Airway, Sleep Apnea & Dentistry

The mouth is the gateway to the entire body. It’s a connection between dentistry and medicine. Routine dental visits are crucial not only for oral health, but also screening for general health concerns because the majority of people visit their dentist at least twice per year which is typically more often than their general physicians. One of the most important things we evaluate is the airway. The airway provides a path for air in and out of the lungs, where it supplies oxygen to the brain and body. We’re meant to breathe through our nose so that it can filter out the dirty air. If not, then inflammation of the airway, respiratory infections, enlarged tonsils or obstructed airway can result. An open airway is important for sleep, rest for the brain, and overall growth and development. For pediatric dentists, a healthy and open airway is crucial for dental treatment with sedation because many of the medications given can cause a temporary depression in the respiratory drive for the patient, with potential severe outcomes in a compromised patient.

Sleep apnea (or sleep disordered breathing) is a dysfunction of breathing during sleep. It can be an actual airway obstruction or failure of the brain to send the right signals telling the body to breath. Sleep apnea is characterized by abnormal patterns of breathing such as repetitive starting and stopping, snoring, abnormally slow or shallowed breathing, or breathing through the mouth rather than the nose. A person can actually stop breathing for at least 10 seconds before “waking up” to catch a breath. The brain and entire body require sufficient oxygen to function. When that is constantly disrupted, it can have detrimental long-term effects such as high blood pressure, stroke, heart disease, diabetes, behavior problems (like ADHD), etc. Other signs that a child is having some sort of sleep apnea includes restless sleep, waking up multiple times during the night, wetting the bed, morning headaches, constant nasal congestion, chronic bad breath, trouble focusing in school or falling asleep in class, etc.

Our doctors at Smiles for Kids screen all of our patients for airway concerns at every dental visit. We evaluate the TMJ, head and neck muscles, mouth opening, tongue, teeth, throat, tonsils, and overall oral health. There are many clues in the mouth that can signal potential problems with the airway and sleep disordered breathing such as clenching/grinding, pain in the TMJ, large tonsils or adenoids, bite issues (or “malocclusions”), narrow palate, open mouth posture, cavities, gum disease, dry mouth, etc. Any of these signs will lead us to ask questions about the patient’s quality of sleep and a history of signs or symptoms previously mentioned.

There is much to consider before treatment of sleep apnea, and we work closely with our medical community, Ear Nose and Throat doctors (ENT) and Myofunctional Therapists for proper referral and evaluation. Dental treatment may include night guards or appliances such as a palatal expander. Expanding the palate can create more room for the teeth and the tongue, open the nasal passages, allowing for more air exchange and more relaxed muscle posture during sleep. Are you or your child experiencing any of the signs or symptoms of sleep apnea? Ask us more about it at your next dental visit!

Dr. Lindhorst, Dr. Theriot and our Smiles For Kids Team

Missing Teeth

We’re not talking about teeth lost because of cavities, but did you know that you could be missing teeth that just never develop? It’s quite possible that you or someone in your family are missing primary “baby” teeth or permanent teeth. The dental term for this is called hypodontia or congenitally missing teeth. Studies regarding missing teeth estimate that as many as 20 percent of adults are born with at least one missing tooth, making hypodontia one of the most common developmental oral health conditions. In addition, if you as a parent are missing teeth, it’s very likely that your child is missing teeth as well as the cause for missing teeth can be genetic. Other causes are environmental or associated with syndromes such as ectodermal dysplasia and Downs Syndrome. 

Missing baby teeth is very rare and only seen in less than one percent of the population. If a baby tooth is missing, it is very likely that the permanent tooth to take its place is also missing. Permanent teeth start to develop around the time of birth and the most common teeth to be missing are third molars, which are also know as “wisdom teeth.” Missing third molars is actually a great finding as there is no issue in needing them extracted in the future as most people do. Other than wisdom teeth, common missing teeth are right in the front of your mouth, called lateral incisors. Missing lateral incisors do pose a particular issue and a plan needs to be established regarding these missing teeth, as they are in the esthetic area of your mouth. Typical plans for these missing teeth include retaining baby teeth for as long as possible, leaving space for a future dental implant, or closing the spaces altogether. 

Missing teeth is one of the many issues we check for during your exam appointment at Smiles for Kids and also an important reason for taking periodic x-rays. If it is determined that any teeth are missing, our goal is to educate you to make the most informed decision regarding a plan. Generally, we will choose the most conservative plan, as is the case with any other treatment at our practice. We understand that these decisions as well as any other healthcare decisions are difficult to make regarding your children, but we are certainly happy to help walk you through them! 

