Paediatric Dentist

What is a Paediatric Dentist?

_AC04507What is a Paediatric Dentist? A Paediatric Dentist is dedicated to the oral health of children from infancy through to teenage years. At just 6 months after birth, children begin to grow their baby teeth which they later lose at around age 6 or 7. They normally develop 20 baby teeth – 10 in their upper jaw and 10 in their lower jaw.  These baby teeth (also known as deciduous teeth, milk teeth or baby teeth) will be replaced with permanent teeth which will hopefully be with them for most of their adult life.  (The very young, pre-teen and teenagers all need different approaches in dealing with their behaviour, guiding their dental growth and development, and helping them avoid future dental problems.The Paediatric Dentist is qualified to meet these needs.

In the same way that paediatricians are trained to meet a child’s medical needs, paediatric dentists are uniquely qualified to protect your child’s oral health using the most advanced techniques, and all in our delightfully friendly treatment area. A paediatric dentist learns how to deal with the behavioral aspects of children, and how to make them feel comfortable, so that they will have a wonderful visit. They also are trained and qualified to treat special needs patients.

Dr. Audrey Camilleri, a fully qualified peadiatric dentist at our dental clinic, strives to provide the highest level of preventative and comprehensive dental care for each child, including children with special healthcare needs. Her focus is on prevention and education in collaboration with each parent and child.  She values continuing education and professional development both for herself and for her team. She believes in embracing the latest paediatric dentistry technology and her new equipment improves each child’s level of discomfort, time in the chair and overall dental care. An intra oral camera gives her the ability to show children what she is doing and educate them on their oral care.

Why Restore Baby Teeth?

A common question asked of the dentist is: Why do we have to fix the baby teeth? They are going to fall out anyway. There are a number of reasons baby teeth are important and should be maintained properly. 1. These are the only teeth the child has at this point in life. Even though baby teeth are thought to be only “temporary” teeth, this temporary time period spans over the first 12 years of the child’s life. From the time the first tooth erupts into the mouth (usually around 6 months of age) until the last baby tooth is lost (usually around 12 years of age), the child has baby teeth in the mouth (either all baby teeth or a combination of baby teeth and permanent teeth). The baby teeth are as important to the child at this time as the permanent teeth are to you and me. The anatomy of the baby teeth is similar to the permanent teeth and is just as susceptible to the decay process. Once the decay process has invaded the nerve chamber, the tooth may become abscessed, which results in pain and swelling. If left untreated, an abscessed baby tooth can become a life-threatening situation requiring hospitalization of the child. 2. They allow the child to eat properly. This is probably an obvious statement. The child with healthy baby teeth is able to eat properly due to the fact that they are pain-free and the teeth are present to aid chewing. 3. Baby teeth are designed to be natural space maintainers. The baby teeth serve as guides for the permanent teeth to erupt into normal position. When baby teeth are lost prematurely or severely broken down due to dental decay, abnormal shifting can occur prior to the permanent tooth erupting into the mouth. This can cause abnormal eruption, crowding and impaction of the permanent teeth, which can in turn lead to complicated orthodontic problems in the future. As you can see, although baby teeth are eventually lost, they play an important role while they are in the mouth. Proper care of the baby teeth can prevent many more complicated problems in the future. You can view our case studies to find more information.

