What is Pulp Therapy?
The pulp of a tooth is the inner, central core of the tooth. The pulp contains nerves, blood vessels, connective tissue and reparative cells. The purpose of pulp therapy in Pediatric Dentistry is to maintain the vitality of the affected tooth (so the tooth is not lost).
Dental caries (cavities) and traumatic injury are the main reasons for a tooth to require pulp therapy. Pulp therapy is often referred to as a “nerve treatment”, “children’s root canal”, “pulpectomy” or “pulpotomy”. The two common forms of pulp therapy in children’s teeth are the pulpotomy and pulpectomy.
A pulpotomy removes the diseased pulp tissue within the crown portion of the tooth. Next, an agent is placed to prevent bacterial growth and to calm the remaining nerve tissue. This is followed by a final restoration (usually a stainless steel or zirconia crown).
A pulpectomy is required when the entire pulp is involved (into the root canal(s) of the tooth). During this treatment, the diseased pulp tissue is completely removed from both the crown and root. The canals are cleansed, disinfected and, in the case of primary teeth, filled with a resorbable material. Then, a final restoration is placed. A permanent tooth would be filled with a non-resorbable material.
Early Orthodontic Treatment
What is the Best Time for Orthodontic Treatment?
Developing malocclusions, or incorrect bites, can be recognized as early as 2-3 years of age. Often, early steps can be taken to reduce the need for major orthodontic treatment at a later age.
Stage I – Early Treatment: This period of treatment encompasses ages 2 to 6 years. At this young age, we are concerned with underdeveloped dental arches, the premature loss of primary teeth, and harmful habits such as finger or thumb sucking. Treatment initiated in this stage of development is often very successful and many times, though not always, can eliminate the need for future orthodontic/orthopedic treatment.
Stage II – Mixed Dentition: This period covers the ages of 6 to 12 years, with the eruption of the permanent incisor (front) teeth and 6 year molars. Treatment concerns deal with jaw malrelationships and dental realignment problems. This is an excellent stage to start treatment, when indicated, as your child’s hard and soft tissues are usually very responsive to orthodontic or orthopedic forces.
Stage III – Adolescent Dentition: This stage deals with the permanent teeth and the development of the final bite relationship.
Adult Teeth Coming in Behind Baby Teeth (Ectopic Eruption)
This is a very common occurrence with children, usually the result of a lower, primary (baby) tooth not falling out when the permanent tooth is coming in. In most cases, if the child starts wiggling the baby tooth, it will usually fall out on its own within two months. If it doesn’t, then our pediatric dentists, Dr. Chen and Dr. Hunter Griffith can easily remove the tooth. The permanent tooth should then slide into the proper place.
In America, 30% of the children have 80% of the decay. Quite a few factors are known to play a role in whether a patient has cavities or not, those include:
- decay history of patient
- decay history of parents (esp. mother)
- decay history of siblings
- frequency of sugar (fermentable carbohydrates) in the diet
- timing of sugar in diet related to brushing
- brushing and flossing timing and frequency
- fluoride exposure
- saliva – flow and quality
- tooth formation
- type and number of Strep mutans bacteria the patient has
As soon as the teeth come in, start cleaning them – if possible after each feeding. This will acclimatize your baby to having the mouth/teeth touched. Some doctors even advocate wiping the gums before the teeth come in. Try to not share utensils so that you do not spread Strep mutans. Try to clean the teeth after each feeding. Each time a child has a ‘fermentable carbohydrate’ (these include many healthy foods!) the bacteria produce acid. It takes normal saliva flow approximately 20 minutes to neutralize this acid, during this time the tooth is ‘under attack’ from the acid environment. Limiting carbs in-between meals will help decrease these ‘acid attacks.’ Raw vegetables and cheese as snacks are much less likely to cause decay. Avoid introduction of very sweet foods to toddlers as long as possible.
Bottle and nursing habits can contribute to decay formation. Try to wean to a cup between 12-18 months depending on your child. After this, it gets harder, especially for mom and dad! Remember, a two year old’s job seems to be protesting. Sippy cups are very convenient to avoid spills, but please do not give them as a “pacifier” all day – unless they are filled with water. Water sipping is a tooth-healthy habit to encourage.
