One of Two Phases of Braces

It’s a common sight these days to see eight or nine-year-old smiles adorned with braces.  As pediatric dentists we encounter many questions from parents and healthcare providers on when kids need to get braces and why.  Some families are in a hurry to start orthodontics as soon as possible, while others want to hold off as long as they can.  The right path of action depends on multiple factors of growth and development and we are here to guide you through them during regular six-month dental checkups.

Orthodontic treatment of our pediatric patients is not a “cookie cutter” experience.  Pediatric dentists follow growth and development of jaws, teeth, and oral structures from the youngest years to determine the appropriate time for orthodontic intervention.  Most kids do not need braces until around twelve years of age, when all of their baby teeth have been replaced by permanent teeth.  At that time, orthodontists will often put in a full set of finite braces and call it “Phase 2” treatment.

However, some kids need help with growth and development of jaws.  At the time when front baby teeth wiggle out and permanent ones grow in (around seven years of age), we evaluate symmetry of the jaws, size of teeth and bone, relationship and shape of upper and lower jaws, as well as soft tissues of oral structures.  We know that some kids will do great growing on their own, but some will need a little help during the next few years before the rest of the adult teeth come in.  If we feel that your little one needs assistance, we will either do simple orthodontic procedures ourselves (such as expanders of the upper jaw) or more likely send you to an orthodontist for an evaluation of what we call “Phase 1” orthodontic treatment.

This first phase of orthodontics is usually shorter and involves procedures that line up baby teeth to allow for better eruption of permanent teeth, expand jaws to fit all permanent teeth in, or guide jaws into better positioning for future growth.  This phase usually takes less than one year and sometimes involves brackets, but other times only dental and orthodontic appliances such as spacers and expanders.  In some instances, orthodontists will follow kids from that age on with periodic recommendations to the pediatric dentists to extract certain baby or permanent teeth or simply just waiting for more growth and permanent teeth development.

Your orthodontist will only recommend phase 1 treatment if it is absolutely necessary for healthy outcome of lining up teeth and jaws.  Many factors in addition to growth and development go into consideration before braces are applied, such as oral hygiene, general dental follow-up, assessment of risk for cavities, cooperation of the patient, insurance reimbursement, and patient’s overall health.  So if you see that pre-teen smile sporting braces, please know that a very careful thought process went into putting them on!  And as always, please do not hesitate to call us with any questions about braces, alignment or overall growth and development of teeth.

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

Silver Diamine Fluoride

Silver diamine fluoride has been in the news recently as a new product for dentistry. Smiles for Kids Pediatric Dentistry offers it as an alternative to traditional cavity treatment.

It’s primarily for patients with decay who may be too young, medically compromised or apprehensive for fillings and crowns. The good news is that it involves no injections, drilling, or pain. The mechanism of action is that the silver acts as an anti-microbial agent by killing bacteria and preventing the formation of new biofilm. The fluoride prevents further demineralization of tooth structure.

Teeth with minimal to moderate decay or hypoplasia (defect in formation) can be treated. Any tooth that has very deep decay that is close to the nerve or a tooth that is abscessed cannot be treated with this technique. The actual application of the product takes a few minutes. Dr. Lindhorst or Dr. Jadav apply this medication with a small brush onto the tooth. The entire length of the appointment varies based on how many teeth are treated and the child’s behavior. Once teeth are treated, we may have to re-apply the medication. At your follow-up appointment, we will let you know if the tooth needs more applications of the product.

The main drawback of silver diamine fluoride is that any active decay on the tooth will turn black permanently. This affected tissue can be removed with traditional methods when teeth get fillings or crowns in the future. It’s contraindicated for patients with a true silver or heavy metal allergy.

The medication has a metallic taste and can stain any gingiva and mucosa that it comes in contact with. This stain on the tissue is like a temporary tattoo and will fade over a few weeks. We carefully isolate the tooth and place a barrier on the gingiva to minimize the chances of this happening.

All in all, this treatment is a safe interim option for the young, apprehensive dental patient. Please let us know if you have any other questions or concerns. We would be happy to answer your questions about this new and exciting option for treatment.

If you have any questions, please don’t hesitate to contact us.

First Dental Visit

The American Academy of Pediatric Dentistry recommends that a child’s first dental visit be scheduled by his or her first birthday. You may be wondering what we do at a first visit and why it’s so important to start early.

ORAL DEVELOPMENT- A lot of changes happen in a child’s mouth from when they are born until they get their full set of baby teeth.  It’s important for us to let parents know what to expect. We will talk about timing of new teeth coming in, what to expect as they are coming in, and how many of them are left to come in. The dentist will show you if there are any variations of normal with the teeth and what that means. By starting early, we can let parents know if we see any early signs of decay. Many times, when we see very early changes, we can suggest dietary or habit changes that can prevent having to do treatment on these teeth. Aside from checking his or her teeth for cavities, we will be assessing the tongue, cheeks, jaws, and tonsils. We want to make sure every aspect of your child’s mouth, bite, and jaws look healthy!

ORAL HYGIENE- Parents often ask when to start brushing and how to brush their little ones. We will review when to start, how to position them, and toothpaste use.  At our office, we rate oral hygiene on a scale from 1-5 with 5 being the best. That way, parents can have a comparison point to see how they are doing in terms of hygiene.

DIET- Diet plays a major role in cavity formation. For babies, we’ll review bottle use. For toddlers, we talk about gummy snacks, sippy cups, and juices. For older kids, we’ll review the types of gummy, sticky and sugary foods to avoid. Sippy cups, juices, and candy are just a few of the topics we’ll cover.

HABITS- We will talk about habits that children may have like thumb sucking, a pacifier, or nail biting. Although a lot of these habits are age appropriate, we will review what long term changes that they can cause in terms of his or her bite. We will let parents know when it is the right time to intervene and what to try.

TRAUMA- We will review what to do if and when your child ever has any trauma. It’s a very common childhood injury and we want parents to know what to look for, when to call us, or when to come see us in the office.

Most of all, Dr. Lindhorst and Dr. Jadav want parents and children to be very comfortable. The more the child visits, the more likely that he or she will realize that coming to the dentist is a fun adventure!

