What is a pediatric dentist?
A pediatric dentist is a specialist dedicated to the oral health of children and monitoring their facial growth and development. Our office is designed for children from infancy through adolescence, as well as the medically and the mentally compromised children. The American of Pediatric Dentistry recommends that a child’s first dental visit should occur by the eruption of their first eight teeth or by their first birthday. This visit will enable Dr. Keels and Dr. Neal to build a relationship with your child and introduce you to proper oral hygiene. Diet, fluoride, finger sucking and other habits, and in addition we will discuss tooth eruption to insure optimal dental health.
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PREVENTIVE DENTISTRY
Will Preventive dentistry benefit my child?
Yes! Your child will benefit from the preventive approach recommended for all children – effective brushing and flossing, moderate snacking and adequate fluoride intake. Home care takes just a few minutes a day and prevents needless dental problems. Regular professional cleanings and fluoride treatments by our staff and doctors are also very beneficial. In addition to regular cleanings, sealants on the biting surfaces of your child’s teeth are highly recommended to protect against decay because this area is where four out of five cavities occur in children.
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SEALANTS
What are sealants?
Sealants protect the surfaces of teeth with grooves and pits, especially the surfaces of back teeth where most cavities are found. Made of shaded, tooth color plastic, sealants are applied to the teeth to help keep them cavity-free.
How do sealants work?
Even if your child brushes his/her teeth and flosses carefully, it is difficult – sometimes impossible – to clean the tiny grooves and pits on certain teeth. Toothbrush bristles are just too thick to reach into the pits and fissures. Food and bacteria build up in these depressions placing your child in danger for decay. Sealants “seal out” food and plaque reducing the risk for decay.
How long do sealants last?
Research shows that sealants can last for many years. So, your child will be protected throughout the most cavity prone years. If your child has good oral hygiene and does not bit on hard objects like ice cubes, crunchy candy or sticky foods, sealants will last even longer. Our doctors can easily replace or repair a lost or damaged sealant – we even have sealant warranty that guarantee our sealant work.
What is the treatment like?
Dr. Keels and Dr. Neal can apply a sealant quickly and comfortably! It is only one visit. Our doctors and their assistant condition the tooth and then dry the tooth, paint the sealant on, and then harden it with a blue light. It is that easy!
Which teeth should be sealed?
The teeth most at risk for decay - and therefore most in need of sealants – are the six- year molars and twelve-year molars. But any tooth with groves or pits may benefit form the protection of sealants.
If my child has sealants are brushing and flossing still important?
Absolutely! Sealants are only one step in the protection against decay, therefore they aid in keeping your child cavity – free for lifetime. Brushing, flossing, and regular dental visits are essential to a bright healthy smile!
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FLUORIDE
We are offering an improved method of decay prevention to our patients. We are using a varnish to apply fluoride to children's teeth.
The fluoride varnish has a longer working time than the traditional fluoride gels or foam applications. To keep the varnish on the teeth for as long as possible:
** Avoid drinking or eating for ten minutes after placement of the varnish.
** Your child should eat a soft, nonabrasive diet for the rest of the day.
** Teeth should not be flossed and brushed until tomorrow morning, at which
time a regular schedule of careful oral hygiene should be resumed.
What is enamel fluorosis?
A child may face the condition called enamel fluorosis if he or she gets too much fluoride during the years of tooth development (while they are growing in the jawbones). Too much fluoride can result in defects in the tooth enamel. It is shown as white, yellow or brown splotches, streaks or lines, usually on the front teeth.
Why is enamel fluorosis a concern?
In severe cases of enamel fluorosis, the appearances of the teeth are marred by the discoloration or brown markings. The enamel may be pitted, rough, and hard to clean areas therefore setting those teeth up for increased risk of decay. In mild cases of fluorosis the tiny white specks or streaks are often unnoticeable.
How does a child get enamel fluorosis?
By swallowing too much fluoride for the child’s size and weight during the years of tooth development (while they are growing in the jawbones). This can happen in different ways:
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A child may take more of a fluoride supplement than the optimum amount they need (sometimes pediatricians do not take a thorough fluoride history and over prescribe supplements!).
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The child may take a fluoride supplement when there is already an optimal amount of fluoride in their drinking water.
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Some children simply like the taste of fluoridated toothpaste. They may use too much toothpaste, and then swallow it instead of spitting it out.
How can enamel fluorosis be prevented?
First Dr. Keels and Dr. Neal will determine the appropriate fluoride supplementation, if any should be given. Dr. Keels and Dr. Neal may choose to test the level of fluoride in your child’s source of drinking water. After they know how much fluoride your child receives from his or hers water supply, they will decide if there is a need for supplemental fluoride within your child’s diet.
