel crown).
A pulpectomy is required when the entire pulp is involved (into the root canal(s) of the tooth). During this treatment, the diseased pulp tissue is completely removed from both the crown and root. The canals are cleansed, disinfected and in the case of primary teeth, filled with a resorbable material. Then a final restoration is placed. A permanent tooth would be filled with a non-resorbing material.
Crowns
Stainless Steel Crowns/Ceramic/Zirconia Crowns
When there is not enough tooth structure left after decay removal of a tooth to support a typical filling, or if a nerve treatment is performed on a tooth, a stainless steel or zirconia crown is the restoration of choice. This is a durable, silver-colored or tooth coloured crown that fits over the remaining decay free tooth structure and falls out with the tooth itself. Permanent teeth may also need stainless steel crowns. In this case, they are used until the occlusion stabilizes with the eruption of more permanent teeth, and may be eventually replaced by a porcelain crown.
Sealants
What are sealants?
Tooth sealants refer to a plastic which bonds into the grooves of the chewing surface of a tooth as a means of helping to prevent the formation of tooth decay.
How do sealants work?
In many cases, it is near impossible for children to clean the tiny deep and narrow grooves on the chewing surface of their teeth. When a sealant is applied, the surface of the tooth is somewhat flatter and smoother. There are no longer any places on the chewing part of the tooth that the bristles of a toothbrush can’t reach and clean. Since plaque can be removed more easily and effectively, there is much less chance that decay will start.
What is the life expectancy of tooth sealants?
The longevity of sealants can vary. Sealants which have remained in place for three to five years would be considered successful; however, sealants can last much longer. It is not uncommon to see sealants placed during childhood still intact on the teeth of adults.
Our clinic will check your child’s sealants during routine dental visits and will recommend repair or reapplication when necessary.
Which teeth should be sealed?
Any tooth that has characteristics, which a sealant can correct, and thus place the tooth at less risk for developing decay, should be sealed. The most common teeth for a dentist to seal are a child’s “back” teeth, and of these teeth the molars are the most common teeth on which dental sealants are placed. The recommendation for sealants should be considered on a case-by-case basis.
What is the procedure for placing sealants?
Generally the procedure takes just one visit. Placing dental sealants can be a very easy process. The tooth is cleaned, conditioned and dried. The sealant is then flowed onto the grooves of the tooth where it is hardened with a special blue light. All normal activities can occur directly after the appointment.
How important is brushing and flossing after sealants are applied?
It is just as important for your child to brush and floss their teeth. Sealants are only one part of the defensive plan against tooth decay.
Fluoride treatment
Fluoride is an element, which has been shown to be beneficial to teeth. However, too little or too much fluoride can be detrimental to the teeth. Little or no fluoride will not strengthen the teeth to help them resist cavities. Excessive fluoride ingestion by preschool-aged children can lead to dental fluorosis, which is a chalky white to even brown discoloration of the permanent teeth. Many children often get more fluoride than their parents realize. Being aware of a child’s potential sources of fluoride can help parents prevent the possibility of dental fluorosis.
Some of these sources are:
Two and three year olds may not be able to expectorate (spit out) fluoride-containing toothpaste when brushing. As a result, these youngsters may ingest an excessive amount of fluoride during tooth brushing. Toothpaste ingestion during this critical period of permanent tooth development is the greatest risk factor in the development of fluorosis. Excessive and inappropriate intake of fluoride supplements may also contribute to fluorosis. Fluoride drops and tablets, as well as fluoride fortified vitamins should not be given to infants younger than six months of age. After that time, fluoride supplements should only be given to children after all of the sources of ingested fluoride have been accounted for and upon the recommendation of your pediatrician or pediatric dentist.
Certain foods contain high levels of fluoride, especially powdered concentrate infant formula, soy-based infant formula, infant dry cereals, creamed spinach, and infant chicken products. Please read the label or contact the manufacturer. Some beverages also contain high levels of fluoride, especially decaffeinated teas, white grape juices, and juice drinks manufactured in fluoridated cities. Parents can take the following steps to decrease the risk of fluorosis in their children’s teeth:
Tooth extraction
In most cases, a tooth may need to be pulled when other less radical procedures, such as filling or root can treatment, make it impossible or imprudent to save your child’s original tooth.
Space maintainers
Guidance eruption is a method used to create enough room for crowded lower permanent incisors. Crowding can often be seen with the eruption of the permanent teeth of the lower jaw at 6 to 7 years old. The permanent incisors will usually compensate for this crowding by erupting behind the primary teeth. If this happens, both sets of teeth may be apparent at the same time.
