Pit and fissure sealants
Sealant is a material placed into the pits and fissures of caries-susceptible teeth that micromechanically bonds to the tooth preventing access by cavity causing bacteria to their source of nutrients. Pit and fissure caries account for approximately 80-90% of all caries in permanent posterior teeth and 44% in primary teeth. Sealants reduce the risk of caries in those susceptible pits and fissures. Placement of resin-based sealants in children and adolescents have shown a reduction of caries incidence of 86% after 1 year and 58% after 4 years. Any primary or permanent tooth judged at risk would benefit from sealant application. The best evaluation of caries risk is done by an experienced clinician using indicators of tooth morphology, clinical diagnostics, caries history, fluoride history, and oral hygiene. Sealant placement on teeth with the highest risk will give the greatest benefit. High-risk pits and fissures should be sealed as soon as possible. Low-risk pits and fissures may not require sealants. Caries risk, however, may increase due to changes in patient habits, oral microflora, or physical condition, and unsealed teeth subsequently might benefit from sealant application. Sealants must be retained on the tooth and should be monitored to be most effective. (AAPD Guideline on Pediatric Restorative Dentistry)
Our procedure may include air abrasion (“sand blasting”) or minimal enameloplasty in order to remove debris (plaque, saliva, bacteria) from the pits and grooves of teeth. Once cleaned, the tooth (or teeth) will be isolated with cotton rolls or rubber dam in order to minimize contamination of saliva. Tooth conditioners and sealant will be placed, followed by a blue wavelength light to cure (harden) the sealant.
Special care is taken to minimize contamination of the tooth and to minimize ingestion of materials. The tooth conditioners can chemically burn exposed skin and gum tissue if not immediately removed. The conditioners and sealants may also have an after taste which can be minimized by brushing or rinsing with mouthwash after the appointment. Sealants require care to continue to be preventive. They will be checked at each check-up appointment. Sealants may fail if your child grinds their teeth, chews on ice or hard and sticky foods (e.g. hard candy), or if ideal isolation was not obtainable. It is unlikely for the entire sealant to detach from the tooth. Usually only a small portion is exposed. The exposed tooth is susceptible to decay until the re-application of sealant.
Resin-based composites (tooth colored fillings)
Resin-based composite is an esthetic restorative material used for front and back teeth. Resin-based composites allow the practitioner to be conservative in tooth preparation. With minimal pit and fissure caries, the carious tooth structure can be removed and restored. Resin fillings are our practice’s first choice for restorative materials. Contraindications for these fillings may include the following situations: where a tooth cannot be isolated to obtain moisture control; in individuals needing large multiple surface restorations in the posterior (back) primary teeth; in high-risk patients who have multiple cavities and/or tooth demineralization and who exhibit poor oral hygiene and compliance with daily oral hygiene, and when maintenance is considered unlikely. Amalgam (silver) fillings may be an alternate restoration material. Due to the improved esthetics, conservative or minimal tooth preparation, ability to place overlying sealant, and ability to repair resin fillings, our office chooses resins over amalgams. Please note that the American Dental Association continues to recommend the use of amalgams, and our office does not recommend the removal of amalgam fillings unnecessarily.
Our procedure may include local anesthesia (numbing) for comfort during the procedure. Isolation of the tooth/teeth may include cotton rolls or rubber dam placement. The tooth is prepared as minimally as possible to conserve sound tooth structure but also allows access to place the filling. Tooth conditioners, bonding agents, resin composite and possible sealant will be placed followed by a blue wavelength light to cure (harden) the materials. If the filling is between two teeth, a temporary “ring” is placed around the tooth to prevent bonding to the adjacent tooth.
Special care is taken to minimize contamination of the tooth and to minimize ingestion of materials. The tooth conditioners can chemically burn exposed skin and gum tissue if not immediately removed. The conditioners and filling materials may also have an after taste which can be minimized by brushing or rinsing with mouthwash after the appointment. If local anesthesia is used, care must be taken to minimize self injury to the area (i.e. biting of lip and/or tongue). This may take approximately two hours, but is different for all individuals. Resin fillings can last many years with proper care and maintenance. Resin fillings may fail if your child grinds their teeth, chews on ice or hard and sticky foods (e.g. hard candy), or if ideal isolation was not obtainable. Oral health care (including brushing and flossing) are imperative to their long term success. Resin fillings will be checked at each check-up appointment. Teeth with deep cavities may experience sensitivity issues due to close proximity to the pulp (nerve) and/or possibility of irritation by materials used. While care is taken to minimize sensitivity, it may last for one to two months. Teeth that exhibit long term sensitivity may require root canal (nerve) therapy.