Dr. Jadav

Smiles for Kids Pediatric Dentistry

Are Bad Teeth Hereditary???

Multifactorial causes of cavities: role of bacteria, acid, sugar, saliva and tooth structure.

“Bad teeth run in my family” is one phrase we hear daily at Smiles For Kids Pediatric Dentistry.  It is clear that when parents have dental decay, kids are more prone to it as well.  But the causes for cavities are more complicated and surprising than parents think.  Cavities are not a simple, linear problem, and multitude of research on eradicating this epidemic is being explored.

Facts that we know about cavities:

1. They are caused by several types of clearly identified bacteria.
2. Children are born without any of these bacteria in their mouth and acquire them throughout life from anyone they might share saliva with such as parents, caretakers, friends at school etc.
3. We need to fuel (supply sugar) the bacteria to cause breakdown of teeth.
4. More acidic oral environments make teeth more prone to cavities.
5. Dental decay is slow, progressive process that needs many tools to be identified and addressed early.

However, there is still a lot we do not know about cavities.  For example, identical twins raised in the same household, and eating the exact same diet, might still have completely different level of risk for cavities.  We know that some genetic factors such as makeup of enamel (outer layer of teeth) or factors in salivary makeup that can be either protective or destructive to teeth, affect rate of cavity formation.  Yet, we have not yet been able to identify these factors clearly enough to enhance or fight them before cavities form.  Despite knowing exactly which bacteria cause cavities, we are not able to target them with any medications specific enough to kill the offending bacteria without disturbing the overall oral balance.

With all these unknowns, we are fighting daily battles trying to protect teeth from cavities with the knowledge we have.  We know that bacteria, no matter how aggressive, cannot do any work without steady supply of sugar.  Keeping simple sugars, especially acidic ones (acid speeds up breakdown of teeth and access to the deeper and weaker part of the tooth) to the minimum is the first important step in keeping the teeth cavity free.  We find that “liquid sugars” such as juices, sports drinks, or lemonades as well as sticky candy, which are acidic, sticky, and filled with sugar, are the most dangerous food kids can consume.  Second step is removal of plaque, which contains sugars and allows bacteria to produce acid that destroys teeth.  Diligent brushing and flossing, as well as regular dental visits are the only ways to keep plaque under control.  Third stop is responsible use of fluoride.  It is the mineral that helps remineralize enamel, therefore fighting the destructive action of bacteria.  Using fluoridated toothpaste is extremely important and some children with high risk for cavities might even need extra prescription strength daily fluoride application.  Regular dental visits are crucial to risk assessment and early detection of cavities.  Many new and minimally invasive treatments can be applied to teeth before cavities become large enough for fillings, root canals, crowns or extractions.  However, if not detected early, cavities can become difficult to treat and cause disruptions in daily life.

It truly is difficult to find a simple answer to how cavities form and how to prevent them.  We work very hard at Smiles For Kids Pediatric Dentistry to educate our patients and families on cavity prevention and good oral habits in hope that soon we will have a better way of preventing decay from forming all together.  Meantime, however, we need to understand the factors involved in cavity formation and have a full appreciation for how unpredictable and complicated the process is.  We need to utilize the factors we do know in fighting the unknown ones, and apply them in daily home dental care in order to protect children from complicated dental procedures, pain, and loss of school time.  We also hope to ease some guilt parents feel when they find out that children have cavities, by explaining the complicated issues of dental decay formation.

Why Choose a Pediatric Dentist

Why Choose a Pediatric Dentist and Not a General Dentist for Your Kids?

Opting for a pediatric dentist over a general dentist is no different from choosing a pediatrician over a family doctor for your kids. A general dentist is great for adults, but having additional training in children’s growth and development, baby teeth formation and treatment, as well as behavior management makes pediatric dentists a better choice when it comes to your child’s oral care.

Many children are not cooperative during early teeth check-ups and cleanings. A pediatric dentist’s additional 2-3 years of hands-on training and education in child psychology and development is a definite advantage. Both Dr. Lindhorst and Dr. Jadav are Diplomates of the American Board of Pediatric Dentistry. They are trained to make your child feel safe during treatments and explain oral care and procedures in a manner understandable by kids. They also have highly trained staff that understands that approaching children is a delicate matter. The whole team’s focus is making sure your little ones’ visits are exciting, easy, and fun. They truly understand the importance of building positive experiences.

Pediatric dentists welcome patients from infancy to adolescence. Babies as young as one year old should be brought to the clinic for tooth decay prevention. These appointments educate parents on how to keep their children’s baby teeth healthy. Parents of toddlers are counseled about pacifier or thumb sucking habits. For teenagers, they understand their desire to keep a pleasing appearance. Older patients are guided on the right treatments for cavities, gum health, teeth bleaching and orthodontics.

Pediatric dentists use equipment that is specifically designed for children. Parents can expect the latest technology in ensuring gentle, yet effective procedures. Kids can have short attention span so pediatric dentists need to be fast and accurate. They must use tools that complement such a pace. The entire office is designed with the child in mind. Children can explore toys, play video games, or read books while waiting for their appointment. At Smiles for Kids Pediatric Dentistry, we offer toys for kids of all ages from toddler towers and picture books to Wii and movies for our older patients.

For very young or anxious children, sedation may be administered by a pediatric dentist if treatment is needed. Options depend on the child’s needs and can include applying topical anesthetic, using nitrous oxide, administering oral medications, or going through general anesthesia. The pediatric dentist is well versed in all of these options and can help choose the best one for your little child.

Treatment of children with mental or physical disabilities is also part of pediatric dental training. In fact, even adults with disabilities and special conditions can benefit from the expertise of pediatric dentists. Examples are those with cerebral palsy, Down syndrome and seizure disorders. At Smiles for Kids Pediatric Dentistry, we have a highly effective and individualized program for patients with severe anxiety and/or autism. We have seen great success with this program and we are very proud of our kiddos! A good pediatric dentist will be happy to accommodate all questions and discuss the advantages, as well as risks, of procedures.

This specialized approach to kids of all ages is what makes pediatric dentists a superior choice. Pediatric dentists will then pass on a well-behaved and well-educated patient to their general dentist colleagues.

