Procedures

Whether your childs dental needs are a complete exam and cleaning, a full-mouth restoration, or anything in between, we promise to provide you with exceptional care as we enhance the natural beauty of your smile. Below are just some of the many procedures and services we regularly provide to our patients – with a gentle touch, and stunning results. Your smile is our first priority, and we’ll give you something to smile about.

If you have any questions, concerns, or would like to schedule an appointment, please contact us today. We look forward to providing you with the personal care you deserve.

According to AAPD (American Academy of Pediatric Dentistry) guidelines, infants should initially visit the pediatric dentist around the time of their first birthday.  First visits can be stressful for parents, especially for parents who have dental phobias themselves.

It is imperative for parents to continually communicate positive messages about dental visits (especially the first one), and to help the child feel as happy as possible about visiting the dentist.

How can I prepare for my child’s first dental visit?

Pediatric dentists are required to undergo extensive training in child psychology.  Their dental offices are generally colorful, child-friendly, and boast a selection of games, toys, and educational tools.  Pediatric dentists (and all dental staff) aim to make the child feel as welcome as possible during all visits.

There are several things parents can do to make the first visit enjoyable.  Some helpful tips are listed below:

Take another adult along for the visit – Sometimes infants become fussy when having their mouths examined.  Having another adult along to soothe the infant allows the parent to ask questions and to attend to any advice the dentist may have.

Leave other children at home – Other children can distract the parent and cause the infant to fuss.  Leaving other children at home (when possible) makes the first visit less stressful for all concerned.

Avoid threatening language – Pediatric dentists and staff are trained to avoid the use of threatening language, like drills, needles, injections, and bleeding.  It is imperative for parents to use positive language when speaking about dental treatment with their child.

Provide positive explanations – It is important to explain the purposes of the dental visit in a positive way.  Explaining that the dentist “helps to keep teeth healthy” is far better than explaining that the dentist “is checking for tooth decay, and may have to drill the tooth if decay is found.”

Explain what will happen – Anxiety can be vastly reduced if the child knows what to expect.  Age-appropriate books about visiting the dentist can be very helpful in making the visit seem fun. Here is a list of parent and dentist-approved books:

The Berenstain Bears Visit the Dentist – by Stan and Jan Berenstain.

Show Me Your Smile: A Visit to the Dentist – Part of the “Dora the Explorer” Series.

Going to the Dentist – by Anne Civardi.

Elmo Visits the Dentist – Part of the “Sesame Street” Series.

What will happen during the first visit?

There are several goals for the first dental visit.  First, the pediatric dentist and the child need to get properly acquainted.  Second, the dentist needs to monitor tooth and jaw development to get an idea of the child’s overall health history.  Third, the dentist needs to evaluate the health of the existing teeth and gums.  Finally, the dentist aims to answer questions and advise parents on how to implement a good oral care regimen.

The following sequence of events is typical of an initial “well baby checkup”:

Dental staff will greet the child and parents.

The infant/family health history will be reviewed (this may include questionnaires).

The pediatric dentist will address parental questions and concerns.

More questions will be asked, generally pertaining to the child’s oral habits, pacifier use, general development, tooth alignment, tooth development, and diet.

The dentist will provide advice on good oral care, how to prevent oral injury, fluoride intake, and sippy cup use.

The infant’s teeth will be examined. Generally, the dentist and parent sit facing each other.  The infant is positioned so that his or her head is cradled in the dentist’s lap.  This position allows the infant to look at the parent during the examination.

Good brushing and flossing demonstrations will be provided.

The state of the child’s oral health will be described in detail, and specific recommendations will be made.  Recommendations usually relate to oral habits, appropriate toothpastes and toothbrushes for the child, orthodontically correct pacifiers, and diet.

The dentist will detail which teeth may appear in the following months.

The dentist will outline an appointment schedule and describe what will happen during the next appointment.

If you have questions or concerns about your child’s first dental visit, please contact the pediatric dentist.

Dental radiographs, also known as dental X-rays, are important diagnostic tools in pediatric dentistry.  Dental radiographs allow the dentist to see and treat problems like childhood cavities, tooth decay, orthodontic misalignment, bone injuries, and bone diseases before they worsen.  These issues would be difficult (in some cases impossible) to see with the naked eye during a clinical examination.