Dr. Lindhorst, Dr. Theriot and our Smiles For Kids Team 

Summer Snacks and Hydration

Summers can be some of the most challenging times for parents when it comes to nutrition. Kids are home from school and keeping them well hydrated becomes a chore. As the temperatures rise and kids come home sweaty, it is tempting to reach for quick refreshments. Unfortunately, many of those drinks and snacks are not healthy for their bodies, and certainly not for the teeth.

However, there are plenty of wonderful hydrating options that can keep our little ones happy and healthy! From the overall health perspective, there are many dietary considerations as obesity and sedentary life styles are becoming epidemics. In dentistry, we monitor our patients’ weight and overall health, but the following recommendations are strictly teeth related.

In dentistry, we consider three factors when picking snacks:

1. How acidic is it?

2. How much sugar does it have?

3. How long will it stay in the mouth?

Anything that has acid interacts with the enamel and causes cavities over time. Juices, sports drinks, and sodas are prime examples of such culprits. They are also full of sugar, which is a perfect recipe for cavities. Instead, we recommend water or flavored SUGAR FREE sparkling water. If you want to occasionally supplement with other drinks, some such as G2 have lower sugar options. Milk and chocolate milk are also great choices. Regular milk has only 1 teaspoon of sugar and neutral acidity. Flavored milk options are better than juice, but have about 5 teaspoons of sugar, so use them sparingly. They are great recovery drinks after strenuous exercise since they are full of protein and replenish lost electrolytes and sugar.

When picking snacks, try to stay with things that are cold, refreshing, and do not stick to teeth. We recommend shopping in the outer aisles of grocery stores where fruit, veggies, cheeses, yogurts and similar snacks reside. All of these can be stored in the fridge and readily available for the hot summer days. For an easy “grab and go” snack, cut up apples, pears, watermelon or berries. Popsicles made out of fresh fruit are a refreshing and healthy choice. Ice cream, although filled with sugar, is not acidic and melts away quickly, so in moderation it is also a wonderful summer snack. Protein is important to keep kids full longer as pure carbohydrates will only satisfy them shortly. Cheese, yogurts, and sandwich meats can help for easy foods on the go.

Try your best to avoid sticky snacks such as gummies, processed sugars in crackers, pop-tarts, or cookies, and candy that stays in the mouth for a long time such as lollipops. Those snacks fill kids up for a short period of time and then leave them craving more sugar. They are full of chemicals and ingredients that have no nutritional value in addition to causing cavities.

We know that this will be a long summer! Call us if you want more specific advice on what is healthy for baby and young permanent teeth! Our team is here to answer all your questions.

Dr. Lindhorst, Dr. Theriot and our Smiles For Kids Team

Board Certification

Board certification is an optional step taken by dental practitioners that goes above and beyond to show that they have achieved the highest level of expertise and mastery in their respective fields. Not all doctors choose to embark on this process. However, the doctors that do, find it important to show that they have achieved the premier level of education to indicate that they will deliver unparalleled professionalism and the best quality of care possible to their patients. 

Becoming board certified is not an easy process. The eligible doctor is required to complete their dental training from an accredited dental school, which takes four years. Before graduation from dental school, they must complete their board certification exam to become a general dentist. This is a two-part exam, where the first part is taken halfway through dental school and consists of a written exam. The second part, which is the practical assessment of dental skills, is taken right before graduation. Once this is accomplished, if the dentist chooses to continue his or her education in a post-graduate specialty such as pediatric dentistry or orthodontics, he or she must be accepted into a program at an accredited university to continue onward. This process can take an extra 2 to 3 years of training. Following the completion of this education, the pediatric dentist or orthodontist is now eligible to begin practicing their specialty. The final step, or the pinnacle of education, is the option to sit for the board certification exam. The specialty board examinations are comprised of two parts: the written portion and the clinical portion. The preparation for this exam is extensive and rigorous. It requires much dedication outside of daily work to prepare. The written board exam tests the candidate’s knowledge on basic sciences, a variety of clinical situations, as well as current research in the respective specialties. Once the candidate has passed the written board examination, he or she is eligible to sit for the oral portion of the board examination. This part of the exam is performed in front of a board of examiners and tests the candidate’s knowledge of difficult cases, how they would approach them, and how he or she would handle challenging dental puzzles. To remain board certified, the doctor is required to renew their board certification every 10 years through another written exam. 

All doctors at Smiles for Kids believe in becoming board certified. We believe in the highest quality of dental care for our patients and challenge ourselves to always stay current on dental research, new developments in dental technology, modern treatment approaches, and cutting-edge dental materials. We are dedicated to pediatric dentistry, orthodontics, but most of all to our patients and being board certified is one way to challenge ourselves to be the best dentists we can be. 

