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Dr. Frank Foreman 11700 NE 95th St. Suite #120 |
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Pediatric Dentist Phone 360-735-0222 Fax 360-735-0223 |
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OVERVIEW I have always enjoyed babies and little children. It's why I had three children of my own and then adopted two more as a bonus. It's why, when I became a dentist, I found that the care of children's dental needs was more enjoyable than treating adults. Since 1980 I have committed myself to the care of children's dental needs. A two year residency after dental school is required in order to become a specialist in Pediatric Dentistry. Pediatric Dentists have additional education in preventing cavities, in growth and development, in children's psychology, in strategies for managing the behaviors of children, and in treating children with special needs. Family dentists treat the majority of children. However, the additional training of Pediatric Dentists give them significant advantages. My over 25 years of experience in helping very young and frightened children successfully tolerate required dental treatment and enjoy their visits will insure that your child will experience the highest quality of dental care. Please click on any of the following links for information about your child's dental care.
The key to successfully treating children's dental needs is communication with the parents. I prefer to have a parent back with the child when I am doing an examination. In this way I can communicate more directly. I can point to teeth that might have cavities and places where brushing needs to be improved. I can address concerns about how the teeth are coming in and discuss the findings on the X-rays. X-RAYS : I usually defer screening X-rays until age five. If cavities are visible or suspected I will take X-rays on younger children. In most cases we will take only two X-rays. We have digital X-ray machines, which use only about one forth of the radiation of the older X-ray systems. If you have concerns about the safety of dental X-rays for children, a very good resource is the web site of the American Academy of Pediatric Dentistry. On the AAPD site, go to the selections on the left and click onto "Info for Parents". PARENTS WITH THE CHILD: Parents are welcome to stay back with their child for the cleaning and for the required treatment. In my experience, younger children usually do better with a parent in the treatment room. There are rare exceptions and these are discussed individually. For older children, it is at the discretion of the parent whether they wish to stay in the reception room or remain with their child during treatment. FIRST VISITS TO THE DENTIST: The American Academy of Pediatric Dentistry recommends that the first dental examination be completed in the first year. I am glad to see any babies at any age. At such appointments we will look at the baby's teeth in the parent’s lap and apply a fluoride varnish, to reduce the risk of decay. However, if the parent can get a good look at the baby's teeth and they all appear pearly white, we can defer the examination until age three. At age three we can usually polish the child's teeth and do a much more thorough examination. However, if you see anything suspicious on your baby's teeth or have any questions about them, you should bring them in and have the teeth examined. It a mistake to wait until the baby is old enough to sit in the chair. I have seen many babies whose teeth were defective when they came in. By the time they were three the cavities were so large that the tooth had abscessed and needed to be pulled. We have strategies for restoring teeth even when the patient is still a baby. TALKING TO YOUR CHILD ABOUT THE DENTIST: Parents can help me by positive communication with their child at their age level. Through experience I have learned which words communicate the dental experience in the least frightening manner. My recommendation is to simply tell your children that the dentist is a nice man, who will help their teeth. For older children who require treatment, defer their questions to me. I've had years of practicing how to explain on a child's level what needs to be done.
PLAQUE : Plaque is the cause of cavities. Plaque is the colonies of hundreds of varieties of bacteria that attach to the teeth. When exposed to sticky, sweet, or acid foods or drinks, the bacteria consume the food and produce acid. The acid dissolves the enamel of the teeth a little at a time. The saliva in the mouth tends to self-heal the dissolved enamel. Over a period of months or years, if the plaque dissolves the tooth more than the saliva heals the tooth, a cavity will form. A cavity occurs when the acid from the plaque dissolves all the way through the enamel. At this point the softer inner part of the tooth (the dentin) will begin to dissolve much more rapidly than the enamel. This process is irreversible. If the cavity is not fixed, it will spread to the nerve (the pulp) and may cause pain and infection. BRUSHING: The best strategy for preventing cavities is twice a day brushing and at least once a day flossing. This should be started as soon as the baby's first tooth comes in. I recommend a baby toothbrush over a tooth wipe. Soft toothbrushes small enough for the child's mouth are recommended. Statistically, mechanical toothbrushes do a slightly better job cleaning the teeth. However, if used correctly, an inexpensive toothbrush will prevent cavities just as well. FLOSSING: Flossing only needs to be done on teeth that contact each other tightly. Many babies and children have gaps between their teeth. A toothbrush is adequate to clean all of the surfaces of these teeth. But if a child has tight contacts between even just two teeth, that spot should be flossed. Floss holders work best on children. PARENTS HELPING: Oftentimes two-year olds will resist the parent brushing their teeth. My recommendation is simple: WIN. If you successfully wash their hair, change their diapers, and trim their nails while they are resisting, you can also brush their teeth. From about age three to six , parents should partner with their children in brushing. The child can "do it". But the parent should "finish" and make sure that all of the surfaces of all of the teeth are brushed. Flossing can be difficult for children to do by themselves until age 10 through 12. Parents should help until the children have the fine motor skills to floss on their own.
