pediatric procedures

Fluoride, a substance that's found naturally in water, plays an important role in healthy tooth development and cavity prevention. Fluoride combats tooth decay in two ways:

1. It strengthens tooth enamel, a hard and shiny substance that protects the teeth, so that it can better resist the acid formed by plaque.
2. Fluoride allows teeth damaged by acid to repair, or re-mineralize, themselves.

Fluoride cannot repair cavities, but it can reverse low levels of tooth decay and thus prevent new cavities from forming.

The American Academy of Pediatrics recommends that these fluoride supplements be given daily to children between the ages of 6 months and 16 years. The dosage will change as your child grows. Only children living in non-fluoridated areas or children who drink only non-fluoridated bottled water should receive supplements.

Most children get the right amount of fluoride through a combination of fluoridated toothpaste and fluoridated water or supplements. Too much fluoride before 8 years of age can cause enamel fluorosis, a discoloration or mottling of the permanent teeth. This condition is unsightly but harmless and often can be treated with cosmetic procedures.

This refers to a tooth or teeth (primary or permanent) that have become "fused" to the bone, preventing it or them from moving "down" with the bone as the jaws grow. This process can affect any teeth in the mouth, but it is more common on primary first molars and teeth that have suffered trauma (typically the incisors). Treatment can vary depending on the degree of severity of the ankylosis (how "sunken into the gums" a tooth may appear). The degree of severity usually will vary depending on how early the process started, and as a general rule, the earlier it starts, the more severe the ankylosis becomes with age. Several considerations must be taken before any treatment is provided, and your dentist will discuss all the risks and benefits of each treatment option.

These are two common problems in children that have their origin in discrepancies between the size of the jaws (top and bottom), or discrepancies between the size of the teeth and the amount of space available.

• A posterior cross bite can appear at an early age, and depending on its cause (malpositioned teeth or misaligned jaws) treatment may be warranted early. It can involve one or both sides of the molar area and in some cases in can cause a "shift" of the bite. Many appliances are available for treating this condition and your dentist will discuss in detail the risks and benefits of treating a posterior cross bite.
• Anterior open bites refer to a condition in which the top and bottom front teeth are not in contact (they do not touch each other when the patient bites). The origins of open bites can be traced to habits that patients have or had in the past, and occasionally to discrepancies between the sizes of the jaws. Since most open bites in children are associated to an existing habit, treatment usually addresses the habit itself and is most effective when done at an early age. Many appliances are available for treating this condition and your dentist will discuss in detail the risks and benefits of treating an open bite in children.

Ectopic canines are generally found in the Buccal Vestibule. Impacted canines may be retrieved with braces, using a surgical approach via a gold chain or straight wire. Tissue covering the tooth is uncovered. A chain or wire is attached to the tooth crown. Tissue is placed back over the tooth leaving the chain or wire coming out of the gum. For the purpose of this illustration a gold chain is used to retrieve the canines. The chain is attached to the tooth crown and the link is attached to a flexible archwire so that the wire is active (bent). Once a month, the wire is reactivated by using the next link up on the chain until the impacted canine erupts enough to attach a regular bracket on the canine. With the regular bracket in place, a more flexible wire is added directly to the bracketed canine. This process will bring the canine into position within the arch by forcing the canine to conform to the straight archwire form. This is a long process taking anywhere from 8-12 months.

Baby teeth that have large caries (cavities) and some degree of pain occasionally require that the "coronal" (top) portion of that tooth's nerve be removed before a filling or a crown (preferably) is placed. The main goal of this procedure is to preserve the baby tooth, since baby teeth help to maintain adequate room for the permanent teeth. Pulpotomies have published success rates that range from 60% to 90% and represent a good and reliable way to save a badly decayed baby tooth.

Recent controversy regarding the use of Stainless Steel Crowns (SSCs) in some states have led some parents to question dental care providers more thoroughly on their use and on other alternatives. SSCs have been used in dentistry for over 50 years for primary and permanent dentition.

For primary teeth, SSCs are usually placed on teeth that have extensive caries (where two or more surfaces are extensively involved), or teeth that have pulp treatment (such as pulpotomy or pulpectomy). We also use them in teeth that will remain in the mouth for a considerably long period of time; where other materials will not last long enough.

SSCs become loose and come out of the mouth just like normal primary teeth. They work just like normal teeth do, and require the same care. Alternatives to Stainless Steel Crowns do exist, particularly for front teeth. Usually these can be one of the following:

• A prefabricated SSC that has a white facing bonded to it on the front.
• A white cap fabricated with a white filling material (Usually we call these strip crowns).
• A normal SSC that we modify by building a window in the front of it, which we later fill with a white filling material.

Strip crowns, also known as 'white crowns', is an alternative to placing crowns on primary incisors (top baby teeth) with large caries. Because these teeth are fixed using the same material that is used to place 'white fillings', this procedure is very technique sensitive and may not be an option for young children. With proper case selection, these 'fillings' may last for at least two to three years. Stainless steel crowns with 'white' facings (the front part is white) are also available, in the event that strip crowns are not an option. Your dentist will be happy to discuss all options available for aesthetic restorations on primary teeth.