"Caring for your children as our own"

What are sealants, fillings, and crowns?
A sealant is a clear or shaded plastic material that is applied to the chewing surfaces (grooves) for the back teeth (premolars and molars), where most cavities in children can form.  This sealant acts as a barrier to food, plaque, and acid, thus protecting the decay-prone areas of the teeth.  However, cavities between the teeth are not protected by sealants.  As long as there is no cavity in the tooth, sealants will be recommended for all children.

If your child has a cavity, a filling is placed after the cavity is removed.  Most of the time, the filling is a tooth colored (white) filling, but there are certain situations in which a silver filling is necessary.  In our practice, when a tooth needs a filling, a sealant is placed over the filling and the remaining tooth for added protection.

In a primary tooth, if a cavity is too large to restore with a filling, a crown may be recommend or the tooth may need to come out.  If the cavity is too large and has involved the nerve of the tooth, then the nerve will be removed (pulpotomy) along with the cavity, and a crown will be placed.  A crown can either be tooth colored or stainless steel.  For front teeth, white crowns are routinely used for esthetics.  For back teeth, stainless steel crowns are used for their durability and longevity.  The purpose of the crown is to help provide structure for the tooth, to help maintain space for permanent teeth to erupt properly, and to help protect the remaining tooth.

 
All of these procedures are associated with a certain failure rate depending on the severity of disease, cooperation of patient during treatment, and individual response to the treatment.  All treatment is recommended based on scientific criteria and clinical experience in the best interest of your child.  If your child needs any of the above treatments, please talk to Dr. Pham about any questions or concerns that you may have.

What about an extraction?

Your child may at some timeneed to have a tooth removed.  This may be due to pain, irritation, or infection and in some instances the tooth is un-restorable due to advanced infection.  We make every effort to provide longevity for your child’s teeth but unfortunately there are instances where this not feasible.  Premature loss of a primary tooth may require that the space be temporarily held open until the permanent tooth comes in, this will allow for a straighter smile without exacerbated problems with crowding.  This is achieved by custom fitting a Space Maintainer to your child’s tooth which fabricated by our laboratory.

What about sedation?
Small procedures in cooperative children can often be done under local anesthesia with or without nitrous oxide.  The most common form of sedation we routinely use in our office is nitrous oxide (laughing gas).  This is given through a small breathing mask which is placed over the child's nose.  The AAPD recognizes this technique as a very safe, effective technique to help relax your child during treatment.

Slightly more involved procedures in certain children will require the use of an oral medication along with nitrous oxide to help relax your child and facilitate cooperation with the procedure.  These procedures are scheduled carefully, require your child to be fasting the morning of the procedure, and also be free of any respiratory symptoms in the two weeks preceding the procedure.  Often we ask that two adults be present so that one is able to sit in the back seat with your child on the drive home.

Some children require an extensive amount of dental work.  In these situations, it is difficult for younger children to cooperate fully and often the treatment cannot be done properly.  For these children, we may recommend treating your child in the operating room under general anesthesia. 

Can I go back with my child?
We do not have any policy that restricts parents from being with their child during their visit.  We do feel that children vary as individuals.  It has been our experience that most children do better with the parents waiting in the reception area.  There are exceptions, and there are certain children who will have a better experience if the parents are with them throughout the visit.
Our preference is to have one parent with the child for their initial visit.  If the child requires treatment during another visit, the need for parental presence should be discussed between the dentist and the parent and decided on a case by case basis.

Cut or Bitten Tongue, Lip, or Cheek
    Apply ice to bruised areas.  If there is bleeding, apply firm pressure with a clean gauze or cloth.  If bleeding does not stop after 15 minutes or it cannot be controlled by simple pressure, take the child to the emergency room.

Toothache
    Clean the area around the sore tooth thoroughly.  RInse the mouth with warm salt water or use dental floss to dislodge impacted food or debris.  DO NOT place aspirin on the gum or on the aching tooth.  If the face is swollen or the pain still persists, contact our office as soon as possible.

Knocked out Permanent Tooth
    Find the tooth. Handle the tooth by the crown, not the root portion.  You may rinse the tooth, but DO NOT wipe or handle the tooth unnecessarily.  Inspect the tooth for fractures, if there are no fractures, try to reinsert it into the socket.  Have the patient hold the tooth in place by biting on a gauze.  If you cannot reinsert the tooth, transport the tooth in a cup containing milk.  If there is no milk, place the tooth in a cup containing the patient's own saliva.  DO NOT place the tooth in water.  Call our office immediately.  Time is a critical factor in saving the tooth.

Fractured Tooth
    Rinse debris from injured area with warm water.  Place cold compresses over the face in the area of injury.  Locate and save any broken tooth fragments in milk.  If your child experiences severe pain, contact our office as soon as possible.