But Aren't They Just Baby Teeth?
24 Common Questions in Pediatric Dentistry



1. When Should I Bring Jerad for His First Dental Visit?

      A. My Answer: "At six months of age or when the first tooth erupts"

      B. Current emphasis is being placed on exams as soon as the first tooth appears

           1. To create a dental home

           2. Discuss caries risk assessment    

           3. Emphasize need for home care with first tooth

      C. Historically three year olds were started-- why age 3?

           1. These children are very curious

           2. They want to please      

           3. Most 3 year olds have all their primary teeth

           4. They can handle the treatment to be done


2. How Will Megan Do When You Fill Her Tooth?

      A. My Answer: "Fine"

      B. What to say"

           1. Be realistic

           2. Be optimistic

           3. Be clear and layout out guidelines for parents

                a. Do not overprepare child or frighten them

                b. Use our terminology

                c. Be an observer only

                d. Leave when asked


3. My Husband Wants No Crowns-- Can These Teeth Just Be Filled?

      A. My answer: "Probably not"-- it may not be the correct thing to do

      B. Crown indications

          1. Large lesion with or without loss of space

          2. Expectation of life of the restoration is 4 or more years

          3. More than 2 surfaces involved with caries

        C. Technique

            1. Reduce occlusal surface about 1-2 mm

          2. Remove all caries—check for pulpal involvement

          3. Perform pulpotomy or place cavity liner (glass ionomer)

          4. Reduce mesial and distal surfaces with thin fissure bur

          5. Place counter-bevels on buccal-occlusal and lingual-occlusal anges

          6. Select snug-fitting crown (not too loose/not too tight)

          7. Check for proper length—if more than 1mm tissue blanch, trim crown

          8. Contour and crimp crowns for excellent adaption

          9. Cement with appropriate luting cement


4. We Don't Want Any Pulp Treatments-- Can't We Just Pull Colin's Teeth?

      A. My answer: "No"-- it is not the most appropriate treatment

      B. Extraction may lead to problems

           1. Drifting and space loss with result of increased chance of orthodontic care

           2. Decreased function

           3. Potential impaction of permanent teeth

      C. Spacer can replace extracted tooth, but may be more expensive

      D. Loss of a second primary molar, means unerupted six year molar will likely drift

      E. Pulpotomy techniques

           1. If exposure occurs open into pulp chamber with any high speed bur

           2. Amputate coronal pulp tissue

               a. Should only have two “snake eyes”

