What is Pediatric Dentistry?

What Do I Do If My Child Is In An Accident?

What is Enamel Fluorosis?

What if My Child Has Special Needs?

What if My Child is Being Teased About His/Her Appearance?

What Should I Know About Early Orthodontics?

Should I Get a Mouth Protector (Mouth Guard) For My Child

What are Nerve Treatments? (Pulpotomy)

What Should I Know About Endocarditis, Antibiotics and Dentistry

What are Tooth Sealants and Does My Child Need Them?

What are Space Maintainers and What Do They Do?

What About Thumb Sucking & Pacifier Habits?

What is Posterior Crossbite?

What About General Anesthesia

Pediatric Dentistry
A pediatric dentist is a specialist dedicated to the oral health of children and the monitoring of their facial growth and development. Our office is designed for treating children from infancy through adolescence, as well as the medically and the physically compromised.
The American Academy of Pediatric Dentistry recommends that a child's first visit to the dentist should occur by 12 months of age. This visit will enable Dr. Elliott or Dr. Molina to evaluate your child and introduce you to proper oral hygiene. Diet, fluoride, finger and pacifier habits and tooth eruption will be discussed to insure optimal dental health.

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What Do I Do If My Child Is In An Accident?
If 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 the answering machine.
The first 30 minutes after an accident are the most critical to treatment of 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 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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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 tooth enamel. It shows up 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 appearance of the teeth is marred by discoloration or brown markings. The enamel may be pitted, rough, and hard to clean, 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 several different ways:

• 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!)
• The child may take a fluoride supplement when there is already an optimal amount of fluoride in the drinking water.
  
• Some children simply like the taste of fluoridated toothpaste. They may use too much toothpaste, then swallow it instead of spitting it out.
  

How can enamel fluorosis be prevented?
First, Dr. Elliott or Dr. Molina can determine the appropriate fluoride supplementation, if any, that should be given. Dr. Elliott or Dr. Molina may choose to test the level of fluoride in your child's source of drinking water. After he knows how much fluoride your child receives from their water supply, he will decide if your child needs a fluoride supplement.

Second, monitor your child's use of fluoridated toothpaste. A pea-sized amount on the brush is plenty for fluoride protection. Teach your child to SPIT out the toothpaste; do NOT swallow it, after brushing. Unless Dr. Elliott or Dr. Molina advises it, don't use fluoridated toothpaste until your child is age 2-3.

Should I avoid fluorides all together for my child?
NO! Fluoride prevents tooth decay. It is an important part of helping your child keep a healthy smile for a lifetime. Getting enough - but not too much - fluoride can be easily accomplished with the help of Dr. Elliott or Dr. Molina.

Can enamel fluorosis be treated?
Once fluoride is part of the tooth enamel, it can't be taken out. But the appearance of teeth affected by fluorosis can be greatly improved by a variety of treatments Dr. Elliott or Dr. Molina provides. If your child suffers from severe enamel fluorosis, Dr. Elliott or Dr. Molina can tell you about dental techniques that enhance your child's smile and self-confidence!

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DENTAL CARE FOR YOUR SPECIAL CHILD

Do special children have special dental needs?
Most do. Dr. Elliot and Dr. Molina have found that some special children are very susceptible to tooth decay, gum disease or oral trauma. Others require medication or diets detrimental to dental health. Still other children have physical difficulty with effective dental habits at home. The good news is, dental disease is preventable! If dental care is started early and followed conscientiously, every child can enjoy a healthy smile.

How can I prevent dental problems for my special child?
A first dental visit by the first birthday will start your child on a lifetime of good dental health. Dr. Elliott or Dr. Molina will take a full medical history, gently examine your child's teeth and gums, and then plan preventive care designed for your child's needs.

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. Home care takes just minutes a day and prevents needless dental problems. Regular professional cleanings and fluoride treatments by Dr. Elliott or Dr. Molina are also very beneficial. Sealants can prevent tooth decay on the chewing surfaces of molars where four out of five cavities in children occur.

Is Dr. Elliott or Dr. Molina prepared to care for special children?
Absolutely! Dr. Elliott has had 3 years of advanced training beyond dental school. His education as a specialist focuses on care for children with special needs. In addition, Dr. Elliott and Dr. Molina's office is designed to be physically accessible for special patients. Pediatric dentists, because of their expertise, are often the clinicians of choice for the dental care of 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 dental treatment. Restraint or mild sedation may benefit your special child. If a child needs extensive treatment, Dr. Elliott or Dr. Molina may suggest providing care at a local hospital. Dr. Elliott has comprehensive education in behavior management, sedation and anesthesia techniques. He will select a technique based on the specific health needs of your child, then discuss the benefits, limits and risks of that technique with you.

