Category Archives: Pediatric Dentist

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, 
M.M.

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?

Maggie

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?

Katie

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.

Daughter Broke Her Front Tooth

My daughter fell and broke a chunk off her front tooth. I immediately called our pediatric dentist and he said the soonest he could see her is six months from now. I told him we are pretty anxious to get it fixed and asked him to recommend somewhere. His response was that everyone will tell us that the nerves need time to calm down and then they can see us. For some reason that felt like an excuse to me. If not, why not say that upfront instead of originally saying he’s booked for six weeks? Is there really a necessary time to wait?

Belinda

Dear Belinda,

Your instincts are good. There isn’t really a reason you should have to wait. I’m guessing your pediatric dentist just didn’t want to lose any business. This can be treated right away.

If you have the piece that broke off, a good cosmetic dentist can reattach it. If not, the solution would be to have dental bonding done. This will also need to be done by a good cosmetic dentist. It doesn’t necessarily need to also be a pediatric dentist. There are general dentists who work well with children.

As she ages, the pulp of her tooth will get smaller. At that point, it may be necessary to do a dental crown. Until then, bonding or reattachement are your best options for her.

If she gets nervous at the dentist, look for someone who offers dental sedation. They can give her something to relax her. It doesn’t have to be very strong, even just nitrous oxide will be enough.

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

Daughter has a Broken Tooth

I have a ten-year-old daughter. Today she fell and broke a front tooth. I am a bit frustrated with my dentist who said that he can fix it but he cannot see her for six weeks. When I told him I did not want to wait that long, he said it was necessary for the tooth to desensitize anyway. If that is the case, I’ll wait. However, I got the impression he was just saying that. If that is the case, I’d rather go somewhere else. What is the right thing for me to do?

Cassie

Dear Cassie,

No, there is not a medical reason to wait. I suggest you take her to another pediatric dentist to be evaluated and treated. If you tell them what happened, they may be able to schedule an emergency appointment for you. It would be ideal if it is a dental practice that also has a highly-trained cosmetic dentist on staff. It’s okay if they don’t, but you’ll want a skilled cosmetic dentist to do the repair.

If you have the piece that broke off they may be able to re-attach it. If that peice is missing, then dental bonding will be the right solution. Both require expert cosmetic dentists as I mentioned above.

As she gets older, the pulp of her teeth will shrink. At that point, she’ll need a single dental crown. Be aware that dental insurance only pays for the cheapest option. For children, that is usually a silver crown. I doubt you’ll want that on her front tooth, so call the office and find out what the price difference will be from what the insurance will cover and what you want for her. If you start saving now when the time comes it won’t be as much of a financial burden.

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

Dental Flipper for Toddler

My two-and-a-half-year-old had a nasty fall. It caused a lot of tooth trauma, which led to him losing his front two teeth. Our normal pediatric dentist retired and we were sent to another one. Our old dentist had always warned me that we want to save as many baby teeth as possible because if they’re taken out too early the teeth would shift. Now, here my son is with two front teeth missing when he is a toddler. I spoke to the new dentist about getting him a dental flipper and he just snapped at me and said the idea was ludicrous. Now what do I do? I don’t want his teeth to shift everywhere.

Kelsey

Dear Kelsey,

Four children smiling at camera

First, I want to talk about this new dentist and then I’ll answer your question. I know this is the dentist you were sent to, but I think you need to find another dentist. This one is not serving you well. One of the most important skills of a pediatric dentist , other than the actual dentistry part, is good communication with the parents.

These are your children and you are responsible for their care. Of course, you will have questions! It’s ridiculous of HIM to think that your question is stupid. After all, if you went to dental school you wouldn’t need him. He’ll have the information you don’t and instead of acting the way he did, he should have kindly and patiently explained to you why he didn’t think it would be a good solution.

Whether he was right or not, he handled this badly. I would like you to find a pediatric dentist who is more receptive to questions.

As it turns out, he was actually correct about the dental flipper. There are a few reasons why you wouldn’t want one for your sweet boy. First, it is removable. Even if he was the most responsible toddler on the planet and never removed this device that will likely feel weird to him in his mouth, it is a choking hazard.

Additionally, he is constantly growing, including his jaw. This means he will outgrow the flipper many times between now and the time his adult teeth come in.

There is good news for you, though. When your retired dentist told you about teeth shifting, he was referring to the importance of keeping in his baby molars. These have to stay in place until your son is around twelve years of age. The other teeth are fine to come out much sooner. His front teeth will be fine with the space left as is.

You may now be wondering, well what if he loses a molar? Great question! Dentists have a way of protecting that space using a space maintainer. It is a small apparatus placed in the open area in a way that keeps the space open until his twelve-year-old molars are ready to come in.

