Dental Instructions

We want all of our patients and their parents who have a tooth in which a composite crown has been placed, to have the right information on how to care for and what the benefits are of a composite restoration. The composite crown must be maintained with effective removal of plaque by brushing and flossing daily, home care fluoride prescription, and a low sugar diet to avoid cavities returning to the edges of the composite restoration.

Over time, all composite crowns will become darker. This change in color is due to the intake of stains into microscopic pores in composite restoration surface. These stains come from the foods and beverages that have natural or artificial pigments (i.e., coffee, tea, coke, Kool-Aid, grape juice, blueberries, chocolate, etc.). To slow the change in color of your child’s composite crowns, have them avoid intake of pigmented foods or drinks when possible.

In order to give your child’s tooth with the composite crown the longest possible life span, please have your child avoid the following foods: ice or ice cubes, hard candies, taffy, caramels, and jaw breakers. If you have any questions or concerns about your child’s composite crowns, please do not hesitate to ask our dental team.

What can you eat? Let’s talk about what you shouldn’t eat! For the first day or so, stick to soft foods. Avoid tough meats, hard breads, and raw vegetables. Before long, you’ll be able to bite a cucumber again. But you’ll need to protect your orthodontic appliances when you eat for as long as you’re wearing braces.

Avoid

• Chewy foods: bagels, hard rolls, licorice
• Crunchy foods: popcorn, ice, chips.
• Sticky foods: caramels, gum.
• Hard foods: nuts, candy
• Foods you have to bite into: corn on the cob, apples, and carrots
• Chewing on hard things (for example, pens, pencils or fingernails) can damage the braces.

Damaged braces will cause treatment to take longer.

General Soreness

When you get your braces on, you may feel general soreness in your mouth and teeth may be tender to biting pressures for three to five days. This can be relieved by rinsing your mouth with a warm salt water mouthwash. Dissolve one teaspoonful of salt in 8 ounces of warm water, and rinse your mouth vigorously. If the tenderness is severe, take aspirin or whatever you normally take for headache or similar pain. The lips, cheeks and tongue may also become irritated for one to two weeks as they toughen and become accustomed to the surface of the braces. You can put wax on the braces to lessen this. We’ll show you how!

Loosening of Teeth

This is to be expected throughout treatment. Don’t worry! It’s normal. Teeth must loosen first so they can be moved. The teeth will again become rigidly fixed in their new–corrected–positions.

To successfully complete the treatment plan, the patient must work together with the orthodontist. The teeth and jaws can only move toward their corrected positions if the patient consistently wears the rubber bands, headgear or other appliances as prescribed. Damaged appliances lengthen the treatment time.

Brushing

It’s more important than ever to brush and floss regularly when you have braces, so the teeth and gums are healthy after orthodontic treatment. Patients who do not keep their teeth clean may require more frequent visits to the dentist for a professional cleaning.

At times the dental restoration of choice for children is a cap (crown). A crown restoration encircles and covers all surfaces of your child’s tooth. A crown is generally the strongest restoration that can be provided for your child. We are providing you with some instructions on how to care for this type of dental restoration in order to maintain a functioning and healthy dentition for your child.

The gum tissue surrounding your child’s crown may be red, inflamed, bleed easily, and sore immediately after placement of the crown. This is normal at this time and may persist for 7- 10 days after crown placement. For the first 72 hours after crown placement do not brush the crowned tooth with a tooth brush, but use a moistened wash cloth or gauze with tooth paste 3 times per day to clean the crown surfaces. All the other teeth are to be brushed with a toothbrush as normal. After the first 72 hours the crowned tooth and all the other teeth are to be brushed with a tooth brush and tooth paste 3 times per day as normal.

While crowns are one of the strongest restorations, nothing is stronger than an undecayed natural tooth. Crowns are not able to withstand the forces of biting on non- food items such as anything made of plastic, wood, or metal. Have your child avoid biting on all non-food items. Crowns will also not withstand the forces of trauma from a fall or blow to the face and/or dentition.