Pediatricians now advise limiting the total ounces of fruit juice per day to 4-6oz. Diluting with water will help it go further, again be wary of frequency. Gatorades and sports drinks can promote cavities quickly (especially if used frequently). Move to water between meals as early as possible. Avoid sodas – even diet soda has a high acid content.
This generation sees more ads for sweets and junk food on TV than any previous generation. Be proactive and warn them that we don’t believe everything we see on TV. At the grocery store, take them through the produce section and make a production about tastes, scents, colors, textures and vitamins and minerals we get from fruits and vegetables. Pick out a treat there so when you finish shopping and when you hit the candy isle, they already have their ‘goodies’. The sticky candies which are marketed as ‘fruit’ are more likely to cause decay than candies which melt away from the teeth such as chocolate. Try not to pack them in lunches or give them as snacks where they can stay on the teeth even longer!
Start with a small soft brush. It is very normal for children to chew on them. When the bristles are bent, use a new brush. Have your child brush first (if age appropriate) and then a parent brushes afterwards. It may be a good idea for the parent to have a separate brush which will usually not be bitten as much. As children grow, they normally get very independent about brushing. The compromise we recommend is: they get to brush first and they get to use a small dot of toothpaste – then parents ‘touch up’ . Remind them that their eyes cannot see germs inside their own mouth, but parents can. Parents should help with brushing until at least 8 years of age.
Parents should floss when teeth touch together or if a youngster is packing food. Children are not able to floss well alone until age 9 or 10. Some parents find pre-threaded flossers much easier to use! There are character flossers which can be fun, or Glide flossers which work well for very tight contacts.
Fluoride – Different types of fluoride can be used to strengthen teeth. A small amount daily has been found to be most beneficial. There are toothpastes, rinses, gels, varnishes, and tablets- each patient has a different need so we will discuss fluoride with you in the office. Swallowing too much fluoride can cause fluorosis (discoloration) in the developing permanent teeth.
A great deal of knowledge about ‘cavities’ has been gathered with scanning electron microscopes and evidence-based bacteriologic studies. Cavities are not created fair and equal.
Cavities are caused by a common bacteria. Infants are usually born without the bacteria known as Strep mutans, but are thought to be inoculated through feeding practices. 99% of children inherit the type of Strep mutans (S.mutans) their mother is colonized with. If that happens to be a particularly virulent type of S.mutans, the child is more likely to develop decay. The earlier the child is infected with S.mutans, the greater the chance of developing decay.
This ‘plastic-type’ coating can significantly decrease decay in grooved areas of the teeth. Unfortunately, they are not very effective on smooth areas of the teeth. We routinely place sealants on permanent molars with deep grooves, but only occasionally place them on baby molar teeth. Most recent studies show an 80% decrease in pit and fissure cavities when sealants are placed and kept up to date. Sealants are not permanent. They wear over time with chewing and need to be replaced every 2-3 years. Learn more about dental sealants here.
This is a Calcium product derived from MILK proteins which is currently in several chewing gums. Your child cannot use this product if they have a milk allergy. Otherwise, the minerals in the gum become available in the saliva and the tooth may use the calcium to repair small defects before the defects become a full cavity. Currently, it is available in TRIDENT White gum. It is also available in pastes and mints.
This hexose sugar is produced from birch trees and several fruits and vegetables. Strep mutans cannot metabolize this sugar and it makes it harder for the bacteria to stick to the teeth. Xylitol is currently available in the most efficacious dose in Ice Breakers Ice Cubes gum. Please search the web for other products. Using too much xylitol may cause an unwanted laxative effect.
Use it on their LIPS! The most common site of skin cancer in the South is on the lower lip. When you put it on their bodies, don’t forget the lips.
Thumb and finger habits
These are very common for children. Most children break themselves of the habit between age 2 and 3. Between the ages of 4 and 6 we will check to see if intervention is necessary.
Grinding teeth – 50% of children grind their teeth at some time. If your child is grinding, let us know so we can try to pinpoint causes and solutions. Many children grind if they have sinus drainage or if they are teething, especially when they are sleeping.
Tooth or mouth trauma
Thankfully, most trauma is related to bumps and bruising while playing. Ice in the form of popsicles is helpful to slow and stop minor bleeding and bruising. If the teeth are broken more than ¼ or if you can visibly see the nerve (red in the middle of the tooth) your child needs to be evaluated promptly. If at any time your child loses consciousness or is not acting like himself, go to the emergency room for evaluation promptly.