Common Procedures in Pediatric Dentistry

By: Growing Smiles

Pediatric dentists mainly focus on the health of milk teeth throughout their transition to permanent teeth. Pediatric dental treatment is often an undiscovered territory for most parents. Dr. Harini Krishnan and Dr. Janani Rangaswamy from Growing Smiles have curated a list of common treatments performed by pediatric dentists to help the parents.

By continuously tracking the growth and development of the child, pediatric dentists can anticipate any sort of malalignment in the growth and development of the teeth and quickly intervene before any discrepancy occurs. They focus on early corrective treatment to improve function and the confidence of the child. This early assessment of a child’s teeth prevents extensive orthodontic treatment in his/her future.

A pediatric dental visit could be very simply broken down into 3 steps:

• The Pre-Procedure
• The Dental Procedure Itself
• The Follow-Up

The treatment plan curated by the pediatric dentist considers a multitude of factors (eg: cooperation level of the child, the disease status of teeth, the entire dentition, etc). Thus when a treatment plan is proposed, it’s usually specific to a child.

The most common treatment procedures performed during a routine pediatric dental visit can be broadly classified as preventive and intervention procedures.

The Most Common Preventive Procedures are:

1. Dental Cleaning/ Prophylaxis
2. Fluoride Application
3. Pit and Fissure Sealants

The Intervention Procedures are:

1. Restorations/ Fillings
2. Pulpectomy/Root Canal Treatment
3. Extraction/ Tooth Removal

PREVENTIVE PROCEDURES:

1. Dental Cleaning (Prophylaxis):

Accumulation of tartar/ calculus affects the health of the teeth and the gums. Regular oral prophylaxis/ dental cleaning along with polishing can prevent many dental diseases in children.

2. Pit and Fissure Sealants:

As shown above, pits and fissures are the most common sites of food retention. This is where the sealants come into play. They are basically low viscous materials that flow into the pit and fissure regions, thus allowing the food to glide smoothly over the tooth surface.

It has been shown consistently that pit and fissure sealants help in the reduction of tooth decay (AAPD 2016)

With the rapid growth in the field of pediatric dentistry, there are a wide range of materials available for filling up a cavity. Gone are the days when a dentist would use the silver filling for kids. Tooth-colored fillings are now being used to restore front or back teeth or where cosmetic appearance is of prime importance, while not compromising on strength.

Sealants are a safe and painless way of protecting your teeth from tooth decay. A sealant is a protective plastic coating that is applied to the biting surfaces of the back teeth. The naturally occurring pits and grooves on the chewing surfaces of teeth can often collect plaque and thus, the sealant forms a hard shield that keeps food and bacteria from getting into the tiny grooves in the child’s teeth and causing decay. Sealants and fluoride work together to help prevent tooth decay.

3. Fluoride Application:

Fluoride has been an anti-cavity soldier for quite a while now, and its effect has been time

tested and is still considered as one of the most potent preventive measures.

Fluoride protects the teeth and can even help reverse early signs of decay. Fluoride treatments for kids are meant for teeth to absorb the fluoride. This is helped by fluoride toothpaste and rinses.

For the pediatric population, it is available in gels and varnishes which are professionally applied. These are usually available in flavors that make them more pleasant for the child. This procedure is usually done on a bi-annual basis.

Post-Procedure Instructions:

1. Do not brush teeth/ floss for 24 hours
2. Do not consume anything for half an hour post-procedure.
3. Avoid hard and sticky food

INTERVENTION PROCEDURES:

1. Restorations / Fillings:

This is one of the most routinely performed procedures in everyday pediatric dental offices. This procedure quite plainly involves the removal of the decayed portion of the tooth and replacing it with a tooth-friendly material. The choice of material is usually left to the discretion of the clinician.

The extent of decay usually determines the size and extent of the filling as well.

Pulp Capping Procedures:

This is done in situations where the extent of decay is very close to the blood space of the tooth and requires an additional layer of protection. This procedure helps in preserving the vitality of the tooth.

Post-Procedure Instructions:

1. Do not brush teeth/ floss for 24 hours
2. Do not consume anything for half an hour post-procedure.
3. Avoid hard and sticky food, especially on the treated tooth.

