Frequently Discussed Topics
It has long been a topic for discussion if the parent should be present in the operatory when providing dental treatment to a child.
Most Pediatric dental offices require parental separation, feeling that a parent’s presence will hinder the formation of a relationship between the dental professional and the child.
At Hunterdon Pediatric Dental Associates, we have adopted Our Unique Team Approach in which parent, child and dental professional are all present and working together to educate the child about dental procedures and treatment. Thus, we encourage parental presence and parental participation during your child’s treatment. We feel this method will not only make your child feel more comfortable but also provides us the opportunity to educate the parents about their child’s oral health and their responsibilities to continue to reinforce this care at home.
In order to achieve these goals, it is important that the parent assume a supportive role and act as a silent observer while the child is cared for. We encourage parents to ask questions and to follow the instructions of the dental care provider as they lead and educate your child.
According to the American Academy of Pediatric Dentistry, a child’s first dental visit should occur at the time that their first tooth erupts but no later than one year old. Although this makes perfect sense, it is Dr. Tafaro’s belief that the first dental visit for routine and preventative care should occur around age three. This is advised because most three year olds will be behaviorally adjusted to be educated about how dental care is provided, tolerate an examination and cleaning and leave with having a positive experience.
This by no means suggests that children under three should not be seen. Dr. Tafaro recommends children under three years old be seen if any of the following circumstances are present- child being breast or bottle fed past age of one year old, difficulty brushing child’s teeth, use of sippy cup or bottle during the day or at bedtime, presence of white spots, pitting or any discoloration of the child’s teeth. In these instances, the child’s visit will be limited to a complete examination and consultation of the findings with the parents.
Fluoride is the best substance we have to fight the formation of cavities. When ingested as a liquid or a chewable tablet, fluoride becomes incorporated into the developing enamel of permanent teeth. This makes the enamel harder and more resistant to the harmful effects of bacterial acids.
Some communities make it easy for children to obtain Fluoride by placing it in their water supply. Unfortunately, the rural population of Hunterdon County makes this very costly. In this case, a Fluoride supplement should be prescribed.
It is our recommendation that all children should be placed on a Fluoride supplement according to their age as follows
Fluoride in water
18mths – 3yrs
3yrs – 6 yrs
6 yrs – 13yrs*
0 – .3mg
0.4 – 0.7mg
* – until eruption of second permanent molars or longer if patient is cavity prone.
Fluoride is one of the most extensively studied drugs. Many reports suggest that Fluoride is a carcinogen and can cause harm to ones bones and muscles. These studies are mostly anecdotal and they exaggerate their findings.
The true fact is that Fluoride is a drug and like any drug, too much is not good. The problems that arise from excessive fluoride ingestion are discoloration and pitting of permanent teeth. This will arise during the toddler years as the permanent teeth are developing.
To prevent excessive fluoride ingestion, parents need to monitor the ingestion of Fluoride from secondary sources. These include fluoridated water ingestion when the child is in daycare, a relative’s or other family member home where fluoride is in the water. Toothpaste contains lots of fluoride and only a small, flat row along three bristle rows of the toothbrush is recommended. Avoid using fluoride rinses in children under six years of age. If you have a concern with your child’s Fluoride intake, then our office can do a Fluoride history review with you.
Dental radiographs are a very necessary part of the examination process. Because baby teeth are developed very quickly, there tooth structure is not as well formed. Thus, they are more prone to developing decay. A small cavity that starts in between the teeth can become very large in a short period of time. This could cause the tooth to require more costly and extensive restorations or loss of a tooth from infection. Radiographs are also needed to monitor the development and eruption of teeth for orthodontic purposes.
Improvements in technology has led to the development of X Ray machines and fast films that deliver very little radiation to a very specified area. When comparing digital radiographic systems to traditional film systems, there is very little difference in the amount of radiation the patient receives.
Although there is no way to determine exactly how much radiation is too much for any given person, we do know that children are more susceptible to the effects of radiation and all efforts to limit radiation should be done.
In following this recommendation, our office’s standard radiation policy is to take two radiograph per year beginning at the age of 4 ½ years. A Panoramic radiograph (Equivalent to three regular radiographs) is taken at the age when the first permanent teeth erupt, about six years old. If determined it is necessary, it is repeated at the age of 10 – 11 years old. Once the patient has all permanent teeth present, Radiographs are taken every 18 – 24 months.
