Category Archives: Pediatric Dentistry

Pediatric Dentistry

Can You Help Me Understand a Pulpotomy?

My son’s dentist says he needs something called a pulpotomy. I tried to ask him questions about it, but he gets annoyed and feels like I’m questioning him. I know he’s the dentists, but this is my son. I don’t want to just have a procedure done on him without understanding it.

Laura L.

Dear Laura,

I hate to hear that your dentist has you afraid to ask questions. Yes, he’s the dentist, but part of his job is to make sure you understand why he’s recommending certain procedures and gives you all the options. Especially as a pediatric dentist, you’d think he’d understand that. There’s nothing more precious to you than your child. If he can’t understand that, you need another dentist. You’re not stuck having to go to a pediatric dentist if your options are limited. There are general dentists who are great with children. Whoever you go to, I’d love for you to be able to ask as many questions as necessary for you to feel at peace.

Now, onto your question. Think of a pulpotomy as a mini root canal treatment for baby teeth which are infected. It’s usually done on molars which need to last until your son is around twelve years old. Otherwise, if he loses a molar, his teeth will shift causing crowding with his adult teeth. If his molar is infected, it does need a pulpotomy.

The procedure is fairly simple and your son won’t think of it any worse than a normal dental appointment. The pulp is removed from the roots of the tooth. Then it’s daubed with a disinfectant such as formocresol. When that’s completed, the tooth will be sealed. Usually, they’re covered with a stainless steel crown.

If it turns out the tooth has to be removed, make sure the dentist puts a space maintainer in its place so the teeth don’t shift.

I hope this helps you. Feel free to ask as many questions as you need.

This blog is brought to you by Affordable Dentist Dr. Kevin Peck.

Pediatric Dentistry

Bummed My Son’s White Filling Keeps Falling Out

I don’t know what to do. I’ve been going to a pediatric dentist for my son. I wanted a white filling for him. The dentist understood that and gave him one. Or, at least he tried. He’s given him three and all of them have fallen out. I don’t know what to do. I don’t think it’s the pediatric dentist. He’s a respected dentist. He knows what he’s doing. Can you help me know what’s going on? I don’t want to give him a mercury filled filling.

Christina – New Jersey

Christina,

I understand your feelings about mercury-free fillings. Many patients are opting for them. Some patients even insist on them. With children it’s tricky. The process is completely different than with ye old silver amalgam fillings. Composite fillings work almost like a glue. The surface is etched and then the composite is bonded to it. As you can imagine, even a tiny bit of moisture missed in during this bonding process will destroy the bond, which is why a lot of dentists prefer to use amalgam when they’re working on back teeth or helping wiggly children. However, that doesn’t mean it’s impossible.

Without an examination it’s impossible to tell what the actual culprit is. But, moisture is the likely bad guy. With adults, you can usually work around this and take steps to keep the tooth dry during the procedure. Doctors generally use a mixture of cotton rolls, air, and dental dams to isolate the area they’re working on. Kids, especially little ones, have the tendency to fight this kind of stuff. They’ll move around in the chair, push their tongue into the preparation, and they aren’t typically fond of dental dams. So, when you get to the point where a parent really wants the white filling and the child can’t cooperate enough to keep it dry, sedation during the procedure becomes the next solution.

Dental sedation is not like surgical sedation. He will be conscious, but completely relaxed and very sleepy. It will help him stay still and cooperative during the procedure and is perfectly safe.

If you want to, you can get a second opinion from another pediatric dentist to determine if moisture is the actual issue. Then make a decision from there.

This blog is brought to you by Dr. Kevin Peck.

Pediatric Dentistry

What the Real Reason My Toddler Can’t Get a Dental Flipper?

My son lost a tooth prematurely. He’s only three and it’s a front tooth. I’ve been told children’s teeth shift if the spaces are left open. I asked my pediatric dentist to provide him with a dental flipper. Instead, the dentist started shouting. He said it was the most ridiculous thing he’d ever heard. No child can sit still for a flipper. I’m not only offended, I’m sure with sedation it could be done. Unless you give me a better reason, I’m going to a different dentist.

Marilyn H. – Michigan

Marilyn,

I’m sorry your dentist was rude. That’s not a great way to build trust with patients, especially when you’re talking about their child’s dental health. While I’m sure you could work with sedation, the pediatric dentist is right, a dental flipper is a bad idea. Here’s why.

1. A child’s mouth is constantly growing. The flipper won’t fit for long. You’d have to keep making a new one.
2. It’s a choking hazard. Flippers are removable appliances. Even if he didn’t pull at it, which is highly unlikely, it could just slip out and he’ll partially swallow it.