Second, monitor your child’s use of fluoridated tooth paste. A pea-size amount applied to the toothbrush is plenty for fluoride protection. Teach your child to SPIT out the toothpaste NOT swallow it, after brushing. Unless Dr. Keels and Dr. Neal advise it DO NOT use fluoridated toothpaste until your child is age 3-4.
Should I avoid fluorides all together for my child?
NO! Fluoride prevents tooth decay. It is an important part of helping your child to have a healthy smile for a lifetime. Getting enough – but not too much – fluoride be accomplished with the help of our practice.
Can enamel fluorosis be treated?
Once fluoride is part of the tooth enamel, it can not be taken out. But the appearance of the teeth affected by the fluorosis can be greatly improved by a variety of treatment that our practice offers. If your child suffers from severe fluorosis, our practice will educate you and your child about the various techniques and choose the best procedure to help enhance your child’s smile and their self-confidence.
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DENTAL TREATMENT AND OPTIONS
Treatment Options:
Our goal is to complete your child’s dental care in a safe and comfortable environment. We need your child to be able to follow specific instructions and sit still in order to provide quality care. We reserve time every morning for special dental procedure, because children are more cooperative in the morning hours. We want to avoid your child having a bad experience and becoming scared of the dentist. Therefore, we need your guidance in selecting the best option described below. If child is unable to sit or follow instructions, then fixing their teeth is like a car upside down in the dark going 100miles per hour ----- in other words this situation becomes not only dangerous but the quality of the dental care is severely compromised.
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Local anesthesia only: To restore or extract any tooth, local anesthesia is usually necessary. This technique involves injecting a small needle into the gingival (gum area or skin) near the tooth to be fixed. The needle delivers the lidocaine to the tooth. This option is good for the cooperative child. However, for younger children, this method can be very unpredictable --- because young children can become restless and fearful for a variety of reasons such as the noise from the dental drill. Also a child who is anxious may metabolize (use up) the local anesthetic much faster than is needed.
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Local anesthesia and nitrous oxide & oxygen: Nitrous oxide is a very safe sedative inhaled by the child breathing through their nose. After breathing the gas, the child usually feels relaxed and less anxious. It is important that your child understand that throughout the procedure, they will need to breathe through their nose and avoid mouth breathing. This approach is very helpful with minor surgeries and restorations for children older than 4 years old. Note--- most insurance companies DO NOT cover nitrous oxide.
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Local anesthesia with Versed sedation: This regimen involves your child sipping medication from a cup. We mix the sedative with Children’s Tylenol or Children’s Motrin to improve the taste. Your child will continue to remain conscious (awake); therefore, it is not possible to ensure that your child will be quiet and calm during the entire treatment. Versed oral sedation is the preferred approach for young children, between the ages of 2-4. Poor results can be expected when treatment time extends past 25-30 minutes. Children who have severe asthma are not candidates for this type of treatment. In addition, a child that has been sedated with Versed is requested to return home for the remainder of the day with appropriate supervision.
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Local anesthesia with Valium sedation: This option involves your child sipping or swallowing the medicine. The prescription for Valium is filled at the pharmacy and administered by the parent at home 30 minutes prior to the child’s appointment. This option is most effective for children older than 4 years old. The benefit characteristics include decreased anxiety and longer acting sedative (> 30 minutes). Children who have been sedated with Valium are requested to return home for the remainder of the day with appropriate supervision.
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General Anesthesia: This technique renders your child asleep and unaware of any treatment being preformed. This is the same technique used to put tubes in children’s ears or to have their tonsils removed. Our team goes to the Operating Room at Duke North Hospital every Wednesday and Friday to fix children’s teeth under general anesthesia. A down side to this technique is the cost. This procedure requires a medical anesthesiologist – so there will be a bill from the hospital, the anesthesiologist and the dentist. General anesthesia is a wonderful option for the fearful child, a child with complex dental needs or a child with complex medical needs.
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Questions about General Anesthesia
Who should receive general anesthesia?
Children with severe anxiety and /or the inability to relax are candidates for anesthesia. Usually, these children are young or have compromised health issues, helping them control their anxiety is not possible using other methods.
Is general anesthesia safe?
YES! In addition, to ensure the best possible care of your child, Dr. Keels and Dr. Neal request that all of their general anesthesia cases be covered by pediatric anesthesiologist. The anesthesiologist is the doctor who is responsible for delivering the general anesthesia, monitoring and medical care of your child while he/she is unconscious. Many precautions are taken to provide safety for the child during general anesthesia by anesthesia personal who are highly trained to manage complications. Our doctors will discuss the benefits and risks involved with general anesthesia and why it is recommended for your child’s treatment.
What special considerations are associated with the general anesthesia appointment?
Most of the time, your child’s surgery will be done on an “outpatient” basis. This means they will have their surgery in the morning and be allowed to go home in the afternoon.
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Physical examination – is required prior to a general anesthesia appointment to complete dental care. This physical examination provides information to ensure the safety of the general anesthesia procedure. Dr. Keels and Dr. Neal will advise you about any evaluation appointments that may be requested.