X-Ray Frequency

As dental professionals we are often faced with the question of dental x-ray frequency and necessity. With our health conscious, cancer aware, google researching, and protective of our children society, the x-rays have achieved a gold medal in the danger category.

At Smiles For Kids we respect the radiation emitted by the x-rays, but it is our role as dental professionals to educate families on why, how, and when we utilize this important diagnostic tool. The interval of taking dental x-rays depends on individual child’s risk for cavities or pathology. At each appointment we carefully analyze the risk factors. Cavities are formed by bacteria making acid and then colonizing and dissolving enamel surfaces of teeth. Some children have aggressive bacteria and some do not. We assess the evidence of bacterial presence by the amount of plaque, tartar buildup, white or brown lines on enamel surfaces visible during a visual exam, and cavities on the visible parts of the tooth. We carefully analyze risk factors such as parental and sibling decay history, nighttime feeding practices (such as going to bed with food or drink or nighttime nursing), amount and frequency of acid and sugar exposure (especially in the form of juice, sticky and acidic foods, or milk at bedtime), daily oral hygiene practices (how often and how well brushing and flossing are done), spacing between the teeth, age of the child, as well as previous history of decay. Depending on the risk factors we decide whether the child needs x-rays at every visit, or as rarely as every two years. One of the most common areas for children to have cavities is where the back teeth touch. The x-rays called bitewings show us these areas in between the teeth that cannot be seen during a visual exam. It is impossible to reach those areas unless flossing takes place daily. We often see children with no visual evidence of cavities, who surprise us on x-rays with significant cavities between the teeth. Children’s back baby molars are very important for holding space, providing guidance for permanent teeth, and for chewing. They last until about 12 years of age and if decayed, have to be restored to keep them from getting large cavities leading to infections and subsequent extractions. If the cavity is caught on the x-ray early, we can double our preventative methods or restore the tooth with a small filling. However, if we do not take an x-ray in early stages of cavity development, we can visually discover it only once it is large and needs “baby root canal” and crown or even an extraction. The radiation from our state of the art digital x-ray machines for bitewing x-rays is minimal and we always utilize lead aprons in order to limit exposure area. Sometimes an additional x-ray must be taken to assess health of a root or other pathology such as cysts, extra teeth, development of a permanent tooth, dental trauma, or other anomalies. This is done only after careful visual exam and assessment of risks.

One additional x-ray known as panoramic image, needs to be taken on children at prescribed frequency to assess development of permanent teeth, pathology of the jaw bone, as well as TMJ structure. This x-ray is first taken around eight years of age when first stage of permanent teeth eruption has taken place, and then repeated at twelve years of age when all permanent teeth are in, and around seventeen years of age to assess position and development of the wisdom teeth. With today’s digital technology we can share x-rays via email with all other dental professionals, such as orthodontists or oral surgeons, in order to minimize radiation. On panoramic x-ray we look for anomalies such as faulty positioning of permanent teeth, cysts or extra teeth that need to be removed, missing teeth that will dictate future orthodontic treatment, as well as other pathology. If these anomalies are discovered in time, we can address them when necessary. However, without this panoramic x-ray we are blind to them.

At Smiles For Kids we are very careful not to expose children to any unnecessary radiation. We are aware of the damage that radiation can cause, and we take the risks as well as benefits of this important diagnostic tool very seriously. Please let us know if you have any questions or concerns and we will be happy to sit down and explain each x-ray with have taken on our precious patients.

Thumb Sucking Tools

“Non-nutritive sucking” is a normal behavior in children. As dental professionals we are often asked by concerned parents when and how to help their children stop sucking on thumbs, fingers, or pacifiers. 

Let us start from pacifiers. These tools are wonderful self-calming devices for babies. For the first months of child’s development they aid both kids and parents with much needed sleep. However, if used for a long time, they become a crutch and a powerful “orthodontic” device that can reshape the jaws and move teeth. It is hard to determine when exactly we should take pacifiers away, but our advice is to do it around eighteen months of age. Past that age children become more psychologically than physically attached to pacifiers. It is never easy for us as parents to take this step, but we do need to remember that we are in control of the pacifier. Some parents choose to take the pacifiers away “cold turkey” and prepare for few nights of fussy misery. Others take a gentle approach of cutting off the tip a little at a time or using a Lily Pacifier system, which has a series of pacifiers each with smaller tip that eventually lead to weaning. It usually does not take but a few nights for children to forget about this device. The longer we wait to take this step, the harder it will be as children outsmart us and know how to tug our heart strings as they get older. Any “damage” done by the pacifier to the jaw can be corrected. Young bones are soft and flexible and simply removing the pacifier with allow the tongue, the cheeks, and the teeth to reshape the jaws back to the natural state. The earlier we are able to get rid of the pacifier, the greater the chances are for this “self-reshaping”. 

On the other hand, thumbs and fingers cannot be removed! Many parents struggle with these habits for years. Some children wean themselves at an early age, but most will continue the habit well into the school age. We tell all our families that little can be done until the child is of an age that he or she understands the importance of quitting this habit. Children under three years of age rarely can be convinced to remove the thumb. We advise our families to positively talk to their children about the thumb or finger starting at about that time. We encourage parents to give children examples of their childhood heroes who do not suck fingers or thumbs. If sucking behavior is connected with a favorite toy or blanket, it must be removed as otherwise it provides an irresistible trigger. Rewards for not sucking on thumbs or fingers can be utilized starting at about the age of three with sticker charts or promises of a prize to celebrate success. Physical barriers can also be used as reminders during idle or tired times. Those range from gloves, plastic thumb/finger guards, fabric guards that look like one finger/thumb gloves, to a variety of dental guards made by the dentist. At Smiles For Kids we encourage our families to try home remedies before we discuss the dental thumb guards. We have candid discussions with the children about thumb/finger sucking and we run our own reward program for our patients including a “wall of winners”. If all these methods fail by the time that permanent teeth are ready to erupt (around the age of six), we discuss dental appliances with children and parents. These appliances are metal cribs attached on ring-like bands glued on the back upper molars. They provide a physical barrier to the suction that gives children the soothing and satisfaction. These appliances are passive and do not hurt, but they limit certain foods and can cause speech difficulty for a limited time. We advise parents and children to keep it for six months as that’s usually a substantial time to retrain the brain. Some families chose to have it removed earlier and we keep the appliance in our office so we can place it back in the mouth in case of a relapse. 