                 b. For ferric sulfate, need to countersink one round bur smaller

           3. Obtain hemostasis

                    a. Use cotton balls to dry

               b. Formocresol pellets 2-3 minutes to mummify stumps

               c. Ferric sulfate—instantaneous coagulation

               d. Electro-surge

                e. MTA

           4. Cover fixed pulp stumps with ZOE


5. My Other Children Never Had Cavities-- How Can Nicole Have Six?

      A. My answer: "It's common"

      B. We emphasize the variation in oral bacterial populations

      C. There are often non-dental considerations

           1. Parents have less control with each consecutive child

            2. Vigilence decreases with more children


6. Aren't They Just Baby Teeth?

      A. My Answer: "Yes"

      B. Reasons to move ahead with treatment though

           1. Primary teeth provide function of chewing during years of greatest body growth

           2. Esthetically, they provide an attractive appearance and smile

           3. They play a role in speech

           4. Permanent tooth guidance is greatly effected by primary teeth

      C. Longevity of primary teeth

           1. Permanent incisors and first molars usually erupt between 6-7 1/2 years of age

           2. Permanent cuspids and biscuspids usually erupt between 10-13 years of age


7. Heather Bumped Her Front Tooth and It's Dark-- Is It Dead?

      A. My Answer: "Probably Not"

      B. Most primary teeth heal normally without treatment

      C. What is normal?

           1. Bleeding

           2. Swelling

           3. Mobility

           4. Pain

           5. Darkening of tooth--  usually progresses for about 6-8 weeks and eventually      

               lightens back up

      D. What won't heal normally?

           1. Root fractures

           2. Avulsions-- partial and complete

           3. Severe displacements

           4. Internal resorption


8. Jessica is Still Sucking Her Thumb-- Is This a Problem?

      A. My answer: "Yes and no"-- this will largely depend on the age of the child

      B. Children under 3-4 years of age

           1. So common as to be normal

           2. Will often cease spontaneously

           3. Correction of dental and skeletal changes are likely

      C. Children over 4- 4 1/2 years of age

           1. More important to bring habit to a stop

           2. Now approaching eruption of permanent anteriors

           3. Likelihood of more difficult skeletal corrections becomes greater

       D. Suck-cess progress

           1. Behavior modification program

           2. Only the child can truly stop the habit

           3. Takes parents out of the loop and eliminates power struggle

      E. The program

           1. Parent paints Suck-cess on child's finger after breakfast and dinner

           2. Child scores on calendar with non-judgemental system

           3. Reward is given after 30 consecutive days without sucking

      F. Pacifiers

           1. Will also tend to open the bite

           2. Solutions

           a. Cold turkey

           b. Snip the Tip over time


9. Marlene Never Eats Any Sugar-- How Can She Have 8 Cavities?

      A. My answer: "It's common"-- it may have to do with the nature of the snack foods

      B. Cariogenicity of foods

           1. Sugar content is generally well known

           2. Frequency is not as often understood by parents

           3. Physical properties, such as stickiness is rarely known

           a. Fruit rollups

           b. Raisins

           c. Gummy bears, etc.


10. I Will Not Allow Any X-rays For My Child

      A. My answer: "I can agree to disagree, but I cannot see your child""

      B. Without radiographs, no examination is complete

      C. Potential problem areas

           1. Cysts

           2. Supernumerary or congenitally missing teeth

           3. Pathology, such as odontomas, etc.

      D. Our criteria

           1. A minimum of bitewings every other year

           2. We do not insist on annual x-rays when caries rates are low


11. Does Madison Really Need a Space Maintainer?

       A. Band and Loop

           1. Unilateral single tooth loss

           2. First primary molar space

           3. Can be used in either dental arch 

      B. Lingual Arch

           1. Bilateral mandibular tooth loss

           2. Unilateral multiple tooth loss in mandible

           3. Single second primary molar loss in mandible

      C. Nance Appliance

           1. Bilateral maxillary tooth loss

           2. Unilateral multiple tooth loss in maxilla

           3. Single second primary molar loss in maxilla


12. Will You Put Sealants on Bob's Baby Teeth?

      A. My answer: "No"-- success on primary teeth is not as great

      B. Statistics

           1. 70 percent of caries in primary teeth occur interproximally

           2. Retentiveness in broader and shallower grooves is not as predictable

      C. Sealants on permanent teeth

           1. We always use a rubber dam to isolate and keep dry

           2. We use topical anesthetic for placement of clamps

           3. Cleaning of grooves is done by air abrasion

           4. Etching is brief

           5. Unfilled bonding agent is used to increase flow of filled sealant material

           6. Filled sealant material will increase strength and wear resistance


13. Why is Erin the only one in her class who hasn't lost a tooth?

      A. My answer: "This is common and well within normal growth limits"

      B. Let's define terms

           1. Average= a human invention that indicates the mid-point of a series of data

           2. Normal= a range of possibilities within a series of data

      C. Some other thoughts

           1. We see 4 year olds with permanent teeth and 9 year olds without any

           2. Many children get their molars first, then incisors, but this is less noticeable


14. School Pictures Are Tomorrow, So Would You Treat Diana's Front Tooth First?

      A. My answer: "No" (not the top priority and may disrupt the success of future visits)

      B. The long-term strategy:

          1. Build on successful visits

          2. Start simple and painless

          3. Prioritize for function and longevity of teeth

          4. Keep them coming in for complete care


15. Isn't 8 A Little Early For Orthodontics?

      A. My answer: "Probably not"-- timing is often critical in some situations

      B. Early orthodontic situations that lend themselves to early treatment

           1. Skeletal descrepancies

              a. Class II

              b. Class III

               c. Deep bites and Open bites

            2. Functional problems

              a. Crossbites

              b. Ectopic eruption

           3. Dental problems

              a. Severe crowding

                b. Congenitally missing teeth

              c. Ankylosis

              d. Supernumeraries

      C. Rationales for early treatment

           1. Enthusiastic patient

           2. Take advantage of growth

           3. Prevent trauma

           4. Esthetic improvements


16. Does Bill Really Need To Come For Checkups Each Six Months?

      A. My answer: "Yes"-- for children every examination is a new patient exam

      B. In addition to caries detection, children need development checked

           1. Exfoliation and eruption

           2. Habits that may alter function

           3. Skeletal descrepancies

           4. Ankylosis

           5. Fusion and gemination

           6. Pathology


17. Will the Shot Hurt When You Fill Ben's Tooth?

      A. My Answer: "I don't know"

      B. Some scream with prophy cups, others say nothing during extractions

      C. My injections:

           1. Use appropriate, positive terminology

                a. I "put teeth to sleep"

