Parents play a major role in preventive dentistry for their children by guiding them into an excellent oral hygiene routine, providing a healthy diet and scheduling their regular dental check-ups. At our practice, we like to teach preventive dentistry to all of our patients and their families. Our preventive methods include:
Over-retention of primary lower teeth is due to the delayed resorption of the roots due to lingual positioning of the permanent teeth, crowding of the permanent teeth, root canal obliteration (from trauma), or failure of endodontic obturation material to resorb. The timing of treatment is dependent on which arch is involved.
Lower Arch:
In the lower arch, if the primary tooth is mobile, we will usually monitor and allow the tooth to exfoliate on its own. We encourage "wiggling" the teeth with clean fingers for 1-3 months; most of the time, the teeth will exfoliate & no treatment is necessary. However if the tooth is not mobile and not exfoliated by age 8 or three quarters of the root of the permanent tooth is formed (from looking at the x-ray), the primary tooth should be extracted. Once the primary tooth is no longer present the permanent will migrate forward spontaneously.
Upper Arch:
In the upper arch, even if the primary teeth are mobile, they should be extracted to prevent the permanent tooth from erupting in cross-bite with the mandibular incisor. If the permanent tooth erupts in cross-bite, orthodontic intervention will be necessary to move the tooth into its proper position, as interference by the lower incisor will prevent spontaneous labial/forward migration.
If the permanent tooth is erupting labially, extraction of the primary tooth is not urgent.
Most people probably grind and clench their teeth from time to time. Occasional teeth grinding, also called bruxism, does not usually cause harm. However, when severe teeth grinding occurs on a regular basis the teeth can be damaged and other oral health complications can arise.
Bruxism is defined as habitual grinding of the teeth. It most often occurs at night but can occur when awake or asleep. The etiology of bruxism includes habit, emotional stress (eg response to anxiety, tension, anger, or pain), parasomnias, neurologic abnormalities, tooth malocclusion, and, rarely, a medication side-effect. Most often, however, the etiology of bruxism is unknown.
Bruxism is very common in young children. In fact, approximately 30% of children develop bruxism during the early-school years. Bruxism usually decreases by 7 to 8 years of age and stops before age 12, after eruption of all the permanent teeth.
For children younger than 10-12 years, treatment is usually not required. For older children, a dentist may recommend a mouth guard be worn at night.
Oral sucking habits are normal for babies and young children. Most children stop sucking on thumbs, fingers, and pacifiers on their own between two and four years of age. Usually, no harm is done to their teeth or jaws. In children who continue to suck on thumbs, fingers, and pacifiers, changes may be noted in tooth position and supporting bone structure.
At Park Smile, we recommend that children stop oral habits well before the eruption of their first permanent tooth, usually by the age of five. In children who continue with sucking habits, we recommend the use of positive reinforcement for motivation. The use of an oral appliance may be necessary if the habit persists.
A mouth guard should be a top priority on your child’s list of sports equipment. Athletic mouth protectors, or mouth guards, are made of soft plastic and fit comfortably to the shape of the upper teeth. They protect a child’s teeth, lips, cheeks and gums from sports-related injuries. Any mouth guard works better than no mouth guard, but a custom-fitted mouth guard fitted by one of our doctors is your child’s best protection against sports-related injuries.
A well-balanced diet is one of the most important elements in achieving healthy teeth and gums. We recommend one serving each of: fruits and vegetables, breads and cereals, milk and dairy products, and meat, fish and eggs. You should limit the amount of sugars and starches in order to prevent harmful tooth decay and cavities.
One of the benefits of Park Smile is our team of specialists that allows for timely expert input and seamless transition across treatment. Following the American Association of Orthodontics guidelines, we will arrange for your child to have a preliminary orthodontic screening around age 7 with our Orthodontist. Approximately 20% of children can benefit from early orthodontic treatment to create a healthy, functional bite (occlusion) while the face and jaw are still growing. Otherwise, our orthodontic team will check your child’s growth and development periodically. If and when the time is right for your child, orthodontic treatment can begin.
Additionally, when your child has their full adult dentition in their late teen years, they will be introduced to Dr. Geetan Virdi, who specializes in adult dentistry.
We recommend that your child come for a check-up every 6 months. However, this may vary depending on the oral health and individual needs of each patient.
Pediatric dentistry is a dental specialty that specifically focuses on the oral health of young people from infants to adolescents. Following dental school, a pediatric dentist goes through two to three years of additional specialty training focusing solely on the special needs of children.
Your child should use a toothpaste with fluoride with the first eruption. Brushing twice a day offers more benefits than just once a day. Parents should dispense the toothpaste to prevent excessive use. For those under 3, use a smear. For those aged 3 to 6 years, a pea-sized amount is recommended.
