Routine Cleanings and Prophylaxes
Our office prides itself in prevention and total care begins with regular hygiene visits, routine check-ups and continued oral health routines at home. Our regular check-ups should instill and perpetuate proper and thorough home hygiene practices including tooth brushing, flossing, the use of fluoride toothpaste and supplements, tooth eruption and prevention. By visiting our office at regular intervals we can maintain a healthy oral cavity, be proactive in oral health, and instill a positive image for a child’s dental health. As with most childhood situations, the more familiar the child gets with the dental environment and the same consistent interactions, he or she will develop the coping skills needed to feel comfortable in any situation. We try to maintain consistency with our staff and use the parent’s or caretakers’ presence to alleviate anxiety and educate all parties in the best interests in the child’s oral health.
For many generations, x-rays were utilized in dentistry to diagnose decay and other pathology of the oral cavity. With the advances in technology, dentistry now uses a variety of digital radiographs instead of conventional x-rays which are much more diagnostic and safer. There are two main types of dental radiographs – intraoral and extra-oral. Intraoral radiographs require a phosphor or digital plate to be placed inside a patient’s mouth and then a picture is obtained. The picture is then sent to a computer where is can be uploaded and showed on a monitor or emailed. The most common type of intraoral radiographs for cavity detection are called bitewing radiographs in which a patient bites down and both the top and bottom teeth are seen n a single image of “film.” If patients have a hard time biting down, separate images of top and bottom teeth may be obtained through PA’s or periapical radiographs. Extra-oral radiographs are films that are use d to detect dental problems in the jaw and skull. These are commonly called panoramic, cephalometric, or tomograms and are often used in orthodontic and surgical cases. The amount of radiation is reduced by nearly 90% using digital radiographs versus conventional x-ray films.
Dental sealants are thin, plastic coatings painted on the chewing surfaces of teeth – most often the back teeth (premolars and molars) – to prevent tooth decay. The sealant quickly bonds into the depressions and grooves of the teeth, forming a protective shield over the enamel of each tooth. The placement of sealants is simple and painless although isolation is critical (the tooth surface cannot be contaminated with saliva, water or blood) or the bond will be weakened. The tooth is often isolated with cotton and suction and an acid etchant (often phosphoric acid) is placed to remove plaque and bacteria and prepare the collagen fibers for an optimal bonding surface. A bonding agent is then placed on the tooth surface, thinned and air-dried and then the sealant is placed and light cured. The entire procedure takes about two minutes from start to finish. They are very durable and children can eat or drink right away after their placement. Most dental insurances co ver sealants on permanent teeth that have never had a filling before and before a certain age.
Dental Fillings (Restorations)
The concept of a “filling” is the replacement and restoration of tooth structure that is damaged due to decay, cavitation, decalcification or fracture with a biocompatible material. Traditionally, silver fillings (amalgams) have been used to fill teeth. More recently, white fillings (composites) have become more popular and quite often requested because of their color by parents. We at Golnick Pediatric Dental recommend the best filling material for your child’s tooth based on a number of factors as each material has its advantages and disadvantages. Silver fillings are durable, can be placed in a wet or non-isolated environment and do not require a bonding agent. They are held in place with mechanical retention, meaning the extent and preparation of the cavity is critical. The concern with mercury is more with regard to the disposal of the remaining silver alloy or the removal of it when heated. Conversely, the white filling materials, although highly cosm etic, are very moisture sensitive (if they get wet or contaminated they will fail), and require a highly acidic bonding agent that may cause tooth sensitivity and even pulpal (nerve) damage. We attempt to educate our parents and children as to the best restorative option possible and remember there is nothing better then maintaining the tooth structure itself!
Teeth that are severely decayed or damaged require full coverage restorations or crowns (caps). Teeth having a biting surface and four sides and generally when two or more sides and the chewing surface are damaged, a crown is indicated. Stainless steel crowns have been used to restore primary teeth that either have had nerve treatments or severe decay. They require minimal reduction and although they are not “cosmetically” white, they are easy to place and are very durable. Newer “white” crowns have been introduced which require greater removal of tooth surface (due to the thickness of the porcelain) and nearly always require nerve treatments. Also, the white shades cannot be adjusted and thus may not match the adjacent or existing teeth. Primary tooth crowns are prefabricated and no impression or lab involvement is necessary. For adult permanent teeth, impressions may be procured and a lab can fabricate a crown indirectly to match the existing teeth.