All crowns are either bonded or cemented onto the existing tooth. This bond or cement is strong, but if hard, sticky, or chewy foods/candy are eaten the crown may be dislodged. In order to avoid this from occurring, it is recommended to have your child avoid the following foods/candy: gummy bears, Jolly Ranchers, hard candies, salt water taffy, chewing gum, caramels, suckers, fruit roll-ups, corn nuts, beef jerky, raw carrots or ice.

Baby (primary) teeth with crown restorations will be lost in the same way that other baby teeth are lost when the permanent tooth replacing them dissolves the root enough for them to be lost. There are no special concerns if the baby tooth with a crown is lost due to the eruption of a permanent tooth.

If your child grinds his/her teeth excessively, a hole can be worn through a crown which could lead to decay and/or the loss of the crown. If you notice a hole in your child’s crown, bring it to the dentist’s attention.

If your child’s crown is loose or has come off, call the office immediately. Many times a loose crown can be recemented, if your child is treated immediately. If your child’s crown is off, store it in a plastic baggy and bring it into the office immediately. Delay in seeking treatment could lead to need for a new crown, decay, or loss of the tooth.

We have recommended and placed a palatal crib in your child’s mouth to help them stop sucking their thumb/fingers. It is very important that this is a positive team effort. Please be very supportive of your child as they attempt to stop their habit. Remember that the crib is a “stop sign” to remind your child to take the thumb/finger out of their mouth. This appliance will only work with everybody’s cooperation. We want to provide you with some information which will allow you to care for your child’s space maintainer in the best manner possible.

Diet – All of our palatal cribs are cemented with strong dental cement, however, the crib still can be dislodged if the wrong types of food are eaten. We do not recommend that your child eat any of the following: caramels, taffy, hard candy, chewing gum (any type), gummy bears, jolly ranchers, ice cubes, hard crunchy foods, or any sticky, chewy food. Sugary foods should be kept to a minimum.

Oral Hygiene – While almost all of our crib designs are easy to clean, your child must have above average oral hygiene. Palatal cribs will catch extra food debris and plaque so your child will have to make an extra effort in brushing and flossing to maintain healthy gums and teeth.

Periodic Evaluation – Patients with cribs should be seen by the dentist at a minimum of every 1 month for routine examination for evaluation of the habit, fit of the bands, and tooth eruption. Failure to return for follow-up visits can lead to gum problems, cavities, and crooked teeth. Once the crib is ready for removal the dentist will remove it.

Patient Cooperation – The palatal crib is not a toy. Do not “flip” the appliance with the tongue, because it may loosen the fit. Do not pick at the wires or bands with fingers.

Loose Space Maintainer – Should the palatal crib come loose for whatever the reason, call the office immediately. If the crib is loose enough to come out of the mouth, place it in an envelope, store it in a safe place, then call the office. Many times a loose crib can be easily re-cemented if the appliance has not been bent or broken and your child is seen as soon as possible. A delay in getting in for an appointment could cause the need for the crib to be remade.

Patient Comfort – Palatal cribs are a passive (they do not move teeth) appliance, therefore, there should not be any pain or discomfort associated with crib. Pain or discomfort could be an indication that something is wrong with the crib. Call the office if your child has any pain or discomfort associated with the crib. With a new palatal crib there may be an initial accommodation period of a few days to a week.

During this time there may be an initial difficulty in speech and the appliance’s presence will be noted. Usually, after this time the palatal crib is hardly noticed.

We have recommended and placed a pediatric dental partial or “Hollywood Bridge” in your child’s mouth. We want to provide you with some information which will allow you to care for your child’s partial denture in the best manner possible.

Diet – All of our pediatric partials are cemented with strong dental cement, however, the space maintainer still can be dislodged if the wrong types of food are eaten. We do not recommend that your child eat any of the following: caramels, taffy, hard candy, chewing gum (any type), gummy bears, jolly ranchers, ice cubes, hard crunchy foods, or any sticky, chewy food. Sugary foods should be kept to a minimum.

Oral Hygiene – While almost all of our pediatric partial designs are easy to clean, your child must have above average oral hygiene. Pediatric partials will catch extra food debris and plaque so your child will have to make an extra effort in brushing and flossing to maintain healthy gums and teeth.

