Category Archives: Pediatric Dentist

Why Would a Dentist Use Restraints on a Child?

I am expecting my first child and have been getting advice from a friend. One of the things she told me is never to use a dentist who does not allow me to go back with my child. She did that once and they put her son in restraints. Can you tell me why they would do that?


Dear Sally,

Pediatric Mouth Props
Pediatric Mouth Restraints


There are two type of pediatric restrains. The first is pictured up above. These are mouth restraints. They are designed to help keep your child’s mouth open when they are having dental work that includes a drill.

I know of a colleague that didn’t use this once. Unfortunately, the child bit down during his procedure, which caused the drill to go through his tooth and into gums. What should have been a simple filling ended up with the child needing a root canal treatment.  These type of restraints are absolutely essential.

papoose board
Papoose Board

The next type of restraints I would say are only rarely necessary.  Also, a dentist should ask a parent’s permission before using them. If your friend’s dentist didn’t I would say she was right to get rid of him.

Your question about why a dentist would use this is valid. Most pediatric dentists have techniques to keep children calm and cooperative. Every once in a while, however, there is a child who is so terrified that they won’t let the dentist near them and become destructive. If the procedure is not essential, normally you would just send the child home and then schedule another appointment for them, possibly using dental sedation if that is available.

However, sometimes a child has a dental emergency that has to be treated right then for their own safety. In those cases, I would understand a papoose board. Though they have been criticized, they actually feel more like a hug, sort of like a weighted blanket that closes. Every time a child has gotten into one when I have been present, they calmed right down and are able to get the dental work done with no trauma.

You are wise to be planning and learning everything you can now that you are a mother. One thing I would advise is to take your child to see a pediatric dentist as soon their first teeth come in. Don’t wait until they are older and there is a problem. You want their early experiences with a dentist to be positive ones so they are not afraid to go.

This blog is brought to you by Lafayette, LA Dentists Drs. Foreman and Thimmesch.

Why Do My Children Keep Getting Decay?

I am at my wit’s end. I do everything for my children possible, including taking care of their teeth. We brush twice, sometimes three times a day. We floss. I take them to the dentist every year. I also limit their sugar and still they are getting cavities. I want them to grow up with healthy teeth and do not know what I am doing wrong. At our last appointment, my four year old had four new cavities and my seven year old had two new cavities. What can I do differently?


Dear Libby,

young mother, holding and giggling with two children

It sounds like you are a loving and conscientious mother. That is fantastic and will only benefit your children. You have checked off some important items in caring for your childrens teeth. These include regularly brushing and flossing. You mentioned that you take them to the dentist every year. If at all possible, I would increase that to twice a year. Dental plans generally give you two full cleanings a year.

One thing you did not mention was the duration of their eating. Do they snack a lot or drink lots of juices? Believe it or not duration of eating, not what you eat, is one of the leading factors of tooth decay.

Our saliva contains bacteria fighting minerals, but it can’t properly do its job if they are frequent snackers. While limiting sugars can be helpful, it would be better to have a sugary snack once in a while than to have pasta or snacks a few times throughout the day. Most people are not aware that pasta and other carbohydrates break down into sugar. Many foods do, in fact.

Brushing constantly won’t even help. However, they only prevent decay on smooth surfaces. All those pits and fissures in your children’s back teeth are at a much greater risk of decay. If you have a good pediatric dentist, then they should have recommended you get sealing done on your children’s back teeth. This is a liquid that is “painted” over your children’s back teeth, the ones with all those pits. This dries then seals them up so that food and other debris cannot get trapped there. This should be done after a thorough cleaning by the dentist so that the teeth are healthy and clean when they are sealed.

They should also be getting regular fluoride treatements, which will help strengthen their teeth. We are fortunate to live in a country that fluorinates the water. However, that extra bit at the dentist makes a difference.

You are doing a great job, mamma. Check their snacking frequency and give yourself some grace.

This blog is brought to you by Lafayette, LA Dentist Drs. Foreman and Thimmesch.

Can Teething Cause a Fever?

Our first-born son is eight months old and seems to run a lot of fevers. A friend told me that it is probably because he is teething and we may need to slit his gums. I can’t imagine doing that! Can you give me some guidance here? We don’t have a pediatric dentist yet.


Dear Melanie,

Photo courtesy of St. John’s Pediatric Dentistry, St. John’s, FL

The first thing I am going to say is not to slit your child’s gums. I’ve never even heard of that for teething children. Doing that runs the risk that the roots are not adequately formed and they will erupt prematurely now unable to properly support the tooth. Let nature take its course. The teeth will erupt when the root is ready.

