General Treatment
Research has shown that most people have a 95% chance of experiencing some tooth decay in their lifetime. When tooth decay does occur, it is highly important to remove the decay, clean the tooth and repair the tooth with some type of restoration. Additionally, lost or missing teeth need to be replaced to protect your overall oral health. This is true of adult dentition as well as the primary dentition, or "baby teeth." It is important to maintain the health of the baby teeth even though they will eventually be replaced because they are necessary for eating, speaking, proper growth and development of the jaws and placement of the permanent teeth.
In this section, we will look at the various restorations we can use to protect and restore decayed or missing teeth. Our primary goal for your children’s dental development is to achieve and maintain optimum oral health. through advances in techniques, technologies and by maintaining their scheduled dental exams.
Sealants
Protect the chewing surface of teeth from decay.
The Problem:
Protect normal pits and grooves on the chewing surface of back teeth.
The Solution:
Normal pits and grooves on the chewing surfaces of back teeth can trap food that can't be removed by brushing or washed out by water or saliva. A sealant is a tough, plastic material designed to bond (stick) to tooth enamel. These clear or tooth colored sealants are painted onto the tooth surface to "seal" the pits and grooves and protect against decay. They are generally applied to children's first permanent back teeth.
Advantages:
Sealants are an excellent way to protect chewing surfaces of teeth from decay. They are a much better financial investment than treating decay after it has started.
Disadvantages:
Sealants are not permanent. They generally last about five years with normal wear, but can wear off or chip off earlier in certain instances. Also, sealants do not prevent decay between teeth or the onset of gum disease, so regular home care and dental visits are important.
Alternatives:
There are no appropriate alternatives to sealants. If a tooth has decay, it will need a filling or other restoration.
Fillings
A way to restore a small amount of tooth decay.
The Problem:
Decay on a small portion of any tooth.
The Solution:
A composite filling is a tooth colored quartz-like material. After tooth decay is removed and cleaned, this tooth colored material is layered into the tooth. Each layer is hardened or cured with highly intense visible light, and the final surface is shaped and polished to match the tooth. The final restoration is virtually invisible.
Advantages:
WHITE FILLINGS:
Composite fillings are more than just attractive. They require minimal tooth preparation, in other words less healthy tooth structure is removed to restore the tooth. Some white filling materials contain fluoride and can prevent further decay in the area where they are placed. Also, a sealant can be placed over the remaining exposed grooves of the tooth to minimize the risk of decay on another area of the tooth.
SILVER FILLINGS:
Silver fillings have been proven to be a durable restoration in baby teeth.
Disadvantages:
WHITE FILLINGS:
The initial investment in a composite filling is higher than that for a silver filling. This is due to the fact that the composite material is more expensive and the restoration is more difficult and time consuming to place.
SILVER FILLINGS:
The obvious disadvantage is the color. Also, people have various beliefs about the metal contents in silver fillings, as they do contain a small amount of mercury. Another disadvantage is that more tooth structure needs to be removed to retain a silver filling. Thus, more healthy tooth structure is removed than is for a composite filling.
Alternatives:
In cases of extensive decay or if the baby tooth required a pulpotomy, a crown is the best option.
Stainless Steel Crowns (Caps)
Protect and keep badly decayed or fractured teeth.
The Problem:
- Badly decayed teeth
- Fractured teeth
- Need to protect and strengthen teeth
- Tooth has had a baby root canal "pulpotomy"
The Solution:
A crown (often called a cap) covers the tooth and restores it to its original shape and size. Decay is removed and cleaned from the tooth and a preformed crown is placed over the tooth. Unlike adult crowns, in which the crown is made to fit the tooth, which require 2 appointments, baby crowns are placed in one visit, because the tooth is prepared to fit the crown.
Advantages:
Crowns are incredibly strong due to the fact that they cover the entire tooth. This protects and strengthens the remaining tooth structure. They are the best chance for survival of a tooth that has had a baby root canal.
Disadvantages:
Crowns are excellent restorations and have few disadvantages.
Most children's crowns are silver in color. Our office does provide a white alternative, which is a stainless steel crown with composite fused on to the metal. These crowns are more costly than the silver crowns and the facing has a possibility of chipping, exposing the silver color underneath.
Alternatives:
Typically there are no good alternatives to crowns. If the tooth has sustained enough damage to require a crown then the best prognosis for the tooth is to receive the crown. Placing a filling on a tooth that should have a crown will likely result in fracture, recurrent decay, and loss of that tooth.
Pulpotomy, "Baby Root Canal"
The Problem:
Decay that has reached the nerve/pulp of the baby tooth.
The Solution:
Like adult root canals, the dentist will access the nerve chamber of the tooth, and remove some of the nerve/pulp of the tooth. Unlike adult root canals, this is a very short procedure, as only part of the pulp needs to be removed, and does not require the time consuming filing of adult root canals.
Advantages:
- If the tooth has been symptomatic this procedure will likely alleviate the pain
- Allows for the tooth to be preserved until it is ready to fall out naturally
Disdvantages:
Pulpotomies have a 90% success rate. Occasionally, the nerve of the tooth is so badly damaged that it does not respond to pulp therapy, resulting in the need for extraction of the offending tooth. Certain circumstances increase the likelihood of failure with pulpotomies, your dentist will discuss your child's situation with you during diagnosis.
