Children’s Preventative Dentistry

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Cleaning (Prophylaxis)

Prophylaxis refers to the cleaning of teeth as a preventative measure against periodontal (gum) disease and tooth decay. This treatment can include plaque detection, the removal of plaque and tartar in the supragingival (upper) and subgingival (lower) levels of the gum line, the application of caries-preventing agents, checking for signs of food impaction, and the checking of restorations and prostheses.

In prophylaxis, the procedures of dental scaling and dental polishing are used. Dental scaling refers to the removal of plaque and calculus from the surface of tooth, within periodontal pockets, or the surface coronal to the gingival margin. Dental polishing refers to process of maintaining a smooth and glossy surface finish on a denture or amalgam.


Enamel Sealants

Proper oral care greatly reduces the risk for dental problems-but it cannot eliminate it entirely. The chewing surfaces of the premolars and molars, or back teeth, remain hot spots for bacteria to gather. Because the pits and fissures of these teeth are hard to reach by toothbrush bristles, bacteria can bunch up in these crevices and eventually cause tooth decay. Dental sealants, plastic resin materials, “seal” the pits and fissures of the back teeth. These “seals” shield these areas from bacteria and offer further protection from decay. Dental resin blocks the food and bacteria access to the tooth enamel. It creates a smooth tooth surface, making the tooth easier to clean and eliminating any tricky spots that plaque can sink into.

“Sealing” teeth is a fairly simple procedure. Your dentist requires only a few minutes per tooth. First, he or she cleans the teeth about to be sealed. Then, he or she roughens the chewing surface with an acid solution. This solution helps the sealant stick to the tooth. Next, the dentist dries the tooth. Finally, your dentist “paints” the sealant onto the tooth enamel. The sealant bonds to the tooth and hardens. Curing light is used to speed up the hardening process.

Once the sealant is in place, your dentist will ask you to bite down to ensure that the sealant is not too large and distorting your bite. If it is too large, your dentist will buff it down to a more natural size. After the dental visit, you can continue eating as you normally would, even immediately. Sealants are strong enough to withstand the pressure of chewing, and tend to last several years between applications.

Dentists recommend sealants for children and teenagers, as these are the years when preventative health care begins. Adults, too, can benefit from sealants. The need for a sealant depends on the shape of the tooth. A tooth with deep or narrow grooves will benefit from a sealant, while a tooth with shallow or rounded grooves may not need one at all. Ask your dentist if he or she thinks sealants might be a worthwhile preventative measure for you.

Because sealants are a preventative measure, most dental insurance companies are willing to cover the cost, as sealants will save them decay-related costs in the long run. Note, though, that some policies impose a cutoff age of between 12 and 16 for sealants on the permanent molars and premolars.


Extractions

Extraction is the term given to a tooth extraction and can also be known as Exodontia. Tooth extraction is the removal of a tooth from its socket in the bone.

Teeth may also be extracted to make more room in the mouth prior to straightening the remaining teeth (orthodontic treatment), or because they are so badly positioned that straightening is impossible. Extraction may be used to remove teeth that are so badly decayed or broken that they cannot be restored.

Tooth extraction can be performed with local anesthesia if the tooth is exposed and appears to be easily removable in one piece. An instrument called an elevator is used to loosen the tooth, widen the space in the bone, and break the tiny elastic fibers that attach the tooth to the bone. Once the tooth is dislocated from the bone it can be lifted and removed with forceps.

If the extraction is likely to be difficult, the dentist may refer the patient to an oral surgeon. Oral surgeons are specialists who are trained to give nitrous oxide, a general anesthetic to relieve pain. Extracting an impacted tooth is one such difficult extraction.

Before an extraction, the dentist will take the patient’s medical history, noting allergies and prescription medications. A dental history is also taken, with particular attention to previous extractions and reactions to anesthetics. The tooth is also x-rayed to determine its full shape and position, especially if it is impacted.