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STRATEGIES FOR TEASING
Guidelines for the Development of Positive Self Esteem

Social inhibition, or feeling uncomfortable in social situations is common for everyone, but particularly for people who think they "look different". Teasing is the act where someone annoys another person persistently, or bullies another person to anger, resentment, or confusion. Many problems can occur because of the behavior of the person who looks, or thinks he looks different. Problems also occur because of facial expression, and concern with appearance.

Important social skills to learn and practice are:
Reassurance: for yourself and others - try something that helps people see that you have feelings just like them - a big smile can make you feel better.

Energy and Effort: get on other's wavelength, make an effort with your appearance so you feel good about yourself and match the energy of the person you are talking with.

Assertive: make your point directly and politely, be prepared, think about questions you have had to answer before.

Courage: try and think positive, "I can do this", give yourself encouraging messages, even if you don't quite believe it.

Humor: don't be afraid to use your sense of humor, have a few little jokes for especially awkward times.

What to do???
Practice the above skills, with your family, with your close friends, and in front of the mirror. If you get comfortable with yourself, you'll get comfortable with others and they will get comfortable with you.

When faced with an uncomfortable situation:

• look at the person straight in the eyes and SMILE
  
• when asked a curious, but hurtful question about your face or body, be up front; give a short explanation of what happened. Make sure you're comfortable with the story you give. Or you can just ask "why on earth would you ask or say such a thing?"
  
• make a joke that everybody can laugh at without hurting anyone's feelings, including your own
  
• think of something else, tuneout hurtful comments, like you didn't even hear them, actively switch the topic of conversation or switch to a different friend or group of friends
  
• find a teacher or adult who is supportive and will also HELP
  

if it's just a couple of kids or a specific group who is always giving you a hard time, avoid the places where they hang out - staying away from hurtful situations is a smart thing to do, not cowardly

Developed by:
Kim S. Uhrich, CCSW, Clinical Assistant Professor, Department of Surgery, UNC Craniofacial Center, School of Dentistry
Robert D. Elliott, D.M.D., M.S., Department of Pediatric Dentistry, UNC School of Dentistry, Chapel Hill, NC
Diane Dilley, D.D.S., Associate Professor, UNC School of Dentistry, Chapel Hill, NC

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INTERCEPTIVE ORTHODONTICS

As a child grows and matures, many indications become apparent to Dr. Elliott that your child's teeth may not develop into normal position and biting relationships. Dr. Elliott has suggested to you that your child will likely need orthodontic treatment once their permanent teeth have fully erupted.

Interceptive orthodontic treatment (commonly referred to as Phase I) allows minor tooth movement during an early developmental time in your child's life. Braces are attached only to the limited number of permanent teeth erupted (usually the front 4 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 result of the interceptive procedure cannot be predicted totally before it is accomplished. The risks are the same as for full orthodontic therapy, but usually to a lesser degree.

Are there alternatives?
Waiting to see if your child's dentition (jaws and teeth) develops normally without orthodontic therapy is an alternative, but indicators of the development of orthodontic problems are quite clear. Waiting is not an alternative without predictable risk.

How much does Interceptive Orthodontics cost?
The costs are lower for Interceptive Orthodontics than for full orthodontic therapy because interceptive therapy is usually much less comprehensive. Dr. Elliot and Dr. Molina offers Interceptive Orthodontics to patients who meet the criteria. Dr. Elliott or Dr. Molina will discuss the difference if fees depending on the complexity of the patient's 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 the interceptive care. Also the treatment is likely to be more difficult because early problems were not corrected or decreased in severity.

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MOUTH PROTECTORS

What are athletic mouth protectors?
Athletic mouth protectors, or mouth guards, are made of soft plastic. Dr. Elliott and Dr. Molina adapts them to fit comfortably to the shape of your upper teeth.

Why are mouth guards important?
Mouth guards hold top priority as sports equipment. They protect not just the teeth, but the lips, cheeks and tongue. They help protect children from such head and 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?
Dr. Elliott and Dr. Molina recommends you wear a mouthguard whenever you are in an activity with a risk of falls or of head contact with other players or equipment. This includes football, baseball, basketball, soccer, hockey, skateboarding, rollerblading, and even gymnastics. We usually think of football and hockey as the most dangerous to teeth, but nearly half of sports-related mouth injuries occur in basketball and baseball.

