- Prevention & Early Intervention
- Periodic Examinations
- Teeth Cleaning & Fluoride Treatment
- Pulpotomy or “Baby Root Canal”
- Space Maintainers
- Nitrous Oxide “Laughing Gas”
- Oral Conscious Sedation
- General Anesthesia for Dental Treatment
Your child should visit a pediatric dentist by their first birthday. This visit will establish a dental home for your child where they can continue wellness and preventive visits.
The most important reason for this initial visit is to begin a thorough prevention program. Dental problems can begin very early especially if the child is sleeping with a bottle or sippy cup throughout the night. This may cause a condition referred to as “Early Childhood Caries” or “Baby Bottle Tooth Decay.”
The earlier the dental visit, the better the chance of preventing potential dental problems. These early visits can educate parents and establish great dental knowledge for a lifetime of good dental habits.
Because the caries process, which leads to cavities, can progress rapidly, it is important for the dentist to perform routine exams on your child at least twice a year. Often times, we can identify a cavity in its early stages and repair it much less invasively than if it were left untreated.
The causes of cavities are complex and involve numerous processes. That’s why during the exam we look to identify the following:
- The child’s diet and offer appropriate nutritional counseling
- Oral hygiene
- Dental growth and development to identify the possible need for orthodontics
- Oral cancer and other pathologies
- Evaluation of existing fillings and other dental treatments
- Gingivitis and gum disease
At the initial visit, and subsequent wellness visits, your child will receive a thorough cleaning of his/her teeth with our special instruments and toothpastes.
During the cleaning process, we will:
- Remove Plaque – Plaque is the yellow-white material that builds up on teeth. Because plaque is sticky, it builds up quickly on the teeth and, if left alone, can cause cavities, gum disease and bad breath.
- Remove Stubborn Stains – Our specially formulated toothpaste allows us to remove superficial stains more effectively than standard toothpaste.
- Remove Tartar (calculus) – Calculus is hardened plaque that can build up above and below the gum line. It is difficult to remove and requires special instruments only found at the dental office.
- Provide a topical fluoride treatment.
- Educate yourself and your child on proper brushing and flossing techniques.
X-rays are a very important component of a dental exam. They allow us to see areas of the teeth that are not clinically visible. They also allow us to see how well the permanent teeth are developing before they erupt. In some cases, x-rays can detect cysts and tumors in their early stages. At each exam, we will determine which x-rays, if any, will be required.
Dental x-ray machines are much safer today than ever before. With your child’s health and safety in mind, our state-of-the-art digital x-ray system produces very little radiation. To put this into perspective, the amount of radiation your body gets on an airplane ride from the east coast to the west coast is more than the amount you will receive from our dental x-ray machine.
When considering the benefits of x-rays compared to the minimal risk involved in their use, it is clear why we take regular diagnostic x-rays.
The chewing surfaces of the molars often times have deep pits and fissures, or grooves, which are not easily cleaned by routine brushing and rinsing. Sealants are placed into these grooves to prevent food and bacteria from getting trapped and causing cavities.
Sealants are made of a hard, plastic-like material that is bonded to the tooth surface. We use BPA-free sealants that match the tooth’s color. The sealant is painted onto the pits and grooves to “seal” out the plaque and bacteria to help protect against cavities. Studies have shown that the occurrence of new cavities decreases by more than 50% when sealants are used in conjunction with good oral hygiene.
Although sealants are effective, they are not permanent and will typically last 3–5 years under the best of conditions. In children with poor oral hygiene and a high sugar diet, they may wear or chip off earlier.
Once bacteria have established themselves in the mouth, they will produce acidic by-products that create holes (cavities) in your teeth. The weakened tooth structure and bacterial infection must be removed to prevent the process from progressing and causing further damage.
After removal of the infected tooth structure, we typically use one of the following ADA (American Dental Association) approved materials:
Composite Resin (White Fillings)
Composite resin is a tough, plastic-like material that allows us to keep that bright white smile that we all strive to maintain. It bonds to the tooth, allowing us to be more conservative and less invasive by removing less tooth structure in order to place it. Furthermore, composite does not contain mercury or BPA. This is our material of choice in most instances.