The American Academy of Pediatric Dentistry (AAPD) approves the use of dental radiographs for diagnostic purposes in children and teenagers.  Although radiographs only emit tiny amounts of radiation and are safe to use on an occasional basis, the AAPD guidelines aim to protect young people from unnecessary X-ray exposure.

What are dental X-rays used for?

Dental x-rays are extremely versatile diagnostic tools.  Some of their main uses in pediatric dentistry include:

Assessing the amount of space available for incoming teeth.

Checking whether primary teeth are being shed in good time for adult teeth to emerge.

Evaluating the progression of bone disease.

Monitoring and diagnosing tooth decay.

Planning treatment (especially orthodontic treatment).

Revealing bone injuries, abscesses, and tumors.

Revealing impacted wisdom teeth.

When will my child need dental X-rays?

Individual circumstances dictate how often a child needs to have dental radiographs taken.  Children at higher-than-average risk of childhood tooth decay (as determined by the pediatric dentist) may need biannual radiographs to monitor changes in the condition of the teeth.  Likewise, children who are at high risk for orthodontic problems, for example, malocclusion, may also need sets of radiographs taken more frequently for monitoring purposes.

Children at average or below average risk for tooth decay and orthodontic problems should have a set of dental X-rays taken every one to two years.  Even in cases where the pediatric dentist suspects no decay at all, it is still important to periodically monitor tooth and jaw growth – primarily to ensure there is sufficient space available for incoming permanent teeth.

If the oral region has been subject to trauma or injury, the pediatric dentist may want to X-ray the mouth immediately.  Developments in X-ray technology mean that specific areas of the mouth can be targeted and X-rayed separately, reducing the amount of unnecessary X-ray exposure.

What precautions will be taken to ensure my child’s safety?

Though dental radiographs are perfectly safe for use on children, the pediatric dentist will take several precautions to ensure the X-ray process does not unduly damage the child’s cells and bodily tissues.

First, the child will be covered in a lead apron to protect the body from unnecessary exposure.  Second, the dentist will use shields to protect the parts of the face that are not being X-rayed.  Finally, the pediatric dentist will use high-speed film to reduce radiation exposure as much as possible.

If you have questions or concerns about dental radiographs or X-rays, please contact your pediatric dentist.

Tooth decay has become increasingly prevalent in preschoolers.  Not only is tooth decay unpleasant and painful, it can also lead to more serious problems like premature tooth loss and childhood periodontal disease.

Dental sealants are an important tool in preventing childhood caries (cavities) and tooth decay.  Especially when used in combination with other preventative measures, like biannual checkups and an excellent daily home care routine, sealants can bolster the mouth’s natural defenses, and keep smiles healthy.

How do sealants protect children’s teeth?

In general, dental sealants are used to protect molars from oral bacteria and harmful oral acids.  These larger, flatter teeth reside toward the back of the mouth and can be difficult to clean.  Molars mark the site of four out of five instances of tooth decay.  Decay-causing bacteria often inhabit the nooks and crannies (pits and fissures) found on the chewing surfaces of the molars.  These areas are extremely difficult to access with a regular toothbrush.

If the pediatric dentist evaluates a child to be at high risk for tooth decay, he or she may choose to coat additional teeth (for example, bicuspid teeth).  The sealant acts as a barrier, ensuring that food particles and oral bacteria cannot access vulnerable tooth enamel.

Dental sealants do not enhance the health of the teeth directly, and should not be used as a substitute for fluoride supplements (if the dentist has recommended them) or general oral care.  In general however, sealants are less costly, less uncomfortable, and more aesthetically pleasing than dental fillings.

How are sealants applied?

Though there are many different types of dental sealant, most are comprised of liquid plastic.  Initially, the pediatric dentist must thoroughly clean and prepare the molars, before painting sealant on the targeted teeth.  Some sealants are bright pink when wet and clear when dry.  This bright pink coloring enables the dentist to see that all pits and fissures have been thoroughly coated.

