Common Procedures
COMMON PROCEDURES EXPLAINED
GETTING NUMB: Getting numb is the part of seeing the dentist that most people fear. At Zooka! we make it easy for children. We begin, in many cases, by using laughing gas (nitrous oxide) to allow the child to relax a little bit. We turn on the ceiling television that is above your child’s chair and allow the child to get interested in TV and less interested in what we are doing. At that point, the doctor will address the child, and using calming and distraction techniques, place a small amount of anesthetic (sleepy juice) next to the gums. We allow that to “sink in” a little. We will then finish getting your child fully numb so as to allow your child the best possible, pain-free experience.
FILLING (tooth colored or silver): We try to keep the explanation very kid friendly. We will explain to your child that we will be “washing” the cavity away and afterwards, he/she will be getting a “silver star” or a “cloud” in the tooth where the cavity was. We explain that there will be lots of water as we “wash” the cavity away. He / she will also hear a whistle and it may feel like it is tickling the tooth. We want to be honest with children, but not use wording that could scare them. As child become older, we become more technical in our terminology, but a lot depends on the patient’s anxiety level.
PULPOTOMY (root canal therapy for a primary tooth): If the cavity is deep and the bacteria has began to invade into the live nerve tissue of the tooth (called the pulp), we must sterilize the nerve tissue as to avoid an infection and abscess. After removing all decay, the doctor will open the nerve chamber and remove the effected tissue. At that point the doctor will use medicines that sterilize the remaining tissue to ensure that any microscopic remnants of bacteria are destroyed. Next the nerve chamber must be closed with a filling material to ensure a proper seal. Finally, a crown is placed on the tooth to maintain the tooth’s structural integrity. If a filling is placed after a root canal procedure or a pulpotomy, the tooth will fracture under the biting pressures of the mouth.
CROWN / STAINLESS STEEL CROWN: Crown for primary teeth are different than crowns for permanent teeth. Crowns for permanent teeth require multiple visits for preparation, impression, and seating. They are also much more expensive than crowns for primary teeth. Crowns for primary teeth are done in a single visit due a child’s inability to tolerate multiple visits. Crowns on primary teeth are necessary to preserve the tooth if the tooth is either badly decayed or if the tooth requires a pulpotomy. After removing all decay, the tooth is shortened in height and relieved between adjacent teeth to accommodate the placement of the crown. (Remember that the crown is replacing all of the lost tooth structure.) We then will use a special “tooth glue” that cements the crown to the remaining tooth. We finish by removing all excess cement and checking the bite.
EXTRACTIONS (“wiggling teeth”): Extractions are performed for several reasons. Some of these reasons are: infection, badly decayed, impaction, trauma, and crowding (ie orthodontic purposes). We attempt to keep the procedure very simple. We avoid using words that may scare children, so we sometimes use wording like: “check how loose the tooth is” or “I’m going to push on your tooth”. Please avoid any wording that may be “more honesty than the child can handle”.
IMPRESSIONS FOR SPACE MAINTAINERS: Space maintainers are used to control the space in the mouth were a tooth or multiple teeth are missing or have been removed. Maintaining space in the mouth is important to avoid significant orthodontic bills later on as your child get older. Baby teeth are not only good for chewing and chomping food, but they maintain space. As the permanent teeth push out the baby teeth, they take the space where the baby tooth was. If that space has collapsed, then the permanent tooth has no place to erupt and either becomes impacted or erupts into the wrong place causing gums problems and additional orthodontic problems.
In order to fabricate a space maintainer, an impression of your child’s mouth must be taken. We will place small orthodontic bands around one or more teeth, then take the impression. The orthodontic bands are removed and placed in the impression. Both the bands and the impression are sent to the laboratory to custom fabricate your child’s space maintainer.
PLACEMENT / CEMENTATION OF SPACE MAINTAINERS: After the space maintainer has been custom fabricated at the laboratory, we will schedule a follow up appointment to deliver your child’s retainer. At that appointment, we will make sure the retainer fits properly and make any adjustments that are necessary at that time. We will then use special “tooth glue” to fix the retainer to the molars. We finish by removing excess cement and giving you and your child “care instructions” for the retainer.
MAXILLARY FRENECTOMY: This is a procedure done to remove excess tissue from between the upper front teeth. It is performed to allow the teeth to close spontaneously or in combination with orthodontics. As we perform the procedure, we explain to your child that he / she will fell us “brushing” the gums. The procedure is performed with electro-cautery. Electro-cautery is kind to the tissue and alleviates the necessity for stitches and follow up visits to remove stitches. As we remove the tissue, the machine stops the bleeding automatically.
LINGUAL FRENECTOMY (tongue tied): The procedure is performed to allow free movement of the tongue and to avoid future gum disease and gum problems in the adult teeth. If a young child is having difficulty speaking, the procedure will be performed at a young age under sedation or general anesthetic. If the child can speak properly, but is at risk for developing periodontal (gum) problems as an adult, the procedure will be performed around 7-8 years old. As we perform the procedure, we explain to your child that he / she will feel us “brushing” the tongue and gums. The procedure is performed with electro-cautery. Electro-Cautery is king to the tissue and alleviates the necessity for stitches and follow up visits to remove stitches. As we remove the tissue, the machine stops the bleeding automatically.
EXAMINATION (check up or new patient exam): During every examination, a staff member will educate the parent and child on oral hygiene instructions, nutritional education, pertinent age appropriate education material, and answer any specific questions the parent may have regarding his / her child. The doctor will perform 3 or 4 specific different tasks. First he / she will perform a Head and Neck Cancer Screening. This is to check for lumps, bumps or discolorations that should not normally be there. Next he / she will perform an orthodontic evaluation. This is done, even on very little children, to educate the parents on what to expect in the future in regards to the child’s possible orthodontic problems. Next the doctor will count the teeth, check for cavities, and examine for any dental anomalies or abnormalities. Finally, if your child had dental x-rays exposed, the doctor will thoroughly examine them, looking for evidence of cavities or problems that were not visible to the naked eye. If the doctor recommends any treatment, he / she will formulate a treatment plan to restore the patient to optimal oral health. At the end of the examination, the doctor will discuss his / her findings with the parent and child and go over any recommended treatment (if there is any). The examination will conclude with a discussion of any specific questions the parent may have regarding the child and a secondary review of previous information at the parents request.