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Children's Dentistry of Virginia in Midlothian and Chester, VA
Midlothian
804-639-6445
Chester
804-318-1052
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Children with Clean Teeth from the Pediatric Dentist in Virginia

Patient Services


Our office, as well as the The American Academy of Pediatrics (AAP), the American Dental Association (ADA) and the American Academy of Pediatric Dentistry (AAPD), recommends establishing a "Dental Home" for your child by one year of age. Children who have a dental home are more likely to receive appropriate preventive and routine oral health care.

The Dental Home is intended to provide a place other than the Emergency Room for parents.

You can make the first visit to the dentist enjoyable and positive. If old enough, your child should be informed of the visit and told that the dentist and their staff will explain all procedures and answer any questions. The less to-do concerning the visit, the better. It is best if you refrain from using words around your child that might cause unnecessary fear, such as "needle", "shot", "pull", "drill" or "hurt". The office makes a practice of using words that convey the same message, but are pleasant and non-frightening to the child.

We strive to make each and every visit to our office a fun one!

Routine Check-ups:

Routine check-ups every 6 months are very important to your child’s oral health. They allow us to detect early signs of disease and provide appropriate prevention or treatment in order to avoid lengthy procedures and maintain a healthy mouth. Without routine check-ups cavities will progress very fast and possibly cause your child pain or an abscess.

Brushing:

All children should brush their teeth at least two times a day, at night before bedtime, and in the morning after breakfast. By removing the plaque formation twice a day, parents can minimize or eliminate their children’s potential for decay. Younger children only require a pea-sized amount of toothpaste.

As the child gets older and demonstrates the dexterity and patience to properly brush, parents may allow them to brush on their own. But it is beneficial to monitor their care periodically. Smaller toothbrushes are better than bigger ones, and always use in a circular manner, preventing toothbrush abrasion, or excessive wear of the enamel at the gum line. Replace your child’s toothbrush when it is worn, bristles are splayed, or your child has had a serious cold or infection such as strep throat.

  • Infants - Gums and teeth should be wiped with a gauze or washcloth.
  • Toddlers - Parents should brush their teeth twice a day with a very small amount of toothpaste to prevent excessive swallowing. Toothpaste has fluoride in it, and excessive swallowing of toothpaste can cause white or brown spots to occur on developing permanent teeth. Use toothpaste sparingly with young children.
  • 3-6 years old - Allow your child to brush themselves with your supervision. Do the final brushing to ensure all surfaces of the teeth are cleaned. As they get older and the teeth get tighter together introduce flossing to remove plaque from areas the toothbrush cannot. Make sure your child can properly spit so they do not swallow the toothpaste.
  • 6 and older - Continue supervision until you are sure they can brush and floss properly.

Fluoride

What is fluoride? Fluoride is an element, which has been shown to be beneficial to teeth. Fluoride has been proven to prevent tooth decay, strengthen tooth enamel, and reduce the harmful effects of plaque. Fluoride also makes the entire tooth structure more resistant to decay and promotes remineralization, which aids in repairing early decay before the damage is even visible. However, too little or too much fluoride can be detrimental to the teeth. Little or no fluoride will not strengthen the teeth to help them resist cavities.

Excessive fluoride ingestion by preschool-aged children can lead to dental fluorosis, which is a chalky white to even brown discoloration of the permanent teeth. Many children often get more fluoride than their parents realize. Being aware of a child’s potential sources of fluoride can help parents prevent the possibility of dental fluorosis. See fluoride (link to FAQ and General questions page) for more information.

Where is fluoride found? Topical fluoride is found in products such as toothpaste, mouth rinse, and fluoridated varnishes that are applied topically by a dentist. Systemic fluoride can be ingested through public and private water supplies, as well as other drinks or dietary supplements. Once ingested, systemic fluoride is absorbed via the gastrointestinal tract and distributed and deposited throughout the body via the blood supply.

To avoid misuse or overconcentration of fluoride: Avoid drinking overly fluoridated water, swallowing toothpaste and other dental hygiene products. You can call your local water department and/or health department to evaluate the fluoride level in your local drinking water.

Following your child’s cleaning appointment a topical form of fluoride will be applied onto the teeth in the form of varnish. It may be delivered by simply painting the fluoride onto the teeth. With fluoride varnish your child will be able to eat and drink right after the dental visit.