Choosing a Restoration for Baby Teeth

When determining the best type of restoration for a baby tooth, many factors must be considered. Probably the most important factor to consider is that of durability. The main goal when restoring baby teeth is to place a restoration that is durable enough to last until that tooth is naturally lost. Restorations that are not durable can fall out before the tooth is naturally lost. This can lead to sensitivity, pain and possible infection of the tooth. An additional procedure for the same tooth would then be necessary, and it would require putting the child through another dental experience for the same tooth. Therefore, restoring baby teeth with the most durable restoration is the most sensible approach. The size of the cavity, the depth of the cavity and the location of the cavity on the tooth are also factors considered in determining the type of restoration of a baby tooth. The structure of some baby teeth is such that large fillings will not stay in over a long period of time. There are two main ways to restore baby teeth. One type of restoration is called a filling. Once the decay is cleaned out of a tooth, a filling is essentially placed in the “hole” where the decay was cleaned out. In small cavities, the “hole” is small and the filling is surrounded by normal tooth structure and will normally stay in long-term. However, in teeth where the decay has destroyed a large area of the tooth, extended to multiple surfaces or extended deep toward the nerve, cleaning out the tooth will make the “hole” too large for a filling to stay in. In these cases, the filling has a tendency to fall out or fracture. The second type of restoration, a crown, is used in situations where the decay has destroyed much of the tooth. A crown covers the entire tooth and, therefore, protects the tooth from further breakdown. A crown placed on a baby tooth will function as a normal baby tooth and fall out normally at the appropriate time. The procedure to place a crown on a baby tooth is totally different than the procedure used for a permanent tooth. The crown procedure on a baby tooth is accomplished in one appointment. There is no lab procedure involved and, consequently, the procedure is less costly. In most cases, baby teeth are restored with fillings. However, there are times when a crown is the restoration of choice for baby teeth due to the factors mentioned above. Each situation is evaluated on a case by case basis. If crowns are indicated on the front teeth, Dr. Bowden will recommend cosmetic tooth colored crowns to restore these teeth.

Pulpotomy (Partial Nerve Treatment)

As a cavity forms in a tooth, the natural decay process will destroy the enamel, then the dentin (the material beneath the enamel), and finally infect the nerve (pulp) of the tooth. As the nerve of the tooth becomes infected, normally the top area of the nerve becomes infected first and then the process spreads to the root of the tooth. If diagnosed early in the process, chances are that the infection may only be limited to the top part of the nerve and, in that case, the tooth may be saved and restored. The procedure used in this case is called a pulpotomy or partial nerve treatment. It involves removing the infected part of the nerve (the top part) and placing a medicated material into the nerve chamber. The lower part of the nerve is left intact. A stainless steel crown is then placed over the tooth to protect it from further breakdown. The crown will then function as the normal tooth would and be lost naturally at the appropriate age. The procedure will be accomplished with local anesthetic to completely numb the area to ensure the child’s comfort. Discomfort after a pulpotomy is usually very minimal. However, if the child does experience any discomfort, it is okay to give the child Children’s Tylenol or Motrin.

Stainless Steel Crowns

Stainless steel crowns are used very widely in pediatric dentistry for the restoration of large cavities in baby teeth. Durability is probably the most important factor when determining what type of restoration to be used in children. When restoring a baby tooth, it is important to use a material that will last until the tooth is naturally lost. Restorative materials such as silver filling material or bonding material have a tendency to fall out when placed in a large cavity in baby teeth. It is then necessary to perform another procedure on that tooth. This may become costly, and it requires the child to go through another dental experience on the same tooth. A stainless steel crown, on the other hand, has been shown to be the most durable restoration used in pediatric dentistry. Occasionally, a stainless steel crown may become loose and simply require recementation. The procedure to place a stainless steel crown is accomplished in one appointment. The tooth is prepared for the crown, the decay is removed, and then a pre-sized crown is fit and cemented. The crown is placed over the visible part of the crown of the tooth. This crown will function just as the natural tooth did, and the tooth with the crown will be lost naturally at the appropriate age. Although nothing is completely “child-proof,” the stainless steel crown is the restoration of choice for large cavities in baby teeth because it can normally withstand the rigors of childhood. The stainless steel crown is one restoration that will normally last until the baby tooth is lost naturally. As is the case with most restorative procedures, this procedure will be accomplished with the use of local anesthesia to completely numb the area to be restored. This will ensure complete comfort for the child. Sensitivity to hot and cold or even slight discomfort may be experienced for 2-3 days after the crown is placed. Children’s Tylenol or Motrin may be used if this occurs. Sometimes the child may complain that the bite feels different for the first few weeks as they adjust to the crown. This is not abnormal. Good oral hygiene is imperative so that the gums around the new crown may return to normal more quickly. Normal toothbrushing should be performed in this area.

