FREQUENTLY ASKED QUESTIONS
Dental Care for Children with Special NeedsDigital X-ray
Sealants
Space Maintainers
Dental Emergencies
Nitrous Oxide
Sedation
General Anesthesia
Fluoride
Dental Care for Children/Adults with Special Needs
Q: Do special children have special dental needs?A: Most do. Some special children are very susceptible to tooth decay, gum disease or oral trauma. Others require medication or diet detrimental to dental health. Still other children have physical difficulty with effective dental habits at home. The good news is, dental disease is preventable. If dental care is started early and followed conscientiously, every child can enjoy a healthy smile.
Q: How can I prevent dental problems for my special child?
A: A first dental visit by the first birthday will start your child on a lifetime of good dental health. The pediatric dentist will take a full medical history, gently examine your child's teeth and gums, then plan preventive care designed for your child's needs.
Q: Will preventive dentistry benefit my child?
A: Yes! Your child will benefit from the preventive approach recommended for all children- effective brushing and flossing, moderate snacking, adequate fluoride. Home care takes just minutes a day and prevents needless dental problems. Regular professional cleanings and fluoride treatments are also very beneficial. Sealants can prevent tooth decay on the chewing surfaces of molars where four out of five cavities occur.
Q: Are pediatric dentists prepared to care for special children?
A: Absolutely. Pediatric dentists have two or more years of advanced training beyond dental school. Their education as specialists focuses on care for children with special needs. In addition, pediatric dental offices are designed to be physically accessible for special patients. Pediatric dentists, because of their expertise, are often the clinicians of choice for the dental care of adults with special needs as well.
Q: Will my child need special care during dental treatment?
A: Some children need more support than a gentle, caring manner to feel comfortable during dental treatment. Restraint or mild sedation may benefit your special child. If a child needs extensive treatment, the pediatric dentist may provide care at a local hospital. Your pediatric dentist has a comprehensive education in behavior management, sedation and anesthesia techniques. He or she will select a technique based on the specific health needs of your child, then discuss the benefits, limits and risks of that technique with you.
Copyright © 2002-2009 American Academy of Pediatric Dentistry.
Digital X-Ray
**In order to minimize radiation exposure, Loudoun Pediatric Dentistry offers digital x-ray, which emits 80% less radiation than traditional x-ray machines.Q: How often should a child have dental X-ray films?
Since every child is unique, the need for dental X-ray films varies from child to child. Films are taken only after reviewing your child’s medical and dental histories and performing a clinical examination, and only when they are likely to yield information that a visual examination cannot.
In general, children need X-rays more often than adults. Their mouths grow and change rapidly. They are more susceptible than adults to tooth decay. For children with a high risk of tooth decay, the American Academy of Pediatric Dentistry recommends X-ray examinations every six months to detect cavities developing between the teeth. Children with a low risk of tooth decay require X-rays less frequently.
Q: Why should X-ray films be taken if my child has never had a cavity?
X-ray films detect much more than cavities. For example, X-rays may be needed to survey erupting teeth, diagnose bone diseases, evaluate the results of an injury, or plan orthodontic treatment. X-rays allow dentists to diagnose and treat conditions that cannot be detected during a clinical examination. If dental problems are found and treated early, dental care is more comfortable and affordable.
Q: Will X-ray films be taken routinely?
No. X-ray films are recommended only when necessary to evaluate and monitor your child’s oral health. The frequency of X-ray films is determined by your child’s individual needs. If your child’s previous dentist obtained X-ray films, request copies be sent to your new pediatric dentist to help reduce radiation exposure.
Q: How safe are dental X-rays?
Pediatric dentists are particularly careful to minimize the exposure of child patients to radiation. With contemporary safeguards, the amount of radiation received in a dental X-ray examination is extremely small. In fact, dental X-rays represent a far smaller risk than undetected and untreated dental problems.
Q: What safeguards are used to protect my child from X-ray exposure?
Lead body aprons and shields help protect your child. Today’s equipment filters out unnecessary X-rays and restricts the X-ray beam to the area of interest. High-speed film, digital X-rays, and proper shielding assure that your child receives a minimal amount of radiation exposure.
Copyright © 2002-2009 American Academy of Pediatric Dentistry.