All habits are hard to break! We realize that it takes work and dedication to get rid of a habit, and we believe in a team approach. Like with the pacifiers, any damage to the jaws and teeth will eventually be corrected either be itself or by orthodontic appliances. We try to provide parents and children encouragement and resources on this journey and we celebrate their eventual success! 

A True Dental Emergency

Often as parents we are caught in the middle of the dilemma of calling or not calling the emergency number to our doctors or dentists. The emotions of fear, crying children, fevers, or blood spread panic. We don't want to call if it's unnecessary, but we do want to make sure all is well. So our Smiles For Kids team wanted to make it easier on parents and provide a guide to dental emergencies.

BABY TEETH often fall victim to unstable first steps, and poor decision making of a young explorer. Front teeth are often broken, moved, and otherwise abused. Often children have a thick and low positioned frenulum (piece of fleshy tissue) that holds the lip to the gums between the two front teeth and is very vascular. That area bleeds heavily when cut. Gums and lips around those front teeth are also easily bruised and bleed freely. Whenever those front teeth and surrounding soft tissues are injured it is best to call the dentist. Injuries include fractures, complete loss of a baby tooth, teeth being pushed into the gums, misplacement of teeth, or soft tissue bleeding. Many times we can simply discuss the details on the phone and look at texted photos, which will help us make a decision on whether this is an emergency needing immediate attention (rarely) or something that can be looked at during regular business hours within a day or two. Most of the time, waiting for a little while is perfectly fine, as long as bleeding and pain are controlled. However, you do want to see your dentist soon as an x-ray must be taken to rule out fractures of the bone or roots and to have a baseline image in case of future injury in the area. Many times these teeth heal on their own with occasional darkening, but serious fractures might warrant extractions. Another baby teeth dental emergency is pain connected to an abscessed (infected) tooth. This is usually preceded by large decay or previous treatment such as a large filling or a crown. An abscess usually presents as swelling, pimple on the gum, redness, and pain. This pain cannot be easily controlled and requires treatment with antibiotics and eventual extraction of the baby tooth. It is very important to call your dentist as this infection can spread and have serious consequences. Your dentist will either see your child within a short period of time or call in antibiotics and see you within few days for extraction once the infection is controlled.

ADULT TEETH are a bit different ball game as we must do everything we can to save them from consequences of the injury. Dentists are much more likely to come in after hours to treat an adult tooth emergency. Infections of permanent teeth need to be seen by a general dentist or a root canal specialist (endodontist) and will be eventually treated with a root canal. Initially we might call in an antibiotic to control the infection. Front teeth fractures are the most common adult teeth emergencies. Call your dentist immediately and email or text them photos of the fracture from various angles to determine urgency of the appointment. These teeth must be restored soon, but immediate action is needed only if the nerve is exposed or if the patient has sensitivity. The most urgent front tooth injury and one that requires immediate attention to ensure a chance of survival for the tooth, is avulsion, or complete loss of an intact tooth. Here time is of essence and you MUST immediately call your dentist and meet him or her in the office to have the tooth reimplanted within minutes. It is best if you can put the tooth back in the socket or store in patient’s saliva. If you cannot do this, your second best option is milk. However, DO NOT let the tooth stay dry on your way to the dentist and DO NOT put it in regular water (saline solution is fine).

There are probably million other reasons why you would and should call your dentist. Dr. Lindhorst or Dr. Jadav are always on call with cell phone in hand to ease anxiety, look at photos, and to answer any questions. If in doubt, call!

The Asthmatic Dental Patient

What is Asthma?

The prevalence of asthma is 9.3% in the general population. That means that about one out of every ten patients has this condition. It’s defined as a chronic respiratory disease associated with airway obstruction, with recurrent attacks of paroxysmal dyspnea and wheezing due to spasmodic contraction of the bronchi. Patients that are having an asthmatic attack usually cough, wheeze, have chest tightness, and shortness of breath. Asthma affects people of all ages but it most often starts in childhood.

How is it treated?

Asthma does not have a cure but it is a manageable condition. A spectrum of medications is used to treat asthma. Some of these medications are prescribed to be taken daily while others are considered “rescue” medications used only during an acute episode. It’s important for us to get a full medical history from our patients to understand how well-controlled they are. This aids us in making decisions about their specific dental prevention plan and options for treatment.

Asthma and the Oral Cavity

Dentally, asthmatic patients have an increased risk for cavities. One major factor is dry mouth caused by medications that patients are taking daily. This decreased salivary flow rate leads to less efficient clearing of sugar and the harmful cavity-causing bacteria. The salivary pH also tends to be lower which is more favorable for cavity formation. Studies have found that asthmatic patients have an increase in enamel defects and incidence of oral candidiasis. There’s also an increased rate of malocclusion likely due to mouth breathing. For this reason, we continually assess orthodontic needs for asthmatic patients.

Dental Treatment of the Asthmatic Patient

For every patient and every appointment, we assess the child’s risk of having an asthmatic attack. This is precisely why we ask detailed questions about asthma frequency and severity. Specifically, we need to know how many episodes per week the patient experiences and any previous hospitalizations and/or emergency room visits. We need to know any triggering agents and medications that are used for management (more medication could indicate poorly controlled asthma). This detailed medical history allows us to safely and cautiously treat our patients.

For a treatment appointment, we always verify that a rescue inhaler and EpiPen are readily accessible. We always have supplemental oxygen available during treatment in case of an asthma attack. If a child is symptomatic, we will reschedule the appointment. Using a barrier or instruments to help isolate the tooth being worked on from the oral cavity will substantially decrease chance of inhalation of particles and irritation of the airway.

Behavior management is very important for asthmatic patients because anxiety can trigger an attack. Using nitrous oxide analgesia is appropriate for patients with mild to moderate asthma. For patients with more serious asthma, medical consult may be indicated. If oral sedation is needed for any reason, only medications indicated for the asthmatic patient are used.

Prevention Plans

It’s integral to consider putting patients at high risk for cavities on fluoride gels or fluoride rinses for home use. This can help combat caries in a patient that already suffers from dry mouth. A major part of the individualized plan is always a good diet and daily oral hygiene.