It is important to note that factors such as decay rate, ectopic positions of teeth and the frequency your child visits the dentist may alter the need for radiographs.
Sealants are special restorations placed on the biting surfaces of teeth with the specific goal of preventing tooth decay.
During development, many teeth will develop defects in the form of pits and grooves. These imperfections are areas for impaction of food and bacteria. Because there are no effective methods to thoroughly cleanse them (toothbrush bristles are even too large to get into them), tooth decay can easily develop.
Sealants prevent decay by acting as a protective barrier so food and bacteria can not penetrate these imperfections. Thus, brushing becomes an effective method to clean these surfaces.
For sealants to be effective, they must be properly placed on the tooth. Any debris or salivary contamination will destroy the bonding of the sealant to the tooth. This will allow bacteria to penetrate between the tooth and sealant, causing a failure that could lead to tooth decay.
To prevent this, our office uses only the most effective methods and materials to insure the strongest bond of the sealant to the tooth. First, a rubber dam is used to isolate the tooth to prevent salivary contamination. Prior to its placement, a small amount of novacaine is usually given to numb the gum tissues around the tooth. This will insure the comfort of the patient. Bacteria and debris in the pits and grooves are cleaned out using a high speed drill. The enamel surface is recontoured, allowing us to detect any decayed areas and producing a superior bonding surface.
After conditioning the enamel, a special adhesive is applied to seal the enamel and aloe for good adaptation of the sealant to the tooth. A tooth colored filling material is then spread over the tooth and light cured. This material is much stronger than traditional sealant material and more resistant to wear. After polishing, a surface sealer is used to seal the margins where the tooth and sealant meet.
Although there is no specific time period a sealant will last, our office guarantees all sealants for three years. At this time, I am finding most sealants lasting over ten years without having any problems.
Dental decay is a progressive disease that can cause extensive damage to primary and permanent teeth. The sooner a cavity is diagnosed, the less treatment will be required to restore the tooth.
Cavities that are confined to the biting surfaces of teeth are treated with a tooth colored filling. In this procedure, only the decayed areas are removed. These areas receive the filling while the rest of the tooth is sealed with the same filling material. This method of restoration is known as a preventive resin restoration.
Deeper cavities and those cavities that form in between the teeth require the removal of more healthy tooth structure. Here a definitive preparation is made in the tooth and a tooth colored composite resin material is used to restore the form and function of the tooth. Sometimes the placement of a protective base is required to insure the nerve of the tooth will not become irritated and cause sensitivity after treatment.
When decay progressive to the point where most of the crown of the tooth is affected, a stainless steel crown is required. Here, the entire crown of the tooth is prepared so the crown will fit over the tooth. Once properly fitted, the crown is cemented on.
When decay gets into the nerve of the tooth, the nerve must be treated to insure its health and prevent the tooth from abscessing. In this procedure, the nerve is removed from the inside of the tooth and a medication is placed to disinfect and preserve any healthy nerve in the root of the tooth. After this is completed, a stainless steel crown is used to restore the tooth.
Severely decayed front teeth in the young child present a cosmetic issue. Here, a stainless steel crown that has a tooth colored facing is used.
Restorative dental treatment is performed in the office with the use of local anesthesia to numb the mouth and teeth. Nitrous Oxide (laughing gas) is often used to help relax the children and provide a mild analgesic effect.
Orthodontic problems in children are either due to crowding of teeth, improper growth and positioning of the jaw bones or a combination of both of these problems.
When these problems are seen in children between the ages of 6 to 8 years old, limited orthodontic treatment could be very helpful in preventing the orthodontic problem from becoming worse. Such treatment is known as Interceptive Orthodontics or Phase I treatment.
By doing Interceptive Orthodontics, bite problems can be corrected that could prevent or reduce the amount of orthodontic care needed in the future. Such treatment includes promotion of front tooth alignment, space maintenance, correction of crossbites and habit control.
Many orthodontic problems are more complex and require a child to grow and develop before a definitive plan of treatment can be developed. In these cases, Comprehensive Orthodontic Treatment is best. This will usually consist of full braces and possibly some type of orthodontic appliance therapy that will promote the proper growth and development of the jaws.