How do I choose a mouthguard?
Any mouthguard works better than no mouthguard! Choose one that is comfortable to wear. If a mouthguard feels bulky or interferes with speech, it will be left in the locker room. You can buy mouthguards in sports stores that are pre-formed or "boil-to-fit". Different types and brands vary in terms of comfort, protection and cost. Alternatively, Dr. Elliott or Dr. Molina can make customized mouth guards. They cost a bit more, but are more comfortable and more effective in preventing injuries. Dr. Elliott or Dr. Molina can advise you on what type of mouthguard is best for you.

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NERVE TREATMENTS
(Pulpotomy)

Dr. Elliott or Dr. Molina has offered you the treatment option of removing the unhealthy part of the nerve in your child's tooth.

Baby teeth respond well to the removal of a diseased part of the dental pulp (nerve) 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 bacteria of 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 stay vital (alive) in 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 teeth that receive nerve treatments likely require a crown (silver cap) to be placed on the tooth to provide adequate strength. Occasionally, the bacteria invade the nerve completely and a pulpotomy fails and the tooth must be removed, but the risk is low.

Are there alternatives?
Alternatives include removal of the tooth (with the diseased nerve) and placement of a space maintainer, which allows the room to be "held open" for the permanent tooth to erupt between the ages of 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 a space maintainer. Remember that the cost of either treatment likely ensures that the space for the erupting permanent tooth will be held over the next few years.

What is the result of non-treatment?
Usually the patient will experience continued and increased pain and infection. There is also a risk of damage to the underlying permanent tooth below the infected primary (baby) tooth. Ignored nerve infection will usually result in an abscess and require removal of the tooth.

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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 settle in the heart lining or heart valves. Bacteria can enter the bloodstream in many ways. One common way is through infection of the gums or teeth (cavities). Poor dental hygiene in conjunction with inflammed, bleeding gums can greatly increase the risk for 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 an infection starts. When the infection is in the heart, it is called endocarditis.

Children with congenital heart problems have a greater risk of developing endocarditis when bacteria enters the bloodstream. Endocarditis can seriously damage the heart. Therefore, Dr. Elliott or Dr. Molina 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 maintain healthy teeth and gums.

Antibiotics given immediately before teeth cleaning (or other procedures which may cause bacteremia) protect against infection. This is called SBE prophylaxis: protection against sub-acute bacterial endocarditis. Individuals at risk should receive this protection each time they have a procedure that increases their risk of bacteremia. The goal of antibiotic treatment is to provide short-term protection. Usually, one dose of antibiotic is given one hour before the procedure. This provides protection at the time it is needed, but limits the child's exposure to antibiotics.

Cleaning of teeth below the gumline, tooth extraction, treatment of the vital nerve of the teeth and placement of orthodontic and appliance bands require premedication.

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 every day because he/she has no spleen. Will that protect him/her?"
No. The normal body bacteria will have some resistance to that antibiotic. A different antibiotic should be used.

"I didn't remember my child's antibiotic until we arrived at Dr. Elliott and Dr. Molina's dental office. Do we have to cancel?"
Not necessarily. According to the most recent guidelines published by the AHA (American Heart Association), antibiotic prophylaxis given within 2 hours following the procedure will provide effective protection for most individuals.

STANDARD DOSES
Oral recommendation for dental procedures for individuals who are NOT allergic to penicillin:

• Amoxicillin: 50mg/kg (max. dose = 2gm) 1 hour before procedure

Oral recommendation for dental procedures for individuals who ARE ALLERGIC to penicillin:

• Clindamycin: 20 mg/kg (max. dose = 600 mg)
  
• Y Azithromycin: 20 mg/kg (max. dose = 500mg)
  
• Y Clarithromycin: 20mg/kg (max. dose = 500mg)
  

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SEALANTS

What are sealants?
Sealants protect the surfaces of teeth with grooves and pits, especially the chewing surfaces of back teeth where most cavities are found. Made of shaded, tooth colored plastic, sealants are applied to the teeth to help keep them cavity-free.

How do sealants work?
Even if your child brushes 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 of tooth decay. Sealants "seal out" food and plaque, thus 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 avoids biting hard objects like ice cubes, crunchy candy or sticky foods, sealants will last longer. Dr. Elliott or Dr. Molina can easily replace or repair a lost or damaged sealant - he even has a Sealant Warranty that guarantees his work! Click here to see a copy of this limited warranty.

What is the treatment like?
Dr. Elliott, Dr. Molina or their staff can apply a sealant quickly and comfortably! It only takes one visit. Dr. Elliott, Dr. Molina or his staff conditions and dries the tooth, paints the sealant on, then hardens it with a blue light. It's that easy!