I have some great news for you, though. The only teeth where you have to worry about shifting are the back teeth. In those cases, we’d place a space maintainer to prevent the shifting. Also, your child’s age means he won’t be self-conscious about the tooth loss. In fact, he might be proud he’s the first among his friends to lose a baby teeth.

You didn’t mention how he lost his tooth. If it was due to trauma, it might be a good idea to have the adult tooth checked for damage. In the unlikely event the adult tooth is damaged, don’t panic. There are plenty of options for his adult tooth. Dentistry has developed tremendously. Even if he completely lost the adult tooth (and again, unlikely, so don’t panic), we now have dental implants that mimic having a natural tooth exactly, even down to the tooth root.

This blog is brought to you by Dr. Kevin Peck.

Pediatric Dentistry

Must I Stop Seeing a Pediatric Dentist When I Turn 18?

I love my pediatric dentist. I’ve been seeing her since I was five years old. I love her. The office is great. The staff is nice. Everything is good there. She has seen me through a lot. We talk about everything. I also have some anxiety issues and she has always been good with me about it. The problem is, I’m turning 18 in a few months.  Are they going to kick me out of the office and make me see a regular dentist? If they let me stay, should I feel weird about it?

Jessi – Georgia

Dear Jessi,

Typically, they do see kids, but they also take care of adults who have special needs and those who can be better served by the fun and relaxed atmosphere only a pediatric dentist can provide. However, every pediatric dentist has his or her own guidelines, but many of them are glad to continue seeing people until they’re ready to move on, even after they are officially a legal adult.

At this stage, you probably still have another year of high school anyway, so it makes sense to keep with what you have going for the time being, especially because you’ve got such a good relationship with her.

The only real concern is if you need to have serious dental work done. If you wind up needing a root canal, crowns, periodontal care, or something along those lines, your dentist may not be able to do them. It wouldn’t be because she “can’t.” She has the same training and schooling as any other dentist, but with additional training in working with kids. However,  kids don’t often need those kinds of services, and so she might not be set up to perform them or she might perform them so infrequently that she’d refer you to someone else.

This may not even be a concern that you have to face, though, as long as your oral health remains good for your remaining years with her.

In all likelihood, they’ll be glad to see you for quite some time, but you may want to call ahead and see what their policy is just to be sure. No, you shouldn’t feel weird about it at all. You’ve found a great dentist that you’re comfortable with and it sounds like she treats you well. That’s worth hanging onto and she’d probably be glad to know how much she’s touched your life.

You may also tell her how you’re feeling. She may know who the perfect dentist will be for you when you’re ready.  It will be much easier to see a new dentist before there’s a serious issue than after.

This blog is brought to you by Dr. Kevin Peck.

Pediatric Dentistry

How Many X-Rays Are Really Necessary?

Can you give me an unbiased perspective? Our pediatric dentist insists on x-rays every. single. visit. I think that’s a little excessive, both for the cost and the radiation. Is that really necessary?

Emily S. – Oregon

Emily,

Well, truthfully, the standard is x-rays once a year. Twice a year is not completely necessary, unless there is a special reason. For instance, if you have a family history of cavities or the dentist noticed something about your children’s teeth.

Talk to your dentist about it. If there’s nothing specific, then tell your pediatric dentist you prefer to only do the x-rays once a year.

Regarding the radiation, that’s perfectly safe. Most dentist use digital x-rays which have much less radiation than traditional x-rays.  Your children aren’t getting very much radiation.

This blog is brought to you by Dr. Kevin Peck.

Pediatric Dentistry

Should My Preschooler See A Pediatric Dentist for Teeth Grinding?

I planned on waiting until my daughter was in elementary school to bring her to the dentist. She is a little (lot) on the hyperactive side and I didn’t want to drive a dentist batty. However, I’m worried I need a change of plans. I went into her bedroom the other night to put some of her clothes away. She was sound asleep, but was grinding her teeth like crazy. Is this normal?

Adrianne L – Oregon

Adrianne,

I have a mixed message for you. First, this is perfectly normal. Many children grind their teeth and many children outgrow it. But, here’s the mixed message. I still think you need to change your plan and take your daughter to a dentist.

I realize she’s an active child, but dentists who enjoy working with children are perfectly comfortable with that. They have means of helping children with their wiggles.

You want your daughter’s first experience with the dentist to be a pleasant one. If you wait until her elementary years (and here you’re assuming/wishing her hyperactive side will just fade away), she’s likely to develop a cavity and her first experience with the dentist will be much more scary than it needs to be.

This blog is brought to you by Drs. Kevin and Hillary Peck.

Pediatric Dentistry

My pediatric dentist refuses to make a dental flipper

I need some advice. My pediatric dentist absolutely refuses to make a dental flipper for my son.  He’s three years old and lost a front baby tooth in an accident. I keep hearing how important it is to replace missing teeth in children because of shifting, but my dentist absolutely refuses. She says toddlers can’t do the procedure. I think she just can’t be bothered working with him because he’s so young. But, why did she go into pediatric dentistry then?