When every targeted tooth is coated to the dentist’s satisfaction, the sealant is either left to self-harden or exposed to blue spectrum natural light for several seconds (depending on the chemical composition of the specific brand).  This specialized light works to harden the sealant and cure the plastic.  The final result is a clear (or whitish) layer of thin, hard, durable sealant.

It should be noted that the “sealing” procedure is easily completed in one office visit, and is entirely painless.

When should sealants be applied?

Sealants are usually applied when the primary (baby) molars first emerge.  Depending on the oral habits of the child, the sealants may last for the life of the primary tooth, or need replacing several times.  Essentially, sealant durability depends on the oral habits of the individual child.

Pediatric dentists recommend that permanent molars be sealed as soon as they emerge.  In some cases, sealant can be applied before the permanent molar is full grown.

The health of the sealant must be monitored at biannual appointments.  If the seal begins to lift off, food particles may become trapped against the tooth enamel, actually causing tooth decay.

If you have questions or concerns about dental sealants, please contact your pediatric dentist.

In contrast to general anesthesia (which renders the child unconscious), dental sedation is only intended to reduce the child’s anxiety and discomfort during dental visits.  In some cases, the child may become drowsy or less active while sedated, but this will quickly desist after the procedure is completed.

When is sedation used?

Sedation is used in several circumstances.  Firstly, very young children are often unable keep still for long enough for pediatric dentist to perform high-precision procedures safely. Sedation makes the visit less stressful for both children and adults and vastly reduces the risk of injury.  Secondly, some children struggle to manage anxiety during dental appointments.  Sedation helps them to relax, cope, and feel happier about treatment.  Thirdly, sedation is particularly useful for children with special needs. It prevents spontaneous movement, and guides cooperative behavior.

What are the most common types of sedation?

Most pediatric dentists have several sedation options available, and each one comes with its own particular benefits.  The dentist will assess the medical history of the child, the expected duration of the procedure, and the child’s comfort level before recommending a method of sedation.

Conscious sedation allows children to continually communicate, follow instructions, and cooperate during the entire procedure.  The major methods of conscious sedation are described below:

Nitrous oxide – The pediatric dentist may recommend nitrous oxide (more commonly known as “laughing gas”) for children who exhibit particular signs of nervousness or anxiety.  Nitrous oxide is delivered via a mask, which is placed over the child’s nose.  Nitrous oxide is always combined with oxygen – meaning that the child can comfortably breathe in through the nose and out through the mouth.

Laughing gas relaxes children extremely quickly, and can produce happy, euphoric behavior.  It is also quick acting, painless to deliver, and wears off within a matter of minutes.  Before removing the mask completely, the pediatric dentist delivers regular oxygen for several minutes, to ensure the nitrous oxide is eliminated from the child’s body.  On rare occasions, nitrous oxide may cause nausea. For this reason, most pediatric dentists suggest minimal food intake prior to the appointment.

Oral sedation – Children who are uncooperative, particularly anxious, or unable to control their muscles for prolonged periods, may be offered an oral sedative.  Oral sedatives come in many different forms (usually tablets, pills, and liquids), and may make the child feel drowsy.  If oral sedatives are to be used, the pediatric dentist may require parents to prepare the child before the appointment.  Some common preparatory measures may include: limiting food and fluid intake prior to the appointment, having the child wear comfortable clothing to the appointment, and preparing to stay with the child for several hours after the appointment.  Oral sedatives rarely produce serious side effects – nausea is among the most common.

Other forms of conscious sedation – Other less common ways to administer sedatives include intravenous (IV sedation), the use of suppositories, and even the use of a nasal spray.  In most cases, the method of delivery may change, but the chemical nature of the sedative remains the same.

What about general anesthetic?

General anesthetic (which puts the child in a deep sleep), is rarely used in dental work unless:

A procedure cannot otherwise be performed safely.

The child has a condition which limits cooperation or the ability to follow instructions.

The child needs a lengthy treatment.

The child needs more complex dental treatment or oral surgery.

General anesthetic requires more intensive preparation before the treatment and a longer period of recovery after the treatment.  Conscious sedation is usually favored wherever possible.