Dr. Lindhorst, Dr. Theriot and our Smiles For Kids Team 

Acid Reflux

As dental care providers, we do not usually see kids before one year of age when our pediatric colleagues are dealing with reflux in babies. Most of the time those “colicky” babies are able to sleep and eat a variety of foods by one year of age once acid reflux seems to have resolved. That is usually when we take over care of children’s oral tissues and growing teeth. By three or four years of age we often note severe wear on primary molars that presents very differently than grinding. When kids grind or clench their teeth (which is both common and normal until a certain age) the wear makes teeth appear flat. However, acid wear presents as holes on the cusps of teeth or shiny smoothness on the backs of the front teeth (incisors).

When kids are under six years of age, they do not have any permanent teeth, and we usually monitor growth and development to see if they will grow out of the issue as their digestive system matures. However, when permanent teeth erupt, seeing acid wear on them prompts us to have a conversation with parents and pediatricians. Because most of these kids never knew life without acid reflux, they often do not know that the feeling of “heart burn” is abnormal and therefore never complain about it. Our questions involve many areas of growth and development.

We start the conversation with the following inquiries to both parents and kids:

1. Quality of sleep.

2. Growth charts for both height and weight.

3. Persistent hoarseness in patient’s voice.

4. Morning cough or frequent throat clearing.

5. Preference to sleep on multiple tiers of pillows to simulate sitting up.

6. Natural avoidance of any acidic or spicy foods that trigger the symptoms.

7. Patient’s diet including soft drinks, juices, or any other fatty and acidic foods.

8. Any eating aversions or difficulties swallowing.

9. Frequent stomach problems or vomiting.

10. Persistent bad breath once other causes, such as dental decay, have been eliminated.

Once we discuss these problems with parents and discover multiple answers matching diagnosis of reflux, we encourage parents to speak to the pediatricians about more diagnostic testing that will help with treatment. Many anti acid medications are over the counter, but we prefer for parents to eliminate other causes such as obesity or poor diet before starting medications. Our concern is not only the acid wear on the teeth, but all the problems with the esophagus and stomach that regurgitation of stomach acid can cause. We truly appreciate collaboration of our pediatric colleagues for helping us as dentists diagnose and treat acid reflux for overall better health of our patients.

Dr. Lindhorst, Dr. Theriot and our Smiles For Kids Team

Impacted Canines

By DR. DREW DARSEY

Did you know that braces have a few different uses? Braces are commonly thought of as “tooth straighteners”, which they are, but they also have another use – to assist in guiding teeth that are stuck in the bone into the mouth. This is the definition of an impacted tooth = a tooth that is stuck and cannot erupt into the mouth on its own. The canine/ “eye-tooth” is actually the 2nd most prone to impaction in the mouth and sometimes needs help coming in. This usually happens because of the direction that it started to develop or because it doesn’t have the appropriate amount of room to be able to come in. Here’s a Fun Fact: The tooth most prevalent to have eruption problems is the 3rd molar “wisdom tooth”. 

Sometimes an impacted or “stuck” tooth can be fixed by making room in the arch for this tooth to erupt on its own (using springs on the braces wires to make enough room). Other times, the tooth requires a minor surgery done by an oral surgeon. This procedure consists of exposing the tooth in the bone and attaching a gold chain to the impacted tooth so that it can be guided into the mouth in the correct direction towards the wire. 

Another Fun Fact: 2/3rds of canines are impacted on the palate side of the arch and 1/3rd of them are located on the lip side of the arch. Often these impacted teeth cannot be helped until the roots are developed enough to be moved in the right direction. However, early identification of these teeth starting to get stuck can help in preventing it from happening. If the patient gets too old, there is a chance that this tooth can fuse to the bone and will never be able to be brought into the mouth. This is another reason that addressing the problem early is important. Therefore, it is crucial to stay on top of your routine dental appointments so that your dentist can observe the eruption of the teeth by x-ray and let you know when you should have an orthodontic consultation to address any stubborn “problem” teeth. 

Dr. Lindhorst, Dr. Theriot and our Smiles For Kids Team 

Two-Phase Orthodontic Treatment: What is it and why does my child need it?

“My child might need braces twice?!” is a common question asked in our orthodontic office. Sometimes the answer is yes, but that does not necessarily apply to every child we see. Let us dive into this mysterious “two-phase” orthodontic treatment idea and break down the needs for early orthodontic intervention. 