Sealants
Q: What are sealants?Sealants protect the grooved and pitted surfaces of the teeth, especially the chewing surfaces of back teeth where most cavities in children are found. Made of clear or shaded plastic, sealants are applied to the teeth to help keep them cavity-free.
Q: How do sealants work?
Even if your child brushes and flosses carefully, it is difficult—sometimes impossible—to clean the tiny grooves and pits on certain teeth. Food and bacteria build up in these crevices, placing your child in danger of tooth decay. Sealants “seal out” food and plaque, thus reducing the risk of decay.
Q: How long do sealants last?
Research shows that sealants can last for many years if properly cared for. Therefore, your child will be protected throughout the most cavity-prone years. If your child has good oral hygiene and avoids biting hard objects, sealants will last longer. Your pediatric dentist will check the sealants during routine dental visits and recommend re-application or repair when necessary.
Q: What is the treatment like?
The application of a sealant is quick and comfortable. It takes only one visit. The tooth is first cleaned. It is then conditioned and dried. The sealant is then flowed onto the grooves of the tooth and allowed to harden or hardened with a special light. Your child will be able to eat right after the appointment.
Q: How much does it cost?
The treatment is very affordable, especially in view of the valuable decay protection it offers your child. Most dental insurance companies cover sealants. Some companies, however, have age and specific tooth limitations. Check with your benefits provider about your child’s coverage and talk to your pediatric dentist about the exact cost of sealants for your child.
Q: Which teeth should be sealed?
The natural flow of saliva usually keeps the smooth surfaces of teeth clean but does not wash out the grooves and fissures. So the teeth most at risk of decay—and therefore, most in need of sealants— are the six-year and twelve-year molars. Many times the permanent premolars and primary molars will also benefit from sealant coverage. Any tooth, however, with grooves or pits may benefit from the protection of sealants. Talk to your pediatric dentist, as each child’s situation is unique.
Q: If my child has sealants, are brushing and flossing still important? Absolutely! Sealants are only one step in the plan to keep your child cavity-free for a lifetime. Brushing, flossing, balanced nutrition, limited snacking, and regular dental visits are still essential to a bright, healthy smile.
Copyright © 2002-2009 American Academy of Pediatric Dentistry.
Space Maintainers
Q: What are space maintainers?A: Space maintainers are appliances made of metal or plastic that are custom fit to your child’s mouth. They are small and unobtrusive in appearance. Most children easily adjust to them after the first few days.
Q: Why do children lose their baby teeth?
A: A baby tooth usually stays in place until a permanent tooth underneath pushes it out and takes its place. Unfortunately, some children lose a baby tooth too soon. A tooth might be knocked out accidentally or removed because of dental disease. When a tooth is lost too early, your pediatric dentist may recommend a space maintainer to prevent future space loss and dental problems.
Q: Why all the fuss? Baby teeth fall out eventually on their own!
A: Baby teeth are important to your child’s present and future dental health. They encourage normal development of the jaw bones and muscles. They save space for the permanent teeth and guide them into position. Remember: Some baby teeth are not replaced until a child is 12 or 14 years old.
Q: How does a lost baby tooth cause problems for permanent teeth?
A: If a baby tooth is lost too soon, the teeth beside it may tilt or drift into the empty space. Teeth in the other jaw may move up or down to fill the gap. When adjacent teeth shift into the empty space, they create a lack of space in the jaw for the permanent teeth. Therefore, permanent teeth are crowded and come in crooked. If left untreated, the condition may require extensive orthodontic treatment.
Q: What are space maintainers?
A: Space maintainers are appliances made of metal or plastic that are custom fit to your child's mouth. They are small and unobtrusive in appearance. Most children easily adjust to them after the first few days.
Q: How does a space maintainer help?
A: Space maintainers hold open the empty space left by a lost tooth. They steady the remaining teeth, preventing movement until the permanent tooth takes its natural position in the jaw. It is more affordable -- and easier on your child -- to keep teeth in normal positions with a space maintainer than to move them back in place with orthodontic treatment.
Q: What special care do space maintainers need?
A: Pediatric dentists have four rules for space maintainer care. First, avoid sticky sweets or chewing gum. Second, do not tug or push on the space maintainer with your fingers or tongue. Third, keep it clean with conscientious brushing and flossing. Fourth, continue regular dental visits.