Additional room for a permanent lower incisor can be achieved through either the extraction of a primary tooth, or the discing away of portion of the primary tooth. If enough room is provided. the permanent lower incisors usually glide into a straight orientation without further intervention.
Guidance eruption may reduce the need for future orthodontic movement of the permanent lower incisors. Guidance eruption may also reduce the risk of future gingival recession and periodontal concerns of the lower front incisors, however, it will not gain any room for future permanent tooth eruption. Because more crowding may be encountered at about 9 years old, the need for space maintenance or future orthodontic treatment may be warranted.
Mouth protectors
What are mouth guards?
Athletic mouth protectors are comprised of soft plastic. They come in standard or custom fit to adapt comfortably to the upper teeth.
Why are mouth guards important?
Mouth guards protect the teeth from possible sport injuries. They not only protect the teeth, but the lips, cheeks, tongue and jaw bone as well. They can contribute to the protection of a child from head and neck injuries such as concussions. Most injuries occur to the mouth and head area when a child is not wearing a mouth guard.
When should my child wear a mouth guard?
They should be worn during any sports based activity where there is risk of head, face or neck injury. Such sports include hockey, soccer, karate, basketball, baseball, skating, skateboarding, as well as many other sports.
Most oral injuries occur when children play basketball, baseball and soccer.
How do I select a mouth guard for my child?
Choose a mouth guard that your child feels is comfortable. If a mouth guard feels bulky or interferes with speech to a great degree, it is probably not appropriate for your child.
There are many options in mouth guards. Most guards are found in athletic stores. These vary in comfort, protection as well as cost. The least expensive tend to be the least effective in preventing oral injuries. Customized mouth guards can be provided through our practice. They may be a bit more expensive, but they are much more comfortable and shock absorbent.
Sedation Dentistry
Facts About Sedation Dentistry
Common Questions
Will I feel any pain?
No. You will feel nothing!
Will I be unconscious?
No, you are in a deeply relaxed state, you are responsive.
Will I be monitored?
Yes, one of our team is always with you and your vital signs are monitored during the entire visit. You are never alone.
How long will I be relaxing?
Depending on your needs, from two to six hours.
Will someone need to accompany me?
Yes, due to the sedative effects of the medication, you will need someone to drive you to our clinic and home again.
Who Is a Candidate For Conscious Sedation?
People who have . . .
– high fear
– had traumatic dental experiences
– difficulty getting numb
– a bad gag reflex
– very sensitive teeth
– limited time to complete their dental care
– complex dental problems
People who . . .
– hate needles and shots!
– hate the noises, smells and tastes associated with dental care
– are afraid or embarrassed about their teeth
Cavities
Tooth decay is another name for the disease known as “caries,” or cavities. A cavity is the result of your tooth enamel, dentin, or cementum being destroyed over long-term exposure to harmful bacteria.
Many cavities are preventable Tooth decay is promoted by your teeth being frequently exposed to foods rich in carbohydrates (starches and sugars) like soda, candy, ice cream, milk, and cakes.
When these foods break down in your mouth, they provide food for the bacterial film on your teeth and gums called plaque. The plaque interacts with deposits left on your teeth from sugary and starchy foods to produce acids. These acids break down tooth enamel over time by dissolving, or demineralizing, the mineral structure of your teeth. This leads to tooth decay and weakening the teeth.
Plaque is a film of bacteria that forms on teeth and gums after eating foods that produce acids. These foods may include carbohydrates (starches and sugars), such as candy and cookies, and starchy foods, such as bread, crackers, and cereal.
Tooth decay leads to cavities and occurs when plaque remains on your teeth for an extended period of time, allowing the bacteria to “eat away” at the surfaces of your teeth and gums. Ironically, the areas surrounding restored portions of teeth (where fillings have been placed) are particularly vulnerable to decay and are a breeding ground for bacteria.
In addition to causing cavities, plaque can lead to gum irritation, soreness, and redness. Sometimes, your gums may begin to bleed as a result of plaque accumulation. Long-term, plaque can lead to serious problems. Sometimes, the bacteria can form pockets of disease around tooth structures, eventually destroying the bone beneath the tooth.
Consistency of a person’s saliva also makes a difference; thinner saliva breaks up and washes away food more quickly. When a person eats diets high in carbohydrates and sugars, they tend to have thicker saliva, which in turn produces more of the acid-producing bacteria that causes cavities.