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Prior to surgery –Minimal discussion to your child about the appointment will reduce the anxiety. Explain they are “going to go to sleep and when they wake up their teeth will be fixed.”
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EATING AND DRINKING - It is IMPORTANT NOT to have a meal or snack past 12:00am before anesthesia. You will be informed about food and fluid intake guidelines at the time of the pre- op appointment.
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Changes in your child’s health – If your child is sick or running a fever the day or night before the actually surgery appointment PLEASE CALL DR. KEELS OR DR. NEAL IMMEDIATELY! It may be necessary to arrange another appointment.
Usually, children are tired following general anesthesia. You may wish to return home with minimal activity planned for the remainder of the day. The next day can return to their normal everyday routine.
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STAINLESS STEEL CROWNS
(all silver crowns)
*Please avoid sticky candy (i.e., Skittles, Jelly Beans, Tootsie Rolls) as repeated chewing on sticky candy may loosen the cement that is holding the crown on the tooth.
*If the silver crown comes off, then the tooth will have to be anesthetized (numbing shot) in order to place a new crown. We would like to avoid this if at all possible. If the crown should come off, then please save it and call our office as soon as possible.
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STAINLESS STEEL CROWNS WITH A WHITE VENEER
(white on the front/ silver underneath)
*The white veneer is very delicate and can be easily chipped and fractured off. Chewing on toys and hard candy can create fractures in the white veneer and should be avoided.
*If the white veneer should come off, then the crown will appear all silver. In order to restore the white color, the tooth will have to be numbed and either a new veneer or a new crown can be placed.
*Our goal is to have these crowns last until their baby tooth falls out. These tips should help meet this goal.
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NERVE TREATMENTS
(pulpotomy)
One of our doctors has offered you a treatment option of removing the unhealthy part of nerve of your child’s tooth.
Baby teeth respond well to the removal of a diseased part of the dental pulp while leaving the healthy portion intact. The cavity is removed from the tooth in addition to the portion of the pulp that has been infected by the bacterial growth from the cavity. A disinfectant is placed on top of the remaining pulp, the tooth is sealed and a crown (silver cap) is placed over the tooth. This allows the tooth to stay vital (alive) within the mouth.
What are the advantages and disadvantages of pulpotomies?
The obvious benefit is that the tooth is maintained in service and holds the space for the developing permanent tooth below it. The disadvantages are the teeth that have had nerve treatments are likely to require a crown (silver cap) to be placed on the tooth to provide adequate strength. Occasionally, the bacterium invades the nerve completely and the pulpotomy fails and the tooth must be removed, but the risk is low.
Are there alternatives?
Alternatives include removal of the tooth (with the diseases nerve) and the placement of a space maintainer, which will hold space for the permanent tooth to erupt between ages
10 – 11 years old.
What are the cost differences?
Although the cost for a pulpotomy and crown are moderate, they are similar in price for the removal of the tooth and space maintainer. Remember that the cost of either treatment likely ensures that the space for the erupting permanent tooth within the next few years.
What is the result of non-treatment?
Usually the patient will experience continued and increased pain and infection and also the risk of damage to the underlying permanent tooth below the infectious (baby) tooth.
Ignored nerve infection will usually result in an abscess and require removal of the tooth.
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DENTAL SURGERY POST OPERATIVE INSTRUCTIONS
In order for the area to heal where the tooth was removed, please make sure your child complies with the following instructions.
* Bite on the gauze until bleeding has stopped.
* Do not rinse the mouth for the remainder of the day.
* Eat a soft diet and drink fluids for the remainder of the day.
* Avoid very hot or very cold fluids.
* Do not drink through a straw.
The lip, cheek and tongue may be numb for as long as 2 hours in the area · **where the tooth was removed. During this period your child may chew
*or bite his/her lip, cheek and tongue without feeling any pain. Please
*observe your child carefully to help avoid injury.
* Children's Tylenol or Motrin may be taken for pain or discomfort.
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DENTAL ACCIDENTS OR TRAUMA
What do I do if my child is in an accident?
I f your child has an accident; please call our office as soon as possible. We will see your child immediately. If it is an after-hours emergency a pager number will be given on our voice mail.
The first 30 minutes after an accident are the most critical to treatment of a dental trauma. If a permanent tooth is knocked out, gently rinse, but do not scrub the tooth under water. Replace the tooth in the socket if possible. If this is impossible, place the tooth in a glass of milk or a clean wet cloth and come to the office immediately. If the tooth is fractured, please bring in any pieces that you can find. Our Schedule may be delayed in order to accommodate an injured child. Please accept our apologies in advance should an emergency occur during your child’s appointment.
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POST-OP DENTAL TRAUMA INSTRUCTIONS FOR PRIMARY TEETH
PAIN * a liquid pain reliever such as Motrin or Tylenol is recommended to control discomfort.