If you have any questions, please don’t hesitate to contact us.

Kids with Sensory Disorders

At Smiles For Kids we know that each and every child comes with his or her set of challenges. We love all of the kiddos and customize our dental care specifically to individual needs. Perhaps the ones that we spend the most time and energy with are the kids with sensory challenges such as PDD or Autism Spectrum Disorders. Through continuing education, research, talking to parents of our patients, and years of experience we have developed a program that works beautifully for most patients in our office.

Most children with sensory disorders need extra time, slow and patient explanation of what will be done, and short appointment times. Our philosophy is to slowly but surely lead them through as many appointments as it takes to accomplish our goals. We do not charge for multiple appointments, just for the tasks accomplished. If it takes us 5 appointments to get teeth cleaning done we charge only for one cleaning, not for each appointment. We do realize that parents are already paying the price of time having multiple appointments, but we find this approach rewarding, successful, and worth every minute of our time as well as parents’ time.

Our initial appointment with kids who need extra time involves detailed interview with parents about more than just the medical history. We talk about specifics such as habits, likes, dislikes, behaviors, triggers as well as previous dental and medical experiences. We let the kids play and get familiar with our office. They roam our reception area, hang out in our New Patient room where we talk to the parents, or play in the open bay hygiene area. We encourage them to play as much as possible and try out any piece of equipment they would like to touch, sit on, or play with. Often this is all we accomplish during these initial appointments and we do not force more because we want to build a friendly relationship. We encourage parents to bring kids in just to play in our reception area between appointments if they feel that would help.

On subsequent appointments we have few things to accomplish (cleaning, exam and x-rays) and take as many tries as necessary. We have a Social Story with pictures of each piece of equipment, how it works, and what it does that we show our patients before using anything. During some appointments all we accomplish is having a child sit in our dental chair. Over time we are able to get full dental cleaning, radiographs, and exam done in small increments. Mrs. Yvette is a constant source of information and always stays with our little ones who need consistency and gradual introduction to the world of dentistry. The rest of the team comes in to do our respective jobs through her leadership and judgement of when the patient is ready for the hygienist, assistant or a doctor.

Our success in treating kids with sensory disorders has been tremendous once we implemented our approach of letting the kids’ comfort level lead us with gentle introduction to a new task each time. We discuss with parents at the beginning of each appointment the goals we want to achieve on that particular day and what cues we need to pick up on from the kids to stop. Usually, once we go through the first round of several appointments, for the next six-month checkup the kids are doing great as they have gained confidence and we have gained their trust!

Please call us for more information!

"They Are Just Baby Teeth"

We hear this statement more often than we like to for sure! We hear it from parents when discussing oral hygiene habits and teeth-friendly dental foods, and we hear it when discussing cavities to the point of rampant dental decay and infections. So why are we at Smiles For Kids so adamant about keeping up with those “Just Baby Teeth”? Why is pediatric dentistry a specialty? Why do we want to keep those teeth healthy? All these are great questions!

Our team is well aware that in most cases all baby teeth will eventually be replaced by permanent teeth. We work very hard on guarding them for the necessary period of time and you will often hear our doctors discuss how to control dental decay and keep it in check as opposed to doing dental treatment. Yet, you have to remember few facts about the baby teeth:

* Most baby teeth (12 of them in the back) must last until 12 years of age. That’s ten years considering that most kids have complete     dentition at 2 years of age. Losing baby teeth due to dental decay     (especially the ones in the back of the oral cavity) will cause loss  of space for permanent teeth. This loss of space compromises proper jaw growth and development, bone formation, and causes major orthodontic problems which often require complicated and otherwise unnecessary orthodontics and possibly surgical treatment. Baby teeth help with chewing and proper nutrition. It is hard for kids to consume and break down food appropriately with large spaces in the back of the mouth.
 
 
* Front baby teeth serve a very esthetic function and are important in development of speech. That said, those teeth are the first ones to get replaced at around seven years of age so at Smiles For Kids we often only note the development of decay on these teeth and extract them only in extreme cases of infection.

* Baby teeth with large cavities will get infections! Those infections are painful and dangerous. Any infection in the head and neck area is an emergency situation not to mention a very painful development for kids. Many kids end up in the hospital on IV antibiotics to control dental infections and swelling. Pain often keeps kids and parents up all night and makes for very unpleasant reminder of why we should take care of those "Just Baby Teeth".

 
* Baby teeth have different structure than permanent teeth and their thin enamel can easily be attacked and penetrated by bacteria therefore they need more diligent preventative dental care. "Fixing" baby teeth is not a small affair! Although the restorations are fairly simple to do comparing to permanent teeth, the teeth are smaller, more prone to recurrence of decay, and kids are young and often not cooperative for restorative appointments.

So in conclusion, we would like to remind you to take immaculate care of those pearly whites. Please remember that as much as dental decay is multifactorial and we have no control over large part of the problem, we can control oral hygiene and diet such as going to bed with milk, sweet drinks (juices and Gatorades) and gummy candy. Let’s give those baby teeth a chance to live out all 12 years of their life in health and prosperity!

The DIAGNOdent Advantage

DIAGNOdent, a technology brought by a leader in dental equipment, KaVo USA, is one of the extra steps taken by dentists and hygienists at Smiles For Kids in providing quality and modern dental care. This state-of-the-art equipment detects decay on biting surfaces of teeth, ensuring that no sealants are placed on any tooth with decay. The DIAGNOdent technology gives us the edge we need to find even the most elusive decay and allows us to act before it destroys the tooth. For patients, it means an accurate, fast and painless step to possessing healthy and attractive teeth.

**How it works**

Some cavities are simply harder to detect than others, particularly when they are still in the early stages or settling in areas more challenging to locate, for instance, in the deep grooves of molars. Whether or not to open a suspicious-looking tooth remains a dilemma for many dentists because of the risks associated with both options. While older dental devices and equipment such as explorer and bitewing x-rays can perform a decent job with larger decay areas, the same cannot be guaranteed when locating tiny lesions and hidden or very early dental caries.