Glass Ionomer restoratives are used when the cavity is deep and near the nerve. They are also used as a cement for crowns. Glass Ionomers have the benefit of bonding chemically to the tooth and releasing fluoride.
Crowns covers the entire tooth to provide added strength and longevity for severely decayed teeth. These pediatric crowns are completed at one appointment and are generally used after a “baby root canal” or when the cavity severely undermines the tooth by involving multiple surfaces. Placing a filling on a tooth that has been weakened extensively will likely result in fracture, recurrent decay, and loss of that tooth.
When the cavity is very near to or has reached the nerve of the baby tooth, it may mean that we need to perform a “Baby Root Canal.” It is always a better option to save the existing baby teeth to preserve the space for the eruption of permanent teeth and to allow proper chewing and function for the child.
The procedure differs from the typical Adult Root Canal. After accessing the nerve of the tooth, we will remove the infected tissue and place a medicine that helps soothe the remaining nerve tissue. It is also completed in one simple appointment. Because these procedures are simpler than the adult version, they take very little time to complete.
However, while this procedure carries an 85–90% success rate, there are situations where the nerve is so badly infected by the cavity that it does not respond to this treatment. In these cases, it becomes necessary to remove the tooth and discuss the need for space maintainers.
Extractions are the last resort for treatment. We reserve extractions for teeth that are infected or no longer restorable. At the time of the extraction, we will evaluate whether a space maintainer will be necessary for your child.
Space maintainers are devices made of metal and acrylic that are designed to hold space for erupting permanent teeth after premature loss of a “baby” tooth. Placing a space maintainer after the premature removal of a “baby” tooth will give your child a better chance of avoiding the orthodontic problems associated with premature tooth loss. It is always better to maintain the existing space than to try and regain it later.
Nitrous oxide, also known as laughing gas, is often used for children with mild to moderate anxiety. Nitrous is mixed with oxygen and generally eases the child’s fears so that they can relax and dental treatment can be rendered safely and effectively.
Nitrous oxide is administered by placing a small mask over your child’s nose. Additionally, it works well for children whose gag reflex interferes with dental treatment. Nitrous oxide/oxygen is perhaps the safest sedative in dentistry. It is well tolerated, has a rapid onset, and is easily reversible. Nitrous oxide can be adjusted in various concentrations and it does not cause allergies.
Your child remains fully conscious and maintains all natural reflexes. He/she will be awake and capable of responding to questions or requests. Nitrous oxide/oxygen may also be used in combination with other sedative agents.
When the treatment has been completed, the nitrous oxide is turned off and pure oxygen is delivered for 5–10 minutes to help flush the child’s body of the gas. The effects of nitrous oxide should dissipate as your child breathes the oxygen.
Children who are younger or more anxious may have more difficulty tolerating dental treatment. These children may need an oral medication that is stronger than nitrous oxide to help us render treatment effectively.
Oral sedation may cause drowsiness, but your child will maintain his/her reflexes and can be aroused if needed. Possible side effects of oral sedation include nausea and vomiting. However, oral sedation works extremely well in certain situations.
We will discuss the criteria for oral sedation in detail and expected efficacy based on your child’s age, temperament and amount of dental treatment needed.
General Anesthesia for Dental Treatment
General anesthesia is used thousands of times a year for children with various medical needs. Your child’s safety is of the utmost importance to us. We understand that placing your child under general anesthesia is not something to take lightly and as such we reserve this treatment modality for more advanced cases when it is indicated.
Under general anesthesia, the entire dental treatment is completed in a single visit. Dr. Asgari has done hundreds of dental rehabilitation cases under general anesthesia and is very experienced in safely and effectively using this service for your child. The general anesthesia is done by a dental anesthesiologist who rigorously monitors the child while Dr. Asgari completes the treatment.
The proper candidates for general anesthesia are usually:
- Children with severe anxiety
- Children with extensive medical problems
- Young children with severe early childhood caries that would normally require multiple appointments
- Patients with special needs
- Children with physical disabilities who cannot tolerate dental treatment under normal circumstances