DIET * a soft diet is recommended for the next 6 weeks. In particular, avoid using the injured tooth for biting or tearing. Cut up hard foods like apples and carrots and use your uninjured teeth to chew.
HABITS * a difficult matter * but try not to suck any objects or fingers. Further pressure on the injured tooth will likely delay healing.
MOUTHCARE * excellent oral hygiene is needed to facilitate the healing process. Run your toothbrush under warm water to make the bristles softer for gentle brushing.
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POST-OP DENTAL TRAUMA INSTRUCTIONS FOR PERMANENT TEETH
PAIN * a liquid pain reliever such as Motrin or Tylenol is recommended to control discomfort.
DIET * a soft diet is recommended for the next 6 weeks. In particular, avoid using the injured tooth for biting or tearing. Cut up hard foods like apples and carrots and use your uninjured teeth to chew.
SPORTS * try to avoid any further injury to the damaged tooth, especially in the next few weeks. If you have a sports mouth guard, please wear it! If you do not have a sports mouth guard, one can be made for you after your injured tooth has stabilized.
MOUTHCARE * excellent oral hygiene is needed to facilitate the healing process. Run your toothbrush under warm water to make the bristles softer for gentle brushing. Rinsing with Perioguard will help keep bacterial growth under control. Rinsing after every meal is recommended.
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What can happen to an injured tooth?
1)*Change color- yellow, dark gray or brown
2) Loose sensation, feel dull- tooth nerve has died
3) Abscess- infected, draining pus from the end of the tooth root
4) Increased mobility or looseness- or infection
What follow-up care will my child need?
Possibly:
Splint Removal**Tooth Fracture Repair**Orthodontic Treatment/Braces
Endodontic Procedure/Root Canal* Bleaching
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DENTAL HABITS
THUMB, FINGER AND PACIFER HABITS
Are these habits bad for the teeth and jaws?
Most children stop sucking on thumbs, pacifiers, and other objects on their own normally between the ages of two or three years old, and in most cases no harm is done to their teeth or jaws. However the children who repeatedly suck on their fingers, pacifier or other objects over along period of time tend make their upper front teeth tip outward toward their top lip and in some case make their adult teeth not erupt properly.
When should I worry about a sucking habit?
Our doctors will carefully watch the way your child’s teeth come in and how the jaws are developing with sucking habit in mind at all tomes. For most children there is no need to worry about the sucking habit until their permanent front teeth are ready to come in, but the habit should be discourage by the age of four.
What can I do to stop my child’s habit?
Most children stop sucking habits on their own, but some children need the help of their parents. When your child is old enough to understand the possible results of the habit, our doctors will begin to encourage your child to stop, as well as talk about what happens to the teeth if your child does not stop. This advice, coupled with support of their parents, helps most children quit.
Are pacifiers a safer habit for the teeth than thumbs or fingers?
Thumb, finger and pacifier sucking all affect the teeth essentially the same way however, a pacifier habit is often easier to break.
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SPACE MAINTAINERS
Why do children lose their baby teeth?
A baby tooth usually stays in until a permanent tooth underneath pushes it out to take its place. Unfortunately, some children lose a baby tooth too soon. A tooth might be knocked by trauma or removed due to dental disease. When a tooth is lost too early, our doctors may recommend a space maintainer to prevent future space loss problems.
Why all the fuss? Baby teeth fall out eventually on their own?
Baby teeth are important to your child’s present and future dental health! They encourage normal development of the jaw bones and muscles. They save space for permanent teeth and guide them into position. Remember some baby teeth are not replaced with adult teeth until a child is 12 or 14 years old!
What are space maintainers?
Space maintainers hold open the empty space left by a lost tooth. They steady the remaining teeth; prevent movement until the permanent tooth takes its position in the jaw.
It is more affordable – and easier on your child – to keep the normal positions with space maintainer than to move them back in place by orthodontic treatment.
How does a lost baby tooth cause problems for permanent teeth?
If a baby tooth is lost too soon, the teeth beside it may drift or tilt into the empty space. Teeth in the other jaw may move up or down to also fill the gap. When adjacent teeth shift into an empty space, they create a lack of space in the jaw fore the permanent teeth below or above. So Permanent teeth are crowded and come in crooked. If left untreated, the condition may require extensive orthodontic treatment.
What special care do space maintainers need?
Dr. Keels and Dr. Neal have for rules four space maintainer care:
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Avoid sticky sweets or chewing gum,
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Do not tug or push on the space maintainer with your fingers or tongue,
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Keep it clean with conscientious brushing, and
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Continue regular dental visits.
CARE FOR SPACE MAINTAINERS
* The appliance in your child's mouth should not be removed by you or your child.
* The teeth may be sore for several days after the appliance is first placed or adjusted. Children's Tylenol or Children’s Motrin may be taken to relive the pain.