The First Phase 

Here is the good news: not every child will need an early round of orthodontic treatment. However, if needed, interceptive orthodontic care is one of the most rewarding treatment options that we offer to our patients and sets them up for healthy dental growth. Our goal is to intercept a potential problem before it gets out of hand. Treatment occurs at a younger age than conventional orthodontic care and is not typically as long. The idea is to shift teeth, manipulate growth, create space for permanent teeth that need to come in, break habits, and prevent trauma. Children between the ages of 7 and 10 are best suited for this treatment. Options often include expanders, braces, habit appliances, and sometimes the extraction of primary teeth. The American Association of Orthodontics actually recommends children start seeing an orthodontist at the age of 7 years of age, which is when the first permanent teeth start to erupt. If any treatment is needed, younger children are more flexible, compliant and their growth potential is at a maximum. Treatment usually lasts 8 to 12 months after which the child is monitored for several years and the decision as to the need for a second phase is made. 

The Second Phase 

Once all permanent teeth are present, we evaluate for any needed additional treatment. Sometimes this “Second Phase” is the only treatment needed. This phase usually requires at least 12 months with braces on all of the top and bottom teeth. The goal of this second phase is to establish the proper working relationship between the teeth and jaws and to correct the alignment of all the teeth. After the second phase of treatment, retainers will be worn in order to hold the teeth in the correct position. 

Orthodontic treatment is not a “one size fits all” approach. Each patient has a different set of teeth that require personalized treatment plans. While not every child needs two phases of treatment, it is an option that can greatly benefit the patient and our orthodontists will evaluate each patient’s individual needs. 

Dr. Lindhorst, Dr. Theriot and our Smiles For Kids Team 

Enamel Hypoplasia

Enamel is that hard, protective, visible outside layer of the tooth. It keeps teeth strong and healthy! Have you ever noticed any discolorations or defects in your child’s tooth? You could be noticing enamel hypoplasia. This condition is a defect that causes a lesser quantity of enamel than normal. It can appear as a white spot, yellow to brown staining, pits, grooves or even thin, chipped or missing parts of enamel. In severe cases, the enamel doesn’t develop at all. 

Because of these surface irregularities, hypoplastic teeth can have the following dental problems: more sensitive to heat or cold or pain, more prone to wearing down from grinding or “tooth to tooth contact”, more susceptible to an “acid attack” from the sugars in our foods and drinks, more susceptible to trapping plaque and bacteria, and more prone to tooth decay. 

If you see a concerning area on your child’s teeth, it’s best to schedule an appointment with your pediatric dentist! It is important to check and monitor these teeth. There are also many different treatment options if necessary depending on the severity of the hypoplasia and the child’s ability to cooperate during dental treatment. Options may include protective sealants, desensitizing agents like Silver Diamine Fluoride (SDF), esthetic composite resin or “tooth-colored” fillings, full coverage crowns, or microabrasion. If left untreated, cavities may form and lead to pain or dental infection. 

Just because a baby tooth has hypoplasia doesn’t mean a permanent tooth will. These irregularities can occur before, during, or after birth of the child. Your primary and permanent teeth are developing at different times. 

There are many different causes of enamel hypoplasia from genetics to environmental factors. This list includes: inherited developmental conditions, vitamin deficiencies, maternal illness, medications given to mother prior to birth or to the child during early childhood when teeth are developing, preterm birth, low birthweight, trauma to the teeth, infection, malnutrition, systemic diseases, and smoking or drug abuse. 

Good oral hygiene and a healthy diet are important for all of our patients, especially those with hypoplastic teeth. We recommend brushing twice daily with fluoridated toothpaste. Maintain a diet low in sugar and be sure to avoid those ooey, gooey, sticky snacks! And don’t forget to visit your dentist at least twice a year for a checkup, professional cleaning and fluoride application. 

Dr. Lindhorst, Dr. Theriot and our Smiles For Kids Team 

Dental Insurance

Unfortunately, these days we live in a world ruled by insurance. Between our individual policies, home policies, car, health, life, and others, we spend over 30% of our income on insurance coverage. No wonder that we want a return on our investment and count on paying little out of pocket when we use our insurance policies. 

Dental insurance benefits are different from medical and are probably the most commonly discussed topics in our office. In comparison to medical insurance, the cost of dental coverage is fairly low ranging from $10-50 per month. The actual benefits can be customized by the employer’s negotiations with the insurance company and vary widely. Within the same company, you can often choose from a variety of dental plans and your coverage will depend on the amount of premium you are willing to spend per month. Most dental plans have a yearly maximum of $1000 to $2500 and any dental work beyond that number will be an out of pocket expense. In addition, some plans will also have a deductible that will have to be paid before any of the costs will be covered by the plan. 

DMO plans (like medical HMO) are usually the least expensive plans that limit the patient’s choices on which dental providers they can see. Dental offices must abide by their set fees for each procedure. Unfortunately, those fees are often so low that only corporate dental chains will be on the lists of choices since privately owned offices often cannot afford care at that fee. 

