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Dental care for children is one of the most important events in a child’s development. Not only will good dental care and experiences set the tone for an entire life of dental Pediatric Dentistry Marielaina Perrone DDScare but also keep them healthy and happy. The first dental visit is an extremely important step in a child’s life.

Best Age For First Visit?

The ideal time for a child’s first dental visit is about 6 months after the first tooth eruption, or up to 2 years old. The reason for this timing is to give the dentist a chance to assess development of the child’s mouth as well as to dispense dental hygiene instructions, help with teething, thumb sucking, and pacifier sucking issues to the parents. Dental issues, and tooth decay can start early, so it is best to see the dentist sooner than later.

So What happens at the first visit?

The first dental visit is usually quite short and probably will not involve any treatment. This visit is usually designed as a meet and greet in a non threatening and very friendly way. Usually the child will sit in the parents lap, and experience a ” tell, show, do” visit. This is where the dentist talks to the child , shows the instruments, lets them touch things, and does a limited dental examination. Depending on the dentist and child, parents may or may not be asked to wait outside. Each child, and parent will be different in how they handle being at the dentist.

During the dental examination, your dentist will check all of your child’s existing teeth for tooth decay, examine your child’s bite, and look for any potential problems with the gums, jaw, and oral tissues. If necessary, the dentist will clean any teeth and check the need for fluoride application. The big component of the first dental visit at this age is dental hygiene education as well as answering any questions that parents might have.

Pediatric Dentistry Marielaina Perrone DDSThe early dental visit will help you and your child build trust in your dentist. As a parent, you will see, that every 6 months there is a huge change in your child’s development and maturity. So, be assured, that even if your child cannot handle very much the first visit, it will become markedly easier at the next 6 month visit. For a child, they will become used to the dental visits, and usually look forward to them.

Dental Education Can Include:

-How to maintain a good oral hygiene regimen for your child’s teeth and gums as well as cavity prevention.

-Assess the need for fluoride supplements.

-Oral habits and their effects. These include thumb sucking, pacifier habits, and tongue thrusting.

-Developmental issues like teething.

-Nutrition instructions including foods, and beverages to avoid to decrease chance of tooth decay.

-Schedule of dental examinations. Most children are seen every 6 months just like adults. This allows the child to become more and more comfortable at the dentist as well as allow the dentist to closely monitor development and promptly treat any issues.

First Dental X-Rays for Children?

In general, dental x-rays should be taken when a child has back teeth which are in tight contact with each other, when a cavity is detected, or an anomaly is noted. Back teeth x-rays, (bite wings) and a jaw x-ray,(panoramic) should be taken by age 6 to assess developing teeth. It all depends on the children and their risk levels for dental problems like tooth decay or cleft lip/palate. If the child is deemed to be at a higher risk, then x-rays will be necessary earlier. Most children will have had their first dental x-rays by age 6. Dental X-rays play an important role in allowing your dentist to see if all permanent teeth are developing properly in your child’s jaw as well as detecting tooth decay.

Conclusion

The main takeaway is that children need proper dental care and instruction to maintain their dental health. The earlier you get started with your kids the better off they will be  as children and as adults.

 

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Marielaina Perrone
2551 N. Green Valley Pkwy #A405 HendersonNV89014 USA 
 • 702-458-2929

Tooth eruption is a process in tooth development in which the teeth erupt into the mouth and becomes visible.

The arrival of a new tooth, or tooth eruption is a big event for most of us! As a baby, tooth eruption allows for introduction of new foods with more substance. Later on, many parents and kids look forward to a visit from the tooth fairy, and for their new “grown up” teeth to come in. It is an exciting time for parents and children alike and losing baby teeth is an important

Tooth Eruption - Marielaina Perrone DDS

Tooth Eruption

milestone in most kids and parents lives. It means they are growing up, getting bigger, and taking on more responsibility for themselves at home and school.

Tooth Eruption Facts

Humans have two sets of teeth, primary (or baby) teeth and then permanent teeth. These teeth develop in stages. The schedule is different but the development and tooth eruption of each of these sets of teeth is very much the same. Following are a few facts about tooth eruption:

-Tooth eruption tends to happen in parallel. This means that the bottom molar tooth on your left side should erupt into your mouth at about the same time as the bottom molar tooth on the right side.