* If the gum tissue becomes sore or irritated, or the appliance becomes loosen or broken, call us immediately so that we can make arrangements to see your child.
* Hard or sticky foods and chewing gum should be avoided.
* Your child should not "play" with the appliance with his/her fingers or tongue.
* Careful tooth brushing around the appliance is necessary to reduce the risk for
gum irritation and tooth decay.
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POSTERIOR CROSS BITES
Posterior cross bite is a reverse bite in the back teeth on one or both sides of mouth. Normally top teeth fit on the outside of the bottom teeth – in a cross bite, the opposite is true.
A posterior cross bite is usually the result of constriction of the top jaw. Constriction usually occurs from an active thumb habit, although there are many cases in which a cross bite is from an unknown origin.
The importance or correcting a cross bite ensures proper alignment and bite of the teeth. An incorrect bite can lead to wear spots, a crooked smile, and malocclusion. If not corrected the permanent teeth will also likely erupt into cross bite if not corrected.
Expansion of the upper jaw is needed to correct the cross bite. An appliance called a quad helix can slowly expand the upper jaw to correct the cross bite. Two bands with a small wire are fit on the back molars. This appliance is glued in and cannot be removed by the patient. Usually the cross bite is corrected in approximately 6-8 months with a 4-6 month retention time afterwards. There is no discomfort experienced during this expansion.
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QUAD HELIX
The purpose of the quad helix (QH) is to stimulate the upper teeth and jaw to grow wider. This creates more room for the permanent teeth and shapes the upper dental arch to more closely match the patient's lower dental arch.
What is the initial adjustment time?
The device is not removable and you will not need to adjust it. Since it fits behind the teeth, it is not very visible. Most patients require between 3 and 5 days to become accustomed to the QH device. After these days of initial adjustment, most patients forget that the appliance is in their mouth. As well, the first 3 to 5 days of wear usually result in some alteration in speech. If the patient will speak slowly, speech will become normal within 3 to 5 days adjustment period. Although the QH works slowly and gently, some discomfort is to be expected. Ibuprofen (Advil), Tylenol or similar analgesics will be all that is necessary. It is an excellent idea to take the proper dose of medication before discomfort starts. Another point of information is that many patients have the habit of pressing their tongue against the QH wire. This will create a groove in the tongue. Although this is not harmful, it may make the tongue sore.
What is the care of Quad Helix?
Patients must not play with the wire or pick at it. Hard, sticky, or brittle foods such as Jolly Ranchers, Gummy Bears, Now or Laters, Skittles, Taffy or ice will destroy the wire resulting in discomfort and added expense. These types of things must not be put in the patient’s mouth at all. Carrots, apples, steak, pizza, or similar foods, should be cut into small pieces before being chewed. Teeth should be brushed and flossed in the usual manner.
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HEADGEAR
Remember, if you only wear the headgear 11 hours per day, then you're missing 3 hours each day. That means you’re losing 21 hours every week. At that rate, we'll never get your teeth corrected. Remember, patients who consistently get in their 14 hours everyday achieve excellent results in the shortest time.
How will I get 14 hours every day?
If you get home from school at 4:00p.m and wear your headgear until 6:00p.m that's 2 hours. Put it back on at 7:00p.m and wear it all night until the next morning at 7:00a.m. Well, that's it- 14 hours. Getting more than 14 hours per day on the week-ends will certainly help you reach your goal faster.
How long will I have to wear this thing?
That depends on 4 factors: 1.How consistently you get that 14 hours; 2. How much correction needs to be done; 3. How fast your face is growing; 4. What your individual treatment response is. With out doubt, the most critical factor is your compliance of 14 hours every day. If you can wear it to school (even if you get an additional 3 hours of wear at school in the morning) and get more than 14 hours 14 hours, you'll finish that much sooner. Average treatment time is 12-14 months of full time (14 hours per day) wear.
What will happen after we are successful?
You'll change to wearing it during sleep only. This helps stabilize the results. Gradually, you'll decrease the amount of time you’re wearing it until you stop.
What is the proper care for my headgear?
Patients must not play with the headgear. Hard, sticky, or brittle foods such as Jolly Ranchers Gummy Bears, Now or Laters, Skittles, Taffy, gum, eye Poppers or ice will loosen or destroy the molar bands that the headgear attaches to. This will result in discomfort and added expense. These types of foods and snacks must not be put in your child's mouth at all! Carrots, apples, steak, pizza, or similar foods should be cut into small pieces before being chewed. Teeth should be brushed and flossed in the usual manner.
Trouble Shooting for headgear
If a band does come loose, carefully try to remove it from your tooth. Place the band in an envelope and bring it with you when you come to the office. If the band will not come off, but stays in place on the tooth, stop wearing the headgear, then call us for an appointment to re-cement the band. Please call us early in the day so that we can arrange for you to be seen. True emergency is when something is loose or broken and you can't fix it and can't eat. If something like that were happen, call the office at 220-1416. Remember always bring your headgear to every appointment!