Sealants

A sealant is a clear or shaded plastic material that is applied to the chewing surfaces (grooves) of the back teeth (premolars and molars), where four out of five cavities in children are found. This sealant acts as a barrier to food, plaque and acid, thus protecting the decay-prone areas of the teeth. Sealants may last several years before they need to be replaced. Over time, sealants can become loose or worn. Each time your child comes in for their check-up, the sealants will be assessed to make sure they are in intact.

Space Maintainers

Space maintainers are appliances made to custom fit your child’s mouth to maintain the space intended for the permanent tooth. They do this by “holding open” the empty space left by a prematurely lost tooth. They prevent the movement of the remaining teeth until the permanent tooth erupts into its natural position in the child’s mouth. All space maintainers are a combination of steel wires and rings that fit the appropriate teeth surrounding the area of the lost tooth. This treatment is much more affordable and acceptable by children than moving teeth later with orthodontic procedures.

Why are they important to children’s dental care?

Unfortunately when a baby tooth is lost too early due to trauma or severe disease, a space maintainer may be required to prevent future dental problems. Space maintainers encourage normal development of the jaw bones and muscles, and save space for the permanent teeth to help guide them into position. Teeth like to touch each other and “fill up” the space. In the event your child loses a baby tooth too early the remaining teeth may tilt, drift, or move up or down to fill the gap. When this happens, the space for the permanent tooth is not maintained and if left untreated, this may require extensive (and expensive) orthodontic treatment (braces or even surgery).

Do space maintainers require special care?

Yes they do, and as a parent it is important for you to help the patient maintain them. Make sure your child avoids hard/sticky foods (suckers, caramels, popcorn, etc). Teeth should be brushed after each meal and the teeth as well as the bands cleaned. Help to prevent your children from putting their fingers in their mouths and touching the spacer, they may loosen it. Keep in mind that a spacer is something unnatural replacing something natural (lost tooth). Occasionally the spacer may become loose or come out. If this happens place the spacer in a Ziploc bag, contact the office within the next few days so that the spacer can be put back in your child’s mouth. It is important that the spacer stays in until the permanent tooth is near eruption. This will be monitored at each check-up. If you see the permanent tooth starting to erupt under the spacer, call the office and schedule an appointment for the spacer to be evaluated.

Why treat baby teeth if they are just going to fall out?

Baby teeth serve the important function of eating, speech, and esthetics (self image). These teeth not only help form the developing jaws, but they hold space for the permanent teeth so that a normal bite occurs. The last baby tooth falls out around twelve years of age. A decayed baby tooth can become so badly decayed that it can damage the developing permanent tooth. At times severe infections of the face, head, and neck can be caused by infected baby teeth. It is very important to restore baby teeth as soon as decay is first detected. In our office dental decay is restored with tooth colored fillings, however if the decay is extensive it may require a crown.

Restorative visit (what to expect)

Our goal is to make your child’s dental visit a positive experience. You can help us achieve this goal by talking to your child about this visit using positive words like fun, easy, tooth asleep, etc. Do not use negative words such as pain, hurt, needle, shot, tooth pulled, etc. It is also very important that if you have any dental anxiety that it is not transferred to your child. Children can handle dental treatment very well if positive words are used to describe what the dentist is doing. We welcome parents to come back and be with their child while dental treatment is being rendered as long as the environment stays positive.

Each procedure will be explained to your child and you before the procedure is performed. Pediatric Dentists are trained to deliver the local anesthetic in a gentle and delicate manner. However we do offer nitrous oxide and conscious sedation if necessary.

After the dental procedure please help us continue the positive experience by praising your child and referring to the “fun” time they had. Please avoid negative comments such as: “Did it hurt? You know you got a shot? Were you afraid?”. These comments could persuade your child in thinking there was a reason to be afraid, even though they were cooperative, had a good time, and this may make future visits more difficult.

Composite (Tooth Colored) Fillings

In the past, cavities were predominantly treated with metal fillings that are highly noticeable and unaesthetic. These fillings can often weaken teeth due to the large amount of original tooth that has to be removed. Modern dentistry has increasingly turned to tooth colored or composite restorations. This is the predominant filling material utilized in our office. They are strong, safe, and more natural looking than the silver fillings. Composite fillings utilize a soft white plastic substance that is hardened with a blue light. These fillings do require more careful attention to home care (diet and oral hygiene, particularly flossing). If oral hygiene is poor, it is possible to develop more cavities around the filling.