That being said, teething can cause fevers. However, it will only be a mild fever. Teething infants will also be a bit fussy, drool a whole lot more, and eat a bit less. Giving them some infants Tylenol will help some.

There is a slight difference when it comes to adult teeth erupting. If the baby teeth are still in place and you see the adult teeth breaking through, you need to seek some help from a pediatric dentist to remove the baby teeth. If you don’t, the adult teeth will get deflected, which will cause them to come in out of alignment. From there, you will be looking at expensive orthodontics that you might have gotten away with needing.

As your son is approaching a year old soon, I recommend beginning your search for a pediatric dentist. It is always best to acquaint them with a dentist before a problem arises. This way their first experience with a dentist is a positive one and not a scary emergency appointment.

This blog is brought to you by Lafayette, LA Dentists Drs. Foreman and Thimmesch.


Dental Bonding for Children

My eleven-year-old broke her two front teeth quite badly. Most of the structure is gone. She only has the top and sides left. Everything else is gone. We went to our pediatric dentist and he suggested removing the teeth. I wasn’t keen on that idea so I took her to my dentist. He said that dental bonding was the solution. I was so glad to hear that she could keep her teeth, I didn’t even look into the procedure. When the results were done, her bonding was so awful. It was lumpy and uneven and in places the color didn’t even make sense. She’s horrified and I don’t blame her. I don’t know what to do. Is there any way to fix this? I’m devastated for her.


Dear Carolyn,

before and after dental bonding

I’m shocked that your pediatric dentist suggested you extract her teeth. That was quite extreme. I expected he would have suggested dental crowns, but that would be a bad idea as well. The pulp of our teeth shrink as we age. In an 11 year old, that pulp is still quite large. Doing a crown on their teeth can kill the pulp.

Your other dentist was on the right track in recommending dental bonding for the repair. The problem lie in he did not have the skills to do such a massive repair. Dental bonding has to be done freehand and takes a great deal of training and artistry. When done well, it will blend in perfectly with the remainder of the tooth structure, as evidenced by the image above.

My suggestion is you look for a practice that has a dentist who is accredited with the American Academy of Cosmetic Dentistry on their staff. Ideally, they should also be a practice that enjoys working with children. But, if you had to choose, go with the AACD accredited dentist. Your current dentist should be willing to give you a refund.

This blog is brought to you by Lafayette, LA Dentists Drs. Foreman and Thimmesch.

Why Fill a Baby Tooth?

Can you tell me why my dentist wants to fill a baby tooth? My son has a cavity on one of his back teeth, but this isn’t his adult tooth. As it is just going to fall out anyway, why should I spend this money and put him through the procedure?


Dear Callie,

boy smiling with a toothbrush

Nobody wants unnecessary medical or dental procedures so I completely understand your question. While some baby teeth will start to fall out soon, his back molars need to stay in until he is around 12 years of age. You don’t want this cavity to turn into a dental infection. A simple cavity is easy to treat, with little trauma. If the tooth gets infected, you will need a child’s version of a root canal treatment, called a pulpotomy.

In most cases, you will want to prepare ahead of time and possibly even arrange to have oral conscious sedation used during this procedure, so he is as comfortable as possible. If you let the tooth go, it could go downhill fast, which will mean a dental emergency. In that case, oral conscious sedation may not be an option for him which would make the appointment more traumatic for him.

What If He Loses This Tooth?

Another problem with letting the decay continue is that the tooth may become unsaveable. If that happens and it has to be extracted, you will need your pediatric dentist to place a space maintainer in that spot. This will prevent the other teeth from shifting and tipping into that spot.

Without that, the other teeth will drift. This will mean there is not correct placement left for his twelve-year-old molars and will lead to crowding. Crowding means crooked teeth and expensive orthodontics.

A little prevention now by getting this tooth filled can save you and your son a lot of expense and hassle.

This blog is brought to you by Lafayette, LA Dentist Drs. Foreman and Thimmesch.

Will a Pediatric Dentist Cost Me More Money?

I have been taking my son to my dentist. He’s four years old and isn’t doing well with them. They are not doing anything wrong, but seem to not be used to children. I’ve never really seen other children at their office either. I noticed that they get frustrated when he fidgets, but it is not excessive, just normal kid fidgeting. It takes everything I have to be able to afford the dentist as it is. I feel like my son may need a pediatric dentist, but I don’t know if they are more expensive. I’m not sure I can afford it if it is.


Dear Miranda,

boy smiling with a toothbrush

Dental prices vary and are set by the dentists themselves. That being said, there are some general “rules of thumb” that could be helpful to you.

