Common Pediatric Dentistry Procedures
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 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
–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 the 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.
-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 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 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.
Marielaina Perrone DDS