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INTERCEPTIVE ORTHODONTICS
As a child grows and matures, many indications become apparent to our doctors that your child’s teeth are not developing or growing into normal position and their biting relationships between upper and lower arch may need help to become aliened.
Interceptive orthodontic treatment (commonly referred to as Phase I) allows tooth movement during an early developmental time in your child’s life. Braces are attached only to a limited number of permanent teeth erupted (usually the incisors and the back permanent molars).
What are the benefits and limitations of Phase I Ortho?
Benefits: minor preventive orthodontic procedures can often prevent major problems from developing later. Discomfort is reduced, and time and money are often saved.
Limitations: cost to the family and inconvenience are present early in a child’s life. Occasionally the results of the interceptive procedure cannot be predicted totally until it is accomplished. The risks are the same as for full orthodontic therapy, but to a lesser degree.
Are there alternatives?
Waiting to see if your child’s dentition (jaw teeth) develops normally without the help of orthodontic therapy as an alternative, but indicators of the development of orthodontic problems are quite clear. Waiting is not an alternative without predicable risk.
How much does Interceptive Orthodontics cost?
The costs are lower for Interceptive Orthodontics tan for full orthodontics because the interceptive therapy is usually much less comprehensive. Our doctors will offer Interceptive Orthodontics to patients who meet the criteria, and then discuss fees based on the level of complexity of each individual case.
What is the result of non- treatment?
If the choice by the parent is non-treatment (or to wait), your child will eventually need full orthodontic treatment, which will cost more than interceptive care. The treatment will most likely be more difficult because early problems were not corrected or have not decreased in severity.
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CARE OF ORTHODONTIC APPLICIANCES
We believe strongly in patient and parent education. It is the responsibility of the parents and the patient to know what is required for successful orthodontic treatment. We hope your child will have support, encouragement and supervision from home to be certain that our instructions are followed carefully.
1. Avoid hard foods such as ice, candy, popcorn, peanuts, corn on the cob and pizza crust. Fruits and vegetables, such as apples and carrots, should be cut into small pieces and chewed with back teeth. Biting into hard foods may bend wires, loosen bands or brackets. Damage to the braces will prolong treatment time.
2. Avoid sticky foods such as snickers bars, gummy bears or tootsie rolls. These foods can also bend wires, loosen bands and brackets.
3. Brush immediately after every meal and before bedtime. Orthodontic appliances make tooth brushing more difficult. Therefore, special attention to oral hygiene must be given to avoid Cavities and Gingivitis. We will demonstrate proper oral hygiene techniques after the placement of the appliances and reinforce these instructions at each appointment.
4. Floss the teeth at least once per day. The evening is usually the best time to floss because it takes ten to fifteen minutes to brush and floss thoroughly
5. Rinse with a fluoride mouth rinse daily to reduce the risk of Cavities during orthodontic treatment. We suggest using ACT or any over-the -counter fluoride mouth rinse.
6. Maintain your six month check-ups. While we check the teeth at every orthodontic appointment, a thorough examination and cleaning is needed twice a year.
If the suggestions are followed routinely, your child's orthodontic treatment will proceed smoothly and will result in a pleasing smile and a healthy mouth. If you have any questions about the care of your child's orthodontic appliances, please do not hesitate to ask one of us.
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RETAINERS
Congratulations, your teeth are finally out of jail.
The retainers that you'll be receiving are receiving are designed to retain (or hold) your teeth in their finished position. Unless instructed otherwise, you must wear the retainers every night while sleeping. Always bring your retainers with you when you visit the office.
Hawley Retainers
Hawley retainers are colored plastic and wire retainers. Unless instructed otherwise, you must wear these retainers every night while sleeping. If you spend the night at a friend’s house, it's best to leave your retainers at home. Not wearing them for 1 night is o.k. but skipping 3 nights in a row is not o.k. At first your retainers may feel tight against your teeth. After a few weeks of wear they'll loosen up. Unless your teeth are actually being moved with the retainers, they won't feel very tight. When the retainers are not in your mouth, keep them in the protective case given to you. Never wrap your retainers in a napkin, never put them in your pocket or purse without the protective case, and never put them on a lunch tray. Keep your retainers clean by brushing them daily with water and tooth paste or soap. Be careful. New retainers are very costly. Always bring your retainers with you when you visit the office.
Vacuumed Formed Retainers
Please be absolutely certain that these are picked-up at the office tomorrow and worn each and every night, 7 nights per week while sleeping. The patient does not need to be present to pick-up these retainers.