DIAGNOdent, uses laser technology to penetrate deep into the tooth through its accurate scanning system. It operates at a wavelength that makes tooth with bacteria or an altered substance fluoresce. This laser fluorescence is measured numerically so you will not only be able to detect decay, you can also gauge the amount of it. This portable machine that is just a little bigger than a pen and displays a reading accompanied by an audible sound. When tooth is healthy and clean, you will see none or very little fluorescence with low numbers. It is like having a dentist with laser vision!

**Safe and pain-free**

Pain has always been a top concern among dental patients. In this regard, many will surely feel relieved to know that DIAGNOdent is non-invasive and as pain-free as taking your temperature with a digital thermometer. As a matter of fact, it even encourages patient interaction because the patient can hold and glide the pen-like tool over tooth surface and watch as the monitor displays the results.

DIAGNOdent also saves a patient from pain caused by unnecessary excavation of a tooth that is suspected to have decay but is actually healthy. Many teeth have staining in the grooves that although suspicious looking, is not decay. Likewise, when decay is immediately detected and treated, patient is spared from toothache and other painful and expensive dental procedures. But perhaps more important than being a pain-free device, DIAGNOdent is safe. It makes use of light and sound energy so there is no fear of x-ray exposure to both patient and staff.

**Just one caveat**

Like many other products of technology, the benefits of DIAGNOdent can only be maximized when you have qualified professionals by your side. Though the machine is easy to use and results are instantly available and reliable, its effectiveness still relies on correct interpretation and the subsequent treatment plans. DIAGNOdent must be used as just one factor in the exam that includes also full evaluation and x-rays if necessary because unfortunately DIAGNOdent cannot “see” between teeth. Hence, make sure you are seen by a skilled dentist or hygienist and that he or she is trained in using DIAGNOdent.

GERD and Children’s Teeth

Gastroesophageal reflux disease or GERD is actually a digestive, and not an oral, problem. However, teeth are naturally affected when stomach acid flows back up and reaches the mouth and often are the first sign of this condition. Imagine the havoc it can cause especially on thin enamel of baby teeth. If your child has been diagnosed with GERD or its less severe form, acid reflux, then be prepared to accompany your child to more dental trips than usual to protect those delicate teeth.

Kids suffering from GERD often adjust to life with acid reflux without complaining and parents as well as pediatricians do not realize that the child is suffering. However, sometimes they do complain of acidic taste in mouth, frequent heartburn, and difficulty in swallowing, vomiting or coughing during sleep and discomfort while laying down. GERD is associated with other conditions such as premature birth, ADHD, cerebral palsy and asthma. A child with GERD is more susceptible to common dental problems such as bad breath, cavities and tooth decay. If your child already has such conditions, they could get worse.

Signs of wear on the teeth might be the first sign of acid reflux parents notice. You might notice holes in your child’s teeth especially on cusps of molars and canines. These holes are signs of enamel erosion and can cause sensitivity. Over time, if left untreated, the holes can become bigger and deeper, even exposing tooth nerves and causing irreversible tooth structure loss. It is important to work closely with your child’s pediatric dentist as early as possible.

At Smiles For Kids we recommend certain lifestyle and dietary changes that may be similar or supplementary to what your child’s pediatrician might have mentioned. The list usually includes teaching your child to eat a balanced diet and avoiding acidic foods, as well as how to eat smaller amounts and chew well. Keep in mind that food has a huge impact on the success or failure of your attempts to keep your child’s dental health at bay.

Most kids with GERD are discouraged from eating sour foods and acidic drinks. However, fried and spicy foods are proven to be just as harmful. Furthermore, what may be helpful to the condition could be harmful to the teeth. Take carbohydrates for example. They are recommended for people with this condition but most carbs are starchy, sugary and sticky on teeth which easily causes decay. Sugar, another known tooth decay ally, is added to most GERD medications.

It is helpful to make a list of conditions that trigger your child’s GERD. Know the kinds of food that cause symptoms of GERD, what your child experiences when it occurs, the time of day it happens and how frequently it occurs. Lastly, brushing teeth is often a challenge for a child with GERD because of tooth sensitivity caused by erosion or perhaps due to other related negative experiences. Be patient though. Try to make brushing a more pleasant experience. Buy toothpaste for sensitive teeth, a toothbrush with soft bristles. You can try one with sounds or one with his or her favorite cartoon characters. Do whatever helps your little one brush.

Preparing Your Child for a Dental Visit: What to Say and Not to Say

It may or may not be your child’s first trip to the dentist but you know it is going to be a challenging day. After all, you may have the same fear of being in the dental chair yourself. Quite figuratively and literally, you know the drill. However, you are also aware of the importance of these dental visits especially for the little one’s fragile teeth, so it’s time to keep those fears wrapped up and get your child prepped. Here are some things to tell and not to tell your child when doing the dental pep talk.

**What to say:**

* It’s not an option. Be friendly but firm when telling your child that dental visit is a necessity and not a choice because really, you wouldn’t want them to think otherwise. Remember that you will be doing this regularly so better instill this good habit from the start. 

* The importance of this visit. Tell your child how the dentist keeps teeth clean and strong. Is your child concerned about having a beautiful smile or maybe a set of strong teeth that enables him or her to eat well? Like any good old advertising, telling the benefits sells always. 

 
* Your enthusiasm. Children do not usually have an idea that a dental visit is scary until parents start a “heart-to-heart” talk that implies it is. So, share enthusiasm instead or just stay relaxed. Nowadays, it is not difficult to find an adorable dental office with friendly staff. At Smiles For Kids, we call it taking kids on an adventure! 

**What not to say:**

* Everything will be fine. Keep a positive attitude but don’t make promises you may not be able to keep as it can be more disastrous. You never know if the child is going to need treatment that can cause pain or anxiety. When this happens, your child might lose trust in you and the dentist.

* Your own experiences. Parents naturally want to share how they did well or conquered their own dental fears thinking this will help their child feel better. Avoid taking this route though because you might not be aware that your “triumph” tales are riddled with your past anxieties too. Taking your little ones to your own dental visits may do more harm than good because adult cleanings often involve a long time, scary sharp instruments, and often some bleeding. This is certainly not how you want your little one feel about cleanings! 