Copyright © 2002-2009 American Academy of Pediatric Dentistry.
Dental Emergencies
When your child needs urgent dental treatment, your pediatric dentist stands ready to help. Please keep the emergency number available and convenient.Q: What should I do if my child's baby tooth is knocked out?
A: Contact your pediatric dentist as soon as possible. The baby tooth should not be replanted because of the potential for subsequent damage to the developing permanent tooth.
Q: What should I do if my child's permanent tooth is knocked out?
A: Find the tooth and rinse it gently in cool water. (Do not scrub or clean it with soap -- use only water!) If possible, replace the tooth in the socket immediately and hold it there with clean gauze or a wash cloth. If you can’t put the tooth back in the socket, place the tooth in a clean container with cold milk, saliva or water. Get to the pediatric dental office immediately. (Call the emergency number if it’s after hours.) The faster you act, the better your chances of saving the tooth.
Q: What if a tooth is chipped or fractured?
A: Contact your pediatric dentist immediately. Quick action can save the tooth, prevent infection and reduce the need for extensive dental treatment. Rinse the mouth with water and apply cold compresses to reduce swelling if the lip also was injured. If you can find the broken tooth fragment, place it in cold milk or water and bring it with you to the dental office.
Q: What about a severe blow to the head or jaw fracture?
A: You need immediate medical attention. A severe head injury can be life-threatening. Keep in mind that an emergency medical team might be able to reach you faster than you can get to the hospital.
Q: What if my child has a toothache?
A: Call your pediatric dentist and visit the office promptly. To comfort your child, rinse the mouth with water. Over-the-counter children’s pain medication, dosed according to your child’s weight and age, might ease the symptoms. You may apply a cold compress or ice wrapped in a cloth to the face in the area of the pain, but do not put heat or aspirin on the sore area.
Q: Can dental injuries be prevented?
A: Your child’s risk for dental injuries can be reduced greatly by following a few simple suggestions. First, reduce risk for severe oral injury in sports by wearing protective gear, including a mouthguard. Second, always use a car seat for young children and require seat belts for everyone else in the car. Third, child-proof your home to prevent falls and electrical injuries. Regular dental check-ups provide your dentist an opportunity to discuss additional age-appropriate preventive strategies with your child.
Copyright © 2002-2009 American Academy of Pediatric Dentistry.
Nitrous Oxide
Most children are calm, comfortable and confident in a pediatric dental office. The office is designed for young people, and pediatric dentists have additional training in caring for infants, children and adolescents. Staff members choose to work in a pediatric dental office because they like children and want to cater to their special needs. These elements combine to make your child feel relaxed and special.Sometimes, however, a child may feel anxious before or during treatment. Your child may need more support than a gentle, caring manner to feel comfortable. Nitrous oxide/oxygen is a safe, effective sedative agent used to calm a child’s fear of the dental visit and enhance effective communication. Additionally, it works well for children whose gag reflex interferes with dental treatment.
Q: What is nitrous oxide/oxygen?
Nitrous oxide/oxygen (N2O-O2) is a blend of two gases -- oxygen and nitrous oxide. A fitted mask is placed over the nose and, as the patient breathes normally, uptake occurs through the lungs. At the end of treatment, it is eliminated after a short period of breathing oxygen and has no lingering effects.
Q: How will my child feel when breathing nitrous oxide/oxygen?
Your child will smell a faint, sweet aroma and experience a sense of well-being and relaxation. Since it may produce a feeling of giddiness or euphoria, it is often called "laughing gas." Children sometimes report dreaming and their arms and legs may feel "tingly." It raises the pain threshold and may even make the time appear to pass quickly. If your child is worried by the sights, sounds or sensations of dental treatment, he or she may respond more positively with the use of nitrous oxide/oxygen.
Q: How safe is nitrous oxide/oxygen?
Very safe. Nitrous oxide/oxygen is perhaps the safest sedative in dentistry. It is well tolerated. It has a rapid onset, is reversible, can be adjusted in various concentrations and is non-allergenic. Your child remains fully conscious -- keeps all natural reflexes -- when breathing nitrous oxide/oxygen. He/she will be capable of responding to a question or request. Nitrous oxide/oxygen may also be used in combination with other sedative agents.