The time to start Comprehensive Orthodontic treatment is between the ages of 11 and 14 years old. Such factor that need to be considered before determining the exact time to begin are growth and development, when permanent teeth are erupting, the child’s emotional and maturity levels and the complexity of the problem.
Dr. Tafaro has extensive training in Orthodontics as he has been providing such care for 15 years. At your child’s recall visits, an orthodontic evaluation is done. This information helps guide us to determine the proper path of care.
Although the primary teeth will eventually be lost, they are vital to a child’s health. Not only are they needed to eat, chew, talk and cosmetic appearance, the primary teeth hold space for the permanent teeth that replace them. When primary molars are lost prematurely, a space maintainer is needed to prevent the shifting of the other primary teeth.
There are two types of space maintainers. Unilateral or one sided space maintainers consist of an orthodontic band placed upon one anchor tooth with a wire soldered to both sides of the band. A bilateral space maintainer uses two orthodontic bands placed on opposing anchor teeth on each side of the jaw with a wire soldered to one side of each band.
The space maintainers are made by taking an impression of your child’s mouth and having it custom made by an orthodontic laboratory. They are cemented in the mouth so they can not be removed. They are removed when the permanent teeth are erupted in the mouth.
Children under 3 ½ years old who have extensive restorative treatment needs present a problem in delivering quality dental care. Because they can not understand how to cooperate and are unable to tolerate longer appointments, dental care must be provided with the use of general anesthesia.
At our office, these cases are performed at Hunterdon Medical Center. Here, a trained anesthesiologist administers the anesthesia while all of the child’s dental care is completed. All children must undergo a routine physical examination prior to receiving anesthesia and be free of any illnesses.
New Jersey law prevents insurance companies from denying payment for medical benefits for dental care rendered in a hospital. Because of the inherent risk involved in receiving general anesthesia, Dr. Tafaro will only treat cases in which he deems it absolutely necessary.
Gingivitis is a reversible inflammation of the gum tissues due to plaque accumulation around an in between the teeth. It presents as red, swollen gum tissues where the teeth and gums meet. The body’s immune system recognizes the bacteria and responds to it by sending antibodies to the area to fight the infection. To do this, the small blood vessels become opened and fragile, thereby causing them to bleed when touched. If the gingivitis should worsen, the gum tissues can swell up, over growing the teeth and making it easier for plaque to stay on the teeth.
Treatment for gingivitis starts with more attentive and regular home care. Gentle brushing at the gumline and daily flossing will remove the bacteria and stimulate healing. If bleeding still occurs, then a professional cleaning as well as detailed home care instruction may be needed.
Children who have braces on their teeth are much more prone to developing gingivitis as the braces allow plaque to more easily accumulate. In this case, more attentive and frequent home care care is required.
It should be noted that gingivitis is the first step in gum disease. Because children’s immune systems are normally stronger, progression to more severe forms of gum disease is very limited. However, if good oral hygiene habits are not developed early, then there is a good chance that irreversible gum disease could form. Remember, once you have irreversible gum disease, it can not be cured. The disease can only be controlled through more frequent cleanings and many times surgical procedures.
Dental decay is a bacterial disease of the teeth. This disease begins by bacterial plaque forming sticky colonies around the teeth. These bacteria use sugar to produce an acid that dissolves the minerals out of the tooth’s enamel. This process is known as decalcification or acid attacks. As enamel is decalcified, it becomes porous and soft. Bacteria will infiltrate these pores and continues the process. If undetected, the decay progresses and creates the hole we call the cavity.
Fortunately, our mouth fights against this process by putting minerals back into the teeth through our saliva. However, it takes the mouth 20 minutes to recover from an acid attack before this can occur. If the mouth stays in cavity formation stages more than cavity repair stages, remineralization of the enamel cannot occur.
Cavities that develop in between the teeth are most frequently seen in children who eat lots of small meals, consume juices or soda by sippy cups or straws, or tend to take long times eating meals. Additionally, food that sticks in the mouth takes a long time to be cleared out. This will cause the loss of minerals from the teeth for as long as the food stays in the mouth. Such foods as potato chips, pretzels, and crackers are digested in the mouth to sugar and cause cavities faster than other sugary foods.