Author: Adam R. Pershing, DMD

Sometimes, children are too fearful to receive necessary dental treatment. When this happens, conscious sedation with nitrous oxide may be recommended to help make your child’s experience of dental treatment stress-free.

Conscious sedation involves medication to help ease tension and block pain during dental treatment, and does not put you to sleep. For pediatric treatments that opt for conscious sedation, nitrous oxide is used. Nitrous oxide is an anxiolytic, which means it makes anxiety disappear. It might cause a floating sensation, and maybe tingling in hands and feet. While under treatment, your child will be fully alert, aware of what is going on, and able to speak.

Nitrous oxide is delivered through a small mask that fits over the child’s nose. Once it has been confirmed that your child is calm and comfortable, the dental procedure can begin.

Nitrous Oxide is not a direct substitute for a local anesthetic, but sometimes an anesthetic injection is not needed while under nitrous oxide.

When treatment is over, the flow of nitrous oxide is decreased to zero, and the oxygen will be increased. After resting in the chair for a few minutes, the child will feel completely normal.

If your child’s anxiety prevents them from getting the care they need, conscious sedation with nitrous oxide might be a good option. Before your child is treated, you will be asked for a complete medical history, including any medications your child is taking. Your child will be kept safe and comfortable throughout the procedure.

The most likely location for a cavity to develop in your child’s mouth is on the chewing surfaces of the back teeth. The deep and varied crevices in these teeth make it easy for food particles to hide, and it can be difficult to keep these teeth clean, even with regular brushing. Your child’s dentist might recommend sealants to prevent cavities and prevent the need for more extensive dental treatments in the future.

Sealants are invisible plastic resin coatings that are painted on the chewing surfaces of back teeth. Sealants smooth out teeth, making them easier to brush, as well as create a protective barrier, so food and bacteria cannot penetrate the tooth.

Because tooth enamel does not contain any nerves, placing a sealant is painless and does not routinely require anesthetic. First, the tooth or teeth to be sealed are examined, and if any minimal decay is found, it will be gently removed. After the tooth is cleaned and dried, an acidic gel will be placed on the tooth or teeth to prepare the tooth for the sealant. After a few seconds, the gel will be rinsed off, and the sealant will be applied onto the grooves of the tooth. A special blue light is used to harden the sealant.

Sealants can last up to ten years and require minimal care. Brushing and flossing regularly will keep them clean. Sealants can occasionally become loose, but they can easily be reapplied during a dental appointment.

Sealants can reduce tooth decay by up to 70%, and are a great way to prevent the need for expensive restorative treatment later in life.

As soon as your child’s first tooth has erupted, which generally happens between six months and a year, you will need to schedule their first appointment with a pediatric dentist. The first visit often involves very little treatment. It is more for the child to meet their dentist, for the dentist to assess if their baby teeth are developing properly, and to educate the parents about proper oral hygiene for children.

Introductions

It’s important to try to establish a non-threatening relationship between your child and their dentist. To help this along, your dentist may ask you to sit in the dental chair with your child during the examination. Or, your dentist may ask you to wait in the reception area during part of the appointment, so that a positive connection between your child and the dentist can be built. The method to ease your child’s anxiety depends on the child’s personality. Some children don’t fear the dentist at all.

Examination

During your child’s examination, the pediatric dentist will evaluate the health and development of the baby teeth, including checking for tooth decay, bite, or any oral issues with the gums, jaw, or surrounding tissues. If needed, the dentist will clean the teeth and determine your child’s need for fluoride. Asking questions will be encouraged and the dentist will educate the parent about proper oral hygiene and dental development issues to look for.

Proper Oral Hygiene

Providing education about maintaining your child’s oral hygiene is a big part of the first appointment. The routine slightly changes as your child develops, so some helpful tips your dentist may provide you with include:

• Watching out for signs that your child is teething; this is the indicator that their baby teeth have begun to erupt.
• Maintaining proper nutrition for healthy teeth.
• Brushing twice a day with a grain-of-rice-sized dollop of fluoride toothpaste, especially after consuming foods or beverages.
• Teaching your child to spit out excess toothpaste after brushing.
• Refraining from letting your child go to bed with a bottle since this can lead to cavities.
• Increasing fluoride toothpaste to a pea-sized amount after the age of three.
• Watching if your child develops any bad oral habits, such as thumb sucking, tongue thrusting, or lip smacking.
• Placing the toothpaste on your child’s toothbrush until they reach six years of age.
• Monitoring and assisting your child while brushing until they reach seven or eight years old.
• Scheduling dental checkups once every six months to help build your child’s comfort with their dentist, monitor tooth development, and to treat any oral problems that arise.

