Pediatric Dentistry

procedures

Pediatric dentistry primarily focuses on children from birth through adolescence. Your dentist may refer your child to a pediatric dentist (pedodontists) who specialize in oral care for children with special needs, specifically children with autism, varying levels of a cognitive impairment, or cerebral palsy.

One of the most important components of pediatric dentistry is child psychology. Pediatric dentists are trained to create a friendly, fun, social atmosphere for visiting children, and always avoid threatening words like “drill,” “needle,” and “injection.” Dental phobias beginning in childhood often continue into adulthood, so it is of paramount importance that children have positive experiences and find their “dental home” as early as possible.

What Does a Pediatric Dentist Do?

Pediatric dentists fulfill many important functions pertaining to the child’s overall oral health and hygiene. They place particular emphasis on the proper maintenance and care of deciduous (baby) teeth, which are instrumental in facilitating good chewing habits, proper speech production, and hold space for permanent teeth.

Other important functions include:

Education – Pediatric dentists educate the child using models, computer technology, and child-friendly terminology; thus emphasizing the importance of keeping teeth strong and healthy. In addition, they advise parents on disease prevention, trauma prevention, good eating habits, and other aspects of the home hygiene routine.

Monitoring growth – By continuously tracking growth and development, pediatric dentists can anticipate dental issues and quickly intervene before they worsen. Also, working towards earlier corrective treatment preserves the child’s self-esteem and fosters a more positive self-image.

Prevention – Helping parents and children establish sound eating and oral care habits reduces the chances of later tooth decay. In addition to providing check ups and dental cleanings, pediatric dentists are also able to apply dental sealants and topical fluoride to young teeth, advise parents on thumb- sucking/pacifier/smoking cessation, and provide good demonstrations of brushing and flossing.

Intervention – In some cases, pediatric dentists may discuss the possibility of early oral treatments with parents. In the case of oral injury, malocclusion (bad bite), or bruxism (grinding), space maintainers may be fitted, a nighttime mouth guard may be recommended, or reconstructive surgery may be scheduled.

Cleanings

Kids’ dental cleanings at the dentist are an important part of keeping young smiles healthy and strong. During a cleaning, the dental team gently removes plaque and tartar buildup that brushing at home may miss, helping to prevent cavities and gum problems. The teeth are then polished to remove surface stains and leave them feeling smooth and fresh. Cleanings also allow the dentist to check on tooth development and catch any issues early. Regular dental cleanings help children build healthy habits, feel comfortable at the dentist, and maintain a bright, confident smile.

Exams

According to the Canadian Dental Association (CDA) guidelines, infants should initially visit the 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?

There are several things, parents can do to make their child’s 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 – Dentists and staff are trained to avoid the use of threatening language, like drills, needles, pain, 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.

What will happen during the first visit?

There are several goals for the first dental visit. First, the Dentist and the child need to become 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 checkup:

Dental staff will greet the child and parents.
The infant/family health history will be reviewed (this may include questionnaires).
The 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.

How often should children have dental check-ups?

The Canadian Dental Association (CDA) advises parents to make biannual dental appointments for children, beginning approximately six months after the first tooth emerges.

These two important yearly visits allow the pediatric dentist to monitor new developments in the child’s mouth, evaluate changes in the condition of teeth and gums, and continue to advise parents on good oral care strategies.

The dentist may schedule additional visits for children who are particularly susceptible to tooth decay or who show early signs of orthodontic problems.

What is the purpose of dental checkups?

First, the dentist aims to provide a “good dental home” for the child. If a dental emergency does arise, parents can take the child for treatment at a familiar, comfortable location.

Second, the dentist keeps meticulous records of the child’s ongoing dental health and jaw development. In general, painful dental conditions do not arise overnight. If the dentist understands the child’s dental health history, it becomes easier to anticipate future issues and intervene before they arise.

Third, the dentist is able to educate parents and children during the visit. Sometimes the dentist wants to introduce one or several factors to enhance tooth health – for example, sealants, fluoride supplements, or xylitol. Other times, the pediatric dentist asks parents to change the child’s dietary or oral behavior – for example, reducing sugar in the child’s diet, removing an intraoral piercing, or even transitioning the child from sippy cups to adult-sized drinking glasses.

Finally, dental X-rays are often the only way to identify tiny cavities in primary (baby) teeth. Though the child may not be feeling any pain, left unchecked, these tiny cavities can rapidly turn into large cavities, tooth decay, and eventually, childhood periodontal disease. Dental X-rays are only used when the dentist suspects cavities or orthodontic irregularities.

Restorations

Children’s fillings are a common and helpful way to fix cavities and protect young teeth so children can keep smiling, eating, and speaking comfortably. When a child gets a filling, the dentist gently removes the decayed part of the tooth and replaces it with a white filling material (composite) that restores the tooth’s shape and strength. This prevents the cavity from getting bigger and helps avoid pain or infection in the future. With good brushing habits, regular dental visits, and a healthy diet, fillings can last a long time and support strong, happy smiles as children grow.

Pulpotomies (Baby Root Canal Treatment)

A pulpotomy, often referred to as a “baby root canal,” is a safe and gentle treatment used when a child’s tooth has deep decay that has reached the nerve. During the procedure, the dentist removes the infected tissue from inside the tooth to eliminate pain and stop the infection from spreading, while preserving the healthy part of the tooth. This treatment helps save the tooth so it can continue to function normally until it is ready to fall out on its own. Pulpotomies help keep children comfortable, support proper chewing and speech, and maintain healthy development of the smile.

Extractions

Dental extractions for children are sometimes recommended when a tooth is severely decayed, infected, or interfering with the healthy growth of other teeth. The dentist focuses on making the experience as gentle and stress-free as possible, using techniques designed specifically for kids. Removing a problem tooth can help eliminate pain, reduce the risk of infection, and support proper alignment and development of the smile. Parents are given clear instructions for at-home care to ensure smooth healing. When needed, extractions are a safe and beneficial step in protecting a child’s long-term oral health.

Dental Emergencies

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 your 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 your 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 your dentist immediately. In general, 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.

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 your dentist or take your 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. Often, 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 your dentist immediately. Depending on the nature and depth of the intrusion, the 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 your 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 often 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 to save the tooth and prevent infection. It is important to contact the 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 your 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 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 your 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 (IE, Children’s Tylenol)
Contact your 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.

Mouth Guards

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 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.

How can mouth guards protect my child?

Most 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).

Considering these points, below 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. 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. We offer a large selection of colours on our mouthguards as well.

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

Sealants

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 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 oral hygiene care. 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 sealants, most are comprised of liquid resin. Initially, the 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 light works to harden the sealant and cures the resin. The 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 they may need replacing several times. Essentially, sealant durability depends on the oral habits of the individual child. 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, causing tooth decay.