If you have questions or concerns about sedation techniques, please contact your pediatric dentist.

Although dental injuries and dental emergencies are often distressing for both children and parents, they are also extremely common.  Approximately one third of children have experienced some type of dental trauma, and more have experienced a dental emergency.

There are two peak risk periods for dental trauma – the first being toddlerhood (18-40 months) when environmental exploration begins, and the second being the preadolescent/adolescent period, when sporting injuries become commonplace.

Detailed below are some of the most common childhood dental emergencies, in addition to helpful advice on how to deal with them.

Toothache

Toothache is common in children of all ages and rarely occurs without cause.  Impacted food can cause discomfort in young children, and can be dislodged using a toothbrush, a clean finger, or dental floss.  If pain persists, contact the pediatric dentist.  Some common causes of toothache include: tooth fractures, tooth decay, tooth trauma, and wisdom teeth eruption (adolescence).

How you can help:

Cleanse the area using warm water.  Do not medicate or warm the affected tooth or adjacent gum area.

Check for impacted food and remove it as necessary.

Apply a cold compress to the affected area to reduce swelling.

Contact the pediatric dentist to seek advice.

Dental avulsion (knocked-out tooth)

If a tooth has been knocked-out of the child’s mouth completely, it is important to contact the pediatric dentist immediately.  In general, pediatric dentists do not attempt to reimplant avulsed primary (baby) teeth, because the reimplantation procedure itself can cause damage to the tooth bud, and thereby damage the emerging permanent tooth.

Pediatric dentists always attempt to reimplant avulsed permanent teeth, unless the trauma has caused irreparable damage.  The reimplantation procedure is almost always more successful if it is performed within one hour of the avulsion, so time is of the essence!

How you can help:

Recover the tooth.  Do not touch the tooth roots! Handle the crown only.

Rinse off dirt and debris with water without scrubbing or scraping the tooth.

For older children, insert the tooth into its original socket using gentle pressure, or encourage the child to place the tooth in the cheek pouch.  For younger children, submerge the tooth in a glass of milk or saliva (do not attempt to reinsert the tooth in case the child swallows it).

Do not allow the tooth to dry during transportation.  Moisture is critically important for reimplantation success.

Visit the pediatric dentist (where possible) or take the child to the Emergency Room immediately –time is critical in saving the tooth.

Dental intrusion (tooth pushed into jawbone)

Sometimes, dental trauma forces a tooth (or several teeth) upwards into the jawbone.  The prognosis is better for teeth that have been pushed up to a lesser extent (less than 3mm), but every situation is unique.  Oftentimes, the force of the trauma is great enough to injure the tooth’s ligament and fracture its socket.

If dental intrusion of either the primary or permanent teeth is suspected, it is important to contact the pediatric dentist immediately.  Depending on the nature and depth of the intrusion, the pediatric dentist will either wait for the tooth to descend naturally, or perform root canal therapy to preserve the structure of the tooth.

How you can help:

Rinse the child’s mouth with cold water.

Place ice packs around affected areas to reduce swelling.

Offer Tylenol for pain relief.

Contact the pediatric dentist where possible, or proceed to the Emergency Room.

Tooth luxation/extrusion/lateral displacement (tooth displacement)

Tooth displacement is generally classified as “luxation,” “extrusion,” or “lateral displacement,” depending on the orientation of the tooth following trauma.  A luxated tooth remains in the socket – with the pulp intact about half of the time.  However, the tooth protrudes at an unnatural angle and the underlying jawbone is oftentimes fractured.

The term “extrusion” refers to a tooth that has become partly removed from its socket.  In young children, primary tooth extrusions tend to heal themselves without medical treatment.  However, dental treatment should be sought for permanent teeth that have been displaced in any manner in order to save the tooth and prevent infection.  It is important to contact the pediatric dentist if displacement is suspected.

How you can help:

Place a cold, moist compress on the affected area.

Offer pain relief (for example, Children’s Tylenol).

Contact the pediatric dentist immediately.

Crown fracture

The crown is the largest, most visible part of the tooth.  In most cases, the crown is the part of the tooth that sustains trauma.  There are several classifications of crown fracture, ranging from minor enamel cracks (not an emergency) to pulp exposure (requiring immediate treatment).