In regards to early childhood caries, avoid putting your baby or small child to sleep with a bottle containing anything but water, because juices and milk contain sugars that can be harmful to teeth. When a child sleeps, these liquids “pool” in the mouth and bathe the teeth.
Early childhood caries may occur when sweetened liquids, such as milk, formula, and fruit juice, are given and are left to pool in an infant’s mouth for long periods of time. Baby bottle tooth decay can lead to severe cavities in your child’s mouth, and destroy the teeth if left untreated.
Avoid allowing your child to fall asleep with a bottle and avoid breast feeding at will after the first baby tooth begins to erupt.
Tips for cavity prevention:
Gum diseases
Periodontal disease is a condition in which the structures that support the teeth, including the gums and bone surrounding each tooth, become infected and begin to break down. Periodontal disease (also known as “periodontitis”) can be influenced by the body’s response to infection caused by the bacteria in plaque. Poor oral hygiene in children could set the stage later on for gum disease – the major cause of tooth loss in adults. It is most often caused by bacteria.
In the early stage of gum disease, called gingivitis, the gums can become red, swollen and easily bleed. At this stage, the disease is still reversible and can usually be eliminated by daily brushing and flossing.
Like some diseases, gum disease isn’t painful until it reaches a more critical stage, in which treatment options narrow. If it goes unchecked, inflammation begins to allow surrounding bone to demineralize and dissolve. As the bone dissolves around the teeth in the more advanced stages of gum disease, called periodontitis, the gums and bone that support the teeth can become seriously damaged. The teeth can become loose, fall out, or have to be removed.
Early symptoms of gum disease:
If your child currently has poor oral health habits, work with your child to change these now. It’s much easier to modify these habits in a child than in an adult.
Serve as a good role model by practicing good oral health care habits yourself and by scheduling regular dental visits for family checkups, periodontal evaluations and cleanings. A healthy smile, good breath and strong teeth all contribute to a young person’s sense of personal appearance, as well as confidence and self-esteem.
Habits
Thumb/ pacifier sucking:
Sucking is a natural reflex and infants and young children may use thumbs, fingers, pacifiers and other objects on which to suck. It may make them feel secure and happy or provide a sense of security at difficult periods. Since thumb sucking is relaxing, it may induce sleep.
Thumb sucking that persists beyond the eruption of the permanent teeth can cause problems with the proper growth of the mouth and tooth alignment. How intensely a child sucks on fingers or thumbs will determine whether or not dental problems may result. Children who rest their thumbs passively in their mouths are less likely to have difficulty than those who vigorously suck their thumbs.
Children should cease thumb sucking by the time their permanent front teeth are ready to erupt. Usually, children stop between the ages of two and four. Peer pressure causes many school-aged children to stop.
Pacifiers are no substitute for thumb sucking. They can affect the teeth essentially the same way as sucking fingers and thumbs. However, use of the pacifier can be controlled and modified more easily than the thumb or finger habit. If you have concerns about thumb sucking or use of a pacifier, consult your pediatric dentist.
A few suggestions to help your child get through thumb sucking:
Bruxism
Parents are often concerned about the night grinding of teeth (bruxism). Often, the first indication is the noise created by the child grinding on their teeth during sleep. Or, the parent may notice wear (teeth getting shorter) to the dentition. One theory as to the cause involves a psychological component. Stress due to a new environment, divorce, changes at school; etc. can influence a child to grind their teeth. Another theory relates to pressure in the inner ear at night. If there are pressure changes (like in an airplane during take-off and landing, when people are chewing gum, etc. to equalize pressure) the child will grind by moving his jaw to relieve this pressure.
The majority of cases of pediatric bruxism do not require any treatment. If excessive wear of the teeth (attrition) is present, then a mouth guard (night guard) may be indicated. The negatives to a mouth guard are the possibility of choking if the appliance becomes dislodged during sleep and it may interfere with growth of the jaws. The positive is obvious by preventing wear to the primary dentition.
The good news is most children outgrow bruxism. The grinding gets less between the ages 6-9 and children tend to stop grinding between ages 9-12. If you suspect bruxism, discuss this with your pediatrician or pediatric dentist.
Teething and sore gums
Sore Gums/Teething
When babies are teething, usually between the ages of four months and 2.5 years, they often have sore and tender gums. The pain usually can be soothed by gently rubbing the baby`s gums with a clean finger, a small, cool spoon or a wet gauze. A clean teething ring, but never dipped in sugar or syrup, for the baby to chew on also may be helpful.