Periodic Evaluation – Patients with partials should be seen by the dentist at a minimum of every 6 months for routine examination for evaluation of the bite, fit of the bands, and tooth eruption. Failure to return for follow-up visits can lead to gum problems and cavities. Once the partial is ready for removal the dentist will remove it.

Patient Cooperation – The pediatric partial is not a toy. Do not “flip” the appliance with the tongue, because it may loosen the fit. Do not pick at the wires or bands with fingers.

Loose Partial – Should the pediatric partial come loose for whatever the reason, call the office immediately. If the partial is loose enough to come out of the mouth, place it in an envelope, store it in a safe place, then call the office immediately. Many times a loose partial can be easily re-cemented if the appliance has not been bent or broken and your child is seen as soon as possible

Patient Comfort – Pediatric partials are a passive (they do not move teeth) appliance, therefore, there should not be any pain or discomfort associated with the pediatric partial. Pain or discomfort could be an indication that something is wrong with the partial. Call the office if your child has any pain or discomfort associated with the partial.

We want all of our patients and their parents who receive dental sealants to have the right information on how to care for dental sealants and what the benefits are of dental sealants. Sealants are a plastic resin that is flowed into and bonded to the natural grooves that occur on the chewing surfaces of the back primary and permanent teeth. Sealing the grooves of a back tooth is a procedure to prevent dental decay from occurring in the pits and fissures in the chewing surface of a back tooth.

Sealants do not protect the smooth surfaces of teeth including the surfaces between teeth. Flossing is the only way to clean between the teeth and to prevent tooth decay between teeth. Sealants have been clinically shown to last up to 9 years and seal the grooves of teeth where around 60% of all tooth decay begins. As a service to our patients, as long as our patients come back for their 6-month preventive re-care visits on a consistent basis, we will repair any of the sealants we placed on their teeth for no fee.

If decay-occurs on one of our patient’s tooth surfaces where a sealant had been placed in our office, we will reduce the fee of the needed restoration by the fee paid for the sealant as long as the patient has been returning for their 6-month re-care visits on a consistent basis.

In order to give your child’s sealant the longest possible life span, please have your child avoid the following foods: ice or ice cubes, hard candies, taffy, caramels, and jaw breakers. Your child’s sealants will be evaluated at each re-care visit to make sure that they are intact and in no need of repair. If you have any questions or concerns about sealants, please do not hesitate to ask our team.

After extractions of teeth many patients have questions concerning care after the procedure. The following information will give you general guidelines for after-extraction care.

Bleeding – Bleeding is to be expected when teeth are extracted. A majority of the heaviest bleeding will be in the first 15-30 minutes after the tooth extraction. Oozing of blood from the extraction site can continue for 3 to 6 hours post-extraction. Placing direct pressure on the extraction site for a continuous 10-15 minutes with gauze, washcloth, or tissue paper can control a majority of normal bleeding.

Numbness – Your child’s cheek, lip, and tongue will be numb for approximately 2-3 hours. Please be very careful that your child does not bite his or her cheek or pick at this area. As this area wakes up, it may feel funny.

Pain – Some patients may have pain with dental extraction. If and how much pain each individual child may have depends on several factors. All patients who have dental extraction will have the extraction area numbed with local anesthetic before the extraction. This local anesthetic will last 1 to 3 hours after the tooth extraction. To help with the potential pain, each child should have an age/weight appropriate dose of ibuprofen (Advil, Motrin) before the numbness wears-off. Once the numbness wears off, the ibuprofen should be continued for the next 24 to 48 hours as needed for pain. Children less than 100 pounds in weight are best treated with liquid children’s ibuprofen (read packaging for dosage) and those over 100 pounds can take up to 600 mg of adult ibuprofen tablets every 6 hours as needed for pain. Use of aspirin is discouraged.

Diet – It is recommended to have a soft/liquid diet for the first 6 to 12 hours after dental extraction. Drinking through straws is discouraged. Cold foods, i.e., popsicles, milk-shakes, crushed ice, may feel the best during this first 6 to 12 hours.