PPO plans have both IN NETWORK and OUT OF NETWORK benefits. You can see any dentist you would like and they will pay the dentists certain percentage of your dental procedures. If your dentist signed up with your particular insurance company, he or she is IN NETWORK and bound by the contract to accept the insurance company’s rates. If you choose an in-network dentist, you will likely have a lesser copay since your dentist must abide by the negotiated fees. If your dentist is NOT signed up with this plan, you can still see them and collect all your insurance benefits the same way. However, you will need to pay your dentist the difference between the fee the insurance company established for each procedure and the fee your dentist set. If your insurance has good benefits, there should be little difference for in and out of network providers. 

Let us look at an example. Your dentist feels that a reasonable fee for a particular dental procedure is $100. However, a PPO insurance company set their fee at $50. If your dentist is IN NETWORK, he or she would have agreed with the insurance company to accept $50 for this in exchange for placement on their distribution list and benefit of getting a larger volume of patients. If your dentist is OUT OF NETWORK your insurance company will pay $50, but you will need to pay the additional $50 to your dental office. In addition, if your dentist is OUT OF NETWORK, insurance companies do not share their actual fees with your dentist. They only share percentage of coverage leaving dentists to guess the actual dollar amount. In the above example, the insurance company might say that they cover dental cleaning at 100%, but not tell the dentist that their allowable 100% is $50. Therefore, when the dentist checks insurance and sees that 100% amount, he or she can only guess at an actual number. It takes insurance companies several weeks to pay most claims. 

ORTHODONTIC INSURANCE can be included in your benefits, but sometimes it is an add-on. It is best to check with your insurance before starting orthodontic treatment to make sure that your particular plan has orthodontic benefits. Orthodontic insurance usually has a lifetime benefit of anywhere between $1000 and $2500. If your child needs two phases of treatment, this life time benefit might get used in the first round of braces and leave little or no money for the second phase. Most insurance companies do not have orthodontic benefits past 19 years of age so adult orthodontics is usually an out of pocket expense. In most cases IN and OUT of network benefits for orthodontics only differ by the total amount that an orthodontist is allowed to charge for full treatment, but the benefits are paid out equally for IN and OUT of network orthodontists. 

QUALITY OF CARE is what prevents most dentists from signing up with insurance companies. Most dentists are conscientious healthcare providers who truly care about their patients and want to provide the highest quality of care. They want to be able to spend time with their patients, use high quality materials and tools, hire fantastic teams, continue education on modern dentistry, and make long lasting and well-fitting dental restorations. This can only be achieved when they get compensated fairly. 

Our office accepts all dental insurances that allow OUT OF NETWORK benefits. We both take and file your insurance for you. As long as your insurance does not bind you to a specific group of dentists, our team is here to help all our patients collect and maximize their dental benefits. We do not bend our fees depending on insurance companies, rather set them fairly to provide highest quality of care. We believe in doing things right and treating all children in our office as well as their parents with respect, love, and time to take care of all their dental and emotional needs. We are committed to our values and will fight for every penny with your dental insurance company. However, we do not allow insurance companies to tell us how to take care of our patients and do not allow their statistical calculations to overrun our clinical judgement. 

I hope this helps to clear up some potentially confusing aspects of dental insurance vs other types of insurance. As always, if you ever have any questions, please feel free to reach out to us. 

Dr. Lindhorst, Dr. Theriot and our Smiles For Kids Team 

Intraoral Scanner

What is your most traumatizing dental experience? For many of us it is one of those ooey-gooey, messy molds of teeth taken in order to produce some sort of an orthodontic appliance, thumb habit crib, dental crown, mouthguard or space maintainer. Did you ever feel like the goop is going down your throat? Maybe that’s your most vivid memory of having braces, Invisalign, or getting a crown on one of your teeth. 

If so, then we have great news for you and your kids! At Dr. Lindhorst’s second location, Heights Pediatric Dentistry and Orthodontics, we use a scanner called an iTero Intraoral Scanner that takes thousands of photos of your teeth (6,000 per minute to be exact) and makes your teeth impressions digital! The scanner takes only photos so no radiation is involved in the process and the scan is completely painless and atraumatic. 

Once your teeth are digitized, we can send the image to respective labs to develop appropriate appliances for you or your kids. We send them to Invisalign to fabricate aligners for our orthodontic patients or to a lab to make other appliances such as expanders or habit cribs. Labs love having this digital image as it allows them to manipulate the image and make the appliances in less time and with much better fit and accuracy than with the older method. 

