Pedodontics (Children Dentistry)
Fissure Sealant
An increasingly popular treatment in dentistry is making it possible for kids to slip through childhood without a single cavity.
 The dental sealant is one of the most revolutionary materials available for protecting our children’s teeth. For the past 18 years, a new generation of children has been enjoying the benefits of protective sealant.
Most of them know nothing of what a cavity is and how a tooth is treated when it has a cavity.
What is Dental "Fissure" Sealant?
Dental Sealants or pit and fissure sealants, are made of a thin plastic material that is applied to the chewing surfaces of the back teeth — premolars and molars. Dental sealants along with daily oral hygiene can keep your children’s teeth free of tooth decay.
Sealants are just for kids, right?
The likelihood of developing pit and fissure decay begins early in life, so children and teenagers are obvious candidates. But adults can benefit from sealants as well.
Why to use a Dental Sealant?
 The chewing surfaces of molars and premolars are not smooth. They have pits and fissures where the toothbrush bristles can’t reach, so dental plaque is free to grow causing tooth decay (even with good dental hygiene). Most of the cavities on a kid’s freshly erupted permanent teeth occur in these areas.
Dental cavity research has revealed that almost 84% of cavities in ages 5-17 involved these pit and fissure areas.
How Do Dental Sealants Work?
A dental sealant is a clear or white, liquid-plastic material applied on the chewing surfaces of the back teeth. This plastic resin bonds into the depressions and grooves (pit and fissure) of the teeth surfaces making them smooth and much easier to clean by brushing.
The role of dental sealants is to act as a barrier, protecting the enamel from the acids produced by the bacteria of dental plaque. The use of pit and fissure sealants has been shown to reduce tooth decay and cavities by more than 50% (and over 70% along with proper dental hygiene). Dental sealants are effective in preventing pit and fissure cavities and complement fluoride’s role which is more effective for smooth surface cavities.
Application of Pit and Fissure Sealants
Does it hurt?
Dental sealants are easy for the pediatric dentist to apply, and painless for the child. After the tooth is cleaned and dried, the chewing surfaces are roughened with an etching solution or gel to help the sealant adhere to the tooth. After a few minutes the tooth is cleaned and dried again. Then the dental sealant is ‘painted’ on the tooth enamel and hardened with a special ‘curing’ light. It takes only a few minutes to seal each tooth. Dental sealants can last as long as five years and often longer.
Pit and fissure dental sealants should be applied soon after the molars have erupted, before the teeth have a chance to decay.
During regular dental visits, your dentist will check the condition of the dental sealants and reapply them when necessary.
The use of pit and fissure dental sealants in combination with fluoride is the most cost-effective way to protect the teeth of children who are at higher risk for tooth decay.
Fluoride Application
 Fluoride is a naturally occurring element that can help to prevent tooth decay by strengthening teeth.
 Fluoride is found naturally in water sources in small but traceable amounts, and in certain foods such as meat, fish, eggs and tea. Fluoride also is added to water in some areas and to toothpastes, rinses and professional treatments. Prescription fluoride tablets are available for children who do not drink fluoridated water.
What it’s Used For?
Enamel, the outer layer of the crown of a tooth (the visible part), is made of closely packed mineral crystals. Every day, minerals are lost and gained from inside the enamel crystals through processes called demineralization and remineralization. Demineralization occurs when acids, formed from the combination of plaque bacteria and sugar in your mouth, dissolve the crystals and the spaces between them. But this process is balanced by remineralization, in which minerals such as fluoride, calcium and phosphate are deposited inside the enamel, building it back up. Too much demineralization without enough remineralization to repair the enamel leads to tooth decay.
Fluoride strengthens teeth by helping to speed remineralization and disrupt the production of acids by bacteria. Fluoride can be incorporated into teeth in two ways. When children swallow fluoride in small doses (through food, supplements or fluoridated water), it enters the bloodstream and becomes incorporated in their developing permanent teeth, making it harder for acids to cause demineralization. Fluoride also can enter teeth directly in the mouth when it is applied at the dental office, when you brush with fluoride toothpaste or use a fluoride rinse and when fluoridated water washes over your teeth as you drink.
Fluoride treatments help to prevent decay in both children and adults. The fluoride treatments are really helpful If your child has a history of cavities or is at high risk of decay. Often, children get fluoride treatments every six months for extra protection against cavities, even if they already drink fluoridated water.
Anyone who is at risk of dental decay is a good candidate for fluoride treatments. Factors that increase the risk of tooth decay include; history of cavities, infrequent dental visits, poor brushing habits and dietary factors, especially frequent snacking.
How's it Done?
Fluoride is applied as a gel, foam or varnish during a dental appointment. The teeth are dried so the fluoride doesn’t become diluted. Fluoride can be applied by using a tray that looks like a mouth guard for one to four minutes. Fluoride also can be painted directly on the teeth. It comes in a variety of flavors, but it should never be swallowed.