Q: Are there any special instructions for nitrous oxide/oxygen?
First, give your child little or no food in the two hours preceding the dental visit (occasionally, nausea or vomiting occurs when a child has a full stomach). Second, tell your pediatric dentist about any respiratory condition that makes breathing through the nose difficult for your child, as it may limit the effectiveness of nitrous oxide/oxygen. Third, tell your pediatric dentist if your child is taking any medication on the day of the appointment.
Q: Will nitrous oxide/oxygen work for all children?
Pediatric dentists know that all children are not alike. Every service is tailored to your child as an individual. Nitrous oxide/oxygen may not be effective for some children, especially those who have severe anxiety, nasal congestion, or discomfort wearing a nasal mask. Your pediatric dentist will review your child’s medical history, level of anxiety, and dental treatment needs and inform you if nitrous oxide/oxygen is recommended for your child. Pediatric dentists have comprehensive specialty training and can offer other sedation methods that are right for your child.
Copyright © 2002-2009 American Academy of Pediatric Dentistry.
Sedation
Q: What is sedation?Sedation is a technique to guide a child’s behavior during dental treatment. Medications are used to help increase cooperation and to reduce anxiety or discomfort associated with dental procedures. Sedative medications cause most children to become relaxed and drowsy. Unlike general anesthesia, sedation is not intended to make a patient unconscious or unresponsive.
Q: Who should be sedated for dental treatment?
Sedation may be indicated for children who have a level of anxiety that prevents good coping skills, those who are very young and do not understand how to cope in a cooperative fashion, or those requiring extensive dental treatment. Sedation can also be helpful for some patients who have special needs.
Q: Why utilize sedation?
Sedation is used for a child’s safety and comfort during dental procedures. It allows the child to cope better with dental treatment and helps prevent injury to the child from uncontrolled or undesirable movements. Sedation promotes a better environment for providing dental care.
Q: What medications are used?
Various medications can be used to sedate a child. Medicines will be selected based upon your child’s overall health, level of anxiety and dental treatment recommendations.
Q: Is sedation safe?
Sedation can be used safely and effectively when administered by a pediatric dentist who follows the sedation guidelines of the American Academy of Pediatric Dentistry. Your pediatric dentist will discuss sedation options and patient monitoring for the safety and comfort of your child.
Q: What special instructions should I follow before the sedation appointment?
Children often perceive a parent’s anxiety which makes them more fearful. They tolerate procedures best when their parents understand what to expect and prepare them for the experience. If you have any questions about the sedation process, please ask. As you become more confident, so will your child.
Should your child become ill, contact your pediatric dentist to see if it is necessary to postpone the appointment. Tell your pediatric dentist about any prescribed, over-the-counter or herbal medications your child is taking. Check with your pediatric dentist to see if routine medications should be taken the day of the sedation.
Your pediatric dentist will provide you with additional detailed instructions before your sedation visit. It is very important to follow the directions regarding fasting from fluids and foods prior to the sedation appointment.
Q: What special instructions should I follow after the sedation appointment?
Your pediatric dentist will evaluate your child’s health status and discharge your child when she is responsive, stable and ready to go. Children recover from effects of sedatives at different rates so be prepared to remain at the office until the after-effects are minimal. Once home, your child must remain under adult supervision until fully recovered from the effects of the sedation. Your pediatric dentist will discuss specific post-sedation instructions with you, including appropriate diet and physical activity.
Copyright © 2002-2009 American Academy of Pediatric Dentistry.
General Anesthesia
Q: What is general anesthesia?General anesthesia is a controlled state of unconsciousness that eliminates awareness, movement and discomfort during dental treatment. A physician or dentist with specialized training can use various medications to provide general anesthesia for patients receiving dental care.
Q: Who should receive general anesthesia for dental treatment?
General anesthesia may be indicated for children with extensive dental needs who are extremely uncooperative, fearful or anxious or for the very young who do not understand how to cope in a cooperative fashion. General anesthesia also can be helpful for children requiring significant surgical procedures or patients having special health care needs.
Q: Is general anesthesia safe?