The scanner is a great tool because it allows us to avoid taking those messy molds of your teeth. No matter the age, our patients enjoy a quick and easy appointment to start on their orthodontic appliances. We think that’s a win-win for our practice and our patients. We know that the kids and teens also find it fascinating to watch the action as your teeth become digital and look like a video game on the screen. For Invisalign patients it also allows us to move digitized teeth into alignment. That way on this initial appointment you can see the end result of what your smile will look like before your treatment even begins. 

As with the other tools and technology in our office, the intraoral scanner helps to make your appointments as easy and convenient as possible. If you would like to see the scanner in action or have more questions about it please let us know. Remember that our orthodontic exams are complimentary, so come get your questions answered with the help of our iTero Intraoral Scanner! 

Dr. Lindhorst, Dr. Theriot and the Smiles For Kids Pediatric Dental Team 

IV Sedation

We would love nothing more than to have every kiddo come to our office, sit in the dental chair like a champ, and have healthy teeth. We strive for that with many educational initiatives and campaigns. However, kids come in all shapes and sizes and so do their teeth. Our doctors see kids with special needs and with high anxiety that make it impossible to bear sitting in a dental chair. We also see very young children with severe dental decay making in-office treatment intolerable for them. Knowing that we have an obligation to help all children, we utilize many tools in our office. One of the options we have for treatment is in-office IV general anesthesia where kids are asleep for the necessary treatment. 

Our pediatric dentists have the highest level of training in multiple levels of sedation, but for IV sedations we utilize a board-certified dental anesthesiologist. Dr. Chris Ballard comes to our office with all the medications he uses, a fully stocked emergency cart, and decades of experience in dental anesthesia. He has worked in our office since Dr. Lindhorst purchased it over ten years ago. This allows our doctors to concentrate on dentistry and our anesthesiologist to concentrate on anesthesia. Our preparation for this procedure is detailed and our case selection is precise. 

Before the procedure, we consult with all necessary doctors to make sure that our patient is a good candidate. Dr. Ballard discusses each case with parents the night before the sedation and checks all health markers the morning of the procedure. He then gently sedates the patient and allows them to sleep comfortably through the procedure while our doctors perform all necessary dental procedures quickly and efficiently. The kids wake up after about an hour with healthy teeth, but without the stressful experience of multi cavity treatment. Within about another hour or two, after careful observation and clearance by both our dentists and Dr. Ballard, families are able to go home to rest. We follow up on our patients that afternoon and parents are given all phone numbers for both our office and our anesthesiologist in case of questions or concerns. 

Being able to provide this service allows us to take care of fearful patients, young patients with multiple cavities, patients with developmental disorders such as ASD spectrum, patients with physical barriers such as CP, and many other kids who otherwise would be suffering through excruciating dental pain or a traumatizing treatment experience. We are extremely respectful of IV sedation decisions and make them as a collaboration with parents, medical providers, financial support options, and our dental team. We understand that with our excellent providers, many times this is the best and the safest option for our patients and we love being able to offer it to our sweet kids! 

Dr. Lindhorst, Dr. Theriot and the Smiles For Kids Pediatric Dental Team 

Dental Trauma

Dental trauma is most common in pre-school children that are learning to walk, run, jump and climb, and in school-age children playing sports, but can happen anytime. Our team wants to help your family feel prepared to handle these emergencies.

The most common types of trauma in baby teeth are movements of the teeth in the bone displacing them in one direction or another. At that time, damage to the supporting ligament or fracture of the bone is also possible. Examination and treatment at this age can be difficult due to fear and lack of cooperation. Treatment of these luxation injuries must consider having the least amount of risk to damage permanent teeth developing underneath. Most heal spontaneously and no treatment at the time of injury may be necessary. In more severe luxation injuries, an extraction may be the treatment of choice. If a baby tooth is knocked out of the mouth, it is best NOT to re-implant the tooth due to poor healing capability and possible injury to the developing permanent tooth underneath it.

The most common type of trauma in the permanent dentition is a crown fracture. This can vary from slightly chipped teeth to fractures of majority of the crown even exposing the nerve of the tooth. We recommend keeping the tooth fragment that broke of as we may be able to bond it back to the tooth. Otherwise, a composite restoration can be done. X-rays of the lip or cheek may also be taken to search for lost tooth fragments. If the nerve is exposed, a pulpotomy may need to be done. Pulpotomy is a procedure where the infected pulp tissue is cleaned, medicine is placed and then the fracture is restored. Lastly, some fractures could be so severe that the tooth may need to be splinted to the adjacent teeth for stability. A wire will be bonded to the injured tooth and adjacent teeth for a few weeks while the bone and supporting ligaments heal.