The fluoride treatments you receive in a dental office have a higher concentration of fluoride than over-the-counter fluoride mouthwash or toothpaste. They are used for both children and adults. Dental-office treatments also are different chemically and stay on the teeth longer.
Dental Fillings
Why bother to fill baby teeth since they will all fall out anyway?
Nursing bottle syndrome (Early childhood cavities)
There are three very good reasons that baby teeth are just as important as adult teeth, and must be just as well protected from disease.
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Children need their teeth as much as you do to chew and smile. If the teeth are allowed to become decayed, that child will suffer pain and an inability to eat properly which can lead to lifelong eating disorders, or at minimum poor nutrition for the time during which the child is unable to eat properly. Children have social lives too, and the stigma of blackened stumps and bad breath can lead to derision (serious teasing) at school and at play, and could effect the child’s social development.
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Bad baby teeth usually mean frequent visits to the dentist under very poor circumstances. The child has not slept well, he is in a bad mood, and the dentist is the last person he really wants to see. In addition, by the time they are seen, the dentist must usually remove the tooth, which is what the parents expect anyway. So his visits always amount to painful episodes from which he emerges missing a piece of his body! This sets the stage for not only bad behavior on succeeding dental visits, but for a person with a lifelong fear of dentists who will probably end up with dentures.
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Finally, baby teeth are essential for holding the spaces open so that the adult teeth can come into the correct position when they are finally developed enough to erupt (“erupt” means to come through the gums for the first time). If certain of the baby teeth are removed before nature intended, the adult teeth that develop earliest will move into inappropriate positions crowding out the space necessary for the eruption of other adult teeth which develop at a later date. This can lead to not only crooked teeth, but to real functional problems as well. These involve chewing difficulties, TMJ problems, and pronounced facial asymmetries (this means that one side of the face develops more than the other side due to the differences in the way that the muscles on either side are used in chewing and grinding the teeth.
A person gets two sets of teeth at different stages of life for very good reasons. The adult version will not fit into a baby’s mouth, yet that child must still be able to chew food. So while nature gave children a temporary set of teeth in order to fill a space that would otherwise have to remain vacant until age 12, she thought she might give them some extra work to do as well.
The baby teeth begin to erupt at about age 6 months and continue until about age 24 months at which time all 20 of the baby teeth should be in place. In general, the teeth erupt from the front to the back, and the lowers come in about 2 to 6 months before the corresponding top teeth. If your child is late, don’t worry.
They may finish as much as a year behind schedule. If your child is missing one or more baby teeth, it does NOT necessarily mean that she will be missing the corresponding adult teeth. If some of the baby teeth are discolored or misshapen, it does NOT usually indicate that there will be a problem with the adult teeth.
At what age should my child’s adult teeth erupt?
 You should begin to see your child’s first adult teeth even before they lose their first baby teeth, at about age 6.
They are the first adult molars and they erupt behind the existing baby teeth. They are yellow in the diagram on the right. At about the same time the lower baby central incisors will loosen and fall out to allow the adult central incisors (blue) to erupt. All the baby teeth should be gone, or the remaining ones lose by age 12.
The adult teeth that are forming under them will continue to erupt through age 17 or 18 when the wisdom teeth (white) finally are supposed to erupt. I say “supposed to” because many times they remain impacted and must be extracted. This eruption schedule is not set in stone. Some kids are just late bloomers and may be a year late in their eruption schedule. Some may even be a year early.
There are basically three types of tooth-colored materials which are used to restore posterior primary teeth: resin-modified glass ionomers, composites, and compomers.
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Resin-modified glass ionomers (RMGI) are glass ionomer cements to which a resin has been added for strength.
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Composites are a tooth colored material consisting of two main components: a matrix and filler.
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Compomers are polyacid-modified resin composites. They consist of a single, hydrophobic resin which is filled with acid-leachable glass particles similar to those found in glass-ionomer cements.
What are the Advantages of a Tooth-Colored Restoration?
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Less tooth enamel needs to be removed by the dentist when an adhesive, tooth-colored restoration is placed in a tooth, than when an amalgam restoration is placed.
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Resin-modified glass ionomer (RMGI), a tooth-colored material has the advantage of bonding chemically to the tooth, and releasing fluoride for a relatively long period of time while amalgam restoration neither releases fluoride, nor adheres to the tooth.
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Because dental esthetic demands have increased during the last decade, tooth-colored restorations are becoming more popular.
Pulpotomy and Pulpectomy
Definition: the surgical removal of the entire coronal pulp, leaving intact the vital radicular pulp within the canals.
When the nerve or pulp tissue of a primary or permanent tooth is infected, it needs to be treated to prevent a dental abscess and loss of the tooth. The two methods of treating infected dental nerve tissue are the pulpotomy and pulpectomy. The ultimate objective of these procedures is to save the tooth, so that it will maintain the integrity and function of the dental arch.
Pulpotomy for Primary Teeth
Treatment Objectives for the Pulpotomy
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Amputate the infected coronal pulp.