Contrary to common belief, fever is not normal for a teething baby. If your infant has an unusually high or persistent fever while teething, call your physician.
The Tooth Tour
Let’s take a closer look at a tooth. The crown is the part that can be seen in the mouth, while buried in the bony socket of the jaw firmly enclosed is the root. The crown of the tooth is covered with the enamel. Enamel is one of the hardest natural substances known and forms the outermost protective layer. The Dentin, which lies just under the enamel is yellowish and is not as hard as enamel. This forms the bulk of the tooth. The soft tissue that fills the chamber of the center of the tooth and the canals that extends down the roots forms the pulp of the tooth. It contains nerves and blood vessels. Cementum is a thin bone like tissue which covers and protects the tooth root.
Why are the Primary Teeth so Important?
There are twenty primary teeth, which can be seen, in a baby’s mouth, 8 incisors, 4 canines, 8 molars. These are called as milk teeth or more scientifically deciduous teeth. These primary teeth are designed to function during the childhood years. Some of them until the child is 10 or 12 years old – and they have several important jobs to do. Primary teeth are foundation teeth.
They are in fact as important as the permanent teeth. Lets see why –
When will my Baby Start Getting Teeth?
Six months of age is when most babies start teething. By two years of age, they will have all 20 baby teeth. During this time, your child may show the signs of teething including drooling, sucking, biting, gum rubbing, facial rash, irritability, restlessness, decreased appetite and possibly even a mild elevation in temperature. Symptoms typically last from 4 days before a tooth emerges until 3 days afterward. During these periods, comfort your baby with teething rings or a cold washcloth to bite on. Massaging the gums, increasing fluid intake and providing non-aspirin analgesics will also help provide relief to our youngest of patients.
Taking Care of your Child’s Teeth
Although many parents don’t think too much about their toddler’s or preschooler’s teeth, it is important to do so, because 20 percent of them develop cavities before they are 5 years old.
Good dental hygiene habits should begin before your child’s first tooth comes in. Wiping your baby’s gums with a soft damp cloth after feedings helps to prevent the buildup of bacteria. When teeth appear, start using a soft children’s toothbrush twice a day.
Once your child is preschool-age, start using fluoride toothpaste. Don’t cover the brush with toothpaste; a pea-sized amount is just right. Young children tend to swallow most of the toothpaste, and swallowing too much fluoride toothpaste can cause permanent stains on their teeth.
Permanent teeth
The first permanent molars (which are not preceded by primary teeth) begin erupting around the age of six. Extra care should be given to this first set of molars; they have a significant impact on the structure and position of future erupting teeth and, consequently, the shape of your child’s lower face in later years.
Throughout your child’s formative years (up and through the age of 21), the bones and muscles the face are constantly growing, shifting and changing. Most important (and visible to no one because it happens so gradually) is the fact that a child’s jaw expands over a period of time, making way for an increase of 12 additional teeth. By about age 14, your child should have a full set of 28 permanent teeth, plus four additional teeth, called wisdom teeth, that grow behind the permanent teeth in late adolescence.
Wisdom teeth
Your child’s third set of molars are no different than any other tooth, save for the fact that they are the last to erupt, or grow, into the mouth. Because they typically do so at around the age of 18 to 20, when adolescents are close to turning into adults, these teeth are commonly referred to as “wisdom teeth.”
People normally have three permanent molars that develop in each quadrant of the mouth – upper, lower, right, and left. The first molars usually grow into the mouth at around six years of age. The second molars grow in at around age 12.
In many cases, wisdom teeth do not grow in properly, have a proper bite relationship, or have unhealthy gum tissue around them. Often, wisdom teeth improperly erupt or become impacted, requiring them to be extracted.
Our clinic must examine your child’s mouth and X-rays to determine if the teeth are impacted or will not grow in properly. Impacted teeth may cause problems that can lead to infection, adjacent tooth resorption, gum disease, cysts, or tumors.
To avoid potential problems later in life, many dentists safely remove impacted wisdom teeth. In many cases, wisdom teeth do not grow in properly, have a proper bite relationship, or have healthy gum tissue around them. Often, wisdom teeth improperly erupt and become impacted, requiring them to be extracted, or pulled. Although they are like any other teeth, most people continue to have normal bites and well functioning sets of teeth in their absence.
Symptoms of impacted teeth
Wisdom teeth are typically removed after the roots are formed, or at least three-fourths developed. This is usually in the adolescent years.