Alternatives:
The only alternative to a pulpotomy is extraction, and placement of a space maintainer. However, if it is possible to save the baby tooth, this is the best alternative because it preserves the appropriate spacing for the adult dentition.
Space Maintainers
The problem:
- Premature loss of baby tooth
The solution:
Space maintainer -- a combination of bands and wires designed to hold the remaining teeth in a position that will allow the future permanent tooth to erupt in the proper location.
Advantages:
Prompt placement of a space maintainer will give the permanent tooth the best chance of erupting in the mouth in the correct location. This will minimize orthodontic problems caused by premature loss of a baby tooth.
Disadvantages:
Your child will need to wear the appliance until the permanent tooth erupts. If not kept clean decay can occur under the bands.
Alternatives:
If a space maintainer is not placed, the teeth will shift into the open area, making it difficult or in some cases impossible for the permanent tooth to erupt. This requires orthodontics to remedy.
POST-OP CARE
Extractions
BLEEDING
Most of the bleeding should have subsided by the time you have left the office. It is important to keep pressure on the extraction area for about 20 minutes after extraction. This can be done with the gauze provided when you left the office. If the place where your child’s tooth was begins to bleed again, have the child bite on wet gauze or a tea bag for 20 minutes.
SWELLING
Most likely swelling after an extraction is due to your child biting the area that was anesthetized without realizing it. Place ice bags around the area if it is the day of extraction, and warm compresses the days after. Call to make an appointment to evaluate the severity of the swelling. If the swelling is rapidly progressing call us as soon as possible.
Space Maintainers
DISCOMFORT AFTER CEMENTATION
Expect some discomfort after a space maintainer is placed. They are similar to braces because they do not allow the teeth to move as much as they did before. The discomfort should resolve in 2-3 days. Children's Motrin and a soft diet during this time will help ease your child’s discomfort.
CAME LOOSE
If the appliance is very loose and can be easily removed from mouth, take appliance out and place in a safe place. If slightly loose, leave in mouth. Call for an appointment to have appliance recemented as soon as possible.
TEETH ARE COMING IN
If the adult teeth are starting to erupt where the prematurely lost baby was please make an appointment to have your child evaluated for the removal of the space maintainer.
Oral Sedation
EATING BEFORE THE APPOINTMENT
Your child should have nothing to eat or drink 6 hours before the appointment. This is extremely important to the health and safety of your child.
EATING AFTER THE APPOINTMENT
Start by giving your child water or apple juice after the appointment when they request it. Feeding your child to quickly, or feeding them heavy foods immediately after sedation will likely result in nausea and vomiting.
If your child can tolerate the apple juice, move to soft foods such as yogurt, pudding, etc. Gradually increase to normal foods as they are able to tolerate it.
SLEEPING
Your child will likely go home and take a nap after sedation. This is normal. Place them on their side. Do not leave your child unattended, or place anything (such as gauze) in their mouth while they are sleeping.
ACTIVITY
It is best that your child rest for the remainder of the day. Watching videos at home is an excellent idea. Your child may resume normal activity the day after their appointment if they feel able. Some children may not feel up to normal play and may seem "hung over" from the medications. Encourage clear liquids to help clear the medication from their system.
Remember, your child is not as awake as they think they are, avoid swimming, biking, vigorous activity for the remainder of the day.
ORAL HYGIENE
A fluoride varnish was placed on your child's teeth during the sedation. It is the orange colored material you see in their mouth. This will brush off, and the teeth will be back to their normal color. It is best to leave the varnish on overnight, so no brushing is needed the day of sedation. You can, and should, resume normal hygiene practices the day after sedation.
Please call our office if you have any questions or concerns after your appointment. We know it is a stressful event for the parents and it is often difficult to remember all the instructions, so don't hesitate to call with questions or concerns.
Filling/Crowns
PAIN
It is normal for your child to have some soreness in the area they had treatment done. Children's Tylenol or Motrin should alleviate the pain. If your child is still having difficulties after a day or two, please call the office for a follow up appointment. If the pain is severe, not alleviated by pain medications, or swelling occurs please call as soon as possible to discuss the situation with the doctor.
SWELLING
If your child experiences swelling after treatment, it is likely due to lip biting in the anesthetized area. However, if you do not see teeth marks in the area and the swelling is increasing please call the office as soon as possible.
LIP BITING
Often children will bite themselves in the area they were anesthetized without realizing it. The area can become quite swollen and painful. Your child will need to remain on a soft diet until the area heals to avoid re-injuring themselves. Give Children's Motrin/Tylenol as needed for the pain.
Cleaning
What do I do if my child has a stomach ache or has vomited?
During your child's dental cleaning, fluoride was placed on the teeth to help strengthen the enamel. Fluoride is irritating to the stomach if swallowed. Your child may have swallowed a small amount of fluoride during their treatment. You may give your child a glass of milk to help neutralize the fluoride.