The pediatric dentist can readily assess the severity of the fracture using dental X-rays, but any change in tooth color (for example, pinkish or yellowish tinges inside the tooth) is an emergency warning sign.  Minor crown fractures often warrant the application of dental sealant, whereas more severe crown fractures sometimes require pulp treatments.  In the case of crown fracture, the pediatric dentist should be contacted. Jagged enamel can irritate and inflame soft oral tissues, causing infection.

How you can help:

Rinse the child’s mouth with warm water.

Place a cold, moist compress on the affected area.

Offer strong pain relief (for example, Children’s Tylenol).

Pack the tooth with a biocompatible material.

Visit the pediatric dentist or Emergency Room depending on availability and the severity of the injury.

Root fracture

A root fracture is caused by direct trauma, and isn’t noticeable to the naked eye.  If a root fracture is suspected, dental x-rays need to be taken.  Depending on the exact positioning of the fracture and the child’s level of discomfort, the tooth can be monitored, treated, or extracted as a worse case scenario.

How you can help:

Place a cold, moist compress on the affected area.

Offer pain relief (for example, Children’s Tylenol).

Contact the pediatric dentist.

Dental concussion

A tooth that has not been dislodged from its socket or fractured, but has received a bang or knock, can be described as “concussed.”  Typically occurring in toddlers, dental concussion can cause the tooth to discolor permanently or temporarily.  Unless the tooth turns black or dark (indicating that the tooth is dying and may require root canal therapy), dental concussion does not require emergency treatment.

Injured cheek, lip or tongue

If the child’s cheek, lip or tongue is bleeding due to an accidental cut or bite, apply firm direct pressure to the area using a clean cloth or gauze.  To reduce swelling, apply ice to the affected areas.  If the bleeding becomes uncontrollable, proceed to the Emergency Room or call a medical professional immediately.

Fractured jaw

If a broken or fractured jaw is suspected, proceed immediately to the Emergency Room.  In the meantime, encourage the child not to move the jaw.  In the case of a very young child, gently tie a scarf lengthways around the head and jaw to prevent movement.

Head injury/head trauma

If the child has received trauma to the head, proceed immediately to the Emergency Room.  Even if consciousness has not been lost, it is important for pediatric doctors to rule out delayed concussion and internal bleeding.

If you have questions about dental emergencies, please ask your pediatric dentist.

Orthodontic treatment is primarily used to prevent and correct “bite” irregularities.  Several factors may contribute to such irregularities, including genetic factors, the early loss of primary (baby) teeth, and damaging oral habits (such as thumb sucking and developmental problems).

Orthodontic irregularities may be present at birth or develop during toddlerhood or early childhood.  Crooked teeth hamper self-esteem and make good oral homecare difficult, whereas straight teeth help minimize the risk of tooth decay and childhood periodontal disease.

During biannual preventative visits, the pediatric dentist is able to utilize many diagnostic tools to monitor orthodontic irregularities and, if necessary, implement early intervention strategies.  Children should have an initial orthodontic evaluation before the age of eight.

Why does early orthodontic treatment make sense?

Some children display early signs of minor orthodontic irregularities.  In such cases, the pediatric dentist may choose to monitor the situation over time without providing intervention.  However, for children who display severe orthodontic irregularities, early orthodontic treatment can provide many benefits, including:

Enhanced self-confidence and esthetic appearance.

Increased likelihood of proper jaw growth.

Increased likelihood of properly aligned and spaced adult teeth.

Reduced risk of bruxing (grinding of teeth).

Reduced risk of childhood cavities, periodontal disease, and tooth decay.

Reduced risk of impacted adult teeth.

Reduced risk of protracted orthodontic treatments in later years.

Reduced risk of speech problems.

Reduced risk of tooth, gum, and jawbone injury.

When can my child begin early orthodontic treatment?

Pediatric dentists recognize three age-related stages of orthodontic treatment.  These stages are described in detail below.