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Neutralize any residual infectious process.
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Preserve the vitality of the radicular pulp.
 Indications for the Pulpotomy
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Curiously exposed primary teeth, when their retention is more advantageous than extraction.
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When inflammation is confined to the coronal portion of the pulp.
Contraindications for the Pulpotomy
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Fistula or swelling
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The tooth crown is no restorable
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Absent hemorrhage; profuse hemorrhage
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Marked tenderness to percussion
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Mobility
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Radiolucency exists in the furcal or periradicular areas
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Spontaneous pain, especially at night
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Necrotic pulp
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Dystrophic calcification (pulp stones).
Pulpectomy for Primary Teeth
Definition of Pulpectomy for Primary Teeth
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A nonvital technique.
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The removal of necrotic pulp tissue followed by filling the root canals with resorbable cement.
Treatment Objectives for Primary Tooth Pulpectomy
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Maintain the tooth free of infection
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Biomechanically cleanse and obturate the root canals
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Promote physiologic root resorption, and
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Hold the space for the erupting permanent tooth.
Indications for Pulpectomy of Primary Teeth
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Cooperative patient
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Teeth with poor chance of vital pulp treatment
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Strategic importance for space maintenance
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Absence of severe root resorption
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Absence of surrounding bone loss from infection
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Expectation of restorability
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Pulpless primary teeth with sinus tracts
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Pulpless primary teeth in hemophiliacs
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Pulpless primary teeth next to the line of a palatal cleft
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Pulpless primary teeth when space maintainers or continued supervision are not feasible (handicapped or isolated children).
Contraindications for Primary Tooth Pulpectomy
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Teeth with nonrestorable crowns
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Periradicular involvement extending to the permanent tooth bud
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Pathologic resorption of at least one-third of the root with a fistulous sinus tract
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Excessive internal resorption
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Extensive pulp floor opening into the bifurcation
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Systemic illness such: as congenital or rheumatic heart disease, hepatitis, leukemia, and children on long-term corticosteroid therapy, or those who are immunocompromised.
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Primary teeth with underlying dentigerous or follicular cysts
Space Maintainer
 If a baby tooth is lost prematurely, you may need a space maintainer to “save” the space. What does that mean? Baby teeth are there for a reason. One key reason is that they save space for the permanent tooth, which will erupt into its position when the baby tooth is lost normally.
If a primary tooth (baby or milk tooth), has to be removed early due to say, an abscess, or is knocked out in some kind of trauma, a space maintainer may be recommended to save the space. If the space is not preserved, the other teeth may drift causing difficult to treat crowding and orthodontic problems. If it is a front tooth then you don’t need a space maintainer. However, you can place a Pediatric Partial to replace the teeth for cosmetic reasons.
Now “Spacers” may be in there for a while, but they are not permanent. They are removed when the new tooth (usually a bicuspid) erupts or the abutment teeth get loose.
Kinds of Space Maintainers:
1. Fixed Space Maintainers:
Unilateral:
Unilateral band and loop for erupted first permanent molar
 Unilateral Distal Shoe Type for unerupted 1st permanent molar:
Just on one side, usually “replacing” one tooth. Can be a band and loop as you see here, or a crown and loop type (in photo below). This can also be a Distal Shoe type. The distal shoe being one used when the permanent first molar has not yet erupted. Hey, you are usually going to get “silver” in there no matter what kind of spacer it is.
Bilateral:
 These are very useful. They are usually cemented with bands on back teeth on both sides connected by a wire just behind the lower incisors, usually called a Lingual Arch. This can eliminate the need for two unilateral spacers. They are most useful if there is more than one tooth missing or you are trying to keep the lower incisors from tipping. An altered form can incorporate a looped lingual arch to actually move the lower incisors forward (straighten them a little too) before maintaining them in a better position. A maxillary bilateral spacer may incorporate an acrylic button and is called a Nance space maintainer.
2. Removable:
These are like orthodontic retainers, with part of the plastic placed in the empty space to keep things from drifting.
Stainless Steel Crowns
For primary (baby) molars
Stainless steel crowns are needed when decay has destroyed a tooth to such a degree that there is little of the tooth remaining or the tooth has received a pulpotomy (nerve removed) because of an abscess.
Amalgam or silver fillings are not recommended for large fillings in “baby” teeth because if these large filling fracture, there is a greater chance that a pulpotomy or extraction will be necessary.
Stainless steel crowns are highly recommended on primary (“baby”) molars so they will have the benefit of a much more durable and reliable restoration.
But crowns for front baby teeth have to provide superior esthetics
Natural-Looking Crowns for Kids Front Teeth
NuSmile® Primary Crowns provide superior esthetics. We use these natural looking crowns to restore children teeth to provide them with a beautiful new smile that will foster self confidence in their smile.
Advantages:
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Anatomically correct
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Color compatible tooth colors.
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Easy to place.
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Hollywood Smile Clinic