Pediatric pulp (nerve) therapy is commonly referred to as root canal therapy, pulpotomy, pulpectomy or nerve treatments. The primary goal of pulpal therapy is to treat, restore, and save the affected tooth. Pediatric dentists perform pulp therapy on both primary and permanent teeth when caries, infection or trauma affects the nerve(s) of a tooth. Dentists may use endodontic files to clean and sterilize the pulp or root canal space, and then fill it with a variety of materials.
An extraction is the complete removal of a tooth, both crown and root(s). Extractions are necessary when a primary tooth is preventing the normal eruption of a permanent tooth, if a tooth has suffered extensive tooth decay or trauma that cannot be repaired, if there is infection which has overwhelmed the tooth and extends into the surrounding bone and tissue or if there is an impaction. Extractions generally require the use of profound anesthesia.
When primary teeth are lost prematurely, space maintainers are indicated to hold the space for the permanent tooth. Failure to maintain the space may lead to impaction of the permanent tooth, crowding of the teeth, and problems with occlusion and function. There is a wide variety of space maintainers available including band-loop, lingual holding arch, maxillary TPA, Nance holding arch and distal shoe appliances. The indication as to which one is best utilized depends on the arch, the number of teeth missing, the age of the child, the growth and development of the child and how much crowding or spacing exists. All space maintainers are passive appliances and usually are cemented and fixed in place.
Interceptive orthodontics is simply the diagnosis and treatment of developing malocclusions as soon as they are detected. Some orthodontic problems, if left untreated, may develop into more serious dental problems in time. These include ectopic eruption, dental cross-bites, narrow palates and habits such as thumb sucking. By correcting these problems early, while a child is still growing, less orthodontic intervention in the future is likely. By using the child’s growth and development these problems are often easier and quicker to correct.
Sports Mouth guards and Injury Prevention
Mouth guards, also called mouth protectors, help cushion a blow to the face, minimizing the risk of broken/fractured teeth and injuries to your lips, tongue, face and jaw. They have also been very effective in minimizing concussions and brain injuries. Mouth guards may be fabricated at home with boiling water or they can be made more accurately with an impression taken at the dentist’s office. More common, sports teams and leagues require children and athletes to wear protective mouth guard during practice, games and play or else sit out due to legal implications. A well-fitted mouth guard is a great investment and shouldn’t interfere with their ability to play, communicate or compete in any contact sport.
Bruxism and grinding appliances
If a patient grinds their teeth at night, a special mouth guard-type of dental appliance, called a nocturnal bite plate or bite splint – may be indicated to prevent tooth damage as well as muscle pain, headaches, limited jaw opening and trismus. These night guards are hard dental splints that prevent the teeth from the opposing jaws touch during the night and act as a “shock absorber.” They may also be indicated during stressful times (i.e. exams) and when playing electronic games or working on computers. Research has shown that electrical impulses and stimulus over time cause people to clench subconsciously and thus grind their teeth. To properly fabricate a splint, impression of the upper and lower arches are obtained as well as a bite registration. The bite guards may need to be adjusted over time.
Emergency care and Trauma
Emergencies will ultimately occur and our office attempts to see every emergency promptly and professionally. Our doctors and staff are well prepared in all aspects of dental emergency care. There is always an after hours emergency number available and if needed we will meet you at the office. Dental emergencies need to be addressed timely and accurately.
Solea Laser therapy
Golnick Pediatric Dentistry is one of the select offices in the country to offer soft and hard tissue treatment using the Solea laser. This laser allows us to treat soft tissue lesions and problems with virtually no anesthesia, minimal bleeding, and little or no pain. Frenectomies, gingivectomies, treatment of canker sores, exposure of teeth can all be accomplished in minutes without scalpels, blades, scarring or pain. The laser seeks out water in the tissue to work and the healing time is remarkable. It is also possible to treat cavities with the laser, thus avoiding drilling and local anesthesia.