Stage 1: Early treatment (2-6 years old)

Early orthodontic treatment aims to guide and regulate the width of both dental arches.  The main goal of early treatment is to provide enough space for the permanent teeth to erupt correctly.  Good candidates for early treatment include: children who have difficulty biting properly, children who lose baby teeth early, children whose jaws click or grind during movement, bruxers, and children who use the mouth (as opposed to the nose AND mouth) to breathe.

During the early treatment phase, the pediatric dentist works with parents and children to eliminate orthodontically harmful habits, like excessive pacifier use and thumb sucking.  The dentist may also provide one of a variety of dental appliances to promote jaw growth, hold space for adult teeth (space maintainers), or to prevent the teeth from “shifting” into undesired areas.

Stage 2: Middle dentition (6-12 years old)

The goals of middle dentition treatments are to realign wayward jaws, to start to correct crossbites, and to begin the process of gently straightening misaligned permanent teeth.  Middle dentition marks a developmental period when the soft and hard tissues are extremely pliable.  In some ways therefore, it marks an optimal time to begin to correct a severe malocclusion.

Again, the dentist may provide the child with a dental appliance.  Some appliances (like braces) are fixed and others are removable.  Regardless of the appliance, the child will still be able to speak, eat, and chew in a normal fashion.  However, children who are fitted with fixed dental appliances should take extra care to clean the entire oral region each day in order to reduce the risk of staining, decay, and later cosmetic damage.

Stage 3: Adolescent dentition (13+ years old)

Adolescent dentition is what springs to most parents’ minds when they think of orthodontic treatment.  Some of the main goals of adolescent dentition include straightening the permanent teeth, and improving the esthetic appearance of the smile.

Most commonly during this period, the dentist will provide fixed or removable “braces” to gradually straighten the teeth.  Upon completion of the orthodontic treatment, the adolescent may be required to wear a retainer in order to prevent the regression of the teeth to their original alignment.

If you have questions or concerns about orthodontic treatment, please contact your pediatric dentist.

Mouth guards, also known as sports guards or athletic mouth protectors, are crucial pieces of equipment for any child participating in potentially injurious recreational or sporting activities.  Fitting snugly over the upper teeth, mouth guards protect the entire oral region from traumatic injury, preserving both the esthetic appearance and the health of the smile.  In addition, mouth guards are sometimes used to prevent tooth damage in children who grind (brux) their teeth at night.

The American Academy of Pediatric Dentistry (AAPD) in particular, advocates for the use of dental mouth guards during any sporting or recreational activity.  Most store-bought mouth guards cost fewer than ten dollars, making them a perfect investment for every parent.

How can mouth guards protect my child?

The majority of sporting organizations now require that participants routinely wear mouth guards.  Though mouth guards are primarily designed to protect the teeth, they can also vastly reduce the degree of force transmitted from a trauma impact point (jaw) to the central nervous system (base of the brain).  In this way, mouth guards help minimize the risk of traumatic brain injury, which is especially important for younger children.

Mouth guards also reduce the prevalence of the following injuries:

Cheek lesions

Concussions

Gum and soft tissue injuries

Jawbone fractures

Lip lesions

Neck injuries

Tongue lesions

Tooth fractures

What type of mouth guard should I purchase for my child?

Though there are literally thousands of mouth guard brands, most brands fall into three major categories: stock mouth guards, boil and bite mouth guards, and customized mouth guards.

Some points to consider when choosing a mouth guard include:

How much money is available to spend?

How often does the child play sports?

What kind of sport does the child play? (Basketball and baseball tend to cause the most oral injuries).

In light of these points, here is an overview of the advantages and disadvantages of each type of mouth guard:

Stock mouth guards – These mouth guards can be bought directly off the shelf and immediately fitted into the child’s mouth.  The fit is universal (one-size-fits-all), meaning that that the mouth guard doesn’t adjust.  Stock mouth guards are very cheap, easy to fit, and quick to locate at sporting goods stores.  Pediatric dentists favor this type of mouth guard least, as it provides minimal protection, obstructs proper breathing and speaking, and tends to be uncomfortable.

