Pediatric Dentist Archives - Susan M. Dennis, D.D.S

Space Maintainers for Pediatric Teeth

Posted on July 6, 2024 by writeradmin.

My six-year-old daughter has decayed back teeth that have led to one of the molars breaking and getting infected. Her dentist said that the tooth needs to be extracted. Is there no way to save her tooth? When I have a severely infected tooth, my dentist does a root canal treatment. Do we really have to extract the tooth?

Cam

Dear Cam,

A boy smiling and holding a toothbrush proudly.

While there is a child’s version of a root canal treatment, called a pulpotomy, in many cases it doesn’t work. Plus, it sounds like your daughter’s tooth is quite far gone. Those back teeth have lots of pits and grooves where bacteria can become trapped. It helps if your daughter gets those back teeth sealed, but that doesn’t eliminate the possibility of decay.

If the tooth is infected and is as far gone as it sounds, your daughter is much safer getting it extracted. If not, then the infection can spread. Not only can that affect her bone and the development of her permanent teeth, but it can even spread outside of her bone and become a life-threatening infection. I would consider your daughter’s situation a dental emergency and not delay treatment.

You did not mention anything about a space maintainer. I hope your pediatric dentist was planning on that. Often, baby teeth are fine coming out early. However, the back teeth are an exception. These need to stay in until your daughter is around twelve-years-old, otherwise the adjacent teeth will shift into that space during that time period and will crowd out the adult teeth.

Sometimes, however, like in a situation such as what your daughter is in now, the tooth has to be removed. Using a space maintainer will protect that space until her adult molars are ready to come in.

I hope this helps.
This blog is brought to you by Kalamazoo Dentist Dr. Susan Dennis.

Can Teething Cause Fevers?

Posted on April 27, 2024 by writeradmin.

I’m at my wit’s end. My 9 month old is so unhappy and keeps getting fevers. I am so worried that something serious is wrong but we’ve been to the doctor half a dozen times and they can’t find anything. Today, a lady from church came by and I burst into tears. She said that my son is probably just teething. Apparently, when she was a mother they used to slit the baby’s gums if they were struggling a lot with teething. She did say that she doesn’t think they do that anymore and that there is probably some new technique, so I thought I’d write and check. First, does teething cause fevers. Second, is there a newer technique or do you still slit the gums? That seems awful to me but he’s miserable so I’m not sure if it’s mean to leave him that way.

Penny

Dear Penny,

It is never easy being a parent. However, you are doing a better job than you think. Yes, it is true that teething can cause a fever, but only a low-grade fever. If it is a high fever, I would keep investigating. You will also find some other symptoms too:

They will be more fussy than normal.
Some babies pull at their ears.
There gums could be swollen.
They could drool more.
Loss of appetite.
Difficulty sleeping.

I have never heard of slitting a child’s gums. There is not a new technique for dealing with a teething baby. However, I would NOT recommend you go with the slitting method. There is a reason that our bodies are designed for those teeth to push through. That pressure is coming from the eruption of the tooth root as it is growing. If you slit the gums, the teeth will come out prematurely and the root will not have the strength to support the tooth properly.

You can give a fussy baby some children’s Tylenol, as long as your pediatrician approves. There are also teething rings and some over the counter numbing medication. I’ll be honest, the numbing medication is very temporary.

By the way, once your child’s tooth erupts, this is a good time to introduce them to a pediatric dentist. It is always best for them to first see a dentist when it is fun and there are no problems with their teeth. Too many parents wait until there is a dental emergency. Then the child associates the dentist with the pain of that urgent appointment.

It’s hard to believe this right now, but this will pass… then, he’ll be a teenager!

This blog is brought to you by Kalamazoo Dentist Dr. Susan Dennis.

5 Year Old With Lots of Dental Problems

Posted on December 28, 2023 by writeradmin.

I have a five year old with lots of dental problems. She needs crowns on two molars and the other two need fillings for decay along with a few other teeth. I think this problem stems from her being so scared and uncooperative at the dental offices. We’ve tried three different dentists hoping for a different outcome each time, but to no avail. She just loses her mind and they can’t get any work done on her. Do you have any recommendations for a parent in my situation?

Melanie

Dear Melanie,

I can tell that you care a lot about your daughter as well as her oral health. I think I can help you with this. Even with her being uncooperative at the dentist, this is a lot of decay for someone so young. I’ll go over how to prevent that in a moment. First, let’s deal with your immediate problem— getting her the dental care she desperately needs.