Although there is some risk associated with general anesthesia, it can be used safely and effectively when administered by an appropriately-trained individual in an appropriately-equipped facility. Precautions are taken to protect your child during general anesthesia; personnel who are trained to manage complications will monitor your child closely. Your pediatric dentist will discuss the benefits and risks of general anesthesia and why it is recommended for your child.
Q: What special considerations are associated with the general anesthesia appointment?
A physical evaluation is required prior to general anesthesia for dental care. This physical assessment provides information to ensure the safety of your child during the general anesthesia procedure. Your pediatric dentist or general anesthesia provider will advise you about evaluation appointments that are required.
Parents are instructed to report to the pediatric dentist any illness that occurs prior to the general anesthesia appointment. It may be necessary to reschedule the appointment. It is very important to follow instructions regarding fasting from fluids and foods prior to the appointment.
Your child will be discharged when stable, alert, and ready to depart. Patients often are tired following general anesthesia. You will be instructed to let the child rest at home with minimal activity until the next day. Post-operative dietary recommendations also will be given.
Copyright © 2002-2009 American Academy of Pediatric Dentistry.
Fluoride
Q: What is fluoride?Fluoride is a compound that contains fluorine, a natural element. Using small amounts of fluoride on a routine basis can help prevent tooth decay. In areas where fluoride does not occur naturally, it may be added to community water supplies. Research shows that community water fluoridation has lowered decay rates by over 50 percent, which means that fewer children grow up with cavities. Fluoride can be found as an active ingredient in many dental products such as toothpaste, mouth rinses, gels and varnish.
Q: How does fluoride prevent cavities?
Fluoride inhibits loss of minerals from tooth enamel and encourages remineralization (strengthening areas that are weakened and beginning to develop cavities). Fluoride also affects bacteria that cause cavities, discouraging acid attacks that break down the tooth. Risk for decay is reduced even more when fluoride is combined with a healthy diet and good oral hygiene.
Q: Will my child need fluoride supplements?
The pediatric dentist considers many factors before recommending a fluoride supplement. Your child’s age, risk of developing dental decay and dietary sources of fluoride are important considerations. Infant formulas contain different amounts of fluoride. Bottled, filtered and well waters also vary in the amount of fluoride they contain. Your pediatric dentist can help determine if your child is receiving -- and not exceeding -- the recommended amount.
Extra note on well water:
Most well water in Northern Virginia and surrounding regions has insignificant to minimal amounts of natural fluoride. It is recommended to have your well water tested for fluoride concentration to ensure your child is receiving the proper amount of fluoride in his or her diet. It is also important to test your well water for possible microbial or chemical contamination. Well_Water.pdf
Q: How safe is fluoride?
Using fluoride for the prevention and control of decay is proven to be both safe and effective. Nevertheless, products containing fluoride should be stored out of the reach of young children. Too much fluoride could cause fluorosis of developing permanent teeth. Fluorosis usually is mild, with tiny white specks or streaks that often are unnoticeable. In severe cases of fluorosis, the enamel may be pitted with brown discoloration. Development of fluorosis depends on the amount, duration and timing of excessive fluoride intake. The appearance of teeth affected by fluorosis can be greatly improved by a variety of treatments in esthetic dentistry.
Q: What type of toothpaste should my child use?
Your child should use toothpaste with fluoride and the American Dental Association Seal of Acceptance. Brushing twice a day (after breakfast and before bedtime) provides greater benefits than brushing once daily. Parents should dispense toothpaste to prevent their young children from swallowing too much.
Q: How much toothpaste should my child use?
For children under 2-years-old, use a smear of fluoridated toothpaste. For those aged 2 to 5 years, a pea-sized amount is recommended.
Q: What is topical fluoride?
Topical fluoride is a preventive agent applied to tooth enamel. It comes in a number of different forms. A dental professional places gels or foams in trays that are held against the teeth for up to four minutes. Fluoride varnish is brushed or "painted" on the enamel. Varnish is especially useful for young patients and those with special needs who may not tolerate fluoride trays. Children who benefit the most from fluoride are those at highest risk for decay. Risk factors include a history of previous cavities, a diet high in sugar or carbohydrates, orthodontic appliances, and certain medical conditions such as dry mouth.
Copyright © 2002-2009 American Academy of Pediatric Dentistry.