Boil and bite mouth guards – These mouth guards are usually made from thermoplastic and are easily located at most sporting goods stores.  First, the thermoplastic must be immersed in hot water to make it pliable, and then it must be pressed on the child’s teeth to create a custom mold.  Boil and bite mouth guards are slightly more expensive than stock mouth guards, but tend to offer more protection, feel more comfortable in the mouth, and allow for easy speech production and breathing.

Customized mouth guards – These mouth guards offer the greatest degree of protection, and are custom-made by the dentist.  First, the dentist makes an impression of the child’s teeth using special material, and then the mouth guard is constructed over the mold.  Customized mouth guards are more expensive and take longer to fit, but are more comfortable, orthodontically correct, and fully approved by the dentist.

If you have questions or concerns about choosing a mouth guard for your child, please contact your pediatric dentist.

Though many parents think of “teenagers” when presented with the term “dental appliances,” the use of such appliances in young children is very common.  Some dental appliances may be recommended for preventative purposes, while others may be recommended for treatment purposes.

It can be extremely difficult to encourage young children to wear removable dental appliances regularly, but there is some good news.  Pediatric dental appliances can prevent injury to the teeth and may also reduce (or even eliminate) the need for extensive treatment later.

What types of pediatric dental appliance are most common?

There are many types of pediatric dental appliances – each one fulfilling a different dental function.  The major categories of pediatric dental appliance are described below:

Mouth Guards

The American Academy of Pediatric Dentistry (AAPD) and American Dental Association (ADA) recommend that children wear mouth guards when engaging in any potentially injurious activity, including sporting and recreational endeavors.

The pediatric dentist can craft a customized mouth guard for the child, or a thermoplastic “boil-and-bite” mouth guard can be purchased at a sporting goods store.  Similar mouth guards are used for children who “brux” or grind their teeth at night.

Space Maintainers

Sometimes, primary (baby) teeth are lost prematurely due to trauma or decay.  Adjacent teeth tend to shift to fill the space, causing spacing and alignment problems for permanent (adult) teeth.  Space maintainers or “spacers” are inserted as placeholders until the permanent teeth are ready to erupt.  There are two main types of space maintainer:

Fixed space maintainers – Depending on the position of the missing tooth and the condition of the surrounding teeth, the pediatric dentist may adhere a “band and loop,” a “crown and loop,” or a “distal shoe” type of spacer to fill the empty gap.  All spacers fulfill the same function; just the nature of the attachment to the adjacent teeth differs.  Fixed spacers are usually made of metal and are highly durable.  If a highly visible tooth is missing, an acrylic button may be added to reduce the esthetic impact.

Removable space maintainers – Removable spacers are rarely used with young children.  Working a little like orthodontic retainers, special plastic parts fit into the empty slot to prevent the “drifting” of adjacent teeth.

Thumb Sucking Appliances

The majority of children naturally outgrow their thumb-sucking habit.  However, children who continue to thumb suck after the age of five or six (especially vigorously) risk oral complications.  These complications include: narrowed arches, impacted teeth, and misaligned teeth.  The “palatal crib” appliance usually stops thumb sucking immediately.

The “crib” is crafted and affixed to the teeth by the pediatric dentist, almost like a barely visible set of dental braces.  Preventing the thumb from reaching the roof of the mouth reduces gratification – and breaks the habit very quickly.  Removable variations of the “crib” are also available, and can be used depending on the age of the child and his or her willingness to cooperate.

Expansion Appliances

An overbite, where the upper front teeth protrude over the lower front teeth, can be corrected with an expansion appliance, as can a crossbite.  The expansion appliance is used to stretch and widen the arch, providing enough space for the teeth to be realigned in a straight manner.  Expansion appliances are custom-made, and can be affixed to the inside or the outside of the teeth.  Children born with a cleft palate may be required to wear an expansion appliance to prepare the jaw for oral surgery.

Bionator

If the pediatric dentist suspects that the child’s jaws are not growing in proportion to one another, a bionator device may be recommended.  In general, the bionator positions the lower jaw forward, helping the teeth to erupt and align properly.  This dental appliance is successful in reducing extensive orthodontic treatments later on, and helps to promote natural-looking alignment.

If you have questions or concerns about dental appliances, please contact your pediatric dentist.

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