Brooklyn L. – Minn.

Brooklyn,

I wish your dentist had a better chairside manner and took the time to explain things for you. It is only a child’s molars that require some form of replacement. Otherwise it could cause shifting as you mentioned. That is because molars aren’t replaced until around twelve years old. Permanent front teeth come in much sooner.

However, even with molars a pediatric dentist wouldn’t make a flipper for the missing tooth. Instead, they’d place a space maintainer. That just holds the space so things come in properly when it’s time.

Despite her poor manners toward you, she’s right that a toddler wouldn’t easily tolerate the procedure for a flipper. Plus, because they’re so easily removable, they’re a choking hazard.

This blog is brought to you by Drs. Kevin and Hillary Peck.

 

Pediatric Dentistry

What Happened to my son’s tooth?

When my son was three, he took a tumble and bumped his face. He was upset and cut his lip, but his teeth looked fine, so I didn’t even consider taking him to the pediatric dentist back then. Here we are six months later and his tooth is turning an ugly gray color. At first, I thought it was just come kind of staining, but I have scrubbed at it to no avail and it looks like the whole thing is colored. I know in an adult this means the tooth is dead, but my son doesn’t seem bothered by it at all unless I’m messing with it. I think this must be connected to the fall, but I don’t understand why it would take so long to develop- he’s four now. I’m kicking myself for not taking him to the pediatric dentist back then. Could this have been prevented? Going forward, do I need to book him with a pediatric dentist, a root canal specialist, or should I just monitor for more symptoms?

Thanks,

Delilah

Dear Delilah,

It does sound like that tooth has died. When a tooth is injured, it can start to look like a bruise is developing from the inside. This may be from the fall he experienced earlier or from an unrelated incident. It’s not always easy to tell with small kids. Moreover, a dead or dying tooth doesn’t always cause pain. It just depends on what happened with the nerve. Taking him to the pediatric dentist right after the fall would not have prevented this from happening. The damage was instantaneous and even if it wasn’t killed right away, nothing could have stopped the progression.

At a certain point, baby teeth begin the process of resorption, in which the body starts diminishing the roots in order for the tooth to fall out. The pulp fades away naturally at this point anyway, and your son could be getting to that stage. With an adult, there’s concern over bacteria entering the chamber and creating an infection, which is why a root canal is necessary. The dentist cleans out the canal, and then fills the space so bacteria can’t seep in and cause a problem.

Given that your son will probably lose the tooth naturally in the next couple of years, you may not need to treat the tooth at all. It’s a good idea to keep an eye on it and if you’re worried about anything, you can have it checked out by the pediatric dentist.

This blog is brought to you by Dr. Kevin Peck.

Pediatric Dentistry

Questions from a child

Hi my name is Neil and I’m going to the dentist for the first time. I had some questions and my mom said the best thing to do would be to ask a dentist. So, she’s typing my questions to you.

  1. Will it hurt?
  2. What happens if my teeth ever get twisted?
  3. What happens if my teeth look like a cows? (My mom doesn’t want to ask this one, but I made her promise).

Thanks, Neil

Hi Neil,

Great questions! (Even the one about the cow).

  1. Usually children’s dentist appointments don’t hurt, especially first ones. The dentist just checks out that your teeth are growing in healthy. A special helper called a hygienist will give your teeth a gentle cleaning and take off any bacteria. Most children like going to the dentist.  (Some even give treats at the end of the appointment)
  2. If your teeth come in twisted, your dentist will suggest that when you’re old enough you get braces. Those gently fix your teeth into their proper position.
  3. Hmmm….that’s a new question for me.  I think if you had cow’s teeth (and didn’t like them), when you were old enough you could get them to look different with porcelain veneers.

I hope you really enjoy your first dental appointment. I bet it will be awesome!!!

This blog is brought to you by Drs. Kevin and Hillary Peck.

Pediatric Dentistry

Does a child really need a filling?

My four year old has a cavity. The dentist wants to fill it. Why, when he’s just going to lose it anyway?

Becky K. – Texax

Becky,

Much of that will depend on the type of tooth. If the cavity is small and on a tooth that is already quite loose then, yes, let nature take it’s course. But, if it is a tooth that’s going to be there for a while, especially one like a molar, than your pediatric dentist is right and it does need to be filled.

The cavity will spread and then become an abscess. IT might seem scary to give your four year old a filling, but that will be much less traumatic and painful than waiting until infection is set in and then he needs a pulpotomy.

If it is a molar and he ends up losing it, make sure your dentist puts a space maintainer there so his teeth don’t shift.

This blog is brought to you by Phoenix Dentists Drs. Kevin and Hillary Peck.