Pediatric Dentists are Specialists

Pediatric dentists have to spend a bit more time in school in order to specialize in children. As a result, their fees are often at least a little higher. That being said, location often has a greater impact on their fees than whether or not they specialize. If you go to a pediatric dentist in a wealthy area of town, their prices will be a bit higher. However, if you go to one just a few miles away from that area, you may see a drop in the fees.

Leverage Dental Insurance

If you have dental insurance, going in-network will often save you a lot of money. In many cases, regular checkups are completely covered or only have a small fee attached to them. In many cases, the insurance companies dictate the fees, which is why they will be lower than if you go out of network.

There are General Dentists Who are Great with Children

Though your dentist may not be great with children, there are many general dentists who are and love treating them as well. One way to know how good they are with children is to ask them which age they prefer to start treating them. If they say 2 years old (or around there) you can know they enjoy treating children. If they prefer to wait until they are around 5-8 years old, they don’t really enjoy treating children. They tolerate it.

Also, to put your mind at ease regarding qualifications, every general dentist has done a pediatric rotation so they are perfectly qualified to treat children. If anything tricky comes up, they will then refer you to a specialist.

I hope this helps.
This blog is brought to you by Lafayette, LA Dentist Drs. Foreman and Thimmesch.

Did Our Pediatric Dentist Do Unnecessary Work?

I need some advice about a pediatric dental appointment we recently had. Previous to this, our son has been seeing our dentist but it wasn’t going well. He always had trouble sitting still and my dentist doesn’t really see children. It was just a temporary arrangement. We tried this pediatric dentist who said that there were a few cavities. We scheduled an appointment to take care of them using dental sedation, which went really well for our son. He doesn’t even remember the appointment. However, once it was over the assistant came out and told me that one of the cavities was so far along that they had to do a pulpotomy and place a dental crown. Was this really necessary? I feel like they did it without asking because it was not and they didn’t want me question them. How do I know whether it was necessary?


Dear Claire,

boy smiling with a toothbrush

Given the situation and your son’s wiggles (which are perfectly normal), I am guessing that the cavities were there and it is very likely that one of them had been there a while and spread to a dental infection. If that were the case, depending on which tooth it was, the pulpotomy and dental crown were necessary.

While most baby teeth can come out without a problem, back molars need to remain in place until your son is about twelve years old. If that tooth was infected then the dentist would need to deal with the infection using a pulpotomy if at all possible because he would want to save the tooth. If it wasn’t a back tooth, just extracting the tooth would be all that was necessary.

That being said, they should have spoken to you first. This is the one area where they can get in trouble for what they did. It is improper for them to do any work on your son without running it by you first. I would try having a conversation about that and let them know it is an expectation in the future. If they can’t do that, then you will need to find a different pediatric dentist.

This blog is brought to you by Lafayette, LA Dentist Drs. Foreman and Thimmesch.

Autistic Daughter’s First Dental Visit

My daughter Ava, 4, is mildly autistic and has difficulty with new and different stimuli. Her first dental visit is coming up, and I thought bringing her favorite weighted “blankie” and her beloved stuffed panda might be a good idea. I’m just worried about keeping her calm throughout the procedure. I do have an odd question, though. She adores her twin sister Rachel and was asking if Rachel can come along and sit in the room while she gets her cleaning. The twins do everything together and have a very strong bond. I honestly feel it would really help her. Rachel is not on the spectrum as Ava is. She already had her cleaning last week (and did great!) but Ava had another appointment that day and couldn’t come in at the same time. Rachel has such a calming effect on Ava, so I thought it might be a good idea. I will sit in the room with them as well, instead of leaving the dentist with two four-year-old’s! Does this sound like something that might work? 

Many thanks, 

Dear M.M.,

cheerful child in a dental chair

Twins are a special delight to be sure–congratulations! These are great questions; let’s see what we can do to ensure a wonderful first-time visit for your angel. There are a couple of things to consider: 

The First Pediatric Dental Visit is Meant to be Fun

Some pediatric dentists are fine with parents coming back with their children. Others, prefer to work with the child with just his or her assistant so they can build a rapport. In fact, some children are much better-behaved on their own than their parents might suspect. This is especially true if you as the parent have any deep-seated dental anxieties of your own. Though not intentional, these fears may inadvertently be transferred to your child; children are very intuitive.

That being said, this is a “first” visit, and that makes it a special type of fun. While yes, Ava is here to have her teeth cleaned and examined, she’s also here to get a first-time view of the dental office and we want that to be favorable. We all know first impressions count, and the goal is to have her leave the chair with a smile. If this includes you and her twin sister sitting in, then it shouldn’t be a problem. Just be sure to mention this to the hygienist before being called back to a chair, so she can prepare. Explaining your daughter’s special circumstances will help.