Fluoride is a simple mineral element (like sodium or chloride). It is, far and away, the most effective way to prevent cavities. It is more effective in preventing cavities than brushing, flossing, or controlling the child's diet. TOOTHPASTES: All toothpastes that are labeled with the seal of the American Dental Association (ADA) are equally effective. The only reason that these toothpastes are effective is because they contain fluoride. Little children often do not like the stronger, mint-flavored, adult toothpastes. The milder, child, fruit-flavored toothpastes are just as effective. Care should be taken with toothpastes for babies. Only a pea-sized amount is recommended for under three year olds. More is not better. WATER : About half of the cities in the USA have fluoridated their water for about 50 years. The city water departments of Vancouver , Camas, Battle Ground, Woodland, Longview, and Kelso fluoridate their water. This means that they add one molecule of fluoride for every one million molecules of water. To pediatric dentists, this tiny bit of fluoride in the water has a dramatic effect upon their practice. In my decades of treating children, I consistently see much, much fewer very young children with many large cavities from fluoridated areas. It is the most cost effective way to prevent cavities. If you have concerns about the safety of water fluoridation, I recommend that you go to the Center of Disease Control for the further information. For maps of the fluoridated areas in Clark County go to Fluoride Maps Clark County SUPPLEMENTS : If you live in the county, where the water is not fluoridated, a daily fluoride supplement is recommended for children from the time that the first baby teeth come in until they all fall out. This is from age 6 months until about age 12. Dentists or physicians must prescribe fluoride supplements to insure that the proper amount is given only to children who live in areas where the water is not fluoridated. Babies are prescribed drops. I prescribe the chewable tablets for children age three and older. These are best taken before bed, after brushing. Consistent daily fluoride supplementation is nearly as effective as water fluoridation. However, it is the very rare parent who can consistently maintain the daily habit throughout the 12 years required. But some benefit is gained by giving the supplement as often as remembered. Don't give up, just because sometimes you forget! MOUTHWASHES: I recommend fluoride rinses for children who have a history of forming cavities and who are six years old or older. They are not recommended for younger children, because they have been shown to swallow a little bit with every use. Mouthwashes without fluoride are of no benefit to children.
Most cavities happen on the chewing surfaces of the back chewing teeth, the molars. This is because the molars usually have deep and narrow pits and fissures on the chewing surfaces. These pits and fissures are often too narrow for toothbrush bristles to reach down and cleanse. The enamel is often very thin at the bottom of the pits. The only way to prevent these kinds of cavities is by bonding a plastic coat over the chewing surfaces of molars to seal these pits and fissures. These sealants have been shown to bond for over 15 years. The sealants must be checked at each examination to confirm retention. If part of the sealant doesn't bond, it should be reapplied. As long as the sealant is present cavities will not form.
The most common cause for severe early decay is allowing a baby to sleep with a bottle in its mouths. Any fluid (except water) in the bottle can cause cavities on the upper front teeth of babies. But acidic fluids (like juices) cause the earliest and largest cavities. I have had to extract the front teeth on babies as young as ten months old from sleeping with a bottle of juice. My recommendation is to not use the bottle as a pacifier. Feed the baby with the bottle, then remove it. If the baby still needs to suck on something, use a pacifier. A pacifier is preferable to the baby finding its thumb and sucking on it. Only put milk or formula in a bottle. Juices should be postponed until the baby is ready to drink out a of tippy cup. It will make the transition easier.
Many babies suck their thumbs. Most stop long before the permanent teeth come in. The thumb does effect the position of the teeth. Most of this effect will self-correct when the thumb habit stops. It is best to encourage the child to stop sucking the thumb on the third birthday. But if the habit continues, it is not that big a deal. Most will again stop around kindergarten. If the habit persists past age 7, when the permanent teeth are coming in, then options should be discussed for stopping the habit.
Permanent teeth often come in crooked. The first teeth to come in (the lower front teeth) often come in behind the baby teeth. The upper front teeth often come in with a gap between them and tipped back. Many of these situations will correct themselves with growth. I evaluate these situations individually to determine if the children are likely to grow out of them. But if there are significant situations where the children will not grow out of them, I look closer. If braces will not be required later and only a minor orthodontic correction is required, I will recommend such corrections at ages 7-10. But if the child will probably still require braces later, I will wait and monitor the situation. I feel that it is better for the child and the pocketbook to only do braces once, if possible. Braces take about two years. It is best to complete the treatment with all of the permanent teeth in place. Between the ages of 11 to 13, twelve baby teeth fall out and 16 permanent teeth come in. It is in this transition that orthodontic corrections are most quickly and efficiently completed. So I work closely with orthodontists, monitor the eruption of teeth, and refer the child to the orthodontist at the most appropriate time.