Stainless Steel Crowns

Crowns are used in cases where a cavity has affected so much tooth structure that filling material cannot be used to repair the tooth. We offer several types of crowns depending on the location of the cavity. For the front teeth we have white crowns and silver crowns with a white facing. We choose which crown based on the patient’s bite and the extent of the cavity. For the back teeth we have stainless steel crowns that are silver. A crown covers the baby tooth completely and restores it to its original shape and size. It is important to be careful with home care (diet and oral hygiene), so that the gum tissue around the crown doesn’t become red, swollen, and irritated from plaque buildup.

Nerve Treatment

Very large cavities can result in toothaches and nerve irritation or infection. If a cavity has affected the nerve, we will clean out the infected part of the nerve, place an antibacterial medicine on the remaining nerve structure and finally place a protective filling over the nerve. Once a tooth has had nerve treatment it is weakened and must have a crown placed over it to protect it.

Extractions

We perform both baby tooth extractions and extractions of permanent teeth when needed. This includes the need for extractions prior to or during orthodontic treatment.

Please review our Post-Operative Instructions to care for your child before and after an extraction or dental surgery.

Injuries to the face, mouth and teeth are common among children. We are here to help you in the time of an emergency. Do not panic, stay calm and determine the extent of injury. If your child has a head/facial injury, determine if the injury caused a loss of consciousness. If this is the case, your child should see a physician immediately. Worry about the mouth and teeth later. Stop any bleeding with a clean washcloth or gauze. If there is any swelling, place a cold compress onto the area. As you do this, check for broken teeth and/or missing teeth. If there are missing teeth or fragments, see if you can find them.

If a permanent tooth has been avulsed (knocked out of the mouth) clean the tooth by handling it with the crown and not the root. Gently rinse the tooth with saline water, contact solution, or milk. Avoid rinsing tooth with water. Do not scrub the root. Then place the tooth in cold milk and immediately see a dentist so the tooth can be professionally reimplanted and stabilized. Time is the determining factor for saving the tooth. If more than 30 minutes has elapsed since the tooth was dislodged, the prognosis is guarded.

Primary teeth are not reimplanted. An x-ray is taken to ensure that no remnants of the tooth remain in the bone and the area is allowed to heal.

Broken or chipped baby teeth

If the fracture is superficial, it often can be restored with cosmetic bonding. If the fracture extends to the pulp or nerve inside the tooth additional treatment will likely be indicated.

Gum boil or Abscess

This is caused by an infected tooth. The pulp or nerve inside the tooth is infected by decay. The abscess extends beyond the tooth root into the surrounding bone, perforating the bone into the gum tissue causing a gum boil. The infected tooth cannot be saved. It has to be extracted to protect the permanent tooth bud from getting infected.

Toothache

If your child is having a toothache, clean the area around the tooth. Rinse the mouth with warm salt water and use dental floss to remove any trapped food between the teeth. DO NOT place aspirin on the gums or tooth. This will cause a burn to the gum tissues. If there is swelling, apply cold to the outside of the face. Give your child acetaminophen or ibuprofen for pain. Call the office to set up an appointment to treat the tooth.

Cold Sore or Canker Sore

Some patients get canker sores periodically. There is no definite cause for a canker sore, it could be due to stress, vitamin or zinc deficiency, or acidic foods. Cold sores may have a viral origin. Both usually last for about 7 days and there is no definitive treatment for them. Treatment is aimed towards relieving the pain either with over the counter medication or prescription medication.

We try to accommodate all emergencies on the same day. Please call early in the morning. If it is after working hours, please call the office and leave a message for the on call doctor and the doctor on call will call you as soon as they are able. It is imperative for you to leave your name, your child’s name, your phone number and the reason for calling.

Nitrous Oxide

Some children are given nitrous oxide/oxygen - or what you may know as laughing gas - to relax them for their dental treatment. Nitrous oxide/oxygen is a blend of two gases, oxygen and nitrous oxide. Nitrous oxide/oxygen is given through a small breathing mask which is placed over the child’s nose, allowing them to relax without putting them to sleep. The American Academy of Pediatric Dentistry recognizes this technique as a very safe, effective technique for treating children’s dental needs. The gas is mild, easily taken, and it is quickly eliminated from the body and it is non-addictive. While inhaling nitrous oxide/oxygen, your child remains fully conscious and maintains all of their natural reflexes.