To maximize the beneficial effect of fluoride in the toothpaste, rinsing after brushing should be kept to a minimum or eliminated altogether.
The frequency of drinking the juice is key as well as the length of time juice is being drunk. There are 39 grams of sugar in a 12 oz. can of soda. In a 6 oz. glass of juice, there are between 25 and 29 grams - more than soda! In fact, the American Academy of Pediatrics recommends no more than 6 ounces of juice per child per day because it is "empty calories.”
Starting at birth, the American Academy of Pediatric Dentistry suggests cleaning your child’s gums with a soft infant toothbrush or cloth and water at least once a day at bedtime. When the first teeth begin to appear, start brushing twice a day using a soft-bristled toothbrush.
Use a smear of fluoridated toothpaste for children less than three years of age. A pea-size amount of fluoridated toothpaste is appropriate for children aged three to six.
Cavities are on the rise again. There is a delicate interplay taking place in getting cavities; it is not just eating sugar or candy. In fact, it is a combination of what you eat, how frequently you eat, your genetic ability to fight decay through tooth hardness and saliva, and your use of preventative measures such as brushing, flossing, and toothpaste with fluoride.
The American Academy of Pediatric Dentistry recommends establishing a dental home by the age of 1 or no later than 6 months from when the first tooth erupts.
1. What is Halitosis?
2. Causes of Halitosis:
3. Tips for Managing Halitosis:
Every child is different and we tailor the treatment plan for them. In some cases, it is preventative intervention known as anticipatory guidance. It might involve a fluoride varnish, or it might involve a filling. If a tooth is near being lost, it may include just waiting. This is all part of your child's "Cavities Risk Assessment.”
Our office uses bonded composite resin fillings which are aesthetically pleasing, durable, and long lasting. They are more difficult to place and technique sensitive than the silver amalgam fillings, but we have found parents like them more. In some cases, we need to use stainless steel crowns in the back of the mouth for extremely damaged teeth.
We have an open door policy. Parents are invited in if they wish. Some children do better with parents present, some without. It is unique for each child. We can help you make the decision. Note: Under new COVID-19 protocols and the need for social distancing, we now ask that parents remain in the reception areas and not enter the treatment rooms.
We use many forms of behavioral training to help a child get through a visit. Some children require the use of sedating medicines or general anesthesia to complete their treatment.
Oral Conscious Sedation: Nitrous Oxide/Oxygen
It is important that children remain calm during dental treatment to prevent injury to themselves and to allow them to receive proper dental care. The American Academy of Pediatric Dentistry recognizes nitrous oxide/oxygen inhalation as a safe technique to reduce anxiety and enhance effective communication. Indications for its use include: 1) a fearful and anxious patient, 2) certain patients with special health-care needs, 3) a patient whose gag reflex interferes with dental care, and 4) a cooperative child undergoing a lengthy procedure.
Understanding safe sedation
During procedure
After treatment
With contemporary safeguards, such as lead aprons and high-speed film, the amount of radiation received in a dental X-ray examination is extremely small. Even though there is very little risk, pediatric dentists are particularly careful to minimize the exposure of child patients to radiation. In fact, dental X-rays represent a far smaller risk than an undetected and untreated dental problem.
Fluoride is a compound that contains fluorine, a natural element. Using a small amount of fluoride on a regular basis can prevent tooth decay. Studies show that cavities are reduced by 15 to 30% in kids who use fluoride toothpaste. Research shows that community water fluoridation has lowered decay rates over 50%. For nearly 70 years, studies have consistently shown that fluoridation of community water supplies is safe and effective in preventing dental decay in both children and adults.
Fluoride inhibits loss of minerals from tooth enamel and encourages remineralization, strengthening areas that are weakened/beginning to develop cavities. Fluoride also affects bacteria that cause cavities, discouraging acid attacks that break down teeth. Fluoride binds with natural tooth minerals of calcium and phosphate, resulting in tooth structures that are more acid-resistant. Thus fluoride helps fight decay in people of all ages. Risk for decay is reduced even more when combined with a healthy diet and good oral hygiene.
Use of fluorides for the prevention and control of cavities is documented to be both safe and highly effective. However, too much fluoride can cause fluorosis of the developing permanent dentition. Fluorosis is generally mild, with tiny white specks that are often unnoticeable. In severe cases, the enamel may be pitted with brown discoloration. Development of fluorosis depends on the amount, the duration and timing of excessive fluoride. Numerous studies and years of clinical experience shows that in-office application of fluoride are beneficial to dental health.
Our teeth are covered with a sticky film of bacteria, called plaque. When we eat or drink anything that contains sugar, bacteria turn the sugar into acids that can attack tooth enamel . Over time, these attacks can cause decay, or cavities. The good news is that there is a way to protect teeth and prevent decay: dental sealants.