-Primary tooth development begins during the 2nd trimester of a woman’s pregnancy. Primary teeth are place holders for permanent teeth.

-Loss of primary teeth due to extraction or loss of space due to breakdown of baby teeth, makes a child susceptible to malocclusion and more likely to need orthodontic treatment.

-The crown of a tooth is the first to begin forming. The roots continue to develop and lengthen even after the teeth have come through the gums.

-There are 20 primary teeth. These are usually fully erupted by age 3, and remain until around 6 years of age when they begin to fall out to make room for your permanent teeth.

-Adult teeth usually begin to erupt into the mouth between 6 and 12 years of age. Most adults have 32 permanent teeth.

-Permanent teeth are larger and take longer to erupt than primary teeth.

Tooth Eruption – Types of Teeth

Tooth Eruption. Missing teeth boy - Marielaina Perrone DDS

Tooth eruption – Types of Teeth

A person’s teeth will vary in size, shape, and their location. Each tooth in your mouth has a job to do and that is why it is shaped the way it is and where it is located. Tooth eruption follows a definite pattern.  There are 5 types of teeth:

1) Incisors. Incisors are the eight teeth in the front of your mouth (four on top and four on bottom). These teeth are used to take bites of your food. Incisors are usually the first teeth to erupt. Primary incisors erupt at around 6 months of age.Permanent incisors should come in at  6 and 8 years of age.

2) Canines. We have four canines in our mouths. These are the next type of teeth to erupt. Canines are your sharpest teeth and are used for ripping and tearing food apart. Teeth eruption for primary canines usually occurs between 16 and 20 months of age, with the upper canines coming in just before  the lower canines. The order is reversed for permanent teeth. Lower canines erupt around age 9, with the uppers erupting at about 11-12 years of age.

3) Premolars. Primary molars are replaced by premolars. Premolars (also called bicuspids) are used for chewing and grinding of food. You have four premolars on each side of your mouth, two on the upper and two on the lower jaw. The first premolars appear around age 10 and the second premolars arrive about a year later. Premolars are generally the teeth that may need to be removed during orthodontic treatment to create space.

4) Molars. Primary molars (replaced by the permanent premolars) are also used for chewing and grinding food. Teeth eruption for these happens between 12 and 15 months of age. The first permanent molars erupt around 6 years of age while the second molars come in around 11-13 years old.

5) Third Molars. These are also referred to as “wisdom” teeth. These are the last teeth to erupt into the mouth and do not typically erupt until age 18-21 years of age. Some

Tooth Eruption Issues - Peg Laterals - Marielaina Perrone DDS

Tooth Eruption Issues – Peg Laterals

people never develop third molars at all. These molars may cause crowding and need to be removed. Other times they develop in the jaw but never erupt into the mouth. When this happens it is referred to as impacted.

Tooth Eruption Issues

-Supernumerary teeth.  Extra teeth may form and make normal tooth eruption more difficult, delayed or impacted. This happens most often in the wisdom tooth area. Another type of extra tooth is called a mesiodens. This is an extra small tooth growing right between the two upper front teeth and needs to be removed surgically. There is also Gemination, or twinning of a tooth, wherein, a double tooth forms.

-Malformed  Teeth. Tooth eruption is not always perfect. Sometimes genetics, medications etc. can cause malformed teeth. Examples are peg laterals (very small lateral incisors), mulberry molars (a molar

Fused Tooth - Marielaina Perrone DDS

Tooth Eruption Issues – Fused Tooth

that has a raspberry like appearance), Fused teeth (two different teeth which form conjoined into one tooth such as a lateral and canine),  Dens in dente (a tooth growing completely inside of another tooth).

If a tooth does not form in the primary dentition (for example a child never forms a front baby tooth), there will never be a permanent tooth to replace it. Also, tooth eruption in the lower arch in front can sometimes erupt behind the primary teeth. This is quite normal but may necessitate the need of removal of the primary teeth to aid tooth eruption.

If teeth are not erupting properly, have your dentist take an x ray. Sometimes there are developmental or genetic issues causing malformed teeth, extra teeth or lack of tooth development. It is important to monitor tooth eruption as it happens. The earlier these issues are detected, the better you can prepare for future treatment needs.

