Preparation for the first visit
We understand that parents sometimes worry about what to say to their child before a dental visit. We really want your child to enjoy the trip. You can help your child by using the following preparatory information.
- Make the first dental visit an enjoyable outing
- Explain that the dentist will count all of his or her teeth
- Emphasise that the dentist will be kind and gentle
- Convey good feelings about dental visits being part of growing up
- Avoid reassuring your child that we won’t hurt as this will make them worry unnecessarily
- Avoid using unpleasant words such as injection needle, drill, or pulling teeth
What do I do if my child knocks their tooth out?
Ask is the tooth a primary/milk tooth or is it a permanent tooth?
- Primary/baby teeth should never be replanted
- You should ensure your child has a dental visit to assess any damage to the developing adult tooth in the gum above the tooth
- If the tooth is a permanent tooth then time is critical
- Handle the tooth by the crown and not the root
- Rinse the tooth under cold water or milk if contaminated with dirt
- Never leave the tooth dry or in water
- The best option is to replant the tooth in the socket
- Do not delay in contacting the dental surgery for treatment
There are just a few guidelines for appointments:
- If you arrive late for the appointment, we will make every effort to see your child. In certain situations we may have to reschedule your child so that other children are treated fairly.
- If you need to reschedule, please give us at least 24 hour notice. There is a fee for an appointment missed without giving us 24 hours notice.
- If you need to reschedule a Monday appointment please ring on Thursday or early Friday as we have a half day on Fridays.
Payment is made at each treatment session. Payment methods include cheque, mastercard/visa and cash.
If you have health insurance for your child and they need a general anaesthetic for dental treatment, an application may be made to your insurance provider. The application is submitted by the practice outlining why it is necessary for your child to have their treatment completed under general anaesthetic. Each case is assessed individually by your provider prior to treatment. If the application is approved some of the expences may be covered.
A number of health care insurance providers offer dental insurance. This frequently involves you having to submit a claim to the company on completion of treatment. We will be more than happy at the practice to assist you in completing these forms.
Emergency out of hours treatment is only required in a small number of instances such as a facial swelling or the avulsion of a permanent tooth.
The type of management appropriate for dental injuries in children depends on whether the injured tooth is a primary tooth or a permanent tooth. Injury to a primary tooth can in some instances have serious, long term effects on the developing adult tooth. Injury to a permanent tooth in a growing child can also have significant long term consequences on the vitality of the tooth and the growth of the tooth relative to the adjacent teeth.
If your child damages their teeth it is essential that an accurate diagnosis is made as soon as possible so that the appropriate treatment is carried out to ensure the best possible outcome for the developing teeth.
Prevention is always better than cure. Dental decay is a preventable disease. Appropriate recommendations on fluoride use, oral hygiene and diet can ensure children remain cavity free. Topical application of fluoride has been shown to be a very effective way to protect teeth from disease. Fluoride alone will not be enough to prevent decay if dietary and brushing habits are poor.
Fissure sealants are another method of preventing decay. A plastic barrier is placed into the grooves in your child’s teeth to prevent food and bacteria lodging in the cracks. This has been shown to be a very effective method of preventing decay in children at risk of developing dental disease.
If your child has decayed teeth treated and preventive care is not adhered to, decay will cause fillings to fail and any new teeth that erupt may also be affected by the decay.
Management of Pain and Anxiety
Our goal at Northern Cross Paediatric Dental Practice is to complete your child’s dental care in a safe and comfortable environment. Many children cope very well with having their dental treatment carried out by having their tooth numbed using age appropriate explanations and a kind, empathetic and patient approach. Some children however, find this approach more difficult. This might be due to young age, anxiety and fear, difficulty in communication or because they have sensory problems.
Local anaesthetic is used when extracting or restoring teeth in cooperative children. The technique involves placing a small needle into the gum near the tooth being treated. The gum is numbed with a cream before the needle is used. The needle delivers local anaesthetic and causes numbness. This type of management is carried out in conjunction with verbal and non-verbal behaviour shaping using positive reinforcement to encourage good behaviour. Child friendly language is used to help describe the treatment in a way that is easy and fun for them to understand.
At Northern Cross Paediatric Dental Practice we have the facility to deliver local anaesthetic through a computerised device called “The Wand” which ensures that anaesthetic enters the gum in a slow controlled manner thereby reducing any discomfort associated with the procedure. This device still uses a needle to deliver the anaesthetic however, for children who have previously had an unpleasant experience with local anaesthetic; the device can be very effective.
Inhalation Sedation is the gold standard for sedating anxious children in Ireland and the United Kingdom. It carries an excellent safety record and has been shown to be effective in helping to reduce anxiety. Inhalation sedation involves your child wearing a hood over their nose. During the procedure they inhale a sweet smelling mixture gasses (nitrous oxide and oxygen). In order to be suitable for this type of behaviour management the child must be capable of communicating and willing to cooperate.
The technique is heavily dependant on psychological reassurance from the paediatric dentist. Whilst the sedative agent has some pain reducing properties local anaesthetic is still required. There is also an amnesic affect from the gas which reduces the amount the child will remember from the procedure. Inhalation sedation can be used in conjunction with desensitisation techniques for children who are phobic or extremely fearful about a particular aspect of treatment. Children remain awake and communicative throughout an inhalation procedure and do not loose consciousness at any point.