I would go to a pediatric dentist (or general dentist who works with children) that also offers dental sedation options. They can give your daughter a medication which will complete relax her. In fact, she will be very likely to sleep through her dental procedure all together. This will give her the treatment she needs in a way that eliminates her anxiety. Depending on the type of sedation used, she may not even remember the appointment. As she builds up more appointments where things go well, she’ll become more cooperative.

As for the amount of decay she has, it makes me wonder how much she is snacking and drinking throughout the day. One of our biggest weapons in the fight against decays is our saliva. This is because it contains vital minerals that fight against the bacteria that leads to decay. If your daughter is snacking a lot or drinking a lot of sugary drinks during the day, then her saliva will not have an opportunity to do its job.

Limit her to one snack a day and try to give her much more water than juice or soda, both of which contain lots of sugar and citric acid that will damage her teeth.

I hope this helps.
This blog is brought to you by Kalamazoo Dentist Dr. Susan Dennis.

Restraints in Pediatric Dental Care

Posted on November 30, 2023 by writeradmin.

We recently relocated to another state. I am getting the children set up with their new caregivers. Normally, I just sign the papers they have me sign without reading them. I happened to skim them this time when I came across something that shocked me. It was asking my approval to use restraints on my children. I lied and told them I had a family emergency and left. Why would you ever need to use restraints on children at the dentist? I went to the dentist my whole life and not once were restraints even brought up. Is this a new thing?

Carrie

Dear Carrie,

This isn’t a new thing, but I think your potential pediatric dentist could have given some explanation. One of the most important things for you to look at when looking for a dentist for your children is for the dentist as well as the rest of the office to answer questions when you have concerns. Communication is so important when it comes to any type of medical care.

In dentistry, the are two basic types of restraints. The first is for the bite. The other for the body.

The materials pictured directly above are mouth props. These are essential and should be used even with a cooperative child. One of my colleagues told me a story from his dental school days. A fellow student was drilling a cavity on a child. Everything was going smoothly when the child suddenly bit down. This caused the drill to go through the pulp of the tooth. Now, instead of a simple filling this child had to undergo a full pulpotomy, which is the child’s equivalent of a root canal treatment. This was easily preventable had the child had a mouth prop in.

The second type of restraint is a pappose board (pictured directly above). This wraps a child up tightly as well as keeps their head still. While I wouldn’t go to a dentist who uses this as a matter of course, there are times when a child has a dental emergency but is not cooperative that this becomes essential. Most dentists who treat children prefer to find other ways of dealing with a fearful child. However, in emergency situations, this is an important back up option. In general, children, once they are in the papoose calm down completely.

If you have a child who is particularly anxious at the dentist and uncooperative, you may want to look for a pediatric dentist who also offers dental sedation. This will help with their anxiety.

This blog is brought to you by Portage, MI Dentist Dr. Susan Dennis.

My Child Struggles at the Dentist

Posted on September 20, 2023 by writeradmin.

I need some advice. My son is six years old and really struggles at the dentist. He won’t sit still and sometimes tries to grab the instruments. Our pediatric dentist puts up with it but now he needs to have a cavity filled and I’m worried about him and the drill. My dentist just suggested we use a papoose board. She showed it to me but I’m not sure I want to go that direction. Is there any other option?

Amanda

Dear Amanda,

It is not uncommon for young people to struggle with sitting still at the dentist. You are right, though, that you do not want him doing that when a drill is involved. For those who don’t know what a papoose board is, I am going to post an image here.

This is not as scary as it may look to a parent. It’s more like a big hug. It works a bit like the way swaddling does for infants. The wrapping makes the child feel more secure. Most of them calm down very quickly and can even fall asleep.

Another option is to see a family dentist who offers dental sedation options. There are generally two levels of sedation offered. The first is nitrous oxide. This is a gas that he can breathe through a nose piece. It will relax him. However, if his anxiety is high it he will be able to fight off its effects. In that case, he’d be better off using oral conscious sedation. This is so strong that he will sleep through the procedure and likely not even remember it. He will be groggy for a few hours after the procedure as well.

Either one of these procedures will help your son get the care he needs. What you don’t want is to put off treatment. Cavities have a way of turning into tooth infections when left untreated. You do not want him to end up with a dental emergency.

This blog is brought to you by Kalamazoo Dentist Dr. Susan Dennis.

Dentist Can’t Treat Daughter

Posted on September 29, 2022 by Dr. Dennis.