 

Primary Tooth Eruption Chart

Tooth Eruption Chart - Marielaina Perrone DDS

Tooth Eruption Chart

 

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Women have known for years that different changes to their hair, makeup, or clothes can give them a whole new look. Makeup has been used for centuries by women trying to highlight

Anatomy of a Smile - Cosmetic Dentistry

Cosmetic Dentistry – Anatomy of a Smile

and define their individual facial features. While these techniques have long been known….Did you know that changing your teeth can give you similar results?

Some of us are born with teeth that complemnts our facial features. But not all of us are so lucky.

A bright, white, beautiful smile creates a first impression that poeple are sure to take note of. Without a spoken word, your smile can give off a confident, optimistic and friendly personality. An esthetically pleasing smile is an attractive quality that brings people to you, making them respond in a positive way towards you.

Physical characteristics aside, a winning smile can also have a major mental and emotional influence on you. People who are self conscious about their smiles tend to appear timid, hesitant, withdrawn or even angry. You may not feel as attractive as you can be.

Modern advances in cosmetic dentistry has allowed a growing number of people to benefit from smile makeoversCosmetic dentistry smile makeovers are capable of transforming a person’s smile to produce dramatic life changing results. A cosmetic dentist will examine your smile and make notes of the changes that need to be made.

Cosmetic Dentistry - smile makeover

Cosmetic Dentistry – smile makeover

Smile Design Principles or Smile Design for Cosmetic Dentistry

A smile design influences the overall cosmetic impact of an person’s smile. Smile design can be divided into four separate components:

-Facial Esthetics. A person’s facial esthetics varies greatly from patient to patient. A cosmetic dentist can evaluate this using a visual examination and the use of photography. Facial Esthetics will include not only the teeth but also the bone structure of the face and the musculature. It will also inlcude the way your lips frame your smile when you speak, smile, or laugh.

-Gingival (Gum) Tissue Esthetics. A smile with diseased gum tissue will never bo one that is considered attractive. Healthy gum tissue is an essential element in smile design. Common cosmetic dentistry complaints include a gummy smile, uneven gum tissue, and exposed root surfaces from recession. All of these things take away from a person’s smile appeal.

-Microesthetics. This component deals with the subtle attributes that make your teeth appear the way they do. This includes how they reflect light, any unique marks or colorations. This technique is applied when restoring a tooth from decay. Cosmetic dentistry will restore the tooth to give it qualities closely resembling the natural tooth. The anatomy and coloration of natural teeth is a unique quality that varies from patient to patient.

-Macroesthetics. This area allows the cosmetic dentist to analyze the relationship and proportions between a patient’s front teeth, surrounding tissues, and facial characteristics. Analyzing these characteristic will ensure the final result will be natural and attractive for the patient. Working together, your cosmetic dentist and dental laboratory technician combine their technical and artistic abilities to create a natural and esthetically pleasing appearance in which the shapes, sizes and arrangement of individual teeth blend with and complement your

smile makeover

Cosmetic Dentistry

particular features.

Anatomy of a Smile in Cosmetic Dentistry

The following are the important anatomical structures or landmarks used in cosmetic dentistry:

-Lips. In cosmetic dentistry the lips are usually compared to a picture frame. The lips frame your smile, teeth, and gums. Lip enhancements correcting shape, fullness, and symmetry of your lips can make your smile seem broader and fuller.

For optimal cosmetic effect, your facial features should line up to your teeth and lip lines. When your lips form a broad smile, an imaginary line can be drawn through the corners of the mouth, from one side to the other. The amount of upper front (maxillary anterior) tooth revealed below this line helps create a vibrant, youthful image. In a youthful smile, the upper front teeth should fill between75-100% of the space between your upper and lower lips in a full smile.

-Midline. The facial midline is an important landmark in cosmetic dentistry. It is an imaginary vertical line drawn between the front two upper teeth. For optimum esthetics the facial midline should line up with the middle of the face.

Sometimes facial features can throw the midline off. These include the eyes, nose, and chin. A portion of the population has uneven eye levels or a nose that is slightly off center. If not taken into account this will throw the whole analysis off. Cosmetic Dentistry uses a more accurate landmark on the face. The point between the eyebrows and the cupid’s bow in the center of the upper lip is used. By using these two landmarks, cosmetic dentists can draw and locate the facial midline wile also determining its direction.