General anaesthesia is a behaviour management approach whereby your child is sent to sleep and is unaware of any treatment carried out. Our general anaesthetic treatment sessions are carried out at The Beacon, Sandyford. www.beaconhospital.ie. The general anaesthetic is carried out by a Consultant Anaesthetist in an operating theatre. This is an excellent way of providing high quality care for children with severe anxiety, inability to cooperate or complex treatment needs.
When primary teeth become decayed, inflammatory changes soon begin to occur in the nerve of the tooth even though the tooth may not be painful. In order for the tooth to be restored fully, the inflamed portion of the nerve must be removed and the remainder is medicated. This procedure is no different from the child’s point of view to having a filling done. The purpose of the technique is to maintain the vitality of the tooth, prevent pain and infection and the need for extraction of the tooth. This procedure is known as a pulpotomy.
When decay is extensive the nerve of the tooth may die and become infected. In this case if there is sufficient tooth left to fix the tooth, the infected part is removed and the nerve space is filled before the tooth is fixed. This is known as a pulpectomy.
These are used to fix decayed or fractured teeth. They are principally used where aesthetics are a concern. They may be used to fix back teeth where cavities are minimal. They are matched to the colour of your child’s natural tooth colour.
Extractions/Minor Oral Surgery
Primary teeth are essential in maintaining the correct spacing in your child’s jaw for the permanent teeth. Therefore extractions are done only as a last resort in the case of tooth decay. In other cases, extractions may be necessary in orthodontic care to help in the correction of crooked teeth.
This is a procedure carried out in child dental patients where a careful evaluation is made of the space needed for adult teeth to erupt into. In some cases, loss of primary teeth can lead to crowding and poor guidance of the erupting adult teeth. An appliance called a space maintainer may then need to be fitted. Space maintainers require excellent oral hygiene and are not suitable for children at high risk of developing tooth decay.
This is a procedure which facilitates the proper eruption of the developing dentition into a functional and stable position compatible with a healthy growth pattern. When teeth erupt into the wrong position in the mouth interference with the development of other teeth and the jaws may occur. The treatment may require either a removable appliance to be worn or to have teeth removed to guide the teeth into their correct position.
Dental care of medically, physically and mentally handicapped children
Certain medical conditions can affect your child’s dental care in a number of ways. For example those vulnerable to infection such as diabetics require urgent care or even hospital admission in the presence of a dental abscess to ensure glycaemic control is not affected.
In some a medical condition can influence delivery of care. Children with cardiac anomalies may not clot normally after dental extractions due to medications they take or the effect of the condition on their clotting mechanisms. Physical handicap can affect manual dexterity and a child’s ability to maintain good oral health putting them at higher risk of dental disease.
Often children with chronic medical conditions have more anxiety about visits to the dentist than children who have not been in hospital before. Preventive care in these children is a huge priority! Appropriate dental treatment needs to be delivered in a way that meets all the special requirements of your child. Comprehensive treatment planning and appropriate delivery of that care ensures the care provided for your child is of the highest standard.
Management of Dental Anomalies
Dental anomalies encompass a wide range of conditions. This can mean that one or more of your child’s teeth have formed with a special shape, size or structure. It may mean that one or more teeth has not developed at all. These malformations may affect a child’s appearance if front teeth are affected or can cause the tooth to have a higher risk of decay if the structure is weak or defective.
One of the most common anomalies by far seen in this population is Molar Incisor Hypomineralisation or MIH. This condition results in weak enamel on one to four of the first permanent molar teeth (these are the first adult teeth hot grow in the back of the mouth around the age of 6). The upper and lower incisor teeth (or front teeth) may also be affected but usually to a lesser extent. The affected teeth may have white opaque spots, yellow/brown spots or breakdown of the enamel that occurs after eruption.
The incidence of the condition is 4 -25%. The cause of the condition is poorly understood however, if the birth of your child was complicated or they suffered illness up to the age of three years, this is considered to be an indicator of risk for the condition.
These teeth are more difficult to numb than healthy teeth and as a result if your child has this condition and has previously been to a dentist they probably will have more dental anxiety. These teeth require more complex techniques to fix them. White and silver fillings frequently fail requiring multiple fillings again leading to more anxiety, therefore choosing the appropriate type of filling has an important role in the outcome. In severe cases, extraction of the first permanent molars is appropriate. The timing of extractions is very important to obtain the best possible outcome. Delayed diagnosis can lead to ongoing problems with dental sensitivity, high risk of dental decay in the affected teeth, failure of fillings, loss of a first permanent molar causing orthodontic complications and may cause your child to have a life long fear of dental visits.
Sucking on fingers and pacifiers is normal for babies and young children. The habit usually stops age 2 to 4 years. Beyond this age the habit can cause the front teeth to protrude or constrict the roof of the mouth thereby preventing the upper and lower teeth from meeting properly. If you notice your child continuing to use a pacifier or thumb suck beyond 3 years the development of the teeth and jaws should be monitored to ensure the growing teeth do not erupt into unfavourable positions.
Referring Doctors & Dentists
At Northern Cross Paediatric Dental Practice we value our relationship with our referring specialists, dentists, doctors and their staff. We try to accommodate all referrals to our office in a timely fashion. Your patients are our patients and they will be treated with care and compassion.
If a referring doctor needs to speak with Dr. Daly regarding a mutual patient, she will respond in a timely fashion to discuss the referring practitioner’s needs and the patient’s concerns.