                b. I don't "give shots"

                c. This is not deceptive and it does work

           2. Techniques

                a. Use topical anesthetic

                b. I don't show the child the needle

                c. Talk throughout procedure, using positive words to describe sensations                

          3. Types of injections

                a. Mandibular infiltrations                                

                b. Bilateral mandibular blocks are OK                

                c. Palatals go through papillae

          4. Onset by OnPharma

                a. Buffering system to neutralize acidity of local anesthetic

                b. Takes “sting” out of injections and shortens uptake time for anesthesia

                c. Mixed chairside with unique “pen”



18. I Don't Want Tyler To Miss School--Can We His Appointment Be After School?

      A. My answer: "No" -- Tyler is better able to cope in the morning, and so are we

      B. Scheduling of children should serve their ability to succeed

          1. Age of child

              a. Young children earlier in day

              b. Older children (8+) later in day

              c. Teenagers after school

          2. Length of appointment

               a. Usually 30-45 minutes

              b. Want to complete all treatment in 3 or fewer appointments

          3. Type of visit (procedures to be done)

              a. Sedation and heavier restorative visits earlier in day

              b. Simpler restorative visits later in mornings or early afternoon

              c. 6 month checkups anytime in day


19. I've Been Told That Nursing Can't Hurt Michael's Teeth-- Is This True?

      A. My answer: "No"-- ad lib nursing in conjunction with carbhoydrates can be harmful

      B.  It is important to identify the parent's issue

           1. If nursing is important, focus on restorative plan and deal with nursing later

           2. If person is truly open to information, explain relationship of nursing to caries

      C. It is difficult to NOT fall into the "they are wrong" attitude


20. I Want A Good Experience For My Child Without Sedation, Restraint or Verbal

      A. My answer: "Yes and no"-- this will depend on the child and the situation

      B. For very young, anxious child with large treatment plan= "No"

      C. For older children and/or small treatment plans= "Yes"

      D. What to say

           1. Be honest

           2. Be realistic

           3. Discuss all possibilities

      E. These parents probably don't need much to be disappointed or angry


21. How Soon Should I Start Brushing Beth's Teeth?

      A. My answer: "As soon as the first teeth erupt into the mouth"

      B. Some tips to increase success

           1. Start with Q-Tip, washcloth or “Tenders”

           2. Recommend that the parent let the child watch the parent brush

           3. Avoid strongly flavored toothpastes, especially mint flavored, which is "hot"

           4. May want to use child in parents' lap technique

      C. This is also an opportunity to educate parents about fluoride, diet and checkups


22. Can I Come Here For Treatment?

      A. My Answer: "No"

      B. What are they saying?

           1. We like what you do here

           2. This experience is different

           3. I want what you provide

      C. How does this happen?

           1. Pay attention to what patients like about dental offices

                a. This is usually not a technical factor

                b. They want to have a “good feeling” in the office

           2. Pay attention to what patients would change about a dental office

                a. This is also not usually technically related

                b. They are looking for relationships


23. Ashley Has a New Tooth Coming In Behind The Front Ones-- Is This a Problem?

      A. My answer: "Probably not"-- it is a possible indicator of crowding, though

      B. Nature will sometimes take care of this by itself

           1. Centrals blocked lingually, then primary laterals exfoliate

           2. Tongue then pushes centrals into proper location

           3. Permanent laterals erupt lingually-- final lateral growth of anterior mandible

           4. This is better time for evaluation

      C. When to "do something"

           1. No mobility of primary teeth

           2. Permanents are fully erupted

           3. Development of crossbite


24. Daniel's Teeth Just Came in Rotten-- Does He Have Soft Teeth?

      A. My answer: "No" (sometimes the case, but Daniel doesn't fit a usual pattern)

      B. Nature of the problem

          1. Is it generalized or only in a limited area?

          2. Any changes in the shape and size of root canals?

          3. Is it removeable or intrinsic?

      C. Bottle syndrome

      D. Enamel hypoplasia

      E. Intrinsic stains 


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