Prior to your appointment:

  • Please inform us of any change to your child’s health and/or medical condition.
  • Tell us about any respiratory condition that makes breathing through the nose difficult for your child. It may limit the effectiveness of the nitrous oxide/oxygen.
  • Let us know if your child is taking any medication on the day of the appointment.

Conscious Sedation

Conscious Sedation is recommended for apprehensive children, very young children, and children with special needs. It is used to calm your child and to reduce the anxiety or discomfort associated with dental treatments. Your child may become quite drowsy and may even fall asleep, but they will not become unconscious.

There are a variety of different medications that can be used for conscious sedation. Your dentist or orthodontist will prescribe the medication best suited for your child’s overall health and dental treatment plan. We will be happy to answer any questions you might have concerning the specific medicine we plan to administer to your child.

Prior to your appointment:

  • Please notify us of any change in your child’s health and/or medical condition. Do not bring your child for treatment if they have a fever, ear infection or cold. Should your child become ill, contact us to see if it is necessary to postpone the appointment.
  • Inform the doctor of any prescriptions that your child is currently taking and any drug reactions or change in medical history.
  • Please dress your child in loose fitting, comfortable clothing.
  • Please make sure that your child goes to the bathroom immediately prior to arriving at the office.
  • Your child should not have solid food for at least 6 hours prior to their sedation appointment, and should only consume clear liquids for up to 4 hours before the appointment.
  • The child's parent or legal guardian must remain at the office during the complete procedure.
  • Please watch your child closely while the medication is taking effect. Do not leave them unattended.
  • Your child will act drowsy and may become slightly excited at first.

After the sedation appointment:

  • Your child will be drowsy and will need to be monitored very closely. Keep your child away from areas of potential harm.
  • If your child wants to sleep, place them on their side with their chin up. Wake your child every hour and encourage them to have something to drink in order to prevent dehydration.
  • At first, it is best to give your child sips of clear liquids to prevent nausea.
  • Your child's first meal should be light and easily digestible.
  • If your child vomits, help them bend over and turn their head to the side to insure that they do not inhale the vomit.
  • Because we use local anesthetic to numb your child’s mouth during the procedure, your child may have the tendency to bite or chew their lips, cheeks, and/or tongue and/or rub and scratch their face after treatment. Please observe your child carefully to prevent any injury to these areas.
  • Please call our office for any questions or concerns that you might have.

Outpatient General Anesthesia

Outpatient General Anesthesia is recommended for apprehensive children, very young children, and children with special needs that do not work well under conscious sedation or I.V. sedation. General anesthesia renders your child completely asleep. This would be the same as if he/she was having their tonsils removed or having a hernia repaired. Outpatient General Anesthesia is performed in a hospital or outpatient setting only. While the assumed risks are greater than that of other treatment options, the benefits of this treatment greatly outweigh the risks. Most pediatric medical literature places the risk of a serious reaction in the range of 1 in 25,000 to 1 in 200,000, far better than the assumed risk of driving a car. If this is not chosen, your child risks having multiple appointments, potential for physical restraint to complete treatment, and possible emotional and/or physical injury to your child in order to complete their dental treatment. The risks of NO treatment include tooth pain, infection, swelling, the spread of new decay, damage to their developing adult teeth and possible life threatening hospitalization from a dental infection.

Prior to your appointment:

  • Please notify us of any change in your child’s health. Do not bring your child for treatment with a fever, ear infection or cold. Should your child become ill, contact us to see if it is necessary to postpone the appointment.
  • Please inform the doctor of any prescriptions that your child is currently taking and any drug reactions and/or change in medical history.
  • Please dress your child in loose fitting, comfortable clothing.
  • Your child should not have milk or solid food after midnight prior to the scheduled procedure, and ONLY clear liquids like water, apple juice, or Gatorade for up to 6 hours prior to the appointment.
  • The child’s parent or legal guardian must remain at the hospital or surgical site waiting room during the complete procedure.

After the appointment:

  • Your child will be drowsy and will need to be monitored very closely. Keep your child away from areas of potential harm.
  • If your child wants to sleep, place them on their side with their chin up. Wake your child every hour and encourage them to have something to drink in order to prevent dehydration. At first it is best to give your child sips of clear liquids to prevent nausea.
  • Your child's first meal should be light and easily digestible.
  • If your child vomits, help them bend over and turn their head to the side to insure that they do not inhale the vomit.
  • Prior to leaving the hospital/outpatient center, you will be given a detailed list of "Post-Op Instructions" and an emergency contact number if needed.


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