Thumb sucking is a common habit that babies develop before they’re born. While most children naturally stop thumb sucking between the ages of two and four, some children might struggle to break the habit. If your child is still thumb sucking around the age of four, it’s important to help them stop.

Thumb sucking puts excess pressure on the teeth, gums, and jaw and can alter the growth and development of the jaw, leading to an open bite. In an open bite, the front teeth do not touch as they should, and instead point outward. Because the teeth are at an angle, the front teeth are more at risk to trauma. Open bites also make eating and chewing difficult, and requires orthodontic treatment.

Here are a few things you can do to help your child to help your child stop thumb sucking:

Praise and Reward

Positive reinforcement is the most effective way to encourage good habits. When your child avoids thumb sucking, offer praise or even a reward, like stickers. If you do notice them thumb-sucking, offer gentle reminders to stop.

Comfort and Distract

Thumb sucking is a self-soothing tool, so if you notice your child thumb sucking during certain situations that might be stressful or boring. If this is the case, finding ways to comfort your child or even entertain them might dissuade them from the habit.

Get Help

There are special tools that will help your child stop thumb sucking, including a bitter nail polish or an oral appliance called a tongue crib. This appliance physically prevents thumb sucking, and can usually break the habit in a few months. In other cases, sometimes having a dentist gently explain why it’s important to stop thumb sucking is all that’s needed to help your child stop.

One of the many functions of baby teeth is to hold space for the adult teeth that will eventually push them through. When baby teeth are lost prematurely, the permanent teeth that are coming in on either side can actually drift into the space that was reserved for another tooth. This can cause teeth to erupt out of position or to be blocked entirely, and it may result in crowded or crooked teeth.

There are both fixed and removable space maintainers. A fixed space maintainer is cemented onto the adjacent teeth, and saves room for teeth that haven’t grown in yet.

There are four types of fixed space maintainers:

• Crown and Loop: A stainless steel loop is attached to an existing crown, pressing against the tooth on the other side of the gap to ensure that the space will stay open for the incoming tooth.
• Unilateral: A unilateral device uses a wire that is wrapped around the teeth and connected to a metal loop to maintain a space between two teeth.
• Distal Shoe: A distal shoe is used for molars, and is placed directly into the gum line. It guides the incoming tooth as it grows in. These maintainers might require more maintenance and check-ups to make sure it is working properly.
• Lingual: Lingual maintainers are typically used when a child is missing multiple teeth due, and are cemented to molars. Wires are connected to crowns to make space across several gaps. It’s also commonly used in congenital defects, like in cases where the adult teeth never develop. The space maintainer is then used to make room for a future bridge or dental implant.

Removable maintainers are used when the tooth is growing in or almost ready to grow in. They are sometimes made to look like an artificial tooth, and are placed between teeth to save room.

Both permanent and removable space maintainers are custom-made to fit into your child’s mouth. Space maintainers are worn until X-rays reveal that the tooth underneath is ready to erupt naturally. It is very important that anyone wearing a space maintainer keep up good oral hygiene at home and have regular professional dental cleanings.

Fluoride is a naturally occurring mineral essential for proper tooth development.

Benefits of fluoride:

• Strengthens tooth enamel, by capturing minerals in saliva and forcing them into the tooth’s makeup
• Inhibits bacterial metabolism, slowing down the growth of bacteria and their reducing their acidic byproduct, which can weaken tooth enamel
• Inhibits tooth demineralization, meaning it can slow or stop the progression of an already existing cavity
• Fluoride can be found in most drinking water, as well as most common toothpastes.

Rules to Follow When Using Fluoride with Your Child

Because children can overconsume fluoride, it’s important to follow these rules when it comes to fluoride and your child:

Use only a pea-sized amount for children ages two to six, and just a tiny smear for children under two years of age
Fluoride should not be used on children younger than six months
Overexposure to fluoride can cause a condition called fluorosis, which is characterized by a streaked or mottled appearance of the teeth.

What does Fluorosis Look Like?

• A streaked or mottled appearance on the teeth
• White spots that are hard to see
• Dark discoloration with a pitted texture

The risk for fluorosis ends by the time a child is nine years old, and all permanent teeth have fully formed.