The first baby teeth come in at about six months of age. The final molars come in after age two. The front baby teeth fall out between ages 6 to 8 . The back baby teeth fall out between ages 10 to 12 . These back baby molars are especially important to maintaining space for the permanent teeth to come in. If they are lost early, space maintainers may be required to keep the permanent molars in place. Small cavities on baby teeth, that are due to fall out in a year or so, may not require restoring. However cavities grow relatively faster on baby teeth. Cavities that reach the nerve (the pulp) of the tooth can cause pain, swelling, and infection. Therefore, cavities on baby teeth are best treated when they are still small.
FILLINGS: Smaller cavies in baby teeth are restored with fillings. I recommend white fillings in the front teeth and silver ones in the back. White fillings can be placed on the back teeth. However, on the whole, they are not as strong as the silver fillings and need to be replaced more often. This makes them more expensive than silver fillings. The best and most recent study of the safety of the silver/amalgam fillings in children was published in Journal of the American Medical Association in 2006. Its conclusion was that: " the health effects of amalgam restorations in children need not be the basis of treatment decisions when choosing restorative dental materials". For more information on the safety of silver fillings, click HERE. STAINLESS STEEL CROWNS: Baby teeth are smaller and not as strong as permanent teeth. A medium sized cavity on a permanent tooth, that could easily be filled, will be relatively too large and deep to allow a filling to succeed on a baby tooth. In these cases, I will recommend a stainless steel crowns. These are not in the same league as gold or porcelain crowns. These are snap on steel caps. These are little league crowns. I only do these on the back molars. They have a very high success rate. EXTRACTIONS: If the decay is deep enough to be in the nerve of the tooth, oftentimes the tooth will not be fixable. Again removal of baby teeth is little league. Don't think of your "Wisdom Teeth" experience. SPACE MAINTAINERS: If the loss of the tooth will cause the permanent molars to tip and move forward, a space maintainer may be required. A space maintainer is like a retainer that is cemented in place. They are an expensive hassle. They may need to remain in place for up to five years until the permanent tooth replacement has come in. ROOT CANALS: Therefore, if such an important baby tooth has decay into the nerve, we may try to save the tooth with a baby root canal (a pulpotomy). Again this is little league, compared to the adult root canals. It is much quicker and less expensive. For immature permanent teeth that need root canals, I will refer the child to root canal specialists (endodontists).
MANAGING BEHAVIOR
It is in the managing children's fears and immaturity that pediatric dentists take the greatest pride. The greatest satisfaction that I have in my profession is when a mother expresses her amazement and gratitude to our team. We had accomplished all the treatment required by her young children and still they come back happy to see us again. Such an outcome seemed unimaginable to her when she brought first brought them to see us. I experience a great deal of satisfaction from my profession, because this is common event. My assistants, Skyla, Kim, and Sam, are very skilled at receiving new patients and introducing them to the dental environment. They are all still basically kids at heart. So they identify easily with the children. As a team we insure that even the youngest and most frightened children receive the best experience possible. My philosophy with children and cavities is to be conservative in starting treatment. I tend to monitor suspicious spots on teeth and not jump in and do fillings immediately. They are baby teeth and are going to fall out. But once a cavity is confirmed, I will attempt to restore it in the least traumatic way possible. I have learned how to restore many small cavities without numbing and without discomfort. If numbing is required, I am very good at making the injection as comfortable as possible. NITROUS OXIDE SEDATION : However, if the child is immature or frightened or there are numerous or large cavities, I will often recommend "laughing gas". I have tried many medications for making the dental experience as pleasant as possible. In my experience, nitrous oxide is the safest and most versatile medication to use. It is not a general anesthetic gas as used in the hospital. It is over a 1000 times less potent. It is a light sedative. The children are awake, relaxed, and feel as if they are "floating on a cloud". It can be turned up at more uncomfortable times (like at the injection or when we are pulling a tooth) and then turned back down the rest of the time. It takes about 5 minutes to become effective and about 5 minutes to leave the body. The only side effect is very occasional nausea. If you have concerns about the safety of nitrous oxide, you can go online to American Academy of Pediatric Dentistry .
TRAUMA
Tottelers often fall and bump their teeth. Older children often damage their teeth in falls from bikes, trampolines, skates, etc. The teeth will often become a little loose. It may bleed a little around the tooth. In most cases like this the tooth will heal up in a week or so. I like to take a look at these cases, just in case the parent misses something. However, if the tooth is moved out of place or broken, I recommend definitely bring the child in for an evaluation.
EMAIL QUESTIONS
I would be glad to answer any specific questions that you might have about your children's teeth. Just email me at drforeman@drfrankforeman.com.
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