My daughter’s teeth are in a bit of a mess. She’s seven years old but terrified of the dental chair. I honestly don’t know what to do. She’ll do okay for part of it and then just flip out completely. She’ll bound from the chair and hide. I’ve got to get her oral health under control. My dentist doesn’t know what to do. Any recommendations?

Penny

Dear Penny,

Going to the dentist can be scary for even grownups, so don’t feel too bad about your little girl. Often those fears develop after a traumatic experience with a dental procedure, though some people are just more prone to anxiety than others, especially when there are sharp pointy objects coming toward us.

This isn’t going to be the best dentist for your daughter. I’m going to recommend the new one you look for be either a pediatric dentist or a general dentist who is good with children, that offers some type of dental sedation.

Before we get into the sedation, let’s talk about how you know if a general dentist is good working with children. One quick give away is when they are willing to first see children. If they suggest coming in when their first teeth erupt in their toddler years, you can be fairly sure they are experienced and comfortable with children. If they want you to wait until they are seven or eight, they are willing to work with tiny adults, but not children.

What Type of Sedation is Good for Children

When a dentist is trained in sedation, all types are safe. Even with that; however, I tend to recommend using the lightest form of dental sedation necessary. Not because it is safer, but it is much less maintenance for the parent after the procedure is done.

For most children, nitrous oxide is all they need. This used to be nicknamed laughing gas. It won’t make her giggly, but will give her a relaxed, floaty feeling. Most children fall asleep with it. It’s administered through a nosepiece that just fits over her nose and she breathes normally. It is very non-threatening. Once the procedure is completed, your dentist will switch the gas from nitrous to pure oxygen and she’ll be back to normal in just a few minutes and ready to go on with her day as normal.

For some, their anxiety is so high that nitrous isn’t enough. In this case, she’d need oral conscious sedation. This is administered by pill or liquid depending on how old the patient is. Once in her system, she will be very woozy and sleep. In fact, some people call it sleep dentistry. She’ll need someone to keep an eye on her for several hours after the procedure. Until she is lucid again, she’ll be unsteady on her feet and you don’t want to risk a fall.

This blog is brought to you by Portage, MI Dentist Dr. Susan Dennis.

Baby Teeth Not Coming Out

Posted on September 25, 2022 by Dr. Dennis.

I have a twelve-year-old who still has quite a few baby teeth. Some of the adult teeth are coming in but the baby teeth still aren’t loose. I’m not sure what to do. I know we’re not supposed to be going to the dentist right now. Should I just wait this out?

Carla

Dear Carla,

The first thing I would do is try to wiggle the baby teeth and see if you can get it loose on your own. If the baby teeth aren’t budging, then you will need to have them extracted. If they aren’t extracted, then the baby teeth will deflect the adult teeth. This will lead to them coming in crooked, requiring her to have orthodontics.

I would call your pediatric dentist and schedule an appointment. I know we’re under quarantine right now because of COVID-19. However, the CDC has left provision for essential care. They haven’t listed specific procedures that are considered essential. The one thing they said with certainty is to skip routine procedures.

I think they’re leaving what is essential as vague intentionally. As medical professionals themselves, they understand that the doctor or dentist will understand the patient best and know what is routine and what isn’t.

If your child’s teeth are being deflected, that means it is not a routine procedure and it is acceptable for you to call the dentist and schedule extractions. The good news is these are easier than extracting adult teeth because of the differences in the roots.

If Your Child is Prone to Dental Anxiety

Some children face anxiety at the dentist when dealing with unfamiliar procedures. If your sweetie is one of them, may I suggest you ask your dentist to use nitrous oxide. This is a gas they’ll breathe in with a nose piece that will give them a relaxed, floaty feeling. It puts most young people at ease.

Some students have much more severe anxiety. If that is your child, then you could consider using oral conscious sedation. This is a pill they’ll take about a half-hour before their appointment. This is significantly stronger and they’ll be a bit woozy for a few hours after the appointment and will need you to stay with them.

You know your child best and whether they’ll need any form of dental sedation or not.

This blog is brought to you by Pediatric Dentist Dr. Susan Dennis.

Flipper for a Four Year Old

Posted on September 17, 2022 by Dr. Dennis.

My four-year-old had an accident that caused him to lose his two front teeth. I wanted a way to replace those teeth so I didn’t have to worry about his other teeth shifting. When I asked about getting him a dental flipper, my dentist said that was a ridiculous idea. I don’t understand. I looked online for one you can order but they only seem to have adult-sized ones. Is there a way to get him one or is my dentist right and I’m being ridiculous?