Cosmetic Crowns

We offer tooth colored cosmetic crowns for baby teeth. Our office will be happy to discuss these with you at your appointment.

How is it applied?

The top surfaces of your teeth – where the chewing takes place – aren’t smooth and flat. They are cris-crossed with tiny hills and valleys – called pits and fissures. These are places where plaque can build up safe from your toothbrush and dental floss. Some of the pits and fissures are so narrow that even a single bristle from your toothbrush can’t get deep enough to clean them out. One method of preventing cavities from developing in the pits and fissures is to seal them off with a special varnish called a pit and fissure sealant. If your dentist determines that you need a pit and fissure sealant to help protect your teeth from decay, some special steps are taken to prepare the teeth first. Your dentist will clean the tooth first, then apply a mild acid solution to ‘etch’ the surface and make it easier for the pit and fissure sealant to stick. (The etching solution is the blue gel in the sealant video below). The whole procedure is quick and painless. Keeping the area dry and away from your saliva during the application is very important. If the tooth gets wet, the sealant might not stick properly. Once everything is ready, your dentist ‘paints’ the sealant right over the pits and fissures on the tooth surface. (Do you see it being painted on with a cotton swab in the video?). A special kind of light cures the sealant and makes it ready for use.

Is there anything that can help me with my fear of the dentist?

Yes. Some people are so frightened of the dentist that they will not go for dental treatment. They can overcome their fears with relaxation or sedation. Dentists today are sympathetic about these feelings, and you can ask your dentist about these ways to help.

What is sedation?

Your dentist may recommend an intravenous or IV sedation. This is given by injection, either in the back of your hand or in your arm. The dose will depend on the amount of treatment needed and the length of time it will take to complete.

How will IV sedation in the surgery affect me?

You become drowsy and unaware of any treatment, but you are still able to co-operate with the dentist. The effects of sedative medicine take some time to wear off and your dentist will tell you how long the drugs will take to clear from your body. You won’t be able to drink alcohol, drive or work machinery during this time.

What else can help?

You can be helped to feel relaxed by ‘relative analgesia’ sometimes known as inhalation sedation. This means breathing in a mixture of nitrous oxide and oxygen (‘laughing gas’) which quickly leads to a pleasant, relaxed feeling. The dentist puts you at ease at the same time, by talking softly and suggesting what you feel. You remain conscious all the time, although you may be a little drowsy, and any treatment given causes you no discomfort. You breathe in the mixture through a nosepiece, which is very comfortable. You can’t overdose on the gas, as the mixture quickly leaves the body if you breathe in one or two breaths of ordinary air. There are no after-effects either, and you can drive a car after about 15 minutes. Many dentists use this safe and effective technique.

How does relaxation work?

When we are faced with a challenge or something we’re afraid of, such as a visit to the dentist, our bodies produce substances, which raise our anxiety. However, we can train our bodies to work against this anxiety, by learning to relax. It’s not possible to be anxious and relaxed at the same time, so learning relaxation helps control our anxiety. If you are a mother, you may have learned some relaxation techniques in childbirth classes. In fact, almost anyone can learn them. You can practise at home. Some people find that meditation and yoga work well, too.

What about hypnosis?

Hypnosis is a way of relaxing where you concentrate on suggestions of relaxation given by the hypnotist. It’s a bit like daydreaming, although you are awake and in total control.

How do I know which technique is right for me?

Talk to your dentist. Most people can use relaxation techniques, but relative analgesia and sedation may not be suitable for everyone. Your dentist will tell you. You also need to tell your dentist about any medicines you may be taking, whether or not your doctor prescribes them.