An important aspect of tooth extraction is the aftercare and encouraging a clot to form at the extraction site. The patient should put pressure on the area by biting gently on a roll for several hours after surgery. Once the clot is formed, it should not be disturbed. The patient should not rinse, spit, drink with a straw or smoke for at least 24 hours after the extraction and preferably longer.

For the first two days after the procedure, the patient should drink liquids without using a straw, and eat soft foods. Any chewing must be done on the side away from the extraction site. The mouth may be gently cleaned with a toothbrush, but the extraction area should not be scrubbed.


Fillings

Teeth that have been affected by tooth decay (caries or cavities) require a filling.

A tooth filling is a very common procedure and is used to fill up the cavities in the teeth. There are generally three types of tooth filling: amalgam, or alloy mixed with mercury composite, or white filling with same color as that of teeth indirect filling, or filling made in a lab

Dental amalgams, also known as silver fillings, are comprised of a mixture of mercury (45 to 50 percent), and an alloy of silver, tin, and copper (50 to 55 percent). When it is combined with other materials in dental amalgam, mercury’s chemical nature changes and it is no longer considered harmful to the body.

The procedure to fit an amalgam filling involves excavating the intended tooth and removing all the decay present. The tooth is then shaped in a specific manner in order to accept silver filling. After shaping the tooth, a band is placed around the tooth and the amalgam is condensed into the prepared tooth. The final filling is then carved and adjusted to the persons bite.

A new filling takes almost two weeks to become fully hardened with light sensitivity to cold or hot occurring for up to six weeks after surgery is completed.


Fluoride Therapy

Fluoride therapy is the delivery of fluoride to the teeth, topically or systemically, to protect them from dental caries (cavities). Strictly speaking, fluoride therapy repairs rather than prevents damage to the teeth, causing the mineral fluorapatite to be incorporated into damaged tooth enamel. Fluorapatite is not a natural component of human teeth, although it is found in the teeth of sharks. The main mineral found in natural tooth enamel is hydroxyapatite rather than the fluorapatite created in the presence of fluoride. Even without fluoride, teeth experience alternating increases and decreases in mineral content, depending upon how acidic or basic the mouth is, and depending upon the concentration of different substances in the mouth. Fluoride enhances and modifies the restoration of the mineral content of the teeth, and couteracts the breakdown of the teeth from lactic acid producing bacteria.

In topical fluoride therapies, fluoride is applied directly to the surface of the teeth, most commonly by means of a fluoride toothpaste. The main reason for tooth-brushing is mechanical disposition of plaque, but fluoridated toothpaste is used to apply fluoride to the tooth surface, promoting re-mineralisation with fluorapatite instead of hydroxyapatite. Other topical fluoride therapies include fluoridated mouth rinses, lozenges, gels, foams, and varnishes.

In systemic fluoride therapies, fluoride is swallowed as an additive to drinking water, salt, or milk, or as an ingredient in tablets, lozenges, or drops.


Instructional Oral Hygiene

A beautiful smile starts with an excellent oral hygiene regimen, so we’ve provided a few guidelines to help you lay the foundation for at-home care:

Brushing

Brushing is a common oral hygiene practice, yet many people don’t do it correctly. Dentists recommend you brush at least twice a day and after meals. After eating, sugars and carbohydrates from food left on teeth combine with the bacteria in your mouth. This produces acids that attack your teeth, leaving you susceptible to tooth decay. A good tooth cleaning after eating will help remove dental plaque bacteria and reduce your chances of getting dental cavities.

Learning how to brush properly is vital. For proper brushing techniques, hold your toothbrush at a 45-degree angle towards the gums. Brush in a back-and-forth motion, making sure to reach every surface of each tooth. And don’t forget the tongue — brushing the tongue will further remove the bacteria that cause bad breath! Your toothpaste may also play a role in the success of your oral hygiene routine — since there are several toothpastes to choose from, it’s best to ask your dentist which will benefit you. The American Dental Association recommends brushing with fluoride toothpaste to greatly reduce dental plaque bacteria.