The retainer(s) you'll receive are clear, thin plastic and will cover all of your teeth. This type of retainer is called a vacuum formed retainer and it's very easy to slip these retainers over your teeth. If you are receiving upper and lower vacuum formed retainers, there's only one way that they'll fit. The top retainer will not fit on the bottom teeth.
The retainer should be cleaned with cool water and a toothbrush. The plastic is very heat sensitive. If it is placed in hot water or exposed to any high temperatures (like in a hot car) the plastic will melt and the retainer will be ruined. This will mean crooked teeth and added expense which will upset everybody.
When not in your mouth, be certain that your retainer is kept in its protective case. Never wrap retainers in a napkin or paper towel. If you go to spend the night with a friend, it's o.k. to not wear your retainers for 1 night. Skipping 3 nights in a row is a bad idea. Caution: if a dog gets the retainer it will be destroyed. This could lead to bad feelings about the dog and I'm sure you like your dog- so, let's keep it that way.
Always bring your retainers with you when you have an appointment. If you have any questions you can reach us at 220-1416.
References:
*Little,R.M;Orthodontic Stability and Relapse. Pacific Coast Society of Orthodontics Bulletin(PCSO),pp.35-38, Spring , 1991.
*Behrents,R.G;Growth in the Aging Craniofacial Skeleton. Center for Human Growth and Development. University of Michigan, 1985.
*Richardson, M; The Role of the Third Molar in the Cause of Late Lower Arch Crowding: A Review. AJO 95;79-83; 1989.
Why are my teeth shifting after braces?
*As you get older your face will look different. A great deal of research has proven that just as your face changes and shifts with age, your teeth will shift with age. This is true for everyone whether they've had their teeth straightened or not and is especially true for he lower front teeth. Therefore, as we say, wrinkling skin, wrinkling teeth. So, if you want your teeth to stay really straight you must wear your retainers about 5 nights per week for the rest of your life. Only those retainers will succeed in the battle against aging of the teeth. The reality is that most people are not willing to wear retainers for the rest of their life and simply accept aging of the face and shifting of the teeth.
*Please keep in mind that it's your responsibility to wear the retainers
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MOUTH PROTECTORS
What are athletic mouth guards?
Athletic mouth protectors, or mouth guards, are made of soft plastic. Our Doctors will take impression of your teeth and design a guard that will fit tightly and comfortably to your child upper teeth.
Why are mouth guards important?
Mouth guards are top priority when participating in any sport. They protect not just the teeth but also the lips, cheeks, and tongue. They help protect children from such head neck injuries as concussions and jaw fractures. Increasingly, organized sports are requiring mouth guards to prevent injury to their athletes. Research shows that most oral injuries occur when athletes are not wearing mouth protection.
When should you wear a mouth guard?
Our practice recommends that your child wear a mouth guard whenever you are in an activity where there is a risk of falls or head contact with other players or equipment. This includes baseball, basketball, soccer, hockey, skateboarding, rollerblading, lacrosse, field hockey, and even gymnastics. Normally people would think that football and hockey are the sports that would propose the most danger to teeth, but in reality nearly half of sports-related mouth injuries occur in basketball and baseball.
How do I choose a mouth guard?
Any mouth guard works better than no mouth guard! Choose one that is comfortable to wear for an extend length of time. IF a mouth guard feels bulky or interferes with speech, it will be left in the bedroom or locker room to collect dust. You can buy mouth guards in sports stores that are preformed or boiled to fit. Different types and brands vary in terms of comfort, protection, and cost. Our office can make a customized mouth guard as well. This type of guard cost a little bit more, but is the most comfortable and the best protection against injuries. If there is ever a need for sports mouth guards ask our Doctors and they will advise the best type for you.
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DENTAL CARE FOR YOUR SPECIAL CHILD
Do special children have special needs?
Most do. Our practice has found that some special children are more susceptible to tooth decay, gum disease; oral trauma and heavy tartar build up. Other requires medication or diets that are detrimental to good dental health. Still other children have physical difficulty with effective dental habits at home. The good news is that poor dental health is preventable if dental care is started early and followed conscientiously, every child can enjoy a beautiful healthy smile.
How can I prevent dental problems for my special child?
A first dental visit by the first birthday will start you child on a lifetime of good dental health. Our Doctors will take a full medical history, gently examine you’re your child’s teeth and gums, and then plan preventive care designed for your child’s needs.
Are your doctors and staff prepared to care for special children?
Absolutely! Our doctors have 3 years of advanced training beyond dental school and their education has specialized focus on care for children with special needs. In addition, our office is universally designed to assist children and parents who may have additional needs. Pediatric dentist, because of their expertise, are often the clinicians of choice for adults with special needs as well.
Will my child need special care during dental treatment?
Some children need more support than a gentle, caring manner to feel comfortable during treatment. Restraint or mild sedation may benefit your special child. If your child needs extensive treatment, our doctors may suggest providing care at a hospital. Dr. Keels and Dr. Neal have comprehensive education in behavior management and anesthesia techniques. He will select a technique based on the specific health of your child, and then discuss the benefits, limits, and risk of that.