2. Pulpectomy:

A pulpectomy is done when the decay has extended to the pulp space (blood portion) of the tooth, continuous pain, increased pain on change in posture, and night pain.

When the inner pulp of a tooth becomes infected, the typical treatment for adults is a root canal. However, a procedure called pulp therapy is often the best option for saving a baby tooth in children. The most common reason for a child needing a pulpectomy is because a cavity went untreated for too long and the soft pulp within a child’s tooth has become infected. Once the decay reaches the pulp, your child may complain of toothache and pain, as well as tooth sensitivity, especially to hot and cold temperatures.

The purpose of a pulpectomy is to extend the life of the baby tooth, thereby avoiding the need for extraction and a space maintainer, until the eruption of the permanent tooth. In other words, the tooth can be preserved for chewing food and maintaining proper space for permanent teeth, as well as helping your child to preserve a healthy, happy smile.

What:

It involves the removal of the blood portion of the tooth and replacing it with a biocompatible material. This procedure renders the tooth nonvital, thus making it brittle and often needs to be followed by placement of a Cap (Crown).

Post-Procedure Instructions:

1. Do not brush teeth/ floss for 24 hours
2. Do not consume anything for half an hour post-procedure.
3. Avoid hard and sticky food, especially on the tooth treated.

Crowns in Pediatric Dentistry:

Simply known as caps, are full coverage materials that cover the entire tooth. They are usually placed during the following situations

1. Post a root canal procedure
2. In case of extensive decay that cannot be restored
3. Multiple restoration fractures.

There are basically two types of crowns available:

• Stainless Steel Crowns

• Aesthetic Crowns

Post-Procedure Instructions:

1. Do not brush teeth/ floss for 24 hours
2. Do not consume anything for half an hour post-procedure.
3. Avoid hard and sticky food, especially on the tooth treated.
4. Crown Dislodgement: In cases of the crown dislodging from the tooth, the crown is to be preserved and taken to the pediatric dentist immediately
5. Crown Ingestion: in case the child swallows the crown, please report it to the dentist immediately.

Note: A common misconception is that caps interfere with the normal shedding process of the tooth. This is false. The tooth will continue to undergo the natural processes even after crown placement.

3. Extraction/ Removal of Primary Teeth:

What:

It is the complete removal of the tooth from its socket

Pediatric dental extractions are done only as a last resort in the case of severe tooth decay, where one is not able to save the tooth. Some extractions are needed for pediatric orthodontic reasons to help facilitate tooth alignment when crowded teeth are present. Primary teeth are essential in maintaining the correct spacing in your child’s jaw for permanent teeth.

When:

1. When the permanent tooth has come, and the primary has not yet fallen
2. In case of badly broken teeth that cannot be filled
3. Teeth that are close to their shedding process.

How:

It is usually done under local anesthesia. This means that the anesthetic medicine is given right next to/ just surrounding the tooth in question.

Post Procedure Instructions:

1. Avoid spitting for half an hour post-procedure.
2. Have a cup of ice cream/ cold juice (without straw) half an hour after the procedure.
3. Avoid consumption of hot, spicy, and hard food
4. Mild swelling at the site of extraction is normal, ice packs may be placed from OUTSIDE to relieve pain and swelling.

Other Common Procedures:

If a milk tooth is removed prematurely, a space maintainer will be placed.  A space maintainer is an appliance that is custom-made by a pediatric dentist using a metal material. Its purpose is to keep the space open to allow the permanent tooth to erupt and come into place.

Additionally, pediatric dentists can help in habit correction. Habits like thumb sucking, lip biting, mouth breathing, and many other habits have an effect on the growth and development of the jaws and face. A pediatric dentist evaluates these habits and analyses the discrepancy that can happen in the future. Custom-made appliances are fabricated to correct these habits.

Pediatric dentists also assess the alignment of teeth for an orthodontic check-up. While pediatric dentistry and orthodontics are two separate dental specialties, pediatric dentists have practical training in early orthodontics and are often the first ones to diagnose any orthodontic concerns.

It’s advisable to take your child to a pediatric dentist once every SIX months as a part of a routine dental check-up.

Source: https://www.beingtheparent.com/common-procedures-in-pediatric-dentistry/

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