* Use the dentist as threat or punishment. We all love to have a scapegoat in making sure our children behave well. Using a dental visit as a threat however will most definitely scare your child, but probably not to do what you would like them to do! Instead it will make your little one afraid to see a dentist and make every visit dreaded by not just your child but also you!

Try to keep the talk short. Don’t think that giving your child more information can lessen their fear because the opposite happens most of the time. Allow our team to answer if your child has questions as we are well trained to do that. Every day our job is to have your child succeed in our office, to have them walk out of Smiles For Kids with a happy and healthy smile on his or her little face. Always choose a dentist that caters especially to kids. Pediatric dentists took extra years of training to handle kids’ dental and emotional concerns, including anxiety. Furthermore, our teams are well trained to make kids happy and our clinics are designed to make children feel at ease during treatment.

Panoramic X-ray

A panoramic x-ray or panoramic radiography is a type of dental x-ray that shows a broad view of the mouth, including teeth, jaws, nasal area and surrounding tissues and structures. It is one of the most commonly used dental x-rays along with the bitewing x-ray (used mainly in detecting cavities) and the periapical x-ray (shows entire tooth including roots and surrounding bones). The panoramic x-ray delivers a flat image despite curvy structure captured such as jaw. It is non-invasive and easier to take than other x-rays.

When and why we take it

Panoramic x-ray is a valuable diagnostic tool in modern dentistry. From common procedures like getting implants, braces or dentures to more serious conditions such as oral cysts, tumors and cancer, most dentists and oral surgeons recommend taking panoramic x-ray first before preparing a treatment plan. Patients who have impacted teeth, particularly impacted wisdom teeth, are usually ordered to take panoramic x-rays for evaluation of the affected teeth. Those with gum diseases, deep cavities, TMJ problems and facial or teeth trauma are encouraged to have it done as well.

At Smiles For Kids panoramic x-rays are taken in accordance with the AAPD recommendations of growth and development unless patients have other conditions and concerns requiring more frequent radiographic exam. Routine times to take this x-ray for the first time is around seven or eight years of age as permanent teeth start erupting. At that time, we check for correct development of all permanent teeth, missing or additional teeth, health of the TMJ and correct angulation of erupting teeth as well as for any cysts, growths and other bone problems. The next time this x-ray is taken is around twelve years of age after permanent dentition has replaced baby teeth. At that age, we check for all of the above conditions and readiness for orthodontic treatment as well as health of the jaw, teeth and all oral structures before such treatment begins. The final time that a pediatric dentist takes this x-ray is around seventeen years of age in order to evaluate condition of wisdom teeth and their need or readiness for extractions in addition to all of the previous reasons. Other dental specialists might require it for reasons mentioned previously throughout a patient’s adult life.

The Procedure

When advised to take a panoramic x-ray, special preparation is not necessary. The procedure is fast and painless and the result is instant. Women should always check first if they are pregnant and inform their dentist or oral surgeon before going through the procedure. Metals and jewelry should be removed as these might interfere with the images. The dentist provides the lead apron with thyroid collar as a safety precaution. It helps shield the rest of the patient’s body from unnecessary radiation.

Advantages and Limitations

Panoramic x-rays possess several advantages. Since the film is inside the machine (which moves around the patient’s head), it is easier and more convenient for young children, as well as patients who are not comfortable placing film inside their mouth or those suffering from severe gagging.

Though very useful, the panoramic x-ray is not a comprehensive picture as it cannot provide details for every tissue or muscle scanned. It cannot for example be used to detect cavities (although some of newer machines have those capabilities). It is primarily used for initial evaluation of teeth, bones and adjacent structure. There is also distortion of some degree in a panoramic x-ray since it takes a flat picture of a curved jaw, which can be crucial in a critical dental condition. When dentists and oral surgeons need more precise and detailed results, another type of dental x-ray or an MRI or CT scan may be performed with or in lieu of a panoramic x-ray.

Tooth Decay

Dental decay is number one disease in children in the United States. It has caused more lost school days and more lost work hours than any other disease! Yet, it is largely preventable! The true problem lies in lack of knowledge about factors causing decay and resulting from it bad habits. Good news for little ones (and you with a sweet tooth): Sugar alone does not cause tooth decay. Rather it is the delicate balance of cavity-causing bacteria, sugar, acid and time. Plaque, which contains those bacteria, builds up on our teeth and gums and if not cleaned regularly the bacteria feeds on sugar and as they feed, they produce acids that destroy the tooth enamel. If not controlled over time they create holes called cavities or dental decay. Unfortunately, and as you can see, it all starts with something that looks so sweet and so harmless – sugar.

Do you have dental decay?

Cavities cause pain in late stages when they have reached the inner part of the tooth, the nerve. Left untreated, it can also lead to infection and even tooth loss. When you notice signs like toothache, bad breath, gum swelling and spots on your teeth, visit your dentist immediately. Your dentist will likely perform a visual check-up as well as order necessary x-rays. Some dentists use more modern equipment such as DIAGNOdent to locate and measure the amount of decay present. All that said, regular dental checkups will diagnose incipient, or barely starting, cavities in early stages and allow for preventative treatments rather than aggressive ones.

Everyone is susceptible to tooth decay, even babies. While we are not born with decay-causing bacteria, we get them from adult care takers as well as other children. Babies can get early childhood caries when put to bed with a bottle of a sweet drink such as milk and juice. Kids are more susceptible to cavities than adults since the outer layer of their teeth are thinner and easier for acids to penetrate. They are also more likely to consume sweet and starchy foods. Parents often do not realize that children have cavities until their teeth chip, abscess or hurt. However, there is no reason to wait that long! Dental decay is 100% preventable with early childhood visits, good habits and knowledge.

Beat it

Tooth decay is a lifelong battle and it starts with smart dietary and lifestyle choices. Avoid foods high in sugar and carbohydrates. Brush and floss teeth properly at least twice a day, and see your dentist regularly. Getting optimal amounts of fluoride also helps as it makes teeth stronger. If you have conditions like diabetes and dry mouth (saliva washes away food including sugar), tell your dentist about it as these make people more prone to tooth decay. Many medications for children are sugary and some cause dry mouth (such as allergy medications or inhalers) which can also contribute to being prone to cavities.