Oral Hygiene – Brushing and flossing are encouraged as normal except in the immediate extraction site area for 3 days. In the extraction area, just use a moistened washcloth to cleanse the teeth and gum tissue. Mouth rinses, i.e., Scope, Listerine, or salt water are fine, but try to keep them to a minimum as frequent rinsing may lead to continued bleeding.

Questions or Concerns – Call if your child has: prolonged bleeding, pain after the first 48 hours, or an extraction site that won’t heal after 14 days. If you have any questions or concerns about dental extractions, please do not hesitate to call (910) 791-7380.

We want all of our patients and their parents who have a tooth in which a pulpotomy (nerve treatment) has been performed, to have the right information on how to care for and what the benefits are of a pulpotomy.

When decay enters the nerve of a primary (baby) tooth, a pulpotomy procedure becomes necessary to save the tooth. A pulpotomy is the removal of the nerve tissue and blood vessels inside the crown portion of a primary tooth. Once the decay and tissue have been removed, a medicated filling is placed in the space previously occupied by the nerve tissue and blood vessels.

While serving in a capacity similar to a root canal, a pulpotomy is not a root canal. The human body can dissolve all materials used in a pulpotomy. Primary teeth with pulpotomies will be lost in the same way that other baby teeth are lost when the permanent tooth replacing them dissolves the root enough for them to be lost. There are no special concerns if the baby tooth with a pulpotomy is lost due to the eruption of a permanent tooth.

A temporary filling is placed over the medicated filling to build the tooth up to a more natural contour. This temporary filling will usually last 1 to 3 months. With few exceptions, all teeth that have had a pulpotomy will need a stainless steel crown (cap) in the near future to prevent breakdown of the tooth. Pulpotomies have been shown to have an 85% to 90% clinical success rate in primary teeth. It must be noted however, that some pulpotomies will fail unpredictably and the primary tooth may need to be removed in the future.

In order to give your child’s tooth with the pulpotomy the longest possible life span, please have your child avoid the following foods: ice or ice cubes, hard candies, taffy, caramels, and jaw breakers. If you have any questions or concerns about pulpotomies, please do not hesitate to ask our team.

We have recommended and placed a space maintainer(s) in your child’s mouth to either maintain the space for erupting permanent teeth or to maintain the current position of already erupted permanent teeth. Without this space maintainer your child’s teeth may have difficulty in erupting or staying in their proper position. We want to provide you with some information which will allow you to care for your child’s space maintainer in the best manner possible.

Diet – All of our space maintainers are cemented with strong dental cement, however, the space maintainer still can be dislodged if the wrong types of food are eaten. We do not recommend that your child eat any of the following: caramels, taffy, hard candy, chewing gum (any type), gummy bears, jolly ranchers, ice cubes, hard crunchy foods, or any sticky, chewy food. Sugary foods should be kept to a minimum.

Oral Hygiene – While almost all of our space maintainer designs are easy to clean, your child must have above average oral hygiene. Space maintainers will catch extra food debris and plaque so your child will have to make an extra effort in brushing and flossing to maintain healthy gums and teeth.

Periodic Evaluation– Patients with space maintainers should be seen by the dentist at a minimum of every 6 months for routine examination for evaluation of the bite, fit of the bands, and tooth eruption. Failure to return for follow-up visits can lead to gum problems, cavities, and crooked teeth. Once the space maintainer is ready for removal the dentist will remove it.

Patient Cooperation – The space maintainer is not a toy. Do not “flip” the appliance with the tongue, because it may loosen the fit. Do not pick at the wires or bands with fingers.

Loose Space Maintainer – Should the space maintainer come loose for whatever the reason, call the office immediately. If the space maintainer is loose enough to come out of the mouth, place it in an envelope, store it in a safe place, then call the office immediately. Many times a loose space maintainer can be easily re-cemented if the appliance has not been bent or broken and your child is seen as soon as possible. A delay in getting in for an appointment could cause the need for the space maintainer to be remade.