Whenever possible, the midline between the upper front teeth (central incisors) should coincide with the facial midline. In cases where this is not possible, the midline between the central incisors should be perpendicular to the imaginary line that could be drawn through the corners of the mouth.

 

Cosmetic Dentistry

Cosmetic Dentistry – Smile Makeover

-Smile Line. Your smile line is the line created by the top of your lower lip. In an ideal smile line, the edges of your upper teeth should be parallel to your lower lip when you smile. The bottom of your lower lip should have the same line as the gums of your lower jaw. This should always be a standard, regardless of the size or shape of your smile. Once your cosmetic dentist has determined the orientation of your smile line, they can design its curve, or shape, and determine the length of your new restorations for your smile makeover.

-Teeth. Smiles that tend to be considered attractive usually hve a few things in common. These features include white teeth, teeth that are unstained, and evenly spaced with no crowding.

Upon smiling, your top teeth show fully in a good proportion to your gums. The line where the gums and teeth meet is smooth and even. The smile line of the upper teeth follows the curve of the lower lip. The midline of the upper front teeth ideally is in the center of the face. Tooth reveal is a term that describes the amount of tooth structure that shows during smiling and various angles of your face.

Cosmetic Dentististry Variations

The impact of a smile cannot be judged just by the individual beauty of teeth and gums. Each and every patient has their own unique qualities, quirks, and traits. These include age, sex, personality traits, as well as cosmetic dentistry expectations.

When considering  person’s ideal smile, the cosmetic dentist will always consider an individuals personal traits. These include facial features, skin tones, hair color, as well as how your teethare framed by your overall appearance. Occlusal and functional considerations will also play a role in the final treatment.

Macroesthetic concepts provide only guidelines and reference points for beginning esthetic evaluation, planning and treatment. The artistic component can be applied and

Smile makeover

Cosmetic Dentistry – Anatomy of a Smile Makeover

perfected in cosmetic dentistry by dentists who understand the rules, tools and strategies of smile design. In modern cosmetic dentistry there are tools such as digital imaging, lasers, teeth whitening procedures that allow a skilled cosmetic dentist to create smile makeovers.

The cosmetic dentistry procedures range from teeth whitening to dental bonding to porcelain veneers, crowns, and dental implants. Cosmetic dentists also have at their disposal the ability to augment soft tissues. The use of dermal fillers can correct certain facial feature such as thin lips or even facial asymmetry. Advances in cosmetic dentistry and sedation dentistry make it possible to do these procedures with less patient anxiety and pain.

Ultimately any cosmetic dentistry smile makeover is in the eye of the beholder. Just because certain procedures are possible it does not mean it should be done on each and every patient. Many patients embrace their uniqueness and are fine with the way they look. Others are looking for a change and thats where cosmetic dentistry can come in and make that happen for them.

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Pediatric Dentistry is the area of dentistry treating children from birth through adolescence. Children are special patients and have different needs than adults. So the field of dentistry

Marielaina Perrone DDS Pediatric Dentistry

Pediatric Dentistry

developed a specialty of pediatric dentistry surrounding their needs. In general, pediatric dentistry takes care of severely broken down teeth requiring sedation. They also are great if your child is too fearful or disabled to handle treatment without sedation. Family dentists are also trained in pediatric dentistry and can treat children of all ages. A pediatric dentistry specialist is not always needed nor required for your children. Most children do quite well in a family dental practice and actually prefer to be with the rest of the family. The earlier a child starts with dental checkups, the easier it is on them and you. Problems are detected early and treatments can be quick and simple. Most children look forward to dental appointments when they have built a trust and confidence in their dentist. This is true for a family dentist or a pediatric dentist.

Whereas adult patients present with one set of teeth and its various issues. Children present to the dentist with three phases of teeth. These phases are called:

1) Deciduous Dentition (teeth) Phase. In this phase all of the child’s teeth are still baby or deciduous teeth. The child has not yet had any permanent teeth erupt.

2) Mixed Dentition Phase. This is where some of the child’s permanent teeth have erupted and replaced some of the primary teeth. So they have a mixture of primary and permanent teeth. This phase has also been coined the “ugly duckling phase”.

3) Permanent Dentition Phase. This is when all the child’s permanent teeth have erupted. This is the point where pediatric dentistry ends and adult dentistry begins.