Stainless steel crown restorations
Unlike adult type crowns which usually require two or more office visits and lab fabrication, stainless steel crowns are prefabricated crown forms that are adapted to individual teeth and cemented with a biocompatible agent in one office visit. Stainless steel crowns have been indicated for the restoration of primary (baby) and permanent (adult) teeth with cavities, cervical (near the gums) decalcification, and/or developmental defects (eg, tooth malformation), when failure of other available restorative materials is likely (large cavities, patients who grind/clench), following pulpotomy or pulpectomy (baby teeth root canals), for restoring a primary (baby) tooth that is to be used as an abutment (support tooth) for a space maintainer, or for the intermediate restoration of fractured teeth. In high cavity-risk children, definitive treatment of primary teeth with stainless steel crowns may be better over time than multisurface restorations.
When possible, a resin (white filling) restoration is our first choice. When a stainless steel crown is indicated, the procedure is as follows: Local anesthesia (numbing) for comfort is given for the procedure. The tooth will be isolated with rubber dam placement. The tooth is prepared for the stainless steel crown and possible pulpotomy (see below). Once a crown is fitted to the tooth, it is then cemented with a biocompatible tooth cement. While the stainless steel crown should last for the longevity of the tooth, preventive care and maintenance is required. If plaque is not removed along the tooth/crown interface, recurrent (additional) decay may initiate. Excessive grinding or clenching may perforate the crown. There is a possibility that an erupting (growing) adult tooth can be impacted (not able to move) by the crown on an adjacent tooth. More common, the crowns can dislodge if the child eats sticky foods (e.g. hard candy, fruit roll ups, hard caramel, gum). If this occurs, keep the crown and call the office within a couple of days so that our office can recement the crown.
Pulpotomy (nerve treatment on baby tooth)
A pulpotomy is a procedure performed in a tooth with a deep cavity lesion adjacent to the pulp. The coronal pulp (nerve tissue in the crown of the tooth) is removed, and the remaining vital radicular (root) pulp tissue surface should be treated with a medicament to preserve the radicular pulp’s health. The coronal pulp chamber is filled with a soothing filling and the tooth is restored. The pulpotomy procedure is indicated when cavity removal results in pulp exposure in a primary (baby) tooth that is not infected or after a traumatic pulp exposure (from a tooth accident).
The procedure is as follows: local anesthesia (numbing) for comfort is given for the procedure. The tooth will be isolated with rubber dam placement. The tooth is prepared to remove cavity and for restoration placement. The exposed pulp tissue is prepared (drilled), and is treated with an agent (ferric sulphate) which stops any bleeding. This is followed by an antiseptic (chlorohexidine), and a soothing filling material. The final restoration (composite resin or stainless steel crown) is then placed. Recent studies have shown that this procedure is about 86% effective. If the procedure fails, the tooth may show signs of root resorption (loss of roots) and/or tooth abscess. An abscess usually indicates a need for extraction (removal of tooth). Visual exam and periodic xrays are necessary to monitor the success of the tooth treatment.
If your child loses a baby tooth early through decay or injury, the child’s other teeth could shift and begin to fill the vacant space. When your child’s permanent teeth emerge, there’s not enough room for them. The result is crooked or crowded teeth and difficulties with chewing or speaking. To prevent that, a space maintainer is placed to hold the spot left by the lost tooth until the permanent tooth emerges. The space maintainer might be a band or a temporary crown attached to one side of the vacant space. Later, as the permanent tooth emerges, the device is removed (ADA.org).
Space maintainers are usually completed in 3 steps. First, a separator (special rubber band) is placed much like floss in between the teeth that will receive an orthodontic band (ring). Three to seven days later, the separator is removed and the right size band is fitted on the tooth/teeth and an impression is taken. The impression takes between 30 to 60 seconds and may cause some gagging, The band is then removed and the impression is sent to a dental lab for fabrication of appliance. Your child will return to our office approximately two weeks later when the appliance is cemented (“glued”) in. The dental cement has a sour/bitter taste. Eating should be avoided for approximately one hour after the procedure to allow further setting (drying).
Care should be taken to avoid sticky, chewy foods for the duration that the appliance is in the mouth. These foods can loosen or pull the appliance out of place requiring recementation or new fabrication if the appliance is non-repairable. Examples of sticky, chewy foods include hard and soft candy, fruit roll ups, fruit chews, and chewing gum.
Removable appliances may include acrylic retainers, night guards, sports / athletic guards, and pediatric partial dentures. These appliances usually require two appointments in the office. First for the impression, and the second visit to place in the mouth to ensure its fit. At that appointment, instructions will be given on placing and removing the appliance to both you and your child. Just like your teeth and gums, the appliance will need to be brushed. In order to avoid the appliance breaking, care must be taken to avoid sticky, chewy, and hard foods. Hard foods may include hard pretzels and corn-on-the-cob.