If a permanent tooth is knocked out, it’s important to put the tooth back into its socket as quickly as possible. Time is of the essence in these emergencies. The long-term survival of the tooth after 15 minutes outside of the mouth declines quickly. Second best option is to store it in the child’s saliva or in cold milk. Do NOT store the tooth in water. Call our office immediately so we can splint the teeth together to stabilize the tooth in the socket. In some cases, especially if the tooth is not in a safe storage solution for more than 60 minutes, the long-term survival is poor and a root canal may have to be done.

After trauma to the teeth, we recommend monitoring the teeth over time for signs and symptoms of infection even if the child does not feel pain. Most common signs are: 1) discoloration of the teeth 2) mobility of the tooth 3) swelling and infection that look like a bubble overlying the gum of the injured tooth.

For the best chance of long-term survival, call our office as soon as possible when trauma occurs. We are always on call for our patients. You can also ask us about our dental trauma protocol at your next routine check-up.

Dr. Lindhorst, Dr. Theriot and the Smiles For Kids Team

CLEFT LIP AND PALATE – Dental and Orthodontic Considerations

As pediatric dentists we see patients with a variety of health and developmental anomalies. We often support craniofacial teams at various hospitals in Houston as those teams treat patients born with a variety of facial abnormalities including cleft lip and palate, hemifacial microsomia, Crouzon Syndrome, Apert syndrome and Pierre Robin. Some of the treatments for these patients begin with Nasoalveolar Molding (NAM) working with patients born with cleft lip and palate as early as one week of age. In conjunction with the other specialists on the cleft and craniofacial team, we can manage the pediatric dental needs of patients born with craniofacial abnormalities from the time of birth up through adulthood.

A huge part of this effort is trusting the orthodontic teams we work with that treat many patients with an array of different misalignment of the teeth. The orthodontists in local hospitals as well as ones in private practices often treat kids with complex medical and dental needs. Cleft lip and palate can be one of those complex treatments. A cleft occurs when certain structures do not fuse together during fetal development. Clefts can involve only the lip or both the lip and the palate. A cleft lip presents as an opening of the lip on one side or both sides of the face and depending on how severe the cleft is, it may extend up into the nose. A cleft palate is an opening in the roof of the mouth, known as the palate. The average incidence of cleft lip and palate is 1:750 births.

Of the different variations of cleft lip and cleft palate, each individual cleft is treated in its own unique way both surgically and orthodontically. One of the main dental issues with having a cleft is the possibility of missing teeth in the area of the cleft. The common tooth to be missing in the region of the cleft is the lateral incisor. This orthodontic challenge can be overcome with the use of braces either closing the space or making room to replace that missing tooth with a future bridge or implant.

Another issue in patients with cleft lip and palate is that teeth could erupt (come into the mouth) in inappropriate locations. Teeth can be misaligned, rotated and even blocked out and unable to erupt. This can cause problems with brushing, and maintaining excellent oral hygiene becomes a challenge. Team approach between the craniofacial team and a pediatric dentist is extremely important in upholding excellent oral health in these patients. If you have any questions regarding treating dentally complex patients, please don’t hesitate to contact us.

Dr. Lindhorst, Dr. Theriot and our Smiles For Kids Team

Sugar in a Bottle

Marketing companies are amazing at well… marketing. It’s no wonder that most families’ refrigerators are stocked with “healthy” juice, sodas, and Gatorades. As dentists we cringe at the site of eye level positioned and well-advertised liquid sugars on grocery store shelves. Labels show clearly that the amount of sugar packed in juice much exceeds daily recommended levels. A normal size adult should have no more than 25 g of sugar per day, which amounts to around 6 tsp. A glass of typical juice has between 35 and 60 grams of sugar. Sports drinks do not trail far behind with around 40 grams of sugar. Because of lack of true regulations on food labels, even juices that claim to be “100% natural fruit” often have sugar added, other juices mixed in for volume and flavor, or are stored in tanks for a long time, which makes it necessary to add preservatives containing sugar. All these drinks are also extremely acidic due to naturally occurring fruit acids as well as added preservatives such as citric acid. This makes their acidity close to battery acid. 

As health professionals and dentists, our worry is both on a large scale of body health, and on a small scale of teeth. We witness staggering BMI numbers that lead to problems such as diabetes, heart problems, social difficulties, and behavioral issues starting in childhood and culminating in solemn complications in adulthood. We see more and more kids with diabetes, kids who have difficulty exercising and keeping up with their peers, and kids with serious social tensions due to weight. Our role as health providers often puts us in a position where we must counsel and educate parents and families to reinforce information already discussed by their family physicians. 