A tooth has three layers: the enamel, dentin and pulp. Treatment of tooth decay largely depends on its severity and how far it has affected the tooth. When decay has not gotten through the outer strong layer, the enamel, dentists usually recommend good oral hygiene, flossing and fluoride treatments. However, if decay has already passed through the enamel and formed a cavity, a filling likely must be used. The decay is removed first and the hole is filled with another material to prevent further damage.

Severe decay in children is usually remedied by a pre-formed crown that replaces the part of the tooth that was damaged. For an infected pulp, a root canal treatment called pulpotomy, may be needed. When a tooth is beyond saving from tooth decay, it needs to be extracted and space must be held for permanent teeth with a space maintainer.

What You Need To Know About Baby Teeth

Baby teeth, also called primary teeth, are often taken for granted because in a few years, they will be replaced with permanent teeth. But baby teeth serve special purposes and must be taken care of because they are not only essential for your baby’s physical looks but perform many functions.

Aside from basic purpose of aiding in biting and chewing, baby teeth are also important because:

• They aid in providing nutrition to your baby
• They help in speech development
• They assist in the development of facial muscles and jaw bones
• They enhance physical appearance
• They save space and prepare the jaw bones for permanent teeth

Essential food will not be properly digested by the body when it is not processed by the teeth through chewing. Digestion starts in the mouth where food is broken down into small pieces so it can get processed in the body properly. Chewing also produces saliva which begins the chemical breakdown of nutrition and naturally cleanses the mouth and teeth protecting it from various infections when combined with proper care.

In helping your baby pronounce words and speak clearly, well-aligned teeth can make a huge difference. Notice how your child pronounces words when he/she is already losing baby teeth? That is how the lack of teeth can affect speech, hence the importance of keeping primary teeth healthy.

Facial and jaw muscles, just like in other parts of the body, need exercise for proper development. Since your child is at that age when facial and jaw muscles are still rapidly developing, properly aligned baby teeth are a very important aspect of this development. Chewing food exercises the said muscles too.

Good set of primary teeth is also important in enhancing appearance. Teach your child proper oral hygiene to maintain a great smile at any age. Primary teeth usually last for ten years. Cavities in them can cause children pain, swelling, infections and even hospitalizations. Extracting them can cause loss of space and orthodontic problems as well as difficulties in chewing and development of muscles. Primary teeth are very important to take good care of and properly maintain. It is therefore important to have regular visits to a pediatric dentist to monitor the development of your child’s permanent teeth and maintain primary teeth for as long as possible.

When it is time for permanent teeth to emerge, they will push out the primary teeth. If your child has lost his/her primary teeth early, the permanent teeth don’t have guide to follow which can result in misaligned teeth.

Tips on how to care for primary teeth

• For infants, clean the gums with damp cloth every day.
• Use infant toothbrush and clean the teeth with water.
• Check if tap water in your area has fluoride. According to studies, fluoride helps prevent tooth decay and preserve primary teeth until it’s time for them to be replaced by permanent teeth. If tap water has fluoride, you can mix it with your baby’s formula. If there’s no fluoride in your tap water, you can buy “nursery water” which has fluoride at any grocery store.
• Feed your baby healthy foods, combining fruits and vegetables in his/her daily diet and avoid sugary snacks.
• Don’t let your baby sleep with a bottle that contains juice or milk. The sugar and acid in those drinks will stay in your baby’s mouth while she or he or he sleeps and this will cause tooth decay. Put water in the bottle instead if your baby is used to this routine.
• Teach your baby good oral hygiene routine so she or he can adopt healthy habit

Are “Healthy” Drinks Good for Your Teeth

To maintain good oral health it is important to be conscious of what you put in your mouth. Food and drinks must be checked for their contents and what it can contribute to your general well-being. Most people know that cokes and soda pops are not good for your health, but advertisers go a long way to promote “healthy” drinks such as Gatorade or Vitamin water. Unfortunately, many people are not aware that even the so-called “healthy” drinks can cause more harm than good to the condition of your teeth. Because baby teeth have thinner enamel, the effects on them can be even more pronounced than on permanent teeth.

The following are some examples of beverages that are commonly thought as harmless and healthy:

• Sports/Energy drinks – After an hour in the gym or playing your favorite sport most people will reach for sports or energy drinks. According to studies, several brands contain low pH, which means it is acidic and bad for your teeth. Acidic drinks can weaken the teeth by eroding its enamel gradually. When the enamel is weak, your teeth become sensitive to heat and cold and susceptible to cavities. Next time you buy sports drink, check the pH level which should be at least 5.5, lower than that is considered acidic. And as with all sugary drinks, minimize your intake and drink it at once instead of sipping and making it last the whole day.
• Bottled water – Water in general is an excellent choice for rehydration, but bottled water does not contain fluoride, an ingredient that helps keep teeth strong and healthy. So when available, drink fluoridated tap water instead. It does not only save you a few dollars but also helps you keep your pearly whites for many years.
• Fruit juices – Most people think that fruit juices are healthy so they take it in large doses and often give it to their children as sources of vitamins. However, fruit juices can never replace the benefits that you get from eating real fruits. Fruit juices’ sugar and acidity levels are high enough to weaken the tooth enamel.
• Tea – Tea is an antioxidant and several studies show that it is good for overall health. But a study on its effect on teeth shows that this health drink can also erode and stain teeth. Black tea is found to erode teeth faster than the green variety. However, this effect is not as fast when compared to that of fruit juices and energy drinks because there is no sugar in plain tea unless it is artificially added. Though there is no reason not to enjoy the overall benefits of tea, drinking it in moderation is better for your teeth.

Drinking to your health must be coupled with awareness and knowledge so that you can make the right choices to maintain good oral health. Here are some tips on minimizing damage from sugary and acidic drinks:

• Read the label. If you can’t resist reaching for a “healthy” drink, at least choose one that has the least sugar and right pH level.
• Use straw to minimize contact of acid and/or sugar ingredients on your teeth and drink it in short amount of time.
• Fluoridated tap water remains the best choice so reach for the faucet instead of acidic beverages.
• After having an acidic drink, rinse your mouth with water to give your enamel time to recover.
• Visit your dentist regularly.