Which teeth should be sealed?
The teeth most at risk of decay - and therefore most in need of sealants - are the six-year and twelve-year molars. But any tooth with grooves or pits may benefit from the protection of sealants.

If my child has sealants, are brushing and flossing still important?
Absolutely! Sealants are only one step in the plan to keep your child cavity-free for a lifetime. Brushing, flossing and regular dental visits are still essential to a bright, healthy smile!

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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 and takes its place. Unfortunately, some children lose a baby tooth too soon. A tooth might be knocked out accidentally or removed because of dental disease. When a tooth is lost too early,
Dr. Elliott or Dr. Molina may recommend a space maintainer to prevent future space loss and dental 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 the 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, preventing movement until the permanent tooth takes its natural position in the jaw. It's more affordable - and easier on your child - to keep teeth in normal positions with a space maintainer than to move them back in place with 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 tilt or drift into the empty space. Teeth in the other jaw may move up or down to fill the gap. When adjacent teeth shift into an empty space, they create a lack of space in the jaw for the permanent teeth. 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. Elliott and Dr. Molina have four rules for space maintainer care:
1. Avoid sticky sweets or chewing gum,
2. Don't tug or push on the space maintainer with your fingers or tongue,
3. Keep it clean with conscientious brushing, and
4. Continue regular dental visits.

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THUMB, FINGER & PACIFIER HABITS

Are these habits bad for the teeth and jaws?
Most children stop sucking on thumbs, pacifiers or other objects on their own between two and three years of age. No harm is done to their teeth or jaws. However, some children repeatedly suck on a finger, pacifier or other object over long periods of time. In these children, the upper front teeth may tip toward the lip or not come in properly.

When should I worry about a sucking habit?
Dr. Elliott or Dr. Molina will carefully watch the way your child's teeth come in and jaws develop, keeping the sucking habit in mind at all times. For most children there is no reason to worry about a sucking habit until the permanent front teeth are ready to come in, but it should be discouraged 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 a sucking habit, Dr. Elliott or Dr. Molina can encourage your child to stop, as well as talk about what happens to the teeth if your child doesn't stop. This advice, coupled with the support from 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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POSTERIOR CROSSBITE
(W-Arch Appliance)

What is Posterior Crossbite?
Posterior crossbite is a reverse bite in the back teeth on one or both sides of the mouth. Normally top teeth fit on the outside of bottom teeth - in a crossbite, the opposite is true.

A posterior crossbite is usually the result of constriction of the top jaw. Constriction is usually from an active thumb habit, although there are many cases in which the crossbite is from an unknown origin.

The importance of correcting a crossbite ensures proper alignment and bite of the teeth. An incorrect bite can lead to wear spots, a crooked smile and malocclusion if not corrected. Permanent teeth will also likely erupt into crossbite if not corrected.

Expansion of the upper jaw is needed to correct the crossbite. An appliance called a W-Arch (due to its shape) can slowly expand the upper jaw to correct the crossbite. Two bands with a small wire are fit on the back molars. This appliance is glued in place and cannot be removed by the patient. Dr. Elliott or Dr. Molina will slowly expand the W-arch every 4-6 weeks until the crossbite is corrected. Usually the crossbite is corrected in approximately 6-8 months with a 4-6 month retention time afterwards. There is little to no discomfort experienced during the expansion.

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GENERAL ANESTHESIA

What is general anesthesia?
General anesthesia provides a way of effectively completing dental care while a child is unconscious.

Who should receive general anesthesia?
Children with severe anxiety and/or the inability to relax are candidates for general anesthesia. Usually these children are young or have compromised health issues and 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. Elliott and Dr. Molina requests that all of their general anesthesia cases be covered by a pediatric anesthesiologist. They are responsible for delivering the general anesthesia, monitoring and medical care of the child. Many precautions are taken to provide safety for the child during general anesthesia care. Patients are monitored closely during the general anesthesia procedure by anesthesia personnel who are trained to manage complications. Dr. Elliott or Dr. Molina 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.

• A 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. Elliott or Dr. Molina will advise you about any evaluation appointments that may be requested.
  
• Prior to surgery - Minimal discussion to your child about the appointment may reduce anxiety. Explain they are "going to go to sleep when their teeth are being fixed".
  
• Eating and drinking - It is important NOT to have a meal the night before general anesthesia. You will be informed about food and fluid intake guidelines prior to the appointment.
  
• Changes in your child's health - If your child is sick or running a fever, contact Dr. Elliott or Dr. Molina 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 your child until the next day. After that, you can usually return to a routine schedule.

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