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WHAT PARENTS SHOULD KNOW ABOUT ENDOCARDITIS, ANTIBIOTICS AND DENTISTRY
Bacterial endocarditis is an infection caused by bacteria that enter the bloodstream
and settled in the heart lining or heart valves. Bacteria can enter the bloodstream in several ways. One common way is of the gums or teeth (cavities) dental hygiene in conjunction with inflamed, bleeding gums, can greatly increase bacteremia (bacteria in the blood). Any professional dental treatment that causes bleeding – such as cleaning below the gumline, repairing or removing teeth can also allow bacteria to enter the bloodstream.
Usually bacteria entering the bloodstream circulate through the body and are destroyed by normal body defenses. Sometimes, however, bacteria find a place to settle and that is when infection starts. When infection is in the heart, it is called endocarditis.
Children with congenital heart problems have a greater risk of developing endocarditis when bacteria enter the bloodstream. Endocarditis can seriously damage the heart. Therefore, Dr. Keels and Dr. Neal may prescribe antibiotics as additional protection to help the child’s normal body defenses destroy bacteria before they can infect the heart.
Basic prevention can start at home with careful dental care. Anyone at risk for endocarditis should be especially careful about daily brushing and flossing to ensure healthy teeth and gums.
Antibiotics given immediately before teeth cleaning or other dental procedures will protect against bacteremia (bacterial infection). This is called SBE prophylaxis: protection against a sub-acute bacterial endocarditis. Individuals at risk should receive this protection each and every time they have a procedure that increases their risk of bacteriemia. The goal of the antibiotic treatment is to provide short-term protection. Usually one dose is given one hour before the procedure. This provides protection at the time it is needed, but limits the child’s exposure to antibiotics.
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QUESTIONS PARENTS OFTEN ASK
“Does my child need antibiotics when a “baby tooth” falls out?”
No. Antibiotics are not necessary at these times.
“My child is taking an antibiotic for an ear infection. Will that protect him/her?”
No. Some bacteria may have developed resistance to that antibiotic. A different antibiotic should be used.
“My Child already takes antibiotic prophylaxis everyday because he /she have no spleen. Will that protect him/her?”
No. The normal body bacteria will have some resistance to that antibiotic. Another antibiotic should be used.
“I did not remember my child’s antibiotic until we arrived at you practice. Do we need to reschedule our appointment?”
Not necessarily. According to the most recent guidelines published by the AHA (American Heart Association), antibiotics prophylaxis given within 2 hours following a dental procedure will provide effective protection for most individuals.
Standard Doses
Oral recommendation foe dental procedures for individuals who are not allergic to penicillin:
Oral recommendation for dental procedures for individuals who are allergic to penicillin:
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Clindamycin: 20mg/kg ( max. dose = 600mg)
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Y Azithromycin:20mg/kg (max. dose = 500mg)
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Y Clarithromycin: 20mg/kg (max. dose = 500mg)
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Bruxism
Dental Manifestations:
**Grinding of baby teeth or adult teeth
**Usually occurs at night
**Results in mild to severe wear of front and back teeth
**Very common in young children with baby teeth
**Usually decreases by age 7-8 years old and is eliminated after the eruption of the permanent teeth at 12 years.
What happens in severe cases?
*1.You can develop tooth sensitivity once the enamel covering is gone-uncommon in baby teeth.
*2.The nerve can be exposed- OUCH! May require extraction.
Suggested Treatment
**Young children up to 8 years old usually require no treatment. Parents may have to purchase earplugs!
**Older children may require a mouth guard at night to protect their permanent teeth.
**Dr. Keels and Dr. Neal will monitor your child's occlusal wear and recommend any treatment if needed.
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GE REFLUX ( GASTROESOPHAGEAL REFLUX NICKNAME “GERD”)
Dental Manifestations
*Enamel erosion from the stomach acid washing over the teeth
*Tooth sensitivity can develop once the enamel covering is gone*
*Acid reflux can make untreated cavities worse
*In severe cases the nerve can be exposed * OUCH!
What can I do to slow down or stop the GE REFLUX?
SuggestDietary Changes to help reduce acid erosion
*Avoid sour candies (skittles, gummies, war heads, nerds, etc)
*Avoid fried foods and acid cdrinks (OJ with pulp)
Avoid over eating (super sizing)
Don*t lay down after eating
Place a 2x4 under the head of the bed
Your Pediatrician may recommend -
Zantac, Prilosec, Prevacid or Reglan
*Referral to a Pediatric GI Specialist
What are the long-term effects?
* If untreated, GE reflux can cause irreversible
* Loss of tooth structure
What are the long-term medical risks?
* If untreated, GE reflux can predispose you to
**Esophageal (throat) problems in adulthood
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