Remember, a great rule to live by is to brush longer, not harder. You should brush for at least two minutes to remove as much dental plaque as possible. Harder brushing won’t actually get teeth cleaner — it can irritate the tissues in your mouth and actually cause gum damage! Use a soft-bristled toothbrush to protect your gums, and be sure to replace your toothbrush every three months.

Flossing

No matter how well you brush, there are some areas you just won’t be able to reach. Flossing removes dental plaque that’s hiding in between teeth. Learn how to floss properly with these tips: Start by holding the floss securely with each hand, and ease the floss between teeth. Gently rub the floss up and down, and curve it towards each tooth to cover more surface area. Once you reach the top, slide it under your gum line to remove plaque from beneath the gums. And be sure to use a fresh section of floss for each tooth — you don’t want to put food particles and bacteria back in your mouth!

Flossing at least once a day is recommended to remove the ongoing accumulation of dental plaque that forms between teeth. If you have trouble flossing, dental products are available to help — waxed floss makes for easier maneuvering and floss holders assist those who have trouble handling the stringy material.

Mouthwash

Antibacterial mouthwashes can also remove the bacteria that cause dental plaque. This helps prevent gingivitis, the first stage of gum disease. Like fluoride toothpastes, fluoride rinses help strengthen teeth and prevent tooth decay.

Diet

You’re probably surprised by this one! But healthy eating habits are an equally important part of your oral hygiene regimen. Since sugars and carbs promote tooth decay, the more you eat, the better chances you have of ruining your teeth! Instead, focus on protecting your oral health by eating nutritional foods.

Professional Techniques

Regardless of how well you practice oral hygiene at home, regular dental visits every six months are essential to your dental health. A professional dental cleaning will remove dental tartar that you can’t remove on your own. If necessary, your dentist may even perform an in-office fluoride dental treatment. And an exam is not only a good time for a checkup, but for checking in — a dental hygienist can provide tips on brushing and flossing, and show you areas that need improvement in your oral hygiene routine.

Conclusion

What happens when you don’t practice proper oral hygiene on a daily basis? Well, not to mention the bad breath problems you’re likely to encounter, you’ll be a shoe-in for many dental problems, which can lead to tooth loss! And without flossing, cavities can form between teeth, which are harder to spot and even more difficult to treat.

When it comes to optimal oral hygiene care, remember the “Rules of Twos” — brush at least twice a day, and see a dentist twice a year. Oral hygiene is an ongoing practice that requires your attention, but once you get the hang of it, you’ll be happy with the results. Unfortunately, you can’t take a vacation from your teeth, but you can set them up for a lifetime of dental health!


Crowns

A crown is a permanent covering that fits over an original tooth that is either decayed, damaged or cracked. Crowns are made of a variety of different materials such as porcelain, stainless steel, gold, acrylic resin or a mix of these materials. Porcelain generally has the most natural appearance, although it is often less durable.

The treatment plan for a patient receiving a crown involves:

  1. Numbing the tooth to remove the decay in or around it.
  2. Re-sculpturing the tooth to provide an ideal fit for the crown.
  3. Making an impression of your teeth in order to create a custom-made crown (usually takes one to two weeks).
  4. Making a temporary crown out of acrylic resin and fitting it onto the tooth during the interim period when the permanent custom-made crown is being created.
  5. Applying the permanent crown (when received from the lab) by removing the temporary crown and fitting the permanent one onto the tooth.
  6. After ensuring that the crown has the proper look and fit, the dentist cements it into place.

This process generally consists of a minimum of 2-3 visits over a three to four week period.

Once the procedure is completed, proper dental hygiene, including daily brushing and flossing, is required to maintain healthy, bacteria-free teeth, gums and crowns. This helps in the prevention of gum disease. Given proper care, your crowns can last a lifetime.