Following Visits May be Different

Once Ava has successfully completed her first visit, she will have hopefully formed a good opinion of the dental office and what it entails. If further visits are needed, such as for fillings if any decay is found, the assistant may ask you and Rachel to remain in the reception area.

You Know Your Autistic Child’s Tolerance Best

Autism and its effects can be a challenge for parents. In the practice, we often see patients on varying degrees of the spectrum, and what works for one may not work for another. Some may require prior medication, such as dental sedation. Some require shorter visits; some do fine without any of these. I’m glad you’ve had the foresight to suggest bringing her special blanket and stuffed toy. These things will certainly help. You know her best, and we don’t forget that. 

Twins Are Wonderful

All children are gifts, yet twins are another thing altogether! I can recall having 5-year-old twin girls in the operatory once, very similar to your situation: one in the chair, the other watching from the corner. These two had formed their own rudimentary language, and I’ll never forget listening to them talk to one another in their unique chatter! It was an amazing experience.

This blog is brought to you by Lafayette, LA Dentists Drs. Foreman and Thimmesch.

Numbing Medicine Doesn’t Work On My Daughter

My seven-year-old daughter developed a cavity on a back tooth, which is weird because they have sealings. I took her in for them to do the filling and they could not get the numbing medicine to work. She is in agony and ended up thrashing about. He did seven shots to no avail. He finally just sent her home without the tooth dealt with. Where do I go from here?


Dear Maggie,

Little girl smiling in a dental chair

I am sorry you and your daughter had to go through this. It is agony watching our children suffer. The good news is I have a solution. It appears that your current pediatric dentist is not aware of the connection between anxiety and numbing medication.

If a patient is very anxious, it has the effect of metabolizing the numbing medication very quickly. Sometimes so quickly that the patient gets no benefit out of it. I feel this was what happened to your daughter. Traumatic experiences like this are what keep people away from the dentist in adulthood.

Our goals right now for her are two-fold. First, get the cavity dealt with before it blows up into something more substantial or even a dental emergency. Two, give her a positive experience at the dentist so she can feel good about her oral health care.

I want you to find a dentist who is good with children that also offers dental sedation. It doesn’t have to be a pediatric dentist. There are many general dentists who enjoy treating children and are qualified.

Under normal conditions, she would only need some nitrous oxide to relax her. However, after her recent experience, I am concerned that will not be enough. Look for someone who offers oral conscious sedation. It is so strong that she will sleep through her whole procedure. In fact, some people call it sleep dentistry for that reason. She is still conscious. This is not anesthesia. It just completely relaxes her which will allow that numbing medication to do its job.

Be aware that she will still be woozy for a few hours after that procedure. You might want to set her up a little castle on the couch and let her binge watch something like “A Series of Unfortunate Events,” which will entertain her while simultaneously realizing her life isn’t so bad.

As for her sealants. Sometimes those will come off. Make sure you have the dentist check that the others are still intact.

This blog is brought to you by Lafayette, LA Dentists Dr. Foreman and Thimmesch.

My Daughter’s Teeth Are Rotting

I have a five-year-old daughter who is extremely uncooperative at the dentist’s office. I have been through four pediatric dentists in our small city trying to find one who can get her to cooperate and it just hasn’t happened. She needs a lot of dental work and is having trouble eating. I’m worried. She has four teeth with decay right now and some of them have even lost tooth structure. What do I do?


Dear Katie,

Mom holding her two children

I can tell you love your daughter Katie very much and want to get her the best care possible. She is in a position now where you almost have a dental emergency on your hands. The first thing I would do is find a dentist who works with children and also offers dental sedation. It does not necessarily have to be a pediatric dentist. There are general dentists who are good with children. If she is uncooperative, this will at least allow her to get the work done she needs.

While these are baby teeth we are dealing with, they are still most important for her to keep for two reasons. One, so she can eat properly. Two, if any of them are molars, she will need to keep those in place until she is twelve years old. If the teeth cannot be saved, then make certain the dentist places space maintainers there to keep the space open. Otherwise, her other teeth will shift and it will lead to crowding.

One other thing, the only way to get that much decay at her age is for her to snack quite a bit during the day. You may have to show some tough love. Do not let her eat between meals. This includes having too much juice. Try to limit her to water until her teeth are under control.

This blog is brought to you by Lafayette, LA Dentists Drs. Foreman and Thimmesch.