Orthodontics
Orthodontics is the branch of dentistry that specializes in the diagnosis, prevention and treatment of dental and facial irregularities. The technical term for these problems is "malocclusion," which means "bad bite."
Dr. Shannon and Dr. Capalbo have extensive training in diagnosing orthodontic conditions in children. At every 6 month check up we will evaluate your child’s developing occlusion. When, and if, we feel your child would benefit from an orthodontic consultation we will make the appropriate referral. All of the orthodontists that we work with offer this initial consultation at no charge, so you will be able to make an informed decision for your child. Certain orthodontic conditions are best treated at an early age, whereas others are better treated in the teenage years. This can be confusing to many parents but do not worry, we will make sure you are well informed. We can even speak with you after you see an orthodontist to clarify any questions you might have. We understand that this is a big decision in terms of time, energy, and finances for your family. We will make every effort to make sure you are well informed and feel good about the decision you make.
How Important are Retainers
Once the teeth are moved into their correct position, the braces are removed. The next step is called retention. Retainers are utilized to hold the teeth in the desired position. Retainers must be worn as instructed, or the teeth WILL move back toward their original positions. Dr. Shannon and Dr. Capalbo will tell these children who have decided that they do not need to wear their retainers anymore that they eventually will be faced with 2 choices, either live with crooked teeth when they drift back, or get the braces back on. Usually they do not seem thrilled with either choice, and wearing their retainers does not seem like such a bad option!
Restorative Dentistry
AMALGAM (SILVER) VERSUS COMPOSITE (WHITE) FILLINGS
Most small to moderate cavities can be repaired utilizing either a traditional silver amalgam filling or a white composite filling. The benefits of a white filling are two-fold:
1. Esthetics. The filling is approximately the same color as your tooth. It is virtually invisible to the eye.
2. More conservative. There is less healthy tooth structure removed with a white filling. In a traditional amalgam or “silver” filling the entire groove pattern of the tooth must be filled even if only part of the groove is actually decayed. If not, the decay will extend along the groove in the future, necessitating retreatment. When utilizing a white filling this is not necessary; you can repair only the decayed part of the groove and protect the remaining cavity-free grooves with a sealant. The sealant can bond to the white filling and there is no additional tooth reduction. You cannot bond to the traditional silver fillings.
Is it the same technique for white and silver fillings?
The technique required for placing a white filling is more time consuming and has additional steps. Also maintaining a dry environment is imperative for the white filling to have a long life. Silver fillings are not as sensitive to moisture. Therefore for some very young children, children who have a strong gag reflex, or for restorations in the back of the mouth an amalgam restoration may be a better option than composite.
What about traditional silver fillings?
Amalgam restorations, “silver fillings” have had a long history of success in patients. There are many situations where we feel they are the best choice for your child. Particularly for the young and apprehensive child they are still the best choice. If we discover cavities for your child, we will make sure you are informed of our reccommendation for filling material.
What about the fee for white fillings?
Not all insurance carriers cover these restorations in full, and might even require more of an out-of-pocket expense by you. Some insurance carriers feel the option of the white filling is an esthetic choice that the member makes, and therefore will require a larger co-pay. If you have any questions concerning white fillings please discuss them with us.
STAINLESS STEEL CROWNS
Primary (baby) molars with extensive decay, (especially first primary molars), will have the benefit of a much more durable and reliable restoration if they are restored with a stainless steel crown rather than a large filling. There is a higher rate of fracture if a large filling (silver or white) is used to restore primary molars with multi-surface decay. A fractured filling may not be evident until the restoration falls out of the tooth or until decay becomes much more extensive underneath the fractured filling. These crowns are very strong; however, please avoid sticky candy. The crowned tooth usually will fall out normally when the permanent tooth that replaces it erupts into the mouth.
PULPOTOMIES
If decay has extended deep into the tooth’s nerve, or a tooth has fractured exposing the area deep in the tooth, a pulpotomy is required. During a pulpotomy, only the tissue in the crown of the tooth is removed. The tissue in the root remains intact, so the tooth is still considered to be alive or vital after the pulpotomy. After all of the infected tissue is removed, a medicated filling is placed in the chamber. Because the walls of the tooth’s crown are weak after the decay is removed a stainless steel crown is necessary to support the remaining tooth structure. The success of the pulpotomy depends on the severity of the infection and body’s own immune system. If a pulpotomy is not performed (or fails) and the tooth abscesses, extraction of the tooth will be recommended. If space needs to be held for the permanent tooth a space maintainer will be necessary.
What is needed for an abscessed baby tooth?
An untreated abscessed tooth will lead to pain, infection, possible facial swelling, and injury to the un-erupted adult tooth. An infected or abscessed baby tooth must be extracted. Once the tooth is extracted, a fixed space maintainer must be fabricated and placed to insure the proper spacing for the eventual eruption of the adult tooth.
SPACE MAINTAINERS
Space Maintainers are appliances made of metal that are custom fit to your child’s mouth. They are small and unobtrusive in appearance. Most children adjust to them after the first few days. Space maintainers hold open the empty space left by a lost tooth. It prevents movement until the permanent tooth takes it natural position in the jaw.
Tips for space maintainer care:
• avoid sticky sweets or chewing gum
• do not tug or push on the space maintainer with tongue or fingers
• keep it clean with brushing and flossing
• keep preventive dental visits to ensure timely removal
• if the appliance comes loose, contact our office
Pain Control
Nitrous Oxide
At Children’s Dentistry of Westerly we utilize many non-pharmacological techniques to help a young child through a difficult visit. Most often these techniques, such as distraction, tell-show-do, or a calm reassuring voice make your child feel relaxed and special and allow us to quickly and efficiently provide care.
Sometimes, however, a child may feel anxious during treatment despite these non-pharmacologic methods. Nitrous oxide/oxygen, or “laughing gas,” is a safe sedative agent that can often be used to calm a child’s fear of the dental visit. Additionally, it works well for children whose gag reflex interferes with dental treatment. It does not replace the need for local anesthetic (“novocaine” or “the shot”).