Kathryn

Dear Kathryn,

So here is the thing. You are not being ridiculous, but your dentist is correct that it isn’t a good option. I will say right up front I do not like the way your son’s dentist responded to you. One thing every dentist who works with children needs to understand is the emotional element with parents. Their child is the most important thing in their lives. Your questions should always be treated with respect. Plus, just because your question seems obvious to your dentist doesn’t mean it should be obvious to you.

When it comes to shifting teeth for children, which you were wise to consider, that mostly has to do with their back teeth because their permanent molars don’t start coming in until they’re like twelve years old. The front teeth are not that big of an issue and his adult teeth should come in just fine. If he were to lose a back tooth prematurely, your pediatric dentist would want to put a space maintainer there.

I’d also like to address why the dental flipper would not be a suitable tooth replacement in your son’s case. First, they are removable, which can be a choking hazard. Also, with them being removable it is not very likely a four-year-old is going to keep it in or keep from losing it, even if you have a very responsible young fella’. Another consideration is his jaw and mouth are in constant flux and growth at this stage of his life. This means you will have to buy new ones often.

I hope this puts your mind at ease.
This blog is brought to you by Kalamazoo Cosmetic Dentist Dr. Susan Dennis.

Daughter Broke her Front Tooth

Posted on September 7, 2022 by Dr. Dennis.

I’m not sure what to do. My daughter was playing outside and fell and took off a chunk of her front tooth. I took her to the dentist and he said everything is fine. When I asked him to fix it he said he would need to wait six to eight weeks for the nerves to desensitize. Is that really necessary? By then she should be back in school. Though she’ll probably be in a mask most of the time, at lunchtime the kids will see her tooth. I don’t want her embarrassed.

Lisa

Dear Lisa,

There is no dental reason to wait. He may be stalling to figure out the best fix. What she really needs is a cosmetic dentist familiar with this type of repair.

One thing you didn’t mention is whether it was an adult or baby tooth. If it is a baby tooth, you may just want to extract it. It’s not uncommon for young children to be missing teeth so it won’t be an issue at school. Front teeth don’t have to remain in place as long as their back molars.

If it is her permanent tooth, then the repair should go forward. Ideally, if you have the piece that broke off it could be repaired that way. Otherwise, you will need to find a dentist who does dental bonding. That will use a composite resin to build up the missing structure.

I don’t think most pediatric dentists will be familiar with these types of repairs. You will have more success with a general dentist who treats children.

It was smart of you to have the tooth checked out right away. Whenever there is trauma to a tooth, even if there is no visible challenge, there can be underlying damage to the root or developing adult tooth. Being proactive like you were can save her tooth.

This blog is brought to you by cosmetic dentist Dr. Susan Dennis of Portage, MI.

Baby and Adult Teeth Simultaneously

Posted on August 22, 2022 by Dr. Dennis.

My daughter has four baby teeth that have erupted behind her adult teeth. I’m not sure what to do about it. Do I pull the baby teeth? Will her adult teeth still need braces? I’m surprised this happened. I’ve been deployed for the last year and my husband has been taking her to the dentist (I assume). When I asked him about it he got defensive. Do you have any advice for something like this?

Kelly.

Dear Kelly,

First, I want to thank you for your service. It is greatly appreciated. I know it is a sacrifice. As to the situation you are in, if your husband did take your daughter to the pediatric dentist then they should have addressed this. Since they haven’t, I think you would be better served by a different pediatric dentist or even a family dentist, which is a general dentist who enjoys treating children as well.

You didn’t mention the age of your daughter, so I’ll give a variety of advice for her. First, the baby teeth need to be extracted. Ideally, that would have happened as soon as the adult teeth began to erupt in order to prevent them from deflecting the permanent teeth, but that is water under the bridge.

It is possible she will need some orthodontics. If that happens, both traditional braces or Invisalign for teens will be an option depending on her age and level of personal responsibility.

Congenitally Missing Adult Teeth

Sometimes children have the opposite problem where they have an adult tooth that never forms. When that happens it is best to just leave it there for as long as it is healthy, viable, and aligns with her bite. If any of those change or it falls out, then it will be time for stage 2.

The ideal tooth replacement is a dental implant. However, she’ll need to be of an age where her jaw is fully developed. If she isn’t, then I would use a temporary tooth replacement, such as a dental flipper, which you can get fairly cheaply. Then, when she is old enough, get the dental implant. These are like having a healthy, natural tooth there and are permanently placed. She’ll be able to eat anything and brush and floss as she normally would.

This blog is brought to you by Dental Implant Dentist Dr. Susan Dennis.