Patient Comfort – Space maintainers are a passive (they do not move teeth) appliance, therefore, there should not be any pain or discomfort associated with space maintainer. Pain or discomfort could be an indication that something is wrong with the space maintainer. Call the office if your child has any pain or discomfort associated with the space maintainer. With a new space maintainer there may be an initial accommodation period of a few days to a week. During this time there may be an initial difficulty in speech and the appliance’s presence will be noted. Usually, after this time the space maintainer is hardly noticed.

Purpose

The purpose of the quad helix (Q.H.) is to stimulate the upper teeth and jaw to grow wider. This creates more room for the permanent teeth, and shapes the dental arch to more closely match the patient’s facial form. It is mainly used to correct posterior crossbites in the mixed dentition.

Initial Adjustment Time

The device is not removable and you will not need to adjust it. Since it fits behind the teeth, it is not visible. Most patients require between 3 to 5 days to become accustomed to the Q.H. device. After these days of the initial adjustment, most patients forget that the appliance is in their mouth. As well, the first 3 to 5 days of wear usually result in some alteration in speech. If the patient will speak slowly, speech will become normal within the 3 to 5 day adjustment period.

Care of the Q.H.

Patients must not play with the wire or pick at it. Hard, sticky, or brittle foods such as Jolly Ranchers, Now and Laters, Skittles, Taffy, or ice will destroy the wire resulting in discomfort and added expense.

Carrots, apples, steak, pizza, or similar foods should be cut up into small pieces before being chewed. Teeth should be brushed and flossed in the usual manner. Extra care may be taken to insure that food debris is removed from between the Quad Helix and the roof of the mouth.

Thumb and finger-sucking are calming mechanisms for children–a way for them to soothe themselves. Children usually give the habit up on their own by age four or five, when they become self-conscious and decide that they don’t want other kids to see them doing it. But a new study published in the American Journal of Orthodontics and Dentofacial Orthopedics suggests that children should stop sooner: According to researchers, too much pacifer and thumb-sucking after age two can lead to persistent dental problems in preschoolers, like overbites,crossbites or open bites (where there’s an abnormal space between the upper and lower teeth). If your child is two or three years old and still sucking her thumb, here’s how to eliminate the habit.

Step 1: Time it right

Choose a time when there are no new stressors (like a new school, new babysitter, or new sibling) in your child’s life. You can also look for these signs of readiness:

• Your child is able to practice some degree to self-control
• Your child comprehends the concept of time
• Your child understands cause and effect relationships, like how thumb-sucking can lead to dental problems.

Step 2: Motivate your child

Children have to want to stop sucking their thumbs to be successful. Motivate your child by explaining why she should quit. You can also:

• Show your child her mouth in the mirror and explain what thumb-sucking can do to teeth
• Show her any deformity or calluses on her fingers that have developed from sucking
• Talk about how germs are transmitted from hand to mouth, therefore increasing her chances of getting sick

Step 3: Use a reward system

Small incentives will encourage your child to stick with her plan to quit. Start with a daily reward for no thumb-sucking, like stickers or small toys. As your child progresses, make a chart for long-term goals. For one full week without sucking, offer a special reward, like a trip to the pizza parlor; for two full weeks without sucking offer something bigger, like a night at the movies with two friends, and so on. This chart can also be a fun project to work on together. Teacher’s Aid stores are a great location to find charts, stickers, etc. Another great reward type program is the “money jar”. Place five dollars worth of dimes in jar, at the end of the week, the child gets to go to the store and spend what is left in the jar. Here is the catch, every time you spot the thumb/fingers in the mouth, he/she has to get a dime and give it to you immediately.

More Tips for Success

• Use visual reminders, like a colorful band aid, to keep your child focused on quitting
• Cover your child’s hand with a mitten or glove at night to keep her from sucking her thumb while she sleeps
• Provide a quiet and relaxing environment to help your child fall asleep at night without thumb-sucking
• Plan activities that will occupy your child’s time and keep her hands busy, like coloring, puzzles, and art projects
• Be patient, consistent and focused on helping your child: It is really up to her to break the habit