However, as dentists we are concerned about teeth in particular. Acid in juices can cause erosion of enamel, the hardest structure in your body. Acid creates wear and damage that allows for sugar to easily fit in the microscopic holes on teeth. Worn enamel will demineralize making work of cavity- causing bacteria easy, especially with addition of large amount of sugar, which fuels them. We see rampant cavities in children as young as two years of age. Dental decay is number one reason for missing school hours in young children and is still the most prevalent chronic disease in both children and adults. Costs of dental decay are staggering as many young children end up with expensive treatment including hospitalizations for infections or treatment with IV sedation. Prevention of dental decay is not contained to limiting sweet drinks, but in the face of today’s epidemic, we want to educate our families early and thoroughly on all controllable variables. Eliminating sugary drinks is an easy step in overall personal health and in dental well-being of our patients. Please feel free to contact us with any particular questions. 

Dr. Lindhorst, Dr. Jadav and Smiles For Kids Pediatric Dental Team 

Mouthguards

Jumping on a trampoline, skate boarding, gymnastics, playing hockey, baseball, or basketball are just some of the fun activities kids engage in every day. Although very different, all of these activities have one thing in common: the potential for trauma to the mouth, face, and jaw. Trauma may include fractured or avulsed teeth, broken jaws, laceration of the soft tissues, concussions, and many others. Any of these injuries could impact the way you smile, talk, and eat forever. This can all be easily prevented by wearing a properly fitted mouthguard.

Studies have shown that athletes are 60 times more likely to suffer harm to the teeth if they are not wearing a mouthguard. Mouthguards are recommended to be worn at all times during recreational activities and sports, including practices. We all know that convincing a child to do so will require a comfortable device that does not obstruct his or her ability to talk and excel in the sport of choice.

There are three types of mouthguards: ready-made or stock mouthguard, “boil and bite” mouthguard, and a custom-made mouthguard fabricated by your dentist. According to the American Dental Association, the mouthguard should fit properly, be durable, be easy to clean and not restrict speech or breathing. The best mouthguard is one that is custom-made to fit your mouth. These kinds of mouthguards are tailored to the individual’s mouth, they are gentle on the soft tissues like cheeks and gums, and can be adjusted by your dentist to ensure proper fit over time.

“What if I have braces? Can I wear a mouthguard?” Absolutely! A mouthguard will provide a cushion between your braces and your lips and cheeks. This will prevent damage to the braces but also protect the soft tissues of the mouth. Typically, mouthguards are made to fit on the upper teeth, but if you have appliances that prevent wearing a mouth guard on the top teeth, a custom-made mouthguard for the bottom teeth is possible. Talk to us about which mouthguard is best for you.

Protect your mouth and your smile. Wear a mouthguard!

Invisalign

All conversations about orthodontics these days include Invisalign. Of all the options we have to straighten teeth, it is the most esthetic and accepted treatment. The most common questions we get about the aligners are if they work, if they hurt, and what is the cost?

Invisalign does work! Invisalign is essentially a series of removable clear aligners (much like the bleaching trays) that are worn day and night to align the teeth.  They are almost invisible and allow patients to speak clearly and smile without visible braces. Since the aligners are removable, compliance is absolutely necessary to get a great result, so it takes a persistent patient for the success of Invisalign.  Since compliance is critical, the majority of our Invisalign patients are adults.  However, some teen patients have been excellent at wearing them as well. In addition, with new research and developments, we have been pushing the envelope of treating more difficult orthodontic cases with Invisalign where braces were traditionally the only option.  

So how does it work? Each aligner slightly moves the teeth and treatment consists of a series of aligners, each a little closer to the ideal bite, to progressively straighten teeth.  The more complicated the bite correction is to begin with, the more aligners and greater the length of treatment will be needed. Since the movement with each aligner is slight, the pressure and discomfort are minimal. Most patients adjust to wearing their new aligners very quickly as there are no brackets or wires to get used to.

The cost of Invisalign treatment depends on the length of treatment and number of aligners necessary.  It is however, close to the same price as adult braces.  It can be as few as five aligners for minor treatment.  Longer treatments last between six and twelve months, which is generally shorter than patients expect.  The treatment and cost will be customized to fit patient’s concerns and the orthodontists will work with patients to fulfill their best smiles on a budget.

We have seen that many patients, especially adults who do not desire to have metal braces, have put off orthodontic treatment because of questions about Invisalign.  Now that they have been answered, all the specifics of an individual’s needs can be answered during complimentary consultation.  The orthodontists we refer to are Board Certified and have extensive experience with Invisalign.

The road to straight teeth is easier and shorter than most patients expect.  The key is starting as soon as possible to enjoy a beautiful new smile for a lifetime!

Dr. Lindhorst, Dr. Jadav and Smiles For Kids Pediatric Dental Team