Pediatric Dentistry Treatments

Dentistry for whole family

Pediatric Dentistry

-Oral Prophylaxis. Oral prophylaxis or prophy is another name for a children’s teeth cleaning by hygienist or dentist. The procedure involves some very light use of hand instruments to clean around teeth along with brushing and educational instructions. Education will be reinforced after every visit to ensure patient follows up at home and understands teh importance of keeping their teeth clean.

-Application of Fluoride. Fluoride applications can be done in two ways, through the tray method or the paint-on method. Both methods are quite effective at providing the developing teeth with the right amount of fluoride. It is totally a child’s personal preference. The choice is there to make it more comfortable on the child. Pediatric dentistry should always involve choices for the patient so they feel like they are intimately involved in making decisions in their dental care.

-Sealants. These are also called pit and fissure sealants because they are designed to fill in the pits and fissures that are part of a child’s teeth natural anatomy. It is recommended to place sealants on the molar and premolar teeth as soon as they come in. This is because you do not want to risk tooth cavities when you can have protection from the beginning. When properly applied and maintained, they can successfully protect the chewing surfaces of children’s teeth. By forming a thin covering over the pits and fissures, sealants keep out plaque and food, thus decreasing the risk of developing a cavity.  Since the covering is only over the biting surface of the tooth, areas on the side and between teeth are not protected by the sealant.

Pediatric dentistry for kids of all ages

Pediatric Dentistry

-Preventive Resin Restoration (also called PRR). This procedure is used in pediatric dentistry for teeth that have already developed very small cavities. This technique is similar

to a sealant but the small amount of decay must be removed first. Using a PRR will prevent the progression of the cavity from going any deeper into the tooth.

-Dental Bonding. Dentists are able to restore cavities that are larger than a PRR can fix using tooth colored dental materials. This will allow the teeth to remain white and not be noticeable upon smiling. Dental bonding is not as prevalent in pediatric dentistry as in other forms of dentistry.

-Pulp Therapy.The pulp (or nerve) of a tooth is the inner center of the tooth. Nerves, blood vessels, connective tissue and reparative cells are all inside the pulp. In pediatric dentistry the purpose of pulp treatment is to maintain the affected tooth so that

Marielaina Perrone DDS Pediatric Dentistry

Pediatric Dentistry

the tooth is not completely lost, and can hold the space for the permanent tooth. This can help retain a good bite and makes braces less likely. The main reasons in pediatric dentistry for pulp treatment are dental cavities and trauma. In pulp treatment the dentist removes the diseased pulpal tissue. An antibacterial agent is placed inside the tooth to prevent further bacterial growth and to calm the remaining nerve tissue in the tooth. A stainless steel crown usually follows this procedure.

-Stainless Steel Crowns. This type of Crown is used in pediatric dentistry to restore teeth that have been badly damaged due to large cavities, excessive teeth grinding or wear.  They are used when a filling is not possible in a tooth because of the amount of damage present. For front teeth, stainless steel crowns with white facing are used to help with aesthetics.

-Extractions. Tooth removal may be necessary in pediatric dentistry for various reasons, including, infection, risk of infection, preparation for orthodontics, over crowding, teeth growing behind other teeth, or for larger cavities that cannot be restored.

-Space Maintainers or early Orthodontic Evaluations. Space Maintainers are used to hold the proper amount of space for permanent teeth. When a primary tooth is lost too early, the teeth beside it may tilt or drift into that empty space. Teeth in the opposing jaw may move up or down to fill the gap.  As teeth beside the gap shift into the empty space, they create a lack of space in the jaw for the permanent teeth.  When this occurs, permanent teeth are over crowded and can come in crooked. If left untreated, the condition may require extensive and costly orthodontic treatment.

Space maintainers are used to in pediatric dentistry to prevent any drifting of teeth and loss of space in your child’s teeth.  They keep the remaining teeth in place until a permanent tooth fills that space. Space maintainers are appliances made out of metal and

Pediatric Dentistry

Pediatric Dentistry

are custom designed and fitted to your child’s mouth. Using space maintainers is more affordable and easier on your child than having to move those teeth back in place with orthodontic treatment.

Recognizing orthodontic issues early, gives the dentist more options to plan for the future as the rest of the teeth develop.

Pediatric dentistry has its own special challenges but with dedication by dentist, parents, and child it can be a great experience. Education needs to be at the forefront of all pediatric dentistry.

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