I hope this helped to put your mind at ease.
This blog is brought to you by Lafayette, LA Dentists Drs. Foreman and Thimmesch.

Adult Teeth Behind Baby Teeth

Can you help me? I am 16 years old. I’m with a new foster family who wants to help me with my dental care and we’re trying to figure out what to do. I asked my foster mom if I could research. She agreed so I thought I’d start here. I have both baby teeth and adult teeth but my adult teeth all came in behind my baby teeth. It’s been like this for a long time and it is very embarrassing. Is there a good way to fix this?

Celia

Dear Celia,

Young woman smiling

I am glad to hear you have a foster mom that is being proactive with your oral health care. I’m sorry you had to wait this long for it to happen. Had you been under the care of a good pediatric dentist this would not have happened to you. The good news is all of this is repairable.

The first thing they’ll want to do is extract all of your baby teeth. I know you had no control over this, but for the sake of parents out there reading this, I want to discuss what to do when you have adult teeth ready to erupt when the baby teeth are not coming loose.

The best thing to do in that case is to simply extract them, as I am suggesting to you. However, sometimes you have retained baby teeth when there is no adult tooth to come in. This is called a cogenitally missing tooth. In that case, there is a different plan of attack.

In that case, there are two scenarios. If it a molar or premolar. It is helpful to maintain those as long as possible and then when they finally fall out, you can replace them with a dental implant.

If they are not molars, we usually will extract the baby teeth and separate them with orthodontics in order to make the appropriate space. Then, depending on your age, you can replace it with a dental flipper (which is removable and inexpensive). Then, when your jaw is fully developed replace those with a dental implant as well.

Once Your Baby Teeth are Extracted

Now, back to your case. Once you have your baby teeth removed you will want to straighten the adult teeth. You sound like a very responsible young woman. With teens like yourself, I tend to recommend Invisalign teen. It can straighten your teeth comfortably and invisibly. It is removable so it requires patient compliance. I don’t think that will be a problem for you.

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

When During Illness Do I Throw Away My Daughter’s Toothbrush?

My daughter has strep throat. Our doctor said we’ll want to get her a new toothbrush, but when I got home I realized I wasn’t clear as to when. If I throw it away now and get her a new toothbrush, she still has strep. Won’t that mean she will infect the new toothbrush? But, if I try to wait until she is better, then she could be reinfecting herself. What is the best procedure?

Mary

Dear Mary,

I can tell you are a loving mother and you are looking to do the absolute best for your children. The whole idea about a toothbrush needing to be replaced at every illness is actually something propagated by toothbrush companies more than science.

In my research, I only know of one scientific study that investigated this issue in depth. This study was done at the University of Texas in 2013. Their results showed that there was no transmission of strep throat via a toothbrush.

Honestly, I am not sure why doctors and even some pediatric dentists keep pushing this. Even if you get a new cold or another virus on the back of another one, it is a completely different strain.

How to Sterilize a Toothbrush

If you’re still worried, there is a way to sterilize your and your daughter’s toothbrush anytime you want to. Chlorine bleach has effective bactericidal properties. You just need to put enough in a cup to cover the head of your toothbrush and leave it there for about 5 mintues. Then rinse. It’s that simple.

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

Can tooth decay Affect the Salivary Gland?

I am trying to find a solution for my daughter. She’s had two salivary gland infections and the doctor can’t figure out why. I know the molar above the salivary gland has decay. It is a baby tooth, though, so I haven’t messed with it. It’s going to fall out anyway. Now, I am wondering if maybe that decay is causing her salivary gland problems.

Andrea

Dear Andrea,

Some baby teeth have to stay for many years.

There are a couple of separate issues here. First, let’s talk about that molar with decay. While baby teeth do fall out, your daughter’s molars need to stay until she is around twelve years old. That is when her adult molars will come in. If the molars fall out pre-maturely, then the adjacent teeth will shift or tip into the open space. This will lead to crowding and expensive orthodontics later in life.

You’ll want to preserve that back molar. I would start by getting that decay looked at and filled as quickly as possible. It’s possible at this point that the molar has become infected. If that is the case, then she will need a pulpotomy to keep the tooth viable until it is safe to come out. A pulpotomy is simply a child’s version of a root canal treatment.

I’m concerned your pediatric dentist hasn’t addressed this. Additionally, she should have had her molars sealed to prevent decay to begin with.

Now, regarding her salivary gland. Tooth infections do spread to other parts of the body, which is why they are considered dental emergencies. Because of that, if her tooth is infected, it is possible that it has spread to her salivary gland. Some dental x-rays can let you know either way. You don’t want to leave this any longer because it can also spread to her heart, lungs, or brain. All of those are close to her jaw.

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