A dental sealant is a plastic resin material applied to the chewing surfaces of the back teeth. The sealant material flows into the pits and grooves in the teeth. The sealant acts as a barrier, protecting enamel by sealing out plaque, bacteria, and food.
Permanent molars are the most likely to benefit from sealants. The first molars usually come into the mouth when a child is about 6 years old. Second molars appear at about age 12. It is best if the sealant is applied soon after the teeth have erupted, before they have a chance to decay.
Applying sealants does not require drilling or removing tooth structure. The process is short. After the tooth is cleaned, a special gel is placed on the chewing surface for a few seconds. The tooth is then washed off and dried. Then, the sealant is painted on the tooth. The dentist then shine a light on the tooth to help harden the sealant. It takes about a minute for the sealant to form a protective shield.
Sealants can only be seen up close. Sealants can be clear, white, or slightly tinted.
As with anything new that is placed in the mouth, a child may feel the sealant with the tongue. Sealants, however, are very thin and only fill the pits and grooves of molar teeth.
A sealant can last for as long as 5 to 10 years. Sealants should be checked at your regular dental appointment and can be reapplied if they are no longer in place.
No. Fluorides, such as those used in toothpaste, mouth rinse, and community water supplies also help to prevent decay, but in a different way. Sealants keep germs and food particles out of the grooves by covering them with a safe coating. Sealants and fluorides work together to prevent tooth decay.
Sealants are one part of a child's total preventive dental care. A complete dental program also includes fluoride, twice-daily brushing, wise food choices, and regular dental care.
Decay damages teeth permanently. Sealants protect them. Sealants can save time, money, and the discomfort sometimes associated with dental fillings. Fillings are not permanent. Each time a tooth is filled, more drilling is done and the tooth becomes a little weaker.
This is tricky for you to assess as a parent. Your child’s teeth might appear to be straight, but there may be other jaw or bite alignment issues that aren’t obvious without the expertise of an orthodontist. The American Association of Orthodontists recommends routine orthodontic evaluations for all kids once they are 7, which is when Dr. Lebus usually begins collaborating with Dr. Chang to provide ongoing free assessment, consultation, monitoring, and recommendations.
While most children won’t need early orthodontic intervention, our coordinated care ensures that we can detect problems early and intervene when it will be most effective.
If your child feels embarrassed while talking or smiling, has difficulty chewing or routinely bites their cheeks, or has difficulty cleaning between their teeth, you should mention that to Dr. Chang and Dr. Lebus. Teeth grinding, mouth breathing, and crowded teeth, as well as overbites, underbites, or crossbites that interfere with chewing or speech may also be early indicators.
Some kids need early orthodontic treatment while their teeth are still developing (Phase 1) to prevent more significant orthodontic treatment later after all of their teeth have erupted (Phase 2).
The first phase usually aims to treat problems like crossbites or crowding when they are significant and likely to create bigger problems in the future. This phase of care usually occurs around age 8 or 9 and can significantly improve self-esteem and self-confidence for some kids. Most kids will not need phase one treatment, but it’s important to begin routine evaluations at age 7 so that nothing important is missed.
The second phase is recommended after all permanent teeth have erupted and is focused on proper alignment which can only be created when baby teeth are no longer present.
No! Dr. Lebus finds that most kids do not need early orthodontic treatment. But he provides free, ongoing evaluation and monitoring as part of your child’s routine dental care after age 7, coordinating closely with Dr. Chang to save you and your child time, money, and discomfort down the road. Most patients who need orthodontic treatment will be able to wait until all of their permanent teeth are in.
Yes! Orthodontics aren’t just for kids! Orthodontic care for adults can be transformative -- not just for your bite but for your self-image and self-esteem. Your bite can be adjusted at any age if your gums and bone are healthy. Dr. Lebus can tailor a treatment plan that is best suited for your individual lifestyle.
Coordinated care is the best care, so we provide pediatric dentistry, orthodontics, and adult dentistry all in one practice. Integrating regular, complimentary orthodontic evaluation into your child’s routine visits ensures that nothing gets missed. It also ensures that if your child does need orthodontic treatment, they will receive it at the optimal age and stage.
Because we believe so strongly that our coordinated care model ensures the best possible patient care and results, our dentists collaborate exclusively with Dr. Lebus, preferring the frequent communication and built-in monitoring that their partnership provides.
Most of our families love the convenience of a single home everyone’s dental and orthodontic appointments. They also tell us they like knowing their orthodontist is more focused on patient care than patient acquisition!
Your child’s orthodontic evaluations and ongoing monitoring will always be a free service provided alongside their routine dental care.
